Ch. 14, 48, 49, 50, 51
A patient has suffered a severe laceration to his thumb and index finger during a workplace accident, and local anesthetic is to be utilized to facilitate suturing. Which of the patient's following statements should prompt the nurse to provide further health education? A. "They told me that it will take a few hours before I can feel my hand again." B. "If I understand correctly, I won't be able to move my hand normally for a while after getting the anesthesia." C. "I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out." D. "I have to admit I'm relieved that they'll be freezing my hand before they stitch it up."
"I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out." Local anesthesia is differentiated from general anesthesia in that there is no loss of consciousness. "Freezing" is an accurate description. Normal motor control and sensation return after a period of time.
A patient has been treated for migraines on an ongoing basis and the care provider has just prescribed sumatriptan. Which of the following is the priority intervention for patient education? A. "You will likely experience a brief worsening of your migraine before this drug relieves the pain." B. "Make sure that you stop taking ergotamine before you get this prescription filled." C. "You might get dizzy and lightheaded after you take sumatriptan, but this is normal." D. "It's important that you never take Tylenol within 12 hours of sumatriptan."
"Make sure that you stop taking ergotamine before you get this prescription filled." It is important to ask the patient about recent administration ergot alkaloids. The ergot alkaloids should not be given within 24 hours of the administration of triptans. Signs of low blood pressure should be reported promptly, and there is no particular reason to avoid acetaminophen. Triptans do not make symptoms worse before they provide relief.
A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine. Which of the following interventions is most appropriate to teach the patient? A. "If you follow the instructions, that won't happen to you." B. "The pump will administer all of the doses, so you don't have to worry." C. "The device will give you a placebo when you press it often." D. "The device is preset, so you cannot receive more than you need."
"The device is preset, so you cannot receive more than you need."
A hospice patient has been ordered morphine (Roxanol) 5 mg sub-Q every 2 hours. Roxanol contains 10 mg/mL. How many milliliters will be administered? A. 1 mL B. 0.25 mL C. 2 mL D. 0.5 mL
0.5 ml
An older adult patient has sought care for the treatment of hemorrhoids, and the care provider has prescribed topical lidocaine. The nurse should teach the patient that full pain relief will normally be achieved how long after application of lidocaine? A. 20 to 60 minutes B. 5 to 10 minutes C. 15 to 30 minutes D. 90 minutes to 2 hours
20 to 60 minutes Following topical administration of lidocaine, the area becomes numb in 20 to 60 minutes.
A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient? A. 180 mg B. 650 mg C. 80 mg D. 325 mg
80 mg The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 80 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.
The nurse at a long-term care facility is assessing a new resident's current medication regimen, and the resident states that she often takes an OTC remedy when she experiences a migraine. She has brought the bottle with her, and the nurse notes it to be Anacin Advanced Headache Formula. The nurse should document that the patient takes which drugs? Select all that apply. A. Acetaminophen B. Aspirin C. Codeine D. Naproxen E. Caffeine
Acetaminophen, Aspirin, Caffeine Anacin Advanced Headache Formula and other similar OTC formulations include acetaminophen, aspirin, and caffeine.
Which of the following is the antidote for acetaminophen (Tylenol) poisoning? A. Acetylcysteine (Mucomyst) B. Allopurinol (Zyloprim) C. Diclofenac sodium (Voltaren) D. Ketorolac (Toradol)
Acetylcysteine (Mucomyst) A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.
A patient is suffering from bursitis in the right elbow. Which of the following orally administered medications is most likely to diminish inflammation and assist in relieving pain? A. Acetaminophen (Tylenol) B. Codeine C. Morphine sulfate D. Acetylsalicylic acid (aspirin)
Acetylsalicylic acid (aspirin) Aspirin is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders. Aspirin is administered orally. Acetaminophen (Tylenol) will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation.
A child has symptoms of influenza, including a fever. Which of the following medications should not be administered to the child because of the risk of Reye's syndrome? A. Acetaminophen (Tylenol) B. Ibuprofen (Motrin) C. Ascorbic Acid (vitamin C) D. Acetylsalicylic acid (aspirin)
Acetylsalicylic acid (aspirin) In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen (Tylenol) and ibuprofen (Motrin) are safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children but is not used to reduce fever or pain.
