vSim - Yoa Li
Mr. Li received morphine intravenously (IV) postoperatively. How long did it take for the morphine to take effect (onset) once the medication was infused? a) 15-60 minutes b) 10-30 minutes c) 20-60 minutes d) 0-5 minutes
d) 0-5 minutes The onset of intravenous morphine is 5 minutes or less. Intramuscular and subcutaneous morphine has an onset of 10 to 30 minutes. Epidural and intrathecal morphine have an onset of 15 to 60 minutes. Rectal morphine has an onset of 20 to 60 minutes.
Yoa li had a respiratory rate of 10 breaths/min, his eyes were closed, and he was unarousable, with a Pasero Opioid Sedation Scale (POSS) of 4. Which of the following interventions should be implemented first for Yoa Li? a) Administer naloxone b) Notify healthcare provider c) Discontinue patient-controlled analgesia (PCA) d) Administer oxygen
a) Administer naloxone The priority intervention is reversal of opioid effects with a narcotic antagonist (naloxone). Other interventions should be implemented after reversal of opioid effect.
Yoa Li was prescribed prochlorperazine. Which of the following drug classifications indicates the reason this medication was prescribed for him? a) Antiemetic b) Antihistamine c) Antipsychotic d) Anticholinergic
a) Antiemetic Prochlorperazine was prescribed to manage nausea and vomiting. Drug classification is antiemetic. Prochlorperazine is not classified as anticholinergic or antihistamine. Prochlorperazine is classified as an antipsychotic; however, that is not why it was prescribed for Yoa Li.
A patient is requesting medication for pain. Which of the following is the best way for the nurse to ensure effective pain management for the patient? a) Complete an assessment of the patient's pain. b) Administer an analgesic ordered for the patient. c) Implement nonpharmacological interventions. d) Have the patient self-select a treatment for pain.
a) Complete an assessment of the patient's pain. Accurately assessing pain can lead to effective pain management. Because so many factors play a role in pain perception and it is very subjective, assessment has to depend on the patient's report of pain. Other responses will not provide specific information about the patient's pain.
The nurse is evaluating a patient's level of sedation using the Pasero Opioid Sedation Scale (POSS): S = Sleep, easy to arouse 1 = Awake and alert 2 = Slightly drowsy, easily aroused 3 = Frequently drowsy, arousable, drifts off to sleep during conversation 4 = Somnolent, minimal, or no response to verbal and physical stimulation The nurse gives the patient a score of 3. Based on this score, which of the following interventions should the nurse implement? a) Monitor respiratory status b) Administer narcotic antagonist c) Administer opioid if requested d) Call rapid response team
a) Monitor respiratory status For a POSS of 3, the nurse should carefully monitor respiratory status. The nurse may give opioids for a score of S, 1, or 2. If the patient has a score of 4, the nurse should administer naloxone and call the rapid response team (Code Blue).
Narcotic pain management patient education principles for adults include which of the following? (Select all that apply.) a) Request pain medications before pain gets unbearable. b) Self-regulation of intravenous narcotics can be offered. c) Addiction to narcotics is common during treatment. d) Women who are pregnant can safely use narcotics. e) Opioids such as morphine can be given during labor.
a) Request pain medications before pain gets unbearable. b) Self-regulation of intravenous narcotics can be offered. e) Opioids such as morphine can be given during labor. The nurse should encourage patients to ask for pain medication before the pain is acute to get better coverage for their pain. Many institutions allow patients to self-regulate intravenous drips to control their pain postoperatively. Morphine is used for analgesia during labor. Risk of addiction to a narcotic during treatment is remote. Opioids should only be used with caution during pregnancy.
A postoperative patient receiving morphine for pain is also prescribed prochlorperazine for severe nausea and vomiting. The nurse should monitor the patient for which of the following adverse effects when these two medications are combined? a) Sedation b) Congestion c) Diarrhea d) Tachycardia
a) Sedation Additive CNS depression can be seen when antiemetics are combined with other CNS depressants (such as opioids). Other responses are not side effects of combining antiemetics and opioids.
Yoa Li is receiving analgesia via PCA. Which of the following statements describes why this form of analgesia delivery was an appropriate choice for him? (Select all that apply.) a) Yoa Li has the ability to understand teaching related to use of a PCA. b) He can tailor frequency of medication to his individual pain tolerance. c) PCA allows him to determine dose of the pain medication administered. d) PCA provides Yoa Li with a sense of control over his own pain management. e) Family can administer pain medication for him if he is sleeping.
a) Yoa Li has the ability to understand teaching related to use of a PCA. b) He can tailor frequency of medication to his individual pain tolerance. d) PCA provides Yoa Li with a sense of control over his own pain management. PCA is typically given to patients who are able to understand and comply with instructions. Pain relief is tailored to each patient's pain tolerance. PCA provides the patient with a sense of control over pain. The purpose of PCA is for the patient to control administration. The prescriber determines dosage amounts.
Which of the following procedures describes the method for administering ketorolac 30 mg IV push? a) Infuse at a rate of 5 mg/min b) Inject 30 mg over 15 seconds c) Inject at a rate of 15 mg/s d) Infuse 10 mg every 5 minutes
b) Inject 30 mg over 15 seconds Ketorolac injection should be given over at least 15 seconds. The other responses do not reflect the correct method for administering ketorolac IV push.
