ch 13 - 17 pharm

4. A nurse working on the labor and delivery unit will most likely see which of the following used during the birthing process? Select all that apply. A) Epidural block B) Brachial plexus block C) Transsacral block D) Local infiltration anesthesia E) General anesthesia

A, C( Feedback: Epidural and transsacral blocks are often used in obstetrics during the birthing process.)

11. Which of the following would a nurse integrate into the explanation for a client about the mechanism of action for almotriptan? Select all that apply. A) Vasoconstriction B) Vasodilation C) Decreased neurotransmission D) Increased neurotransmission E) Inhibition of prostaglandin synthesis

A, C( Feedback: Selective serotonin agonists like almotriptan (Axert) exert their effects by causing vasoconstriction and decreased neurotransmission.)

2. A nurse is describing the overall effects associated with aspirin to a client. The nurse integrates knowledge of which of the following when describing this drug? Select all that apply. A) Analgesic B) Antipyretic C) Anti-inflammatory D) Anti-infective E) Antiviral

A, B, C( Feedback: Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects. Aspirin does not anti-infective or antiviral effects.)

16. A nurse working in an outpatient surgical setting may see which of the following volatile liquids used in general anesthesia? A) Sevoflurane B) Desflurane C) Isoflurane D) Methoxyflurane E) Halothane

A( Feedback: A nurse working in an outpatient surgical setting may see sevoflurane used in outpatient general anesthesia.)

28. A 60-year-old client with rheumatoid arthritis visits the health care facility for a regular checkup. The client informs the nurse that he has been using an over-the-counter NSAID for the last few days. The nurse cautions the client about the use of NSAIDs on a long-term basis because of the increased risk for which of the following? A) Ulcer disease B) CNS disorders C) Hearing impairment D) Blindness

A( Feedback: Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease in adults older than 65 years is increased with higher doses of NSAIDs. CNS disorders, hearing impairment, and blindness are not effects associated with using NSAIDs on a long-term basis in older clients.)

21. Which of the following drugs is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction? A) Aspirin B) Diflunisal C) Magnesium salicylate D) Acetaminophen

A( Feedback: Aspirin is used to decrease the risk of myocardial infarction in patients with unstable angina or previous myocardial infarction. Diflunisal, magnesium salicylate, and acetaminophen do not significantly decrease the risk of myocardial infarction.)

31. A client is to receive atropine as a preanesthetic. The nurse would inform the client that this drug is given for which reason? A) Decrease secretions B) Relieve anxiety C) Promote sedation D) Promote relaxation

A( Feedback: Atropine is a cholinergic blocker that is given to dry secretions in the upper respiratory tract. An opioid or antianxiety drug may be given to relax or sedate the client.)

22. A nurse is caring for a client who is hospitalized with arthritis. Celecoxib is prescribed. The nurse reviews the client's medical record for which of the following that would contraindicate the use of this drug? A) Allergy to sulfonamides B) Diabetic retinopathy C) Cataract D) Acute gout

A( Feedback: Celecoxib is contraindicated among clients with allergy to sulfonamides. Ethambutol is contraindicated in clients with diabetic retinopathy and clients with cataracts. Pyrazinamide is contraindicated among clients with acute gout.)

17. A patient has taken a 15-gram (15,000-mg) dose of acetaminophen and is brought by her parents to the emergency department. As the dosage is relatively high, there is a chance of acute acetaminophen poisoning. Which of the following assessment findings would indicate acute acetaminophen toxicity? A) Hypotension B) High fever C) Sweating D) Rapid, deep breathing

A( Feedback: Hypotension is one of the signs of acute acetaminophen toxicity that the nurse should monitor for in the patient. High fever, sweating, and rapid, deep breathing are not symptoms generally associated with acute acetaminophen toxicity.)

29. After teaching a group of nursing students about opioids, the instructor determines that additional teaching is needed when the students identify which of the following as a natural opioid? A) Meperidine B) Morphine C) Codeine D) Opium

A( Feedback: Meperidine is a synthetic opioid. Natural opioids include morphine sulfate, codeine, opium alkaloids, and tincture of opium.)

20. A nurse is to administer a prescribed opioid to a client. Which of the following conditions should the nurse confirm in the client to ensure that opioid therapy is not contraindicated in this client? A) Client does not have acute bronchial asthma. B) Client does not have acute diabetic retinopathy. C) Client does not have acute pre-existing liver disease. D) Client does not have decreased intracranial pressure.

A( Feedback: Opioid therapy is contraindicated in clients with acute bronchial asthma; therefore, the nurse should confirm that the client does not have this condition before administering opioid therapy. Opioid therapy is not known to be contraindicated in clients with diabetic retinopathy and pre-existing liver disease. Opioid therapy is contraindicated in clients with increased, not decreased, intracranial pressure.)

28. A nurse is caring for a client who is addicted to opioids. The physician has prescribed maintenance therapy using methadone for detoxification. Which of the following should the nurse keep in mind when caring for the client undergoing this therapy? A) Dosages vary according to length of the client's addiction. B) Methadone is discontinued on an outpatient basis. C) Dosages vary according to the client's weight. D) Male clients are prescribed higher doses than female clients.)

A( Feedback: The nurse must keep in mind that dosages vary with clients, the length of addiction, and the average amount of drug used each day. Dosages do not vary according to clients' weights. Methadone is not discontinued on an outpatient basis. Clients enrolled in an outpatient methadone program for detoxification or maintenance therapy on methadone must continue to receive methadone when hospitalized. Male clients are not prescribed higher doses than females.)

27. A nurse is developing a plan of care for a client with advanced rheumatoid arthritis who is experiencing moderate pain in the knees and hips. The client also has some deformities that make walking and moving about difficult. The primary health care provider has prescribed diflunisal. Which nursing diagnosis would be most appropriate for this client? Select all that apply. A) Acute Pain B) Impaired Physical Mobility C) Ineffective Self Health Management D) Deficient Knowledge E) Imbalanced Nutrition: Less Than Body Requirements

A, B( Feedback: Based on the situation, appropriate nursing diagnoses would include Acute Pain and Impaired Physical Mobility. There is no indication that the client is having difficulty managing the medication therapy, has a lack of knowledge about the medication, or is experiencing problems with nutrition.)

22. A nurse is assigned to care for a client who has been prescribed an opioid analgesic. Which of the following activities should the nurse perform as part of the preadministration assessment? A) Document description of pain and an estimate of when the pain began. B) Obtain client's blood pressure and pulse within 5 to 10 minutes. C) Monitor the client for symptoms of respiratory depression. D) Record each bowel movement and its appearance, color, and consistency.

A( Feedback: The nurse should document the description of pain and an estimate of when the pain began as part of the preadministration assessment. Obtaining blood pressure and pulse within 5 to 10 minutes, monitoring the client for symptoms of respiratory depression, and recording bowel movements are part of the ongoing assessments conducted by the nurse when caring for the client. The nurse obtains the blood pressure, pulse and respiratory rate, and pain rating in 5 to 10 minutes if the drug is given intravenously (IV). Respiratory depression occurs in clients who do not use opioids routinely and are being given an opioid drug for acute pain relief or surgical procedures. When an opiate is used as an antidiarrheal drug, the nurse records each bowel movement, as well as its appearance, color, and consistency.)

24. A nurse has administered an opioid to a client. Which of the following would the nurse do if the client shows a decrease in respirations? A) Monitor and encourage the client to cough and breathe deeply every 2 hours. B) Instruct the client to restrict his consumption of liquids. C) Instruct the client to take complete bed rest. D) Instruct the client to avoid any kind of exercise.

A( Feedback: The nurse should encourage the client to cough and breathe deeply every 2 hours if the client shows a decrease in respirations after the administration of opioid analgesics. The nurse need not instruct the client to restrict his consumption of liquids to help him cope with the effects of an ineffective breathing pattern. The nurse should perform tasks such as getting the client out of bed and encouraging therapeutic activities such as leg exercises (when ordered); therefore, the nurse should not instruct the client to avoid any kind of exercise or to take complete bed rest.)

