ADN 2 Exam 1

The 35-year-old client has presented to the OB ward for her third delivery by cesarean section. The nurse who is caring for this client prepares for which type of anesthesia?

Spinal Explanation: Spinal anesthesia is a type of regional anesthesia that provides a loss of feeling and movement in the lower extremities, lower abdomen and perineum. In a cesarean section, the infant is delivered through an incision in the lower abdomen. Topical and local infiltration would not provide adequate pain relief. General anesthesia is not commonly used for a cesarean section because the infant would also receive effects from the anesthesia. It may be used if the cesarean must be performed in an emergency.

A primiparous woman who has been in the first stage of labor for 2 hours will receive an anesthetic. What would the perinatal nurse anticipate being the anesthetic of choice?

epidural anesthesia Explanation: Epidural anesthesia involves injecting the anesthetic into the epidural space. It is used most often in obstetrics during labor and birth. Topical, intravenously, and spinal anesthesia are unlikely choices for this client.

Naloxone will reverse the effects of which drugs? Select all that apply.

fentanyl codeine Explanation: Naloxone is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl and codeine. Lorazepam is a benzodiazepine, thus naloxone has no effect on it. Valproic acid is used in the treatment of seizures and is not an opioid. Warfarin is an anticoagulant used to prevent blood clots from forming.

What medical diagnosis is likely to be managed with the daily administration of a 5% to 20% topical benzocaine solution?

hemorrhoids Explanation: Application of the 5% to 20% topical solution of benzocaine relieves hemorrhoid pain. This solution is not indicated in the treatment of psoriasis, chronic pain, or stomatitis.

The nurse is providing discharge instructions to a client who is recovering from extensive dental work. The client states he is hungry and wants to eat. What is the nurse's best response?

"Do not eat or drink anything until the numbness has gone away." Explanation: The client should not eat or drink anything before feeling has returned to prevent injury to the oral tissues.

The nurse is instructing a client in the use of a Lido patch. What statement by the client indicates understanding of proper medication administration?

"I will remove the old patch, clean the skin, and then put on a new patch." Explanation: The client understands the use of the Lido patch when he states that he will first remove the old patch, cleanse the skin, and then put on a new patch at the site that has the most pain.

A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse?

"Tell me more about your pain." Explanation: Nurses must lessen the barriers to good pain management by showing sensitivity to the client and conducting a through assessment. The nurse needs to encourage the client to share information regarding pain so that an appropriate treatment plan can be designed. To do this open ended statements need to be made. Questions with yes/no responses are not as therapeutic. Nurses must demonstrate nonjudgmental attitudes with clients.

Naloxone 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How much naloxone will the client receive?

2 Explanation: The nurse is to administer 2 mg of naloxone. The pharmacy has supplied 1 mg/1 mL. Therefore, in order to administer 2 mg, the nurse must administer 2 mL.

A 36-year-old will receive Carbocaine for a dental procedure. The maximum dose of mepivacaine (Carbocaine, Polocaine) is 6 mg/kg. If this client weighs 60 kg, what is the maximum dose the client could receive?

360 Explanation: If the client weighs 60 kg and the maximum dose is 6 mg/kg, he or she can have 6 x 60 = 360 mg.

Procaine has been administered by injection to facilitate debridement at the site of a fungal infection on a patient's toe and toenail. The nurse should instruct the patient that sensation is likely to return in how much time?

60 minutes Explanation: Procaine has a duration of 1 hour.

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?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. Explanation: It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.

What does the body create using choline?

Acetylcholine Explanation: The nerves that produce acetylcholine use choline from the diet to produce the neurotransmitter.

Nicotinic receptors would be found in which location?

Adrenal medulla Explanation: Nicotinic receptors are found in the CNS, the adrenal medulla, the autonomic ganglia, and the neuromuscular junction. Muscarinic receptors are found in the sweat glands, bladder and GI tract.

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 Explanation: Family history is the most salient risk factor for malignant hyperthermia. This adverse effect is physiologically unrelated to childhood febrile seizures and does not result from cytochrome P450 dysfunction. Malignant hyperthermia is not a hypersensitivity response.

A client with asthma is prescribed albuterol to dilate the bronchioles. The nurse understands that this drug is likely acting on which receptors?

