Pathopharm Exam 1 Review

unintended, undesirable, and often unpredictable severe responses to medication

adverse effects

acetaminophen patient and family teaching

advise patient to avoid alcohol consumption advise patient to notify health care professional and discontinue use if rash occurs caution patient to check labels on all OTC products

celecoxib therapeutic classification

anti-rheumatics

ibuprofen patient and family teaching

caution patient that drinking 3 or more glasses of alcohol a day with treatment may increase GI bleeding advise patient to consult health care prof. if rash, itching, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stool, or influenza-like symptoms or cardiovascular events arise

pain caused by damage to the nerves

central pain

a description of a drug using the nomenclature of chemistry

chemical name

chronic pain that is always present, but varies in intensity

chronic intractable benign pain

which consideration is the nurses concern when responding to the request of a hospice client who has severe pain and asks for another dose of oxycodone? a. prevent addiction b. determine why the medication is needed c. provide alternative comfort measures d. reduce the clients pain

d. reduce the clients pain

the property of an ideal drug: the nurse reassesses the patient 20-30 minutes after administering an opiate analgesic

effectiveness

frequent infections or infection with rare microbe and WBC count fewer than 5000/mm3 a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

f. neutropenia

movement into and out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

f. pharmacokinetics

high risk of bacterial infection a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

f. propofol

true or false: a depot intramuscular (IM) injection of an antibiotic to treat syphilis will be completely effective within 24 hours after administration

false

true or false: a drug that is selective for specific receptors will produce more unintended effects than a nonselective drug

false

true or false: activation of delta receptors is responsible for the delusions and delirium that are seen with certain opioids

false

true or false: adding potassium clavulanate to amoxicillin prevents the body's beta-lactamase enzyme from destroying the amoxicillin

false

true or false: an agonist drug blocks the stimulation of a receptor

false

true or false: an agonist-antagonist blocks pain when taken alone but improves the pain-relieving effect of another opioid if in the blood at the same time

false

true or false: antacids increase urinary excretion of alkaline drugs

false

true or false: aspirin, like most drugs, is primarily absorbed in the small intestine

false

a drugs non-propriety name

generic name

hydromorphone contraindications

hypersensitivity, asthma, respiratory depression, asthma, paralytic ileus, hepatic impairment

aspirin contraindications

hypersensitivity, bleeding disorders, cross-sensitivity

pain that is not associated with any known cause

idiopathic pain

genetic differences can cause uncommon drug responses. these are called ______ reactions

idiosyncratic

ibuprofen action

inhibits prostaglandin synthesis decreases pain and inflammation reduction of fever

acetaminophen action

inhibits prostaglandin synthesis in CNS that serve as mediators of pain and fever

the property of an ideal drug: the nurse explains that a generic form of a newly prescribed drug is available to a patient who has limited insurance coverage for drugs

low cost

acetaminophen indications

mild to moderate pain, fever

lidocaine assessments

monitor ECG continuously and BP and respiratory status frequently during administration

migraine treatment

nonspecific analgesics, aspirin-like drugs, opioid analgesics Senatorin receptor agonists ergot alkaloids beta-blockers antiepileptic drugs antidepressants

cluster headaches characteristics

occur in cluster attacks (lasts 15 min-2 hrs) severe, throbbing, unilateral pain near the eye one or two attacks a day for 2-3 months

hydrocodone therapeutic classification

opioid analgesic

celecoxib indications

osteoarthritis, rheumatoid arthritis, acute pain, primary dysmenorrhea

products that have similar or identical brand names that can contain different drugs and can be purchased without a prescription

over-the-counter (OTC) drugs

pain associated with psychological factors (emotional or mental) as opposed to physiological factors (injury or disease)

psychogenic pain

naloxone indication

reversal of CNS depression and respiratory depression due to opioid overdose

freedom from accidental injury

safety

true or false: a drug that stimulates the transcription factor receptors may not reach a peak therapeutic effect until taken regularly for days to weeks

true

true or false: a drug with extensive first-pass effect may be given sublingually to allow the drug to be absorbed directly into the systemic circulation

true

true or false: a prescriber may prescribe a drug solely because of its interaction with another drug

true

true or false: affinity is the strength of attraction between a drug and its receptor

true

true or false: maximal efficacy is defined as the largest effect that a drug can produce

true

true or false: p-glycoprotein transports many drugs out of the cell

true

true or false: pharmacodynamics includes the study of how drugs work

true

true or false: potency is defined as the dose of drug needed to get the desired effect

true

true or false: the ED50 is usually the recommended dose for the drug

true

true or false: the dose of oral morphine is higher than the intravenous (IV) dose because hepatic first pass metabolizes some of the drug before it reaches the central nervous system

true

oxycodone adverse reactions/side effects

constipation, confusion, sedation, respiratory depression

acetaminophen contraindications

hypersensitivity, with products containing alcohol, hepatic impairment/disease

morphine contraindications

hypersensitivity; respiratory depression, asthma

hydromorphone adverse reactions/ side effects

hypotension, constipation, confusion, sedation, respiratory depression

morphine adverse reactions/side effects

hypotension, constipation, confusion, sedation, respiratory depression

predictable pain that accompanies a movement or activity

incident pain

when a patient take a drug for a long time and becomes tolerant, the nurse would expect the prescriber to _______ the dose to achieve the desired effect.

