The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

Choice A reason:

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that has analgesic, anti-inflammatory, and antipyretic effects. Ibuprofen can be prescribed along with morphine to enhance the pain relief and reduce the inflammation caused by the surgery. Ibuprofen can also reduce the opioid requirement and the risk of opioid-related side effects, such as nausea, constipation, and respiratory depression. Therefore, choice A is correct.

Choice B reason:

Propofol is a short-acting intravenous anesthetic agent that induces and maintains anesthesia and sedation. Propofol is not prescribed along with morphine for post-operative pain management, as it is not an analgesic and has a high risk of hypotension, bradycardia, and respiratory depression. Propofol is only used in controlled settings, such as the operating room or the intensive care unit, under close monitoring and supervision. Therefore, choice B is incorrect.

Choice C reason:

Methadone is a long-acting synthetic opioid that has analgesic and opioid substitution effects. Methadone is not prescribed along with morphine for post-operative pain management, as it is not indicated for acute pain and has a high risk of accumulation, overdose, and addiction. Methadone is mainly used for chronic pain or opioid dependence treatment, under strict regulation and monitoring. Therefore, choice C is incorrect.

Choice D reason:

Senna is a stimulant laxative that increases the intestinal motility and promotes bowel movements. Senna can be prescribed along with morphine to prevent or treat constipation, which is a common side effect of opioids. Senna can improve the comfort and quality of life of the client who is receiving opioid therapy. Therefore, choice D is correct.

Choice E reason:

Docusate sodium is a stool softener that increases the water content and softness of the stool. Docusate sodium can be prescribed along with morphine to prevent or treat constipation, which is a common side effect of opioids. Docusate sodium can improve the comfort and quality of life of the client who is receiving opioid therapy. Therefore, choice E is correct.

Choice F reason:

Naloxone is an opioid antagonist that reverses the effects of opioids by displacing them from their receptors. Naloxone is not prescribed along with morphine for post-operative pain management, as it would counteract the analgesic effect of morphine and cause withdrawal symptoms. Naloxone is only used in emergency situations, such as opioid overdose or respiratory depression, as a rescue medication. Therefore, choice F is incorrect.

Choice A reason: This statement indicates understanding of naloxone. Naloxone is an opioid antagonist that can reverse the effects of opioid overdose, such as respiratory depression, sedation, and hypotension. Naloxone can be administered by different routes, depending on the availability and urgency of the situation. Intravenous, intramuscular, and subcutaneous routes are all acceptable ways to give naloxone.

Choice B reason: This statement also indicates understanding of naloxone. Naloxone works best on pure agonist opioids, such as morphine, heroin, and fentanyl. These opioids bind to the same receptors as naloxone, but naloxone has a higher affinity and can displace them. Naloxone is less effective on partial agonist or mixed agonist-antagonist opioids, such as buprenorphine and pentazocine. These opioids have lower intrinsic activity or antagonize some receptors, making them less susceptible to naloxone.

Choice C reason: This statement indicates no understanding of naloxone. Naloxone is not a harmless drug that can be given repeatedly without consequences. Naloxone has a short half-life of about 30 to 90 minutes, which means it can wear off before the opioid does. This can cause the patient to relapse into respiratory depression and require repeated doses of naloxone. However, giving too many doses of naloxone can also cause adverse effects, such as agitation, hypertension, tachycardia, pulmonary edema, and seizures. Therefore, naloxone should be given cautiously and titrated to the minimum effective dose to reverse respiratory depression.

Choice D reason: This statement indicates no understanding of naloxone. Naloxone will affect the client's level of pain by blocking the analgesic effects of opioids. This can cause the patient to experience acute pain and distress, especially if they have a chronic pain condition or a surgical wound. Naloxone should not be used to treat opioid-induced sedation or pruritus without respiratory depression, as this will unnecessarily expose the patient to pain and suffering.

Choice E reason: This statement indicates no understanding of naloxone. When given IV, naloxone starts working immediately, but it does not last several hours. As mentioned earlier, naloxone has a short half-life and can be eliminated from the body quickly. The duration of action of naloxone depends on the dose, route, and frequency of administration, as well as the type, dose, and route of the opioid involved. Generally, naloxone lasts for about 30 to 90 minutes when given IV, which may not be enough to counteract the longer-lasting effects of some opioids. Therefore, continuous monitoring and repeated doses of naloxone may be needed until the opioid is cleared from the system.