Beta-2 Explanation: Bronchodilation occurs with stimulation of beta-2 receptor sites. Vasoconstriction and increased peripheral vascular resistance occurs with alpha-1 receptor stimulation. Overstimulation of effector sites and moderate insulin release occurs with alpha-2 stimulation. Increased heart rate occurs with beta-1 receptor stimulation.

Which effect results from activation of beta2 receptors?

Bronchodilation Explanation: Activation of beta2 receptors results in bronchodilation.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

Coach the client to breathe. Explanation: Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. The nurse should make efforts to arouse the client and coach him or her to breathe. The nurse need not monitor the blood pH level of the client, continue administering the prescribed drug, or increase the drug dosage level to be administered when caring for a client with a lowered breathing pattern because these interventions will not help increase the client's breathing rate.

A patient develops malignant hyperthermia after receiving a NMJ blocker. Which would the nurse expect to be given?

Dantrolene Explanation: Dantrolene would be used to treat malignant hyperthermia. Succinylcholine is associated with the development of malignant hyperthermia and would not be given. Naloxone would be used to treat opioid overdose. Protamine sulfate is the antidote for heparin.

The nurse is assisting in the care of a client during surgery. The nurse will be prepared to administer which drug if the client develops malignant hyperthermia?

Dantrolene sodium Explanation: Clients who develop malignant hyperthermia will receive dantrolene sodium.

The nursing instructor is explaining the role of the parasympathetic nervous system in influencing body functions. Which change in a patient's body functions would be directly related to the stimulation of the parasympathetic nervous system?

Decreased heart rate Explanation: Specific body responses to parasympathetic stimulation include decreased heart rate, increased motility of the gastrointestinal tract, and pupil constriction.

Which of the following are consequences of repeated exposure of dopamine receptors to dopamine? Select all that apply.

Decreased number of receptors Decreased sensitivity to dopamine Explanation: Repeated stimulation of dopamine receptors decreases their numbers (downregulation) and their sensitivity to dopamine (desensitization).

A client's left adrenal medulla has been injured in a motor vehicle accident. What is a possible implication of this injury?

Disruptions in the levels of norepinephrine and epinephrine Explanation: The adrenal medulla produces epinephrine and norepinephrine, but not dopamine. Impaired adrenal medullary functions would be unlikely to affect action potentials or the function of the sodium potassium pump throughout the nervous system.

A patient with Parkinson's disease is being cared for on your unit. The nurse would be correct in identifying what neurotransmitter as being decreased in this disease?

Dopamine Explanation: Parkinson's disease develops from decreased availability of dopamine, while acetylcholine binding to muscle cells is impaired in myasthenia gravis.

Which statements are correct regarding the autonomic nervous system (ANS) receptors? Select all that apply.

Drug effects depend on the branch of the ANS involved. Medications can either stimulate or inhibit the ANS. Explanation: Because ANS receptors are widespread throughout the body, drug that acts on the ANS usually affects the entire body rather than certain organs and tissues. Drugs effects depend on which branch of the ANS is involved and whether it is stimulated or inhibited by drug therapy. Knowledge of the physiology of the ANS is required by the nurse if drug therapy is administered.

What is true regarding the difference between ester-type local anesthetics and amide-type local anesthetics?

Esters break down quickly; they have a lower risk of systemic toxicity than amides. Explanation: The important difference between amides and ester local anesthetics is that esters are metabolized or broken down quickly by plasma esterases in the bloodstream. This quick metabolism makes ester local anesthetics less likely to cause systemic toxicity than amides. Amides are broken down more slowly in the liver.

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?

Fentanyl Explanation: Fentanyl is available as a transdermal patch.

Naloxone (Narcan) will reverse the effects of which drug?

Fentanyl (Duragesic) Explanation: Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

The anesthesia care provider visits with the client prior to surgery. The choice of type of drugs to administer to the client during surgery are based on what factors? Select all that apply.

General physical condition of the client Area, organ, or system being operated on Anticipated length of the surgical procedure Explanation: The administration of general anesthesia requires the use of one or more drugs. The choice of anesthetic drug depends on many factors, including general physical condition of the client; area, organ, or system being operated on; and anticipated length of the surgical procedure. Personal preference does not come into play, nor does cost of the drugs. It is always what is best for the client.

What is the resulting physiologic effect when the parasympathetic nervous system is stimulated?

