Pharm Exam 1.4

A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of

activation of the woman's delta and C nociceptors.

A caregiver of a 1-year-old asks the nurse if the caregiver can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

"Children younger than 1 year of age should not be given this medication."

A 15-year-old has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?

"Do you ever use alcohol or drugs?"

Benzocaine is a topical anesthetic that is short acting and has a quick onset. The duration is 30 to 60 minutes. How long is the onset of action of this medication?

1 minute

The nurse is administering medications to a 2-year-old child with impaired renal function. What does the nurse understand about the dosage of medication for this child?

The dose should be adjusted to achieve and maintain therapeutic drug levels

An 8-year-old is going home on medication for a chronic condition. The nurse preparing to review the discharge instructions with the mother should include what basic information and/or instructions to help minimize the child's risk for injury? (Select all that apply.)

The drugs' potential side effects Schedule and duration of administration Description of the intended therapeutic drug effect

The students are studying for an exam in pharmacology. They know several local anesthetics have been covered along with other forms. Which medication can they anticipate as being local anethetics on the exam? Select all that apply.

The following are examples of local anesthetics: novocain, xylocaine, and marcaine. The others are examples of pre-anesthetics.

A 39-year-old client is about to undergo combined spinal/epidural anesthesia for lower abdominal surgery. Which area of the spine should the nurse prep with antiseptic for the procedure?

The lumbar portion of the spine . Spinal anesthesia for lower abdominal surgery is usually given in the lumbar portion of the spine at L3-L4. The posterior iliac spine is part of the pelvis.

A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider?

The nurse must consider the patient's dietary habits because foods high in purines increase uric acid concentrations in the blood, making a gouty attack more likely. Assessing the patient's work environment, fluid intake, and ethnicity are not as important as assessing his dietary habits.

The healthcare provider orders lidocaine injection SC before a skin biopsy. Which action should the nurse take?

The nurse should question the order for further instructions, including the dose to be administered, the location, and the use of epinephrine. The nurse should not administer, refuse to administer, or suggest the use of another medication without further information.

What is essential for the nurse to assess prior to the patient taking sumatriptan-naproxen sodium (Treximet)?

The patient's cardiac history

The nurse is completing a preoperative database on a client scheduled for back surgery the next day. Which question is most important to ask to possibly prevent an adverse patient outcome?

"Have you or any family members ever suffered a reaction to anesthesia? Malignant hyperthermia is a rare but potentially fatal reaction that can be triggered by all inhalation anesthetics except nitrous oxide. Predisposition to the reaction is genetic. Malignant hyperthermia can prove fatal and therefore is the highest priority, among the options listed, in a preoperative assessment.

The nurse is teaching a patient with a new prescription for ergotamine [Ergomar]. Which statement is most appropriate to include in the teaching plan?

"You should not use this drug more than 1 or 2 days per week."

The nurse is conducting a first aid class and informs the class that in the case of acute, nonspecific diarrhea in adults where fluid losses are not severe, clients usually need only simple replacement of fluids and electrolytes lost in the stool. The nurse instructs the class to drink how much fluid during the first 24 hours?

2 to 3 L of clear liquids

A client who experiences frequent constipation is using psyllium (Metamucil). The nurse knows what contraindications to using psyllium?

Difficulty swallowing Gastrointestinal obstruction Fecal impaction Undiagnosed abdominal pain

The nurse is conducting a class on nonpharmacologic treatment for occasional constipation. Which treatments will the nurse recommend? (Select all that apply.)

Eat more high-fiber foods Use of prebiotics Use of probiotics

What is first-line therapy for infants and children 1 to 4 years of age with diarrhea?

Electrolyte replacement

C-reactive protein (CRP)

The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

The nurse is preparing to administer an intravenous (IV) medication. What is the minimum injection time to reduce the risk of harm to the patient?

60 seconds Most IV drugs should be injected slowly over at least 1 minute or longer, because all the blood in the body is circulated about once every minute. This allows the drug to be diluted in the largest volume of blood possible.

The drug dobutamine acts as an agonist of norepinephrine (NE) receptors. Which effect is the nurse most likely to observe in a patient receiving this medication?

Dobutamine mimics the action of NE at receptors on the heart, thereby causing an increase in the heart's rate and force of contraction.

bunion

A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are often referred to as hallux valgus. Bunions develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe.