A 16-year-old has been brought to the emergency department by his football coach after twisting his ankle during a practice drill. Diagnostic testing reveals a fracture. This patient is experiencing what type of pain? A. Neuropathic pain B. Visceral pain C. Acute somatic pain D. Acute cutaneous pain
Acute somatic pain
Nonopioid analgesics may sometimes be added to a narcotic analgesic. What action will result? A. Interference B. Antagonism C. Increased excretion D. Additive effect
Additive effect
In which of the following patients should the nurse question the physician's order for IV morphine? A. A 17-year-old female, 1-day postoperative appendectomy B. A 45-year-old female, 1-day postoperative mastectomy C. An 88-year-old female with failure to thrive D. An 8-year-old male with a fractured femur
An 88-year-old female with failure to thrive
A patient is scheduled to undergo craniofacial surgery, a procedure that will necessitate the use of propofol. The operating use nurse should be aware that alternative medications will be absolutely necessary in order to produce what effect in the patient? A. Euphoria B. Hypnosis C. Analgesia D. Amnesia
Analgesia Propofol produces amnesia, euphoria, and hypnosis. It therefore blocks the perception of pain. It does not, however, provide analgesia.
A surgical patient's balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize? A. Monitoring the patient for signs of increased level of consciousness B. Protecting the patient's skin integrity C. Assessing and protecting the patient's airway D. Monitoring the patient's deep tendon reflexes
Assessing and protecting the patient's airway The maintenance of the patient's airway and respiratory function following the administration of neuromuscular blocking agents such as vecuronium is the most important nursing implication. The importance of airway protection supersedes that of DTR assessment, assessing LOC, and maintaining skin integrity, though each of these is a valid consideration.
A patient is taking ibuprofen (Motrin) for knee pain. The patient is admitted to the hospital with abdominal pain. Which of the following assessments should the nurse prioritize? A. Assessment for diarrhea B. Assessment of the patient's urine for hematuria C. Assessment for occult blood in the patient's stool D. Assessment for hemoptysis
Assessment for occult blood in the patient's stool Nonsteroidal anti-inflammatory agents that block COX-1 and COX-2 place the patient at risk for gastrointestinal bleed. Patients who have symptoms of abdominal pain and are taking NSAIDs should be assessed for signs and symptoms of gastrointestinal bleed. Assessing the patient for diarrhea is not related to ibuprofen (Motrin) administration. Assessing the patient for hematuria or hemoptysis is not a priority.
A patient has been administered lidocaine in anticipation of a bronchoscopy and lung biopsy. What change in status would the nurse recognize as a potential hypersensitivity to lidocaine? A. Hemoptysis B. Audible S3 C. Audible wheeze D. Pleural pain
Audible wheeze It is necessary to assess the respiratory status and lung sounds for signs of bronchospasm related to hypersensitivity after lidocaine administration. An audible wheeze is suggestive of bronchospasm. Pleural pain, audible S3, and hemoptysis are less likely to be a direct result of hypersensitivity.
An elderly patient has taken ibuprofen (Motrin) 800 mg two times per day for the past 3 years. Which of the following laboratory tests is the priority assessment? A. Renin and aldosterone levels B. Blood urea nitrogen and serum creatinine C. 24-hour urine for microalbumin D. Complete blood count
Blood urea nitrogen and serum creatinine Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The patient should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen. A complete blood count may not be necessary.
A patient suffers from pain in the elbow related to inflammation. What are the chemical mediators of inflammation? A. Bradykinin, histamine, and leukotrienes B. Insulin, thyroid hormone, and calcitonin C. Red blood cells, lymph, and serosa D. Phospholipids, arachidonic acid, and platelets
Bradykinin, histamine, and leukotrienes Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes. Insulin, thyroid hormone, and calcitonin are not chemical mediators of inflammation. Phospholipids, arachidonic acid, and platelets are not chemical mediators of inflammation. Red blood cells, lymph, and serosa are not chemical mediators of inflammation.
A patient is diagnosed with familial adenomatous polyposis. Which of the following nonsteroidal anti-inflammatory agents has the potential to reduce the number of polyps and decrease the risk of colon cancer? A. Celecoxib (Celebrex) B. Probenecid (Benemid) C. Nabumetone (Relafen) D. Ibuprofen (Motrin)
Celecoxib (Celebrex) Celecoxib (Celebrex), a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen (Motrin) and nabumetone (Relafen) are not recommended for use in preventing familial adenomatous polyposis. Probenecid (Benemid) is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.
A woman's prolonged epistaxis (nosebleed) following a basketball injury has created a need for anesthesia and vasoconstriction of the nasal mucous membranes. These therapeutic effects can best be achieved with what drug? A. Prilocaine B. Cocaine hydrochloride C. Procaine hydrochloride D. Bupivacaine
Cocaine hydrochloride Topical cocaine is an anesthetic administered to the ear, nose, or throat to produce adequate anesthesia and vasoconstriction of the mucous membranes. The other listed anesthetics are not typically used for this purpose.
