PHARM 2 EXAM 4 COURSE POINT
Adrenergic drugs mimic the effects of stimulating what part of the nervous system? -parasympathetic -sympathetic -autonomic -central
sympathetic
Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy? -hypotension -dark black urine -excessive salivation -eczema
hypotension
Administration of which class of medications can decrease secretions of the upper respiratory tract? -Cholinergic antagonists -Opioids -Antianxiolytics -Antiemetics
Cholinergic antagonists
A male client diagnosed with bone cancer has an order for clonidine on his chart. The nurse is concerned that this may be a mistake and asks another nurse why clonidine would be ordered for this client. What would be an appropriate response from the second nurse? -"Clonidine decreases cancer cells within the bone so the provider ordered it for that reason." -"Clonidine is sometimes prescribed for severe pain in cancer clients like this client." -"Clonidine will not hurt him, so follow the order." -"Clonidine is given for hypotension, so this client must have a history of hypotension."
"Clonidine is sometimes prescribed for severe pain in cancer clients like this client."
A patient has been prescribed methocarbamol for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which statement by the patient indicates that the patient has an understanding of at least one of the significant side effects of methocarbamol? -"My urine could be discolored while I take this drug." -"I should have lots of energy while taking this drug." -"I will probably have diarrhea while taking this drug." -"This drug will help my tension headaches."
"My urine could be discolored while I take this drug."
Which assessment finding would indicate to the nurse that the administered isoproterenol is effective? -Decreased heart rate -Bronchoconstriction -Improved cardiac contractility -Uterine contraction
Improved cardiac contractility
The anatomy and physiology instructor is discussing adrenergic receptors with the nursing class. What adrenergic receptor would the instructor tell the students is found in the blood vessels, iris, and urinary bladder? -Alpha1 -Alpha2 -Beta1 -Beta2
-Alpha1
Benzocaine is a topical anesthetic that is short acting and has a quick onset. The duration is 30 to 60 minutes. How long is the onset of action of this medication? -1 minute -15 to 30 minutes -30 to 60 minutes -60 to 90 minutes
1 minute
Which patient is at the greatest risk for developing skin breakdown following a procedure that uses a neuromuscular junction (NMJ) blocking agent? -A 12-year-old boy with history of asthma -A 28-year-old woman with a recent sports injury -A 56-year-old woman with a history of breast cancer -A 73-year-old man with a history of hypertension
A 73-year-old man with a history of hypertension
A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone. Which explanation by the nurse is correct? -After surgery, a client may feel nauseated as a side effect of the anesthesia. -Abrupt reversal of opioid-induced respiratory depression may cause vomiting. -This is a precaution in case the client begins to choke when resuming a general diet. -Suction equipment should be placed in all client rooms as a standard of care postoperatively.
Abrupt reversal of opioid-induced respiratory depression may cause vomiting.
The nurse is caring for a 14 year-old client who has been prescribed metaxalone 800 mg PO t.i.d. by the provider. What is the nurse's best action? -Contact the provider to question the use of this medication in a pediatric client -Contact the provider to confirm that the prescribed dose is correct -Administer the medication and monitor the client's pain levels closely -Ensure that laboratory blood levels have been ordered pre- and post-administration
Administer the medication and monitor the client's pain levels closely
Which condition is treated with an adrenergic agonist? -Renal failure -Hypertension -Tachycardia -Anaphylaxis
Anaphylaxis
To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) Keep the lights in the client's room turned down. -Assist client from their bed to the toilet. -Assist client with rising from a lying position. -Assist client with hall-walking activities. -Advise the client to stay in bed all night.
Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.