The nurse is caring for a new mother who had to have an episiotomy during the birth of her baby. Two days after delivery the client is in need of a laxative. What will the nurse administer?

Docusate sodium . Colace

Which agency is responsible for the enforcement of controlled substances?

Drug Enforcement Agency

The nurse is caring for a female patient receiving sumatriptan [Imitrex]. Which concept guides the nursing care of this patient

About 50% of patients taking sumatriptan have chest symptoms, including a feeling of "heavy arms" or chest pressure. Sumatriptan relieves not only headache but also other migraine-associated symptoms, such as photophobia, nausea, and phonophobia. Sumatriptan may cause harm to the developing fetus and should be avoided in pregnancy. It is classified as Pregnancy Risk Category C.

The nurse is caring for a patient with a migraine. What nursing diagnosis is a priority?

Acute pain

Which nursing action results in the most common cause of fatal medication errors?

Administering a drug intravenously (IV) instead of intramuscularly (IM)

Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?

Administering an antacid to a client taking digoxin will decrease the absorption of digoxin and result in a decreased digoxin effect.

The nurse is formulating a nursing diagnosis for a patient that has developed a Stage III decubitus ulcer on the sacrum. What would be an appropriate nursing diagnosis for this patient?

Alteration in skin integrity

The nurse is explaining differential sensitivity to the nursing student with regard to the use of local anesthetics. The nurse explains that which perception is lost first?

Although local anesthetics can block traffic in all neurons, blockade develops more rapidly in some neurons than in others. Specifically, small, nonmyelinated neurons are blocked more rapidly than large, myelinated neurons. Because of this differential sensitivity, some sensations are blocked sooner than others. Specifically, perception of pain is lost first, followed in order by perception of cold, warmth, touch, and deep pressure.

Some medications are more likely to demonstrate the adverse effects of nausea and vomiting than others. With which medications are nausea and vomiting especially associated?

Although the symptoms may occur with most drugs, they are especially associated with alcohol, aspirin, digoxin, anticancer drugs, antimicrobials, estrogen preparations, and opioid analgesics.

What is the most important teaching point for a client after surgery when the client had epidural anesthesia?

Ambulate with assistance.

The nurse is reviewing the anesthetic record for a postoperative patient. The nurse notes that morphine sulfate, an opioid, was given during the operative procedure. What is the rationale for giving an opioid as part of balanced anesthesia?

An opioid enhances analgesia and reduces the required dosage of the general anesthetic. Opioids are not muscle relaxants. They can cause respiratory depression and do not necessarily reduce the adverse effects of surgery.

The nurse is caring for a patient who has finished a course of clindamycin for an infection. Today the patient reports fever, abdominal pain, and loose, watery stools with mucus. The nurse recognizes this patient needs to be screened for which organism?

Antibiotic-associated colitis is a serious condition that results from antibiotic therapy. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially C. difficile.

When counseling a patient about the proper use of Lidoderm (a local anesthetic patch) what instruction should the nurse include?

Apply the patch to the most painful area of the skin.

The nurse understands that the dose-response relationship is graded and should expect to observe which response?

As the dosage increases, the response becomes progressively greater. Correct If drug responses were all-or-nothing instead of graded, drugs could produce only one intensity level of response. The response may be maintained at a specific level when the therapeutic objective is achieved, but that option does not pertain to a dose-response relationship that is graded.

The nurse is reviewing the laboratory value for a patient prescribed atorvastatin [Lipitor]. Which laboratory value is most useful for monitoring this drug?

Aspartate aminotransferase (AST) AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug.

The development of gout has four distinct phases. Place in order each phase of the development of gout.

Asymptomatic hyperuricemia Acute gouty arthritis Intercritical gout Chronic advanced gout

When a surgical patient receives nitrous oxide at therapeutic concentrations as part of general anesthesia, which adverse effect is most likely to occur?

At therapeutic doses, nitrous oxide does not have serious adverse effects. The major problem with this drug is postoperative nausea and vomiting.

Benzodiazapine

Ativan (lorazepam) and Xanax (alprazolam) are both used to treat anxiety and other psychiatric disorders. They are in the benzodiazapine family of drugs, which help inhibit excess nerve stimulation in the brain.

When assessing a client reporting a classic migraine headache, what would the nurse expect to assess?