A nurse is teaching a patient about her prescription for Tylenol #3 that she will take at home. This medication consists of acetaminophen and what other drug? A. Acetylsalicylic acid (aspirin) B. Tramadol (Ultram) C. Codeine D. Methadone (Dolophine)
Codeine
An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration? A. Decrease activity due to pain. B. Take aspirin with the medication. C. Consume a diet high in fiber. D. Elevate the lower extremities.
Consume a diet high in fiber. Hydrocodone is an opioid, which, in the gastrointestinal tract, slows motility. To prevent constipation, the patient should consume a diet high in fiber. A decrease in activity due to pain will increase constipation. Elevating the lower extremities will not increase or decrease pain. Hydrocodone should not be routinely combined with aspirin unless prescribed by the physician.
A hospital patient's medication administration record specifies the parenteral administration of lidocaine before a tissue biopsy to be performed later in the day. What action should the nurse take in response to this order? A. Administer a 500 mL bolus of normal saline to ensure adequate vascular volume. B. Obtain an order for epinephrine in order to potentiate the action of lidocaine. C. Assess the patient's need for an antihistamine to be on hold during administration of the lidocaine. D. Contact the prescriber because administration should be performed by a physician or nurse anesthetist.
Contact the prescriber because administration should be performed by a physician or nurse anesthetist. A physician or nurse anesthetist administers the injectable form of lidocaine. A fluid bolus, an antihistamine, and epinephrine are not necessarily indicated.
A patient has been administered an opioid. For which of the following effects should the patient be assessed? A. Decreased level of consciousness B. Edema C. Oliguria D. Tachycardia
Decreased level of consciousness
The anesthesiologist has specified that ketamine will be included in a surgical patient's balanced anesthesia. When in postanesthetic recovery, the nurse should assess for what adverse effect of this medication? A. Labile blood pressure B. Hyperventilation and respiratory alkalosis C. Increased intracranial pressure D. Delirium and agitation
Delirium and agitation Ketamine can produce emergence delirium, hallucinations, and unpleasant dreams. Symptoms of this effect may include confusion, agitation, and nystagmus. The drug preserves blood pressure and does not cause hyperventilation or increased ICP.
A woman who is in her second trimester of pregnancy has suffered burns to her forearm from a steaming kettle. What amide local anesthetic can the nurse safely administer by the topical route during pregnancy? A. Bupivacaine (Marcaine, Sensorcaine) B. Dibucaine (Nupercainal) C. Mepivacaine (Carbocaine, Polocaine) D. Lidocaine
Dibucaine (Nupercainal) Dibucaine (Nupercainal) is local anesthetic administered topically to the affected area to induce pain relief. It is not absorbed systemically; therefore, it is considered safe during pregnancy. The other amides are not approved for use during pregnancy.
A nurse is planning the care of a patient whose laceration requires the use of local anesthesia. The nurse recognizes that there is a risk to the patient who has local anesthesia due to what nursing diagnosis? A. Self-care deficit B. Disturbed sensory perception C. Autonomic dysreflexia D. Latex allergy response
Disturbed sensory perception The absence of sensory perception means that patients are at risk for injuring the anesthetized body part without their knowledge. Autonomic dysreflexia and latex allergy response are not plausible risks. The brief action of local anesthetics means that self-care deficit is rarely an issue.
A nurse is instructing a patient on the administration of an opioid medication. What medication effect will most likely develop? A. Lower extremity paresthesia B. Drowsiness C. Occipital headache D. Polyuria
Drowsiness
A 55-year-old woman will have a partial mastectomy performed as treatment for breast cancer. The anesthesiologist has informed the operating room nurse that opioids will be used to supplement anesthesia. What opioid is most likely to be utilized? A. Oxycodone B. Meperidine C. Codeine D. Fentanyl
Fentanyl A synthetic opioid that is about 100 times more potent than morphine sulfate, fentanyl can be used to supplement sedation, regional techniques, and general anesthesia. Codeine, meperidine, and oxycodone do not have intraoperative applications.
A middle-aged patient has not achieved adequate symptom relief of migraines with first-line therapies, and the clinician is considering the use of frovatriptan (Frova). The patient's concurrent use of what medication would contraindicate the safe use of frovatriptan? A. Albuterol (Ventolin) B. Metformin C. Fluoxetine (Prozac) D. Atorvastatin (Lipitor)
Fluoxetine (Prozac) Frovatriptan (Frova) interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Ventolin, metformin, and Lipitor do not present a risk for interactions.
A 30-year-old male patient has been ordered Demerol 75 mg IM every 4 hours after a fractured femur. What action should the nurse take? A. Call the physician for a smaller dose. B. Give the dose by mouth. C. Administer half the dose. D. Give the medication as ordered.
Give the medication as ordered.