A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? -Baclofen -Carisoprodol -Chlorzoxazone -Cyclobenzaprin
Baclofen
A client in distress has been given dobutamine, a medication intended to increase myocardial activity and heart rate. This medication likely stimulates what adrenergic receptor? -Beta-1 -Alpha-1 -Alpha-2 -Beta-2
Beta-1
A client receives a beta-specific agonist. What would lead the nurse to determine that the drug is effective? -Bronchodilation -Decreased heart rate -Tremor -Slowed cardiac conductivity
Bronchodilation
The nurse is aware that which medication will be used in the provision of local infiltrate anesthesia? -Diazepam -Bupivacaine -Glycopyrrolate -Secobarbital
Bupivacaine
Which statement accurately describes the pharmacodynamics of nondepolarizing neuromuscular junction (NMJ) blocking agents? -Compete with acetylcholine for receptor sites -Are excreted unchanged by the kidneys -Are lipophilic and cross the blood-brain barrier -Cause potassium to enter skeletal muscle cells
Compete with acetylcholine for receptor sites
Drugs that produce activity similar to the neurotransmitter norepinephrine are known as which of the following? -Sympathomimetics -Sympatholytics -Antiadrenergic drugs -Anticholinergic drugs
Sympathomimetics
Although naloxone is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist? -Increase in the client's pain rating -Decrease in the client's pain rating -No change in the client's pain rating -None of these options
Increase in the client's pain rating
Which would be assessed with parasympathetic nervous system stimulation? -Reduced secretions -Increased gastric motility -Pupillary dilation -Constriction of the rectal sphincter
Increased gastric motility
Which is an effect of epinephrine? -Peripheral vasodilation -Increased heart rate -Bronchoconstriction -Decreased blood pressure
Increased heart rate
A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer? -Botulinum toxin type B -Dantrolene -Baclofen -Methocarbamol
Dantrolene
A patient is having surgery to repair a ruptured Achilles tendon. The patient develops severe muscle contractions and hyperthermia. Which medications will be administered? -Dantrolene sodium -Baclofen -Carisoprodol -Cyclobenzaprine
Dantrolene sodium
Patients receiving chlorzoxazone should be cautioned that what will occur with administration? -Discoloration of urine -Liver toxicity -Hypotension -Hypertension
Discoloration of urine
The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client? -Do not walk or drive after taking the drug. -Discontinue the use of alcohol. -Learn to self-administer the drug. -Take a laxative when needed.
Discontinue the use of alcohol.
What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)? -Ensure the client has adequate respirations. -Position the client on his side to prevent aspiration of vomitus. -Administer pain medication. -Check the client's pulse and blood pressure.
Ensure the client has adequate respirations.
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan? -Falls prevention measures -Seizure precautions -Continuous pulse oximetry -Deep breathing and coughing exercises
Falls prevention measures
During recovery from general anesthesia, what would be a priority? -Monitoring temperature and reflexes -Providing comfort measures -Have emergency equipment readily available -Providing pain relief as ordered
Have emergency equipment readily available
The autonomic nervous system controls which body functions? (Select all that apply.) Heart rate Muscle movement Blood pressure Glandular secretions
Heart rate Blood pressure Glandular secretions GI activity
A client has had a stroke and computed tomography reveals infarcts in multiple brain regions. An infarct in which region is most likely to affect the function of the client's autonomic nervous system? -Hypothalamus -Parietal cortex -Amygdala -Ventricular system
Hypothalamus
A client comes to the health care provider's office. The client is to receive botulinum toxin. What, if assessed, would suggest to the nurse that the drug administration should be postponed? -Recent gastrointestinal upset -Infection at the intended site of administration -Reports of urinary frequency -Difficulty swallowing
Infection at the intended site of administration
Lidocaine will be administered to a 4-year-old boy with a lacerated knee. From first to last rank what happens when this local anesthetic is used. 1 Lidocaine diffuses into the nerve cells, decreasing the permeability to ions such as sodium. 2 The excitability of the nerve cell decreases and the pain signal cannot be stimulated. 3 Lidocaine diffuses out of the nerve cells and into the bloodstream. 4 Lidocaine is metabolized in the liver. 5 Lidocaine is excreted in the urine.
Lidocaine diffuses into the nerve cells, decreasing the permeability to ions such as sodium. The excitability of the nerve cell decreases and the pain signal cannot be stimulated. Lidocaine diffuses out of the nerve cells and into the bloodstream. Lidocaine is metabolized in the liver. Lidocaine is excreted in the urine.
