Chapter 37. Oxygenation, Chapter 25- Treas Medicating Patients, Chapter 1. Nursing Past & Present, Chapter 42. Community & Home Nursing, Chapter39 Fluid and Electrolyte Imbalances, Chapter 18 documenting and reporting, Chapter 29- Treas Bowel Elimina...
A patient with terminal cancer requires increasing doses of an opioid pain medication to obtain relief from pain. This patient is exhibiting signs of drug: 1) Abuse 2) Misuse 3) Tolerance 4) Dependence
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First-pass effect:
oral medications are formulated with a higher concentration of the drug because they are absorbed from the GI tract and circulate through the liver before they reach the systemic effects
Restorative Effects-
taking vitamins
medications that cause developmental defects in pregnancy:
teratogenic
duration of action:
that period of time in which the med has a pharmacological effect (before it is metabolized and excreted)
Therapeutic level-
the concentration of a drug in the blood serum that produces the desired effect without toxicty
What does the chemical structure of a drug determine?
the drug's tendency to bind to plasma proteins depends mostly on its chemical structure
What should the equivalency be?
the rate of absorption should equal the rate of elimination
The onset action is:
the time needed for drug concentration to reach a high enough blood level for its effects to appear. this will be the minimum effective concentration
A patient develops urticaria and pruritus 5 days after beginning phenytoin for treatment of seizures. Which type of reaction is the patient most likely experiencing? 1) Mild adverse reaction 2) Dose-related adverse reaction 3) Toxic reaction 4) Anaphylactic reaction
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A surgeon prescribes potassium chloride 20 mEq by mouth for a patient with a nasogastric (NG) tube for gastric drainage. How should the nurse proceed? 1) Seek clarification from the surgeon about the medication order. 2) Clamp the NG tube while administering the dose by mouth. 3) Instill the medication through the NG tube. 4) Withhold the oral potassium chloride elixir.
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After receiving diphenhydramine, a patient complains that his mouth is very dry. This is not uncommon for patients taking this medication. Which drug effect is this patient experiencing? 1) Side effect 2) Adverse reaction 3) Toxic reaction 4) Supportive effect
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An adult patient admitted with lower gastrointestinal bleeding is prescribed a unit of packed red blood cells. Which gauge needle should be inserted to administer this blood product? 1) 18 gauge 2) 22 gauge 3) 24 gauge 4) 26 gauge
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How should the nurse dispose of a contaminated needle after administering an injection? 1) Place the needle in a specially marked, puncture-proof container. 2) Recap the needle, and carefully place it in the trash can. 3) Recap the needle, and place it in a puncture-proof container. 4) Place the needle in a biohazard bag with other contaminated supplies
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Laboratory test results indicate that warfarin anticoagulant therapy is suddenly ineffective in a patient who has been taking the drug for an extended time. The nurse suspects an interaction with herbal medications. What type of interaction does she suspect? 1) Antagonistic drug interaction 2) Synergistic drug interaction 3) Idiosyncratic reaction 4) Drug incompatibility
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Teratogenic drugs should be avoided in which patient population? 1) Pregnant women 2) Elderly 3) Children 4) Adolescents
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The nurse must administer eardrops to an infant. How should she proceed? 1) Pull the pinna down and back before instilling the drops. 2) Pull the pinna upward and outward before instilling the drops. 3) Instill the drops directly; no special positioning is necessary. 4) Position the patient supine with the head of the bed elevated 30°
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When the nurse enters a patient's room to administer a medication, he calls out from the bathroom telling her to leave his medication on the bedside table. He reassures her that he will take the medication as soon as he is finished. How should the nurse proceed? 1) Inform the patient that she will return when he is finished in the bathroom. 2) Wait outside the bathroom door until the patient is ready for the dose. 3) Withhold the dose until the next administration time later in the day. 4) Document that the dose was omitted in the medication administration record
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Which documentation entry related to PRN medication administration is complete? 1) 6/5/14 0900 morphine 4 mg IV given in right antecubetal fossa for pain rated 8 on a 1-10 scale, J. Williams RN 2) 0600 famotidine 20 mg IV given in right hand, S. Abraham RN 3) 9/2/14 0900 levothyroxine 50 mcg PO given 4) 1/16/14 furosemide 40 mg PO given, J. Smith RN
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Which term refers to the movement of a drug from the site of administration to the bloodstream? 1) Absorption 2) Distribution 3) Metabolism 4) Excretion
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A patient calls the nurse because he is having incision pain and wants a dose of analgesic medication. When the nurse checks the patient's medication administration record, she notes that he is prescribed the narcotic, hydromorphone (Dilaudid). Where should the nurse expect to retrieve this drug for administration? 1) Cabinet in the patient's room 2) Double-locked medication drawer 3) Stock supply cabinet 4) Portable medication cart