increase

propofol indications

induction of general anesthesia

aspirin indications

inflammatory disorders including: rheumatoid arthritis and osteoarthritis mild to moderate pain fever

the nurse should instruct patients to dispose of aspirin tablets if they develop an odor that smells like _____

vinegar

originates from the internal body organs and the linings of body cavities; described as dull, deep, or aching

visceral pain

SELECT ALL THAT APPLY which nursing interventions would the nurse implement for a child undergoing treatment with opioid analgesics? 1. assessing the childs level of pain 2. administering oral medications with meals or snacks 3. assessing the childs verbal and nonverbal behaviors 4. documenting the childs age, weight, and height before treatment 5. monitoring and documenting the childs vital signs before they start therapy

1, 2, 3, 4

mechanisms of medication action

1. absorption 2. distribution 3. metabolism 4. excretion

the recommended maximum dose of acetaminophen for individuals who regularly consume alcohol is ___

2000mg

hydromorphone assessment

Assess BP, pulse, and respirations before and periodically during administration Assess bowel function routinely assess for risk of opioid addiction

morphine action

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.

celecoxib adverse reactions/side effects

HF, myocardial infarction, stroke, thrombosis, drug reaction with eosinophilia, DRESS, exfoliative dermatitis, stevens-johnson syndrome, toxic epidural necrolysis, GI bleeding

hydrocodone contraindications

Hypersensitivity, paralytic ileus, respiratory depression, severe asthma

lidocaine actions

IV/IM: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes without an effect on the heart Local: produces local anesthesia by inhibiting the transport of ions across neuronal membranes, preventing initiation and conduction of nerve impulses

celecoxib action

Inhibits enzyme COX-2 which is required for prostaglandin synthesis

SELECT ALL THAT APPLY which methods qualify as alternative therapies for pain? a. prayer b. hypnosis c. medication d. aromatherapy e. guided imagery

a, b, d, e

SELCT ALL THAT APPLY which action would the nurse take before administering each dose in client who takes oxycodone every 3 hrs for pain after surgery? a. count the clients respiratory rate b. examine the client for petechiae c. observe the client for movement disorders d. ask the client to rate the level of pain e. assess the clients level of consciousness

a, d, e

movement into the blood a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

a. absorption

numbness and tingling around the mouth and respiratory distress a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

a. anaphylaxis

tachycardia and hypertension can occur in response to abrupt increase in blood levels a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

a. desflurane

which action would the nurse take when a client reports pain and burning at a peripheral intravenous (IV) site after the nurse has flushed the saline lock in another site? a. remove the IV catheter and restart the saline lock in another site b. document the findings per protocol and reassess the site in 8 hours c. flush the IV catheter and saline lock again vigorously with normal saline d. change the dressing and apply a new clean dressing per IV care protocol

a. remove the IV catheter and restart the saline lock in another site

the medical use of drugs a. therapeutics b. drug c. pharmacology d. clinical pharmacology

a. therapeutics

acetaminophen therapeutic classification

antipyretics nonopioid analgesic

ibuprofen therapeutic classification

antipyretics nonopioid analgesics

propofol adverse reactions/side effects

apnea, bradycardia, hypotension, burning, pain, stinging, propofol infusion syndrome

hydrocodone assessment

assess BP, pulse, and reparations before and during administration assess for opioid addiction

naloxone action

blocks the effects of opioids

dose requirements for drugs with a narrow therapeutic range are more precisely calculated based on the patients _____

body surface area

the names under which a drug is marketed

brand name

delirium and unpleasant psychologic reactions can occur postoperatively a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

e. ketamine

change in drug structure a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

e. metabolism

eGFR 50 mL/min and urinary output 750 mL/day; fluid intake 1500 mL/day a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

e. nephrotoxicity

true or false: buprenorphine has less constipation and sedative effects than morphine

false

true or false: first-pass effect means most of the drug is activated by the liver, so it must be administered orally

false

ibuprofen adverse reactions/side effects

headache, HF, myocardial infarction, stroke, drug reaction with eosinophilia, exfoliative dermatitis, stevens-johnson syndrome, toxic epidermal necrolysis, GI bleeding, hepatitis, constipation, dyspepsia, nausea, vomiting, anaphylaxis

naloxone contraindications

hypersensitivity

propofol contraindications

hypersensitivity

oxycodone contraindications

hypersensitivity respiratory depression paralytic ileus asthma

ibuprofen contraindications

hypersensitivity, GI bleeding, severe HF, history of MI, CABG surgery

celecoxib contraindications

hypersensitivity, asthma, CABG surgery

originates from nociceptors located in the skin; usually localized and described as being sharp

somatic pain

the property of an ideal drug: the nurse is aware that African Americans often do not respond as well as caucasian to angiotensin-converting enzyme inhibitors (ACEIs) prescribed for hypertension

predictably

aspirin action

produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins decreases platelet aggregation

the property of an ideal drug: the nurse researches if an antidote is available when administering drugs that have the potential to cause significant harm or death

reversible action

aspirin should not be taken by children, especially for symptoms of viral illness, because of the risk of _____

reye's syndrome

the property of an ideal drug: when a patient is, or could be pregnant, the nurse researches the pregnancy and lactation information for every drug administered

safety

the property of an ideal drug: The nurse teaches a patient to avoid engaging in hazardous activities when taking an antihistamine for allergy symptoms.

