Abrams: Chapter 50 Drug Therapy With General Anesthetics

The nurse is working in the postanesthesia care unit, and several patients are having surgery today. Which patient would be at greatest risk for complications after surgery? A 35-year-old female who had a hysterectomy using general anesthesia A 64-year-old male who had bilateral femoral bypass grafting using spinal anesthesia A 72-year-old female who had general anesthesia for lung removal A 26-year-old female who had a tubal ligation using general anesthesia

A 72-year-old female who had general anesthesia for lung removal The oldest patient is at risk for increased complications with general anesthesia, due to the changes that occur in the body as part of the natural aging process. pg 924

The pharmacology instructor is discussing NMJ blockers with the pre-nursing class. How would the instructor explain the action of depolarizing NMJ blockers? Blocks ACh from acting Acts like ACh then prevent repolarization Takes the place of ACh in the depolarizing/repolarizing process Stops depolarization in the axion

Acts like ACh then prevent repolarization Depolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation pg 923

The nursing student identifies which people as qualifed to administer anesthesia? (Check all that apply.) Anesthesiologist Physician assistant Nurse anesthetist Surgeon Operating room nurse

Anesthesiologist Nurse anesthetist Both specially trained nurses and physicians can administer anesthesia. An anesthesiologist is a physician with special training in administering anesthesia. A nurse anesthetist is a nurse with a master's degree and special training who is qualified to administer anesthetics. pg 916

In a patient who is to be given vecuronium (Norcuron), anesthesia is induced before neuromuscular blockade is started. What is the reason for this? Because it helps reduce the adverse effects of vecuronium Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe Because it ensures that vecuronium does not cross the blood-brain barrier Because it enhances the therapeutic effects of vecuronium

Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe Vecuronium does not cross the blood-brain barrier and has no action on the CNS. For this reason, anesthesia is induced before neuromuscular blockade is started; otherwise, the unanesthetized patient would have the frightening experience of paralysis and the inability to breathe. pg 923 - 924

A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital? Skeletal muscle relaxation Profound analgesia CNS depression Neuroleptanalgesia

CNS depression The nurse is most likely to observe CNS depression. Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia. Skeletal muscle relaxation is caused by skeletal muscle relaxants, halothane and enflurane. An anesthetic state characterized by profound analgesia is produced by ketamine, which is a rapid-acting general anesthetic. Neuroleptanalgesia is caused by a combination of fentanyl and droperidol. pg 922

Which represent the nurse's responsibilities to a client in the PACU? (Select all that apply.) Checking airway patency Positioning the client to prevent aspiration of secretions Reviewing the client's surgical and anesthesia records Checking the client every 15 to 30 minutes for emergence from anesthesia Checking the client's vital signs

Checking airway patency Positioning the client to prevent aspiration of secretions Reviewing the client's surgical and anesthesia records Checking the client's vital signs Checking airway patency, positioning the client to prevent aspiration of secretions, reviewing the client's surgical and anesthesia records, checking the client every 5 to 15 minutes for emergence from anesthesia, and checking the client's vital signs, IV lines, catheters, drainage tubes, surgical dressings, and casts represent the nurse's responsibilities to a client in the PACU. pg 929

The nurse administered morphine 30 minutes ago to a client in the postanesthesia recovery unit (PACU), and now notes that the client vital signs are: Temp: 97.9 F, Pulse: 98 bpm, Respirations: 9 breaths/min, and BP: 107/69. What is the nurse's next best action? Document the findings. Recheck vital signs in 5 minutes. Contact the health care provider. Place a warm blanket on the client.

Contact the health care provider. The health care provider is contacted if the client's respiratory rate is below 10 breaths/min before or after the nurse administers an opioid medication. The client's respiratory rate is 9 breaths/min; it would not be appropriate to document the findings or to recheck in five minutes. Also, the client's temperature does not indicate the need for a warm blanket. pg 929

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? Acetaminophen Toradol Dantrolene sodium Diazepam

Dantrolene sodium Clients who develop malignant hyperthermia will receive dantrolene sodium. pg 918

Which represent responsibilities of a nurse prior to a client's surgery? (Select all that apply.) Describe the preparation for surgery ordered by the physician. Assess the physical status of the client. Describe postoperative care. Demonstrate postoperative client activities. Demonstrate the use of a PCA pump.