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A patient who just returned from the postanesthesia care unit is complaining of severe incision pain. Which drug contained in his medication administration record will offer him the fastest relief? 1) Liquid acetaminophen with codeine 2) Intravenous morphine sulfate 3) Intramuscular meperidine 4) Oral oxycodone tablets
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The nurse must administer hepatitis B immunoglobulin 0.5 mL intramuscularly to a 3-day-old infant born to an HB Ag-positive mother. Which injection site should the nurse choose to administer this injection? 1) Ventrogluteal 2) Vastus lateralis 3) Deltoid 4) Dorsogluteal
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The primary care provider orders peak and trough levels for a patient who is receiving intravenous vancomycin every 12 hours. When should the nurse obtain a blood specimen to measure the trough? 1) With the morning routine laboratory studies 2) Approximately 30 minutes before the next dose 3) Two hours after the next dose infuses 4) While the drug infuses
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The primary care provider prescribes nitroglycerin 1/150 g SL for a patient experiencing chest pain. How should the nurse administer the drug? 1) Place the drug in the cheek and allow it to dissolve. 2) Place the drug under the tongue and allow it to dissolve. 3) Inject the drug superficially into the subcutaneous tissue. 4) Give the pill and water to the patient for him to swallow the tablet.
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Which expected outcome is best for a patient with a nursing diagnosis of Deficient Knowledge related to new drug treatment regimen? 1) After an explanation and written materials, describes the expected actions and adverse reactions of his medication 2) In 1 week after instructional session, describes the expected actions and adverse reactions of his medications 3) Follows the treatment plan as prescribed 4) Experiences no adverse effect from his prescribed treatment plan
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Which factor in a patient's medical history is most likely to prolong the half-life of certain drugs? 1) Heart disease 2) Liver disease 3) Rheumatoid arthritis 4) Tobacco use
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A patient has difficulty taking liquid medications from a cup. How should the nurse administer the medications? 1) Request that the prescriber change the order to the IV route. 2) Administer the medication by the IM route. 3) Use a needleless syringe to place the medication in the side of the mouth. 4) Add the dose to a small amount of food or beverage to facilitate swallowing
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A patient is prescribed fluoxetine 20 mg by mouth daily for treatment of depression. The nurse caring for the patient is unfamiliar with this drug. Which action should she take before administering the medication? 1) Inform the prescriber that she is not comfortable administering the drug. 2) Ask a nursing colleague for relevant information about the drug. 3) Consult the drug formulary accessible to staff at the patient care unit. 4) Trust the prescriber writes the dose and administer the drug as intended.
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The nurse is teaching parents ways to give oral medication to their child. Which action would they implement to improve compliance? 1) Crush time-release capsules to put in his favorite food. 2) Give medication quickly before he knows what is happening. 3) Allow the child to eat a frozen pop before receiving the medication. 4) Mask the flavor of medication in a toddler cup with orange juice.
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The nurse receives a laboratory report that states her patient's digoxin level is 1.2 ng/mL; therapeutic range for this drug is 0.5 to 2.0 ng/mL. Which action should the nurse take?' 1) Notify the prescriber to reduce the dose. 2) Withhold the next dose of digoxin. 3) Administer the next dose as prescribed. 4) Notify the prescribing healthcare provider to increase the dose.
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The time it takes for drug concentration to reach a therapeutic level in the blood is known as: 1) peak action. 2) duration of action. 3) onset of action. 4) half-life.
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While receiving an intravenous dose of an antibiotic, levofloxacin, a patient develops severe shortness of breath, wheezing, and severe hypotension. Which action should the nurse take first? 1) Administer epinephrine IM. 2) Give bolus dose of intravenous fluids. 3) Stop the infusion of medication. 4) Prepare for endotracheal intubation
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A patient is given furosemide 40 mg orally at 0900. The duration of action for this drug is approximately 6 hours after oral administration. At which time in military hours should the nurse no longer expect to see the effects of this drug? 1) 0930 2) 1000 3) 1100 4) 1500
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A patient with end-stage cancer is prescribed morphine sulfate to reduce pain. For which effect is this medication prescribed? 1) Supportive 2) Restorative 3) Substitutive 4) Palliative
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Before administering a medication, the nurse must verify the rights of medication administration, which include: 1) right patient, right room, right drug, right route, right dose, and right time. 2) right drug, right dose, right route, right time, right physician, and right documentation. 3) right patient, right drug, right route, right time, right documentation, and right equipment. 4) right patient, right drug, right dose, right route, right time, and right documentation.