Aura One-sided pulsating pain Sensitivity to light Nausea

The drug the nurse is about to give induces P-glycoprotein (PGP). Which outcome should the nurse expect when this drug is given with other drugs?

Drugs that induce PGP can cause reduced absorption of other drugs, which would reduce their levels. A PGP inducer would not increase the side effects of other drugs and could increase elimination of other drugs.

When are bile-binding drugs useful in treating diarrhea? Select all that apply.

Bile-binding drugs are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn's disease and surgical excision of the ileum.

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin?

Bismuth subsalicylate

Which of the following measurements would prompt the nurse to hold the sumatriptan dose and contact the provider?

Blood pressure 190/100 Triptans are contraindicated in hypertension. The patient may be hypertensive because he or she is in pain, but the nurse should consult the provider before administering the dose.

BUN

Blood urea nitrogen is a medical test that measures the amount of urea nitrogen found in blood. The liver produces urea in the urea cycle as a waste product of the digestion of protein. Normal human adult blood should contain 7 to 20 mg/dL of urea nitrogen.

beta-blocker and it may take up to 3 months to be effective as a migraine

By itself, ergotamine may be poorly absorbed. Caffeine reportedly aids in the treatment of migraines by increasing the absorption and vasoconstrictive effects of ergotamine.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

a return to normal respiratory rate, rhythm, and depth.

A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital?

CNS depression Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia.

A nurse is caring for a client that has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement?

Call the prescriber about the laboratory tests.

Which of the following is a serious risk involved in the use of NSAIDs?

Cardiovascular thrombosis

The nurse is teaching the client how to treat diarrhea and discussing general guidelines. The nurse reminds the client to stop taking the antidiarrheal medication and to call the clinic if fever and abdominal pain become severe, after how many days?

Clients should consult a health care provider if diarrhea is accompanied by severe abdominal pain or fever, lasts longer than 2 days, or if stools contain blood or mucus.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

Coach the client to breathe.

Which of the following statements about cocaine is true?

Cocaine causes intense vasoconstriction. Cocaine is an excellent local anesthetic. Administered topically, the drug is employed for anesthesia of the ear, nose, and throat. Cocaine produces generalized CNS stimulation

A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the client about which adverse effect(s)?

Constipation

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Control button activates administration of the drug.

Ranitidine (Zantac) is preferred over cimetidine (Tagamet) therapy in critically ill clients due to decreased risk of which adverse effect?

Drug-drug interactions Ranitidine, which is longer acting and more potent than cimetidine, is not associated with the antiandrongenic adverse effects or the marked slowing of metabolism in the liver, as cimetidine is, and therefore does not interfere with the metabolism of other drugs.

The nurse is assessing a patient receiving dihydroergotamine [Migranal] for potential side effects. Which symptom, if found, would indicate a side effect of this drug?

Diarrhea is a common problem with dihydroergotamine. The advantage of dihydroergotamine is that, unlike ergotamine, it does not cause nausea, vomiting, or physical dependence. Dihydroergotamine is not associated with constipation.

The nurse is caring for a woman who received epidural anesthesia during the labor and delivery of her baby. The client is anxious to get up and take a shower. What is the nurse's best action in this situation?

Ensure the woman has return of normal feelings and movement in the lower extremities.

Which can be mixed in certain situations with an injectable local anesthetic to cause local vasoconstriction?

Epinephrine

A 2-year-old boy with respiratory syncytial virus has a fluid volume deficit and requires intravenous rehydration. Prior to inserting a peripheral intravenous catheter, the nurse may apply what local anesthetic to the child's skin?

Eutectic mixture of local anesthetics (ELMA) is a cream-based mixture of lidocaine and prilocaine applied to intact skin. The cream is applied at an injection site with an occlusive dressing at least 60 minutes before the vaccination or venipuncture.

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms?

Functional diarrhea disorder

What medical diagnoses would the nurse suspect if the client is experiencing diarrhea with mucus, proteins, and blood in the stool? Select all that appl

Gastroenteritis Diverticulitis Ulcerative colitis Crohn's disease

Hepatic encephalopathy

Hepatic encephalopathy is a syndrome observed in patients with cirrhosis. Hepatic encephalopathy is defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, after exclusion of brain disease.

The nurse is caring for a client who has received a prescription for naproxen sodium for the treatment of migraine headaches. This client also takes lithium carbonate for bipolar disorder. The nurse is aware that this client will be monitored for what condition?