A patient has the following vital signs. Which vital sign will need to be closely monitored if the patient receives an opioid (narcotic)? a) Pulse: 88 beats/min b) Respirations: 14 breaths/min c) Temperature: 98.6 F (37.0 C) d) Blood pressure: 132/86 mmHg
b) Respirations" 14 breaths/min The narcotic agonists act at specific receptor sites in the central nervous system (CNS). They produce rapid analgesia, sedation, and respiratory depression. The most frequently seen adverse effect associated with narcotic agonists relates to their effects on various opioid receptors. Respiratory depression with apnea may result from narcotic-induced respiratory center depression.
A patient is receiving morphine via a patient-controlled analgesia (PCA) system. Which of the following information would be included when teaching the patient about the benefits of PCA? a) The patient can control the route of administering the medication. b) The patient has control over the frequency of the medication. c) The patient may request the specific concentration of narcotic used. d) The patient can choose the rate at which the medication infuses.
b) The patient has control over the frequency of the medication. With a PCA system, the client controls the frequency of medication delivery. The PCA system is designed to deliver medication at a set rate. Standardized medication concentrations ensure patient safety. PCA provides IV analgesia.
The nurse wants to document an assessment of the amount of pain a patient is experiencing. Which of the following methods will provide the most accurate information regarding the level of a patient's pain? a) Assess the patient's nonverbal indicators of pain. b) Use a numeric pain scale and have the patient rate their pain. c) Ask open-ended questions about the patient's pain. d) Have the patient indicate if the pain is high or low.
b) Use a numeric pain scale and have the patient rate their pain. Pain is subjective and specific to the patient. A numeric pain scale is a self-report tool where the numbers range from 0 (no pain) to 10 (worst possible pain). Other responses will not provide specific information about the level of the patient's pain.
A patient is prescribed ketorolac tromethamine 40 mg orally twice a day for 10 days. Which of the following components of the prescription should the nurse clarify with the healthcare provider? a) Frequency (twice a day) b) Route (orally) c) Duration (for 10 days) d) Dose (40 mg)
c) Duration (for 10 days) The nurse should question the duration. Ketorolac should not be taken for more than 5 days in a row. The dose and frequency, 40 mg twice a day (80 mg/d), are within the maximum dose for ketorolac of 120 mg/d. Ketorolac is available in oral form.
Yoa Li became overly sedated during the scenario. Which of the following statements describes the likely reason for his sedation? (Select all that apply.) a) He ad a length surgical procedure with general anesthesia. b) He was given morphine after having a surgical procedure. c) He had limited or no exposure to morphine in the past. d) He was given morphine and prochlorperazine together. e) He had a severe allergic reaction to the morphine sulfate.
c) He had limited or no exposure to morphine in the past. d) He was given morphine and prochlorperazine together. Patients at increased risk for sedation include patients who have not used opioids recently or are first-tome opioid users and patients receiving other sedating drugs simultaneously. Sedation is not a sign/symptom of allergic reaction. Open appendectomies are not considered a lengthy surgical procedure (most take less than 1 hour). Morphine can be safely given after a surgical procedure.
Yoa Li is prescribed ketorolac. Which of the following statements describes how this medication manages pain? a) Acts at specific opioid receptors b) Blocks alpha-adrenergic sites c) Inhibits prostaglandin synthesis d) Mechanism of action is unknown
c) Inhibits prostaglandin synthesis Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketorolac, provide analgesic effects by inhibiting prostaglandin synthesis. Narcotics and narcotic agonist-antagonists act at specific opioid receptors. The mechanism of action for acetaminophen that causes analgesia is unknown. Ergot derivative block alpha-adrenergic sites.
The nurse is notifying the provider about Yoa Li's condition using SBAR (Situation, Background, Assessment, Recommendation) communication. Which of the following statements would be associated with the letter R in SBAR? a) He is awake and his current respiratory rate is 18. b) He was admitted after an open appendectomy. c) I am calling about Yoa Li who was found sedated. d) I would like you to come and see the patient ASAP.
d) I would like you to come and see the patient ASAP. The R (Recommendation) component of SBAR includes evaluation of what the nurse believes will resolve the situation. Information regarding Yoa Li's physical assessment and respiratory rate is part of Background and/or Assessment. Information about previous patient condition and surgery is part of Situation and/or Background.
A patient is prescribed morphine for pain. Which of the following administration routes would provide the most reliable way to achieve therapeutic levels of morphine? a) Intramuscular b) Oral c) Subcutaneous d) Intravenous
d) Intravenous Intravenous (IV) administration is the most reliable way to achieve therapeutic levels of narcotics. Oral, intramuscular (IM), and subcutaneous administration offer varying rates of absorption.
Which of the following medications should be given if the patient experiences a narcotic overdose? a) Flumazenil b) Methadone c) Acetylcysteine d) Naloxone
d) Naloxone Naloxone is a narcotic antagonist. Acetylcysteine is given for acetaminophen overdose, flumazenil is given for overdose of benzodiazepines, and methadone is given to reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs.
Yoa Li was prescribed naloxone. Which of the following assessments would indicate that the medication was effective? a) Reports of nausea b) Tachycardia c) Hypotension d) Reports of pain
d) Reports of pain Naloxone is a narcotic antagonist. Effectiveness is evident if the patient reports pain. Nausea and tachycardia are adverse effects of narcotic antagonists and should not be used to determine effectiveness. Hypotension is not associated with administration of a narcotic antagonist.
If Yoa Li reports a level of pain of 9, which of the following document examples should the nurse use to document Yoa Li's pain in the medical record? a) Moderate level of pain (9) reported by the patient. b) Level of pain reported was higher than scale used. c) Pain reported matched severe level on pain scale. d) States level of pain as 9 out of 10 on the numeric pain scale.
d) States level of pain as 9 out of 10 on the numeric pain scale. When documenting, include the patient subjective report of pain and tool used. The other responses do not include all of the expected information.
