ATI-P ATI Pharmacology - Set 4 - Part 3

Correct Answer: Tapering the opioid gradually

Opioids should be tapered gradually in clients who are physically dependent in order to avoid withdrawal. The nurse should anticipate a gradual reduction in the dose rather than abrupt discontinuation for the client who is physically dependent. Option a is incorrect because stopping the opioid abruptly in a dependent client can precipitate withdrawal. The appropriate plan the nurse should anticipate is to taper the dose gradually instead of discontinuing it suddenly for this client. Option b is incorrect because switching to a single large dose does not address physical dependence and could be unsafe. A gradual taper is the recommended way to discontinue the opioid for the client who is physically dependent on the medication. Option d is incorrect because withholding all pain treatment is not appropriate and ignores the client's comfort. A slow, stepwise reduction of the opioid is what prevents withdrawal, so abrupt cessation is not what the nurse plans.

Correct Answer: Remain upright for a full hour.

Clients who take ibandronate must remain upright and avoid food and other medications for a full hour after the oral dose. The nurse should give this response in order to reduce the client's risk of esophagitis from the medication. Option a is incorrect because lying down right away increases the client's risk of esophageal irritation with ibandronate. The client must stay upright for a full hour, not recline immediately after taking the oral dose of the medication. Option b is incorrect because staying upright only briefly is not enough for ibandronate, which requires a full hour upright. A short interval would leave the client's esophagus at risk for irritation after the dose is taken. Option c is incorrect because remaining upright for just several minutes is far too short for ibandronate. The drug requires a full hour before the client lies down, so a brief pause leaves the esophagus unprotected.

Correct Answer: Meperidine

Morphine should be avoided in clients who have a history of biliary colic because it can worsen biliary spasm. Meperidine is the preferred opioid in this situation, so the nurse should anticipate the provider prescribing it for this client. Option b is incorrect because morphine is the very drug to avoid here, because it can aggravate biliary colic by increasing biliary spasm. Choosing it would risk worsening the client's pain, which is why an alternative opioid is selected for this client. Option c is incorrect because hydromorphone is a strong opioid agonist similar to morphine and is not the source-identified choice for biliary colic. The specific substitute recommended when a client has biliary colic is meperidine rather than another agonist. Option d is incorrect because codeine is used for milder pain and cough suppression rather than as the alternative in biliary colic. The drug singled out to replace morphine when biliary colic is present is meperidine, not codeine, for th

Correct Answer: Muscle weakness and constipation

Hypercalcemia from calcium supplements produces muscle weakness, constipation, lethargy, and confusion. The nurse should identify weakness and constipation as manifestations of hypercalcemia and report them so the client's calcium level can be addressed. Option a is incorrect because hypercalcemia causes muscle weakness and hypotonia rather than brisk reflexes. Increased deep tendon reflexes point toward a low calcium level, which is the opposite of the client's problem with a rising calcium level. Option c is incorrect because a rapid respiratory rate is not a defining sign of hypercalcemia. The expected findings the nurse should identify are muscle weakness, constipation, and lethargy as the client's calcium rises above the normal range. Option d is incorrect because excessive tearing reflects cholinergic activity, not a high calcium level. Hypercalcemia instead presents with weakness, constipation, and confusion, which the nurse should recognize and report for the cli

Correct Answer: It will relieve constipation from the opioid.

Methylnaltrexone is an opioid antagonist that relieves severe opioid-induced constipation unresponsive to laxatives. It blocks opioid receptors in the gut, so the nurse should explain that it treats the client's constipation rather than altering pain control. Option a is incorrect because methylnaltrexone does not increase respirations. It works in the bowel to relieve constipation and does not act on the respiratory drive, so this explanation misstates the purpose of the medication for the family. Option b is incorrect because this medication does not prevent opioid dependence. Its targeted action is on opioid receptors in the gastrointestinal tract to relieve severe constipation, not to change whether the client becomes dependent on morphine. Option d is incorrect because methylnaltrexone does not enhance analgesia; it is given specifically for constipation. Boosting pain relief describes an adjuvant medication, which serves a different role than this opioid antagonist given for

