Patient Data

Which possible side effects of fluticasone should the nurse advise the client about? Select all that apply.

A. Reassure the client that the patch will begin to take effect within a few minutes: Transdermal nitroglycerin provides a slow, continuous release of medication and is not designed to treat acute chest pain. Relying on the patch alone could delay urgently needed relief for ischemic pain.

B. Withhold further doses of nitroglycerin until contacting the healthcare provider: Sublingual nitroglycerin is prescribed specifically for immediate relief of anginal pain. Waiting for provider instructions before addressing active chest pain would not follow standard angina protocols and could endanger the client.

C. Leave the patch in place and administer a PRN dose of sublingual nitroglycerin: In cases of acute chest pain, it is appropriate to maintain the transdermal patch for background therapy and give sublingual nitroglycerin for immediate relief. Sublingual forms act rapidly by dilating coronary arteries and improving blood flow to relieve ischemia.

D. Obtain another transdermal patch and position it on the client's left upper chest: Applying an additional transdermal patch is inappropriate and could result in overdose, severe hypotension and will not provide immediate relief. The onset of action for transdermal nitroglycerin is too slow to address acute chest pain. The focus should be on a rapid-acting form of nitroglycerin.

• Pure opioid agonist: Morphine is classified as a pure opioid agonist because it fully binds and activates opioid receptors, particularly mu receptors, producing maximum analgesic effects for moderate to severe pain management.
• Mixed opioid antagonist: Mixed opioid antagonists, like nalbuphine, both activate and block opioid receptors depending on the site. Morphine does not block opioid activity; it purely stimulates, making this choice incorrect.
• Non-opioid analgesic: Non-opioid analgesics, such as acetaminophen and NSAIDs, relieve mild to moderate pain without acting on opioid receptors. Morphine’s mechanism and use are specific to the opioid class.
• Partial opioid agonist: Partial agonists, such as buprenorphine, activate opioid receptors but produce a weaker response compared to pure agonists. Morphine elicits a full receptor response, differentiating it from partial agonists.
• Mu: Mu receptors are the primary opioid receptors activated by morphine, leading to effects such as analgesia, euphoria, respiratory depression, and decreased gastrointestinal motility.
• Beta: Beta receptors are adrenergic receptors involved in cardiovascular responses, not pain modulation. Morphine does not interact with beta receptors.
• Alpha: Alpha receptors are also part of the adrenergic system and regulate vascular tone and blood pressure. Morphine’s action is not through alpha receptor activation.
• Severe pain: Morphine is most commonly used to treat moderate to severe acute or chronic pain, especially postoperative pain, cancer pain, and trauma-related injuries requiring strong opioid therapy.
• Hypertension: Morphine is not indicated for treating hypertension. While it may indirectly lower blood pressure due to vasodilation and reduced sympathetic tone, it is not a therapeutic antihypertensive agent.
• Depression: Morphine is not used for managing depression. Although it can induce feelings of euphoria, its clinical use is strictly for pain relief, not mood disorders.