selectivity

morphine indications

severe pain, pulmonary edema, pain associated with MI

propofol action

short-acting hypnotic produces amnesia

effects that are nearly unavoidable secondary drug effects at therapeutic doses are called ______ ______

side effects

____ is the reduction in drug responsiveness brought on by repeated dosing over a short time

tachyphylaxis

drugs that are _____ can harm a fetus if the patient takes the drug while she is pregnant

teratogenic

expected physiological response

therapeutic effects

migraine characteristics

throbbing head pain nausea and vomiting sensitivity to light and sound

when a medication accumulates in the blood due to impaired metabolism or excretion; excess amounts of medication within the body

toxic effects

____ is the detrimental physiologic effects caused by excessive drug dosing

toxicity

true or false: a patient who suddenly stops taking an antagonist drug may experience hypersensitivity of the receptor and overstimulation

true

true or false: a transport mechanism is needed for water-soluble drugs to enter a cell

true

true or false: adding a drug to a patients drug regimen can cause the other drugs to be metabolized more slowly or more rapidly

true

true or false: alcohol, bananas, cigarette smoking, chewing tobacco, chocolate candy, garlic, and grapefruit juice can interact with drugs and cause adverse effects

true

true or false: cell membranes are composed of fat with phosphate

true

true or false: chemotherapy is administered through a central intravenous line because chemotherapy is caustic to the vein and a large central vein has rapid blood flow, which dilutes and moves the medication quickly

true

true or false: drugs with high intrinsic activity cause an intense response

true

true or false: enkephalins, endorphins, and dynorphins are body substances with opioid properties

true

true or false: enteric drugs should not be crushed because crushing these preparations can cause stomach distress or cause the acid in the stomach to alter the drug

true

true or false: if a quaternary ammonium compound drug is injected into a vein it will produce effects, but it will not if taken orally

true

true or false: if a receptor is constantly bombarded by a drug, the cell can down-regulate and decrease the response to the drug

true

true or false: intestinal enzymes can release drugs from bile in the duodenum, causing the drug to be reabsorbed

true

true or false: the nurse should consult with the prescriber regarding adequate blood levels of oral drugs when a patient has persistent diarrhea

true

true or false: the protein-bound portion of a drug in circulation is not able to exert its action

true

true or false: the respiratory depression, physical dependence, and euphoria that occur with opioid analgesics are related to activation of mu opioid receptors

true

true or false: two drugs in the same therapeutic class with different recommended doses can have equal effects

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic allows for the use of less anesthetic

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic can cause adverse effects from the systemic absorption of the vasoconstrictor

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic causes local vasoconstriction

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic delays systemic absorption

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic reduces blood flow to the affected area

true

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic reduces the risk of toxicity

true

tue or false: an opiate is a drug that contains compounds found in opium, while an opioid may be a laboratory-created compound

true

a safe environment reduces the risk of possible illness and injury

underlying theory of safety

naloxone adverse reactions/side effects

ventricular arrhythmias

lidocaine indications

ventricular arrhythmias pain

when taking aspirin for its anti-platelet action, other non-steroidal anti-inflammatory drugs (NSAIDs) should be given at least ______ hours before aspirin

2

Predictable, unavoidable secondary effect

side effects

hydromorphone pharmacokinetics

absorption: well absorbed with oral, rectal, subcut, and IM administration distribution: widely; crosses the placenta; enters breast milk metabolism: liver excretion: renally

morphine therapeutic classification

opioid analgesic

oxycodone therapeutic classification

opioid analgesic

naloxone therapeutic classification

opioid antagonist

has a sudden onset as a result of an identifiable tissue injury

acute pain

_____ means cancer-causing

carcinogenic

hydrocodone indications

management of severe pain antitussive

is sensed in a region other than the site of origin

referred pain

____ is the antidote for acetaminophen overdose

acetylcysteine

acetaminophen adverse reactions/side effects

acute generalized exanthematous pustulosis, stevens-johnson syndrome, toxic epidermal necrolysis, hepatotoxicity

preoperative teaching for knee replacement surgery should include that the patient should discontinue high-dose aspirin therapy for _____ before surgery

1 week

the half-life of aspirin is 15-20 minutes, but the anti-platelet effects last ______

8 days

cluster headache treatment

Primary therapy directed at prophylaxis Glucocorticoids (prednisone and dexamethasone) Verapamil Lithium

acetaminophen pharmacokinetics

absorption: well following oral admin. IV results in complete bioavailability distribution: widely; crosses placenta; enters breast milk in low concentrations metabolism: by the liver excretion: renally

oxycodone pharmacokinetics

absorption: well from the GI tract distribution: widely; crosses the placenta; enters breast milk metabolism: by the liver excreted: renally

which route would a nurse expect to administer morphine sulfate prescribed for pain in a client admitted to the emergency department with burns to the anterior trunk, entire arm, and anterior left arm? a. orally b. Intravenously c. subcutaneously d. intramuscularly

