A client with a documented history of opioid abuse just had surgery and is prescribed a high dose of opioid analgesic. The nurse knows that an important consideration for this client is:

This client may have a high tolerance to opioids and require a higher dose for pain control

Clients with a history of opioid abuse should not be given an opioid analgesic

This client should wait until their pain is severe, 10/10 before taking a high dose opioid

The client's self-report of pain may not be trusted if they have a history of opioid abuse

Answer and Explanation

The Correct Answer is A

Choice A reason: This statement is true. This client may have a high tolerance to opioids and require a higher dose for pain control, as tolerance is a condition where the body becomes less responsive to the effects of a drug over time, and needs more of the drug to achieve the same effect. Tolerance can develop from chronic or repeated use of opioids, and can vary from person to person. The nurse should assess the client's pain level, history of opioid use, and response to the medication, and adjust the dose accordingly.

Choice B reason: This statement is false. Clients with a history of opioid abuse should not be denied an opioid analgesic, as opioids are effective and appropriate medications for acute pain management, especially after surgery. The nurse should not discriminate or stigmatize the client based on their history of opioid abuse, but rather provide compassionate and evidence-based care. The nurse should also use a multimodal approach to pain management, which involves using non-opioid analgesics, adjuvant medications, and non-pharmacological interventions, such as ice, heat, massage, or relaxation techniques.

Choice C reason: This statement is false. This client should not wait until their pain is severe, 10/10 before taking a high dose opioid, as this can result in poor pain control, increased stress, and delayed recovery. The nurse should encourage the client to take the medication as prescribed, and to report their pain level regularly. The nurse should also educate the client about the benefits of preventive analgesia, which involves taking the medication before the pain becomes severe, and maintaining a steady blood level of the drug.

Choice D reason: This statement is false. The client's self-report of pain may not be disregarded if they have a history of opioid abuse, as pain is a subjective and personal experience, and the client is the best judge of their own pain. The nurse should not assume that the client is exaggerating, lying, or drug-seeking, but rather respect and validate the client's pain report. The nurse should also use objective indicators of pain, such as vital signs, facial expressions, body movements, and behavioral changes, to support the client's pain assessment.

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Correct Answer is A

Explanation

Choice A reason: Patient stopped taking the medication 2 days ago is the most important information to report to the health care provider. Prednisone is a corticosteroid medication that suppresses the immune system and reduces inflammation. Prednisone also affects the production of cortisol, a hormone that regulates the stress response, blood pressure, blood sugar, and metabolism. Prednisone should not be stopped abruptly, as this can cause adrenal insufficiency, a condition where the adrenal glands cannot produce enough cortisol. Adrenal insufficiency can cause symptoms such as fatigue, weakness, nausea, vomiting, low blood pressure, and hypoglycemia. The patient should be instructed to resume taking the prednisone and taper the dose gradually under the supervision of the health care provider.

Choice B reason: Patient has not been taking the prescribed vitamin D is not as important as choice A, but still requires further education by the nurse. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium and phosphorus, and maintain bone health. Prednisone can interfere with the metabolism of vitamin D and cause bone loss, osteoporosis, and fractures. The patient should be advised to take the prescribed vitamin D supplement and eat foods rich in vitamin D, such as fatty fish, egg yolks, cheese, and fortified milk.

Choice C reason: Patient has bilateral 2+ pitting ankle edema is not as critical as choice A, but still needs to be monitored by the nurse. Ankle edema is swelling of the ankles due to fluid accumulation in the tissues. Prednisone can cause ankle edema by increasing the sodium and water retention in the body, and reducing the potassium excretion by the kidneys. The patient should be assessed for signs of fluid overload, such as weight gain, shortness of breath, and crackles in the lungs. The patient should also be encouraged to limit the intake of salt and fluids, and elevate the legs when sitting or lying down.

Choice D reason: Patient's blood pressure is 148/94 mm Hg is not as urgent as choice A, but still needs to be addressed by the nurse. Blood pressure is the force of blood against the walls of the arteries. Prednisone can increase the blood pressure by stimulating the renin-angiotensin-aldosterone system, a hormonal system that regulates the blood volume and pressure. The patient should be advised to check the blood pressure regularly, and report any readings above 140/90 mm Hg to the health care provider. The patient should also be counseled to follow a healthy lifestyle, such as exercising, quitting smoking, reducing stress, and eating a balanced diet low in sodium, fat, and cholesterol.

A. Purplish streaks on the abdomen B. Chronically low blood pressure C. Bronzed appearance of the skin D. Decreased axillary and pubic hair

Correct Answer is A

Explanation

Choice A reason: Purplish streaks on the abdomen are also known as striae. They are caused by the thinning and weakening of the skin due to excess cortisol, a hormone that is elevated in Cushing syndrome. Striae are a common sign of Cushing syndrome, along with weight gain, moon face, and buffalo hump.

Choice B reason: Chronically low blood pressure is not associated with Cushing syndrome. Cushing syndrome can cause high blood pressure, due to the effects of cortisol on the cardiovascular system. Low blood pressure can be a sign of adrenal insufficiency, which is the opposite of Cushing syndrome.

Choice C reason: Bronzed appearance of the skin is not related to Cushing syndrome. Bronzed skin can be a sign of Addison's disease, which is a condition of low cortisol and low aldosterone. Addison's disease can cause hyperpigmentation of the skin, especially in the areas exposed to sun, such as the face, neck, and hands.

Choice D reason: Decreased axillary and pubic hair is also not related to Cushing syndrome. Cushing syndrome can cause increased hair growth, especially on the face, chest, and back. This is due to the androgenic effects of cortisol. Decreased hair growth can be a sign of hypothyroidism, which is a condition of low thyroid hormone.

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A client with a documented history of opioid abuse just had surgery and is prescribed a high dose of opioid analgesic. The nurse knows that an important consideration for this client is:

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Naxlex Comprehensive Predictor Exams

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Explanation

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