24. A client is prescribed preanesthetic drugs prior to surgery. Which of the following nursing interventions should the nurse perform when caring for this client before the administration of preanesthetic drugs? A) Explain postoperative client activities. B) Check the client every 5 to 15 minutes. C) Assess the respiratory status of the client. D) Admit the client to an appropriate unit.

A( Feedback: When caring for a client prescribed preanesthetic drugs, the nurse should demonstrate, describe, and explain postoperative client activities, such as deep breathing, coughing, and leg exercises. The nurse should check the client every 5 to 15 minutes for emergence from anesthesia, but this is done after the administration of anesthesia, not before. Assessing the respiratory status of the client and admitting the client to an appropriate unit are both postoperative interventions that a nurse should perform. Therefore, these are not performed before the administration of preanesthetic drugs and anesthesia.)

25. A client with edema is receiving a loop diuretic. The client is also receiving acetaminophen for mild pain. The nurse would assess the client for which of the following? A) Increasing edema B) Bone pain C) Gastric upset D) Diarrhea

A( Feedback: When loop diuretics are given in conjunction with acetaminophen, the effectiveness of the loop diuretic is decreased. Therefore, the nurse would need to assess the client for evidence of increasing edema. Bone pain, gastric upset, and diarrhea are not associated with this combination.)

3. A nurse is describing the actions of NSAIDs to a client. Which of the following would the nurse integrate into the description as a mechanism by which NSAIDs elicit their effects? Select all that apply. A) Inhibition of prostaglandins B) Inhibition of cyclooxygenase-1 C) Synthesis of cyclooxygenase-2 D) Synthesis of cyclooxygenase-3 E) Inhibition of platelet aggregation

A, B, C( Feedback: NSAIDs exert their effects by inhibition of prostaglandin synthesis via inhibition of cyclooxygenase-1 and -2.)

8. A nurse is reviewing the medical record of a client scheduled for surgery and notes that the client will be receiving general anesthesia. Which factor would the nurse identify as affecting the choice of general anesthesia medication used in a particular client? Select all that apply. A) Client's general physical condition B) Area of the planned surgery C) Anticipated length of the surgery D) Client's weight E) Client's temperature

A, B, C( Feedback: The choice of anesthetic drug depends on many factors, including general physical condition of the client; area, organ, or system being operated on; and anticipated length of the surgical procedure. The client's weight may affect the dose of the drug to be given. The client's temperature is unrelated to the choice of anesthetic.)

13. Prior to administering an NSAID to a client, the nurse should obtain which of the following? Select all that apply. A) History of allergies B) Pain assessment C) Current medical conditions D) Past medical conditions E) Vital signs

A, B, C, D, E( Feedback: Before administering an NSAID, the nurse should obtain a history of allergies and past medical conditions. Other preadministration assessment includes pain, current medical conditions and vital signs.)

11. A nurse is administering a nonopioid analgesic to a client. Which of the following should the nurse perform during the ongoing assessment? Select all that apply. A) Reassess client's pain rating 30 to 60 minutes after drug administration. B) Assess joints for greater mobility. C) Check vital signs every 4 hours. D) Document pain severity, location, and intensity if pain persists. E) Assess the joints for decreased inflammation.

A, B, C, D, E( Feedback: During ongoing assessment the nurse monitors the client for pain relief; reassesses the client's pain rating every 30 to 60 minutes after drug administration; documents pain severity, location, and intensity if pain persists; checks vital signs every 4 hours; and assesses the joints for decreased inflammation and greater mobility.)

5. Prior to the administration of an opioid analgesic, the nurse should obtain which information from the client? Select all that apply. A) Pain assessment B) Allergy history C) Health history D) Past medication history E) Current medication therapy

A, B, C, D, E( Feedback: Prior to the administration of an opioid analgesic, the nurse should obtain information about the following: pain assessment, allergy history, health history, and past and current medication therapy.)

13. A nurse should monitor a client taking nonopioid analgesics for gastrointestinal bleeding. Which of the following would indicate to the nurse that the client is experiencing this adverse reaction? Select all that apply. A) Abdominal distention B) Blood-streaked vomit C) Vomit that looks like coffee grounds D) Dark, tarry stools E) Bright red blood in stool

A, B, C, D, E( Feedback: Signs of gastrointestinal bleeding include abdominal pain or distention (especially any sudden increases); vomit that appears bright red, blood streaked, dark red, brown, black, or similar to the consistency of coffee grounds; or stools that appear black, loose, tarry, bright red, red streaked, or dark mahogany colored.)

18. After teaching a client receiving NSAID therapy about the drug, the nurse determines that the teaching was successful when the client identifies the need to notify the primary health care provider for which of the following? Select all that apply. A) Skin rash B) Visual disturbances C) Edema D) Chest pain E) Diarrhea

A, B, C, D, E( Feedback: The client should notify the primary health care provider if any of the following adverse reactions occur: skin rash, itching, visual disturbances, weight gain, edema, diarrhea, black stools, nausea, vomiting, chest or leg pain, numbness, or persistent headache.0

20. A nurse is working in the PACU. Which of the following would be most important for the nurse to do? Select all that apply. A) Checking airway patency B) Positioning the client to prevent aspiration of secretions C) Reviewing the client's surgical and anesthesia records D) Checking the client every 15 to 30 minutes for emergence from anesthesia E) Checking the client's vital signs

A, B, C, E( Feedback: Checking airway patency, positioning the client to prevent aspiration of secretions, reviewing the client's surgical and anesthesia records, checking the client every 5 to 15 minutes for emergence from anesthesia, and checking the client's vital signs, IV lines, catheters, drainage tubes, surgical dressings, and casts represent the nurse's responsibilities to a client in the PACU.)

5. A nurse is providing care to a client who is receiving NSAIDs. The nurse would be especially alert for which of the following? Select all that apply. A) Oliguria B) Dysuria C) Hematuria D) Glucosuria E) Polyuria

A, B, C, E( Feedback: Clients receiving NSAIDs should be monitored for the following renal adverse effects: polyuria, dysuria, oliguria, hematuria, cystitis, elevated BUN, and acute renal failure.)

4. A nurse would expect to administer prescribed NSAIDs as part of the treatment plan for clients with which conditions? Select all that apply. A) Osteoarthritis B) Fever C) Rheumatoid arthritis D) Severe postoperative pain E) Primary dysmenorrhea

A, B, C, E( Feedback: NSAIDs are used to treat fever and the mild to moderate pain that may be associated with osteoarthritis, rheumatoid arthritis, and primary dysmenorrhea. Severe postoperative pain would most likely require an opioid analgesic.)

3. Which of the following are responsibilities of the nurse when local injectable anesthesia is to be administered to a client? A) Taking the client's allergy history B) Explaining how the anesthetic will be administered C) Preparing the area to be anesthetized D) Administering the anesthetic E) Applying a dressing to the area if appropriate

A, B, C, E( Feedback: The nurse is responsible for taking the client's allergy history, explaining how the anesthetic will be administered, preparing the area to be anesthetized, and applying a dressing to the area if appropriate. The physician administers the local injectable anesthetic.)

12. A nurse is assessing a client who is to receive an opioid analgesic. The nurse would contact the primary health care provider immediately if which of the following occur? Select all that apply. A) Respiratory rate of less than 10 breaths min B) Decrease in pulse C) Increase in pulse D) Increase in blood pressure E) Blood pressure of 9065 mm Hg

A, B, C, E( Feedback: The nurse should contact the primary health care provider immediately if any of the following occur while a client is receiving an opioid analgesic: significant decrease in respiratory rate or a respiratory rate less than 10 breaths min; significant increase or decrease in the pulse rate or a change in the pulse quality; or significant decrease in blood pressure or a systolic blood pressure below 100 mm Hg.)