A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)? A. Pancreatitis B. Pulmonary insufficiency C. Hepatotoxicity D. Nephrotoxicity
Hepatotoxicity In acute or chronic overdose of acetaminophen (Tylenol), the patient can develop hepatotoxicity. Nephrotoxicity is not an adverse effect associated with Tylenol overdose. Pulmonary insufficiency is not an adverse effect associated with Tylenol overdose. Pancreatitis is not an adverse effect associated with Tylenol overdose.
An adult patient who is currently undergoing rhinoplasty has developed the characteristic signs and symptoms of malignant hyperthermia. The operating room nurse should anticipate what intervention? A. IV administration of dantrolene sodium (Dantrium) B. Tracheal intubation C. Hemodialysis D. IV administration of naloxone (Narcan)
IV administration of dantrolene sodium (Dantrium) The treatment for malignant hyperthermia consists of intravenous dantrolene sodium (Dantrium), oxygenation and hyperventilation, hydration, and body cooling. The patient will already be intubated. Narcan and dialysis are not indicated.
Following the administration of pentazocine (Talwin) to a patient with moderate pain, the nurse should assess for what change in the patient's vital signs? A. Increased respiratory rate B. Decreased oxygen saturation C. Increased temperature D. Increased blood pressure
Increased blood pressure
The nurse is assessing a patient who was recently administered procaine for local anesthesia. Which of the following assessment findings would suggest the possibility of adverse effects? A. Increased heart rate B. Lethargy C. Decreased blood pressure D. Increased temperature
Increased heart rate Following administration of procaine, the nurse assesses the CNS for excitability and the cardiovascular status for tachycardia and hypertension, leading to cardiovascular collapse. Lethargy, hypotension, and fever are not typical adverse effects.
Mrs. Gonzaga is a 60-year-old woman who first began having headaches during the onset of menopause and who has subsequently been diagnosed with migraines. She tearfully explains to the nurse how her husband downplays her health condition and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning Mrs. Gonzaga's care? A. Spiritual distress related to migraine headaches B. Situational low self-esteem related to migraine headaches C. Ineffective role performance related to migraine headaches D. Ineffective health maintenance related to migraine headaches
Ineffective role performance related to migraine headaches
A patient is administered acetylsalicylic acid (aspirin) for fever and headache. What is the action of acetylsalicylic acid (aspirin)? A. Inhibiting the release of norepinephrine to increase blood pressure B. Inhibiting prostaglandin synthesis in the central and peripheral nervous system C. Providing selective action by inhibiting prostaglandin synthesis in the CNS D. Suppressing the function of the hypothalamus to decrease inflammation
Inhibiting prostaglandin synthesis in the central and peripheral nervous system Aspirin inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation.
A patient who lives with migraines has been prescribed naproxen. The nurse should recognize that this drug achieves a therapeutic effect through which of the following means? A. Slowing the reuptake of serotonin and acetylcholine in brain synapses B. Demyelinizing pain fibers in the CNS C. Inhibiting the synthesis of COX-1 and COX-2 D. Selectively antagonizing opioid receptors in the CNS
Inhibiting the synthesis of COX-1 and COX-2 Naproxen is a nonselective inhibitor of cyclooxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2 . It does not involve serotonin, acetylcholine, or opioid receptors.
A patient's chronic venous ulcer on the lower lateral surface of his leg requires incision and debridement (I & D). The nurse should anticipate that lidocaine will be administered by which of the following routes? A. Nebulized B. Injection C. Intravenous D. Topical
Injection Injectable lidocaine is used for infiltration of the skin or subcutaneous administration prior to minor surgical procedures, such as I & D. Nebulized administration of lidocaine is reserved for lung procedures. Topical administration would be insufficient, and IV administration is not warranted.
A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult patient's imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means? A. Intravenous administration of anesthetics B. Intramuscular injection of anesthetics and benzodiazepines C. Subcutaneous injection of a rapid-acting anesthetic D. Intravenous administration of opioid analgesics
Intravenous administration of anesthetics The administration of a general anesthetic can be divided into three phases. The first phase is induction, which is rendering the patient unconscious by using inhalation anesthetics, intravenous anesthetics, or both. Adult patients usually receive a rapid-acting intravenous anesthetic medication. IM medications, sub-Q medications, and opioids are not used.
A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of salicylate overdose? A. Intravenous meperidine (Demerol) B. Inhaled acetylcysteine (Mucomyst) C. Intravenous sodium bicarbonate D. Intravenous furosemide (Lasix
Intravenous sodium bicarbonate Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted in patients with salicylism.