b. intravenously

which action would be taken by the nurse when caring for a client prescribed transdermal fentanyl 25 mcg/h every 72 hours during the first 24 hours after starting the fentanyl? a. titrate the dose until pain is tolerable b. manage pain with an analgesic by a different route c. assess the client for anticholinergic side effects d. instruct the client to take the medication with food

b. manage pain with an analgesic by a different route

aspirin pharmacokinetics

absorption: well absorbed from upper small intestine distribution: rapidly and widely; crosses placenta; enters breast milk metabolism: by the liver excreted: renally

chronic alcohol use interferes with the metabolism of excessive doses of _____

acetaminophen

celecoxib patient and family teaching

advise patient to notify health care professional if symptoms of GI toxicity ( abdominal pain, black stools) occur inform patient of increased risk of HF and MI and stroke

factors that effect pharmacokinetics

age, gender, weight, diet, genetics

a(n) ____ reaction is an immune response

allergic

lidocaine therapeutic class

anesthetic (topical/local) antiarrhytmics

aspirin therapeutic classification

anti-platelet antipyretics nonopioid analgesics

oxycodone assessment

assess BP, pulse, and respirations before and during administration assess risk for opioid addiction

morphine assessment

assess level of consciousness, BP, pulse, and respirations before and during administration assess risk of addiction, abuse, or misuse

acetaminophen assessments

assess overall health status and alcohol usage prior to administration assess amount, frequency, and type of drugs taken in patients assess for rash periodically

celecoxib assesment

assess patient for skin rash monitor for signs and symptoms of DRESS ( fever, rash, facial swelling)

aspirin assessment

assess patients who have asthma, allergies, and nasal polyps for anaphylaxis watch for fever, rash, and facial swelling

ibuprofen assessments

assess patients who have asthma, allergy, and nasal polyps for hypersensitivity reactions assess patient for rash monitor symptoms of DRESS (fever, rash, facial swelling)

propofol assessment

assess respiratory status, pulse, and BP throughout administration monitor for propofol infusion syndrome

aspirin patient and family teaching

avoid alcohol consumption report unusual bleeding of the gums let physician know if you become pregnant during use

oxycodone indications

moderate to severe pain

tension-type headache characteristics

moderate, non-throbbing pain

naloxone assessment

monitor respiratory rate, rhythm, and depth; pulse, ECG, BP; and level of consciousness frequently for 3-4

migraine pathophysiology

neurovascular disorder that involves the dialation and inflammation of inter-cranial blood vessels nuerons of trigeminal vascular system calcitonin gene-related peptide serotonin

rights of medication administration

1. right patient 2. right medication 3. right dose 4. right route 5. right time 6. right documentation 7. right indication

what are some examples of professional sources of drug information?

newsletters, reference books, and the internet

tension-type headache treatment

nonopioid analgesic (acetaminophen) nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen) analgesic-sedative combination (aspirin)

hydromorphone therapeutic class

opioid analgesic

SELECT ALL THAT APPLY which action is the nurses responsibility when administering prescribed opioid analgesics? a. count the clients respirations b. document the intensity of the clients pain c. withhold the medication if the client reports pruritus d. verify the number of doses in the locked cabinet before administering the prescribed dose e. discard the medication in the clients toilet before leaving the room if the medication is refused

a, b, d

SELECT ALL THAT APPLY after undergoing minor surgery, a postoperative child has recovered from anesthesia. which observations alert the nurse the child may be ready for discharge? a. vital signs are stable b. temp is 101 degrees F c. pain rate is at a baseline level d. the child is alert and oriented e. oxygen saturation is 75% on room air

a, c, d

an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

pain

hydrocodone pharmacokinetics

absorption: well absorbed following oral administration distribution: unknown metabolism: by the liver excretion: renally

SELECT ALL THAT APPLY which information would the nurse include in the clients medication teaching on the administration of aspirin 650mg q 6hrs PRN for arthritic pain? a. "report persistant abdominal pain" b. "do not chew enteric-coated tablets" c. "take the aspirin with meals or a snack" d. "see a dentist if bleeding gums develop" e. "switch to acetaminophen if tinnitus occurs"

a, b, c

SELECT ALL THAT APPLY twenty-four hours after receiving spinal anesthesia during childbirth, a client tells the nurse she has a headache is a reaction to the anesthesia? a. 'my ears are ringing' b. 'it gets better when i lie down' c. 'bright lights really bother my eyes' d. 'my head hurts more when I'm sitting watching television' e. 'my head hurts more when I'm lying on my side breast-feeding'

a, b, c, e

SELECT ALL THAT APPLY which benefit would be provided by administering PCA to a client after surgery? a. client is able to self-administer pain-relieving medications as necessary b. amount of medication received is determined entirely by the client c. decreases client dependency d. relieves the nurse of monitoring the client e. increases client sense of autonomy

a, c, e

SELECT ALL THAT APPLY when providing comfort to a client during the last hours of life, which would be the nurse's primary concern? a. pain b. nutrition c. elimination d. respiratory status e. cardiovascular status

a, d

SELECT ALL THAT APPLY after interacting with a client, the nurse thinks the client is in the prodromal phase of a migraine. which statements made by the client led the nurse to reach this conclusion? a. 'i feel drowsy all the time' b.' i feel sever pain over my ear' c. 'i feel a throbbing pain in my head' d. ' i feel confused at this point in time' e. 'i feel weakness in the left side of my body'

