medication/pain

b

A buccal medication acts ______ on the mucosa or _____ as it is swallowed in the persons saliva. A. systemically, locally B. locally, systemically

A (Calls the health care provider, and questions the order) (Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.)

A health care provider writes the following order for an opioidnaive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action: A) Calls the health care provider, and questions the order B) Applies the patch the third postoperative day C) Applies the patch as soon as the patient reports pain D) Places the patch as close to the hip dressing as possible

b

A medication is delivered by the Z-track method when the nurse: A. Use a special syringe designed for Z-track injections B. Pulls laterally and downward on skin before inserting the needle C. Administers the injection in the muscle of the anterior lateral aspect of the thigh D. Injects the needle in a separate spot for each dose on a Z-shaped grid on the abdomen

B (The time interval) (Controlled- or extended-release opioid formulations such as OxyContin are available for administration every 8 to 12 hours ATC. Health care providers should not order these long-acting formulations prn.)

A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? A) The drug B) The time interval C) The dose D) The route

d (Patient safety and assessing the patient are priorities when a medication error occurs.)

A nurse accidentally gives a patient a medication at the wrong time. The nurse's first priority is to: A) Complete an occurrence report. B) Notify the health care provider. C) Inform the charge nurse of the error. D) Assess the patient for adverse effects.

A (Offer information and ask the client if he is interested in trying a relaxation technique.) (Providing information will help the client to make an informed decision. A provider's order is not required for relaxation therapy. Providing reassurance may negate the client's fear. Providing more information without validating this as a need may increase his anxiety. The nurse should not give any therapy without informing the client and obtaining his consent. Telling him to relax does not acknowledge the impact of his anxiety.)

A nurse admits a client for abdominal surgery. The client's initial vital signs are temperature 37° C (98.6° F), pulse 98/min, respirations 20/min, and blood pressure 148/88 mm Hg. The client states, "I am really worried. This is the first surgery I have ever had." Which of the following is an appropriate use of a complementary alternative intervention? A. Offer information and ask the client if he is interested in trying a relaxation technique. B. Call the provider and get permission to use relaxation techniques with the client. C. Provide the client with reassurance and information about the procedure. D. Give the client a therapeutic back massage and tell him to try to relax.

c (younger than 3)

A nurse is administering eardrops to an 3-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the medication? A) Outward B) Back C) Down and back D) Upward and outward

d (Eardrops are administered with the ear positioned upward and outward for patients greater than 3 years of age.)

A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the medication? A) Outward B) Back C) Upward and back D) Upward and outward

c (Do not ignore patient or caregiver concerns; always verify orders whenever a medication is questioned before administering it.)

A nurse is administering medications to a 4-year-old patient. After he or she explains which medications are being given, the mother states, "I don't remember my child having that medication before." What is the nurse's next action? A) Give the medications B) Identify the patient using two patient identifiers C) Withhold the medications and verify the medication orders D) Provide medication education to the mother to help her better understand her child's medications

B (Pain rating of 9 on a scale of 0 to 10) (The client's self-report of pain using a standardized pain scale is the most reliable indicator of pain. Vital signs, nonverbal communication, and other actions may be indicators of pain, but are not the most reliable.)

A nurse is caring for a postoperative client. Which of the following assessment findings is the most reliable indicator that the client is experiencing pain? A. Blood pressure of 166/90 mm Hg B. Pain rating of 9 on a scale of 0 to 10 C. Client grimaces when bed is moved D. Client refuses to eat breakfast

B ("My pain feels like a tight feeling in my chest.") (Option B describes the quality of the pain, referring to how the pain feels to the client. This is typically a description such as throbbing, sharp, dull, or tight feeling. Option A describes associated symptoms such as difficulty sleeping, nausea, and anxiety. Option C describes the timing of the pain. Option D describes a relieving factor.)

A nurse is performing a pain assessment on a client. Which of the following subjective data describes the quality of the client's pain? A. "My pain is so bad that I cannot sleep at night." B. "My pain feels like a tight feeling in my chest." C. "My pain started last week after I went for a hike." D. "My pain feels better if I rest in an upright position."

b (Patients need to know information about their medications so they can take them correctly and safely.)

