N221 Ch 10 NCLEX practice

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose? - Renal failure - Kidney stones - Acute hepatic necrosis - Metabolic alkalosis

- Acute hepatic necrosis Acetaminophen in large doses over a short period is extremely hepatotoxic. The long-term ingestion of large doses of acetaminophen is more likely to result in nephropathy.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? - Stimulation of the immune system - Cough suppressant - Expectorant - Bronchodilation

- Cough suppressant Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? - When pain recurs - Every 24 hours - Every 72 hours - Once a week

- Every 72 hours The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? - Acute pain - Risk for injury related to central nervous system side effects - Impaired gas exchange related to respiratory depression - Constipation related to gastrointestinal side effects

- Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? - Administer a smaller dose and record the findings. - Notify the physician and delay drug administration. - Administer the prescribed dose and notify the physician. - Hold the drug, record the assessment, and recheck in 1 hour.

- Notify the physician and delay drug administration. Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician.

When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient? - Respiratory rate - Heart rate - Blood pressure - Mental status

- Respiratory rate The most serious side effect of narcotic analgesics is respiratory depression.

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity? - naloxone (Narcan) - acetylcysteine (Mucomyst) - methylprednisolone (Solu-Medrol) - vitamin K

- acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by - taking Lomotil with each dose. - eating foods high in lactobacilli. - taking the medication on an empty stomach. - increasing fluid and fiber in the diet.

- increasing fluid and fiber in the diet. Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation.

Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that - massaging muscles decreases the inflammatory response that initiates the painful stimuli. - massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. - massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain. - massaging muscles helps relax the contracted fibers and decrease painful stimuli.

- massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. The gate theory of pain control identifies large sensory nerves that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore the patient is not having the sensation of pain even if the stimulus is still present.

A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication? - morphine - methadone - meperidine - naloxone

- methadone Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype? - meperidine - fentanyl - codeine - morphine

- morphine The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine.

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic? - naloxone (Narcan) - acetylcysteine (Mucomyst) - methylprednisolone (Solu-Medrol) - flumazenil (Romazicon)

- naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that - narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction. - analgesics should be administered as needed (prn) to minimize side effects. - pain relief is best obtained by administering analgesics around the clock. - patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.

- pain relief is best obtained by administering analgesics around the clock. When pain is present for more than 12 hours a day, analgesic dosages are best administered around the clock and not "as needed," but dosages should always be within the dosage guidelines for each drug used. The around-the-clock (or "scheduled") dosing allows steady states of the medication and prevents drug dosage "troughs" and escalation of pain.

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of - autonomic control over circulation. - the cough reflex center. - the chemoreceptor trigger zone. - respiratory rate.

- the chemoreceptor trigger zone. Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.) -Decreased peristalsis -Diarrhea -Delayed gastric emptying -Urinary retention

-Decreased peristalsis -Delayed gastric emptying -Urinary retention Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention.