Chapter 07: Drugs for Pain Control Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition,GRADED A

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Chapter 07: Drugs for Pain Control Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS 1. What is another name for ... an opioid drug? a. Nanogram b. Narcoleptic c. Nociceptor d. Narcotic ANS: D Opioid analgesics, also called narcotics, are drugs that contain any ingredient derived from the poppy plant (or a similar synthetic chemical) that change an individual’s perception of pain and have the potential for psychologic or physical dependence. DIF: Cognitive Level: Remembering REF: p. 106 2. How long must pain be present to be considered “chronic pain?” a. 6 days b. 6 weeks c. 6 months d. 6 years ANS: C Chronic pain is present daily for 6 months. It persists or increases with time, may not have an identifiable cause, and does not trigger the physiologic responses associated with acute pain. This means that an individual with chronic pain can have severe pain intensity without changes from the normal ranges for heart rate, breathing rate, or blood pressure. Chronic pain may hurt less on some days than others but is always present. DIF: Cognitive Level: Remembering REF: p. 104 3. On a 0 to 10 pain rating scale, which of the following numbers reported by a patient represents the worst pain intensity? a. 2 b. 4 c. 6 d. 8 ANS: D How much pain the patient feels is called pain intensity. There are several ways to work with the patient to determine pain intensity. When a patient can speak and use a pain scale, the lower numbers indicate less pain, while the higher numbers indicate more pain. DIF: Cognitive Level: Remembering REF: p. 102 4. What word describes pain that comes and goes? a. Localized b. Intermittent c. Chronic d. Referred ANS: B Pain is divided into types on the basis of its cause, how long it lasts, and whether it is present continuously or comes and goes (intermittent). DIF: Cognitive Level: Remembering REF: p. 104 5. What statement about cancer pain is true? a. Cancer pain has more than one cause. b. All patients with cancer have severe pain. c. Cancer pain is considered chronic rather than acute. d. Opioids are the only class of pain drugs that reduce cancer pain. ANS: A Cancer pain has many causes and is complex. This means that more than one pain strategy and often more than one type of drug for pain control are needed. The patient with cancer often receives traditional pain-control drugs but at much higher doses than those prescribed for other types of pain. DIF: Cognitive Level: Remembering REF: p. 104 6. Which schedule of controlled substance has the lowest potential for addiction? a. Schedule II b. Schedule III c. Schedule IV d. Schedule V ANS: D In the United States any drug that contains ingredients known to be addictive is classified by the federal government as a controlled substance and is regulated by the Federal Controlled Substances Act of 1970. This act classifies controlled substances into five schedules based on how likely they are to result in addiction. The drugs most likely to lead to addiction are in schedule I. Those with the least potential for addiction are in schedule V. DIF: Cognitive Level: Remembering REF: p. 105 7. In which controlled substance class or schedule does heroin belong? a. Schedule I b. Schedule II c. Schedule III d. Schedule IV e. Schedule V ANS: A Heroin has a very high likelihood of abuse and addiction. In addition, it has no accepted medical use in the United States. Therefore it meets the criteria for a controlled substance schedule I drug. DIF: Cognitive Level: Remembering REF: p. 105 8. Which problem is a psychologic response to chronic opioid use? a. Tolerance b. Addiction c. Withdrawal d. Dependence ANS: B The definition for addiction is the psychologic need or craving for the “high” feeling that results from using opioids when pain is not present. DIF: Cognitive Level: Remembering REF: p. 106 9. What is the most common side effect of an opioid used for 5 days? a. Addiction b. Hallucinations c. Constipation d. Excessive thirst ANS: C The most common side effect of opioids is constipation because these drugs slow intestinal movement. Most patients who are on opioids for 2 or more days experience constipation. Ask patients who are prescribed opioids about constipation on a daily basis. Be sure to administer any prescribed stool softeners or laxatives. DIF: Cognitive Level: Remembering REF: p. 108 10. Which is the best clinical definition of pain? a. A state of extreme physical distress or discomfort b. A condition of sensation caused by tissue damage c. A cognitive awareness of a change in comfort d. Whatever the patient says it is ANS: D Pain is a personal experience that includes physical and emotional components. What is painful for one individual may not be painful to another. Because everyone experiences pain in a different way, the most useful clinical definition is that pain is whatever