A nursing student takes a patient's antibiotic to his room. The patient asks the nursing student what it is and why he should take it. Which information does the nursing student include when replying to the patient? A) Only the patient's physician can give this information. B) The student provides the name of the medication and a description of its desired effect. C) Information about medications is confidential and cannot be shared. D) He has to speak with his assigned nurse about this.

a

A patient has an order for 2 puffs of a bronchodilator via a metered-dose inhaler. The nurse should teach the patient to: A. Start breathing in while compressing the canister B. Hold the inspired breath for several seconds C. Deliver 2 puffs with each inspiration D. Inhale slowly for 8-10 seconds

B (Stimulant laxative) (Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administer stimulant laxatives, not simple stool softeners, to prevent and treat constipation.)

A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? A) Stool softener B) Stimulant laxative C) H 2 receptor blocker D) Proton pump inhibitor

c (When an IV medication infiltrates, stop giving the medication and follow agency policy.)

A patient is receiving an intravenous (IV) push medication. If the drug infiltrates into the outer tissues, the nurse: A) Continues to let the IV run. B) Applies a warm compress to the infiltrated site. C) Stops the administration of the medication and follows agency policy. D) Should not worry about this because vesicant filtration is not a problem.

16 (Two puffs × 6 times a day = 12 puffs per day; 200 puffs/12 puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a total of 17 days.)

A patient is taking albuterol through a pressurized metered dose inhaler (pMDI) that contains a total of 200 puffs. The patient takes 2 puffs every 4 hours. How many days will the pMDI last? __________ days

d

A patient is to receive cephalexin (Kefl ex) 500 mg PO. The pharmacy has sent 250-mg tablets. How many tablets does the nurse administer? A) ½ tablet B) 1 tablet C) 1 ½ tablets D) 2 tablets

c (A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications.)

A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse? A) Set up the follow-up appointments with the physician for the patient. B) Ensure that someone will provide housekeeping for the patient at home. C) Ensure that the home care agency is aware of medication and health teaching needs. D) Make sure that the patient's family knows how to safely bathe him or her and provide mouth care.

D (Assess the characteristics of the pain.) (It is necessary to monitor pain on a regular basis along with other vital signs. It is important for the nurse to understand that pain assessment is not simply a number.)

A patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse's first action is to: A) Call the patient's health care provider. B) Administer pain medication as ordered. C) Check the patient's vital signs. D) Assess the characteristics of the pain.

B (Request to have the ordered changed to ATC for the first 48 hours.) (The American Pain Society (2003) states that, if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.)

A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider's order reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate? A) No action is required by the nurse because the order is appropriate. B) Request to have the ordered changed to ATC for the first 48 hours. C) Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn. D) Begin the Vicodin when the patient shows nonverbal symptoms of pain.

D (Physical dependence.) (Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.)

A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of: A) Addiction. B) Tolerance. C) Pseudoaddiction. D) Physical dependence.

A (The sedative administered may have helped him sleep, but assessment of pain is still needed.) (Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness and impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.)

A postoperative patient is currently asleep. Therefore the nurse knows that: A) The sedative administered may have helped him sleep, but assessment of pain is still needed. B) The intravenous (IV) pain medication is effectively relieving his pain. C) Pain assessment is not necessary. D) The patient can be switched

d

A postoperative patient is receiving morphine sulfate via PCA. The nurse assesses that the patient's respirations are depressed. The effects of the morphine sulfate can be classified as A. Allergic. B. Idiosyncratic. C. Therapeutic. D. Toxic.

D (Assess patient's vital signs every 15 minutes for 2 hours) (Reassess patients who receive naloxone every 15 minutes for 2 hours following drug administration because the duration of the opioid may be longer than the duration of the naloxone and respiratory depression may return.)

