Chapter 6: Pain and Mobility Medications Answer Key

6.5 Non-Steroidal Anti-Inflammatory Medications

Learning activity 1

The client should be advised that acetaminophen can cause acute liver damage when taken in excessive amounts or when used with alcohol. Many over-the-counter medications contain acetaminophen, so daily amounts must be monitored carefully.  Recommended daily restrictions for acetaminophen include less than 4,000 mg of acetaminophen in 24 hours for an adult, less than 3200 mg for geriatric adults, and less than 2000 mg for clients with alcoholism.  Fewer than three alcoholic drinks should be consumed daily while using acetaminophen.

Learning Activity 2

The client should be advised that aspirin has an anti-platelet effect, in addition to reducing pain, fever, and inflammation. By preventing the platelets from sticking together, clots that can cause heart attacks and strokes are prevented from forming.

Learning Activity 3

1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which can cause severe and life-threatening stomach bleeding and must be taken cautiously. The client should be advised that the risk for bleeding is higher if the client:

• is age 60 or older
• has had stomach ulcers or bleeding problems
• takes a anticoagulant or steroid medication
• takes other drugs containing NSAIDs (such as aspirin, ibuprofen, or naproxen)
• consumes three or more alcoholic drinks every day while using this product
• takes ibuprofen in higher doses, more frequently, or for a longer time than directed

2. The nurse should evaluate the effectiveness of ketorolac IV in relieving the client’s pain 30 minutes after administration.

3. The nurse should provide the following client education to a client who has been prescribed celecoxib:

• It may be taken with or without food
• You can sprinkle capsules on applesauce and ingest it immediately with water
• You may experience heartburn, vomiting, or diarrhea with this medication
• Notify the provider immediately if you have abdominal pain, vomit blood or have blood in your stool, develop swelling in your hands or feet, or notice yellowing of your skin

6.6 Opioid Analgesics and Antagonists

Learning Activity 1

1. As this is not the first time the client has received analgesia, the nurse should complete the pain assessment (pain scale, severity, radiation, onset, provoking factors, quality of pain), their level of consciousness or sedation level, respiratory rate, oxygen sats and BP, and previous response to pain meds.
2. Oral drops of morphine, commonly used for clients with metastatic cancer, should be effective within 1 hour of administration.
3. The nurse should assess for adverse effects including: Monitor for hypotension and respiratory status (decreased oxygen saturation, RR, respiratory depth due to respiratory depression risk). Other less urgent adverse effects include itching, constipation, and nausea.

Learning Activity 2

Naloxone immediately reverses the effects of respiratory depression and oversedations caused by opioids. After a client receives naloxone, the nurse should continue to evaluate the client’s respiratory status at least every 15-minutes because naloxone has a shorter duration of action than many opioids and repeated doses are usually necessary.

 6.7 Adjuvant Analgesics

Learning Activity 1

The nurse should educate the client to take baclofen with milk or food to minimize gastric upset. Advise the client that baclofen may cause dizziness or drowsiness, so they should change positions slowly and avoid driving and operating machines.  Clients using baclofen should avoid using alcohol or taking other CNS depressants.

Learning Activity 2

Cyclobenzaprine is a muscle relaxer and may cause drowsiness. If used with alcohol or other CNS depressants, it can impair mental or physical abilities, so the client should be advised  not to drive when taking cyclobenzaprine.

6.10 Clinical Reasoning and Decision Making Learning Activity

The correct answers are a), b), and e).

Based on the client’s respiratory status, the nurse should immediately raise the client’s bed and apply oxygen to rapidly increase their oxygenation level.  The nurse should ask for help from a team member and/or call the rapid response team while obtaining naloxone to administer for sedation and respiratory depression.  The nurse should continue to monitor the patient’s respiratory status after naloxone is administered because repeated doses may be required.