a, d, e

after an amputation of a limb, a client reports extreme discomfort in the area where the limb once was. which goal would the nurse plan to focus interventions? a. Identifying actions to decrease pain in the lost limb b. reversing feelings of hopelessness about the future c. promoting mobility in the residual limb d. facilitating the grieving process for the lost limb

a. Identifying actions to decrease pain in the lost limb

a client is admitted to the hospital with severe back and abdominal pain, nausea, and occasional vomiting, and an oral temp of 101 degrees F. the client reports drinking six to eight beers a day. a diagnosis of acute pancreatitis is made. based on the data presented, which clinical finding is a primary nursing concern for this client? a. acute pain b. Inadequate nutrition c. Electrolyte imbalance d. disturbed self- concept

a. acute pain

the nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time? a. at scheduled intervals b. when the child asks for it c. when the pain becomes severe d. before the pain becomes severe

a. at scheduled intervals

which intervention would the nurse incorporate into the plan of care for the older adult experiencing chronic pain? a. exercise b. distraction c. heat therapy d. trigger point massage

a. exercise

the nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients? a. fentanyl b. morphine c. meperidine d. hydromorphone

a. fentanyl

after obtaining vital sign data of BP 90/60 mm Hg, pulse 96 bpm, and RR 10/breaths per min for a postoperative client receiving hydromorphone by a patient-controlled analgesia (PCA) pump, which priority action would the nurse take? a. give naloxone intravenously per protocol b. assess the clients pain level on a 10-point scale c. document the vital signs in the client record d. notify the hospital rapid response team

a. give naloxone intravenously per protocol

a client who had thoracic surgery reports pain at the incision site when coughing and deep breathing. Which action would the nurse take? a. instruct client to splint the wound with a pillow when coughing b. place the client in the supine position and inspect the site of the incision c. assess the intensity of the pain and administer the prescribed analgesic d. notify the health care provider immediately and then check for wound dehiscence

a. instruct client to splint the wound with a pillow when coughing

which pain relief medication would the nurse expect to find in the plan of care of a client with a myocardial infarction admitted to the cardiac intensive care unit? a. morphine b. diazepam c. midazolam d. oxycodone

a. morphine

requires small size a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system

a. passage through channels

collecting baseline data, identifying high-risk patients, and determining the patients capacity for self-care a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

a. pre-administration assessment

which nursing action is beneficial for the client who has pain due to muscle spasm? a. providing heat compresses at the site b. providing a massage to the affected area c. encouraging the client to perform isometric exercises d. encouraging the client to do active ROM exercises

a. providing heat compresses at the site

a client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. after surgery, the clients pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief? a. tolerance b. habituation c. physical addiction d. psychological dependence

a. tolerance

propofol pharmacokinetics

absorption: administered IV only, complete absorption distribution: rapidly and widely; crosses the blood-brain barrier; crosses placenta; and enters breast milk metabolism: by the liver excretion: by the kidneys

lidocaine pharmacokinetics

absorption: after administration in the deltoid muscle distribution: widely; concentrates in the adipose tissue; crosses blood-brain barrier; crosses placenta; enters breast milk metabolism: by liver excretion: by kidneys

ibuprofen pharmacokinetics

absorption: orally is well absorbed; IV admin. results in total bioavailability distribution: does not enter breast milk in significant amounts metabolism: by the liver excretion: small amount renally

celecoxib pharmacokinetics

absorption: unknown distribution: extensively to tissues metabolism: by the hepatic CYP2C9 enzyme excretion: unchanged in urine and feces

morphine pharmacokinetics

absorption: variably absorbed through oral admin. reliably absorbed following rectal, subcut, and IM sites following epidural administration systemic absorption distribution: widely distributed; crosses placenta; enters breast milk metabolism: by the liver excretion: renally

naloxone pharmacokinetics

absorption: well absorbed after IM or subucut administration distribution: rapidly to tissues; crosses the placenta metabolism: by the liver excretion: renally

SELECT ALL THAT APPLY an adolescent is admitted with partial- and full- thickness burns of the arms and upper torso. which are the primary purposes of administering pain medication vi the IV route, rather than the IM route? a. Adolescents are afraid of injections b. it decreases the risk of tissue irritation c. severe pain is reduced more effectively d. impaired peripheral circulation is bypassed e. it provides for more prolonged relief of pain

b, c, d

SELECT ALL THAT APPLY which nursing concern is a priority when a 6-year-old child with sickle cell disease is admitted with a vasoocclusive crisis? a. nutrition b. hydration c. pain management d. prevention of infection e. oxygen supplementation

b, c, e

SELECT ALL THAT APPLY which therapeutic outcome is expected after administering ibuprofen? a. diuresis b. pain relief c. temperatrue reduction d. bronchodialation e. anticoagulation f. reduced inflammation

b, c, f

SELECT ALL THAT APPLY which factors would the nurse consider when administering opioids to a child with severe pain? a. diet modification b. dosing calculations c. body mass index d. appropriate dosage form e. presence of other symptoms

b, d, e

at which time would the nurse plan to administer morphine 2mg PO q 2 hrs PRN to a client who has burns on 55% of the body surface and requires dressing changes? a. 15 min before the dressing change b. 60 min before the dressing change c. along with a stool softener each time it is administered d. only if the client rates pain between 8 and 10 on the pain scale