Describe the preparation for surgery ordered by the physician. Assess the physical status of the client. Describe postoperative care. Demonstrate postoperative client activities. Demonstrate the use of a PCA pump. The nurse is responsible for describing the preparation for surgery ordered by the physician, assessing the physical status of the client, describing postoperative care, demonstrating postoperative client activities, and demonstrating the use of a PCA pump. pg 928

In the preoperative area the nurse reviews the medical records of the client going to surgery. This chart review is performed to ensure that the surgeon and anesthesiologist are aware of what client issues? Select all that apply. Drug allergies Drug idiosyncrasies Abnormal lab values Names of significant others Client's occupation

Drug allergies Drug idiosyncrasies Abnormal lab values The nurse should review the client's chart and flag it for known or suspected drug allergies, drug idiosyncrasies, and abnormal lab values. Though important, it is not necessary to flag the names of the client's significant others or the client's occupation. pg 928

The nurse is admitting a client in preparation of surgery. The nurse is aware that propofol is contraindicated in a client who is allergic to what product? Latex Pollen Gluten Eggs

Eggs Propofol is contraindicated in clients who are allergic to eggs. pg 922

What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)? Ensure the client has adequate respirations. Position the client on his side to prevent aspiration of vomitus. Administer pain medication. Check the client's pulse and blood pressure.

Ensure the client has adequate respirations. The nurse's most important responsibilities when the client is admitted to the PACU are to check the client's airway for patency and assess the client's respiratory status. Taking pulse and blood pressure, and positioning the client on his side are the nurse's next actions. The nurse will then administer pain medication if necessary. pg 929

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 Client's personal preference Area, organ, or system being operated on Anticipated length of the surgical procedure Cost of the drugs

General physical condition of the client Area, organ, or system being operated on Anticipated length of the surgical procedure 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. pg 927 - 928

A 90-year-old frail, elderly woman has arrived at the emergency department with a broken hip and in acute respiratory distress. Succinylcholine will be used because of the need for rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the woman's frail condition, she is at risk for skin breakdown. Which of the following nursing diagnoses would be most appropriate? Impaired Spontaneous Ventilation Impaired Physical Mobility Fear Disturbed Sensory Perception

Impaired Physical Mobility The nursing diagnosis that directly relates to possible skin breakdown is Impaired Physical Mobility related to drug-induced paralysis. Patients who are unable to speak, move, or breathe unassisted can quickly develop pressure sores (decubitus ulcers). It is the responsibility of the nurse to help keep the patient positioned correctly to avoid skin breakdown. The nurse will plan interventions to prevent skin breakdown based on how long the patient will be immobilized. Impaired Spontaneous Ventilation is related to respiratory paralysis. Fear is related to paralysis and helplessness, and Disturbed Sensory Perception is related to CNS depression secondary to drugs used during anesthesia. pg 928

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? Decreased effect of isoflurane Increased effect of isoflurane Extreme agitation Profound coma

Increased effect of isoflurane Alcohol causes an increase in the effect of isoflurane so the client will need to be monitored closely for delayed emergence from anesthesia. pg 919

A student asks the pharmacology instructor how succinylcholine differs from ACh. What should the instructor respond? It is not broken down instantly. It results in a prolonged relaxation of the muscle. The muscle becomes hyperstimulated. It lasts about 2 hours.

It is not broken down instantly. Unlike endogenous ACh, succinylcholine is not broken down instantly. The result is a prolonged contraction of the muscle, which cannot be restimulated. Options C and D are distracters for this question. pg 926

A patient admitted to a local health care facility has to be administered general anesthesia. The nurse knows that which of the following factors will influence the selection of the general anesthesia for the patient? Age of the patient Length of surgical procedure Pre-anesthetic drug prescribed Postoperative care involved

Length of surgical procedure The nurse should know that the choice of general anesthesia depends on factors that include the general physical condition of the patient; the area, organ, or system being operated on; and the anticipated length of the surgical procedure. The selection of general anesthesia does not depend on the age of the patient specifically on the pre-anesthetic drug prescribed for the patient, or on the postoperative care involved. pg 929

The nursing instructor is teaching the students about anesthesia and informs them that there are two types. What are those two types of anesthesia? (Select both that apply.) Local anesthesia Topical anesthesia General anesthesia Regional anesthesia Spinal anesthesia

Local anesthesia General anesthesia Anesthesia ia divided into local and general. Topical, regional, and spinal are types of local anesthesia. pg 916

