Pharm Final Exam 4

A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? (Select all that apply.) A. Counting respirations before and after giving the medication B. Encouraging physical activity and offering increased fluids C. Monitoring the patient's blood pressure closely for hypertension D. Palpating the patient's lower abdomen every 4 to 6 hours E. Requesting an order for methylnaltrexone [Relistor) to prevent constipation

A, B, D

A patient who reports regular consumption of two or three alcoholic beverages per day asks. about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient? A. "Do not take more than 2 pm of acetaminophen a day?" B. "Do not take more than 3 gm of acetaminophen a day." C. "Do not take more than 4 gm of acetaminophen a day:" D. "Do not take a fixed-dose preparation with opioid analgesics."

A. "Do not take more than 2 pm of acetaminophen a day?"

A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen (Motrin) for discomfort. Which statement by the patient indicates a need for further teaching? A. "I may experience tinnitus with higher doses of this medication. B. "I may take up to 800 mg 4 times daily for pain." C. "I should limit alcohol intake to fewer than three drinks a day." D. "I will take this medication with meals to help prevent stomach upses

A. "I may experience tinnitus with higher doses of this medication.

A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topic. anesthetic for pain. Which statement by the patient indicates understanding of the teaching? A. "I will apply a thin laver of the medication to a small area of skin? B. "I will cover the burn with a dressing after applying the medication" C. "I will make sure to apply the medication to the entire burn area." D. "I will use the medication only on the most painful, blistered areas."

A. "I will apply a thin laver of the medication to a small area of skin?

An adolescent is brought to the emergency department by a parent who reports that the patiet took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? A. Acetylcysteine [Mucomyst] B. Activated charcoal C. Hemodialysis D. Respiratory support

A. Acetylcysteine [Mucomyst]

Which side effect most commonly occurs in patients receiving, midazolam as an anesthetic? A. Amnesia B. Anxiety C. Constipation D. Decreased heart rate

A. Amnesia

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse. "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine has which effect? A. Antitussive B. Expectorant C. Decongestant D. Immunostimulant

A. Antitussive

A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication? A. Bethanechol B. Droperidol C. Promethazine D. Ondansetron

A. Bethanechol

A patient who has developed opioid tolerance will experience which effect? A. Decreased analgesic effect B. Decreased constipation C. Increased euphoria D. Increased respiratory depression

A. Decreased analgesic effect

A nurse is assisting the physician during a procedure in which a local anesthetic, the patient has a pulse of 54 beats per minute, respiration of 18 breathers per minute, and a blood pressure of 90/42 mmHg. The nurse should monitor the patient for fither signs of: A. Heart block B. Anaphylaxis C. Central nervous system excitation D. Respiratory depression

A. Heart block

The nurse is planning care for a patient receiving morphine sulfate by means of a patient-controlled analgesia (PCA) pump. Which intervention ray be required because of a potential side effect of this drug? A. Inserting a foley catheter B. Monitoring liver function tests C. Administering an antidiarrheal D>.Administering a cough suppressant

A. Insert foley catheter

A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do? A. Instruct the parents not to activate the device when their child is sleeping. B. Reassure the parents that drug overdose is not possible with PCA C. Suggest that the child use the PCA sparingly. D. Tell the patient that the pump can be proptatiied for PRN dosing only.

A. Instruct the parents not to activate the device when their child is sleeping.

A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient? A. NSAIDs are safe to take while breast-feeding. B. NSAIDs are not safe, even in small amounts. C. She should take only COX-2 inhibitors while breast-feeding. D. She should request a prescription for narcotic analgesics.

A. NSAIDs are safe to take while breast-feeding.

A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss: A. administering epinephrine. B. changing to a first-generation NSAID. C. reducing the dose of aspirin. D. giving an antihistamine.

A. administering epinephrine.

A patient has been receiving intravenous ketorolac. 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorotac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): A. different nonsteroidal anti-inflammatory drug for home management of pain. B. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication. C. lower dose or the oral ketorolac for long-term pain management. D. intranasal preparation of ketorolac for pain management at home.

A. different nonsteroidal anti-inflammatory drug for home management of pain.

Which assessment would the nurse provide for a patient who is receiving a topical anesthetic Select all that apply. A. Monitor neurologic status B. Monitor bowel sounds C. Monitor respiratory rate D. Monitor peripheral pulses E. Monitor cardiac rhythm

B, C?

A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching? A. "Local anesthetics affect large myelinated neurons first." B. "Local anesthetics affect motor and sensory nerves." C. "Local anesthetics do not block temperature perception." D. "Local anesthetics do not cause systemic effects."