A client comes to the emergency department. The client has a small wound that requires suturing. The nurse would anticipate which type of anesthesia? -Local infiltration anesthesia -General anesthesia -Conduction block anesthesia -Topical anesthesia
Local infiltration anesthesia
A client who has multiple sclerosis has experienced a fall and requires open reduction and internal fixation of a femoral fracture. The anesthesiologist has informed the perioperative nurse that the client will be given a neuromuscular junction (NMJ) blocker to facilitate anesthesia. What is the nurse's best action? -Monitor the client's status before, during, and after surgery as per usual protocol. -Question the anesthesiologist about the use of an NMJ blocker with this client. -Inform the surgeon of the anesthesiologist's statement and document in the client's health record. -Document this statement and inform the perioperative nurse manager.
Monitor the client's status before, during, and after surgery as per usual protocol.
The nurse is preparing a patient for an endoscopic procedure that will use a nondepolarizing neuromuscular junction (NMJ) blocking agent. Which condition in the patient's history will require a change in anesthetic medication? -Osteoarthritis -Hypothyroidism -Peptic ulcer disease -Myasthenia gravis
Myasthenia gravis
A client is admitted to the emergency department for an opioid overdose. What would the nurse expect to administer to this client? -Oxycodone -Naloxone -Normeperidine -Corticosteroids
Naloxone
Adrenergic nerves use tyrosine from the diet to make which neurotransmitters? -Serotonin -Acetylcholine -Dopamine -Norepinephrine
Norepinephrine
Monoamine oxidase (MAO) is an enzyme that breaks down which neurotransmitter? -Acetylcholine -Norepinephrine -Serotonin -Dopamine
Norepinephrine
A male client is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The health care provider advises the nurse to pay attention to the clinical management of the client's pain to allow proper agonist coverage during the change in drug dosage. Why is the client likely to suffer unnecessary pain and discomfort if proper management is not ensured? -Tolerance to the drug -Physical dependence on the drug -Addiction to the drug -Adverse effects of the drug
Physical dependence on the drug
The nurse is preparing a teaching plan for a patient who is to receive a nonselective beta blocker. The nurse would make sure to address safety measures as a priority for the patient receiving: Carteolol Nadolol Sotalol Propranolol
Propranolol
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential? -Lower blood pressure -Manage hypertension -Raise blood pressure -Manage hypotension
Raise blood pressure
Which assessment finding would support a client's report of migraine headaches? -Severe unilateral pulsating pain -Sharp steady eye pain -Dull band of pain around the head -Onset occurring during sleep
Severe unilateral pulsating pain
After teaching a group of students about beta-1 selective blockers, the instructor determines that the teaching was successful when the students identify what as a contraindication to using this group of drugs? -Sinus bradycardia -Thyroid disease -Diabetes -COPD
Sinus bradycardia
The operating room nurse has performed an assessment of a preoperative client and the client reports a family history of malignant hyperthermia. The nurse has confirmed with the anesthesiologist that this has been identified. The nurse should anticipate what consequence of this for the client's intraoperative care? -The anesthesiologist will exercise caution when giving the client neuromuscular junction blockers -The use of neuromuscular junction blockers is absolutely contraindicated -The client will likely recover most slowly than usual from the administration of neuromuscular junction blockers -The client will require higher-than-normal doses of neuromuscular junction blockers to achieve desired effects
The anesthesiologist will exercise caution when giving the client neuromuscular junction blockers
A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider? -The client's most recent laboratory results show an upward trend in AST and ALT levels -The client is reluctant to participate in physical therapy this morning, when she is normally highly motivated -The client tells the nurse, "I'm struggling to come to grips with the fact that I'm never going to recover." -The client has gained 1.5 lbs. over the past 48 hours
The client's most recent laboratory results show an upward trend in AST and ALT levels
A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the client on long-term naproxen therapy is experiencing adverse effects of this treatment? -There is an increase in the client's neutrophils but no increase in temperature. -The client's stool tests positive for occult blood. -The client complains of itchy, dry skin. -The client has peripheral edema, and there is a steady increase in the client's weight.
The client's stool tests positive for occult blood.