A client is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist begin anesthesia, what is the next phase of anesthesia? Induction Recovery Medullary paralysis Maintenance

Maintenance Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the client is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. pg 928

The nurse is caring for a client immediately prior to the administration of anesthesia. The nurse knows that what equipment must be available when the anesthesiologist administers vecuronium? Mechanical ventilation Defibrillator Intravenous fluids Cooling blanket

Mechanical ventilation Vecuronium is a neuromuscular blocking agent that causes paralysis of the muscles, so mechanical ventilation needs to be available for intubation. pg 924, 930

The anesthesiologist has informed the perioperative nurse that a surgical client will be receiving a barbiturate anesthetic. What medication is the client most likely to receive? Methohexital Desflurane Etomidate Nitrous oxide

Methohexital Methohexital is a barbiturate general anesthetic. Desflurane is a volatile liquid general anesthetic. Etomidate is a nonbarbiturate general anesthetic. Nitrous oxide is an anesthetic gas. pg 922

After reviewing the various general anesthetics, a group of students demonstrate the need for additional review when they identify which agent as being excreted by the lungs? Midazolam Sevoflurane Nitrous oxide Enflurane

Midazolam Midazolam is excreted by the kidneys. The other agents are excreted by the lungs. pg 927

Which statement best reflects the action of NMJ blockers? They cause muscle paralysis along with total central nervous system depression. They have relatively few adverse effects. Most do not affect pain perception and consciousness. They readily cross the blood-brain barrier.

Most do not affect pain perception and consciousness. NMJ blockers, in most cases, do not affect pain perception and consciousness. They cause muscle paralysis without total central nervous system depression and are associated with serious adverse effects. They do not readily cross the blood-brain barrier. pg 923

A client received fentanyl during a surgical procedure. The nurse will have what drug available to treat any possible respiratory depression associated with the use of fentanyl? Vecuronium Naloxone Midazolam Propofol

Naloxone Fentanyl is an opioid analgesic, and the nurse will have naloxone on hand to reverse the effects of the opioid that is causing respiratory depression. pg 927

The student asks the physiology instructor where the motor neuron communicates with a skeletal muscle fiber. What would the instructor respond? Synapse Neuromuscular junction Synaptic cleft Afferent junction

Neuromuscular junction The neuromuscular junction simply is the point at which a motor neuron communicates with a skeletal muscle fiber. The synapse and the synaptic cleft are part of the NMJ. pg 930

Which agent would the nurse identify as always being given with oxygen? Thiopental Nitrous oxide Halothane Enflurane

Nitrous oxide Nitrous oxide can block the reuptake of oxygen after surgery and cause hypoxia. Subsequently, it is always given in combination with oxygen. pg 918 - 919

After teaching students about neuromuscular junction (NMJ) blockers, the instructor determines that the teaching was successful when the students identify which as an example of a nondepolarizing NMJ blocker? (Select all that apply.) Pancuronium Vecuronium Cisatracurium Succinylcholine Dantrolene Thiopental

Pancuronium Vecuronium Cisatracurium Pancuronium is a nondepolarizing NMJ blocker. Vecuronium is a nondepolarizing NMJ blocker. Cisatracurium is a nondepolarizing NMJ blocker. Succinylcholine is a depolarizing NMJ blocker. Dantrolene is a direct acting skeletal muscle relaxant. Thiopental is a barbiturate general anesthetic pg 926

Prior to administering morphine sulfate to a client in the postanesthesia recover unit (PACU), what information must the nurse obtain? (Select all that apply.) Pulse IV fluid rate Respirations Blood pressure Urinary output

Pulse Respirations Blood pressure The nurse must check the client's pulse, respiratory rate and blood pressure before an opioid such as morphine sulfate is administerd in the PACU. The client's IV rate and urinary output are not neccesary information to administer an opioid. pg 928

A priority assessment prior to a 70-year-old client being given succinylcholine (Anectine) as adjunct to general anesthesia for surgery is: Blood glucose level and complete blood count Nutritional status and weight Renal and hepatic function Activity level

Renal and hepatic function 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. pg 926

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 Myoclonic and tonic movements Nausea and vomiting Chills and hypotension

Respiratory depression and CNS suppression Respiratory depression and CNS suppression may occur during recovery from midazolam, making these areas priorities for post-operative assessment. pg 927

