A client with bulimia and depression who is taking phenelzine 90 mg daily is admitted to an acute care hospital for uncontrolled hypertension. Which dietary choices should the nurse instruct the client to avoid?

Choice A reason: Hard candy can be used for a dry mouth, which is a common side effect of St. John's wort.

Choice B reason: Another form of contraception is needed, because St. John's wort can reduce the effectiveness of oral contraceptives and increase the risk of unplanned pregnancy. This information requires further instruction from the nurse.

Choice C reason: Insomnia may occur while taking the medication, which is another possible side effect of St. John's wort. The client should be advised to take the medication in the morning or afternoon, and avoid caffeine and alcohol.

Choice D reason: Sensitivity to the sun can develop, which is a rare but serious side effect of St. John's wort. The client should be instructed to wear sunscreen and protective clothing when exposed to sunlight.

The correct answer is:

Morphine is a(n) **pure opioid antagonist** and it activates **mu** receptors and is used to relieve **severe pain**.

Choice area A

Choice A reason:

A pure opioid antagonist is a drug that blocks the effects of opioids by binding to their receptors without activating them. Morphine is not a pure opioid antagonist, but a pure opioid agonist, which means it binds to and activates opioid receptors, producing analgesia and other effects. Therefore, choice A is incorrect.

Choice B reason:

An endogenous opioid is a naturally occurring substance in the body that binds to and activates opioid receptors, such as endorphins and enkephalins. Morphine is not an endogenous opioid, but an exogenous opioid, which means it is derived from an external source, such as the opium poppy. Therefore, choice B is incorrect.

Choice C reason:

A pure opioid antagonist is the correct term for morphine, as explained above. Therefore, choice C is correct.

Choice D reason:

A local anesthetic is a drug that blocks the transmission of nerve impulses in a specific area of the body, causing numbness and loss of sensation. Morphine is not a local anesthetic, but a systemic analgesic, which means it affects the whole body and reduces the perception of pain. Therefore, choice D is incorrect.

Choice area B

Choice A reason:

Mu receptors are one of the three types of opioid receptors in the body, along with kappa and delta receptors. Mu receptors are responsible for most of the analgesic and euphoric effects of opioids, as well as respiratory depression and physical dependence. Morphine has a high affinity for mu receptors and activates them strongly. Therefore, choice A is correct.

Choice B reason:

Kappa receptors are another type of opioid receptors in the body. Kappa receptors mediate some analgesic effects of opioids, as well as dysphoria, sedation, and miosis. Morphine has a low affinity for kappa receptors and activates them weakly. Therefore, choice B is incorrect.

Choice C reason:

Delta receptors are the third type of opioid receptors in the body. Delta receptors modulate some analgesic effects of opioids, as well as emotional responses and memory. Morphine has a low affinity for delta receptors and activates them weakly. Therefore, choice C is incorrect.

Choice D reason:

NMDA receptors are not opioid receptors, but glutamate receptors that are involved in synaptic plasticity, learning, memory, and pain modulation. Some drugs that act on NMDA receptors, such as ketamine and dextromethorphan, have analgesic properties, especially for neuropathic pain. Morphine does not act on NMDA receptors. Therefore, choice D is incorrect.

Choice E reason:

GABA receptors are not opioid receptors, but gamma-aminobutyric acid receptors that are involved in inhibitory neurotransmission in the central nervous system. Some drugs that act on GABA receptors, such as benzodiazepines and barbiturates, have sedative, anxiolytic, anticonvulsant, and muscle relaxant properties. Morphine does not act on GABA receptors. Therefore, choice E is incorrect.

Choice area C

Choice A reason:

Mild pain is pain that is easily tolerated and does not interfere with normal activities or sleep. Mild pain can usually be managed with non-opioid analgesics, such as acetaminophen or ibuprofen. Morphine is not used to relieve mild pain, as it is too potent and has more side effects and risks than non-opioid analgesics. Therefore, choice A is incorrect.

Choice B reason:

Moderate pain is pain that causes discomfort and affects normal activities or sleep to some extent. Moderate pain can usually be managed with combination analgesics, such as codeine or hydrocodone with acetaminophen or ibuprofen. Morphine can be used to relieve moderate pain in some cases, but it is not the first-line option, as it may be more effective and safer to use lower doses of opioids with non-opioid analgesics. Therefore, choice B is incorrect.

Choice C reason:

Severe pain is pain that causes significant distress and impairs normal activities or sleep to a great extent. Severe pain usually requires strong opioids, such as morphine or fentanyl, to achieve adequate relief. Morphine is commonly used to relieve severe pain in various settings, such as post-operative pain, cancer pain, or acute myocardial infarction. Therefore, choice C is correct.

Choice D reason:

Neuropathic pain is pain that results from damage or dysfunction of the nervous system, such as diabetic neuropathy or post-herpetic neuralgia. Neuropathic pain often responds poorly to conventional analgesics, including opioids. Morphine can be used to relieve neuropathic pain in some cases, but it may not be very effective or require higher doses than for nociceptive pain (pain that results from tissue damage or inflammation). Therefore, choice D is incorrect.

Choice E reason:

Inflammatory pain is pain that results from tissue damage or inflammation, such as arthritis or appendicitis. Inflammatory pain often responds well to non-opioid analgesics, especially NSAIDs, which have anti-inflammatory properties. Morphine can be used to relieve inflammatory pain in some cases, but it may not be necessary or optimal to use opioids for this type of pain, as they do not have anti-inflammatory effects and may cause more side effects and risks than non-opioid analgesics. Therefore, choice E is incorrect.