Chapter 14,15

A client is admitted to the hospital for major surgery. The OR nurse is explaining major routes of applying local anesthesia to the client. Which routes should be included in the teaching? (Select all that apply.) Spinal Topical Epidural Tendon block Infiltration

A b c e

The nurse is caring for a client who has been diagnosed with migraine headaches that occur every 2-3 days and placed on preventive therapy with the beta blocker propranolol (Inderal). Which data indicates the medica- tion is effective? A. The client supplemented Inderal with sumatriptan (Imitrex) four times. B. The apical pulse is 78 beats per minute for this client. C. The client had only one headache in the past week. D. The client has developed orthostatic hypotension.

C

The nurse is caring for a client who is 24 hours postoperative cholecystectomy. The client has a meperidine (Demerol) PCA pump. Which symptom should be reported to the physician immediately? Constipation Respiratory rate of 18 breaths per minute Urine output of 15 ml per hour Urine output of 35 ml per hour

C

A client complains of pain that is a generalized dull, throbbing, or aching pain. What type of pain does the nurse document that this client is experiencing? A. Visceral pain B. Acute pain C. Somatic pain D. Neuropathic pain

A

A client has taken OTC acetaminophen (Tylenol) and ibuprofen (Motrin) for migraine headaches without relief. Which class of medication would the nurse anticipate being ordered? A. Triptans B. Calcium channel blockers C. Beta-adrenergic blockers D. Tricyclic antidepressants

A

A client with a history of depression is having a thyroidectomy. The client informs the nurse about the use of herbal remedies for depression. What drug would the nurse anesthetist need to know about prior to surgery? Saint John's Wort Comfrey Senna Echinacea

A

The client is prescribed propranolol (Inderal) for migraine headache prophylaxis. The nurse prepares discharge instruction based on the fact that propranolol (Inderal) belongs to which class of medication? A. Beta blocker B. Calcium channel blocker C. Ergot alkaloid D. Triptan

A

The client reports severe headaches that are preceded by flashing lights and strange smells. How would the nurse appropriately document this phenomenon? A. An aura of a migraine B. A tension headache C.An adverse reaction to acetaminophen (Tylenol) d. Combining food with NSAIDs

A

The nurse is caring for a client who is in a state of consciousness yet insensitive to pain and unaware of the surroundings, caused by combining the opioid fentanyl (Sublimaze) with the antipsychotic agent droperidol (In- apsine). What state of consciousness is this client experiencing? Neurolept analgesia Surface analgesia Dissociative analgesia Regional analgesia

A

The nurse is caring for two clients with the same diagnosis. One client complains of pain rated 6/10 and the other client complains of pain 1/10. How does the nurse explain why these two clients experience such differ- ences in their pain rating? A. The client's reaction to pain is a subjective experience. B. The client's reaction to pain should be the same. C. The client with the pain rated 1/10 does not want to complain. D. One client has progressed further in the disease.

A

What is the mechanism of action of sumatriptan (Imitrex) and other triptans? They cause vasoconstriction of cranial arteries. They block prostaglandin synthesis. They block COX-2. They affect mu receptors.

A

When explaining a surgical procedure to a client, the nurse tells the client that a small amount of which drug is sometimes added to the anesthetic solution to lengthen the duration of action of the anesthetic? Epinephrine (Adrenaline) Diazepam (Valium) Diphenhydramine (Benadryl) Lidocaine (Xylocaine)

A

Which statements are true regarding opioid receptors? A. Opioid blockers such as naloxone (Narcan) inhibit both the mu and kappa receptors. B. Some opioids stimulate a particular receptor; others block a receptor. C. Opioid blockers such as naloxone (Narcan) stimulate both the mu and kappa receptors. D. Opioids interact with mu (types one and two) and kappa receptors. E. Opioids interact with sigma, delta, and epsilon receptors only.

A B D

Which statements are true regarding pain medications? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. A. Opioids act within the CNS. B. NSAIDs act at the peripheral level. C. NSAIDs act within the CNS. D. Opioids act at the peripheral level. E. Narcotics act within the CNS.