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The physician prescribes warfarin 5 mg orally at 1800 for a patient who underwent open reduction and internal fixation of his right hip. After administering the medication, the nurse realizes that she administered a 10 mg tablet instead of the prescribed 5 mg PO. Which of the following actions by the nurse is appropriate? 1) No action is necessary because an extra 5 mg of warfarin is not harmful. 2) Call the prescriber and ask her to change the order to 10 mg. 3) Document on the chart that the drug was given and indicate the drug was given in error. 4) Complete an incident report according to the facility's policy.
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Which action should the nurse take immediately after administering a medication through a nasogastric tube? 1) Verify correct nasogastric tube placement in the stomach. 2) Auscultate the abdomen for presence of bowel sounds. 3) Immediately administer the next prescribed medication. 4) Flush the tube with water using a needleless syringe
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Which action should the nurse take to relax the vastus lateralis muscle before administering an intramuscular injection into the site? 1) Apply a warm compress. 2) Massage the site in a circular motion. 3) Apply a soothing lotion. 4) Have the client assume a sitting position.
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The primary care provider prescribes furosemide 40 mg IV for a patient with heart failure. Which drug name is used in this prescription? 1) Chemical 2) Brand 3) Trade 4) Generic
4 Furosemide, the generic name, was used by the physician in the drug order. The brand or trade name of the drug is Lasix; the chemical name is 4-chloro-N-furfuryl-5-sulfamoylanthranilic acid.
Which of the following contributions of Florence Nightingale had an immediate impact on improving patients' health? 1)Providing a clean environment 2)Improving nursing education 3)Changing the delivery of care in hospitals 4)Establishing nursing as a distinct profession
ANS: 1 Improved sanitation (a clean environment) greatly and immediately reduced the rate of infection and mortality in hospitals. The other responses are all activities of Florence Nightingale that improved healthcare or nursing, but the impact is long range, not immediate. PTS: 1 DIF: Easy REF: V1, p. 3; student must infer from content | V1, p. 10; student must infer from content KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application
What is the rationale for wrapping petroleum gauze around a chest tube insertion site? 1) Prevents air from leaking around the site 2) Prevents infection at the insertion site 3) Absorbs drainage from the insertion site 4) Protects the tube from becoming dislodged
ANS: 1 Petroleum gauze creates a seal around the insertion site. Collapse of the lung can occur if there is a leak around the insertion site that causes loss of negative pressure within the system. Air leaks are one common cause of loss of negative pressure. PTS:1DIF:EasyREF:p. 1322 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension
A patient has a history of COPD. His pulse oximetry reading is 97%. What other findings would indicate adequate tissue and organ oxygenation? Choose all that apply. 1) Normal urine output 2) Strong peripheral pulses 3) Clear breath sounds bilaterally 4) Normal muscle strength
ANS: 1, 2, 4 To determine adequacy of tissue oxygenation, assess respiration, circulation, and tissue/organ function. Good peripheral circulation is characterized by strong peripheral pulses. Impaired tissue oxygenation to the kidneys would result in abnormal kidney function (e.g., poor urine output). Hypoxic limb tissue would result in abnormal muscle functioning (e.g., muscle weakness and pain with exercise). Adequacy of tissue oxygenation cannot be determined by assessing pulmonary ventilation alone; circulation must also be assessed. PTS:1DIFgrinifficult REF: p. 1300; higher-order item, some of answer implied in text KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension
Which of the following factors influence normal lung volumes and capacities? Choose all that apply. 1) Age 2) Race 3) Body size 4) Activity level
ANS: 1, 3, 4 Normal lung volumes and capacities vary with body size, age, and exercise level. Volumes and capacities are higher in men, in large people, and in athletes. Race does not influence normal lung volumes and capacities. PTS:1DIF:EasyREF:p. 1305 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension
The nurse is counseling a 17-year-old girl on smoking cessation. The nurse should include which of the following helpful tips in her education? Choose all that apply. 1) "Keep healthy snacks or gum available to chew instead of smoking a cigarette." 2) "Don't tell your friends and family you are trying to quit, until you feel confident that you'll be successful." 3) "Plan a time to quit when you will not have many other demands or stressors in your life." 4) "Reward yourself with an activity you enjoy when you quit smoking."