the patient says it is and exists whenever he or she says it does. DIF: Cognitive Level: Remembering REF: p. 101 11. Which statement about pain is true? a. Each patient perceives a painful event differently. b. Patients who cannot describe their pain do not really have pain. c. It is not necessary to assess for pain in patients who are sleeping. d. Infants and young children feel pain less intensely than adults do. ANS: A How we feel and react to pain depends on our emotional makeup along with our previous experiences with pain. Issues like culture, age, gender, and our interactions with society also affect our responses to pain. As a result, no two people perceive pain in exactly the same way. DIF: Cognitive Level: Remembering REF: p. 103 12. A patient who is paralyzed from the waist down as a result of an injury that completely severed the spinal cord has an open wound on the right heel. Why is this patient unaware of any pain caused from this wound? a. The nociceptors in the heel are no longer stimulated when injury occurs. b. The patient has become completely desensitized to this type of chronic pain. c. The severed spinal cord prevents the sensation of pain from reaching the brain. d. The spinal cord injury results in chronic pain that can mask any acute pain sensation. ANS: C Pain is perceived in the brain, not in the area of tissue injury. When the nociceptors are stimulated by tissue damage, the impulse must be transmitted to the brain before it can be “felt” as pain. With a completely severed spinal cord, the pain impulses are not transmitted to the brain. DIF: Cognitive Level: Remembering REF: p. 102 13. A patient with arthritis of the left knee reports pain extending from the knee half-way down the lower leg. What type of pain is this patient perceiving? a. Localized b. Referred c. Radiating d. Phantom ANS: C Radiating pain may be felt all around and extending from the damaged area causing the pain. DIF: Cognitive Level: Remembering REF: p. 104 14. Pain is considered to be the “fifth vital sign.” How does this principle affect patient care? a. It ensures that pain assessment occurs on a regular basis for all patients. b. It helps health care workers understand that experiencing pain can change heart rate and respiratory rate. c. It helps health care workers to ensure that vital organ function is adequate before administering drugs to reduce pain. d. It encourages health care providers to assess two parameters during patient contact to improve time management. ANS: A Pain is common in patients and undertreated pain remains a major yet avoidable health problem. More frequent and more accurate assessment can improve pain management. Making pain assessment the “fifth vital sign” assists health care workers to both recognize the presence of pain and see how the patient responds to drugs and other interventions. These actions increase the likelihood of appropriate pain management. DIF: Cognitive Level: Remembering REF: p. 104 15. Which event or condition is most likely to result in chronic pain? a. Severe headache associated with a spinal tap b. Insertion of a needle for intravenous (IV) therapy c. Hip replacement surgery d. Osteoarthritis ANS: D The definition of chronic pain involves the length of time that pain is experienced and the progressive nature of the problem causing the pain. Osteoarthritis meets these criteria. A headache caused by fluid loss during a spinal tap is severe but has a duration of only 3 to 5 days. Hip replacement surgery, although resulting in postoperative pain, is time limited and often relieves chronic hip pain. IV needle insertion is considered painful by some patients, but is short procedural pain. DIF: Cognitive Level: Remembering REF: p. 104 16. How do morphine and other opioid pain medications relieve a patient’s pain? a. They reduce tissue damage and alter the physical problems causing the pain. b. They bind to opioid receptors in the central nervous system and alter the perception of pain. c. They inhibit the generation of impulses along sensory nerve tracts and alter pain transmission. d. They redirect substance P release from nociceptors and alter the amount of neurotransmitters reaching the brain. ANS: B Morphine and other opioid agonists do nothing to change the cause or transmission of pain. They bind to naturally occurring opioid receptor sites and alter a patient’s perception of the painful experience. DIF: Cognitive Level: Remembering REF: p. 107 17. How do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve a patient’s pain? a. By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts. b. By binding to opioid receptors in the central nervous system and altering the perception of pain. c. By reducing the amount of bradykinin at the site of injury and altering the stimulation of nociceptors. d. By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission. ANS: C When pain mediators are released from damaged tissue, especially substance P and bradykinin (which is also an inflammatory mediator), they bind to the nociceptors and activate them. NSAIDs reduce pain by suppressing some part of the inflammatory pathway and reducing the amounts of pain-mediating chemicals, especially bradykinin, present. With less bradykinin present, less stimulation of the nociceptors occurs. As a result, pain is reduced. DIF: Cognitive Level: Remembering REF: p. 103 18. A child who is taking gabapentin (Neurontin) for pain control has begun demonstrating all of the following behaviors. Which behavior represents a common side effect of this drug? a. Fighting at school b. Difficulty sleeping c. Wetting the bed three to four nights per week d. Crying more frequently for no apparent reason ANS: A Gabapentin is an anticonvulsant drug that can reduce certain types of pain. Children taking gabapentin often demonstrate an increase in aggressive behavior. DIF: Cognitive Level: Remembering REF: pp. 111-112 19. Which term best describes what occurs when long-term opioid is suddenly stopped? a. Addiction b. Tolerance c. Withdrawal d. Dependence ANS: C Withdrawal is the occurrence of autonomic nervous system symptoms when long-term opioid therapy is stopped suddenly after physical dependence is present. Symptoms include nausea, vomiting, abdominal cramping, sweating, delirium, and seizures. DIF: Cognitive Level: Remembering REF: p. 108 ADVANCED CONCEPTS 20. Which statement by a patient indicates the need for more teaching about pain and pain control? a. “If my pain interferes with my usual activities, I will take medication for it.” b. “There is no reason for me to take drugs for pain; after all, you can’t cure old age.” c. “I don’t mind taking pain drugs for my sprained ankle because I know it won’t hurt this way forever.” d. “I will take enough pain medication to make me comfortable without making me too sleepy.” ANS: B One cause of underreporting pain and undertreating it is that many patients and health care providers believe that pain is a normal part of aging. Pain may occur more frequently among older adults, but is never considered “normal.” Patients of any age with pain for any reason deserve to have their pain reduced to a manageable level. DIF: Cognitive Level: Applying or Higher REF: p. 104 21. What is the best way for you to determine a patient’s need for pain medication on the second day after an abdominal laparotomy? a. Check when the patient last received medication for pain. b. Assess the patient’s facial expression and vital signs. c. Consider the patient’s age and ethnicity. d. Ask the patient to rate his or her pain. ANS: D Pain experience and pain tolerance are very personal. True assessment of a patient’s discomfort cannot be determined by and should not be based on the patient’s behaviors or changes in vital signs. Nor can it be based on how recently the patient received a drug for pain. The only way to know is to ask the patient to rate the pain. DIF: Cognitive Level: Applying or Higher REF: p. 103 22. After surgery, a patient expresses the fear of becoming addicted to the opioid analgesic that has been prescribed for pain. What is your best response? a. “Opioid-based drugs are not addictive.” b. “Have you or anyone in your family ever been addicted to drugs?” c. “When opioid drugs are taken for acute pain, they are rarely addictive.” d. “If you take the medication no more frequently than every 4 hours, it is not possible for you to become addicted.” ANS: C The fear of addiction to opioids is one cause of poorly treated pain. Remind the patient that addiction will not occur if the drugs are taken to relieve pain. Pain after surgery is acute and temporary pain. The use of opioid drugs, when used for relief of acute pain, even in high doses, rarely results in addiction. DIF: Cognitive Level: Applying or Higher REF: p. 106 23. You are assigned to care for a patient with chronic low back pain. What adjustment in pain management do you expect to make? a. Encouraging the patient to hold off taking a pain drug as long as possible to reduce the potential for addiction. b. Relying on patient report of pain rather than on changes in heart rate, blood pressure, and pulse rate. c. Keeping the environment as quiet as possible to avoid distracting or irritating the patient. d. Using nondrug measures in place of analgesics to relieve the patient’s pain. ANS: B Adaptation to the presence of chronic pain is physiologic, not psychologic. Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain. DIF: Cognitive Level: Applying (Application) or Higher REF: p. 104 24. You check a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly. The patient is sleeping and has a respiratory rate of 10 breaths/min. What is your best first action? a. Attempt to arouse the patient by calling his or her name and lightly shaking the arm. b. Administer oxygen by mask or nasal cannula and notify the prescriber. c. Check the patient’s oxygen saturation and raise the head of the bed. d. Document the finding as the only action. ANS: A Many patients experience some degree of respiratory depression with opioid analgesics. If the patient can be aroused with minimally intrusive techniques and the respiratory rate increases spontaneously, no further intervention is required. DIF: Cognitive Level: Applying or Higher REF: pp. 108-109 25. You prepare to give a patient the next scheduled dose of an opioid analgesic. The patient arouses easily but the respiratory rate remains at 10 breaths/min. What is your best first action? a. Hold the dose and notify the prescriber. b. Hold the dose and apply oxygen by mask or nasal cannula. c. Check the patient’s oxygen saturation and ask about his or her pain level. d. Call the Rapid Response Team and prepare to administer the prescribed opioid antagonist. ANS: C Many people experience mild respiratory depression with opioid analgesics. If the patient is easily arousable and the oxygen saturation is at normal levels, it is not necessary to apply oxygen, call the Rapid Response Team, or prepare to administer an opioid antagonist. If the patient’s oxygen saturation level is acceptable and he or she is in pain, it is alright to give the next scheduled opioid dose. Checking the patient’s normal respiratory rate is also a good idea. Most people have a usual respiratory rate that is at least 12 breaths/min, but some patients may have a usual rate of only 10 breaths/min. Although this is not a customary response and you should document it in the patient care notes, check other indicators of breathing adequacy before notifying the prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 109 26. A patient taking oxycodone with acetaminophen (Percocet) for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain that is relieved by the prescribed drug. What is your best advice? a. “Either increase the time between drug doses or take only half the dose at each scheduled time.” b. “Stop taking the Percocet and switch to acetaminophen alone.” c. “Wrap your foot tightly and walk for at least 30 minutes daily.” d. “Drink at least 3 L of fluid daily and increase fiber intake.” ANS: D This patient still needs the Percocet. Most patients taking opioids for 2 days or longer have constipation. Urge the patient to drink plenty of fluids. Increasing fiber intake, either with food containing fiber or with over-the-counter fiber supplements, can help reduce constipation. Although increasing activity can help reduce constipation, walking for 30 minutes with a fractured ankle is not permitted at this time. DIF: Cognitive Level: Applying or Higher REF: p. 109 27. An older adult is taking an oral opioid drug at home for pain control. Which precaution to prevent injury is important for you to teach this patient? a. “Increase room lighting to reduce the risk for tripping.” b. “Sleep in a sitting position to reduce respiratory problems.” c. “Drink at least 3 L of fluids daily to reduce constipation.” d. “Avoid drinks containing caffeine to prevent inactivating the drug.” ANS: A In addition to the usual side effects and adverse effect of opioids, an older adult is at risk for low vision. The pupil of the older adult does not dilate fully and less light enters the eye, reducing vision. When the older patient takes an opioid drug, the pupil is even smaller than usual, reducing vision even more. This problem increases the older patient’s risk for tripping over objects and falling. DIF: Cognitive Level: Applying or Higher REF: p. 110 28. What is the most important question to ask before administering the first dose of celecoxib (Celebrex) to a patient? a. “Do you floss your teeth daily?” b. “Are you allergic to sulfa drugs?” c. “Do you have diabetes mellitus?” d. “Have you ever had glaucoma?” ANS: B Celecoxib is similar to the class of antibiotics known as “sulfa drugs.” An allergic reaction to celecoxib is more likely if the patient is also allergic to sulfa drugs. DIF: Cognitive Level: Applying or Higher REF: p. 111 29. A patient taking warfarin (Coumadin) has mild to moderate pain after exercising. Which over- the-counter pain reliever should you recommend? a. Aspirin (Bufferin) b. Ibuprofen (Advil) c. Naproxen (Aleve) d. Acetaminophen (Tylenol) ANS: D Only acetaminophen does not interfere with blood clotting. The other drugs do interfere with blood clotting, and so does warfarin. Taking warfarin with any other drug that interferes with blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage. DIF: Cognitive Level: Applying or Higher REF: p. 111 30. A patient is taking acetaminophen (Tylenol) for mild headache pain. Which precaution is most important for you to teach the patient? a. “Avoid alcoholic beverages while taking this drug.” b. “Avoid coffee and other caffeinated drinks while taking this drug.” c. “If any decrease in vision occurs, stop the drug and notify your prescriber immediately.” d. “Do not drive or operate dangerous machinery until you know how this drug affects you.” ANS: A Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often. This adverse reaction is much more likely to occur in people who drink alcoholic beverages while on acetaminophen therapy. DIF: Cognitive Level: Applying or Higher REF: p. 111 31. You note all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor) for chronic pain. For which problem do you immediately notify the prescriber? a. Heart rate decreased from 80 to 72 beats/min. b. Respiratory rate decreased from 20 to 16 breaths/min. c. Weight increased from 128 to 137 lb. d. Morning blood glucose increased from 86 to 94 mg/dL. ANS: C Nortriptyline is an antidepressant. These drugs can make heat failure worse and can cause urinary retention. Fluid retention with weight gain is a symptom of worsening heart failure. A weight gain of 9 lb in a week is significant and an indicator of rapidly worsening heart failure. DIF: Cognitive Level: Applying or Higher REF: p. 111 32. Eight weeks after surgery, a patient without pain still takes oxycodone and acetaminophen (Percocet) four to six times a day. What phenomenon do you recognize? a. Addiction b. Dependence c. Withdrawal d. Tolerance ANS: B Dependence is described as physical changes in autonomic nervous system function that can occur when opioids are used long term and are not needed for pain control. DIF: Cognitive Level: Understanding REF: p. 108 33. A patient tells you that the usual dose of an opioid drug for cancer pain no longer relieves the pain. What is your best response? a. “We have to be careful about increasing opioid drug dosages to prevent drug addiction.” b. “You may be developing dependence on the drug and that is why it no longer relieves your pain.” c. “Your body may be adjusting to the drug, eliminating it more rapidly, and thus you will need a higher dose to achieve pain relief.” d. “The danger of increasing your opioid drug dosage is that you may experience respiratory failure.” ANS: C An issue that can occur with longer-term opioid use is drug tolerance. Tolerance is the adjustment of the body to long-term opioid use that increases the rate of drug elimination and reduces the main effect (pain relief) and side effects of the drug. It occurs with anyone who is taking opioids for a long period of time. More drug is needed to achieve the same degree of pain relief. DIF: Cognitive Level: Applying or Higher REF: p. 106 34. You are administering the first dose of an opioid drug to a patient. Which specific related actions should you take before and after giving the dose? a. Ask if the patient is allergic to sulfa drugs and monitor for a reaction after giving the drug. b. Place the patient on bed rest before giving the drug and keep him or her on bed rest after to avoid accidental falling. c. Check the patient’s respiratory rate and oxygen saturation before and after giving the drug and monitor for respiratory depression. d. Administer a drug such as naloxone (Narcan) both before and after giving the opioid drug to prevent respiratory depression. ANS: C When giving the first dose of an opioid to a patient who has never taken an opioid (is opioid naïve), check the patient’s respiratory rate and oxygen saturation. Opioids can cause some degree of respiratory depression. After giving the drug, be sure to monitor the patient’s respiratory rate and oxygen saturation for indications of respiratory depression. This is especially important when the patient is receiving an opioid for the first time or when the drug dosage has been increased. DIF: Cognitive Level: Applying or Higher REF: p. 108 35. A patient is receiving morphine (MS Contin) for severe cancer pain. His wife states that he has difficulty swallowing and asks if the tablets can be crushed and given with applesauce or pudding. What is your best response? a. “That is an excellent solution and will make it much easier for him to swallow his pain medicine.” b. “It might be best if we talk with the prescriber about having a feeding tube placed for medication administration.” c. “You can dissolve the tablets in water then give the drug to your husband mixed with juice.” d. “I will contact the prescriber about this because your husband may need to be prescribed a different form of morphine for his pain.” ANS: D MS Contin is an extended release tablet so crushing or dissolving it can cause a drug overdose from releasing too much drug at a time. The best action is to contact the prescriber with the information about the patient’s difficulty swallowing because a different form or morphine or a different drug may be needed to control the pain. Teach patients and their families to take an extended release (ER) form of an oral opioid drug by swallowing the capsule or tablet whole because chewing it or opening the capsule allows too much of the drug to be absorbed all at once and an overdose can occur. DIF: Cognitive Level: Applying or Higher REF: p. 109 36. Which key point should you teach a pregnant woman who is prescribed opioids drugs during pregnancy? a. Your child may become