12. Which of the following are important points for the nurse to cover when performing discharge teaching for a client receiving a salicylate? Select all that apply. A) Inform all health care providers of salicylate use. B) Discard salicylates if they smell like vinegar. C) Take salicylates with food. D) Store salicylates in the bathroom. E) Keep salicylate container closed tightly.

A, B, C, E( Feedback: The nurse should include the following in the discharge teaching for clients receiving salicylates: take the drug as prescribed, take the drug with food or milk and a full glass of water, inform all health care providers (including dentists) of salicylate use, discard salicylates that smell like vinegar, and store in a tightly closed container away from air, moisture, and heat. Salicylates should not be stored in the bathroom because the humidity can cause the drug to deteriorate.)

3. A group of nursing students are reviewing information about salicylates. The students demonstrate understanding of the information when they identify which of the following as a salicylate? Select all that apply. A) Ecotrin B) Bufferin C) Tylenol D) Dolobid E) Motrin

A, B, D( Feedback: Ecotrin (acetylsalicylic acid), Bufferin (magnesium salicylate), and Dolobid (diflunisal) are classified as salicylates. Tylenol is a nonsalicylate. Motrin is an NSAID.)

10. When reviewing information about general anesthetics, a group of students read about volatile liquids used as inhaled general anesthetics. The students demonstrate understanding of the information when they identify which of the following as a volatile liquid? Select all that apply. A) Halothane B) Desflurane C) Nitrous oxide D) Enflurane E) Cyclopropane

A, B, D( Feedback: Halothane, desflurane, and enflurane are examples of volatile liquids used as inhaled anesthetics. Examples of gas anesthetics are nitrous oxide and cyclopropane.)

1. When describing the properties of ibuprofen to a group of individuals attending a community health promotion presentation, the nurse would integrate knowledge of which of the following? Select all that apply. A) Anti-inflammatory B) Analgesic C) Antipruritic D) Antipyretic E) Antibacterial

A, B, D( Feedback: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects. They do not exert antipruritic or antibacterial properties.)

13. A postoperative client has a nursing diagnosis of Ineffective Breathing Pattern and is fearful that movement may result in more pain. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Get the client out of bed. B) Have the client do deep breathing. C) Encourage the client to lie still in bed. D) Get the client to cough every 2 hours. E) Administer more pain medication.

A, B, D( Feedback: The client taking an opioid may be fearful that exercise will cause more pain. To help overcome this fear, the nurse should get the client out of bed and encourage therapeutic activities, such as deep breathing, coughing, and leg exercises (when ordered). Having the client lie still in bed and giving more pain medication would be inappropriate.)

1. When describing opioid analgesics to a group of nursing students, the instructor would expect to include which classifications? Select all that apply. A) An agonist B) A partial agonist C) A partial antagonist D) An antagonist E) An agonist-antagonist

A, B, E( Feedback: An opioid analgesic may be classified as an agonist, partial agonist, and agonist-antagonist.)

14. When clients receive the rapid-acting general anesthetic ketamine, they would exhibit which of the following? Select all that apply. A) Analgesia B) Cardiovascular stimulation C) Reduced skeletal muscle tone D) Respiratory depression E) Respiratory stimulation

A, B, E( Feedback: Clients administered the rapid-acting general anesthetic ketamine (Ketalar) will exhibit profound analgesia, cardiovascular stimulation, respiratory stimulation, and enhanced skeletal muscle tone.)

9. A nurse is reviewing the medical records of several clients. In which of the following clients would the nurse identify that the use of an NSAID would be contraindicated? Select all that apply. A) A female client who is lactating B) A female client with a hypersensitivity to aspirin C) A female client in the first trimester of pregnancy D) A female client in the second trimester of pregnancy E) A female client in the third trimester of pregnancy

A, B, E( Feedback: NSAIDs are contraindicated in clients with a hypersensitivity to aspirin. In general, NSAIDs are contraindicated during the third trimester of pregnancy (because they can induce labor) and during lactation.)

10. A nurse suspects that a client is experiencing acute acetaminophen toxicity based on assessment of which of the following? Select all that apply. A) Nausea B) Jaundice C) Hypertension D) Cardiac arrhythmias E) Confusion

A, B, E( Feedback: Signs of acute acetaminophen toxicity include nausea, vomiting, confusion, liver tenderness, hypotension, cardiac arrhythmias, jaundice, and acute hepatic and renal failure.)

17. A nursing instructor is preparing a class discussion on the use of NSAIDs and interactions with other drugs. The instructor would emphasize that the effects of which of the following can increase with NSAID therapy? Select all that apply. A) Lithium B) Cyclosporine C) Furosemide D) Lisinopril E) Phenytoin

A, B, E( Feedback: The use of NSAIDs can increase the effectiveness of lithium, cyclosporine, and phenytoin, possibly leading to toxicity.)

7. A nurse informs a client who is prescribed meloxicam that he might experience visual disturbances. The client asks the nurse what types of visual disturbances may occur. Which of the following would the nurse include in the response? Select all that apply. A) Double vision B) Irreversible loss of color vision C) Sensitivity to light D) Blurred vision E) Halos around objects

A, C, D( Feedback: The nurse should tell the client that NSAIDs like meloxicam can cause visual disturbances including blurred or diminished vision, double vision, swollen or irritated eyes, photophobia, and reversible loss of color vision.)

4. A nurse should be aware of contraindications to the use of opioids to help decrease the likelihood of adverse reactions. The nurse understands that opioids would be contraindicated in which client? Select all that apply. A) A client with acute bronchial asthma B) A client with an acute myocardial infarction C) A client with a head injury D) A client with grand mal seizures E) A client with mild renal impairment

A, C, D( Feedback: The use of opioids is contraindicated in clients with acute bronchial asthma, emphysema, upper airway obstruction, head injury, increased intracranial pressure, convulsive disorders, severe renal or hepatic dysfunction, and acute ulcerative colitis.)

1. A group of nursing students are reviewing the different types of anesthesia. The students demonstrate understanding of the information when they identify which of the following as a type of local anesthesia? Select all that apply. A) Topical anesthesia B) General anesthesia C) Local infiltration anesthesia D) Regional anesthesia E) Spinal anesthesia

A, C, D, E( Feedback: Local anesthesia includes topical, local infiltration, and regional anesthesia (spinal anesthesia and conduction block are types of regional anesthesia).)

10. A nurse would expect that epidural administration of opioid analgesics is reserved for which of the following? Select all that apply. A) Labor pain B) Support of anesthesia C) Postoperative pain D) Moderate acute pain E) Intractable chronic pain

A, C, E( Feedback: Epidural administration of opioid analgesics is reserved for postoperative pain, labor pain, and intractable chronic pain.)

3. A nurse would expect to administer opioid analgesics primarily for the client with which of the following? Select all that apply. A) Severe acute pain B) Mild acute pain C) Moderate chronic pain D) Mild chronic pain E) Opioid dependence

A, C, E( Feedback: Opioid analgesics are used primarily for the treatment of moderate to severe acute pain and chronic pain and in the treatment and management of opiate dependence.

6. A nurse suspects that a client is developing salicylism. Which of the following would help confirm this suspicion? Select all that apply. A) Tinnitus B) Bradycardia C) Sweating D) Impaired vision E) Mental confusion

A, C, E( Feedback: Signs and symptoms of salicylism include dizziness; tinnitus; impaired hearing; nausea; vomiting; flushing; sweating; rapid, deep breathing; tachycardia; diarrhea; mental confusion; lassitude; drowsiness; respiratory depression; and coma (from large doses of salicylate).)

10. A nurse is teaching a client who is prescribed sumatriptan about the possible adverse reactions associated with the drug. The nurse determines that the teaching was successful when the client identifies which of the following as most common? Select all that apply. A) Flushing B) Bradycardia C) Dry mouth D) Impaired vision E) Fatigue

A, C, E( Feedback: The most common adverse reactions associated with the selective serotonin agonists like sumatriptan (Imitrex) include dizziness, nausea, fatigue, pain, dry mouth, and flushing.)