ANS: 1, 3, 4 People who are trying to quit smoking often are more successful when they are accountable to other people who are encouraging and supportive. Having something to chew (e.g., carrot sticks, gum, nuts, or seeds) can distract from the desire to smoke a cigarette. Setting a date to stop smoking and choosing a time of low stress are two strategies that help people be more successful with smoking cessation. Self-reward for meeting goals is a form of positive reinforcement. PTS:1DIF:ModerateREF:p. 1311, ESG Self-Care: Smoking Cessation Tips KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Comprehension
Which of the following is/are accurate about nasotracheal suctioning? Choose all that apply. 1) Apply suction for no longer than 10-15 sec during a single pass. 2) Apply suction while inserting and removing the catheter. 3) Reapply oxygen between suctioning passes for ventilator patients. 4) Gently rotate the suction catheter as you remove it.
ANS: 1, 4 Limiting suctioning to 10 seconds or less and reapplying oxygen between suctioning passes prevent hypoxia. Suction should be applied only while withdrawing the catheter, using a continuous rotating motion to prevent trauma to the airway. Endotracheal suctioning is used when the patient is being mechanically ventilated, and most ventilator patients have in-line suctioning, so there is no need to reapply oxygen. PTS: 1 DIF: Moderate REF: p. 1347 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
The nurse is teaching a patient about her chest drainage system. Which of the following should the nurse include in the teaching? Choose all that apply. 1) Perform frequent coughing and deep-breathing exercises. 2) Sit up in a chair but do not walk while the drainage system is in place. 3) Get out of bed without assistance as much as possible. 4) Immediately notify the nurse if she experiences increased shortness of breath
ANS: 1, 4 Patients should regularly perform coughing and deep-breathing exercises to promote lung reexpansion. Also to promote lung reexpansion, the nurse should encourage the patient to be as active as her condition permits, rather than telling her not to walk. Chest drainage systems are bulky, but patients with disposable systems can still get out of bed and ambulate. However, the patient will need assistance from one or two staff members to protect and monitor the system and to monitor her responses to activity; she should not get out of bed on her own. If a patient with a chest drainage system becomes acutely short of breath, the patient should immediately notify the nurse so the nurse can check for occlusion of the system, which can result in a tension pneumothorax. PTS:1DIF:ModerateREF:pp. 1313, 1358 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension
You are caring for an adult patient with a tracheostomy who is being mechanically ventilated. His pulse oximetry reading is 85%, heart rate is 113, and respiratory rate is 30. The patient is very restless. His respirations are labored, and you hear gurgling sounds. You auscultate crackles and rhonchi in both lungs. What is the most appropriate action to take? 1) Call the respiratory therapist to check the ventilator settings. 2) Provide endotracheal suctioning. 3) Provide tracheostomy care. 4) Notify the physician of the patient's signs of fluid overload.
ANS: 2 Increased pulse and respiratory rates, decreased oxygen saturation, gurgling sounds during respiration, auscultation of adventitious breath sounds, and restlessness are signs that indicate the need for suctioning. Airways are suctioned to remove secretions and maintain patency. The patient's symptoms should subside once the airway is cleared. PTS: 1 DIF: Moderate REF: p. 1318, 1342 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
The nurse is caring for a patient who is experiencing dyspnea. Which of the following positions would be most effective if incorporated into the patient's care? 1) Supine 2) Head of bed elevated 80° 3) Head of bed elevated 30° 4) Lying on left side
ANS: 2 Position affects ventilation. An upright or elevated position pulls abdominal organs down, thus allowing maximum diaphragm excursion and lung expansion. PTS:1DIF:EasyREF:p. 1303 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
When using sterile technique to perform tracheostomy care of a new tracheostomy, which of the following is correct? 1) You will need a single pair of sterile gloves. 2) Place the patient in semi-Fowler's position, if possible. 3) Clean the stoma under the faceplate with hydrogen peroxide. 4) Cut a slit in sterile 4 × 4 gauze halfway through to make a dressing
ANS: 2 Semi-Fowler's position promotes lung expansion and prevents back strain for the nurse. You will need two pairs of sterile gloves: one pair for dressing removal, and a clean pair for the rest of the procedure. You should clean the stoma under the faceplate with sterile saline. Never cut a 4 × 4 gauze for the dressing because lint and fibers from the cut edge could enter the trachea and cause respiratory distress. PTS: 1 DIF: Easy REF: p. 1338 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application
The nurse is admitting to the medical-surgical unit an older adult woman with a diagnosis of pulmonary hypertension and right-sided heart failure. The patient is complaining of shortness of breath, and the nurse observes conversational dyspnea. What is the first action the nurse should take? 1) Review and implement the primary care provider's prescriptions for treatments. 2) Perform a quick physical examination of breathing, circulation, and oxygenation. 3) Gather a thorough medical history, including current symptoms, from the family. 4) Administer oxygen to the patient through a nasal cannula.
