ANALGESICS MC CULSTION: PHAMACOLOGY PATIENT –CENTERED NURSING PROCESS APPROACH 11TH EDITION 2024

nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain following abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The patient is not satisfied with their current level of pain relief. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take? a. Administer the next dose of codeine 1 hour early. b. Ask the provider if the codeine dose can be increased. c. Contact the provider to ask if a dose of ibuprofen may be given now. d. Request an order for oxycodone with acetaminophen. ANS: D The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain. The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching? a. "I may take acetaminophen up to 6 times daily if needed." b. "I should increase the dose of acetaminophen if I drink caffeinated coffee." c. "If I take oral contraceptive pills, I should use back-up contraception." d. "It is safe to take acetaminophen with any over-the-counter medications." ANS: A The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe for people without liver disease. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose. The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend? a. Acetaminophen b. Aspirin c. Diflunisal d. Celecoxib ANS: A Acetaminophen is a commonly used analgesic in children. Aspirin carries an increased risk of Reye's syndrome in children. Diflunisal and celecoxib are not available over the counter. The nurse is performing an admission assessment on an adolescent who reports taking extra strength acetaminophen regularly to treat daily headaches. The nurse will notify the patient's provider and discuss an order for which of the following? a. A selective serotonin receptor agonist (triptan) b. Hydrocodone with acetaminophen for headache pain c. Liver enzyme testing d. Serum glucose testing