Lithium toxicity

The perioperative nurse is caring for a patient receiving Isoflurane [Forane]. The nurse understands that this medication will be excreted by the body through which organ system?

Lungs

A patient with end-stage breast cancer is experiencing ineffective pain management. Which statements represent the most likely cause of this problem?

Many cancer patients are reluctant to take pain medication. Healthcare professionals often fear patient addiction to pain medication. The healthcare system often places a low priority on pain management. Most cancer pain is nociceptive and responds well to opioids and other pain relievers. Cancer pain can be relieved in 90% of patients. Healthcare professionals often fear patient addiction, and the healthcare system tends to place a low priority on pain management and control.

The nurse is caring for a patient who is being treated with opioids for cancer pain. The patient has become agitated and is reporting visual disturbances. The nurse suspects opioid-induced neurotoxicity. The nurse anticipates which management actions? (

IV fluids Decreasing the dose of the opioid Rotating different opioids Opioid-induced neurotoxicity symptoms include delirium, agitation, myoclonus, and hyperalgesia. Management consists of hydration, dose reduction, and opioid rotation. Narcan and NSAIDs are not specific management measures for opioid-induced neurotoxicity.

Before administrating the dosage of a prescribed medication, the nurse observes precipitation formation of the intravenous (IV) solution. What is the priority nursing action?

If a precipitate appears in the IV solution, that solution should be discharged.

The nurse is caring for a client who has been prescribed sucralfate for treatment of peptic ulcer disease. Which nursing diagnosis may relate specifically to administration of this medication?

Impaired Bowel Elimination: Constipation

The student nurse prepares to administer ketamine to a patient. The supervising nurse questions this administration for which patient?

In the past, ketamine was used primarily in children. However, an updated guideline, issued in 2011, now recommends expanding ketamine use to include adults, and babies between 3 and 12 months old. Because of its potential for adverse psychologic effects, ketamine should generally be avoided in patients with a history of psychiatric illness.

The nurse is caring for a client who will undergo an emergency repair of an open fracture to the femur that occurred during a motor vehicle accident. Because of the client's elevated blood alcohol, the nurse expects that the client may experience what reaction to the use of isoflurane anesthesia?

Increased effect of isoflurane

The nurse is caring for a patient who will receive an epidural block. In what surgeries would an epidural block be useful for pain control?

Inguinal hernia repair

Prior to the administration of a topical local anesthetic, what is the nurse's priority assessment?

Intact skin

A nurse is completing an assessment on a client experiencing diarrhea. The client states having diarrhea for the past few days, but prior to the diarrhea experienced one week of constipation. Based on the description, what does the nurse suspect?

Irritable bowel syndrome

An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states , "My arms and legs feel like tree trunks and my head feels "fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client?

It would be most important for the nurse to be with the client as much as possible and reassure the client while providing frequent assessment.

The nurse is caring for a client who is diagnosed with hepatic encephalopathy. The nurse knows that which medication will be used to treat the constipation that accompanies this condition?

Lactulose Clients with hepatic encephalopathy are prescribed lactulose which helps to decrease the amount of ammonia in the intestine.

A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure?

Midazolam is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures.

Which prescription would be the most appropriate for treating persistent cancer pain?

Morphine [Duramorph] 30 mg every 3 to 4 hours C For persistent pain, medication should be given on a fixed schedule to prevent opioid levels from becoming subtherapeutic. Meperidine causes accumulation of a toxic metabolite when used on a long-term basis. Pentazocine produces a limited amount of analgesia, and IM injections generally should be avoided. Morphine 30 mg is an appropriate dose and should be given as indicated around the clock.

The nurse is teaching a client about loperamide, which the health care provider has prescribed for treatment of chronic diarrhea. Which adverse effects should the nurse be sure to mention?

Nausea

The nurse is preparing to give ergotamine [Ergomar]. This agent is effective against headaches of which origin?

No identifiable cause Ergotamine is effective against headaches that have no other identifiable cause and are assumed to be migraine or cluster headache. Also, ergotamine is a vasoconstrictor and is contraindicated in an individual with high blood pressure or other cardiac ailments.

An emergency department patient reports that she took frovatriptan 2.5 mg at home an hour ago but still has a migraine. Which action should the nurse take next?

