Review Practice Exercise 4

Exam Review

Practice Exercise 4

Share This Link

Share on social media

Facebook

Messager

WhatsApp

Share URL
Copy

We are excited to announce the release of a NEW VERSION OF THE SYSTEM! To benefit from the latest features, improvements, and component updates, please switch to the new system as soon as possible.

Visit Latest Version

Total Questions : 5

Showing 5 questions, Sign in for more

Question 1:

The nurse is preparing to administer the first dose of buprenorphine to a client whose Clinical Opiate Withdrawal Scale score is 4. Which of the following actions should the nurse take first?

A. Administer the dose sublingually and reassess the client in 1 hour. B. Withhold the dose and continue to reassess the client's withdrawal score. C. Request a prescription for clonidine to lower the client's blood pressure. D. Instruct the client to swallow the tablet with a full glass of water.

Answer and Explanation

Choice A:

Administering buprenorphine prematurely at a low score triggers rapid displacement of full agonists from mu receptors. Reassessing in 1 hour after administration would fail to prevent the acute onset of severe cramping and severe physiological distress. Sublingual administration is the correct route, but timing parameters must be met first based on withdrawal severity. The client requires further opioid clearance prior to receiving the initial dose.

Choice B:

A Clinical Opiate Withdrawal Scale score of 4 indicates minimal withdrawal, which is insufficient to safely initiate buprenorphine therapy. Initiating treatment at this stage risks triggering acute precipitated withdrawal by displacing remaining full opioid agonists from receptors. The nurse must withhold administration and re-evaluate the score until objective clinical signs reach a threshold score ≥8. Continued monitoring ensures patient safety before introducing partial agonist pharmacotherapy.

Choice C:

Requesting clonidine is inappropriate because a withdrawal score of 4 does not indicate severe autonomic hyperactivity requiring alpha-2 adrenergic agonist therapy. Clonidine manages symptoms like hypertension during active withdrawal, but it does not replace the need for accurate scoring prior to buprenorphine induction. Administering antihypertensives without documented hemodynamic instability risks causing unnecessary side effects like iatrogenic hypotension. The priority action remains timing buprenorphine induction correctly.

Choice D:

Instructing the client to swallow buprenorphine results in extensive first-pass metabolism, rendering the medication ineffective due to low oral bioavailability. Buprenorphine must be administered via the sublingual route to achieve therapeutic systemic absorption and clinical efficacy. Furthermore, swallowing the tablet does not resolve the premature timing of administration with a score of 4. Route education is secondary to establishing sufficient clinical withdrawal.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 2:

The nurse is preparing a client for the first extended-release injectable naltrexone dose. The client's last use of hydromorphone was 3 days ago. Which of the following actions by the nurse is most appropriate?

A. Administer the injection into the deltoid muscle and rotate sites monthly. B. Notify the primary health care provider, because the required opioid-free interval has not elapsed. C. Administer the injection after confirming a Clinical Opiate Withdrawal Scale score of at least 8. D. Give a test dose of oral naltrexone 50 mg and observe the client for 1 hour.

Answer and Explanation

Choice A:

Extended-release naltrexone must be administered via gluteal intramuscular injection rather than the deltoid muscle. The formulation requires a deep gluteal injection using the supplied specialty needle to ensure proper absorption and prevent tissue necrosis. Additionally, administering the injection after 3 days remains strictly contraindicated regardless of the route. Route accuracy cannot override the requirement for an adequate drug washout period.

Choice B:

Hydromorphone is a short-acting opioid requiring an opioid-free period of at least 7 to 10 days prior to naltrexone administration. Administering naltrexone after only 3 days will precipitate acute withdrawal due to competitive displacement of remaining opioids. The nurse must notify the provider to delay administration until the appropriate clearance window has elapsed. Patient safety requires verifying complete physiological detoxification before initiating full antagonist therapy.