A client is scheduled for dental surgery and will be given nitrous oxide. What assessment should the nurse prioritize before administering the medication? Respiratory status Expectations for recovery Cognitive status Skin integrity

Respiratory status Nitrous oxide is a potent analgesic and is used frequently for dental surgery. Nitrous oxide can block the reuptake of oxygen after surgery and cause hypoxia. Because of this reaction, it is always given in combination with oxygen. Susceptible patients should be monitored for signs of hypoxia, chest pain, and stroke. Respiratory status would consequently be prioritized over client expectations, skin integrity or cognition. pg 920

The perioperative nurse has created a plan of care for a surgical client. Which diagnosis should the nurse include that is directly related to safety during surgery? Deficient Knowledge regarding drug therapy Acute Confusion related to anesthesia Risk for Powerlessness related to loss of consciousness Risk for Injury related to central nervous system (CNS) depressive effects of drugs

Risk for Injury related to central nervous system (CNS) depressive effects of drugs The nursing diagnosis, which directly relates to safety, is high risk for injury. Knowledge and powerlessness are psychosocial diagnoses that do not apply during general anesthesia. pg 928

A nurse in the recovery room has been assigned to a patient who had an ocular surgical procedure and received isoflurane. The nurse will observe for which of the following during the recovery period? Urticaria and angioedema Facial flushing and hypotension Wheezing and bronchospasm Shivering and tremors

Shivering and tremors Tremors and shivering may occur in response to a decreased body temperature. Allergic reactions such as urticaria, angioedema, bronchospasm, and anaphylactic shock may occur with lidocaine administration. Facial flushing and hypotension can be associated with use of tubocurarine for a surgical procedure. A mild histamine release associated with succinylcholine may result in respiratory difficulty including wheezing and bronchospasm. pg 918

An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states , "My arms and legs feel like tree trunks and my head feels "fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client? Provide analgesic medication for the discomfort. Stay with client as much as possible and provide reassurance. Provide fluids orally to increase the client's wakefulness. Contact the provider and ensure naloxone is available.

Stay with client as much as possible and provide reassurance. Most clients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the client as much as possible and reassure the client while providing frequent assessment. Providing pain medication is important and may be needed during recovery if the client reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to clients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. There is no indication that the provider should be contacted. Naloxone treats opioid overdose, which is not the cause of the client's symptoms. pg 929

A postsurgical patient is awake and extremely anxious while in the postanesthesia recovery unit. She states that "my arms and legs feel like tree trunks and they are hard to move." She also states that "my head feels fuzzy and the right words will not come out." Which of the following is the most appropriate nursing action for this patient? Provide analgesia medication for the discomfort Stay with the patient as much as possible and provide reassurance Provide fluids to increase her wakefulness Encourage the patient to turn from side to side periodically

Stay with the patient as much as possible and provide reassurance Most patients are disoriented and confused when awaking from anesthesia. It would be a priority for the nurse to be with the patient as much as possible and to reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery, but the patient does not state that she is in pain. The nurse would not provide fluids to patients immediately after surgery. Most patients cannot take anything by mouth for several hours after surgery. The nurse will help the patient turn from side to side but it would do little to decrease her fears. pg 928

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

Succinylcholine Of the agents, succinylcholine has the shortest duration of action, 4 to 6 minutes. pg 926

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

Succinylcholine 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. pg 926

The nurse is preparing a male client for surgery. The nurse is reviewing the family history, which includes familial plasma pseudocholinesterase. The patient has a history of malignant hyperthermia and narrow-angle glaucoma. Which anesthetic is highly contraindicated for such a patient? Propofol Lidocaine Vecuronium Succinylcholine

Succinylcholine Succinylcholine is highly contraindicated in patients with a history of malignant hyperthermia, familial plasma pseudocholinesterase disorders, and narrow-angle glaucoma. This is because succinylcholine can induce malignant hyperthermia, interact with acetylcholine to produce prolonged apnea, or cause a transient elevation in intraocular pressure immediately after injection in such patients. Malignant hyperthermia can occasionally occur with vecuronium but is not an adverse effect of propofol or lidocaine. pg 925

A patient that has a history of glaucoma is to receive a NMJ blocker. Which agent would the nurse identify as being most problematic for this patient? Succinylcholine Vecuronium Rocuronium Pancuronium

Succinylcholine Succinylcholine is the only NMJ blocker that may cause increased intraocular pressure; this could be a problem for a patient with glaucoma who has increased intraocular pressure already. pg 926

A PACU nurse is caring for a patient that had anectine as an adjunct to their anesthesia. The nurse knows it is most important to monitor this patient for: Movement Temperature change Mental status change Change in heart rate

Temperature change If anectine is given, monitor patient's temperature for prompt detection and treatment of malignant hyperthermia and have dantrolene readily available for treatment of malignant hyperthermia if it should occur. pg 926

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 nervous. The patient may be at risk for developing malignant hyperthermia. The grandmother's surgery has no relevance to the patient's surgery. The patient may be at risk for hypothermia.