Notify the healthcare provider. Do not give a second dose. The initial dose is 2.5 mg. If headache recurs after initial relief, dosing can be repeated—but no sooner than 2 hours after the first dose. If there was no response to the first dose, repeat dosing is unlikely to help. The maximum dose per 24 hours is 7.5 mg.

An adult patient presents to the emergency department and is diagnosed with a severe migraine headache. Which classes of medication would the nurse expect to be ordered for this patient?

Opioid analgesic Migraine-specific agent Antiemetic

Constipation is a side effect of opioid medications because of which of the following pathophysiologic reasons?

Opioids promote constipation by decreasing propulsive intestinal contractions, increasing nonpropulsive contractions, increasing the tone of the anal sphincter, and reducing fluid secretion into the intestinal lumen.

You are caring for four clients. Which client would you know is at highest risk for constipation?

Paraplegic Spinal cord injury (SCI) impairs the ability of an individual to sense that a bowel movement is imminent, and the ability to control the timing and place of bowel evacuation. Common problems that the individual with SCI must cope with include incontinence and fecal impaction, which, if left untreated, may result in perforation of the bowel.

Which condition should the nurse anticipate when the patient has received an intraspinal opioid medication to control cancer pain?

Potential for delayed respiratory depression and catheter-related infections

A nurse notices that one of the anesthesiologists returns from the staff lounge every day in a brief state of euphoria after her break. The nurse speaks to the unit manager, because she is concerned about abuse of which of these medications?

Propofol Although not regulated as a controlled substance, propofol is subject to abuse, primarily by anesthesiologists, nurse anesthetists, and other medical professionals, all of whom have easy access to the drug. Clinicians use it to produce instantaneous (but brief) sleep, after which they wake up feeling refreshed. When patients awake after receiving propofol, they often are talkative and report feeling elated and even euphoric.

The nurse is reviewing the patient's current medication list and recognizes that which medication is considered a first-line drug for migraine prevention?

Propranolol [Inderal]

A surgical intensive care unit patient has been on a propofol drip for an extended period of time related to multiple injuries and surgeries. The nurse knows to monitor for which signs of propofol infusion syndrome? (Select all that apply.)

Rarely, prolonged, high-dose infusion leads to propofol infusion syndrome, characterized by metabolic acidosis, cardiac failure, renal failure, and rhabdomyolysis. Patients should be on a ventilator if they are on a propofol infusion because of respiratory depression.

The nurse is reviewing the medication orders for a patient on sumatriptan and sertraline [Zoloft]. The nurse notes which of the following possible interactions between these medications?

Sertraline [Zoloft] is a selective serotonin reuptake inhibitor or SSRI. Triptans should not be combined with SSRIs or SNRIs because serotonin syndrome could occur. Triptans can cause hypertension, not hypotension. Neither medication causes sedation.

Before administering alosetron. , the nurse should ensure that the client has been made aware of what potentially severe adverse effect?

Severe constipation, with possible obstruction, perforation, and hemorrhage, is the most common problem resulting from alosetron. None of the other options are associated with this medication.

A surgical client is receiving a neuromuscular junction (NMJ) blocker. The nurse knows that the client cannot move because the client's acetylcholine receptor sites have been stimulated and the drug is remaining in the receptor sites, preventing repolarization. What medication is this client receiving?

Succinylcholine

Diarrhea can be caused by innumerable factors, including drugs. Which of the following medications can cause diarrhea?

Tacrolimus SSRIs Misoprostol Many oral drugs irritate the GI tract and may cause diarrhea, including acarbose, antacids that contain magnesium, antibacterials, antineoplastic agents, colchicine, laxatives, metformin, metoclopramide, misoprostol, selective serotonin reuptake inhibitors, tacrine, and tacrolimus.

The nurse is scheduled to administer sucralfate 1 gram po four times daily to a pregnant client admitted with gastroesophageal reflux disease (GERD). What is the priority teaching that would be provided regarding this medication?

Take the medicine one hour before meals and at bedtime.

The nurse is giving instructions to a client who will be having a colonoscopy in the morning. The client will be taking polyethylene glycol-electrolyte solution for bowel cleaning. What information will help increase the palatability of this medication?

The client should refrigerate the solution to increase the palatability and also to ensure its potency.

The nurse is caring for a postoperative patient who had spinal anesthesia with bupivacaine. The nurse knows to monitor for which possible adverse effects? (Select all that apply.)

