exam

the nurse is teaching a client who will require long term corticosteroid therapy how to reduce the risk of infection. what suggestions will the nurse include? avoid large crowds of people in confined spaces avoid working in areas with other people avoid exercising to reduce risk of injury avoid touching other people who may carry germs

"Avoid large crowds of people in confined spaces."

a postsurgical patient has been provided with a morphine patient controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted how can the nurse best respond to this patient concers?

"It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction." Addiction to opioids is a rare occurrence among hospital clients who do not have a history of drug abuse. It would be inappropriate to downplay the client's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction.

a female client experiences weight gain secondary to the systemic steroid therapy arteitis. she calls the health care provider's office to ask if she can discontinue this medicaion for 1 week to fit into her dress for her class reunion. which response is appropriate

"Your prescription must be tapered gradually with the physician's order."

while learning about corticosteroids in pharmacology class, a student asks the instuctor what a clinical indication for the the use of corticosteroids be the instructors's best response any hormone excessive state anysystemic disease state a disease with an inflammatory component a disease without an immunological compnent

A disease with an inflammatory component

a woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe aspirin diflunisal acetaminophen ibuprofen

Acetaminophen

your patient takes aspirin for chronic arthritis pain. the patient currently hospitalized for treatment of a deep vein thrombosis and is prescribed warfarin. which of the following interventions should be done with this patient? select all that applies monitor daily PT/INR monitor urine output monitor respiratory rate monitor daily CBC

MONITOR daily PT/INR

a nurse is caring for a patient who is severe pain and is receiving an opioid analgesic. which of the following would be the nurse's priority assessment? respiratory rate, seizure activity, and blood pressure pain intensity, paresthesia, and level of consiciousness liver function studies, pain intensity, and blood glucose level respiratory rate, pain intensity, and mental status

Pain intensity, respiratory rate, and level of consciousness Explanation :The nurse must assess the patient's pain intensity before and after administering an opioid analgesic. The respiratory rate and level of consciousness need to be assessed because respiratory depression and sedation are two adverse effects of opioid analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

a 70 year old woman who is on long term ibuprofen therapy for osteoarthritis has returned to the clinical for her regular 6 month visti. in the last she has been having increasing periods of abdominal pain. the nurse suspects that this pain may be related to anemia peptic ulcer disease or gastritis interstitial nephritis consipation

Peptic ulcer or gastritis

the nurse is caring for an 84 year old client with diabetes who is receiving hydrocortisone (a glucocorticoid) 40mg daily PO for treatment of an arthritic flare-up. when writing a plan of care for this client, which nursing intervention would be most appropriate

Take daily blood glucose levels .Caution should be used in patients with diabetes because the glucose-elevating effects disrupt glucose control. The use of hydrocortisone would not indicate increasing sodium, restricting protein, or increasing fluid in the diet.

a client receiving morphine sulfate 5mg every 4 hours for cancer pain for the past several days now states that the pain is not being relieved as well as past what is the reason for this development? patient has developed toxicity natural response to metastatic cancer greater pain asociated with inactivity a tolerance to morphine

a tolerance to morphine

a home care nurse is visting an 88 year old man, who is taking acetaminophen for arthritic pain in his knees. which of the following patient teaching statements is most appropriate to implement?

acetaminophen will only relieve pain but not the inflammation from arthritis

a nurse is caring for a patient who is on morphine therapy. an expected outcome of the morphine therapy would be that the patient has adequate pain control with minimal adverse effects complete pain relief with minimal adverse effects complete pain relief with adverse effects that can be treated adequate pain relief with no addiction to the drug

adequate pain control with minimal adverse effects. Explanation: The most realistic indication of the effectiveness of morphine therapy is when the patient has adequate pain control with minimal adverse effects. Complete pain relief is not a realistic goal. While it is important to ensure that the patient does not become addicted to the drug as a result of the therapy, this is rare occurrence and ensuring minimal adverse effects is the priority

a patient is brought to the emergency room after having attempted suicide by swallowing half a bottle of acetaminophen. the nurse would expect to administer bronchodilator immediately administer acetylcysteine which is been ordered by MD administer Narcan immediately send the patient for an abdominal CT scan immdiately

administer acetylcysteine which is been ordered by MD

corticosteroid therapy is the most effective anti-inflammatory treatment for asthma. the nurse administering oral corticosteroids will teach effects of long term therapy hyperglycemia immune suppression osteoporosis all the above