Choice C:

Confirming a Clinical Opiate Withdrawal Scale score ≥8 is the threshold for buprenorphine induction, not naltrexone initiation. Administering a full antagonist like naltrexone during active withdrawal triggers severe iatrogenic crisis and physiological collapse. Naltrexone requires complete absence of withdrawal symptoms and negative urine toxicology prior to administration. Assessing a COWS score does not substitute for the mandatory 7 to 10 day opioid abstinence.

Choice D:

Administering a 50 mg oral test dose after only 3 days will trigger severe distress by acutely precipitating opioid withdrawal. Oral challenge tests or naloxone challenge tests are only performed when abstinence status is uncertain after the 7 to 10 day window. Giving a full therapeutic oral dose of 50 mg is unsafe and inappropriate when recent opioid use is documented. The immediate priority is delaying therapy until the full washout period is completed.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 3:

The nurse is monitoring a client on day 4 of methadone titration in an opioid treatment program. Which of the following assessment findings should the nurse report to the primary health care provider? Select all that apply.

A. A corrected QT interval of 520 milliseconds on the electrocardiogram. B. A respiratory rate of 10 breaths/min with difficulty arousing the client. C. A serum potassium level of 3.0 milliequivalents per liter. D. A report of mild constipation relieved by a stool softener. E. Diaphoresis noted during the client's afternoon clinic visit.

Answer and Explanation

Choice A:

A corrected QT interval of 520 milliseconds indicates dangerous cardiac repolarization delay from methadone therapy. Exceeding 500 milliseconds significantly increases client susceptibility to torsades de pointes ventricular tachycardia. The nurse must report this finding immediately to adjust medication dosing safely. Urgent intervention prevents life-threatening ventricular dysrhythmias.

Choice B:

A respiratory rate of 10 breaths/min coupled with somnolence indicates central nervous system depression from methadone accumulation. Methadone peak respiratory depressant effects lag behind peak analgesic effects during early titration days. The nurse must report this clinical deterioration immediately to prevent respiratory arrest. Prompt administration of opioid antagonists may be required.

Choice C:

A serum potassium level of 3.0 milliequivalents per liter represents significant hypokalemia that exacerbates methadone-induced cardiotoxicity. Low extracellular potassium impairs repolarization potassium currents, further lengthening the QT interval and precipitating fatal arrhythmias. The nurse must report this electrolyte imbalance to initiate urgent potassium replacement. Electrolyte stabilization reduces overall arrhythmogenic risk.

Choice D:

Mild constipation is a common gastrointestinal side effect resulting from mu-opioid receptor activation slowing intestinal motility. Managing constipation with over-the-counter stool softeners is expected protocol and does not require immediate provider notification. The nurse should encourage fluid intake and dietary fiber rather than reporting mild symptoms. Routine monitoring remains appropriate for controlled bowel dysfunction.

Choice E:

Diaphoresis is a recognized autonomic side effect of methadone maintenance that commonly occurs during early treatment phases. Excess sweating without concurrent fever, chest pain, or respiratory distress is not an emergent finding. The nurse can recommend supportive measures like adequate hydration to manage benign sweating. Reporting is unnecessary unless accompanied by signs of acute withdrawal syndrome.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 4:

The nurse is talking with a client who says, "My group told me I am not really in recovery because I take buprenorphine every day." Which of the following responses by the nurse is most appropriate?

A. "Perhaps you should consider tapering off the medication so you can fully participate in the group." B. "You should not discuss your medication with anyone at those meetings." C. "Medication is a legitimate treatment for this illness, and there are groups that support members who take it." D. "Every recovery group holds that view, so you will need to decide which matters more to you."

Answer and Explanation

Choice A:

Recommending a medication taper prematurely increases overdose mortality and severe relapse risk. Tapering buprenorphine due to peer pressure contradicts evidence-based clinical guidelines for chronic illness management. The nurse should advocate for pharmacotherapy rather than encouraging treatment discontinuation. Maintaining therapeutic stability is essential for client safety.