After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient' s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action: A) Discontinue all ordered opioids B) Close the room door to allow the patient to recover C) Administer the remaining naloxone over 4 minutes D) Assess patient's vital signs every 15 minutes for 2 hours

b (Nursing students cannot take orders.)

After seeing a patient, the physician gives a nursing student a verbal order for a new medication. The nursing student first needs to: A) Follow ISMP guidelines for safe medication abbreviations. B) Explain to the physician that the order needs to be given to a registered nurse. C) Write down the order on the patient's order sheet and read it back to the physician. D) Ensure that the six rights of medication administration are followed when giving the medication.

a (increased effect)

Alcohol has an ________ effect on antihistamines, antidepressants, barbiturates, and narcotics because alcohol is a central nervous system (CNS) depressant. A. synergistic effect B. antagonistic effect

b

Angle of Insertion of 15 Degrees is associated with A. Subcutaneous B. Intradermal C. Intramuscular/Subcutaneous D. Dermal

a

Angle of Insertion of 45 to 90 degrees is associated with A. Subcutaneous B. Intradermal C. Intramuscular/Subcutaneous D. Dermal

c

Angle of Insertion of only 90 degrees is associated with A. Subcutaneous B. Intradermal C. Intramuscular D. Subcutaneous

Transduction

Begins in the periphery when a pain-producing stimulus sends an impulse across a peripheral nerve fiber (nociceptor), initiating an action potential.

a

Clear fluid containing water and /or alcohol; often sweetened A. Elixir B. Extract C. Syrup D. Liniment

PNS

Continuous, severe or deep visceral pain will activate which brach of the nervous system? Resulting in - Pallor - Muscle Tension - Decreased HR and BP - Tachypnea + Irregular

Association cortex

Determines how we feel about pain

a

Food delays stomach emptying, which may decrease the therapeutic effects of oral medications. When liquid medications are not available, crush simple tablets or open gelatin capsules and dilute in sterile water. Do not use tap water. Tap water often contains contaminants (e.g., pathogens, heavy metals) that can interact with a medication and affect its bioavailability. If a medication needs to be given on an empty stomach or is not compatible with the feeding, it needs to be held at least 30 minutes before or 30 minutes after medication administration. a

b

For nasal sprays it's best to A. Pinch the nares of the nose after administrating the drops B. Have the patient do it themselves C. Blow the nose 5 minutes after administration D. Place the patient in posterior position

d

Given when the patient requires it. A, STAT B. Routine/Standing C. Single D. PRN

Chronic

Identify the Pain Not protective Greater than 6 months Can not always identify the cause of pain Delays healing Interrupts life High rates of correlating depression Pseudoaddiction Holistic therapies

Acute

Identify the Pain Protective Less than 6 months Can identify cause of pain Delays healing

b (Redness, warmth, and tenderness at the IV site are signs of phlebitis.)

If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects: A) Sepsis. B) Phlebitis. C) Infiltration. D) Fluid overload.

d

In a proportion, the first and last numbers are called the A. Means B. Averages C. Estimates D. Extremes

a

In a proportion, the second and third numbers are called the A. Means B. Averages C. Estimates D. Extremes

a

Instill eardrops at ____________ to prevent vertigo, dizziness, or nausea. A. room temperature B. below room temperature C. above room temperature D. at patient's desired temperature

b ( filtered needle prevents glass particles from being drawn into the syringe)

It is most important for the nurse to use a filtered needle when preparing parenteral medication that: A. Has to be reconstituted B. Is supplied in an ampule C. Appears cloudy in a vial D. Is to be mixed with another medication

c

Manufactures choose _____ (ex. Tylenol, Panadol) A. Chemical name B. Generic name C. Trade name

c

Medication dissolved in a concentrated sugar solution A. Elixir B. Extract C. Syrup D. Liniment

a

Medications whose early or delayed administration of maintenance doses more than 30 minutes before or after the scheduled dose most likely will cause harm or will result in subtherapeutic responses in a patient. A. Time-critical medications B. Non-time-critical medications

