An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? Select all that apply

Renal insufficiency

Severe asthma

Sleep apnea

Severe head injury

Liver disease

Answer and Explanation

Correct Answer : B,C,D

Opioid analgesics are effective for moderate to severe pain but have significant central nervous system and respiratory depressant effects. Nurses must assess for conditions that increase the risk of respiratory compromise or intracranial pressure before administration.

Rationale for correct answers:

B. Severe asthma:
Opioids can depress respiratory drive and reduce the body’s response to hypoxia and hypercapnia. In patients with severe asthma, this can precipitate life-threatening respiratory compromise.

C. Sleep apnea:
Patients with sleep apnea already have intermittent airway obstruction during sleep. Opioids can worsen hypoventilation and apnea episodes, increasing the risk of severe hypoxia.

D. Severe head injury:
Opioids can increase intracranial pressure and mask changes in neurological status, making monitoring of head injury patients more difficult and potentially dangerous.

Rationale for incorrect answers:

A. Renal insufficiency:
Opioids can be used with caution in renal impairment, adjusting doses if necessary. They are not strictly contraindicated.

E. Liver disease:
Most opioids are metabolized by the liver, so caution and dose adjustment may be needed, but they are not absolute contraindications unless there is severe hepatic failure.

Take-home points:

Opioids can depress respiration, so avoid in severe asthma, sleep apnea, and head injury.
Dose adjustments may be necessary for renal or hepatic impairment, but these conditions are not absolute contraindications.
Always monitor for signs of respiratory depression and CNS changes in high-risk patients.

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Correct Answer is ["A","C","D"]

Explanation

Aspirin is a widely used NSAID and antiplatelet agent with important implications for bleeding risk, GI irritation, and safety in children. Patient teaching is essential to prevent complications, especially when aspirin is used long term or in higher doses.

Rationale for correct answers:
A. Advise the patient to avoid alcohol while taking aspirin: Both aspirin and alcohol irritate the gastric mucosa, greatly increasing the risk of GI bleeding and ulcers.
C. Instruct the patient to inform the dentist of the aspirin dosage before having dental work: Since aspirin inhibits platelet aggregation, it increases the risk of bleeding during dental procedures. The dentist must be aware to take necessary precautions.
D. Instruct the patient to inform the surgeon of the aspirin dosage before having surgery: Aspirin’s antiplatelet effect lasts the life of a platelet (7–10 days). Surgeons often recommend discontinuing aspirin before surgery to reduce the risk of excessive bleeding.

Rationale for incorrect answers:
B. Instruct the patient to take aspirin before meals on an empty stomach: This is incorrect. Aspirin should be taken with food, milk, or water to reduce gastric irritation.
E. Suggest that aspirin may be given to children for flu symptoms: Aspirin should not be given to children with viral illnesses (such as influenza or chickenpox) because it increases the risk of Reye’s syndrome, a rare but potentially fatal condition.

Take-home points:

Aspirin increases bleeding risk—patients must inform dentists and surgeons before procedures.
Avoid alcohol while taking aspirin to reduce GI bleeding risk.
Never give aspirin to children with viral illnesses due to the risk of Reye’s syndrome.

A. fentanyl B. naloxone C. butorphanol D. sufentanil

Correct Answer is B

Explanation

Hydromorphone is a potent opioid analgesic that, in overdose, can cause profound central nervous system and respiratory depression. In emergency situations, the priority is to restore adequate ventilation and prevent death. The specific antidote for opioid overdose is naloxone, an opioid receptor antagonist.

Rationale for correct answer:
B. Naloxone: Naloxone rapidly displaces opioids from the mu-opioid receptors in the CNS, reversing respiratory depression, sedation, and hypotension. It works within minutes when given IV, making it the drug of choice for opioid overdose emergencies.

Rationale for incorrect answers:
A. Fentanyl: Another opioid analgesic, fentanyl would worsen respiratory depression, not reverse it.
C. Butorphanol: This is a mixed agonist–antagonist opioid that can provide pain relief but will not reliably reverse life-threatening respiratory depression.
D. Sufentanil: An even stronger opioid analgesic than fentanyl, it would intensify opioid toxicity instead of reversing it.

Take-home points:

Naloxone is the antidote for all opioid overdoses, including hydromorphone.
It acts by blocking opioid receptors and rapidly restoring respiration.
Other opioids (fentanyl, sufentanil, butorphanol) do not reverse overdose and may worsen the condition.

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An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? Select all that apply

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Naxlex Comprehensive Predictor Exams

The nurse is teaching a patient about taking aspirin. Which are important points for the nurse to include? Select all that apply

Correct Answer is ["A","C","D"]

Explanation

A patient is admitted to the emergency department in respiratory depression following self-injection with hydromorphone. The admitting nurse knows that which drug will reverse respiratory depression caused by opioid overdose?

Correct Answer is B

Explanation

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