all the above

which statements about the pain is true pain is a multidmensional, subjective experience pain is best controlled when analgesics are given before pain becomes severe the PNS and CNS comprise an integrated system that provides a pathway for pain transmission all the above

all the above

while providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as

an attempt by the body to remove the damaging agent and repair the damaged tissue

your patient has given morphine 2mg IV. she now has an increase in her BP and pulse and states that she feels very anxious. you suspect an idiosyncratic reaction an agonistic effect an antagonistic effect showing signs of withdrawal

an idiosyncratic reaction

your patient asks why he is getting aspirin every morning when he does not have any fever or pain. your explanation for receiving th easprin every day is: aspirin a day is good for him since he may experience pain at some point aspirin is used as a prophylaxis agaginst blood clots that may lead to MI his doctor has prescribed this medication which means it is good for him aspirin helps him to breath better since it causes antihistamine effect

aspirin is used as a prophylaxis agaginst blood clots that may lead to MI

a trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. this patient of analgesic administration should prompt the nurse to carefully

bowel patterns

your patient has nasal polyps and asthma. he is prescribed asprin therapy. you will be concerned that he will have which of the following conditions ototoxicity congestive heart failure hypertension bronchospasm

bronchospasm

the mother of a boy who has juse been diagosed with asthma is receiving medication teaching about the prednisone that the child will be taking for the next 2 weeks. which statement by the mother indicates the need for further instruction?

d) "I am so glad that this medication will cure his asthma." Explanation:The mother will need further instruction if she believes that a corticosteroid will cure the asthma. This class of drugs is intended to control symptoms, not cure illness.

an older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease. which action should the nurse perform to reduce the client's risk for developing oral candidiasis administe prophylacic antifungal medications. have the resident rinse his or her mouth after each dose of the drug. encourage the resident not to deeply inhale the medication. have the client gargle with normal saline prior to administering the drug.

have the resident rinse his or her mouth after each dose of the drug.

the parent of a 4 year old taking inhaled corticosteroids, states she has not been routinely administering the medication because of concered about the children not growing properly. what is the nurse' s best response?

inhaled steroids will not affect the growth of your child

a nurse is caring for a 6 year old child who is being treated for flu with a influenza and experiencing a fever of 102.6. the nurse understand that he will not receive aspirin because

it can cause Reye's syndrome

which of following statement about methadone is true? it does not produce poisonous metabolities therefore, no celling or max dose it does not cause addition or dependence more effective than other opiates all the obove

it does not produce poisonous metabolities therefore, no celling or max dose methadone is highly lipiphilic, up to 90% is protein bound, mostly metabolized by the liver and then released into circulation to maintain a steady state

which of the following statement about pentazocine (Talwin) is correct? select all that applies it stimulates at some receptors but blocks at others it has less abuse potential it is a narcotic agonist it is a narcotic antagonist

it has less abuse potential it is a narcotic agonist it is a narcotic antagonist

which of the following statement is true about fentany it is a synthetic opioid used for managing breakthrough pain such as cancer pain less potent than morphine no risk for overdose none of the above

it is a synthetic opioid used for managing breakthrough pain such as cancer pain

the physician is discharging a patient with liver failure with methadone for pain management. the nurse understands that methadone is a preferred choice because it is the safest since it has no effect on liver and renal failure patients no sure, since it is expensive no fear of addiction it works the same as morphine or any other opiates but inexpensive

it works the same as morphine or any other opiates but inexpensive

corticosteroid therapy is never used during infection because: select all that applies its potential to mask infections exacerbate the infectious process corticosteroids are routinely uesed during infection they cause rye syndrome

its potential to mask infections exacerbate the infectious process

codeine is used cautiously in patients with respiratory disorders because it may cause bronchoconstriction cause bronchodilation increase respiratory secretions lead to accumulation of secretions and cause atelectasis

lead to accumulation of secretions and a loss of respiratory reserve

a patient with mild low back pain has been advised to take acetaminophen. the nurse will inform him that excessive intake of acetaminophen may result in : gastrointestinal distress pulmonary edema cognitive deficits liver damage

liver damage.