A nurse in surgical daycare is completing a preoperative assessment of a woman who will undergo hip arthroplasty. The nurse has questioned the woman about her daily use of gabapentin (Neurontin), and the woman has stated that she takes this drug to treat her migraines. What role does this drug play in migraine treatment? A. It lengthens the aura that precedes a migraine. B. It reduces the intensity of menstrual migraines. C. It prevents migraines from occurring. D. It relieves acute migraine pain.
It prevents migraines from occurring. Studies have shown that gabapentin is effective in reducing the frequency of migraines. Gabapentin is not an abortive treatment.
Spinal anesthesia will be used to perform a patient's scheduled bunionectomy. What should the nurse teach the patient about the administration of this form of anesthesia? A. It will be injected at the level of C7 to T2. B. It will be injected into the cerebrospinal fluid. C. It will be injected between T8 and T9. D. It will cause a significant, but temporary, decrease in level of consciousness.
It will be injected into the cerebrospinal fluid. Spinal anesthesia involves injecting the anesthetic agent into the cerebrospinal fluid, usually in the lumbar spine. It does not cause a significant decrease in level of consciousness.
A patient is admitted to a neurological unit with a confirmed cerebrovascular bleed. Which of the following medications used to treat inflammation is contraindicated in this patient? A. Furosemide (Lasix) B. Ketorolac (Toradol) C. Hydrochlorothiazide with triamterene D. Digoxin (Lanoxin)
Ketorolac (Toradol) Ketorolac (Toradol) should not be administered to a patient with a suspected or confirmed cerebrovascular bleed. Furosemide (Lasix) is administered to reduce fluid volume and is not administered to treat inflammation. Hydrochlorothiazide with triamterene is administered to reduce fluid volume and is not administered to treat inflammation. Digoxin (Lanoxin) is administered to increase cardiac output, not to treat inflammation.
A middle-aged patient describes her headaches as "utterly debilitating" and tells the nurse, "It's hard to explain, but I just know when one is coming, and I'm never wrong." This patient's statement suggests that she has what diagnosis? A. Ischemic headaches B. Tension headaches C. Migraines D. Cluster headaches
Migraines The severity of her headaches coupled with the fact that she experiences a prodrome suggests that she experiences migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.
A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms? A. Naloxone (Narcan) B. Ampicillin C. Morphine sulfate D. Meclizine (Antivert)
Morphine sulfate
A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient? A. Nalbuphine (Nubain) B. Naloxone (Narcan) C. Butorphanol (Stadol) D. Capsaicin (Zostrix)
Naloxone (Narcan)
A patient is allergic to acetylsalicylic acid (aspirin). Which of the following medications is contraindicated due to cross-hypersensitivity reactions? A. Naproxen sodium (Naprosyn) B. Acetaminophen (Tylenol) C. Naloxone (Narcan) D. Morphine sulfate (MS Contin)
Naproxen sodium (Naprosyn) In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. Acetaminophen (Tylenol) does not have cross-sensitivity with acetylsalicylic acid (aspirin) because it is not an NSAID. Morphine sulfate (MS Contin) does not have a cross-sensitivity to aspirin because it is an opioid, not an NSAID. Naloxone (Narcan) is an opioid antagonist and does not have cross-sensitivity with aspirin.
A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication? A. Notify the physician for a reduced dosage. B. Assess the patient's pain tolerance. C. Assess the patient's respiratory status. D. Draw up half of the medication for administration.
Notify the physician for a reduced dosage. Morphine and meperidine form pharmacologically active metabolites. Thus, liver impairment can interfere with metabolism, and kidney impairment can interfere with excretion. Drug accumulation and increased adverse effects may occur if dosage is not reduced. The nurse cannot administer half of the medication without a physician's order. It is important to assess the patient's respiratory status before administration, but this action is not the primary intervention in this case. Narcotics prior to surgery are administered to increase pain tolerance during the surgical procedure, not during the preoperative phase.
A perinatal nurse is preparing a dose of IV indomethacin for administration to a neonate. What is the most plausible indication for this treatment? A. Patent ductus arteriosus B. Cardiomyopathy C. Patent foramen ovale D. Tetralogy of Fallot
Patent ductus arteriosus The FDA has approved IV indomethacin for treatment of patent ductus arteriosus in premature infants.
When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A2. What physiological effect results from this action? A. Pain is relieved. B. Core body temperature is reduced. C. Platelet aggregation is inhibited. D. Inflammation is relieved.
Platelet aggregation is inhibited. At low doses, aspirin blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet.
A patient who suffered a laceration while doing woodwork in his garage will have his wound treated under local anesthesia achieved using lidocaine and epinephrine. The nurse who will assist with the procedure should recognize that epinephrine performs what function in this situation? A. Promoting vasodilation B. Preventing adverse effects of lidocaine C. Prolonging the effects of lidocaine D. Blocking the afferent nerve pathways
Prolonging the effects of lidocaine Lidocaine has a rapid effect, and, when combined with epinephrine, this effect is prolonged. Epinephrine can promote vasoconstriction, not vasodilation, and it neither prevents adverse effects nor blocks afferent nerve pathways.
