Pathology and Pharmacology - Final Exam Review Questions

A patient with MS is receiving interferon beta and is hospitalized with pneumonia. What laboratory test result is of greatest importance to report to the prescriber? 1. ALT 45 IU 2. HbgA1C 5.2% 3. RBC 4.9 mil/mL 4. WBC 3,000/mm2

4. WBC 3,000/mm2

A client is scheduled to begin therapy with carbamazepine. The nurse should assess the results of which tests before administering the first dose of this medication to the client? 1. liver function test 2. renal function test 3. pancreatic enzyme studies 4. complete blood cell count

4. complete blood cell count

A client with Parkinson's was prescribed carbidopa and levodopa a few months ago. How does the nurse evaluate if the medication is therapeutically effective in the client? 1. increased urinary output 2. increased diarrhea 3. increased shuffling 4. decreased tremors at rest

4. decreased tremors at rest

In coma

Unable to arouse, might or might not respond depending on severity

Interferon-beta

Given for MS as an immune modulator to reduce axonal injury.

Confused/disoriented

Impaired judgement/disoriented to time/place/person

1. Alzheimer 2. Seizure 3. Parkinson 4. Amyotrophic Lateral Sclerosis (ALS) 5. Myasthenia Gravis 6. Anxiety

a. Acetylcholine decrease/Glutamate increase b. GABA decrease c. Acetylcholine increase/Dopamine decrease d. Glutamate increase e. Acetylcholine decrease/Glutamate increase f. GABA decrease

What is the action of antiepileptic drugs? (Select all that apply.) a. They bind to sodium channels when they are in the inactive state b. They block the action of glutamate at NMDA receptors c. They impair influx of calcium in axon terminals to prevent transmitter release d. They inhibit the action of the neurotransmitter GABA

a. They bind to sodium channels when they are in the inactive state b. They block the action of glutamate at NMDA receptors c. They impair influx of calcium in axon terminals to prevent transmitter release

A patient who uses fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 and requests "something for pain that will work quickly." The nurse will document this as a. somatic pain b. referred pain c. neuropathic pain d. breakthrough pain

d. breakthrough pain

Which of the following reduces or delays nerve impulse transmission? a. low levels of inhibitory neurotransmitters b. high levels of excitatory neurotransmitters c. increased numbers of post-synaptic receptors d. low levels of excitatory neurotransmitters

d. low levels of excitatory neurotransmitters

Mr. R. experiences anaphylactic reaction to the contrast dye (he is allergic to shellfish) What medication needs to be administered?

epinephrine

Excitatory Neurotransmitters

increase activity - Dopamine

Inhibitory Neurotransmitters

inhibit effect, stop it, calming - serotonin - GABA - Dopamine

The nurse will collaborate with the interdisciplinary team on communication assist with a patient with expressive aphasasia. The team decided on which intervention to help with communication?

make sure all staff assist the patient with use of a picture board which is patient driven

Cholinesterase

prevent breakdown of acetylcholine, also given in Alzheimer's

Which of these is an unconscious body process? (Select all that apply.) 1. Sleeping 2. Eating 3. Breathing 4. Beating Heart 5. Peristalsis 6. Pupil Construction

3. Breathing 4. Beating Heart 5. Peristalsis 6. Pupil Construction

Mannitol

-reduced ICP -increased diuresis -increased osmotic pressure of glomerular filtration -reduced tubular reabsorption of water and solutes

Which injury to nerves has the best chance of healing? 1. A leg injury due to a 15 foot cement column falling on it 2. Nerves severed during surgery 3. An amputation of a toe 4. Nearly severed spinal cord from diving into a shallow pond

1. A leg injury due to a 15 foot cement column falling on it

Which drug would be administered to precipitate immediate opioid withdrawal? 1. Naloxone 2. Buprenorphine 3. Fentanyl 4. Tramadol

1. Naloxone

Low levels of serotonin may cause which of the following? 1. anxiety or depression 2. an inability to balance 3. excessive shaking 4. hyperactive behavior

1. anxiety or depression

The Glasgow Coma Scale assesses which of the following specifications related to neurological status with traumatic brain injuries. (Select all that apply.) 1. best motor responses 2. best verbal responses 3. best memory responses 4. best eye responses 5. best leg responses