b. 60 min before the dressing change

which client would be triaged under emergency severity index (ESI)-1 based on threat to life and stability of vital functions? a. Client A; chest pain resulting from ischemia b. Client B; cardiac arrest c. Client C; simple laceration d. Client D; hip fracture

b. Client B; cardiac arrest

which is the most reliable indicator of a 2.5-year-old child's pain? a. crying and sobbing b. changes in behavior c. verbal exclamations of pain d. changes in pulse and respiratory rate

b. changes in behavior

which client would need a correction in the nursing intervention? a. Client 1: 11 yrs old; distraction and creative imagery during administration of medication b. Client 2: 9 yrs old; administration of analgesics only when pain intensifies c. Client 3: 7 yrs old; administration of opioids (PO) along with medications d. Client 4: 14 yrs old; administration of half the adult dose in case suppositories should not be done

b. client 2

which situation would the nurse address first according to Maslow's hierarchy? a. has history of being injured from sudden falls b. complains of sleeplessness due to pain postsurgery c. reports that they feel lonely and socially isolated d. conveys to the nurse that they want to become the manager of the company

b. complains of sleeplessness due to pain postsurgery

which physiological response will occur if a client being treated for myocardial infarction experiences the intended therapeutic effect of morphine? a. increased respiratory rate b. decreased workload of the heart c. dilation of coronary arteries d. diminished metabolites within the ischemic heart muscle

b. decreased workload of the heart

which action would the nurse take when caring for a client using a patient-controlled analgesia pump who identifies attempts to self-administer the analgesic 10 times because the client is still experiencing pain? a. monitor the client's pain level for another hour b. determine the integrity of the intravenous delivery system c. reprogram the pump to deliver a bolus dose every 8 minutes d. arrange for the client to be evaluated by the health care provider

b. determine the integrity of the intravenous delivery system

requires lipid solubility a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system

b. direct penetration of the membrane

which action would the nurse take while giving an injection to a preschooler? a. ask the parent to restrain the child b. distract the child with conversation c. avoid awakening the child if asleep d. avoid using lidocaine ointment over the injection site

b. distract the child with conversation

movement from blood into tissue and cells a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

b. distribution

the rights of drug administration coupled with the knowledge of pharmacology a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

b. dosage and administration

any chemical that can affect living processes a. therapeutics b. drug c. pharmacology d. clinical pharmacology

b. drug

can induce seizures a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

b. enflurane

fatigue and hemoglobin/hematocrit 9.2%/28 mg/dL a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

b. hemolytic anemia

an adolescent client with sickle cell anemia is experiencing a painful episode and has a PCA pump. the current pain rating is 5 on a scale of 1-10 at the right elbow. the nurse observes that the pump is "locked out" for another 10 min. which action would the nurse implement? a. Turning on the television for diversion b. placing the PRN warm, wet compress on the elbow c. calling the primary health care provider for another analgesic prescription d. informing the client gently that they must wait until the pump reactivates to get more medication

b. placing the PRN warm, wet compress on the elbow

which factor would the nurse recognize as a cause of neck pain in a client? a. headache b. poor posture c. low body weight d. sedentary lifestyle

b. poor posture

which nonpharmalogical nursing intervention is effective in helping relieve postoperative pain? a. ambulation b. repositioning c. purse-lipped breathing d. deep breathing and coughing

b. repositioning

withdrawal reactions occur when a drug is stopped when a person is _____ ____ on the drug

physically dependent

which conclusion would the nurse make regarding the client's response to pain medication when a client using a pain scale of 1 to 10 rates the pain as an 8 before receiving an analgesic and at a 7 after being medicated? a. the client has a low pain tolerance b. the medication is not adequately effective c. the medication has sufficiently decreased the pain level d. the client needs more education about the use of the pain scale

b. the medication is not adequately effective

the primary nurse, leaving the unit for lunch, provides a verbal report for the covering nurse. The report included one clients prescription for morphine:2mg intravenously (IV) every 3 hours for abdominal pain secondary to major abdominal surgery that morning. During the primary nurse's lunch, the client complains of pain at a level of 8 out of 10 on the pain scale. Which action would the covering nurse perform first? a. determine the documented time of the last administration of pain medication b. verify that the written prescription matches the administration record c. encourage non pharmacological measures initially to relieve the pain d. explain that the primary nurse will be back from lunch in a few minutes

b. verify that the written prescription matches the administration record

hydrocodone action

bind to opioid receptors in the CNS; alters the perception of and response to painful stimuli

oxycodone action

binds to opiate receptors in the CNS alters perception of and response to pain

hydromorphone action

binds to opiate receptors in the CNS; alters the perception of and response of painful stimuli; supresses cough