A famous magician is known for his outlandish feats, such as being underwater for 10 minutes while removing handcuffs. Some have postulated that he has control over his autonomic nervous system in ways that most people do not. What would be an example of an autonomic response he may have control over? -The rate of his heart beat -The rate of his speech -The rate of his income -The rate of oxygen diffusion within his cells
The rate of his heart beat
When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.) Therapeutic response is achieved and discomfort is reduced. -An adequate breathing pattern is maintained. -Client reports decreased bowel movements. -Client maintains adequate nutritional status. -Client reports decreased urinary output.
Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.
When teaching a client about the action of an opioid antagonist, what should the nurse include in the education? -A medication called an opioid antagonist is given to enhance the effect of the opioid. -An antagonist increases the rate of respirations to counter the effects of the opioid medication. -An opioid antagonist acts on the central nervous system to elevate the level of consciousness. -This medication competes with the opioid pain medication, binding to the cell receptors instead.
This medication competes with the opioid pain medication, binding to the cell receptors
Centrally acting skeletal muscle relaxants lyse or destroy the spasm. -True -False
True
A client with chronic obstructive pulmonary disease (COPD) is experiencing bronchoconstriction. When choosing interventions to address this problem, the nurse should aim to influence the client's autonomic nervous system by stimulating: -the parasympathetic response. -alpha-adrenergic receptors. -beta-adrenergic receptors. -acetylcholine release.
beta-adrenergic receptors.
A patient is receiving a beta-1 selective blocker after a myocardial infarction to prevent reinfarction. The nurse understands that the rationale for using the drug would be to: -improve contractility. -enhance excitability. -decrease cardiac workload. -decrease blood pressure.
decrease cardiac workload.
What medication belongs to the category of inhaled anesthetics? -propofol -etomidate -desflurane -atracurium
desflurane
A client is receiving botulinum toxin type A as treatment for frown lines. The nurse would instruct the client about: -abnormal hair growth. -acne. -photosensitivity. -drooping eyelids.
drooping eyelids.
A nurse should not administer an opioid antagonist to a client with which finding? -hypersensitivity to naloxone -uncontrolled type 2 diabetes -history of opioid abuse -history of alcohol abuse
hypersensitivity to naloxone
A client prescribed dantrolene therapy requires monitoring for what serious adverse effect? -anemia -hepatitis -hypotension -hypoglycemia
hypoglycemia
How do opioid analgesics relieve moderate-to-severe pain? -inhibiting the transmission of pain signals from the hypothalamus to the spinal cord -preventing the opioid from binding with a receptor site -inhibiting the transmission of pain signals from peripheral tissues to the brain -increasing the production of endorphins in the brain
inhibiting the transmission of pain signals from peripheral tissues to the brain
A nurse has just administered an IM injection of meperidine (Demerol) to an elderly client. The priority nursing action for the nurse would be which? -close the draperies. -make sure the side rails are up. -check the temperature of the room. -make sure the client is positioned comfortably.
make sure the side rails are up.
A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by: -skeletal muscle trauma and will improve in time. -nerve damage in the brain and spinal cord, and it is a permanent condition. -inflammation of the muscles; therefore, NSAIDs may be effective. -stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective.
nerve damage in the brain and spinal cord, and it is a permanent condition.
What beta-adrenergic antagonist is used for migraine prophylaxis? -propanolol -valproic acid -verapamil -topiramate
propanolol
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which? -sedation -respiratory depression -over stimulation of the back muscles -kidney pain -urinary retention
respiratory depression
Which of the following adrenergic receptors is responsible for increased heart rate and increased force of myocardial contraction? -β1 receptors -α1 receptors -α2 receptors -β2 receptors
β1 receptors
Which adrenergic receptor is responsible for vasodilation of peripheral vessels and bronchodilation? -β2 receptors -α2 receptors -β1 receptors -α1 receptors
β2 receptors
The nurse instructs a client to use benzocaine to soothe the itching and pain related to an insect bite. Benzocaine is considered to be what type of dermatologic agent? -Anesthetic -Pain relief -Soothing -Antiseptic
Anesthetic
A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response" -"This drug causes your urine to change color, so it's not likely blood that you're seeing." -"It's likely that your chlorzoxazone is reacting with one of your other medications." -"There's a risk of that with this particular medication, so you should come be assessed promptly." -"Please check in again if it doesn't clear up within the next 24 hours."