a

Method of injection prevents deposit of medication into sensitive tissue.The needle remains inserted for 10 seconds to allow the medication to disperse evenly rather than channeling back up the track of the needle. Place the ulnar side of the nondominant hand just below the site, and pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm (1 to 1 1/2 inches) laterally or downward. Hold the skin in this position until you administer the injection. Release the skin after withdrawing the needle. This leaves a zigzag path that seals the needle track where tissue planes slide across one another. The medication cannot escape from the muscle tissue. Injections using this technique result in less discomfort and decrease the occurrence of lesions at the injection site A. Z-track method B. IM method C. S way D. MIR method

c

Minimum blood serum concentration before next scheduled dose A. Onset B. Plateau C. Trough D. Duration

b

Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following? A. Medication before administering it B. Medication after administering it C. Rationale for administering it D. Prescriber rationale for prescribing it

a (avoids mucosal irritation)

On buccal you ______alternate cheeks with each subsequent dose. A. should B. shouldn't

Modulation

Once the brain perceives the pain, inhibitory neurotransmitters work to stop the transmission of pain and help produce an analgesic effect

Transmission

Pain impulse travels to nervous system with the help of some excitatory neurotransmitters: Prostglandins Bradykinin Substance P Histamine

Breakthrough Pain

Pain that extends beyond treated steady chronic pain

Incident Pain

Pain that is predictable and elicited by specific behaviors

Spontaneous Pain

Pain that is unpredictable and not associated with any activity or event

End-of-dose Failure Pain

Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic

Perception

Point at which a person is aware of pain

b

Point at which blood serum concentration is reached and maintained A. Onset B. Plateau C. Trough D. Duration

b

Small, flexible oval (similar to contact lens) consisting of two soft, outer layers and a middle layer containing medication; slowly releases medication when moistened by ocular fluid. A. Paste B. Intraocular disk C. Syrup D. Liniment

d

Syringes have needles that are twisted onto the tip and lock themselves in place. This design prevents inadvertent removal of the needle. A. Non-Luer-Lok B. Barrel tip C.tuberculin D. Luer-Lok

b

Syrup or dried form of pharmacologically active medication, usually made by evaporating solution A. Elixir B. Extract C. Syrup D. Liniment

b

The easiest and the most commonly used route. Have a slower onset of action and a more prolonged effect than parenteral medications. Patients generally prefer this route. A. Topical B. Oral C. Intraocular D. Inhalation

b

The first American law designed to regulate medications was the_________________. This law simply requires all medications to be free of impure products. A. Food and Safety Act B. Pure Food and Drug Act C. Pure Food Act D. Meat Inspection Decree

d

The instructions with a medication states to use the Z-track technique when administrating the injection. Therefore, the nurse should: A. Pinch the site throughout the injection B. Massage the site after the needle is removed C. Remove the needle immediately after the medication is injected D. Change the needle after the medication is drawn into the syringe

c

The main organ for excretion A. Liver B. Large Intestine C. Kidney D. Small Intestine

a (Enteric-coated or sustained-release capsules should not be crushed; the nurse needs to contact the prescriber to change the medication to a form that is liquid or can be crushed.)

The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? A) Ask the prescriber to change the order B) Crush the pill with a mortar and pestle C) Hide the capsule in a piece of solid food D) Open the capsule and sprinkle it over pudding

a

The nurse is administrating an intradermal injection. The nurse inserts the needle at: A. 15 degree angle B. 30 degree angle C. 45 degree angle D. 90 degree angle

b (You must have the right documentation and clarify all orders with the prescriber before administering medications.)