____ is the ability of a drug to reach the systemic circulation from its site of administration

bioavalibility

if the nurse is administering warfarin to a malnourished patient with a serum protein level of 2.9 g/dL, the nurse would expect the patient to be at increased risk for _____

bleeding

SELECT ALL THE APPLY which assessment finding of a client with chronic pain who has been prescribed opioid treatment indicates the need for a priority nursing intervention? a. prurtis b. constipation c. level 3 sedation d. nausea and vomiting e. respiratory rate of 8 breaths per min

c, e

which response would the nurse give to a client newly diagnosed with multiple sclerosis who asks the nurse, "will i experience pain"? a. "tell me about your fears regarding pain" b. "analgesics will be prescribed to control the pain" c. "pain is not a characteristic symptom of this condition" d. "let's make a list of things to ask your primary health care provider"

c. "pain is not a characteristic symptom of this condition"

which response by the nurse asked "how will they 'knock me out' for this colonoscopy?" describes the route of administration for conscious sedation? a. "the medicine will be injected into your spine" b. "you will receive the anesthesia through a face mask" c. "you will receive medication through an intravenous (IV) catheter" d. "we will give you an oral medication about 1 hour before the procedure"

c. "you will receive medication through an intravenous (IV) catheter"

a school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. breakthrough pain occurs and a fentanyl 'lollipop' is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs? a. 'chew it and then swallow every 4 hours' b. 'suck on it for half an hour every 6 hours' c. 'hold it in your cheek only until the pain is relieved' d. 'place it in your mouth and suck on it until it dissolves'

c. 'hold it in your cheek only until the pain is relieved'

which pain description would the nurse expect a client to report when describing pain associated with a suspected duodenal peptic ulcer? a. an ache radiating to McBurney point b. an intermittent, colicky right-flank pain c. a gnawing sensation in the epigastric area d. a generalized abdominal pain intensified by movement

c. a gnawing sensation in the epigastric area

a client with inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. when operating the TENS unit, which nursing action is appropriate? a. maintain the settings programs by the health care provider b. turn the machine on several times a day for 10 to 20 minutes c. adjust the dial on the unit until the client states that the pain is relieved d. apply the color-coded electrodes on the client where they are most comfortable

c. adjust the dial on the unit until the client states that the pain is relieved

which action would the nurse take first for a post-surgical client who is still intubated but becoming restless, with an increased pulse rate and BP, when it has been 4 hours since the last dose of pain medication? a. notify the provider b. perform a full physical assessment c. administer the prescribed pain medicine d. play soft, relaxing music to help calm the client

c. administer the prescribed pain medicine

which property would the nurse understands that the medication is being used primarily for when aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis? a. analgesic b. antipyretic c. anti-inflammatory d. anti-platelet

c. anti-inflammatory

which intervention is useful in promoting comfort for the client experiencing a headache? a. massage b. heat therapy c. cold therapy d. relaxation strategies

c. cold therapy

a client has bee receiving oxycodone for moderate pain associated with multiple injuries sustained in a motor vehicle collision. which assessment finding, in addition to the clients slurred speech, leads the nurse to suspect opioid intoxication? a. mood lability b. hyper-vigilance c. constricted pupils d. increased respirations

c. constricted pupils

prolongs QT interval a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

c. droperidol

change in drug structure and movement out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

c. elimination

the property of an ideal drug: the nurse explains that quinapril and accupril are names for the same drug

possession of a simple generic name

a child is experiencing pain after abdominal surgery and is given an opioid analgesic. which statement is correct regarding children in pain and their response to opioid analgesics when they are prescribed? a. addiction to opioids is more of a risk for children than adults b. analgesics are not needed as frequently because pain is not strongly felt by children as it is by adults c. even though children do not like taking medicines, analgesics will make them more comfortable d. children do not need analgesics because they are easily distracted and will quickly return to play or sleep

c. even though children do not like taking medicines, analgesics will make them more comfortable

clay-colored stool with nausea and vomiting a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

c. hepatotoxicity

a client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which interference will the nurse make? a. the half-life of the medication has decreased b. an idiosyncratic reaction has occurred c. higher doses are needed to achieve pain relief d. an emotional dependence on the medication has developed

c. higher doses are needed to achieve pain relief

the nurse is planning the discharge of a 9-year-old child who has undergone tonsillectomy. in addition to the prescribed analgesic, which would the nurse recommend the parent use to ease their childs pain? a. warm saline gargles b. heating pad to the neck c. light-colored ice pops d. peppermint candy for sucking

c. light-colored ice pops

may require energy or pores a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system

c. passage with the aid of a transport system

for which involuntary physiologic response would the nurse monitor development in a client experiencing pain? a. crying b. splinting c. perspiring d. grimacing

c. perspiring

the study of drugs and their interactions with the living systems a. therapeutics b. drug c. pharmacology d. clinical pharmacology

c. pharmacology

enhancing drug therapy through non-pharmacologic measures a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

c. promoting therapeutic effects

which group of clients who were in a bus accident and admitted to the emergency department with injuries is considered urgent according to the three-tier triage system? a. sprains b. simple fractures c. severe abdominal pain d. chest pain with diaphoresis

c. severe abdominal pain

lidocaine adverse reactions/side effects

cardiac arrest, stinging, confusion, drowsiness, seizures, anaphylaxis

the property of an ideal drug: the nurse teaches the patient that the medicine cabinet is a bad place to store medications because the heat and humidity can damage the drug

