Chapter 21: Opioids
MULTIPLE CHOICE
1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with
acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level
of 7 on a scale of 1 to 10. 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 one 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 (Percocet).
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.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 361
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. 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. 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.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. 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 (Tylenol)
b. Aspirin (Ecotrin)
, c. Diflunisal (Dolobid)
d. Ibuprofen (Motrin)
ANS: A
Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere
with platelet aggregation. Aspirin carries an increased risk of Reyes syndrome in children.
Diflunisal (Dolobid) is not available over the counter.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. The nurse is performing an admission assessment on an adolescent who reports taking extra-
strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the
patients provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.
ANS: C
Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses
are administered over a long period, liver function should be assessed. Daily headaches are not
typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with
acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not
indicated.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is caring for a postoperative older patient who received PO hydrocodone with
acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10.
The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per
minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which
action will the nurse take?
a. Contact the provider and request an order for a more potent opioid analgesic.
b. Reassess the patient in 30 minutes.
c. Request an order for ibuprofen to augment the opioid analgesic.
d. Suggest that the patient use nonpharmacologic measures to relieve pain.
ANS: A
Even though the patient reports decreased pain, the patients vital signs indicate continued
discomfort. The nurse should contact the provider to request a stronger analgesic. The pain
medication should have been effective within 30 minutes. Ibuprofen is used for
musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a
stronger analgesic.
MULTIPLE CHOICE
1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with
acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level
of 7 on a scale of 1 to 10. 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 one 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 (Percocet).
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.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 361
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. 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. 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.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. 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 (Tylenol)
b. Aspirin (Ecotrin)
, c. Diflunisal (Dolobid)
d. Ibuprofen (Motrin)
ANS: A
Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere
with platelet aggregation. Aspirin carries an increased risk of Reyes syndrome in children.
Diflunisal (Dolobid) is not available over the counter.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. The nurse is performing an admission assessment on an adolescent who reports taking extra-
strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the
patients provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.
ANS: C
Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses
are administered over a long period, liver function should be assessed. Daily headaches are not
typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with
acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not
indicated.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is caring for a postoperative older patient who received PO hydrocodone with
acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10.
The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per
minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which
action will the nurse take?
a. Contact the provider and request an order for a more potent opioid analgesic.
b. Reassess the patient in 30 minutes.
c. Request an order for ibuprofen to augment the opioid analgesic.
d. Suggest that the patient use nonpharmacologic measures to relieve pain.
ANS: A
Even though the patient reports decreased pain, the patients vital signs indicate continued
discomfort. The nurse should contact the provider to request a stronger analgesic. The pain
medication should have been effective within 30 minutes. Ibuprofen is used for
musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a
stronger analgesic.