A B E

A client presents with chronic pain that has recently increased in severity. The nurse knows this type of pain can be increased with which occurrence? (Select all that apply.) A. Depression B. Overuse of OTC pain relievers C. Anxiety D. Fatigue E. New pain medication

A C D

The nurse instructs a client on nonpharmacologic therapies for pain management. Which techniques should be included in this teaching? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Reiki Heat or cold packs Massage Anti-inflammatory drugs Opioid drugs

A b c

A client comes into the clinic complaining of jaw pain, and admits to teeth gritting at night. The client wants natural remedies, no prescriptive drugs. Which over-the-counter natural remedy is the most appropriate for this client? Acetaminophen (Tylenol) Pimpinella Eugenia Cooking sherry

B

A client who was admitted with gastrointestinal bleeding secondary to aspirin use therapy is being discharged. The client asks why acetaminophen (Tylenol) doesn't work as well as the aspirin the client had been taking. What would be the nurse's best response? "You should take double the prescribed dose of Tylenol." " Tylenol does not reduce inflammation." "Tylenol is only appropriate for severe pain." "Tylenol and aspirin are the same drug."

B

An OR nurse is quizzing a group of students who are observing in the surgical suite. The nurse asks the stu-dents how many stages of anesthesia there are. Which answer by the students is correct? Two Four Three One

B

The client asks which type of medications will be given for severe pain. Which response by the nurse is most appropriate? A. Acetaminophen (Tylenol) B. Opioids C. NSAIDs D. Beta blockers

B

The nurse is admitting a client to the floor with a diagnosis of migraine headache. The client relates she has had this type of headache for 12 years. On admission, the client states the headaches are coming more fre- quently, which has forced her to quit her job. What type of pain is this client experiencing? Surgical pain Chronic pain Neuropathic pain Acute pain

B

The nurse is caring for a client who has a morphine (Astramorph) PCA. Which medication should the nurse en- sure is readily available? A. Meperidine (Demerol) B. Naloxone hydrochloride (Narcan) C. Butorphanol tartrate (Stadol) D. Naltrexone hydrochloride (Trexan)

B

The nurse is preparing to administer thiopental (Penothal) to a client. Which route of administration is correct? Oral Intravenous Inhaled Topical

B

The nurse is providing discharge teaching to a client who is to take aspirin 325 mg per day. What statement by the client indicates an understanding of the teaching? "Now that I take an aspirin a day, my gastric ulcer will be healed." "I will check with my physician before taking any OTC medications." "Now that I take aspirin, I can no longer take my acetaminophen (Tylenol)." "I can still take my ibuprofen every day, as I did before taking the aspirin

B

Which medication is not an ester? Chloroprocaine (Nesacaine) Bupivicaine (Marcaine) Benzocaine (Americaine) Tetracaine (Pontocaine)

B

A client is being discharged with a prescription for oxycodone HCl (Oxycontin). Which discharge instructions are appropriate? (Select all that apply.) A. Increase the dose of oxycodone if the pain returns. B.Maintain adequate fluid intake. C. Withhold the medication if respirations are fewer than 12 breaths per minute. D. Use OTC sleep-inducing antihistamines when needed. E. Use OTC medications for constipation, if needed

B C E

A client is having major surgery tomorrow. Which statement by the client indicates understanding of the preop teaching? "I will probably feel pain during the procedure." "I won't feel a thing because I will be asleep." "I will lose consciousness, movement, and memory." "I will retain all memory of my procedure."

C

A client is receiving a local anesthetic. What instruction is most appropriate by the nurse? Never take at home. Take only when drowsiness is present. Report any unusual heart palpitations, lightheadedness, drowsiness, or confusion. Allow family members to use as needed.

C

A nurse educator is instructing students about the history of anesthetics. Which type of anesthetic would the educator tell the students was the ester of choice from the mid-1900s to the 1960s? Cocaine Benzocaine (Solarcaine) Procaine (Novocain) Lidocaine (Xylocaine)

C

The client asks the nurse about the uses of nitrous oxide. Which statement is the most appropriate by the nurse? Nitrous oxide is rarely used in any setting. Nitrous oxide is often used for local anesthesia. Nitrous oxide is often used for dental procedures. Nitrous oxide is often used for general anesthesia.

C

The client asks the nurse how local anesthetics work. Which response by the nurse is most appropriate? They numb the skin. They block calcium channels. They block sodium channels. They increase sensation.

C

The nurse educator asks a group of students what occurs when sensation is lost to a limited part of the body without loss of consciousness. Which answer by the student is correct? General anesthesia Surgical anesthesia Local anesthesia Total anesthesia

C

The nurse educator is teaching a group of students about inhaled anesthetics. Which anesthetic would be in- correct if stated by the student? Methoxyflurane (Penthrane) Isoflurane (Forane) Propofol (Diprivan) Halothane (Fluothane)

C

The nurse is performing the AM assessment on a client who is postoperative cholecystectomy. The client states he needs his pain medication. The client has meperidine (Demerol) 50 mg IM ordered for pain. What must the nurse assess before administering a narcotic? The intensity of the pain only The last time the client had a bowel movement The quality, intensity, location, and duration of pain The quality of the pain only

C

What is the appropriate term for the third stage of anesthesia? Topical anesthesia Local anesthesia Surgical anesthesia Balanced anesthesia

C

What should be included in the discharge instructions for a client diagnosed with cancer who is taking hy- drocodone with acetaminophen (Vicodin) PRN? Use Tylenol for any pain unrelieved by the Vicodin. Notify the physician if the medication relieves the pain. Increase the intake of fluids and roughage in the diet, because this medication can cause constipation. Take the medication only when the pain is greater than an 8 on a scale of 1-10.

C

A client having an abdominal resection also has a history of myasthenia gravis. Due to the risk of nitrous oxide, what does the nurse anticipate this client to be at a greater risk for developing? Increased intracranial pressure and respiratory depression Nausea and vomiting during surgery Increased cranial pressure and vomiting Respiratory depression and prolonged hypnotic effects

D

A nurse educator is teaching a group of students about gases used for anesthesia. Which response by the stu- dents indicates understanding of the material? Dibucaine (Nupercaine) is a gas used for anesthesia. Dyclonine (Dyclone) is a gas used for anesthesia. Pramoxine (Tronothane) is a gas used for anesthesia. Nitrous oxide is a gas used for anesthesia.

D

How many medications are used to rapidly cause unconsciousness and muscle relaxation and to maintain deep anesthesia? Always five medications Single medication Always two medications Multiple medications

D

The client has been prescribed Percocet for pain. What should the nurse advise this client to avoid? A. Green, leafy vegetables B. Increased fluids C. Vitamin supplements D. Acetaminophen (Tylenol)

D

The client with a headache rates the pain at a 3 on a 1-10 scale. Which medication would the nurse administer? Sumatriptan (Imitrex), subcutaneous Dihydroergotamine (D.H.E.45) intranasally Butorphanol (Stadol) IM Ibuprofen (Motrin) p.o.

D

The nurse is caring for a client receiving morphine sulfate 2-4 mg IV every 4 hours as needed for pain. The client's family calls the nurses' station to request pain medication for the client. When the nurse arrives in the room, the client is lying in the bed. The nurse obtains the following vital signs: BP 120/80, P 80, and R 8. What is the nurse's first action? Call the physician after giving the pain medication. Call the physician. Find out when the client had the last dose of medication. Withhold the medication.

D

The nurse is instructing a client on the proper procedure for taking an extended-release tablet. Which state- ment by the client indicates understanding of the instructions? "Because these are extended-release tablets, it is okay to chew them." Because these are extended-release tablets, it is okay to crush them." Because these are extended-release tablets, it is okay to break them in half." Because these are extended-release tablets, I must swallow them whole."

D

The nurse is providing care for a client who is taking acetaminophen (Tylenol). What should the nurse pay par- ticular attention to during the assessment? Respiratory rate Pulse rate Blood pressure Severe upper or lower abdominal pain

D

The nurse prepares to administer succinylcholine (Anectine) per the medication order. What does the nurse ex-pect after the medication has been administered? Loss of consciousness Light sedation Prevention of muscle contractions Total skeletal muscle relaxation

D

Which statement by the nurse is correct regarding treatment with methadone (Dolophine)? A. Methadone (Dolophine) can only be safely administered for 1 month. B. Methadone (Dolophine) is only administered when the client is tempted to use illegal drugs. C. Methadone (Dolophine) can only be administered by IV. D. Methadone (Dolophine) treatment continues for many months or years, until the patient decides to enter a to- tal withdrawal treatment program.

D