15. A client who is receiving ibuprofen asks the nurse, "What should I take the drug with?" Which of the following would the nurse suggest in the response? Select all that apply. A) Milk B) Orange juice C) Food D) Clear liquids E) Antacids

A, C, E( Feedback: The nurse should advise the patient to take ibuprofen (Motrin) with food, milk, or antacids.)

14. A client is prescribed tolmetin to be taken at home. The nurse would instruct the client to monitor for which of the following? Select all that apply. A) Dark, tarry stools B) Jaundice C) Hot, dry, flushed skin D) Increased urine output E) Unusual or prolonged bleeding

A, C, E( Feedback: The nurse should instruct the client or caregiver to monitor for dark, tarry stools; hot, dry, flushed skin; decreased urine output; and unusual or prolonged bleeding.)

2. A nurse assesses a client for common adverse reactions of opioids. Which of the following would the nurse identify? Select all that apply. A) Respiratory depression B) Diarrhea C) Mydriasis D) Constipation E) Miosis

A, D, E( Feedback: Respiratory depression, miosis, and constipation are examples of common adverse reactions seen with the use of opioids.)

16. A nurse is reviewing the medical record of a client who is diagnosed with migraine headaches. The history also reveals that the client has phenylketonuria. Which of the following would the nurse least expect to be prescribed as treatment for the client's migraine headaches? Select all that apply. A) Rizatriptan (Maxalt) B) Almotriptan (Axert) C) Eletriptan (Relpax) D) Sumatriptan (Imitrex) E) Zolmitriptan (Zomig)

A, E( Feedback: Rizatriptan (Maxalt) and zolmitriptan (Zomig) are not used as treatment for migraines in a client with phenylketonuria because both medications contain phenylalanine.)

5. For which area on the body would the nurse identify that the use of epinephrine with a local injectable drug would be contraindicated? Select all that apply. A) Use on a toe B) Use on the scalp C) Use on the face D) Use on the abdomen E) Use on a finger

A, E( Feedback: When the local anesthetic is used on an extremity (such as a toe or finger), the use of epinephrine with a local injectable drug is contraindicated.)

30. After teaching a group of students about the stages of general anesthesia, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of the first stage? A) Delirium B) Analgesia C) Respiratory paralysis D) Excitement

B( Feedback: Stage I is characterized by analgesia; stage II is the stage of delirium and excitement; stage III is the stage of surgical analgesia; and stage IV is the stage of respiratory paralysis.)

6. A client is prescribed oxymorphone. The client is also receiving promethazine. The nurse would carefully monitor which of the following? Select all that apply. A) Temperature B) Blood pressure C) Pulse D) Respiratory rate E) Blood glucose

B, C, D( Feedback: The nurse should take care to closely monitor a client's blood pressure, pulse, and respiratory rate when oxymorphone is administered with promethazine.)

17. Which of the following would alert the nurse to suspect that a client is experiencing intermediate manifestations of abstinence syndrome? Select all that apply. A) Rhinorrhea B) Increased blood pressure C) Tachycardia D) Mydriasis E) Miosis

C, D( Feedback: Intermediate symptoms of abstinence syndrome include mydriasis, tachycardia, twitching, tremor, restlessness, irritability, anxiety, and anorexia.)

7. A client is scheduled for surgery. Before surgery, the nurse would be responsible for which of the following? Select all that apply. A) Describing the preparation for surgery ordered by the physician B) Assessing the physical status of the client C) Describing postoperative care D) Demonstrating postoperative client activities E) Demonstrating the use of a PCA pump

Ans: A, B, C, D, E( Feedback: The nurse is responsible for describing the preparation for surgery ordered by the physician, assessing the physical status of the client, describing postoperative care, demonstrating postoperative client activities, and demonstrating the use of a PCA pump.)

14. To decrease the risk of injury to a client taking an opioid, which action would be most appropriate? Select all that apply. A) Keep the lights in the client's room turned down. B) Assist the client from the bed to the toilet. C) Assist the client with rising from a lying position. D) Assist the client with hall-walking activities. E) Advise the client to stay in bed all night.)

B, C, D( Feedback: To decrease the risk of injury to a client taking an opioid, the nurse should assist the client with ambulatory activities and with rising from a sitting or lying position. The nurse should also keep the client's room well lit during daytime hours, keep the client's room free of clutter, and advise the client to seek assistance when getting out of bed at night.

28. A group of nursing students are reviewing information about general anesthesia. The students demonstrate understanding of the information when they identify which of the following as a factor that would influence the selection of the general anesthesia for the client? A) Age of the client B) Length of surgical procedure C) Preanesthetic drug prescribed D) Postoperative care involved

B Feedback: The choice of general anesthesia depends on factors that include the general physical condition of the client; the area, organ, or system being operated on; and the anticipated length of the surgical procedure. The selection of general anesthesia does not depend on the age of the client, the preanesthetic drug prescribed for the client, or the postoperative care involved.)

21. A nurse is preparing a presentation for a local community group about over-the-counter analgesics, including NSAIDs. Which of the following would the nurse integrate into the presentation as a serious risk with this class of drugs? A) Increased granulocyte count B) Cardiovascular thrombosis C) Increased WBC count D) Sickle cell anemia

B( Feedback: A serious risk involved with the use of NSAIDs is cardiovascular thrombosis. Increased granulocyte count, increased WBC count, or sickle cell anemia is not caused by NSAIDs. Sickle cell anemia results from an inherited abnormality of hemoglobin. NSAIDs may cause decreased granulocyte count, decreased WBC count, or aplastic anemia.)

7. A client is being discharged from the hospital on warfarin for atrial fibrillation. The client asks the nurse, "What can I use if I have a headache?" The nurse responds by telling the client that which of the following would be appropriate to use? A) Bufferin B) Tylenol C) Ecotrin D) Empirin

B( Feedback: Clients taking warfarin should avoid the use of salicylates (Bufferin, Ecotrin, and Empirin) and should be encouraged to use the nonsalicylate Tylenol (acetaminophen).)

15. The nurse is reviewing the medical record of a client who has returned from surgery. The client received a volatile liquid that required administration with a special vaporizer because delivery to the client without a vaporizer can result in irritation of the client's respiratory tract. Which of the following would the nurse identify as being administered? Select all that apply. A) Sevoflurane B) Desflurane C) Isoflurane D) Methoxyflurane E) Halothane

B( Feedback: Desflurane is a volatile liquid that must be administered with a special vaporizer because delivery to the client without a vaporizer can result in irritation of the client's respiratory tract.)

28. A group of nursing students are reviewing information about the actions of aspirin. The students demonstrate understanding of the information when they identify which action as being responsible for reducing fever? A) Inhibition of prostaglandins B) Dilation of peripheral blood vessels C) Inhibition of platelet aggregation D) Reduction in endorphins

B( Feedback: Salicylates lower body temperature by dilating peripheral blood vessels. The blood flows out to the extremities, resulting in the dissipation of the heat of fever, which in turn cools the body. Prostaglandin inhibition occurs with pain relief and is responsible for the drug's anti-inflammatory effects. Inhibition of platelet aggregation results in prolonged bleeding times and increases the risk of bleeding.)

22. A client admitted to a local health care facility is to undergo surgery with spinal anesthesia. Which of the following is the nurse most likely to observe when caring for this client? A) Moderate muscle relaxation B) Loss of feeling in the lower abdomen C) Hypotension as anesthesia deepens D) Increase in the client's heart rate

B( Feedback: Spinal anesthesia involves the injection of a local anesthetic drug into the subarachnoid space of the spinal cord. There is a loss of feeling (anesthesia) and movement in the lower extremities, lower abdomen, and perineum. Spinal anesthesia is not known to increase a client's heart rate. Spinal anesthesia also does not cause hypotension or moderate muscle relaxation. Enflurane is a volatile liquid anesthetic that causes hypotension once it deepens. Halothane, which is a volatile liquid anesthetic, produces moderate muscle relaxation. Both halothane and enflurane are drugs used for general anesthesia.)