The nurse is having difficulty reading a physician's order for a medication. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take? A) Call a pharmacist to interpret the order B) Call the physician to have the order clarified C) Consult the unit manager to help interpret the order D) Ask the unit secretary to interpret the physician's handwriting

d (All other sites,except upper chest, okay for injection but abdomen provides fastest rate of absorption)

The nurse is preparing to administer a subcutaneous injection of insulin. The nurse knows that the best site to use to promotes its absorption is the patient's: A. Upper lateral arms B. Anterior thighs C. Upper chest D. Abdomen

d

The nurse is to administer an injection. To limit discomfort, the nurse should: A. Test for blood return before injecting the medication B. Apply ice to area before injection C. Pinch the area while inserting the needle D. Inject the medication slowly

a

The nurse must administer a medication into the ear of an adult. To limit patient discomfort when administrating ear drops, the nurse should A. Warm the solution to body temperature B. Place the patient in a comfortable position C. Pull the pinna of the eat upward and backward D. Instill the fluid in the center of the auditory canal

c

The nurse must administer an intradermal injection. The technique uniquely related to the administration of an intradermal injection is: A. Utilizing air-bubble technique B. Pinching the skin during needle insertion C. Inserting the needle with the bevel up D. Massaging the area after the fluid is instilled

C (The amount of daily acetaminophen) (The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone [Percocet]) because it reduces the dose of opioid needed to achieve successful pain control.)

The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325) two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? A) The patient's level of pain B) The potential for addiction C) The amount of daily acetaminophen D) The risk for gastrointestinal bleeding

a

The nurse plans to administer a 3-mL intramuscular injection. The nurse understands that the least desirable muscle for the administration of this medication is the: A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis

a

The nurse plans to administer a bolus dose of medication via a currently running intravenous infusion. The nurse should first: A. Ensure that it is compatible with the IV solution being infused B. Pinch the tubing above the infusion port while still instilling the bolus C. Instill it into a 50 mL bag of NS and infuse it via a secondary line D. Administer it via a volume-control infusion set with a micro-drip tubing

b (The order from the prescriber needs to indicate the route of administration.)

The nurse receives an order to start giving a loop diuretic to a patient to help lower his or her blood pressure. The nurse determines the appropriate route for administering the diuretic according to: A) Hospital policy. B) The prescriber's orders. C) The type of medication ordered. D) The patient's size and muscle mass.

a (When patients refuse a medication, first ask why they are refusing it.)

The nurse takes a medication to a patient, and the patient tells him or her to take it away because she is not going to take it. What is the nurse's next action? A) Ask the patient's reason for refusal B) Explain that she must take the medication C) Take the medication away and chart the patient's refusal D) Tell the patient that her physician knows what is best for her

c

The nurse teaches a patient about taking a sublingual nitroglycerine tablet. The nurse evaluates that the patient understands the teaching when the patient states, "I should place it: A. On my skin." B. Inside my cheek." C. Under my tongue." D. In the lower lid of my eyelid."

b

The nurse understands that the route of drug administration not considered parenteral is: A. Epidural B. Transdermal C. Subcutaneous D. Intramuscular

d (1 tablespoon = 15 mL; 2 tablespoons = 30 mL.)

The patient has an order for 2 tablespoons of Milk of Magnesia. How much medication does the nurse give him or her? A) 2 mL B) 5 mL C) 16 mL D) 30 mL

B (The patient's report of pain is the best method for assessing the pain.) (A patient's self-report of pain is the single most reliable indicator of the existence and intensity of pain.)

The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain? A) The patient's wife is the best resource for determining the level of pain since she has been with him continually for the entire day. B) The patient's report of pain is the best method for assessing the pain. C) The patient's health care provider has the best knowledge of the level of pain that the patient that should be experiencing. D) The nurse is the most experienced at assessing pain.

b

The tip of a needle, or the_______. Long _______ tips are sharper and narrower, minimizing discomfort when entering tissue used for subcutaneous or IM injection. A. Shaft B. Bevel C. Hub D. Gauge number

a

Thick ointment; absorbed through the skin more slowly than ointment; often used for skin protection. A. Paste B. Intraocular disk C. Syrup D. Liniment

a

Time it takes for a medication to produce a response A. Onset B. Plateau C. Trough D. Duration

a

Tubes enter the patient's mouth and end in the trachea. A. Endotracheal B. tracheostomy C. buccal D. Intraventricular