A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees and elbows with pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process? A. Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. B. Acetaminophen has an antiplatelet effect to decrease edema. C. Prostaglandin inhibition is limited to the central nervous system. D. Prostaglandins decrease the gastric acid secretion.
Prostaglandin inhibition is limited to the central nervous system. The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.
A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family? A. Remove the patch every 3 days. B. Apply it to the chest only. C. Apply it for breakthrough pain. D. Remove it daily and clean skin.
Remove the patch every 3 days.
A patient who suffers from cancer pain is receiving morphine every 2 hours. For which of the following should the family be taught to assess while the patient is on morphine? A. Urinary incontinence B. Diarrhea C. Respiratory depression D. Lung sounds
Respiratory depression
A patient enters the emergency room with complaints of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to which of the following? A. Caffeine overdose B. Salicylism C. Acute acetaminophen toxicity D. Ibuprofen overdose
Salicylism Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A. She has greater pain with inactivity. B. She has developed tolerance to morphine. C. She has developed a dependency on the morphine. D. She has metastatic cancer and is dying.
She has developed tolerance to morphine.
Resetting of a patient's fracture will take place under local anesthetic. These anesthetics reduce movement and sensation by decreasing the permeability of the nerve cell membrane to ions. What is the most important ion that participates in this process? A. Sodium B. Calcium C. Potassium D. Magnesium
Sodium Local anesthetics decrease the permeability of the nerve cell membrane to ions, especially sodium.
A patient with osteoarthritis has been prescribed meloxicam (Mobic). Which of the following instructions should the patient be given? A. Take the medication at bedtime. B. Crush enteric-coated tablets to aid swallowing. C. Take the medication with orange juice. D. Take the medication with food.
Take the medication with food. Meloxicam should be taken with food. Enteric-coated tablets are never crushed, and it is not always necessary to take this medication at bedtime. Orange juice is not of particular benefit.
A certified registered nurse anesthetist is describing the minimum alveolar concentration (MAC) of isoflurane. How will the addition of nitrous oxide or IV anesthetics affect the MAC of isoflurane? A. The MAC will remain the same. B. The MAC of isoflurane will not be relevant. C. The MAC will be more difficult to calculate. D. The MAC will decrease.
The MAC will decrease. With the addition of other medications such as opioids, intravenous anesthetics, or nitrous oxide, the MAC values decrease.
A patient has been diagnosed with migraines after experiencing headaches of increasing severity. When providing health education to this patient about her new diagnosis, what should the nurse convey? A. Migraines are typically the result of prolonged psychosocial stress. B. Migraines can be a precursor to transient ischemic attacks (TIAs) or stroke. C. The etiology of migraines is thought to have a genetic component. D. The pathophysiology of migraine headaches involves a disruption in the limbic system.
The etiology of migraines is thought to have a genetic component. Migraines demonstrate a familial pattern, and authorities believe that they are inherited as autosomal dominant traits with incomplete penetrance. Stress may precipitate a migraine, but this is not an aspect of the etiology. They are not a precursor to TIAs or stroke, and they do not involve disruption of the limbic system.
A patient experiences debilitating migraines on a frequent basis and has had oral prochlorperazine (Compazine) added as an adjuvant medication to abortive therapy. When teaching the patient to take this drug safely in the home setting, the nurse should emphasize what teaching point? A. The need to be aware of the potential for hypotension B. The need to avoid taking the drug after eating fatty food C. The importance of taking the pill whole and not crushing or splitting it D. The importance of having a bimonthly complete blood count (CBC) drawn
The importance of taking the pill whole and not crushing or splitting it When taking prochlorperazine orally, it is important to swallow it whole and not chew or crush the tablets. Blood work is not warranted, and there is no need to avoid fatty food prior to taking the drug. Compazine is not noted to cause hypotension.
A young woman who is 14 weeks pregnant has sought care because she has been experiencing migraine headaches with increasing severity and frequency in recent months. She states, "My headaches used to be something I could live with, but now they're affecting every other part of my life." The patient has conducted online research and requested a prescription for ergotamine. How will this patient's current health status affect the clinician's response to this request? A. The patient cannot safely take ergotamine until she has weaned her infant. B. The patient must wait until she has given birth before taking ergotamine. C. The patient must use a reduced dose of ergotamine until she has given birth. D. The patient can safely use ergotamine but must be monitored for blood dyscrasias.
The patient cannot safely take ergotamine until she has weaned her infant. Pregnancy and lactation are contraindications to the use of ergotamine.
