NURS 334 MIDTERM REVIEW COMPREHENSIVE
EXAM 2026 REVISION NOTES AND
STRUCTURED NURSING OVERVIEW GUIDE
◉ Ventricular Arrhythmias. Answer: Can occur as a result of opioid
withdrawal.
◉ Opioid Agonist-Antagonist. Answer: Butorphanol
◉ Indications. Answer: Treats moderate to severe pain.
◉ Method of action. Answer: Agonist at kappa opioid receptors:
provides analgesia and sedation. Partial agonist/antagonist at mu
receptors, weaker effect at mu receptors compared to full agonist.
◉ Contraindications. Answer: Respiratory depression, alcoholism, or
opioid dependence patients.
◉ Interactions. Answer: CNS depressants (benzos, alcohol, etc.),
muscle relaxants, anticholinergic agents, anti-hypertensives.
,◉ Common side effects. Answer: Sedation, dizziness, drowsiness,
nausea and vomiting, constipation.
◉ Serious side effects. Answer: Respiratory depression (though less
than full agonists), bradycardia or hypotension.
◉ Client instructions. Answer: Take medications as prescribed, avoid
alcohol, increase fiber, stool softener, push po fluids, avoid driving,
operating machinery.
◉ Monitoring. Answer: Monitor for physical dependence, addiction,
respiratory depression, cross tolerance and diversion.
◉ Administration. Answer: Administer 30-60 minutes prior to
painful activity.
◉ Opioid Agonist (ish). Answer: Tramadol
◉ Tramadol method of action. Answer: Weak mu-opioid receptor
agonist, provides analgesia, but weaker than traditional opioids.
◉ Tramadol potency. Answer: About 1/10th of the potency of
morphine.
, ◉ Tramadol classification. Answer: Centrally acting synthetic opioid
analgesic and SNRI (serotonin/norepinephrine reuptake-inhibitor).
◉ Tramadol risk factors. Answer: Verify all opioids the patient is
taking, assess for duplicate therapy, review for drug interactions,
identify risk factors.
◉ Tramadol client instructions. Answer: Take medications as
prescribed, avoid alcohol, increase fiber, stool softener, push po
fluids, avoid driving, operating machinery.
◉ Tramadol BBW. Answer: Addiction, respiratory sedation,
serotonin syndrome, metabolized by p450 system.
◉ Tramadol serious side effects. Answer: Slowed breathing,
serotonin syndrome (agitation, fever, sweating, muscle stiffness), or
seizures seek medical help immediately.
◉ Other narcotics. Answer: Fentanyl (class 1), Oxycodone (class 2),
Hydrocodone (class 2), Codeine (class 3), Tramadol (class 4).
◉ Wasting Narcotics. Answer: If part of a narcotic dose is not used, it
must be wasted according to policy.
EXAM 2026 REVISION NOTES AND
STRUCTURED NURSING OVERVIEW GUIDE
◉ Ventricular Arrhythmias. Answer: Can occur as a result of opioid
withdrawal.
◉ Opioid Agonist-Antagonist. Answer: Butorphanol
◉ Indications. Answer: Treats moderate to severe pain.
◉ Method of action. Answer: Agonist at kappa opioid receptors:
provides analgesia and sedation. Partial agonist/antagonist at mu
receptors, weaker effect at mu receptors compared to full agonist.
◉ Contraindications. Answer: Respiratory depression, alcoholism, or
opioid dependence patients.
◉ Interactions. Answer: CNS depressants (benzos, alcohol, etc.),
muscle relaxants, anticholinergic agents, anti-hypertensives.
,◉ Common side effects. Answer: Sedation, dizziness, drowsiness,
nausea and vomiting, constipation.
◉ Serious side effects. Answer: Respiratory depression (though less
than full agonists), bradycardia or hypotension.
◉ Client instructions. Answer: Take medications as prescribed, avoid
alcohol, increase fiber, stool softener, push po fluids, avoid driving,
operating machinery.
◉ Monitoring. Answer: Monitor for physical dependence, addiction,
respiratory depression, cross tolerance and diversion.
◉ Administration. Answer: Administer 30-60 minutes prior to
painful activity.
◉ Opioid Agonist (ish). Answer: Tramadol
◉ Tramadol method of action. Answer: Weak mu-opioid receptor
agonist, provides analgesia, but weaker than traditional opioids.
◉ Tramadol potency. Answer: About 1/10th of the potency of
morphine.
, ◉ Tramadol classification. Answer: Centrally acting synthetic opioid
analgesic and SNRI (serotonin/norepinephrine reuptake-inhibitor).
◉ Tramadol risk factors. Answer: Verify all opioids the patient is
taking, assess for duplicate therapy, review for drug interactions,
identify risk factors.
◉ Tramadol client instructions. Answer: Take medications as
prescribed, avoid alcohol, increase fiber, stool softener, push po
fluids, avoid driving, operating machinery.
◉ Tramadol BBW. Answer: Addiction, respiratory sedation,
serotonin syndrome, metabolized by p450 system.
◉ Tramadol serious side effects. Answer: Slowed breathing,
serotonin syndrome (agitation, fever, sweating, muscle stiffness), or
seizures seek medical help immediately.
◉ Other narcotics. Answer: Fentanyl (class 1), Oxycodone (class 2),
Hydrocodone (class 2), Codeine (class 3), Tramadol (class 4).
◉ Wasting Narcotics. Answer: If part of a narcotic dose is not used, it
must be wasted according to policy.