1. best motor responses 2. best verbal responses 4. best eye responses

A client is scheduled to begin medication therapy with valproic acid. The nurse looks for the results of which laboratory tests before administering the first dose? 1. liver function tests 2. renal function tests 3. pulmonary function test 4. pancreatic enzyme studies

1. liver function tests

When caring for a patient who is receiving phenytoin (Dilantin), which assessment finding is a priority to report to the prescriber? 1. milliform-like rash 2. continuous back and forth movements of the eyes 3. excessive growth of gum tissue 4. inadequate consumption of foods rich in calcium and vitamin D

1. milliform-like rash

A client has a prescription for valproic acid. To maximize the client's safety, the nurse should plan to monitor for which potential complications of this medication? (Select all that apply.) 1. pancreatitis 2. hypotension 3. renal failure 4. hepatoxicity 5. cardiotoxicity

1. pancreatitis 4. hepatoxicity

Your patient is admitted to the ER after losing consciousness following a baseball hit to the head. What are some nursing interventions? (Select all that apply.) 1. Administer an opioid pain medication as prescribed 2. Check level of consciousness 3. Check blood pressure 4. Assess pain level 5. Keep the patient restrained

2. Check level of consciousness 3. Check blood pressure 4. Assess pain level

Which of the following contributes to increased ICP? (Select all that apply.) 1. Dehydration from being out in the sun 2. Encephalitis 3. Use of an opioid 4. Head trauma 5. Eye strain

2. Encephalitis 3. Use of an opioid 4. Head trauma

Which of the following is applicable to nociceptor pain? (Select all that apply.) 1. Is neuropathic pain 2. Has a known cause 3. Is a response to tissue damage 4. Can involve internal organs 5. Is only somatic

2. Has a known cause 3. Is a response to tissue damage 4. Can involve internal organs

The nurse is teaching a patient on toxicity while taking phenytoin sodium. The nurse determines the teaching is successful after the patient describes which of these should be reported to the health provider? (Select all that apply.) 1. hyperactivity 2. diplopia 3. bruising 4. slurred speech 5. hearing impairment

2. diplopia 4. slurred speech

A patient is receiving opiates for pain therapy following postoperative surgical inguinal hernia repair. Which nursing diagnosis has the highest priority for the patient receiving opiate therapy? 1. alteration in comfort 2. risk for impaired gas exchange 3. risk for injury 4. alteration in urinary elimination

2. risk for impaired gas exchange

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? (Select all that apply.) 1. diarrhea 2. tremors 3. drowsiness 4. hypotension 5. urinary frequency 6. increased respiratory rate

2. tremors 3. drowsiness 4. hypotension

Which finding would the nurse expect to recognize during the assessment of a person with chronic pain? The person is: 1. Experiencing tachycardia 2. Probably malingering (faking) 3. Often depressed 4. Hypertensive

3. Often depressed

A pt. experiencing tachycardia needs a medication that decreases HR and blocks which receptor? 1. The alpha 1 receptors by the sympathetic nervous system 2. The alpha 1 receptors by the parasympathetic nervous system 3. The beta 1 receptors by the sympathetic nervous system - "Beta Blockers" 4. The beta 1 receptors by the parasympathetic nervous system 5. The beta 2 receptors by the sympathetic nervous system

3. The beta 1 receptors by the sympathetic nervous system - "Beta Blockers"

A patient whose mother has Alzheimer disease was reading her mother's medical history and asked the nurse what the medical term "agnosia" means. Which is the best answer by the nurse? 1. agnosia is loss of memory caused by brain degeneration 2. agnosia is the loss of the ability to speak or comprehend language 3. agnosia is the inability to recognize previously familiar objects 4. agnosia is the inability to carry out a skilled movement

3. agnosia is the inability to recognize previously familiar objects

At what level of the spinal cord, if an injury occurred, would someone be able to chew food and talk without needing assistance? 1. C2 2. C3 3. C4 4. C5

4. C5

An asthmatic patient needing a bronchodilation will need a medication that stimulates which receptor? 1. The alpha 1 receptors by the sympathetic nervous system 2. The alpha 1 receptors by the parasympathetic nervous system 3. The beta 1 receptors by the sympathetic nervous system 4. The beta 1 receptors by the parasympathetic nervous system 5. The beta 2 receptors by the sympathetic nervous system

5. The beta 2 receptors by the sympathetic nervous system

Neostigmine

A cholinesterase inhibitor used to treat myasthenia gravis-prevent breakdown of acetylcholine

Which neuron is Afferent, and Which one is Efferent?