addicted to opioids and go through withdrawal after birth. b. These drugs do not cross the placenta so are safe to use during pregnancy. c. Some opioids have been found to cause birth defects in animal studies. d. Opioids are not present in breast milk so it is safe to breastfeed. ANS: A Opioids may be prescribed to women during pregnancy. These drugs do cross the placenta and enter the fetus. The fetus can become addicted to opioids and go through withdrawal after birth. Opioids also cross into breast milk. DIF: Cognitive Level: Applying or Higher REF: p. 110 37. For which opioid pain drug order should you contact and question the prescriber? a. Adult male, hydromorphone (Dilaudid) 4 mg orally every 4 hours b. Older adult, meperidine (Demerol) 50 mg IM every 3 hours c. Child, codeine 0.5 mg/kg orally every 6 hours d. Adult women, hydrocodone with acetaminophen (Vicodin) 5 mg orally every 6 hours ANS: B Opioids, especially meperidine (Demerol), can make the chest muscles of older adults tighter, which makes breathing and coughing more difficult. Thus the risk for pneumonia and hypoxia is greater for them. Check the respiratory rate and depth as well as the oxygen saturation at least every 2 hours. In addition, meperidine causes the buildup of a toxic metabolite in older adults that can result in seizures. Avoid the use of meperidine in older adults. DIF: Cognitive Level: Applying or Higher REF: p. 110 38. After receiving the first dose of an opioid drug, a patient is sleeping and has a respiratory rate of less than 8 per minute. When called by name the patient does not respond. What is your next best action? a. Place an ice cube on his or her forehead. b. Firmly shake his or her leg or arm. c. Apply pressure to his or her nail bed. d. Squeeze his or her trapezius muscle. ANS: B When the patient is receiving an opioid for the first time or when the drug dosage has been increased, if the respiratory rate is 8 or less and the patient is sleeping, try to wake him or her. First call the patient’s name. If there is no response, gently shake his or her arm or leg. Shake more firmly if needed. If the patient does not respond to these actions, use a slightly stronger trigger (without using enough force to cause harm) such as squeezing the trapezius muscle (located at the angle of the shoulder and neck muscle) or applying pressure to the nail bed. DIF: Cognitive Level: Applying or Higher REF: p. 109 39. The patient who received a first dose of an opioid drug is not arousable and has an oxygen saturation of 88% (five percentage points lower than his or her normal saturation) even when fully awake. What is your best next action? a. Wait 2 minutes and recheck respiratory rate and oxygen saturation. b. Shake the patient firmly and keep trying to arouse him or her. c. Notify respiratory therapy to draw an arterial blood gas. d. Call for help and apply supplemental oxygen. ANS: D If the patient cannot be aroused, immediately call for help. If the patient’s oxygen saturation is below 95% or is five percentage points lower than his or her normal saturation, arouse the patient and check the saturation when fully awake. If the saturation does not improve when fully awake, apply supplemental oxygen and notify the charge nurse or prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 109 MULTIPLE RESPONSE BASIC CONCEPTS 1. Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (select all that apply.) a. Bleeding b. Constipation c. Drowsiness d. Dry mouth e. Gastrointestinal ulcers f. Hypertension g. Memory loss (temporary) ANS: A, E, F NSAIDs disrupt platelet action and reduce clotting, which increases the risk for bleeding in response to minor trauma. NSAIDs also reduce the thick, gel-like coating of the stomach, allowing normal stomach acids to irritate the stomach lining and form ulcers. Finally, NSAIDs cause the kidneys to retain more sodium and water. These enter the bloodstream and raise blood pressure. DIF: Cognitive Level: Remembering REF: p. 111 COMPLETION ADVANCED CONCEPTS 1. A 64 lb child with a broken arm is prescribed to receive morphine 75 mcg/kg by intravenous push immediately. The drug available is morphine 1 mg/mL (1000 mcg/mL). What is the correct dose for this patient, in mL? ANS: 2.2 1 kg = 2.2 lb. The child’s weight in kilogram is 64/2.2 or 29.09 kg (round down to 29). 29  75 mcg = 2175 mcg or 2.175 mL round up to 2.2 mL. DIF: Cognitive Level: Applying or Higher REF: p. 107 2. A 2-month-old infant who weighs 11 lb is prescribed to receive acetaminophen 8 mg/kg by oral liquid. The drug on hand is acetaminophen liquid with a concentration of 80 mg/0.8 mL. How many milliliters is the correct dose for this patient? ANS: 0.4 1 kg = 2.2 lb. The infant’s weight in kilogram is 11/2.2 or 5 kg. 5kg  8 mg = 40 mg. The drug concentration is 80 mg/0.8 mL or 10 mg/0.1 mL. 40 mg/10 = 4. 4  0.1 mL = 0.4 mL. DIF: Cognitive Level: Applying or Higher REF: p. 107 [Show More]

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