ANS: 2 The first action the nurse should take is to make a quick assessment of the adequacy of breathing, circulation, and oxygenation in order to determine the type of immediate intervention required. The nurse's assessment should include simple questions about current symptoms. A more thorough medical history can be gathered once the patient's oxygenation needs are addressed. Following a quick assessment, the nurse should then review and implement physician's orders. Administering oxygen is not appropriate without knowing what treatments the primary care provider has prescribed. PTS:1DIF:ModerateREF:pp. 1301-1302 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
When providing safety education to the mother of a toddler, you would inform the mother that, based on the child's developmental stage, he is at high risk for which of the following factors that influence oxygenation? Choose all that apply. 1) Frequent, serious respiratory infections 2) Airway obstruction from aspiration of small objects 3) Drowning in small amounts of water around the home 4) Development of asthma
ANS: 2, 3 As a toddler's respiratory and immune systems mature, the risk for frequent and serious infections is less than in infanthood. Most children recover from upper respiratory infections without difficulty. Toddlers' airways are relatively short and small and may be easily obstructed, and they often put objects in their mouth as part of exploring their environment, thus increasing their risk for aspiration and airway obstruction. In addition, toddlers are at high risk for drowning in very small amounts of water around the home (e.g., in a bucket of water or toilet bowl). The risk for developing asthma is not significantly influenced by the child's developmental stage. PTS:1DIF:ModerateREF:p. 1297 KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Comprehension
Obesity is associated with higher risk for which of the following conditions that affect the pulmonary and cardiovascular systems? Choose all that apply. 1) Reduced alveolar-capillary gas exchange 2) Lower respiratory tract infections 3) Sleep apnea 4) Hypertension
ANS: 2, 3, 4 Obesity causes multiple health problems, many of which affect the lungs, heart, and circulation. Large abdominal fat stores press upward on the diaphragm, preventing full chest expansion and leading to hypoventilation and dyspnea on exertion. The risk for respiratory infection increases because lower lung segments are poorly ventilated, and secretions are not removed effectively. When an obese person lies down, chest expansion is limited even more. Excess neck girth and fat stores in the upper airway often lead to obstructive sleep apnea. Obesity also increases the risk of developing atherosclerosis and hypertension. Obesity does not cause reduced alveolar-capillary gas exchange. PTS: 1 DIF: Easy REF: p. 1299 KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Comprehension
Which of the following is an example of an illness prevention activity? Select all that apply. 1)Encouraging the use of a food diary 2)Joining a cancer support group 3)Administering immunization for HPV 4)Teaching a diabetic patient about his diet
ANS: 3 Administering immunization for HPV is an example of illness prevention. Although cancer is a disease, it is assumed that a person joining a support group would already have the disease; therefore, this is not disease prevention but treatment. Illness-prevention activities focus on avoiding a specific disease. A food diary is a health-promotion activity. Teaching a diabetic patient about diet is a treatment for diabetes; the patient already has diabetes, so it cannot prevent diabetes. PTS: 1 DIF: Moderate REF: p. 18; high-level question, not directly stated in text KEY: Nursing process: N/A | Client need: HPM | Cognitive level: Application
The nurse administers an antitussive/expectorant cough preparation to a patient with bronchitis. Which of the following responses indicates to the nurse that the medication is effective? 1) The amount of sputum the patient expectorates decreases with each dose administered. 2) Cough is completely suppressed, and she is able to sleep through the night. 3) Dry, unproductive cough is reduced, but her voluntary coughing is more productive. 4) Involuntary coughing produces large amounts of thick yellow sputum.