The most significant adverse effect of spinal anesthesia is hypotension. Autonomic blockade may disrupt function of the intestinal and urinary tracts, causing fecal incontinence and either urinary incontinence or urinary retention. Spinal anesthesia frequently causes headache. Nausea/vomiting and tachycardia are not expected adverse effects of spinal anesthesia with bupivacaine.

A 90-year-old frail, elderly woman has arrived at the emergency department with a broken hip and in acute respiratory distress. Succinylcholine will be used because of the need for rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the woman's frail condition, she is at risk for skin breakdown. Which of the following nursing diagnoses would be most appropriate?

The nursing diagnosis that directly relates to possible skin breakdown is Impaired Physical Mobility related to drug-induced paralysis. Patients who are unable to speak, move, or breathe unassisted can quickly develop pressure sores (decubitus ulcers). It is the responsibility of the nurse to help keep the patient positioned correctly to avoid skin breakdown. The nurse will plan interventions to prevent skin breakdown based on how long the patient will be immobilized. Impaired Spontaneous Ventilation is related to respiratory paralysis. Fear is related to paralysis and helplessness, and Disturbed Sensory Perception is related to CNS depression secondary to drugs used during anesthesia.

intramuscular lidocaine

The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours.

A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following?

The patient is at risk for abstinence syndrome because the order is for half of the pain medication he normally takes at home, a significant decrease in his medication.

COX-1

an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers

COX-3 in hypothalamic endothelial cells

antipyretic action of aspirin

and bismuth

can eliminate H. pylori infection,

When teaching a group of recent nursing graduates about the clinical use of promethazine, a nursing educator should emphasize that this drug is absolutely contraindicated in which client population?

children under the age of 2

A nurse is teaching a group of older adults about strategies for preventing constipation that do not involve the use of medications. The nurse should recommend what intervention? Select all that apply.

consuming a high-fiber diet engaging in frequent physical exercise drinking 6 to 10 glasses of fluid each day

histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs)

decrease gastric acid secretion,

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions

Antacids

neutralize gastric acid and decrease pepsin production, antimicrobials

sucralfate

provides a barrier between mucosal erosions or ulcers and gastric secretions

misoprostol

restores prostaglandin activity.

Prebiotics

types of fiber that feed the friendly bacteria in the digestive system.

A patient with a migraine took a dose of a prescribed triptan and 1 hour later the headache is still intense. The patient's husband calls the clinic and asks the nurse what they should do. Which of the following is an appropriate response by the nurse?

"She can take another dose of the drug." A patient taking a triptan to relieve a migraine can take another dose within 1 to 2 hours if the headache is not relieved.

Ketorolac (Toradol)

. Ketorolac is used for moderate or severe pain, and although it can be given orally, its unique characteristic is that it can be given by injection. Parenteral ketorolac reportedly compares with morphine and other opioids in analgesic effectiveness.

The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication?

"This medication may make you feel lightheaded or drowsy." Diphenoxylate (Lomotil) is chemically related to opioid drugs; therefore, it may have sedative and euphoric effects as well as a list of other side effects. It does not increase energy or cause perianal irritation, although perianal irritation is often a result of diarrhea.

A client receiving cancer chemotherapy has been prescribed aprepitant for nausea. The nurse should instruct the client to avoid which liquid?

Grapefruit juice

The nurse should monitor for which central nervous system (CNS) adverse effect that can result when sufficient amounts of local anesthetics are absorbed systemically?

Excitation followed by depression. Local anesthetics can cause CNS excitation followed by depression when large enough amounts are absorbed in the system. This can lead to drowsiness, loss of consciousness, and death.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

Facial expressions Movement of arms and hands Guarding of the leg

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?

Level of consciousness and respiratory rate

What is the benefit of effective communication between all health care providers and nursing staff when considering medication safety for the client?

Help prevent medication errors. Help prevent adverse effects. Help promote a safe and effective medication regimen.

The nurse is administering warfarin, an anticoagulant, to a patient with a low albumin level. Which effect of this medication should the nurse expect to observe?

Increased PT/INR levels Warfarin is an anticoagulant with a high affinity for binding with albumin. If the albumin level is low, more free drug is available for action, resulting in an increased prothrombin time/international normalized ratio (PT/INR). Deep vein thromboses can be prevented with warfarin. An increased risk of bruising and bleeding would occur with more free drug available. Warfarin acts on vitamin K, not on platelets. Aspirin is an example of an antiplatelet aggregator.