Correct Answer: Continuous, severe chest pain

Sumatriptan can cause coronary vasospasm, so continuous or severe chest pain must be reported to the provider. This finding could signal a dangerous cardiac effect rather than the brief, self-limiting tightness that some clients feel with the medication. Option a is incorrect because mild flushing is a minor, transient effect that does not require reporting. The serious warning sign the client should report with a triptan is persistent severe chest pain, which points to coronary vasospasm and a possible cardiac problem. Option b is incorrect because a short-lived sensation of warmth is generally harmless with triptans. It is the continuous, severe chest pain that signals possible vasospasm and warrants notifying the provider, so warmth alone does not need to be reported. Option c is incorrect because slight drowsiness is a mild effect and not the reportable concern with a triptan. The client should instead report continuous or severe chest pain, because of the risk of coronary vasospas

Correct Answer: Use this medication only for a short course.

Ketorolac can cause kidney damage, so its use is limited to a short course of no more than several days. The nurse should teach the client not to take it beyond the brief period the provider prescribes. Option b is incorrect because long-term daily use is exactly what ketorolac must avoid, because extended use injures the kidneys. This NSAID is intended only for short-term management of moderate to severe pain, so this statement reflects an unsafe misunderstanding. Option c is incorrect because ketorolac is given for pain, not to thin the blood. Although NSAIDs can affect bleeding, blood thinning is the purpose of anticoagulants, which represent a different class of medication with a different therapeutic goal. Option d is incorrect because far from protecting the kidneys, ketorolac can harm them, which is precisely why its use is time-limited. The teaching should warn the client about kidney risk rather than suggest any protective benefit from the medication.

Correct Answer: Alternate nostrils each day.

Intranasal calcitonin-salmon can cause nasal dryness and irritation, so the client should alternate nostrils daily. The nurse should teach this rotation and instruct the client to keep the container upright between doses to maintain the medication properly. Option a is incorrect because using the same nostril every day would worsen the nasal dryness and irritation the medication can cause. The correct instruction for the client is to alternate nostrils so that one side is not repeatedly exposed to the spray. Option c is incorrect because lying flat after a dose is not required with intranasal calcitonin and does nothing for nasal irritation. Switching sides with each dose, not lying down, is what shields the nasal lining. Option d is incorrect because the calcitonin container should be kept upright, not on its side. The instruction that protects the client's nasal mucosa is to alternate nostrils with each daily dose, rather than any change to how the container is stored.

Correct Answer: Urinary retention

Opioid agonists suppress the awareness of a full bladder and can cause urinary retention. The nurse should monitor intake and output and palpate the bladder, because the client may not sense the need to void while receiving the medication. Option a is incorrect because opioids tend to cause retention, not increased output. A rise in urine volume would point to a diuretic effect, which is the opposite of what opioid agonists do to bladder function in the client receiving them. Option b is incorrect because opioids suppress the cough reflex, so a productive cough is not an expected adverse effect. The nurse should instead anticipate effects such as sedation, constipation, and urinary retention in the client receiving an opioid agonist. Option d is incorrect because opioid agonists more often produce hypotension from vasodilation rather than hypertension. A high blood pressure is not the expected cardiovascular effect, so it is not the finding the nurse should monitor for with these medic

Correct Answer: Orthostatic hypotension

Amitriptyline, a tricyclic antidepressant used for neuropathic pain, commonly causes orthostatic hypotension. The nurse should monitor the client's blood pressure and teach the client to change positions slowly to prevent dizziness and falls during therapy. Option a is incorrect because amitriptyline does not affect bone density. That outcome belongs to osteoporosis therapies, whereas this adjuvant's notable adverse effects include orthostatic hypotension and anticholinergic symptoms such as dry mouth and constipation in the client. Option b is incorrect because uric acid levels are unrelated to amitriptyline. A rising uric acid level is a concern in gout management, not an effect of a tricyclic antidepressant given to relieve a client's neuropathic pain as an adjuvant. Option c is incorrect because amitriptyline does not speed breathing; it tends to cause sedation and a faster heart rate. The blood pressure drop on standing is the effect the nurse should watch for in th