ANS: 3 Antitussives are cough suppressants that reduce the frequency of an involuntary, dry, nonproductive cough. Antitussives are useful for adults when coughing is unproductive and frequent, leading to throat irritation or interrupted sleep. Expectorants help make coughing more productive. The goal of an antitussive/expectorant combination is to reduce the frequency of dry, unproductive coughing while making voluntary coughing more productive. PTS:1DIFgrinifficultREF:p. 1310 KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application
Which of the following provide the most reliable data about the effectiveness of airway suctioning? 1) The amount, color, consistency, and odor of secretions 2) The patient's tolerance for the procedure 3) Breath sounds, vital signs, and pulse oximetry before and after suctioning 4) The number of suctioning passes required to clear secretions
ANS: 3 Breath sounds, vital signs, and oxygen saturation levels before and after suctioning provide data about the effectiveness of suctioning. Information about the amount and appearance of secretions provides data about the likelihood of airway infection and/or inflammation. Data about the patient's tolerance of suctioning provide information about the patient's overall condition. The number of suctioning passes required to clear the secretions provides information about the amount of secretions present. PTS: 1 DIF: Moderate REF: p. 1351 KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application
Chest percussion and postural drainage would be an appropriate intervention for which of the following conditions? 1) Congestive heart failure 2) Pulmonary edema 3) Pneumonia 4) Pulmonary embolus
ANS: 3 Chest physiotherapy moves secretions to the large, central airways for expectoration or suctioning. This treatment is not effective for conditions that do not involve the development of airway secretions, including congestive heart failure, pulmonary edema, and pulmonary embolus. PTS:1DIF:ModerateREF:p. 1313 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension
A patient has just had a chest tube inserted to dry-seal suction drainage. Which of the following is a correct nursing intervention for maintenance? 1) Keep the head of the bed flat for 6 hours. 2) Immobilize the patient's arm on the affected side. 3) Keep the drainage system lower than the insertion site. 4) Drain condensation into the humidifier when it collects in the tubing.
ANS: 3 The drainage system must be below the insertion site to prevent fluid flowing back into the pleural cavity and compromising the patient's respiratory status. Maintain patient in semirecumbent position (head of bed elevated 30 to 45 degrees), not flat. This is extremely important to promote lung expansion, reduce gastric reflux, and prevent ventilator-associated pneumonia (VAP), if the person is being mechanically ventilated. Patients being mechanically ventilated are at high risk for developing VAP, which is associated with high mortality rates. Mouth rinses and mouthwashes are a part of the recommended routine for preventing VAP. They also provide comfort and preserve integrity of the mucous membranes. Encourage the patient to move the arm on the affected side; if he cannot, perform passive range-of-motion. You should check the ventilator tubing frequently for condensation, and drain the fluid into a collection device or waste receptacle because condensation in the ventilator tubing can cause resistance to airflow. Moreover, the patient can aspirate it if it backflows down into the endotracheal tube. The fluid should not be drained into the humidifier because the patient's secretions may have contaminated it. PTS: 1 DIF: Difficult REF: p. 1353 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application
A 62-year-old man with emphysema says, "My doctor wants me to quit smoking. It's too late now, though; I already have lung problems." Which of the following would be the best response to his statement? 1) "You should quit so your family does not get sick from exposure to secondhand smoke." 2) "You will need to use oxygen, but remember it is a fire hazard to smoke with oxygen in your home." 3) "Once you stop smoking, your body will begin to repair some of the damage to your lungs." 4) "You should ask your primary care provider for a prescription for a nicotine patch to help you quit."
ANS: 3 The nurse's response should focus on correcting the patient's misinformation rather than on convincing him to stop smoking. Once a person stops smoking, the body begins to repair the damage. During the first few days, the person will cough more as the cilia begin to clear the airways. Then the coughing subsides, and breathing becomes easier. Even long-time smokers can benefit from smoking cessation. The suggestions that the patient's family will become ill and that oxygen is a fire hazard appear to be scare tactics, which can be seen as coercive, and would not be effective in motivating the patient to stop smoking. Although asking the primary care provider for a prescription may help the patient to stop smoking, it does not address his incorrect belief that it is "too late" for him to do so. PTS:1DIF:ModerateREF:p. 1299 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
What is the most influential factor that has shaped the nursing profession? 1)Physicians' need for handmaidens 2)Societal need for healthcare outside the home 3)Military demand for nurses in the field 4)Germ theory influence on sanitation
ANS: 3 Throughout the centuries, stability of the government has been related to the success of the military to protect or extend its domain. As the survival and well-being of soldiers is critical, nurses provided healthcare to the sick and injured at the battle site. The physician's handmaiden was/is a nursing stereotype rather than an influence on nursing. Although there has been need for healthcare outside the home throughout history, this has more influence on the development of hospitals than on nursing; this need provided one more setting for nursing work. Germ theory and sanitation helped to improve healthcare but did not shape nursing. PTS: 1 DIF: Moderate REF: pp. 9-10 KEY: Nursing process: N/A Client need: N/A | Cognitive level: Recall
Of the following interventions, which is/are likely to reduce the risk of postoperative atelectasis? Choose all that apply. 1) Administer bronchodilators. 2) Apply low-flow oxygen. 3) Encourage coughing and deep breathing. 4) Administer pain medication.