31. A client is receiving an opioid analgesic following abdominal surgery. The client has been out of bed to the chair and is encouraged to ambulate with assistance. The nurse is also encouraging the client to increase his fluids. He reports that his appetite is good and he has been finishing most of his meals. His bowel sounds are active but he is having difficulty passing stools. A laxative is ordered. Which nursing diagnosis would be most appropriate? A) Imbalanced Nutrition: Less Than Body Requirements B) Constipation C) Risk for Injury D) Deficient Knowledge

B( Feedback: The client is most likely experiencing constipation from the opioid therapy as well as from the lack of ambulation and activity. The client is eating, so imbalanced nutrition is not necessarily a problem. He is at risk for injury if he is experiencing adverse reactions related to the opioid therapy, but this is not apparent. Although he may have deficient knowledge about the drug, this, too, is not seen in this case.)

6. A nurse is performing discharge teaching for a client who is prescribed ibuprofen. After teaching the client about the possible cardiovascular effects of the drug, the nurse determines that additional teaching is needed when the client states which of the following? A) "My blood pressure may increase." B) "My blood pressure won't change." C) "I could develop congestive heart failure." D) "I could experience a heart attack."

B( Feedback: The client should be counseled that NSAIDs including ibuprofen may result in the following cardiovascular effects: increased or decreased blood pressure, congestive heart failure, cardiac arrhythmias, and myocardial infarction.)

24. While obtaining the medication history, a client tells the nurse that he takes acetaminophen every day. The nurse questions the client about the amount of the drug he takes in each dose and how many times a day he takes the drug based on the understanding that the total daily dose should be no greater than which amount? A) 2 grams B) 4 grams C) 6 grams D) 8 grams

B( Feedback: The maximum daily dose of acetaminophen should not exceed 4 grams.)

26. A nurse is caring for a client with chronic pain who has been prescribed epidural analgesia. The nurse monitors the client for which of the following after insertion of the epidural catheter and throughout the therapy? A) Abdominal pain B) Respiratory depression C) Fever D) Nervousness

B( Feedback: The most serious adverse reaction associated with the epidurally administered opioids is respiratory depression. The nurse should closely monitor the client for respiratory depression after insertion of the epidural catheter and throughout the therapy. Clients using epidural analgesics for chronic pain are monitored for respiratory problems with an apnea monitor. The client may also experience sedation, confusion, nausea, pruritus, or urinary retention. The nurse need not monitor the client for abdominal pain, fever, and nervousness because they do not occur as a result of the administration of epidural analgesia.)

21. A client is prescribed an opioid analgesic. The initial interview reveals that the client chronically drinks alcohol. The nurse would assess the client for which of the following as a possible interaction between the opioid analgesic and alcohol? A) Respiratory depression B) Central nervous system depression C) Hypotension D) Sedation

B( Feedback: The nurse should monitor the client for central nervous system depression. The nurse need not monitor the client for respiratory depression, hypotension, or sedation because these are the effects of the interaction of opioid analgesics with barbiturates, not alcohol.)

19. A nurse would be especially alert for the development of liver failure in which client when administering acetaminophen? A) Client with diabetes B) Client who consumes alcohol habitually C) Client with hypertension D) Client with a urinary tract infection

B( Feedback: The risk of liver failure during acetaminophen therapy increases in clients who drink alcohol habitually. Clients with diabetes, high blood pressure, or urinary tract infections are not at a significantly greater risk for liver failure.)

9. A nurse is conducting a presentation for a local community about salicylates and nonsalicylates. When describing aspirin and acetaminophen, which of the following properties would the nurse describe as these two drugs sharing? Select all that apply. A) Anti-inflammatory B) Analgesic C) Antipyretic D) Inhibition of prostaglandins E) Inhibition of platelet aggregation

B, C( Feedback: Acetaminophen has an unknown mechanism of action, has no anti-inflammatory properties, and does not inhibit prostaglandins or platelet aggregation; therefore, analgesic and antipyretic properties are the only properties that acetaminophen and aspirin share.)

5. After administering diflunisal to a client, the nurse would be alert for which of the following as an adverse reaction? Select all that apply. A) Diarrhea B) Tarry stools C) Weight loss D) Heartburn E) Constipation

B, C, D( Feedback: A nurse monitoring a client taking a salicylate like diflunisal should monitor the client for adverse effects including gastric upset, heartburn, nausea, vomiting, anorexia, and GI bleeding (dark, tarry stools).)

11. A group of nursing students are reviewing information about epidural pain management with opioid analgesics. The students demonstrate understanding of the information when they identify which of the following as an advantage over other routes of administration? Select all that apply. A) Longer time to tolerance development B) Lower total dose of opioid C) Fewer adverse reactions D) Greater client comfort E) Decreased demand on nursing staff

B, C, D( Feedback: Epidural administration offers several advantages over other routes of administration for opioid analgesics, including lower total dosages of the drug used, fewer adverse reactions, and greater client comfort.)

29. When discussing effective pain management with a group of nursing students, the instructor would include barriers that need to be overcome. Which of the following would the instructor most likely include? Select all that apply. A) Pharmacists do not provide an adequate supply of pain medication. B) Primary health care providers prescribe improper pain medicine doses. C) Nurses do not administer adequate medication for pain relief. D) Clients do not report accurate levels of pain. E) Clients have misperceptions about receiving pain medication.

B, C, D( Feedback: The main barriers a nurse must overcome to obtain effective pain management in a client are primary health care providers who do not prescribe proper pain medicine doses, nurses who do not administer adequate medication for pain relief, and clients who do not report accurate levels of pain.)

7. A nurse is assessing a client receiving an opioid as treatment for diarrhea. The nurse would notify the primary health care provider immediately if which of the following occur? Select all that apply. A) Constipation B) Blood noted in the stool C) Worsening of diarrhea D) Report of severe abdominal pain E) Diarrhea unrelieved

B, C, D, E( Feedback: A nurse monitoring a client taking an opioid for diarrhea should notify the physician immediately if diarrhea is not relieved or becomes worse, if the client has severe abdominal pain, or if blood in the stool is noted.)

6. A nursing instructor is describing the classes of drugs that are commonly used as preanesthetics. The instructor determines that the teaching was successful when the students identify which as an example? Select all that apply. A) Antihypertensives B) Opioid agonists C) Antianxiety agents D) Antiemetics E) Cholinergic antagonists

B, C, D, E( Feedback: Opioid agonists, antianxiety agents, antiemetics, and cholinergic antagonists represent classes of drugs commonly used as preanesthetics.)

12. The nurse would question an order for a selective serotonin agonist as treatment for a migraine headache for a client with which condition? Select all that apply. A) Diabetes B) Uncontrolled hypertension C) Angina D) Hyperlipidemia E) Transient ischemic attacks

B, C, E ( Feedback: 5-HT agonists should not be used in patients with ischemic heart disease (such as angina or myocardial infarction), transient ischemic attacks (TIA), uncontrolled hypertension, or those patients taking monoamine oxidase inhibitor (MAOI) antidepressants.)

13. A nurse is researching the actions of the drug midazolam. Which of the following would the nurse expect to find about this drug's use as an anesthetic? Select all that apply. A) A common preanesthetic antiemetic drug B) Appropriate for induction of anesthesia C) Often for conscious sedation prior to minor procedures D) Limited for use with general anesthesia E) Supplementation to nitrous oxide and oxygen for short surgical procedures

B, C, E( Feedback: Midazolam, a short-acting benzodiazepine CNS depressant, is used as a preanesthetic drug to relieve anxiety (not prevent vomiting); for induction of anesthesia; for conscious sedation before minor procedures, such as endoscopy; and to supplement nitrous oxide and oxygen for short surgical procedures.)

4. A nursing instructor is preparing a class that will describe aspirin. Which of the following would the instructor include about aspirin's effects on platelets? Select all that apply. A) Aspirin increases platelet aggregation. B) Aspirin inhibits platelet aggregation. C) Aspirin shortens bleeding time. D) The effect of aspirin on platelets is irreversible. E) The effect of aspirin on platelets is reversible.

