10

Answer Key to Chapter 10 

You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.

Critical Thinking Activity Section 10.6a

The patient should be advised that acetaminophen can cause acute liver damage when taken in excessive amounts or when used with alcohol. Many over-the-counter medications contain acetaminophen, so daily amounts must be monitored carefully. Recommended daily restrictions for acetaminophen include less than 4,000 mg of acetaminophen in 24 hours for an adult, less than 3,200 mg for geriatric adults, and less than 2,000 mg for patients with alcoholism. Fewer than three alcoholic drinks should be consumed daily while using acetaminophen.

Critical Thinking Activity Section 10.6b

The patient should be advised that aspirin has an antiplatelet effect, in addition to reducing pain, fever, and inflammation. By preventing the platelets from sticking together, clots that can cause heart attacks and strokes are prevented from forming.

Critical Thinking Activity Section 10.6c

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which can cause severe and life-threatening stomach bleeding and must be taken cautiously. The patient should be advised that the risk for bleeding is higher if the patient:

• is age 60 or older
• has had stomach ulcers or bleeding problems
• takes an anticoagulant or steroid medication
• takes other drugs containing NSAIDs (such as aspirin, ibuprofen, or naproxen)
• consumes three or more alcoholic drinks every day while using this product
• takes ibuprofen in higher doses, more frequently, or for a longer time than directed

Critical Thinking Activity Section 10.6d

The nurse should evaluate the effectiveness of ketorolac IV in relieving the patient’s pain 30 minutes after administration.

Critical Thinking Activity Section 10.6e

The nurse should provide the following patient education to a patient who has been prescribed celecoxib:

• It may be taken with or without food.
• You can sprinkle capsules on applesauce and ingest it immediately with water.
• You may experience heartburn, vomiting, or diarrhea with this medication.
• Notify the provider immediately if you have abdominal pain, vomit blood or have blood in your stool, develop swelling in your hand or feet, or notice yellowing of your skin.

Critical Thinking Activity Section 10.7a

Oral drops of morphine, commonly used for patients with metastatic cancer, should be effective within one hour of administration.

Critical Thinking Activity Section 10.7b

Naloxone immediately reverses the effects of respiratory depression and oversedations caused by opioids. After a patient receives naloxone, the nurse should continue to evaluate the patient’s respiratory status at least every 15 minutes because naloxone has a shorter duration of action than many opioids, and repeated doses are usually necessary.

Critical Thinking Activity Section 10.8a

The nurse should educate the patient to take baclofen with milk or food to minimize gastric upset. Advise the patient that baclofen may cause dizziness or drowsiness, so they should change positions slowly and avoid driving and operating machines. Patients using baclofen should avoid using alcohol or taking other CNS depressants.

Critical Thinking Activity Section 10.8b

Cyclobenzaprine is a muscle relaxer and may cause drowsiness. If used with alcohol or other CNS depressants, it can impair mental or physical abilities, so the patient should be advised to not drive when taking cyclobenzaprine.

Critical Thinking Activity Section 10.8c

The patient should be advised that tizanidine can cause drowsiness and dizziness, and concurrent use with alcohol can worsen these effects. Tizanidine can damage the liver, so alcohol should be avoided to prevent additional damage.

Section 10.12 Light Bulb Moment

The correct answers are a), b), and e). Based on the patient’s respiratory status, the nurse should immediately raise the patient’s bed and apply oxygen to rapidly increase their oxygenation level. The nurse should ask for help from a team member and/or call the rapid response team while obtaining naloxone to administer for sedation and respiratory depression. The nurse should continue to monitor the patient’s respiratory status after naloxone is administered because repeated doses may be required.

Section 10.12 Case Study 1

1. Toradol is a nonsteroidal anti-inflammatory drug (NSAID) that works by blocking the production of prostaglandins, which are chemicals that cause pain, inflammation, and fever. It is used to treat moderate to severe pain, such as postoperative pain or pain associated with musculoskeletal injuries.

2. The side effects of toradol can include nausea, vomiting, constipation, diarrhea, dizziness, headache, drowsiness, and stomach pain. More serious side effects can include stomach ulcers, bleeding, and kidney problems. It can also increase the risk of heart attack and stroke, especially with long-term use or in patients with preexisting cardiovascular disease.

3. Toradol can be administered orally, intramuscularly, or intravenously. The recommended dose for oral and intramuscular administration is 10 mg every 4 to 6 hours, not to exceed 40 mg per day. For intravenous administration, the recommended dose is 30 mg as a single dose or 15 mg every 6 hours, not to exceed 60 mg per day.

4. Toradol should be used with caution in patients with a history of gastrointestinal bleeding or ulcers, kidney disease, heart disease, or bleeding disorders. It should not be used in patients who are allergic to NSAIDs or aspirin, or who have a history of asthma, hives, or other allergic reactions to these drugs. It should also be avoided in pregnant women and nursing mothers.

5. Toradol should be used for the shortest duration possible, typically no more than five days, due to the risk of serious side effects with prolonged use. It should not be used for chronic pain management.

6. Alternative analgesics that could be used instead of toradol include acetaminophen, opioids, and other NSAIDs such as ibuprofen or naproxen. The choice of analgesic should be based on the patient’s individual needs and medical history.

Section 10.12 Case Study 2

1. Narcan (naloxone) is an opioid antagonist that works by blocking the effects of opioids on the central nervous system. It quickly reverses the effects of an opioid overdose, including respiratory depression and sedation.

2. Narcan can be administered intravenously, intramuscularly, subcutaneously, or intranasally. The route of administration will depend on the patient’s condition and the available equipment. The dose of Narcan will also depend on the patient’s weight and the severity of the overdose.

3. The potential side effects of Narcan can include nausea, vomiting, sweating, tremors, anxiety, and irritability. In some cases, Narcan can cause rapid and severe withdrawal symptoms, which can include seizures, hypertension, tachycardia, and pulmonary edema.

4. When using Narcan, health care providers should take precautions to ensure that the patient’s airway is protected and that they receive adequate oxygenation and ventilation. Narcan should be used with caution in patients with a history of cardiac disease, hypertension, or seizures. It should also be used with caution in patients who are pregnant or nursing.

5. The expected outcome after administering Narcan in an opioid overdose is rapid reversal of respiratory depression and sedation. The patient should be monitored closely for signs of withdrawal and respiratory depression, as additional doses of Narcan may be necessary. The health care provider should also address the underlying opioid addiction and provide appropriate treatment and resources to prevent future overdose.