The nurse is concerned with minimizing adverse drug-drug interactions for the patient. Which drug characteristic could result in the most serious consequences from a drug-drug interaction?

Interactions are especially important with drugs that have a narrow therapeutic range, because an interaction that produces a modest increase in drug levels can cause toxicity.

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic?

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage.

Diarrhea can be caused by innumerable factors, including drugs. Which of the following medications can cause diarrhea?

Many oral drugs irritate the GI tract and may cause diarrhea, including acarbose, antacids that contain magnesium, antibacterials, antineoplastic agents, colchicine, laxatives, metformin, metoclopramide, misoprostol, selective serotonin reuptake inhibitors, tacrine, and tacrolimus.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan?

Many postoperative clients require less opioid when PCA is used.

The nurse is preparing a staff education inservice about specific safety measures that reduce patient medication errors. Which measure improves safety for patients during care transition?

Medication reconciliation is a widely used specific patient safety measure that reduces medication errors during transitions of care (eg, hospital admission and discharge and moving to a different level of care within a hospital). Medication reconciliation has resulted in decreasing medication errors by 70% and reducing adverse drug reaction by 15%.

The nurse is caring for a patient who is receiving lidocaine [Xylocaine] by epidural injection. Which nursing intervention is most important when caring for this patient?

Monitoring the patient's blood pressure throughout the epidural infusion Hypotension is the most common complication with epidural anesthetics. Monitoring of the blood pressure is an essential nursing intervention. Supine positioning is not required for epidural injections (spinal only). A double tourniquet is used for regional anesthesia. Hypertension is not an anticipated outcome.

Which statements about over-the-counter (OTC) drugs would the nurse identify as true? (Select all that apply.)

Most illnesses are initially treated with an OTC agent. OTC drugs are administered more than prescription drugs. OTC drugs account for 60% of all doses administered. The average home medicine cabinet contains 24 OTC preparations. Forty percent of Americans take at least one OTC drug every 2 days. Some drugs that were originally sold only by prescription are now sold over the counter.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan Narcan has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-q injection and last 1 to 2 hours.

Which is a true statement about new drug development in the United States?

New drug development takes about 10 to 15 years, and costs can exceed $1.2 billion. Only about one in five drugs undergoing clinical trials gains approval. Randomized controlled trials are the most reliable way to objectively assess drug therapies, and are used to evaluate all new drugs.

What is a result of the Prescription Drug User Fee Act (PDUFA) of 1992?

New drugs reach the market sooner than ever before. PDUFA was a response to complaints about the length of time required for approval of new drugs by the U.S. Food and Drug Administration (FDA). Under this act, drug sponsors pay fees to the FDA that is used to fund additional reviewers. The FDA then must adhere to strict turnaround times for drug review processes.

creatinine

Normal levels of creatinine in the blood are approximately 0.6 to 1.2 milligrams (mg) per deciliter (dL) in adult males and 0.5 to 1.1 milligrams per deciliter in adult females.

cluster headaches

Oxygen therapy

The nurse is preparing a discharge teaching plan to a patient prescribed phenobarbital and oral contraceptives which are known to induce CYP isoenzymes. What patient teaching should the nurse include in the discharge plan?

Phenobarbital induces CYP isoenzymes; therefore, it will increase the metabolism of other drugs. Because phenobarbital is an inducing agent, it will increase the metabolism of oral contraceptives. The nurse should anticipate that this will likely reduce the blood levels of birth control pills. The patient should use another form of birth control while taking phenobarbital.

Which is a true statement about new drug development?

Preclinical drug testing is not performed in humans; it is done mostly in animals. Because drug testing occurs in a relatively small number of patients, those patients are carefully selected, the drug is taken for a relatively short time, and not all adverse effects are detected during the drug testing process. During the testing process, randomized controlled trials are used, in which the participants are unaware of which subjects are getting drug, placebo, or control. Kinetics, toxicities, and effectiveness are tested during the preclinical phase of drug testing.

Which of these local anesthetic agents is most likely to cause an allergic response?

Procaine is an ester-type anesthetic. Ester anesthetics pose a greater risk of allergic reactions than the amide-type anesthetics. All the other choices are amide anesthetics.

migraine headaches

Running hands under cold water i

A 75-year-old male is undergoing a prostatectomy. He has a history of smoking three packs of cigarettes per day and hypertension. Based on the type of surgery this patient is having and his medical history, which would be the most appropriate type of anesthesia for this patient?

