pharmacology chp 10, 11, 44

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?

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.

Immediate postoperative assessment of a patient reveals a body temperature of 102° F. Which action will the nurse perform?

Notify the physician, A fever immediately postoperatively must be evaluated for potential malignant hyperthermia. Infection of a surgical wound takes several days to develop.

The nurse would question an order to administer misoprostol (Cytotec) to a patient with which condition?

Pregnancy, Misoprostol is an abortifacient and thus is contraindicated in pregnancy.

The nurse assesses for therapeutic effects of colchicine based on knowledge that colchicine

decreases mobility of leukocytes, Colchicine works by decreasing the mobility and migration of leukocytes into joints affected by gout, thus resulting in decreased inflammation.

The advantage of cyclooxygenase-2 (COX-2) inhibitors over other NSAIDs is that they

do not decrease the cytoprotective lining of the stomach, By not inhibiting the COX-1 enzyme, production of the protective mucus by parietal cells in the GI tract is maintained, thus decreasing the risks of GI side effects.

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of

he 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.

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by

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.

chp44 Most nonsteroidal antiinflammatory drugs (NSAIDs) work by

inhibiting prostaglandin production, Prostaglandins are produced in response to activation of the arachidonic pathway. NSAIDs work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain?

ketorolac (Toradol), Ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of severe to moderate pain.

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 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?

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?

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

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that

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.

The nurse is administering probenecid (Benemid) to a patient with recurrent strep throat. The nurse teaches the patient that the most likely reason for taking this medication is to

prolong the effectiveness of penicillin therapy, Besides its use for the treatment of the hyperuricemia associated with gout and gouty arthritis, probenecid also has the ability to delay the renal excretion of penicillin, thus increasing serum levels of penicillin and prolonging its effect.

An intubated, mechanically ventilated patient in the intensive care unit is becoming increasingly restless and anxious. The nurse expects to administer which intravenous anesthetic drug?

propofol (Diprivan), Propofol is an intravenous sedative-hypnotic drug used for induction and maintenance of anesthesia as well as controlled sedation in patients who are intubated and mechanically ventilated in the intensive care unit. It has a rapid onset and short duration of action, allowing for easy titration and maintenance of the patient's level of consciousness.

The patient questions a nurse about herbal treatments for arthritic pain. What is the nurse's best response?

"Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Discuss this with your health care provider." There are some demonstrated benefits for the use of some herbal supplements. However, they should always be used in consultation with a health care provider.

Patient teaching for a patient receiving allopurinol (Zyloprim) should include which information?

"Increase your fluid intake to 3 L per day." Patients taking allopurinol should be informed to increase fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine because these drugs will increase uric acid levels and decrease the levels of allopurinol.

A patient expresses fear of nausea and vomiting postoperatively from the anesthesia. Which is the nurse's best response?

"Nausea and vomiting occur much less frequently than in the past related to the use of a balanced approach to anesthesia." Explaining to the patient advances in anesthesia may help alleviate fear.

A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug they use in the emergency room for patients who are coding." Which is the nurse's best response?

"Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site." Epinephrine causes localized vasoconstriction, not only allowing for a bloodless field to suture but also delaying absorption of the lidocaine and thus enhancing its numbing effect.

The nurse should question an order written to administer acetylsalicylic acid (aspirin) to which patient?

14-year-old boy with a history of flulike symptoms, Aspirin should never be administered to children with flulike symptoms. The use of aspirin in children with flulike symptoms has been associated with Reye's syndrome.

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?

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.

While taking a patient's history prior to surgery for a cardiac problem, the patient informs the nurse he is addicted to cocaine. The nurse alerts the anesthesiologist of the finding because the nurse knows the use of cocaine can cause which effect when a patient is under anesthesia?

Anesthetic-induced complications, A patient with a history of substance abuse is at higher risk of anesthetic-related complications and will require closer monitoring by the anesthesia team.

The acetic acid derivative indomethacin (Indocin) has which properties?

Antiinflammatory, Antirheumatic, & Antipyretic

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?

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

Assessment of the patient taking colchicine should include consideration of which nursing diagnoses?

Deficient fluid volume related to side effects of nausea, vomiting, and diarrhea, Colchicine is administered on an hourly basis until pain is resolved or the patient develops diarrhea. Hemorrhagic colitis is a potential life-threatening side effect of colchicine.

When teaching a patient about potential side effects of NSAID therapy, the nurse will teach the patient to promptly report which effect?

Black tarry stools, A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black tarry stools are indicative of a GI bleed

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find?

Decreased peristalsis, Delayed gastric emptying, & Urinary retention

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?

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

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?

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, The most serious side effect of narcotic analgesics is respiratory depression.

Which postoperative nursing action will help the patient recover from the effects of anesthesia?

Turning, coughing, and deep breathing every 2 hours, Turning, coughing, and deep breathing can help prevent postoperative atelectasis, a sequela of generalized anesthesia and mechanical ventilation.

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity?

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).

Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?

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

A mechanically ventilated patient receiving a neuromuscular-blocking drug has tearing in the eyes and increased heart rate and blood pressure. The nurse interprets that the

patient's level of sedation is inadequate, Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking drug cannot move or communicate; thus the nurse must rely on subtle changes to assess adequate sedation.

chp11. While completing preoperative patient teaching, the nurse explains that general anesthesia

produces deep muscle relaxation and loss of consciousness, General anesthesia produces deep muscle relaxation (both visceral and skeletal) as well as loss of consciousness. The other answers are incorrect.