A patient who is well-known to the clinic asked if it would safe for him to take Excedrin Extra Strength for the treatment of a severe headache. The nurse is well aware of this patient's medical history and should advise against using this medication based on what aspect of his current health status? A. The patient has a chronic venous ulcer on his lower leg. B. The patient is a smoker. C. The patient has a diagnosis of liver cirrhosis. D. The patient has not adhered to previous treatment regimens.
The patient has a diagnosis of liver cirrhosis. People with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.
A patient with hand trauma following a gunshot wound currently has bier block anesthesia with lidocaine. What assessment finding should signal the nurse to the possibility that the patient has local anesthetic systemic toxicity (LAST)? A. The patient states that he still has sensation in his hand. B. The patient's heart rate has become bradycardic and irregular. C. The patient has become intensely anxious and agitated. D. The patient has complained of nausea and had an episode of blood-tinged emesis.
The patient has become intensely anxious and agitated. Initial symptoms of LAST may include analgesia, circumoral numbness, metallic taste, tinnitus or auditory changes, and agitation. Nausea, dysrhythmias, and continued sensory nerve function do not suggest LAST.
The operating room nurse is reading the anesthesiologist's consult of a 30-year-old female patient who will undergo surgical repair of a meniscus tear later that day. The nurse reads that total intravenous anesthesia (TIVA) is indicated. What is the most likely rationale for this intervention? A. The patient's insurer does not reimburse for inhaled anesthesia. B. The patient has previously experienced severe postoperative nausea and vomiting. C. The patient is in the first trimester of pregnancy. D. The patient has a diagnosis of chronic obstructive pulmonary disease (COPD).
The patient has previously experienced severe postoperative nausea and vomiting. In patients who have history of severe postoperative nausea and vomiting, the anesthetist may substitute the inhalation anesthetic with a technique called total intravenous anesthesia (TIVA). TIVA is not necessarily indicated in patients who are pregnant or who have COPD. Insurance considerations would not normally be an absolute indication for the use of TIVA.
A nurse has administered a scheduled dose of naproxen to a hospital patient who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the patient is experiencing adverse effects of this drug treatment? A. The patient complains of itchy, dry skin. B. The patient's stool tests positive for occult blood. C. There is an increase in the patient's neutrophils but no increase in temperature. D. The patient has peripheral edema and there is a steady increase in the patient's weight.
The patient's stool tests positive for occult blood. GI bleeding is a significant adverse effect of naproxen. This drug does not typically cause leukocytosis, dry skin, or fluid imbalances.
A 39-year-old patient has been diagnosed with thyroid cancer and will have a thyroidectomy performed. During surgery in this nerve-rich and highly vascular region of the body, the patient may require vecuronium. What will be the primary purpose of this medication? A. To prevent intraoperative vomiting B. To ensure that the patient does not move during surgery C. To protect the patient's airway during surgery D. To induce hypnosis and amnesia
To ensure that the patient does not move during surgery Delicate repairs, such as neck surgery and neurosurgery, may require the use of neuromuscular agents to prevent movement and subsequent damage. Vecuronium is not used to prevent nausea and vomiting, to protect the patient's airway, or to induce hypnosis and amnesia.
A patient suffers from gouty arthritis. Why is probenecid (Benemid) administered? A. To diminish the temperature B. To increase protein metabolism C. To decrease the level of liver enzymes D. To increase urinary excretion of uric acid
To increase urinary excretion of uric acid Probenecid (Benemid) increases the urinary excretion of uric acid. Probenecid (Benemid) will not decrease the level of liver enzymes, diminish temperature, or increase protein metabolism.
What is the most effective way to evaluate the patient's pain response after administering an opioid analgesic? A. Observe the patient when he/she is not aware you are assessing him/her. B. Ask the family to determine the patient's response to the pain. C. Using a pain scale, ask the patient to describe the pain. D. Ask another nurse to assess the patient's response to the medication.
Using a pain scale, ask the patient to describe the pain.
Prior to her elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the patient. The nurse should perform this education in the understanding that general anesthesia is best understood as A. a state of reversible unconsciousness. B. stage N2 non-rapid eye movement sleep. C. stage N3 non-rapid eye movement sleep. D. a nonreversible, temporary state of unresponsiveness.
a state of reversible unconsciousness. General anesthesia is defined as a medication-induced reversible unconsciousness with loss of protective reflexes. There is the misconception that general anesthesia is a deep sleep.