B, D( Feedback: Aspirin prolongs bleeding time by inhibiting the aggregation of platelets. The effect of aspirin on platelets is irreversible and lasts for the life of the platelet (7 to 10 days).)

9. A client is receiving an opioid analgesic. Assessment reveals that his respiratory rate has dropped. Which of the following would the nurse expect to implement? Select all that apply. A) Oxygen administration B) Coaching of the client to breathe C) Discontinuation of the opioid analgesic D) Naloxone administration E) Albuterol administration

B, D( Feedback: Coaching the client to breathe and administering naloxone (in severe cases) are appropriate measures used to treat a drop in respiratory rate in a client receiving an opioid analgesic. Oxygen would have little effect if the client's rate has dropped. The opioid would not be discontinued. Albuterol would be used if the client was experiencing bronchospasms.)

31. A nurse is assessing pain in a 3-year-old child. Which of the following would be most appropriate for the nurse to use? Select all that apply. A) Number scale B) Color scale C) Letter scale D) Facial expression scale E) Shape scale

B, D( Feedback: Color and facial expression scales are especially helpful with children who have trouble understanding or cannot tell the nurse about their pain using numbers.)

19. A client is prescribed frovatriptan. Which of the following would the nurse expect to include in the client's teaching plan? Select all that apply. A) Frovatriptan is used to prevent migraines. B) Frovatriptan should be administered at the earliest onset of migraine symptoms. C) Frovatriptan will decrease the number of migraine headaches experienced. D) No more than two doses of the drug should be used in a 24-hour period. E) The dose of frovatriptan may be repeated every hour until symptoms subside.

B, D( Feedback: Frovatriptan does not prevent migraines or reduce the number of migraines. It should be taken at the earliest onset of migraine symptoms and the dose may be repeated one time after 1 hour if no relief is obtained. The client should never take more than two doses of frovatriptan in a 24-hour period.)

9. A nurse is reviewing the methods for general anesthesia administration. The nurse would expect which route to be used most commonly for this type of anesthesia? Select all that apply. A) Oral B) Inhalation C) Topical D) IV E) IM

B, D( Feedback: General anesthesia is most commonly achieved when the anesthetic vapors are inhaled or the drug is administered IV.)

8. After teaching a group of students about NSAIDs and their uses, the instructor determines that additional teaching is needed when the students identify which of the following as being used to treat osteoarthritis or rheumatoid arthritis? Select all that apply. A) Sulindac (Clinoril) B) Ketorolac (Toradol) C) Piroxicam (Feldene) D) Mefenamic (Ponstel) E) Oxaprozin (Daypro)

B, D( Feedback: Ketorolac and mefenamic are NSAIDs that are not used to treat osteoarthritis or rheumatoid arthritis.)

16. A nurse is working at a substance abuse clinic. The nurse would expect which of the following to be used in the treatment and management of opioid dependence? Select all that apply. A) Fentanyl (Duragesic) B) Methadone (Dolophine) C) Propoxyphene (Darvon) D) Levomethadyl (Orlaam) E) Oxycodone (OxyContin))

B, D( Feedback: Levomethadyl and methadone are the two opiates used in the treatment and management of opiate dependence.)

17. The nurse reviews a client's medical record and finds that the client received Innovar. The nurse understands that this drug results in neuroleptanalgesia and is a combination of which of the following drugs? Select all that apply. A) Lidocaine B) Fentanyl C) Etomidate D) Droperidol E) Methohexital

B, D( Feedback: The drug Innovar is a combination drug consisting of fentanyl and droperidol.)

2. The nurse should inform a client receiving spinal anesthesia to expect a loss of feeling and movement in which of the following? Select all that apply. A) Arms B) Legs C) Face D) Lower abdomen E) Hands

B, D( Feedback: The nurse should inform a client receiving spinal anesthesia to expect a loss of feeling and movement in the lower extremities, lower abdomen, and perineum.)

15. A nurse is caring for a newborn. The newborn's mother is suspected to be opioid dependent. When assessing the newborn, which of the following would alert the nurse to the possibility of withdrawal? Select all that apply. A) Jaundice B) Increased respiratory rate C) Decreased respiratory rate D) Sneezing E) Fever)

B, D, E( Feedback: Opiate withdrawal symptoms in a newborn usually appear during the first few days of life and include irritability, excessive crying, yawning, sneezing, increased respiratory rate, tremors, fever, vomiting, and diarrhea.

18. A nurse is reviewing the differences between opioid agonists and opioid agonist-antagonists. The nurse correctly identifies which of the following as an opioid agonist-antagonist? Select all that apply. A) Alfentanil (Alfenta) B) Buprenorphine (Buprenex) C) Meperidine (Demerol) D) Nalbuphine (Nubain) E) Pentazocine (Talwin)

B, D, E( Feedback: Opioid agonist-antagonists include buprenorphine, butorphanol, nalbuphine, and pentazocine.)

18. To assist with the insertion of an endotracheal tube, the nurse would expect the client to receive which of the following to facilitate its insertion? Select all that apply. A) Hydroxyzine B) Glycopyrrolate C) Atracurium D) Doxacurium E) Meperidine

C, D( Feedback: Atracurium and doxacurium are muscle relaxants used during general anesthesia to facilitate the insertion of an endotracheal tube.)

25. A nurse is caring for a client who has been prescribed an opioid. Which of the following would the nurse include in the ongoing assessment? A) Review the client's health history. B) Review the client's allergy history. C) Inquire about the pain experienced by the client. D) Review the client's past and current drug therapies.

C( Feedback: As part of the ongoing assessment, the nurse should inquire about the pain experienced by the client and believe the client and family in their reports of pain. The nurse must exercise good judgment because not all changes in pain type, location, or intensity require notifying the primary health care provider. The nurse has to review the client's health and allergy history and the client's past and current drug therapies as part of the preadministration assessment, which is conducted before the administration of the drug, not after.)

25. A client admitted for surgery is to receive general anesthesia. Prior to administering the prescribed preanesthetic, which of the following would the nurse do? A) Review the client's surgical and anesthesia records. B) Position the client to prevent aspiration of vomitus and secretions. C) Check the chart for any abnormal laboratory test results. D) Check the airway for patency and assess the respiratory status.

C( Feedback: Before surgery and administering the preanesthetic, the nurse should check the client's chart for any abnormal laboratory test results. Reviewing the client's surgical and anesthesia records, positioning the client to prevent aspiration of vomitus and secretions, checking the airway for patency, and assessing the respiratory status are the postoperative responsibilities of the nurse.)

23. A client admitted to a health care facility for an appendectomy receives methohexital as a general anesthetic. Which of the following would most likely occur as a result of this medication? A) Skeletal muscle relaxation B) Profound analgesia C) CNS depression D) Neuroleptanalgesia

C( Feedback: Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia. Skeletal muscle relaxation is caused by skeletal muscle relaxants, halothane, and enflurane. An anesthetic state characterized by profound analgesia is produced by ketamine, which is a rapid-acting general anesthetic. Neuroleptanalgesia is caused by a combination of fentanyl and droperidol.)

30. A client is prescribed a transdermal opioid. After teaching the client and family how to administer this drug, the nurse determines that the teaching was successful when they state which of the following? A) "The drug should be reapplied every 24 hours." B) "We should try to apply the patch to about the same site each time." C) "The site should only be cleaned with water before each application." D) "A hairy area, like the forearm, is an appropriate place to apply the patch."

C( Feedback: Only water is used to clean the site because soap and other substances may irritate the skin. The patch is applied for 72 hours and sites should be rotated. Any site that is used should be free of hair.)

21. A client is admitted to a local health care facility for minor surgery to be performed with regional anesthesia. The nurse knows that regional anesthesia would be injected around which of the following regions in the body? A) The veins B) The arteries C) The nerves D) The capillaries

C( Feedback: Regional anesthesia involves injection around the client's nerves. Doing so prevents these nerves from sending pain signals to the brain. Regional anesthesia is never injected into the veins, arteries, or capillaries.)

