A patient who was in a motor vehicle accident sustained a severe head injury and is brought to the emergency department. The provider orders intravenous mannitol (Osmitrol). The nurse knows that this is given to:

Choice A reason: Opioid tolerance does not reduce constipation; it may persist or worsen. Tolerance primarily reduces pain relief, so this is incorrect for the effect.

Choice B reason: Respiratory depression risk may not increase with tolerance, as sensitivity to this effect also diminishes. Analgesia is most affected, so this is incorrect.

Choice C reason: Euphoria typically decreases with tolerance, not increases, as receptor sensitivity drops. Reduced analgesia is the primary effect, so this is incorrect.

Choice D reason: Opioid tolerance leads to decreased analgesic effect, requiring higher doses for pain relief. This is the hallmark of tolerance, making it the correct choice.

Choice A reason: Administering captopril risks angioedema, as the patient’s history of tongue and lip swelling with enalapril (another ACE inhibitor) suggests a class effect due to bradykinin accumulation. This is potentially life-threatening, requiring avoidance, not monitoring, making this choice unsafe and incorrect.

Choice B reason: Fosinopril, another ACE inhibitor, carries the same angioedema risk as captopril and enalapril due to similar bradykinin effects. Switching within the same drug class doesn’t address the patient’s history of adverse reactions, making this choice inappropriate and potentially dangerous.

Choice C reason: Holding captopril and notifying the provider is correct, as the patient’s history of angioedema with enalapril indicates a high risk with captopril, another ACE inhibitor. Alternative classes (e.g., ARBs) should be considered to avoid life-threatening reactions, making this the safest and correct action.

Choice D reason: Angioedema (tongue and lip swelling) is a serious, potentially fatal side effect of ACE inhibitors, not benign. Reassuring the patient minimizes the risk, which could delay intervention. The history warrants avoiding captopril and consulting the provider, making this choice incorrect and unsafe.