B. "Local anesthetics affect motor and sensory nerves."

While completing preoperative patient teaching, the nurse provides which explanation of general anesthesia? A. General anesthesia is typically achieved using only one type of medication. B. General anesthesia produces a lack of responsiveness to painful stimuli and loss of consciousness C. General anesthesia provides anesthesia to a specific region of the body and generalized sedation. D. General anesthesia results in moderate sedation in which the patient can follow commands but will not remember anything after the procedure.

B. General anesthesia produces a lack of responsiveness to painful stimuli and loss of consciousness

Which assessment finding indicates that the patient has overdosed on morphine sulfate? A. Blood in urine B. Pinpoint pupils C. Increased peristalsis D. Increased urinary output

B. Pinpoint pupils

A nurse should recognize that a patient who takes ACE inhibitors while also taking high-dose aspirin is at risk of developing what complication? A. Hemorrhage B. Renal failure C. Liver Toxicity D. Congestive heart failure

B. Renal failure

Which situation would the nurse not expect to observe in a patient who is under general anesthesia? A. unconsciousness B. ability to hear C. inability to feel touch D. Inability to feel temperature changes

B. ability to hear

A patient with moderate to severe chronic pain has been taking oxycodone (OxyContin) 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss: A. administering a combination opioid analgesic/acetaminophen preparation. B. changing the medication to a continued-release preparation. C. confronting the patient about drug-seeking behaviors. D. withdrawing the medication, because physical dependence has occurred.

B. changing the medication to a continued-release preparation.

A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedure? Select all that apply. A. Hysterectomy B. Cataract surgery C. Cholecystectomy D. Removal of a skin mole E. Routine dental cleaning

C, A

The nurse is caring for a patient who underwent a procedure that involved the use of injectable lidocaine. For which duration will the nurse expect the action of lidocaine to last? A. 5 to 10 minutes B. 15 to 45 minutes C. 60 to 90 minutes D. 100 to 120 minutes

C. 60 to 90 minutes

A nurse provides discharge instructions for a pshent.wha ly taking acetaminopben after surgery. The nurse would instruct the patient to avoid which product while taxing, acetaminophen? A. Bananas B. Dairy products C. Alcoholic drinks D. Leafy green foods

C. Alcoholic drinks

The primary healthcare provider is taking a medication history of a patient admitted for surgery. tThe patient tells the primary healthcare provider that they drink alcohol. Which information about the patients use of alcohol is important to know? A. Amount consumed weekly B. Type of alcohol consumed C. Amount consumed daily D. Preferred brand of alcohol

C. Amount consumed daily

Which assessment finding in a patient taking nonsteroidal antiinflammatory drugs (NSAIDs) requires immediate intervention? A. Headache B. Palpitations C. Black tarry stools D. Nonproductive cough

C. Black tarry stools

When assessing a patient for side effects of morphine sulfate, which finding would the nurse expect? A. Diarrhea B. Insomnia C. Drowsiness D. Increased bowel

C. Drowsiness

Which question is most important to ask to ask a patient scheduled for surgery to prevent a possible adverse patient outcome? A. Have you ever had surgery before? B. What is your current level of pain on a 0:10 scale? C. Have you or any family members ever suffered a reaction to anesthesia? D. Did you know that you can take your blood pressure pill the morning of surgery?

C. Have you or any family members ever suffered a reaction to anesthesia?

A nurse is caring for a patient in the immediate postoperative period after surgery in which a roiral anesthetic was used. The patient has not voided, and complains of headache. The patient han a pulse of 62 beats/min, a respiratory rate of 16 breaths per minute, and a blood pressure of 42/48 mm He Which action by the nurse is appropriate? A. Contact the anesthetist to request an order for ephedrine. B. Have the patient sit up to relieve the headache pain. C. Lower the head of the bed to a 10- to 15-degree head-down position. D. Obtain an order for a urinary catheter for urinary retention.

C. Lower the head of the bed to a 10- to 15-degree head-down position.

A patient asks the nurse what can be given to alleviate severe, chronic pain of several months duration. The patient has been taking oxycodone (OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider? A. Fentanyl [Duragesic] transdermal patch B. Hydrocodone [Vicodin] PO C. Meperidine [Demerol) PO D. Pentazocine [Talwin) PO

C. Meperidine [Demerol) PO

A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76: RR. 16: and BP. 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer? A. Atropine and morphine B. Bethanechol and ibuprofen C. Morphine and ondansetron [Zofran) D. Promethazine and clonidine (Catapres)]

C. Morphine and ondansetron [Zofran)

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? A. Difficulty moving the hingers of the affected hand B. Inability to feel pressure at the suture site C. Nervousness and tachycardia D. Sensation of pain returning to the wound

C. Nervousness and tachycardia

A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct? A. Administer the Ibuprofen as ordered. B. Contact the provider to discuss nonpharmacilogic pain measures. C. Request an order for meperidine (Demerol) D. Request an order for morphine sultate.