27. After teaching a client about his prescribed NSAID therapy, the nurse determines that the teaching was successful when the client states which of the following? A) "I will take the drug with high-fiber foods." B) "I must take the drug on an empty stomach." C) "I should take the drug with food and milk. D) "I need to take it with a calcium supplement."

C( Feedback: The client should take the drug with food and milk to promote an optimal response to NSAID therapy; this helps minimize the risk of GI effects. The client does not need to take an NSAID with fiber-rich food or with calcium supplements. He should not take it on an empty stomach.)

23. Which of the following interventions should a nurse perform for a patient who is experiencing gastric upset while taking magnesium salicylate? A) Administer the drug with orange juice. B) Include fiber-rich food in the patient's diet. C) Administer antacids to minimize GI distress. D) Ensure drug is given at least 3 hours before meals.

C( Feedback: The nurse may administer antacids to minimize GI distress. Instead of orange juice, the nurse may administer the drug with milk to alleviate gastric upset. The nurse can also administer the drug with food to relieve gastric upset instead of giving the drug 3 hours before a meal. Including fiber-rich food in the patient's diet will not significantly relieve gastric upset.)

27. A client is receiving drugs through a PCA infusion pump. When teaching the client about this therapy, which of the following would the nurse include? A) Pain relief should occur 1 hour after pushing the control button. B) The control button and the button to call the nurse are the same. C) The control button activates administration of the drug. D) The machine delivers the drug every time the control button is used.

C( Feedback: The nurse should inform the client that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the client on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

26. A client comes to the clinic complaining of muscle aches and asks the nurse about using an over-the-counter NSAID. The client tells the nurse that he takes a medication to control his high blood pressure. The nurse cautions the client against using an NSAID while on antihypertensive drug therapy for which reason? A) It increases the metabolism of the antihypertensive drug. B) It increases absorption of the antihypertensive drug. C) It decreases the effectiveness of the antihypertensive drug. D) It decreases the metabolism of NSAIDs.

C( Feedback: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drugs, or decreased metabolism of NSAIDs.)

24. A nurse is caring for a client who is required to take NSAIDS on an outpatient basis. Which of the following would the nurse include in the teaching plan for the client and family? A) Take aspirin if necessary strictly with a full glass of water. B) Use the drug on a very regular basis during treatment. C) Call your primary care provider if you have no relief after 2 weeks. D) Take the drugs strictly with a glass of milk or juice.

C( Feedback: The nurse should instruct the patient to consult the primary health care provider if the pain, swelling, inflammation, or tenderness is not relieved after 2 weeks. The drug takes several days to relieve the discomfort, so it is important for the patient to give the drug time to work. The nurse should instruct the patient to avoid the use of aspirin. The drug should be taken with a full glass of water or with food. It is not necessary to take NSAIDs strictly with a glass of juice or milk. These drugs are not to be used on a regular basis unless the patient is strictly instructed to do so by the primary health care provider.)

19. A nurse is caring for a client who is prescribed an opioid analgesic by her primary health care provider. Which assessment finding would lead the nurse to suspect that the client is experiencing an adverse reaction? A) Decreased intracranial pressure B) Increased breathing rate C) Tachycardia D) Urinary frequency

C( Feedback: The nurse should monitor the client for tachycardia, increased intracranial pressure, depressed breathing rate, and urinary retention as possible adverse reactions.)

26. A client is scheduled for outpatient surgery. When performing the preoperative teaching with the client, the nurse would instruct the client to avoid taking any salicylates for at least how many days before the surgery? A) 3 B) 5 C) 7 D) 10

C( Feedback: The patient should be instructed to avoid salicylates for at least 1 week before any type of major or minor surgery, including dental surgery, because of the possibility of postoperative bleeding.)

29. A nurse is reviewing the medication history for a client who is to receive salicylate therapy. Which of the following if noted by the nurse would lead the nurse to closely monitor the client for salicylism? A) Antacids B) Anticoagulants C) Carbonic anhydrase inhibitors D) Activated charcoal

C( Feedback: The use of carbonic anhydrase inhibitors, used to lower intraocular pressure, along with salicylates places the client at increased risk for salicylism. Combined use of anticoagulants and salicylates increases the client's risk for bleeding. Combined use of antacids with salicylates decreases the absorption of the salicylates. Combined use of activated charcoal with salicylates causes a decrease in the effects of salicylates.)

18. A nurse is administering acetaminophen to a client who has diabetes. Which of the following would be most important for the nurse to monitor? A) Arterial blood pH B) Blood pressure C) Blood glucose levels D) Blood creatinine levels

C( Feedback: When administering acetaminophen to diabetic patients, care needs to be taken when blood glucose testing is done because acetaminophen may alter blood glucose test results, causing falsely lower blood glucose values. Acetaminophen does not significantly alter pH level, blood pressure, or blood creatinine levels in a patient with diabetes.)

8. A nurse is administering an opioid analgesic to a client with severe chronic pain. The nurse understands that the rate of tolerance to an opioid analgesic's effects varies from client to client. The nurse identifies which of the following as affecting the rate at which tolerance develops? Select all that apply. A) Body weight B) Gender C) Dosage D) Route of administration E) Age

C, D( Feedback: The rate at which tolerance to an opioid analgesic develops varies according to dosage, the route of administration, and the individual.)

20. A nurse is preparing to administer NSAID therapy to a client. The nurse would be alert to a decrease in the effectiveness of which drug if given together? Select all that apply. A) Lithium B) Cyclosporine C) Furosemide D) Lisinopril E) Phenytoin

C, D( Feedback: The use of NSAIDs can decrease the effectiveness of furosemide and lisinopril, possibly leading to increased edema or increased blood pressure.)

8. Foods containing salicylates may increase the risk of adverse reactions in clients receiving salicylates. The nurse recommends that a client avoid the intake of which of the following? Select all that apply. A) Turkey B) Pepper C) Paprika D) Tea E) Prunes

C, D, E( Feedback: Curry powder, paprika, licorice, prunes, raisins, and tea are foods that contain salicylates, therefore potentially increasing the risk for adverse reactions in clients receiving salicylate medications.)

12. A nurse is reviewing the anesthesia record of a client who has returned to the unit after abdominal surgery. Which of the following might the nurse note as being used for the induction of anesthesia? Select all that apply. A) Lidocaine B) Prilocaine C) Methohexital D) Etomidate E) Propofol

C, D, E( Feedback: Methohexital, propofol, and etomidate are examples of medications used for the induction of anesthesia. Lidocaine and prilocaine are local anesthetics.)

19. A nursing student is reviewing the stages of general anesthesia. Which pairing if identified by the student demonstrates understanding? Select all that apply. A) Stage I—delirium B) Stage III—respiratory paralysis C) Stage II—delirium D) Stage IV—respiratory paralysis E) Stage I—analgesia

C, D, E( Feedback: The stages of anesthesia are as follows: stage I—analgesia; stage II—delirium; stage III—surgical anesthesia; and stage IV—respiratory paralysis.)

30. A nurse is assessing a client's pain. When reporting the assessment findings to the primary health care provider to ensure the proper prescription for analgesic therapy for effective pain management, which of the following would be most important for the nurse to report? Select all that apply. A) Duration B) Aggravating factors C) Location D) Remitting factors E) Intensity

C, E( Feedback: Although duration, aggravating and remitting factors, location, and intensity are important to assess, to ensure that the primary health care provider prescribes effective analgesics for pain management, the nurse needs to report two key assessments about pain: location and intensity.)

2. A group of nursing students are reviewing NSAIDs. The students demonstrate understanding of this drug class when they identify which of the following as an NSAID? Select all that apply. A) Eletriptan (Relpax) B) Aspirin (Ecotrin) C) Meloxicam (Mobic) D) Acetaminophen (Tylenol) E) Ibuprofen (Motrin)

C, E( Feedback: Ibuprofen and meloxicam are both classified as NSAIDs. Aspirin is a salicylate, acetaminophen is a nonsalicylate, and eletriptan is a serotonin receptor agonist.)

