A hospice client has been prescribed an opioid for the past 6 months for pain control. The nurse contacts the healthcare provider because the dosage of the opioid no longer provides pain relief. What is the reason for this nontherapeutic response to the opioid?

The client has developed a drug tolerance.

The client is exhibiting drug seeking behavior.

The client is displaying an idiosyncratic reaction.

The client is inadequately metabolizing the medication.

Answer and Explanation

The Correct Answer is A

A. The client has developed a drug tolerance: Chronic exposure to opioid agonists leads to neuroadaptive changes and downregulation of opioid receptors. Over time, higher doses are required to achieve the same level of analgesic effect. This is a common, expected physiological phenomenon in long-term hospice and palliative care.

B. The client is exhibiting drug seeking behavior: This term is often inappropriately used for patients experiencing "pseudo-addiction" due to undertreated pain. In a hospice context, reports of increased pain are clinically assumed to be legitimate. Tolerance or disease progression are the primary drivers of increased medication requirements.

C. The client is displaying an idiosyncratic reaction: This refers to an unpredictable, genetically determined abnormal response to a drug upon first exposure. Since the client has used the medication for 6 months, this is not an idiosyncratic event. The lack of efficacy is a progressive change, not an immediate anomaly.

D. The client is inadequately metabolizing the medication: If the client were not metabolizing the drug, levels would likely rise, potentially leading to toxicity rather than decreased efficacy. While metabolic changes can occur, the standard clinical explanation for reduced opioid effectiveness over months is pharmacological tolerance.

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Correct Answer is C

Explanation

A. The kidney function will be improved with celecoxib: Both traditional non-steroidal anti-inflammatory drugs and COX-2 inhibitors can adversely affect renal perfusion. They inhibit prostaglandins that maintain renal blood flow, potentially leading to sodium retention or interstitial nephritis. Celecoxib does not offer a therapeutic advantage for renal health.

B. If insurance pays for celecoxib, it will save you money: Celecoxib is typically more expensive than generic ibuprofen due to its specialized pharmacological profile. Cost is rarely the primary clinical driver for switching to a selective inhibitor. Therapeutic safety and side effect profiles are the priorities in this medication transition.

C. There is less risk of gastrointestinal bleeding with celecoxib: Celecoxib selectively inhibits the COX-2 enzyme responsible for inflammation while sparing the COX-1 enzyme. COX-1 protects the gastric mucosa and facilitates platelet aggregation. By sparing COX-1, this medication significantly reduces the incidence of gastric ulcers and systemic bleeding.

D. A lower dose can be given and still achieve the same degree of pain relief: Dosage strength is not the primary reason for switching from a non-selective to a selective inhibitor. Both medications are effective for arthritis pain at their respective therapeutic ranges. The switch is based on the safety profile rather than potency.

A. That much ibuprofen should relieve your pain. B. You probably should ask your healthcare provider if it is acceptable. C. That amount is greater than the recommended daily amount. Discussing your increased pain with your healthcare provider is important. D. Ibuprofen is eliminated by the kidneys. It would be important for your healthcare provider to order BUN and creatinine levels to determine if the increased dose is safe.

Correct Answer is C

Explanation

A. That much ibuprofen should relieve your pain: This response is dismissive of the client's subjective experience of pain and fails to address safety. Pain threshold and intensity vary among individuals regardless of standard dosing. It lacks the necessary education regarding the maximum daily limits of the medication.

B. You probably should ask your healthcare provider if it is acceptable: While referring to a provider is necessary, this response is too passive and misses an immediate teaching opportunity. The nurse must identify the specific safety risk associated with the current dosage. It does not provide the rationale for the referral.

C. That amount is greater than the recommended daily amount. Discussing your increased pain with your healthcare provider is important: Doubling 400 mg every 4 hours results in 4800 mg daily, exceeding the 3200 mg maximum safe limit. This creates a high risk for gastrointestinal erosion and renal toxicity. The nurse must prioritize patient safety through education and provider consultation.

D. Ibuprofen is eliminated by the kidneys. It would be important for your healthcare provider to order BUN and creatinine levels to determine if the increased dose is safe: This focuses on diagnostic monitoring rather than the immediate danger of exceeding the maximum daily dose. While renal function is relevant, the priority is preventing toxicity by correcting the dosage. Staging the response around lab tests delays the necessary intervention.

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A hospice client has been prescribed an opioid for the past 6 months for pain control. The nurse contacts the healthcare provider because the dosage of the opioid no longer provides pain relief. What is the reason for this nontherapeutic response to the opioid?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client tells the nurse that the healthcare provider switched the pain medication used for arthritis from ibuprofen to celecoxib and questions the reason for this change. Which is the most likely reason for change in medication?

Correct Answer is C

Explanation

A client tells the nurse that the arthritis pain is not relieved by 400 mg of ibuprofen every 4 hours, so the client doubles the dose. What is the nurse's best response?

Correct Answer is C

Explanation

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