Increased GI motility Explanation: When the parasympathetic nervous system is stimulated, the result is increased GI motility, decreased GI secretions, decreased heart rate, and pupillary constriction, which all result from stimulation of the sympathetic nervous system.

The nurse is caring for a client who will undergo an emergency repair of an open fracture to the femur that occurred during a motor vehicle accident. Because of the client's elevated blood alcohol, the nurse expects that the client may experience what reaction to the use of isoflurane anesthesia?

Increased effect of isoflurane Explanation: Alcohol causes an increase in the effect of isoflurane so the client will need to be monitored closely for delayed emergence from anesthesia.

A nurse is caring for a 68-year-old woman who has just returned to her room after a gastroscopy. Prior to beginning the procedure, lidocaine was given to numb her throat. Which of the following is the priority nursing intervention?

Instruct the patient and family that she should not eat or drink for at least 1 hour. Explanation: The nurse must ensure that the patient does not eat or drink anything for at least 1 hour following administration of viscous lidocaine to the throat. Because of the numbing effects of viscous lidocaine, the patient will experience impaired swallowing and is at risk for aspiration. Viscous lidocaine should not affect the patient's blood pressure or heart rate. The nurse will need to provide assistance to the patient when she gets out of bed to ambulate, but this is due to the effects of the anesthesia, not the lidocaine.

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?

Level of consciousness and respiratory rate Explanation: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

The client has had a swimming accident and lacerated his foot on a broken bottle in the water approximately 3 cm. The nurse is prepared to assist the healthcare provider with what type of anesthesia?

Local Explanation: Local infiltration anesthesia is used for dental procedures, the suturing of small wounds, or making an incision into a small area (as for a biopsy). General anesthesia is used when the client needs to be in a sensation-free state. A topical anesthetic may be used for chronic pain relief or for preparation of the skin for an injection deeper into the tissues. A conduction block would be used if the entire extremity needed to be numb.

A patient admitted to a local health care facility for an operation needs to be given spinal anesthesia. Which of the following is the nurse most likely to observe when caring for this patient?

Loss of feeling in the lower abdomen Explanation: The nurse should monitor for a loss of feeling in the lower abdomen in the patient on administration of spinal anesthesia. Spinal anesthesia involves the injection of a local anesthetic drug into the sub-arachnoid space of the spinal cord. There is a loss of feeling (anesthesia) and movement in the lower extremities, lower abdomen, and perineum. Spinal anesthesia is not known to increase a patient's heart rate. Spinal anesthesia also does not cause hypotension or moderate muscle relaxation. Enflurane is a volatile liquid anesthetic that causes hypotension once it deepens. Halothane, which is a volatile liquid anesthetic, produces moderate muscle relaxation. Both halothane and enflurane are drugs used for general anesthesia.( Fransen 50)

The client is to have surgery and is receiving spinal anesthesia. The nurse explains that there will be a loss of feeling and movement in which parts of the body? Select all that apply.

Lower extremities Lower abdomen Perineum Explanation: Spinal anesthesia is a type of regional anesthesia, injected usually at the level of the second lumbar vertebra. There is a loss of feeling and movement in the lower extremities, lower abdomen, and perineum. At this level of injection there is no effect on the chest or upper extremities.

The students are studying for an exam in pharmacology. They know several local anesthetics have been covered along with other forms. Which medication can they anticipate as being local anesthetics on the exam? Select all that apply.

Marcaine xylocaine Novocain Explanation: The following are examples of local anesthetics: Novocain, xylocaine, and Marcaine. The others are examples of pre-anesthetics.

A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure?

Midazolam Explanation: Midazolam is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures. Ketamine carries a higher risk of adverse effects. Nitrous oxide is not used for this purpose, and could not be inhaled during a bronchoscopy. Bupivacaine only provides local anesthesia.

A student is spending a clinical day with a CRNA. The student asks the CRNS why NMJ blocking agents are so important. What would be the CRNA's best response?

NMJs do not cause total CNS depression and its many systemic effects Explanation: The neuromuscular junction (NMJ) blocking drugs are used to prevent the nerve stimulation at the muscle cell and cause paralysis of the muscle directly without total CNS depression and its many systemic effects.

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

Opiate naive Explanation: An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.

A nurse is reading an article about the fight or flight response that includes a discussion of a neurotransmitter. Which neurotransmitter most likely would be addressed?