"This drug causes your urine to change color, so it's not likely blood that you're seeing."
The perioperative nurse is caring for a client who requires an umbilical hernia repair but who has a known family history of malignant hyperthermia. The client has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 121 lbs. The nurse reconstitutes a single-use vial as per the manufacture's instructions, yielding a solution with a concentration of 50 mg/mL. How many mL of the reconstituted dantrolene solution should the nurse add to the client's bag of intravenous fluid? - 2.75 mL - 2.5 mL - 6.05 mL - 6.87 mL
2.75 mL
A client with a family history of malignant hyperthermia is to have bowel resection surgery and has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 185 lbs. The nurse reconstitutes dantrolene to a concentration of 50 mg/mL and should add how many mL to the IV minibag? Provide your answer to one decimal place.
4.2
The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl? -A woman 85 years of age -A man 25 years of age -A man 50 years of age -A woman 35 years of age
A woman 85 years of age
The nurse is working in collaboration with a nurse anesthetist to assess a preoperative client. When addressing the client's risk for malignant hyperthermia as a result of neuromuscular junction blockers, what assessment should be prioritized? -Assessing for a family history of malignant hyperthermia -Assessing for a history of febrile seizures in childhood -Assessing for any history of cytochrome P450 dysfunction -Assessing the client's allergy status
Assessing for a family history of malignant hyperthermia
A 21-year-old man experienced massive trauma and blood loss during a motorcycle accident and has been started on a dopamine infusion upon his arrival at the hospital. In light of this drug treatment, what assessment should the care team prioritize? -Respiratory assessment -Arterial blood gases -Monitoring of intracranial pressure -Cardiac monitoring
Cardiac monitoring
A patient is experiencing toxicity and prolonged paralysis after using a nondepolarizing neuromuscular junction (NMJ) blocking agent. Which type of medication will be used to reverse this condition? -Calcium-channel blocker -Cholinesterase inhibitor -Halogenated hydrocarbon anesthetic -Loop diuretic
Cholinesterase inhibitor
Which nursing focus is the highest priority for the nurse caring for a patient receiving a neuromuscular junction (NMJ) blocking agent? -Altered comfort: pain -Deficient knowledge -Impaired gas exchange -Impaired skin integrity
Impaired gas exchange
A surgical nurse is documenting the different stages of anesthesia on a patient's chart. Which stage will the nurse describe in documentation just before the surgeon makes the incision? -Stage I -Stage II -Stage III -Stage IV
Stage III
The nurse assessed a client at 0800 and obtained a blood pressure of 111/70 mmHg. Two hours later, the client's blood pressure is 130/81 mmHg. The nurse should attribute this change to what action within the autonomic nervous system? -Stimulation of beta-receptors -Antagonism of alpha-receptors -Decreasing levels of acetylcholinesterase -Stimulation of nicotinic receptors
Stimulation of beta-receptors
A nurse is caring for a client who required an opioid antagonist. Which should the nurse confirm to ensure that administration of the opioid antagonist is not contraindicated in the client? -The client is not lactating. -The client does not have high blood pressure. -The client is not hypersensitive to the opioid antagonist. -The client does not have a cardiovascular disease.
The client is not hypersensitive to the opioid antagonist.
The nurse should question the health care provider's IV morphine prescription for which client? -an 88-year-old female with failure to thrive -a 45-year-old female, 1-day postoperative mastectomy -an 8-year-old male with a compound fractured femur -a 17-year-old female, 1-day postoperative appendectomy
an 88-year-old female with failure to thrive
A 30-year-old client experiences migraines that appear closely linked to her menstrual cycle. What pharmacologic treatment is most specific to this client's particular experience of migraines? -estradiol -ergotamine -almotriptan -chlorpromazine
estradiol
The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnoea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist? -Assess the client's other vital signs. -Call for a respiratory therapy consult. -Reassess the client's level of pain. -Reposition the client for comfort.
Assess the client's other vital signs.