ANS: 3, 4 Pain alters the rate and depth of respirations. Often, patients in pain breathe shallowly, which puts them at risk for atelectasis. Regularly assess all patients for pain. Once you have medicated the patient, reassess breath sounds, and encourage the patient to cough and breathe deeply. This will help to open air sacs and mobilize secretions in the airways. PTS: 1 DIF: Moderate REF: pp. 1303, 1313 ; critical-thinking item that requires synthesis of information KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Synthesis
Which of the following blood levels normally provides the primary stimulus for breathing? 1) pH 2) Oxygen 3) Bicarbonate 4) Carbon dioxide
ANS: 4 Carbon dioxide (CO2) level provides the primary stimulus to breathe. High CO2 levels stimulate breathing to eliminate the excess CO2. A secondary, although important, drive to breathe is hypoxemia. Low blood O2 levels stimulate breathing to bring more oxygen into the lungs. PTS:1DIF:ModerateREF:p. 1296 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Recall
The nurse administers intravenous morphine sulfate to a patient for pain control. She will need to monitor her patient for which of the following adverse effects? 1) Decreased heart rate 2) Muscle weakness 3) Decreased urine output 4) Respiratory depression
ANS: 4 Opioids are potent respiratory depressants. Patients receiving opioids should be monitored for decreased rate and depth of respirations. PTS:1DIF:ModerateREF:pp. 1299, 1305; critical-thinking and synthesis required KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Comprehension
While a patient is receiving hygiene care, her chest tube becomes disconnected from the water-seal chest drainage system (CDU). Which action should the nurse take immediately? 1) Clamp the chest tube close to the insertion site. 2) Set up a new drainage system, and connect it to the chest tube. 3) Have the patient take and hold a deep breath while the nurse reconnects the tube to the CDU. 4) Place the disconnected end nearest the patient into a bottle of sterile water.
ANS: 4 Recollapse of the lung can occur because of loss of negative pressure within the system. This is commonly caused by air leaks, disconnections, or cracks in the bottles or chambers. If any of these occur, the nurse should immediately place the disconnected end nearest the patient into a bottle of sterile water or saline to a depth of 2 cm to serve as an emergency water seal until a new system can be connected. Do not clamp the chest tube because this can rapidly lead to a tension pneumothorax. A new drainage system should be set up to decrease the risk of infection, but the immediate action is to place the disconnected end into a bottle of sterile water. PTS:1DIF:ModerateREF:p. 1322 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Analysis
You are admitting a 54-year-old patient with chronic obstructive pulmonary disease (COPD). The physician prescribes O2 at 24% FIO2. What is the most appropriate oxygen delivery method for this patient? 1) Nonrebreather mask 2) Nasal cannula 3) Partial rebreather mask 4) Venturi mask
ANS: 4 The Venturi mask is capable of delivering 24% to 50% FIO2. The cone-shaped adapter at the base of the mask allows a precise FIO2 to be delivered. This is very useful for patients with chronic lung disease. Rebreather masks are used when high concentrations of oxygen are required. A nasal cannula administers oxygen in liters per minute and does not allow administration of a precise FIO2. PTS:1DIFgrinifficultREF:p. 1335 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application
You are caring for a young adult patient with an intracranial hemorrhage secondary to a closed head injury. During your assessment, you notice that the patient's respirations follow a cycle progressively increasing in depth, then progressively decreasing in depth, followed by a period of apnea. Which of the following appropriately describes this respiratory pattern? 1) Biot's breathing 2) Kussmaul's respirations 3) Sleep apnea 4) Cheyne-Stokes respirations
ANS: 4 This respiratory pattern is known as Cheyne-Stokes respirations. It is often associated with damage to the medullary respiratory center or high intracranial pressure due to brain injury. PTS:1DIF:EasyREF:p. 1303 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Comprehension
Free vs bound molecules
Some molecules bind to plasma proteins, and the remainder will be free. Only free drug molecules can produce pharmocological effects because only free molecules can be metabolized or excreted
Effects of pH and ionization:
The acid content of the stomach aids in transporting the medication across the mucous membranes, so acidic meds such as aspirin are more readily absorbed in the stomach it just seems alkaline medications such as sodium bicarbonate, which are more readily absorbed in the more alkaline small intestine.
