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Unfolding Case Study

c. Because this client is taking both aspirin and ibuprofen (which are both NSAIDs), and because she is taking ibuprofen on an as-needed basis, it is important to determine how much ibuprofen the client is taking.
d. This dose exceeds the 3200 mg maximum dose for ibuprofen and, based on the client’s report of black tarry stools, has already caused gastric bleeding.
c. Hydromorphone is a semisynthetic derivative of morphine that is used to treat moderate to severe pain.
a. The use of an opioid, such as hydromorphone, with alcohol can result in sedation and respiratory depression.

Review Questions

b. The client’s pain is considered chronic because it has been going on for more than 3 months.
c. Pain is a subjective rating, and the nurse should define pain as “whatever the client says it is.” Therefore, the nurse should administer the pain medication.
d. Eight tablets of 500 mg acetaminophen is 4000 mg, which is the amount of acetaminophen that should not be exceeded in a day.
c. Ibuprofen is the only option that is an anti-inflammatory drug.
b. The affected nerves were damaged by the varicella-zoster virus. Shingles pain, or postherpetic neuralgia, develops in up to 50% of individuals over the age of 65 who contract the disease.
b. Naloxone works as an opioid receptor antagonist and is the drug of choice to quickly reverse the effects of opioid intoxication, which is indicated here by the client’s unresponsiveness and shallow breathing.
d. This client most likely experienced a reaction to histamine caused by morphine. This adverse reaction is most often seen with morphine and codeine, which is converted into morphine.
b. Naltrexone is an opioid antagonist that can be used orally and intramuscularly to aid clients who are attempting to quit using opioids. While the client is taking naltrexone, any opioids taken will not be able to activate opioid receptors, blunting the effects of opioids and the feelings of euphoria.
b. Tolerance is a natural occurrence in clients receiving chronic opioid agonists. It frequently requires the dosage of the opioid agonist to be increased to achieve adequate pain management.
c. Severe shivering with chills (also known as rigors) may occur in clients who received anesthesia. The treatment of choice for this is meperidine. Because of the well-known toxicities of meperidine in older adults and those with poor renal function, it should almost never be used for pain.

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