patient teaching for long term use of corticosteroids include stop the medication immediately if your blood sugar increase inject deep into the muscle mass to avoid muscle atrophy low dose of drug on alternate days make sure that you take it at night

low dose of drug on alternate days

a client is admitted to the emergency department for an opioid overdose. what would the nurse expect to administer to this client

naloxone

morphine administration is contraindicated in which of the following conditions head injury hepatic insuffciency renal impairment nausea and vomiting

nausea and vomiting

Nociceptive pain somatic or visceral pain caused by activation of the delta and C receptors. COX-1 this enzyme synthesizes prostaglandins involved in platelet aggregation, protection of GI, and normal renal fuctions.

neuropathic pain abnormal processing of pain stimuli in the peripheral or central nervous system COX-2 this enzyme produces prostaglandings whose actions are involeved in inflammation

a nurse is caring for a 49 year old woman in the intensive care unit. the patient was in a motor vehicle accident and is in severe pain. she is being given MORPHINE for days in the unit., the nurse suspects that the patient is developing a cold. the nurse will monitor for which of the following renal impairment myocardial infaction hypersensitivity to the drug pneumonia

pneumonia

the nurse is caring for a 49 year old woman in the ICU. the patient was in a Motor vehicle accident and is in severe pain. she is being given morphine every two hours. she is resisting moving around due to pain. after two days, she is complaining of having difficulty breathing and is coughing. you suspect that she may be develop complication for renal impairment myocardial infarction hypersensitivity to the drug pneumonia

pneumonia

in which of the patient would aspirin be contraindicated hypertension migraine headaches preexisiting Gout chronic constipation

preexisiting Gout

the students nurse asks her pharm faculty to help her understand what Gold standard of morphine means. which of th response by faculty accurately explain what the Gold standard means? the efficacy of other opioid is compared to the efficacy of the drug morphine that is is the opiate which produces the maximum result since it does not produce any side effects. it is the best medication to use to treat cancer pain it is so expansive that it is compared to the gold price

the efficacy of other opioid is compared to the efficacy of the drug morphine

an older adult woman has been experiencing significant joint pain and has informed her primary care provider that she has begun taking aspirin 2 to 3 times each day. what aspect of this patient's medical history may contraindicate the use of aspirin?

the patient has a history of peptic ulcer disease

an 80 year old man has been prescirbed oxycodone for severe, noncancerous, chronic pain. he tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. the nurese will advise the patient that the tablet would have no effect if crushed and ingested there is risk of an extremely high dose available all at once if the tablet is crushed crushing the tablet increases the drug efficacy crushing the tablet is a safe option

there is risk of an extremely high dose available all at once if the tablet is crushed. Explanation: The nurse should caution the client against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner.

the patient on aspirin therapy is notified that a toxic reaction to the medicaiton that should be reported is blurred vision muscle cramps tinnitus joint pain

tinnitus

you understand that the patient may be experiencing salicylism when you see which of the following symtoms tinnitus, headache, and sweating respiratory stimulation, consipation, and GI distress GI distress, diarrhea, and respiratory depression headache, hypervigilance, and confusion

tinnitus, headache, and sweating Salicylism can occur with high levels of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur.

patient receiving ibuprofen on a regular basis should be told to contact the physician or the nurse practioner immediately if they note slow heartbeat unusual brusing upset stomach dizziness

unusual bruising.

a nurse is taking a history for a patient who reports that he is taking aspirin about four times daily for a sprained wrist. which of the prescribed medication that the patient is contraindicated with aspirin? digoxin metfomin warfarin nitroglycerin

warfarin CORRECT: The effect of warfarin and other anticoagulants is increased by aspirin, which inhibitsplatelet aggregation. This client would have an increased risk for bleeding. Use of aspirin generallyis contraindicated for clients who take warfarin

a hospital patient who is being treated for a urinary tract infection has developed a fever. the nurse has responded by administering a dose of acetaminophen. in what way does acetaminophen contribute to a reduction in fever? acetaminophen inhibits the thermoregulatory function of the hypothalamus acetaminophen inhibits cox-1 and cox-2 enzymes acetaminophen inhibits prostaglandin synthesis in the CNS acetaminophne causes the lysis of fever prodecing cells

• Acetaminophen inhibits prostaglandin synthesis. Explanation: The antipyretic activity of acetaminophen results from inhibiting prostaglandin synthesis in the CNS. It does not cause cell lysis, change the function of the hypothalamus, or modulate the function of interferons.