Vecuronium will be administered to a surgical patient to facilitate intubation and achieve balanced anesthesia. This medication induces paralysis by A. binding with serotonin and inhibiting its neuromuscular effects. B. crossing the blood-brain barrier and agonizing cerebellar function. C. antagonizing acetylcholine receptors at neuromuscular junctions. D. potentiating the effects of acetylcholinesterase in synapses.
antagonizing acetylcholine receptors at neuromuscular junctions. Because vecuronium is structurally similar to ACh, it binds to the receptors on the muscle and prevents normal function of ACh, producing skeletal muscle paralysis. The drug does not influence the physiology of serotonin, the cerebellum, or acetylcholinesterase.
A nurse is teaching a patient how to take Imitrex in the home setting in order to maximize therapeutic benefit while reducing the risk of adverse effects. The nurse should teach the patient to take Imitrex A. before breakfast each day. B. as soon as the earliest symptoms of migraine are sensed. C. when the pain of a migraine becomes too much to bear. D. on days when migraines may be anticipated.
as soon as the earliest symptoms of migraine are sensed. It is important to administer sumatriptan at the onset of migraine symptoms. The drug is not taken on a daily, scheduled basis and is not used as a preventative treatment.
A patient undergoing chemotherapy for the treatment of lung cancer has developed stomatitis. Oral lidocaine viscous has consequently prescribed by the primary caregiver. To minimize the patient's chance of aspiration, the nurse should encourage the patient to A. avoid eating or drinking for 1 hour following the use of lidocaine viscous. B. remain in a high Fowler's position for 90 minutes following the use of lidocaine viscous. C. adopt a minced and pureed diet for the duration of treatment. D. take small bites of food and small sips of fluid after administration.
avoid eating or drinking for 1 hour following the use of lidocaine viscous. Patients should not drink fluids or eat after gargling with viscous lidocaine for at least 60 minutes due to risk of aspiration. Upright positioning will not mitigate this risk. A textured diet is unnecessary.
A nurse is conducting a medication reconciliation for a 79-year-old man who has just relocated to the long-term care facility. The nurse notes that the man has been taking colchicine (Colcrys) on a regular basis. This aspect of the man's medication regimen should signal the nurse to the possibility that he has a diagnosis of A. inflammatory bowel disease. B. bursitis or tendonitis. C. gout. D. osteoarthritis.
gout. Colchicine (Colcrys), the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medication. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis.
A patient with traumatic injuries describes his current pain as being "unbearable." The pathophysiology of pain begins with a signal from A. baroceptors. B. nociceptors. C. myelin sheaths. D. synapses.
nociceptors.
Spinal anesthesia using procaine has been ordered for a patient prior to revision of the patient's ankle hardware. This drug achieves anesthesia by A. agonizing opioid receptors in the CNS. B. preventing the influx of sodium into nerve cells. C. antagonizing nociceptors. D. increasing the action of anticholinesterase in nerve synapses.
preventing the influx of sodium into nerve cells. Procaine decreases the influx of sodium into the nerve cell and depresses depolarization to prevent conduction of the nerve impulse. It does not alter the function of nociceptors, opioid receptors, or anticholinesterase.
A young man has been diagnosed with migraines, and the nurse is teaching him about abortive therapy. The primary goal of this form of therapy will be to A. permanently correct the patient's brain physiology. B. relieve the symptoms of the patient's migraines. C. foster coping skills that will allow the patient to live with his migraines. D. ensure that the patient experiences fewer migraine headaches.
relieve the symptoms of the patient's migraines. Abortive therapy is the administration of medications to treat the symptoms of migraine headache. These medications do not provide a permanent correction of pathophysiological neurological function, and they are not preventative. Coping skills are not provided through medications.
A patient will undergo an endoscopy with conscious sedation using midazolam (Versed). The nurse who is participating in this procedure should monitor the patient closely for signs of A. hemorrhage. B. respiratory depression. C. rhabdomyolysis. D. increased intracranial pressure.
respiratory depression. Following administration of midazolam, continuous monitoring for respiratory depression is required, and if necessary, age-specific resuscitative measures should be implemented. Increased ICP, rhabdomyolysis, and hemorrhage are less likely than respiratory depression.
A 54-year-old woman is being admitted to the postsurgical unit following a transverse rectus abdominis myocutaneous (TRAM) flap. The patient's care plan specifies the use of preemptive analgesia. This approach to pain control will involve A. alternating administration of opioid antagonists with opioid agonists. B. simultaneous use of analgesics from different drug classes. C. frequent administration of high-dose opioids. D. patient-controlled analgesia.
simultaneous use of analgesics from different drug classes.
A woman in her 40s has been living with migraines for many years, and these have only just been identified as being linked to her menstrual cycles. Estradiol has been prescribed, which the nurse will administer A. intramuscularly. B. sublingually. C. intravenously. D. transcutaneously.
transcutaneously. Estradiol for the treatment of migraines is administered by the transcutaneous route.