Afferent is the sensory then brain Efferent is the motor after the brain gets it

What is norepinephrine? What type of nervous system is it involved? Which neuroreceptors?

catecholamines, flight and fight response, nervous system, autonomic: sympathetic

Agonist

Ex: Hydromorphone - activate mu and kappa - pain relief - decreased respirations - potential for abuse

Antagonist

Ex: Naloxone - given for overdose - blocks opioid actions

Before administering buprenorphine, the RN asks a pt. if he has used opioids. Administering a mixed opioid agonist-antagonist to a pt. who is dependent on opioid agonists may cause which of the following reaction? A. Hypersensitivity reaction B. Constipation C. Urinary incontinency D. Withdrawal symptoms

D. Withdrawal symptoms

Obtunded/Stuporous

Difficult to arouse but responds to painful stimuli

The nurse is assessing a client with a brain stem injury. What is the priority intervention?

Draw blood for arterial blood gas analysis

Agonist-Antagonist

Ex: Butorphanol - bind to kappa - inhibit mu - not as much pain relief - no euphoria - can cause withdrawal in opioid dept. person

Identify 2 disorders that involve the imbalance of acetylcholine?

Myasthenia Gravis and Parkinson Disease

What class of medication is Morphine? How does it work? What are the common adverse effects the nurse will need to observe for? What will you monitor/assess for after administration? What can you give to reverse an overdose?

Opioid agonist, bind to mu and kappa, causes pain relief, Monitor vitals, respiratory depression, orthostatic hypotension, and sedation. Give Narcan for overdose.

Lethargic

Potentially oriented, easy to arouse but slow mental & motor activity

1.Epidural Hematoma due to embolus 2.Subdural Hematoma due to trauma 3.Intracerebral hemorrhage due to CVA 4.Bacterial Meningitis 5.Viral Encephalitis 6.Hydrocephalus 7.Cerebral edema due to infection or trauma

a. Tissue plasminogen activator (tPA) within 3 hours of symptoms b. Cognitive rest, ice c. Ensure bleeding has stopped and begin rehabilitation d. Antibiotic for bacterial infection e. Treat the headache and other symptoms f. Ventriculoperitoneal shunt g. Osmotic diuresis with mannitol

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based of the information that these strategies a. impact the cognitive and affective components of pain. b. increase the modulating effect of the efferent pathways. c. prevent transmission of nociceptive stimuli to the cortex. d. slow the release of transmitter chemicals in the dorsal horn.

a. impact the cognitive and affective components of pain.

Your patient has a spinal cord injury at T5. What are some characteristics of body function with this injury? (Select all that apply.) a. impaired bladder function b. difficulty breathing independently c. risk of autonomic dysreflexia d. hypotension and bradycardia e. difficulty chewing f. inability to regulate body temperature

a. impaired bladder function c. risk of autonomic dysreflexia d. hypotension and bradycardia f. inability to regulate body temperature

Mr. D. is complaining of crushing chest pain that radiates to his left shoulder... What type of pain is that?

acute, referred pain, and nociceptive (visceral)

When a patient is encouraged to use nonpharmacologic pain relief such as imagery, either singularly or as a complement to analgesic therapy, what is involved in this technique? a. picturing a rushing river or flood coming at you b. picturing yourself on the beach c. concentration on a contraction d. breathing rapidly

b. picturing yourself on the beach

Anticholinergic

block the action of acetylcholine

Your pt. asks you if transcutaneous electrical nerve stimulation (TENS) is a good pain relief technique. You would have answered her that this system of pain relief: a. depends on the insertion of electrically charged needles into the spinal cord b. is based on a modern form of hypnosis or "elective" pain relief therapy c. consists of low intensity "shocks" to block afferent fibers d. consists of cold-pack applications to try and block nerve transmission

c. consists of low intensity "shocks" to block afferent fibers

What substances are produced by the brain to naturally counteract pain? a. catecholamines b. dopamine c. endorphins d. corticosteroids

c. endorphins