Norepinephrine Explanation: Norepinephrine is a catecholamine involved in the fight or flight response. GABA is important in preventing over excitability or stimulation of nerve activity. Serotonin is an important neurotransmitter involved in arousal and sleep. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual.

Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?

Oxygen Explanation: Gas anesthetics such as nitrous oxide and cyclopropane must be combined with oxygen, and then administered by inhalation to the client to produce anesthesia. Nitrous oxide is not combined with water, nitrogen, or helium.

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

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 urinalysis may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

Postoperative clients need constant and careful monitoring of vitals, respiratory status and more. Where is this careful monitoring done?

Post-anesthesia care unit Explanation: After surgery the client is brought to the PACU where the nurse has many responsibilities that include checking the airway for patency, positioning the client, checking vital signs, assessing respiratory status, and giving oxygen as needed.

A priority assessment prior to a 70-year-old client being given succinylcholine as adjunct to general anesthesia for surgery is:

Renal and hepatic function Explanation: Renal or hepatic disease could interfere with the metabolism or excretion of this drug, which could lead to toxic effects. Complete blood count and glucose level, nutritional status, and activity level are all important to assess and would be vital to the client's recovery. However, interference with drug metabolism could cause serious, life-threatening complications for the client.

The post-anesthetic recovery unit nurse is caring for a client whose balanced anesthesia included midazolam. The nurse should prioritize assessments for what health problems?

Respiratory depression and CNS suppression Explanation: Respiratory depression and CNS suppression may occur during recovery from midazolam, making these areas priorities for post-operative assessment.(Fransen 51)

Which neuromuscular blocking agent would a nurse expect to have the shortest duration of action?

Succinylcholine Explanation: Of the agents, succinylcholine has the shortest duration of action, 4 to 6 minutes.

A nurse is monitoring a client closely for malignant hyperthermia because the client received which NMJ blocker?

Succinylcholine Explanation: Succinylcholine is associated with the development of malignant hyperthermia in susceptible clients. Pancuronium, vecuronium, and atracurium are not associated with the development of this condition.

A surgical client is receiving a neuromuscular junction (NMJ) blocker. The nurse knows that the client cannot move because the client's acetylcholine receptor sites have been stimulated and the drug is remaining in the receptor sites, preventing repolarization. What medication is this client receiving?

Succinylcholine Explanation: The action described is associated with depolarizing NMJ blockers, of which succinylcholine is the only example. The other drugs are nondepolarizing NMJ blockers, which act as antagonists to acetylcholine at the NMJ.

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?

Superficial somatic pain Explanation: Sunburn is an example of superficial somatic pain. Somatic pain is characterized as well localized and intermittent, or as constant, aching, gnawing, throbbing, burning, or cramping. Neuropathic pain can be described as shooting, burning, or stabbing and generally follows a radicular or radiating pattern. The bone and joint pain of arthritis and muscle strains after intense physical exertion are examples of deep somatic pain. Visceral pain results from stimulation within the deep tissues or organs and surrounding structural tissues.

A signal has reached the terminus of a client's nerve and is in the space where the nerve is closest to the effector cell in a muscle. At what location is this signal?

Synapse Explanation: The synapse refers to the junction between a nerve and an effector such as a gland, muscle, or other nerve. The neuron is the basic structural unit of the nervous system. Soma refers to the cell body of a neuron. A Schwann cell is a specialized insulating cell on nerve axons.

A 29-year-old female client in labor has just received epidural anesthesia. Before the procedure her blood pressure was 120/78 and her pulse was 60 bpm. Now her blood pressure is 100/60 and her pulse is 80 bpm. She reports a metallic taste in her mouth, hears a ringing in her ears, and appears confused. What is this client most likely experiencing?

Systemic toxicity from local anesthesia Explanation: CNS (central nervous system) symptoms (such as tinnitus and disorientation) are commonly present before hemodynamic changes are evidenced when a client has systemic toxicity. Systemic toxicity in this case is from a local anesthetic being injected into a blood vessel.

The nurse is assessing a client. What assessment finding is the clearest indicator of autonomic function?

The client's respiratory rate is 22 breaths per minute Explanation: The autonomic nervous system functions to regulate respirations. Voluntary motor function, hearing and sensation are not primarily within the ANS. (Fransen ch.46)

A 39-year-old client is about to undergo combined spinal/epidural anesthesia for lower abdominal surgery. Which area of the spine should the nurse prep with antiseptic for the procedure?