C. Request an order for meperidine (Demerol)

A patient takes oxycodone 40 mg by mouth (PO) twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should eat.foods high in lactobacilli B. The patient should take an antacid with each dose C. The patient should increase fluid and fiber in the diet D. The patient should take the medication on an empty stomach

C. The patient should increase fluid and fiber in the diet

A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? A. The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome. B. The patient should increase the dose to a level that suppresses inflammation. C. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead D. The patient should use acetaminophen because of its selective effects on uterine smooth muscle.

C. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead.

The nurse is teaching a patient with cancer about a new prescription for a fentany patch. 25 mcg/s. for chronic back pain. Which statement would the nurse include in the teaching plan? A. This type of pain medication is not as likely to cause breathing problems. B. You will need to change this patch every day, regardless of your pain level. C. With the first patch, it will take about 24 hours before you feel the full effects. D. Use your heating pad for the back pain. It will also improve the patch's effectiveness.

C. With the first patch, it will take about 24 hours before you feel the full effects.

A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: A. continue to use aspirin as scheduled. B. reduce the aspirin dosage by half until after surgery. C. stop using aspirin immediately. D. stop using aspirin 3 days before surgery.

C. stop using aspirin immediately.

A patient will receive intravenous midazolam (Versed) combined with fentaryl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching? A. "The patient may appear anxious and restless during the procedure." B. "The patient will be unconscious during the procedure." C. "The patient will not need cardiorespiratory support during the procedure." D. "The patient will not remember the procedure."

D. "The patient will not remember the procedure."

Which antipyretic drug will the nurse recommend to the parent of a child with influenza? A. Aspirin B. Ibuprofen C. Naproxen D. Acetaminophen

D. Acetaminophen

Which effect do anesthetics have on the urinary tract? A. Anesthetics have no effect on the urinary tract B. Anesthetics increase urine output by increasing renal blood flow C. Anesthetics increase urine production by reducing renal blood flow D. Anesthetics decrease urine production by reducing renal blood flow

D. Anesthetics decrease urine production by reducing renal blood flow

A patient with a history of stroke and myocardial infarction (MI) is on a daily aspirin regimen. Which finding would alert the nurse to contact the primary healthcare provider? A. Temperature 97.9 B. Heart rate 90 beats/min C. Blood glucose 78 mg/dL D. Blood pressure 160/94 mm Hg

D. Blood pressure 160/94 mm Hg

Which local anesthetic is most likely to cause an allergic response? A. Procaine B. Lidocaine C. Ropivacaine D. Bupivacaine

D. Bupivacaine

Which statement about acetaminophen is accurate? A. Acetaminophen can cause kidney failure at high doses. B. Drinking alcohol and taking acetaminophen will cause death. C. There are no risks associated with acetaminophen consumption. D. It is important to watch over-the-counter medications for acetaminophen in the product to prevent an overdose.

D. It is important to watch over-the-counter medications for acetaminophen in the product to prevent an overdose.

Which assessment finding indicates that the nonaspirin nonsteroidal antiinflammatory drug has been effective? A. Patient's bleeding time is prolonged. B. Patient has increased circulation to their legs. C. Partial thromboplastin time (PTT) is 100 seconds. D. Pain has decreased from a 6 to a 1 on a scale of 10.

D. Pain has decreased from a 6 to a 1 on a scale of 10.

A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated, and that the patient is drowsy and lethargic. The patient's heart rate Is 84 beats/min, the respiratory rate rate is 10 breaths per minute and the blood pressure is 90/50 mom What will the nurse do? A. Discuss possible opiate dependence with the patient's provider. B. Encourage the patient to turn over and cough and take deep breaths. C. Note the effectiveness of the analgesia in the patient's chart D. Prepare to administer naloxone and possibly ventilatory support.

D. Prepare to administer naloxone and possibly ventilatory support.

In which way does the ester group of local anesthetics differ from amide-type agents? A. Method of Activation B. Ease of anesthesia induction C. Promotion of allergic responses D. Selectivity

D. Selectivity

In monitoring a patient for side effects related to morphine sulfate. Which is a priority assessment? A. assess circulation B. assess cough reflex C. assess for nausea and vomiting D. assess respiratory rate and depth

D. assess respiratory rate and depth

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephnne is used with the lidocaine to: A. allow more systemic absorption speed up metabolism of the lidocaine. B. increase the rate of absorption of the lidocaine. C. improve perfusion by increasing blood flow to the area. D. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

D. prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of: A. a mild opioid overdose. B. decreased opioid drug levels. C. improved ventilation D. worsening hypoxia.

D. worsening hypoxia.