Spinal anesthesia

A 29-year-old female client in labor has just received epidural anesthesia. Before the procedure her blood pressure was 120/78 and her pulse was 60 bpm. Now her blood pressure is 100/60 and her pulse is 80 bpm. She reports a metallic taste in her mouth, hears a ringing in her ears, and appears confused. What is this client most likely experiencing?

Systemic toxicity from local anesthesia

Topical benzocaine

Topical benzocaine can cause methemoglobinemia, a blood disorder in which hemoglobin is modified such that it cannot release oxygen to tissues. If enough hemoglobin is converted to methemoglobin, death can result. Methemoglobinemia has been associated with benzocaine liquids, sprays, and gels. Because of this risk, topical benzocaine should not be used in children under the age of 2 years without the advice of a healthcare professional.

A client has received procaine hydrochloride (Novocain) for a minor skin procedure. Three days later, the client returns to the clinic and has developed redness, swelling, and inflammation at the injection site. What is the priority action for the nurse to take?

Treat this as a delayed hypersensitivity reaction to procaine hydrochloride.

A nurse prepares to administer acetaminophen [Tylenol] to a patient with an oral temperature of 101.7°F. Which preparation would the nurse expect to have the most rapid onset of action?

Tylenol elixir Correct A liquid does not have to dissolve first to allow absorption; therefore, the onset of action occurs more quickly than with capsules, tablets, or gel caps.

What topics are important for the nurse to share with an adolescent related to self-care and medication administration?

Use of acne medications Adverse effects of prescribed medications Birth control pills and other drug interactions

BUN

a measure of kidney function.

Which drugs would be the safest to prescribe a client with a high risk for bleeding? Select all that apply.

acetaminophen COX-2 inhibitors

The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of what factor?

albumin Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense.

Gastroenteritis

an inflammation of the lining of the intestines caused by a virus, bacteria, or parasites. Viral gastroenteritis is the second most common illness in the U.S. The cause is often a norovirus infection. It spreads through contaminated food or water or by contact with an infected person.

The nurse is assessing a client for the possible development of LAST. The nurse watches for which initial symptoms of this disorder? (Select all that apply.)

analgesia, circumoral numbness, metallic taste, tinnitus or auditory changes, and agitation.

Propranolol

beta-blocker and it may take up to 3 months to be effective as a migraine

The elderly client is being triaged in the emergency department for a report of dizziness. What should the nurse assess? (Select all that apply.)

blood pressure and pulse the client's list of medications a history of renal or hepatic disease

INR International normalized ratio (INR)

comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin.

A client is four months' pregnant. She works in the chemical unit of a research department and is responsible for handling various chemicals. Her gynecologist advised her not to expose herself to chemical or industrial vapors and specific drugs. These restrictions are advised because exposure to industrial vapors could:

damage the immature nervous system of the fetus. Neurotoxicity can occur as a result of exposure to drugs and other chemicals and gases, such as industrial vapors. Immature nervous systems such as those of the fetus and neonate can easily be damaged by drugs that produce neurotoxicity.

NSAIDs may cause

decreased granulocyte count, decreased WBC count, or aplastic anemia.

A client is taking low-dose aspirin daily for her heart. The client is not receiving all the dosage of the aspirin that is being ingested because of:

first-pass effect. A large percentage of an oral dose is destroyed when it reaches the liver and never reaches the tissues. This phenomenon is known as the first-pass effect

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

has a shorter half-life than morphine.

release of GABA

inhibits pain

Celebrex

isk of cardiovascular thrombosis, myocardial infarction, and stroke. BBW

Pruritis

itchy skin that makes you want to scratch. It can be caused by many things. Normally, itchy skin isn't serious, but it can make you uncomfortable. Sometimes, itchy skin is caused by a serious medical condition.

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:

lower extremities, lower abdomen, and perineum.

The students are studying for an exam in pharmacology. They know several local anesthetics have been covered along with other forms. Which medication can they anticipate as being local anethetics on the exam? Select all that apply.

marcaine xylocaine novocain

Zolmitriptan

orally only

Blocking COX-2

pain-relieving effects of NSAIDs.

antitussive

used to prevent or relieve a cough.