The patient may be at risk for developing malignant hyperthermia. 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. pg 918

You are caring for a patient that is scheduled for abdominal surgery in the morning. The patient asks you about the Rocuronium (Zemuron) that is planned as an adjunct to their general anesthesia what the adverse effects may be. What would be your most appropriate response? This drug is associated with pulmonary hypertension. This drug contains benzyl alcohol. This drug is associated with bradycardia. This drug is associated with an increased heart rate.

This drug is associated with pulmonary hypertension. Rocuronium (Zemuron): May be associated with pulmonary hypertension. Cisatracurium (Nimbex) contains benzyl alcohol; Atracurium (Tracrium) is associated with bradycardia; and Pancuronium (Pavulon) is associated with an increased heart rate. pg 925-926

During an operation where the patient has been given isoflurane, the nurse has been asked to frequently change carbon dioxide adsorbents. Why is this necessary? To minimize the risk of nephrotoxicity To minimize the risk of adverse effects such as shivering and tremor To minimize the risk of carboxyhemoglobinemia To minimize the incidence of spontaneous abortions, birth defects, and stillbirths

To minimize the risk of carboxyhemoglobinemia Isoflurane has been observed to react with carbon dioxide dry adsorbents in anesthetic circle systems to form carbon monoxide and cause carboxyhemoglobinemia. To avoid this adverse effect, it is important to change carbon dioxide adsorbents frequently. However, it does not help minimize the risk of nephrotoxicity, adverse effects such as shivering and tremor, or incidence of spontaneous abortions, birth defects, and stillbirths. pg 919

The nurse is aware that midazolam is administered prior to surgery for what reason? To produce amnesia To prevent hyperthermia To produce analgesia To prevent respiratory depression

To produce amnesia Midazolam is administered to reduce anxiety and to produce amnesia prior to surgery.

The client is having dental surgery and the healthcare provider will offer the use of anesthetic gas for the client. The most commonly used anesthetic gas is nitrous oxide. Which is this statement? True False

True Nitrous oxide is the most commonly used anesthetic gas. It is a weak anesthetic and usually combined with other drugs. pg 920

When nondepolarizing NMJ blockers are given, histamine is also released, causing wheezing and bronchospasm. True False

True The histamine release associated with many of the depolarizing NMJ blockers can cause respiratory obstruction with wheezing and bronchospasm. pg 926

Nondepolarizing NMJ blockers act as antagonists to acetylcholine at the neuromuscular junction. True False

True The nondepolarizing neuromuscular junction blockers include those agents that act as antagonists to ACh at the NMJ and prevent depolarization of muscle cells. pg 923

When reviewing the history of a patient who is to receive succinylcholine, the nurse would expect a prolonged drug action if the patient has a history of: collagen disease. cesarean delivery. fractures. spinal cord injury.

collagen disease. Collagen disease is associated with low plasma cholinesterase levels, which can predispose a patient to a very prolonged paralysis because succinylcholine is not broken down in the plasma and continues to stimulate the receptor site. Cesarean delivery is an indication for the use of succinylcholine. Caution is necessary for a patient with fractures because succinylcholine causes muscle contractions, which might lead to further injury. Caution is necessary for a patient with a spinal cord injury because a loss of potassium can occur from the overstimulated cells due to succinylcholine, leading to hyperkalemia. pg 926

The patient in the intensive care unit (ICU) is intubated and on a respirator. What drug would the nurse be told to give so that the patient receives continuous sedation while intubated? propofol versed ativan fentanyl

propofol Propofol (Diprivan) is used for the induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures that use a local anesthetic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in the ICU. pg 921

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: understanding of the pharmacodynamics of vecuronium. goals for recovery. renal and hepatic status. blood glucose levels

renal and hepatic status. 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. pg 924