Choice B:

Advising secrecy promotes internalized stigma and shame regarding essential medical treatment. Secrecy hinders open therapeutic communication and fails to connect the client with supportive networks. The nurse should empower the client to seek inclusive communities rather than hiding their prescribed pharmacotherapy. Honest discussion fosters long-term peer support.

Choice C:

Validating medication-assisted recovery affirms evidence-based pharmacotherapy for substance use disorder management. Recommending medication-assisted support groups addresses stigma while promoting therapeutic engagement and treatment adherence. The nurse provides accurate education without invalidating the client's recovery progress or personal autonomy. Empowering clients with supportive resources preserves long-term relapse prevention.

Choice D:

Stating that all groups hold negative views provides inaccurate information regarding recovery communities. Specialized groups like Medication-Assisted Recovery Anonymous actively support individuals utilizing opioid agonist therapy. Forcing a false dichotomy increases client distress and encourages unnecessary isolation. Inclusive mutual aid options exist for MOUD participants.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Question 5:

The nurse is providing harm reduction education to a client who declines to stop using opioids. Which of the following instructions should the nurse include? Select all that apply.

A. Use a small test amount after any period of not using. B. Keep naloxone available and teach a household member how to give it. C. Avoid using while alone, so that someone is present to summon help. D. Combine opioids with a benzodiazepine to reduce the amount of opioid required. E. Reuse personal syringes indefinitely, as long as they are not shared with anyone else.

Answer and Explanation

Choice A:

Tolerance decreases rapidly during periods of abstinence, making previous doses potentially fatal due to loss of tolerance. Administering a small test amount allows the individual to gauge drug potency and physiological response. This precaution significantly mitigates the risk of fatal overdose when resuming substance use. Testing doses is a cornerstone principle of clinical harm reduction education.

Choice B:

Layperson administration of naloxone rapidly reverses life-threatening opioid toxicity by competitive receptor displacement. Ensuring household members are trained guarantees immediate response capability during an acute respiratory arrest episode. Keeping naloxone accessible converts bystanders into immediate lifesavers before emergency personnel arrive. Widespread naloxone availability directly lowers community overdose mortality rates.

Choice C:

Using opioids alone removes the safety net of bystander recognition and immediate emergency response during overdose events. Having a trusted individual present ensures someone can administer naloxone and summon rescue services if loss of consciousness occurs. Non-fatal overdoses can quickly progress to death without immediate external intervention. Peer presence is a fundamental behavioral safeguard in harm reduction.

Choice D:

Combining benzodiazepines with opioids produces synergistic central nervous system depression and profound respiratory inhibition. Dual administration severely heightens the probability of fatal respiratory arrest and hypoxic brain injury. Clients must be explicitly warned against mixing sedative-hypnotics with opioid substances. Co-ingestion represents one of the highest risk factors for overdose fatalities.

Choice E:

Reusing personal needles causes structural barbed degradation of the syringe tip, leading to severe vascular trauma and tissue destruction. Repeated use introduces skin flora into the bloodstream, dramatically increasing risks for bacterial endocarditis and localized abscess formation. Syringes should be discarded after a single use and replaced with new sterile equipment. Sterile access protects long-term venous integrity and reduces systemic infection risks.

Discussion Section

Posting as Anonymous or Login Here

0 Pulse Checks

No comments

Sign Up or Login to view all the 5 Questions on this Exam

Join over 100,000+ nursing students using Naxlex’s science-backend flashcards, practice tests and expert solutions to improve their grades and reach their goals.

Exam Review

Practice Exercise 4 Share this Share This Link Share on social media Facebook Messager WhatsApp Share URL Copy Close

Total Questions : 5

Sign Up or Login to view all the 5 Questions on this Exam

Practice Exercise 4

Share This Link

Share on social media

Facebook

Messager

WhatsApp

Share URL
Copy