Know your
opioids
opioids
This opioid is one of the most commonly recognized medications for moderate-to-severe pain.
Morphine.
Rationale: Morphine is a classic full opioid agonist used to treat moderate-to-severe pain.
Which common non-opioid analgesic is commonly used for mild-to-moderate pain and fever but can cause liver toxicity in excessive doses?
Acetaminophen (Tylenol).
Rationale: Acetaminophen is effective for pain and fever but excessive doses can cause severe hepatotoxicity.
A patient has a mild headache and no contraindications. Would you generally start with an opioid or a non-opioid analgesic?
Non-opioid.
Rationale: Opioids are generally reserved for moderate-to-severe pain when benefits outweigh risks.
Which medication class is most associated with life-threatening respiratory depression?
Opioids.
Rationale: Opioids suppress the central respiratory drive.
Before administering an opioid, what is one of the most important assessments?
Respiratory rate and level of consciousness.
Rationale: These help identify opioid-induced sedation and respiratory depression.
Which highly potent opioid is commonly used in the ED for severe acute pain and has a rapid onset when given IV?
Fentanyl.
Rationale: Fentanyl is much more potent than morphine and is commonly used when rapid, potent analgesia is needed.
Which class of non-opioid medications reduces pain and inflammation but can increase the risk of GI bleeding and kidney injury?
NSAIDs.
Rationale: NSAIDs inhibit prostaglandin synthesis and can cause GI, renal, and cardiovascular adverse effects.
A patient has severe pain after a major traumatic injury. Which medication class may be appropriate for rapid, potent pain relief?
Opioids.
Rationale: Severe acute pain may require opioid analgesia, often combined with other appropriate pain-control strategies.
Which non-opioid analgesic can cause serious liver injury when taken in excessive amounts?
Acetaminophen.
Rationale: Acetaminophen overdose can cause severe hepatotoxicity.
Before administering an NSAID, which history is especially important?
Kidney disease, GI bleeding/ulcer history, anticoagulant use, and NSAID allergies.
Rationale: These factors can increase the risk of serious NSAID-related complications.
This medication is a potent opioid commonly used for severe pain. Because of its potency, careful dose verification and respiratory monitoring are essential.
Hydromorphone (Dilaudid).
Rationale: Hydromorphone is a potent opioid and is associated with significant risk for respiratory depression.
Which NSAID is commonly used in the ED for acute pain and is known by the brand name Toradol?
Ketorolac.
Rationale: Ketorolac is a potent NSAID often used for short-term management of moderate-to-severe acute pain.
Why might an ED provider combine an opioid with acetaminophen or an NSAID?
Multimodal analgesia.
Rationale: Using medications with different mechanisms can improve pain control while potentially reducing the opioid dose required.
Which medication class can cause GI irritation, GI bleeding, and kidney injury?
NSAIDs.
Rationale: NSAIDs inhibit prostaglandins that normally help protect the GI tract and maintain renal blood flow.
A patient received morphine 20 minutes ago. What should the nurse reassess?
Pain, respiratory status, level of consciousness/sedation, blood pressure, and other relevant vital signs.
Rationale: Reassessment determines both effectiveness and safety.
Which opioid has a unique risk of both seizures and serotonin syndrome?
Tramadol.
Rationale: Tramadol has opioid activity and also affects serotonin and norepinephrine.
A patient with severe kidney disease presents with acute pain. Which medication class should the nurse question due to increased risk of kidney injury & why?
NSAIDs.
Rationale: NSAIDs can reduce renal blood flow and worsen kidney function, particularly in vulnerable patients.
A patient has acute musculoskeletal pain, normal kidney function, no GI bleeding history, and no contraindications to NSAIDs. Why might ketorolac be chosen instead of morphine?
Effective analgesia without the opioid-related risks of respiratory depression and sedation.
Rationale: NSAIDs can be useful for inflammatory or musculoskeletal pain and do not cause the same degree of opioid-induced respiratory depression.
A patient is prescribed ketorolac but has active GI bleeding. Should the nurse administer it?
No. Hold the medication and notify the provider.
Rationale: Ketorolac is an NSAID and can increase the risk of bleeding.
A patient reports taking "Tylenol all day" for pain. Before administering another acetaminophen-containing medication, what should the nurse determine?
The total amount of acetaminophen taken in the past 24 hours, including combination products.
Rationale: Excessive cumulative dosing increases the risk of liver toxicity.
A patient has severe respiratory depression after receiving an opioid. What medication should the nurse anticipate?
Naloxone (Narcan).
Rationale: Naloxone is an opioid antagonist that reverses opioid-induced respiratory depression.
A patient has a history of severe GI bleeding and presents with acute pain. Why would NSAIDs be inappropriate?
NSAIDs can impair gastric protection and platelet function, increasing the risk of GI bleeding.
A patient has severe pain, respiratory depression, and altered mental status. The provider has ordered both morphine and ketorolac. Which medication should the nurse question first and why?
Morphine should be questioned/held due to the patient's respiratory depression.
Rationale: The immediate concern is opioid-induced or worsened respiratory depression. Airway and breathing take priority.
A patient takes acetaminophen every 4 hours at home and is prescribed a hydrocodone/acetaminophen combination. What should the nurse be concerned about?
Unintentional excessive total acetaminophen intake and hepatotoxicity.
Rationale: Combination opioid products may contain acetaminophen. The patient must account for acetaminophen from all sources.
A patient arrives in the ED with 10/10 pain. The patient is hypotensive, has a respiratory rate of 6/min, and is difficult to arouse. What is the nurse's priority?
Address airway and breathing, hold the opioid, and initiate emergency interventions as indicated.
Rationale: ABCs come first. A pain score does not override life-threatening respiratory compromise.