The lumbar portion of the spine Explanation: Spinal anesthesia for lower abdominal surgery is usually given in the lumbar portion of the spine at L3-L4. The posterior iliac spine is part of the pelvis.

The operating room nurse is taking a male patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104°F temperature in the operating room and nearly died 15 years ago. The nurse knows that the anesthetist is planning to use a volatile liquid as part of the anesthetic. What relevance is this information regarding the patient?

The patient may be at risk for developing malignant hyperthermia. Explanation: Malignant hyperthermia is an inherited muscle disorder chemically induced by anesthetic agents. Identifying patients at risk is imperative because the mortality rate is 50%. All of these drugs have the potential to trigger malignant hyperthermia and should be used with caution in any patient at high risk for developing it to avoid development of malignant hyperthermia. The patient's nervousness is not relevant, the grandmother's surgery is very relevant, and all patients are at risk for hypothermia.

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?

They should be given on a regular schedule, around the clock. Explanation: When opioids are required by clients with chronic pain, the main consideration is client comfort, not preventing drug addiction. Effective treatment requires that pain be relieved and prevented from recurring; titration of opioid dosage is usually the best approach. Analgesics should be given on a regular schedule, around the clock. Oral, rectal, and transdermal routes of administration are generally preferred over injections.(Fransen Ch49)

When the nurse administers ethyl chloride to a client, which type of anesthesia is being administered?

Topical Explanation: Topical anesthesia involves application of an anesthetic to the surface of the skin, open area, or mucous membranes. It can be sprayed or applied with a cotton swab. In some instances topical anesthetics can be administered by the nurse. It is not given local, regional or general.

A client has received procaine hydrochloride (Novocain) for a minor skin procedure. Three days later, the client returns to the clinic and has developed redness, swelling, and inflammation at the injection site. What is the priority action for the nurse to take?

Treat this as a delayed hypersensitivity reaction to procaine hydrochloride. Explanation: A delayed hypersensitivity reaction to procaine hydrochloride can occur as late as 72 hours after the initial injection. This is most likely an adverse effect of the injection and should be treated as such. There is no indication of maltreatment or falls in this instance.

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?

Within one to five minutes, an effect may be seen. Explanation: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

What client is most likely to require the least time in recovery from anesthesia?

a client who had oral surgery using nitrous oxide Explanation: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Propofol, sevoflurane, and the combinations that constitute balanced anesthesia would require much more extensive recovery.

Which client's nicotinic receptors are likely being stimulated the most?

a client who is anxious while waiting in the preoperative area. Explanation: Stimulation of nicotinic receptors causes skeletal muscle contractions, autonomic responses such as signs and symptoms of a stress reaction, and release of norepinephrine and epinephrine from the adrenal medulla. These receptors do not respond to levels of dopamine or serotonin. Increased bowel motility is more closely associated with stimulation of muscarinic receptors.

For which clients would the use of a neuromuscular junction (NMJ) blocker most likely be appropriate? Select all that apply.

a presurgical client who requires endotracheal intubation a client with major depression who will undergo electroconvulsive therapy a client with pneumonia who requires mechanical ventilation Explanation: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate a client, who will be paralyzed after administration but will remain alert unless another medication is given. Other, more conservative, forms of restraint would be used for a child who requires sutures.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

a return to normal respiratory rate, rhythm, and depth. Explanation: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

A client's muscle weakness has been found to result from a lack of neurotransmitter communication between nerves and muscles. What neurotransmitter is most likely deficient?

acetylcholine Explanation: Acetylcholine communicates between nerves and muscles. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. GABA inhibits nerve activity. Serotonin is important in arousal and sleep.

A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of

activation of the woman's delta and C nociceptors. Explanation: Nociceptic pain is caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury. The sensation of pain is not the result of potassium release, though this does occur in cases of tissue trauma. The release of GABA inhibits pain. Pain is not the result of injury to the afferent fibers themselves, though these fibers transmit pain signals.

The nurse has just completed administration of an oral local anesthetic mouthwash to a client. What undesired outcome is the nurse preventing by withholding food and fluids following administration?

aspiration Explanation: Clients should not drink fluids or eat after gargling with oral anesthetics due to the risk of aspiration. This intervention does not prevent gastritis, reflux, or dysphagia.