The rate of distribution depends on:
adequate local blood flow in the target area- the site where the drug effects occur.
Substitutive Effects-
administering insulin when a patients pancrease no longer can produce insulin
1. The nurse is drawing up a medication from an ampule. Arrange the following steps in the order in which they should be performed. A. Use an ampule opener to break ampule neck. B. Tap the ampule to remove medication trapped in the top of ampule. C. Invert the ampule, and draw up the medication. D. Dispose of the top and bottom of the ampule and filter needle in sharps container. E. Hold the syringe vertically, and tap it to remove air bubbles.
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2. A nurse is administering a medication using a volume-control administration set (e.g., Buretrol, Volutrol). Arrange the following steps in the order in which they would be performed. A. Inject the ordered medication into the volume-control chamber. B. Fill the volume-control chamber with the correct amount of intravenous fluid from the primary bag. C. Cleanse the port on the volume-control chamber. D. Prime the volume-control tubing. E. Open the lower clamp and start the infusion at the correct flow rate.
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Lipid-soluble drugs:
can penetrate lipid rich cell membranes and enter the cells whereas water soluble drugs such as penicillin cannot penetrate those areas
What is the generic (nonproprietary name), chemical name, brand/trade name (propietary) name of ibuprofen:
chemical:isobutylphenyl propionic acid generic: simpler format "ibuprofen" brand name: Advil
What must happen for excretion to occur:
drug molecules must be removed from their sites of action and eliminated from the body
Water-soluble drugs are:
drugs that mustbe water soluble in order to dissolve in the watery contents of the GI tract
Primary/Therapeutic Effects-
effects that are predicted, desired, intended, the reason the drug was prescribed.
Biological half life example:
half life of 6 hours= 50mg dose in 6 hours it will be 25mg, in 12 hours it will be 12.5mg
What would happen if a person ingested an antacid with aspirin?
it would reduce the effects of the aspirin
Primary site of excretion:
kidneys are the primary site of excretion. and then the liver and GI tract, finally the lungs
Ionized molecules are???
lipid insoluble and therefore cannot pass easily through the phospholipid layer of cell membranes
Metabolism takes place mostly in the ____ but can also take place in the ____.
liver. can also take place in the kidneys, blood plasma, intestinal mucosa, and lungs.
Drug molecules must leave the ______and cross_____
must leave the blood and cross capillary membranes to reach their sites of action
What do you need in order to prescribe medications?
national provider id number
Trough level-
occurs when the drug is at the lowest concentration right before the next dose is due. 30 mins before
When does a medication metabolized?
once a medication reaches its site of action, it is metabolized in preparation of excretion
Enterohepatic recirculation:
reabsorbed by the blood stream, distributed to the target site, returned to the liver, later excreted by the kidneys
Pharmacokinetics is:
refers to the absorption, distribution, metabolism, and excretion of a drug. These four processes determine the intensity and duration of a drug's reaction.
Palliative Effects-
relieve the symptoms of the disease but have no effect on the disease itself. goal is to make the patient as comfortable as possible when treatment options have been exhausted
Secondary Effects-
side effects, adverse reactions, allergic reactions, unintended
Refers to the ability of a medication to be transformed into a liquid form that can be absorbed into the blood stream
solubility
Pharmacodynamics:
study of how medications achieve their effects at various sites in the body- how specific drug molecules interact with target cells, and how biological responses occur.
Patients with diabetes do not metabolize:
sugar effectively so they should not take elixirs which are high in sugar content
Supportive Effects-
support the integrity of body functions until other medications or treatments can become effective
At times, patients may self-administer medications when hospitalized.
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Drugs are classified by?
usage, body system, chemical/pharmacological class
Factors that cause vasodilation vs vasoconstriction:
vasodilation increase circulation to area tissues vasoconstriction decrease circulation to the target tissue
Oral preparations must be:
water soluble and at least partially lipid soluble, they are absorbed faster than tablets because the medication is already dissolved.
the rate of absorption determines:
when a drug becomes available to exert its action; thus absorption also influences metabolism and excretion. Absorption depends on the route of administration, form of the drug, solubility, effects of pH, blood flow and body surface area
Peak action:
when the concentration of med is the highest in the blood