chemical stability

pain that lasts beyond the expected time of healing; usually at-least 6 months

chronic pain

pain associated with a chronic condition that worsens over time

chronic progressive pain

intense episodes of pain interspersed with periods of no pain

chronic recurrent pain

based on the information in this chart, which adolescent may require a modified treatment plan? Client 1: menorrhea; treatment: chaste tree fruit Client 2: endometriosis; treatment: oral contraceptive pills Client 3: breast pain; treatment: ibuprofen Client 4: dysmenorrhea; treatment: acetaminophen

client 4

pulse 52 beats/min and unexplained fainting a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia

d. QT prolongation

when, during the first 24 hours postoperatively, will analgesics be administered to a client who undergoes an abdominal cholecystectomy for gangrene of the gallbladder? a. if repositioning is ineffective b. when the pain becomes severe c. in gradually increasing doses d. as prescribed by the health care provider

d. as prescribed by the health care provider

the nurse applies a cold pack to relieve musculoskeletal pain. which rationale explains the analgesic properties of cold therapy? a. promotes analgesia and circulation b. numbs the nerves and dilates the blood vessels c. promotes circulation and reduces muscle spasms d. causes local vasoconstriction, preventing edema and muscle spasms

d. causes local vasoconstriction, preventing edema and muscle spasms

which recommendation would the nurse give to the client with trigeminal neuralgia? a. drink iced liquids b. avoid oral hygine c. apply warm compresses d. chew on the unaffected side

d. chew on the unaffected side

the study of drugs in humans a. therapeutics b. drug c. pharmacology d. clinical pharmacology

d. clinical pharmacology

according to the nursing process, which action would the nurse take after administering pain medication to a postoperative client? a. administer nonpharmalogical comfort measures b. inform the health care provider of nursing actions c. create a care plan that addresses the clients pain level d. determine whether the pain medication relieved the clients pain

d. determine whether the pain medication relieved the clients pain

assessment findings of a client who is admitted to the emergency department include cramping pain in the left lower quadrant, weakness, bloating, malaise, and a low grade fever. The nurse suspects which condition? a. pancreatitis b. appendicitis c. cholecystitis d. diverticulitis

d. diverticulitis

movement out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics

d. excretion

hypotension can occur from peripheral vasodilation a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

d. isoflurane

Knowing the major adverse reactions of a drug, when they are likely to occur, early signs of development, and interventions to minimize discomfort and harm. a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

d. minimizing adverse effects

which caring intervention helps provide comfort, dignity, respect, and peace to a client? a. listening b. spiritual caring c. providing presence d. relieving pain and suffering

d. relieving pain and suffering

in which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed PRN oxycodone? a. just as a last resort b. before going to sleep c. as the pain becomes intense d. when the discomfort begins

d. when the discomfort begins

aspirin adverse reactions/side effects

drug reaction w/ eosinophilia, GI bleeding, epigastric distress, nausea, anaphylaxis

taking a thorough drug history, advising the patient to avoid drugs that may interact with prescribed medication, and monitoring for adverse reactions a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

e. minimizing adverse interactions

the property of an ideal drug: during discharge teaching, the nurse assesses if the patient will be able to take a prescribed drug four times a day as ordered

ease of administration

factors that trigger migraines

emotions (stress, anticipation, anxiety, depression, excitement, frustration) food (tyramine, nitrates, pheylethylamine, monosodium, aspartame, yellow food coloring), drugs ( alcohol, analgesics, caffine, cimetidine, cocaine, estrogens, nitroglycerin)

knowing the reason for drug use and being able to assess the patients medication needs a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

f. making as-needed (PRN) decisions

true or false: if a drug is selective for specific receptors, it is safe

false

true or false: ionization is a process that allows a drug to enter a cell

false

true or false: most drugs enter cells through channels or pores

false

true or false: phase 2 of the dose-response relationship starts at the point when the therapeutic effect does not increase with increasing the dose

false

true or false: polar drugs can enter fetal circulation and breast milk

false

true or false: powdered drugs can be mixed once they are dissolved in a liquid

false

true or false: the nurse would expect that an intravenous (IV) antibiotic prescribed for bacterial meningitis would most likely get to the site of infection if the drug is water soluble

false

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic causes local vasodilation

false

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic delays the onset of anesthesia

false

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic improves blood flow to the affected area

false

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic increases the risk of toxicity

false

true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic requires the use of a larger dose of anesthetic

false

the property of an ideal drug: the nurse administers ciprofloxacin through a second intravenous line separate from all other drugs

freedom from interactions

the process to determine if a drug is beneficial or causes harm a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

g. evaluating responses to medication

can produce heat and fire in administration apparatus a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane

g. sevoflurane

propofol therapeutic class

general anesthetic

knowing the early signs of toxicity and the proper intervention when it occurs a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity

h. managing toxicity

lidocaine contraindications

hypersensitivity, heart block, wolff-parkinson-white syndrome

hydrocodone adverse reactions/side effects

hypotension, constipation, dyspenia, nausea, confusion, dizziness, sedation, respiratory depression

____ disease is when a drug causes symptoms closely resembling a disease

iatrogenic

based on differences in metabolism of alcohol, if both a man and woman consume the same amount of alcohol (on a weight-adjusted basis) and take the drug metronidazole, the disulfiram-like reaction between alcohol and the drug in the woman should be more ____ and last ____than for the man.

intense; longer

ibuprofen indications

mild to moderate pain, fever, inflammation

hydromorphone indications

moderate to severe pain