A client's nerves have been stimulated and the signal has reached the axon. How will communication continue?

by the release of a neurotransmitter Explanation: The transmission of information between two nerves or between a nerve and a gland or muscle is chemical , achieved by the release of a neurotransmitter. Communication is not electrical or physical, and communication does not necessarily cease at the axon.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine. Explanation: Typically, codeine or hydrocodone are used to relieve coughing.

The nurse is caring for a client who is known to have deficient levels of dopamine because of a dietary lack of tyrosine. The nurse should expect to assess for evidence of:

decreased adrenergic response. Explanation: Dopamine is a precursor to norepinephrine, which is one of the two major postganglionic neurotransmitters of the sympathetic nervous system. Consequently, low levels of dopamine could plausibly lead to a decreased adrenergic response. This would not affect the function of cholinergic neurons. Hypofunction, not hyperfunction, of the SNS would be likely.

The nurse administers a medication that stimulates the parasympathetic nervous system (PNS). What manifestations would indicate the medication is having the desired effect? Select all that apply.

hyperactive bowel sounds increased saliva production constricted pupils Explanation: PNS stimulation results in increased motility and secretions in the gastrointestinal (GI) tract to promote digestion and absorption of nutrients: decreased heart rate and contractility to conserve energy and provide rest for the heart; constriction of the bronchi, with increased secretions; relaxation of the GI and urinary bladder sphincters, allowing evacuation of waste products; pupillary constriction, which decreases the light entering the eye and decreases stimulation of the retina. While urinary sphincters relax, they do not lose control so incontinence would not be an expected manifestation.

An otherwise healthy surgical client has developed sharply increased muscle tone and rapid increase in heart rate and core body temperature. The operating room team should proceed with assessments and interventions that address what health problem?

malignant hyperthermia Explanation: Malignant hyperthermia is a potentially fatal hypermetabolic response after exposure to volatile inhalation anesthetics or the drug succinylcholine. The presentation of malignant hyperthermia may be highly variable, and the response time may be immediate or delayed. The signs include tachycardia, elevated temperature, body rigidity, mixed metabolic and respiratory acidosis, mottling and sweating, masseter spasm (rigid jaw), hyperkalemia, elevated creatine kinase, myoglobinuria, and renal failure. None of the other options present with these signs and symptoms nor are they related to surgical anesthetics.

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids Explanation: Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.

A 71-year-old patient with a history of depression will be receiving vecuronium to prevent trauma during electroconvulsive therapy. Prior to the procedure, the care team must assess the patient's:

renal and hepatic status. Explanation: Before the administration of vecuronium, it is important to evaluate the patient for a history of hypersensitivity to any NMJ blocker or for any renal or hepatic disease. This assessment supersedes the importance of blood glucose monitoring or goals for recovery. It is unnecessary to teach the patient about the pharmacodynamics of the drug.

The nurse is admitting a client to the postanesthesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments?

respirations and airway Explanation: Postanesthetic recovery requires frequent, comprehensive assessments including all of the listed parameters. Among the priority assessments, however, are the client's airway patency and respiratory status. This is because both are heavily influenced by anesthesia and have rapid, serious consequences if disrupted.

A client with a history that suggests a possible hypersensitivity to chloroprocaine requires administration of the drug. Following administration, what assessment should the nurse prioritize?

respiratory Explanation: Excessive doses of chloroprocaine can result in respiratory depression; respiratory assessment is consequently indicated. It is less important to assess the client's temperature, neurologic function, or musculoskeletal status. To determine therapeutic effects, it is necessary to assess for cutaneous sensation in the client's integumentary system.

After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?

respiratory depression Explanation: Opioid-naive clients are mostly at risk for respiratory depression after opioid administration. First time opioid users do not experience diarrhea, hypertension, or physical dependence.

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?

respiratory depression Explanation: The nurse should advise the client to avoid alcohol and any other CNS depressants while taking morphine. These combinations can cause serious respiratory depression and sedation. Over stimulation of back muscles, kidney pain and urinary retention are not know effects of this interaction.

A patient who has suffered a crushing injury to his thumb and two fingers in an accident at a factory is relieved to be administered a local anesthetic prior to treatment. The drugs that were administered decrease the permeability of the nerve cell membrane to:

sodium. Explanation: Local anesthetics decrease the permeability of the nerve cell membrane to ions, especially sodium.