Somatic, Visceral

Two types of Nociceptive Pain

d

Usually contains alcohol, oil, or soapy, emollient applied to skin. A. Elixir B. Extract C. Syrup D. Liniment

d

When a patient takes two or more medications to treat the same illness, takes two or more medications from the same chemical class, uses two or more medications with the same or similar actions to treat several disorders simultaneously, or mixes nutritional supplements or herbal products with medications. Taking over-the-counter (OTC) medications frequently, lack of knowledge about medications, incorrect beliefs about medications, and visiting several health care providers to treat different illnesses increase the risk for this. A.Multipharmacy B. Dipharmacological effects C. Pharmacy intended D. Polypharmacy

B, D (Serotonin and endorphins are natural substances within the body that decrease pain transmission. Substance P, bradykinin, and histamine all increase pain transmission.)

When caring for clients experiencing pain, a nurse should recognize that which of the following substances decrease pain transmission. (Select all that apply.) A. Substance P B. Serotonin C. Bradykinin D. Endorphins E. Histamine

c

When place a foam, jelly or cream into a patient's vaginal canal, the nurse should use. A. A finger B. A gauze pad C. An applicator D. An irrigation kit

D (TENS electrodes are applied near or directly on the site of pain.) (TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.)

When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include? A) TENS works by causing distraction. B) TENS therapy does not require a health care provider's order. C) TENS requires an electrical source for use. D) TENS electrodes are applied near or directly on the site of pain.

A, B (Cold therapies are particularly effective for pain relief. Ice massage involves applying a frozen cup of ice firmly over the skin. When numbness occurs, remove the ice for usually 5 to 10 minutes.)

When using ice massage for pain relief, which of the following are correct? (Select all that apply.) A) Apply ice using firm pressure over skin. B) Apply ice until numbness occurs and remove the ice for 5 to 10 minutes. C) Apply ice until numbness occurs and discontinue application. D) Apply ice for no longer than 10 minutes.

a

Whether or not you actually administer the medication, you remain responsible for monitoring the integrity of the medication delivery system, understanding the therapeutic value of the medication, and evaluating the patient's response to the therapy. A

c (subcutaneous injections are at 90 degrees)

Which characteristic of a subcutaneous injection of 5000 units of heparin should be implemented by the nurse? A. 3-mL B. 22-gauge needle C. 90 degree angle of insertion D. 1 1/2 inch needle length

B (Difficulty arousing the patient) (Opioid-naive patients may develop a rare adverse effect of respiratory depression, and sedation always occurs before respiratory depression.)

Which of the following signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? A) Oxygen saturation of 95% B) Difficulty arousing the patient C) Respiratory rate of 10 breaths/min D) Pain intensity rating of 5 on a scale of 0 to 10

B, C, D (Nociceptive pain is usually localized, responds well to opioid analgesics, and may result in referred pain. Neuropathic pain arises from damaged pain nerves and is associated with phantom limb pain.)

Which of the following statements describes nociceptive pain? (Select all that apply.) A. Arises from nerves by damaged pain B. Usually well localized C. Responds well to opioid analgesics D. May result in referred pain E. Associated with phantom limb pain

A (Only the patient should push the button.) (Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to "push the button" for the patient.)

Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? A) Only the patient should push the button. B) Do not use the PCA until the pain is severe. C) The PCA prevents overdoses from occurring. D) Notify the nurse when the button is pushed.

A (Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs "NSAIDs" to opioids.) (The WHO analgesic ladder transitions from the use of nonopioids "NSAIDS" with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.)

While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends: A) Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs (NSAIDs) to opioids. B) Using acetaminophen for refractory pain. C) Limiting the use of opioids because of the likelihood of side effects. D) Avoiding total sedation, regardless of how severe the pain is.

d

You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may experience problems with A. Absorption. B. Biotransformation. C. Distribution. D. Excretion

b

medications are used on a daily schedule to prevent acute respiratory distress. The effects of maintenance medications start within hours of administration and last for a longer time than those of rescue medications. A. Respiratory B. Maintenance C. Prolonged D. Dire