The nurse and the client have established this goal: The client ...

[misspop]

The nurse and the client have established this goal: The client will verbalize safety considerations for use of tramadol (Ultram) before being dismissed from the hospital.
 
  Which client statements would support evaluation that this goal has been achieved?
  Standard Text: Select all that apply.
  1. I will not drive until I know how I am going to react to the tramadol.
  2. I will limit my alcohol intake to a couple of glasses of wine with dinner.
  3. I will avoid taking my regular dose of kava while I am on this drug.
  4. I will not eat aged cheese while taking tramadol.
  5. I will work with my health care provider to taper off the dose of this medication when it is no longer needed.

Question 2

A client who is allergic to morphine has been receiving meperidine (Demerol) 75100 mg IM every 6 hours for the last 3 days. Five hours after the last dose, the client calls the nursing desk and says, I need some pain medication.
 
  I am hurting so badly that I am shaking. What should the nurse do?
  Standard Text: Select all that apply.
  1. Administer the 100 mg dose.
  2. Administer the 75 mg dose.
  3. Administer 50 mg of meperidine.
  4. Collaborate with the client's health care provider regarding the medication and schedule.
  5. Ask the client when the shaking first began.

[nickk12214]

Answer to Question 1

Correct Answer: 1,3,5
Rationale 1: Symptoms such as confusion and visual impairment can occur with tramadol use.
Rationale 2: Ethanol combined with tramadol may result in death.
Rationale 3: Caution should be observed when using herbs such as kava that may have an additive CNS depressant effect.
Rationale 4: There is no contraindication to eating aged cheese with tramadol.
Rationale 5: If tramadol is abruptly discontinued, symptoms of opioid withdrawal may occur.
Global Rationale: Symptoms such as confusion and visual impairment can occur with tramadol use. Caution should be observed when using herbs such as kava that may have an additive CNS depressant effect. If tramadol is abruptly discontinued, symptoms of opioid withdrawal may occur. Ethanol combined with tramadol may result in death. There is no contraindication to eating aged cheese with tramadol.

Answer to Question 2

Correct Answer: 4,5
Rationale 1: The client's condition does not indicate need for 100 mg of the medication.
Rationale 2: The client's condition does not indicate need for 75 mg of the medication.
Rationale 3: There is no order for a 50 mg dose and the client's condition does not indicate the need for additional meperidine.
Rationale 4: Meperidine can become toxic at doses greater than 400600 mg per day or if given over 48 hours. One of the symptoms of toxicity is tremors and seizures. The nurse should discuss the symptoms with the health care provider, who should change the medication.
Rationale 5: Before contacting the health care provider, the nurse should complete additional assessment regarding the shaking and the pain.
Global Rationale: Meperidine can become toxic at doses greater than 400600 mg per day or if given over 48 hours. One of the symptoms of toxicity is tremors and seizures. The nurse should discuss the symptoms with the health care provider, who should change the medication. Before contacting the health care provider, the nurse should complete additional assessment regarding the shaking and the pain. The client's condition does not indicate need for 100 mg of the medication. The client's condition does not indicate need for 75 mg of the medication. There is no order for a 50 mg dose and the client's condition does not indicate the need for additional meperidine.

[misspop]

TYSM

[pratush dev]

Excellent