11. After teaching an in-service presentation for nurses about general anesthetics, the instructor determines that the teaching was successful when the nurses identify which of the following as an example of a gas anesthetic? Select all that apply. A) Halothane B) Desflurane C) Nitrous oxide D) Enflurane E) Cyclopropane

C, E( Feedback: Nitrous oxide and cyclopropane are examples of gas anesthetics. Halothane, desflurane, and enflurane are examples of volatile liquids used as inhaled anesthetics.)

1. A nurse recognizes the difference between an opioid and nonopioid analgesic. Which of the following would the nurse identify as nonopioid analgesics? Select all that apply. A) Morphine B) Codeine C) Acetaminophen D) Oxycodone E) Diflunisal

C, E( Feedback: The nonopioid analgesics can be divided into three categories: salicylates, nonsalicylates, and NSAIDs. NSAIDs, acetaminophen (nonsalicylate), and diflunisal (salicylate) are nonopioid analgesics.)

27. A client visits a dental health care clinic for a tooth extraction. Which type of anesthesia would most likely be used? A) Regional anesthesia B) General anesthesia C) Topical anesthesia D) Local infiltration anesthesia

D Feedback: Local infiltration anesthesia is often used for dental procedures. Regional anesthesia covers a larger area than that covered by local infiltration anesthesia, so it is not used for minor surgeries like that of a tooth extraction. General anesthesia is used to achieve a pain-free state for the entire body and is not the most appropriate type of anesthesia for a tooth extraction. Similarly, topical anesthesia is used to desensitize skin or mucous membranes for injection of a deeper local anesthetic.)

30. A client has had minor surgery and asks the nurse what he can use for pain. Which of the following would be most appropriate for the nurse to suggest? A) Aspirin B) Diflunisal C) Magnesium salicylate D) Acetaminophen

D( Feedback: After minor or major surgery, the client should avoid salicylates to reduce the risk for bleeding and use acetaminophen for pain control.)

22. A nurse understands that aspirin would be contraindicated in a child with which of the following? A) Liver dysfunction B) High blood pressure C) Diabetes D) Chickenpox

D( Feedback: Children or teenagers with influenza or chickenpox should not take salicylates, particularly aspirin, because their use appears to be associated with Reye's syndrome, a life-threatening condition characterized by vomiting and lethargy progressing to coma. Even though salicylates need to be administered with caution in patients with hepatic dysfunction, high blood pressure, and diabetes, their use does not lead to Reye's syndrome.)

14. A client is prescribed diflunisal. The nurse understands that this drug is being used for which of the following? A) Reducing elevated body temperature B) Decreasing the risk of myocardial infarction C) Reducing the risk of transient ischemic attacks D) Relieving mild to moderate pain

D( Feedback: Diflunisal is used for relieving mild to moderate pain. Unlike other salicylates, diflunisal is not used as an antipyretic (reducing body temperature). It does not reduce the risk of transient ischemic attacks or decrease the risk of myocardial infarction.)

16. A nurse is caring for a patient who is receiving a salicylate for pain relief. The nurse would assess the client for which of the following suggesting salicylism? A) Constipation B) Bradycardia C) Sleeplessness D) Flushing

D( Feedback: Flushing is one of the symptoms of salicylism that the nurse should monitor for. Tachycardia, not bradycardia, is a symptom of salicylism. Sleeplessness and constipation are not symptoms of salicylism.)

25. A nurse caring for a client who is receiving an NSAID for fever reduction documents a decrease in urinary output for the patient. Which of the following would the nurse most likely determine as the reason for the patient's condition? A) Prolonged immobility B) Reduced intake of fibrous food C) Intake of food with antacids D) Prolonged temperature elevation

D( Feedback: If temperature elevation is prolonged while on NSAID therapy, hot, dry, flushed skin and a decrease in urinary output may develop; consequently, dehydration can occur. Prolonged immobility, reduced intake of fibrous food, and intake of food with antacids do not cause a decrease in urinary output.)

29. A client scheduled for surgery has to undergo insertion of an endotracheal tube. The nurse understands that which of the following drugs for general anesthesia would most likely be ordered for this client? A) Benzodiazepines B) Barbiturates C) Opioid analgesics D) Skeletal muscle relaxants

D( Feedback: Skeletal muscle relaxants help produce relaxation of skeletal muscles during certain types of surgeries involving the chest or abdomen and are used to facilitate the insertion of an endotracheal tube. Barbiturates are used for the induction of anesthesia. Benzodiazepines are used to relieve anxiety, induce anesthesia, and consciously sedate the client before minor procedures. Opioid analgesics are used to produce neuroleptanalgesia characterized by general quietness, reduced motor activity, and profound analgesia.)

23. A nurse is providing care to a client with arthritis in several large weight-bearing joints who is receiving NSAID therapy. Which nursing diagnosis would be most likely? A) Risk for Unstable Blood Glucose Levels B) Impaired Gas Exchange C) Risk for Imbalanced Body Temperature D) Impaired Physical Mobility

D( Feedback: The client has arthritis and is receiving NSAID therapy most likely for pain relief and reduction of inflammation. The affected joints would interfere with the client's mobility. Therefore, Impaired Physical Mobility would be most appropriate. There is no indication that the client has diabetes, respiratory problems, or fever. Therefore, the other nursing diagnoses would be inappropriate.)

26. A nurse is assigned to care for a 53-year-old client who is to receive glycopyrrolate as a preanesthetic drug. The nurse reviews the client's history for which of the following that would contraindicate the use of this drug? A) Diabetes B) Hypotension C) Respiratory problems D) Myocardial ischemia

D( Feedback: The nurse should confirm that the 53-year-old client does not have myocardial ischemia to ensure that the use of glycopyrrolate is not contraindicated. The other conditions that contraindicate the drug's use include prostatic hypertrophy and glaucoma. Diabetes, hypotension, or respiratory problems are not contraindications for the use of glycopyrrolate.)

20. Which of the following points should a nurse include in the teaching plan for a patient who has been prescribed a nonopioid analgesic? A) Discontinue the dosage of the drug immediately if symptoms disappear. B) Take any over-the-counter (OTC) drug if pain increases. C) Contact physician if temperature remains high even after 3 days. D) Contact physician if severe or recurrent pain persists for more than 10 days.

D( Feedback: The nurse should instruct the patient to consult the primary health care provider if severe or recurrent pain persists for more than 10 days. No over-the-counter (OTC) drugs should be taken without first consulting the primary health care provider. If the drug is used to reduce fever, contact the primary health care provider if the temperature continues to remain elevated for more than 1 day, not 3 days.)

23. A nurse is caring for a client with pain caused by terminal illness. The primary care provider has prescribed an opioid for the client. The nurse would be alert for the development of which of the following? A) Emphysema B) Alopecia C) Dehydration D) Severe anorexia

D( Feedback: The nurse should monitor the client for severe anorexia, which is one of the adverse reactions of opioid analgesics on the GI system. Other adverse effects on the GI system include constipation, nausea, and acute abdominal pain. The nurse need not monitor the client for emphysema, alopecia, or severe headache. Opioid analgesics do not cause emphysema, but their administration is contraindicated in clients who have this condition. Administration of opioid analgesics is not known to cause alopecia or dehydration in clients.)

15. A patient who has been prescribed aspirin wants to know more about willow bark as a substitute for aspirin. Which of the following would the nurse integrate into the response as an advantage of willow bark as compared to aspirin? A) Willow bark is ideal for patients with peptic ulcers. B) Willow bark works relatively quickly as compared to aspirin. C) Small amounts of willow bark produce a noticeable effect. D) Willow bark has fewer adverse reactions than other salicylates.

D( Feedback: Willow bark causes fewer adverse reactions than other salicylates. The nurse should inform the patient and family members that willow bark treatment should be given cautiously to patients with peptic ulcers. Willow bark takes more time to take effect, and it has to be given in large amounts to produce a significant effect.)