Pathopharm & Pathophysiology Exam 1 Review
oxycodone adverse reactions/side effects
constipation, confusion, sedation, respiratory depression
the process to determine if a drug is beneficial or causes harm a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
g. evaluating responses to medication
can produce heat and fire in administration apparatus a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
g. sevoflurane
propofol therapeutic class
general anesthetic
a drugs non-propriety name
generic name
knowing the early signs of toxicity and the proper intervention when it occurs a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
h. managing toxicity
ibuprofen adverse reactions/side effects
headache, HF, myocardial infarction, stroke, drug reaction with eosinophilia, exfoliative dermatitis, stevens-johnson syndrome, toxic epidermal necrolysis, GI bleeding, hepatitis, constipation, dyspepsia, nausea, vomiting, anaphylaxis
true or false: the nurse would expect that an intravenous (IV) antibiotic prescribed for bacterial meningitis would most likely get to the site of infection if the drug is water soluble
false
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic causes local vasodilation
false
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic delays the onset of anesthesia
false
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic improves blood flow to the affected area
false
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic increases the risk of toxicity
false
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic requires the use of a larger dose of anesthetic
false
the property of an ideal drug: the nurse administers ciprofloxacin through a second intravenous line separate from all other drugs
freedom from interactions
naloxone contraindications
hypersensitivity
propofol contraindications
hypersensitivity
oxycodone contraindications
hypersensitivity respiratory depression paralytic ileus asthma
ibuprofen contraindications
hypersensitivity, GI bleeding, severe HF, history of MI, CABG surgery
celecoxib contraindications
hypersensitivity, asthma, CABG surgery
hydromorphone contraindications
hypersensitivity, asthma, respiratory depression, asthma, paralytic ileus, hepatic impairment
aspirin contraindications
hypersensitivity, bleeding disorders, cross-sensitivity
lidocaine contraindications
hypersensitivity, heart block, wolff-parkinson-white syndrome
acetaminophen contraindications
hypersensitivity, with products containing alcohol, hepatic impairment/disease
morphine contraindications
hypersensitivity; respiratory depression, asthma
hydromorphone adverse reactions/ side effects
hypotension, constipation, confusion, sedation, respiratory depression
morphine adverse reactions/side effects
hypotension, constipation, confusion, sedation, respiratory depression
hydrocodone adverse reactions/side effects
hypotension, constipation, dyspenia, nausea, confusion, dizziness, sedation, respiratory depression
____ disease is when a drug causes symptoms closely resembling a disease
iatrogenic
pain that is not associated with any known cause
idiopathic pain
genetic differences can cause uncommon drug responses. these are called ______ reactions
idiosyncratic
predictable pain that accompanies a movement or activity
incident pain
when a patient take a drug for a long time and becomes tolerant, the nurse would expect the prescriber to _______ the dose to achieve the desired effect.
increase
propofol indications
induction of general anesthesia
aspirin indications
inflammatory disorders including: rheumatoid arthritis and osteoarthritis mild to moderate pain fever
ibuprofen action
inhibits prostaglandin synthesis decreases pain and inflammation reduction of fever
acetaminophen action
inhibits prostaglandin synthesis in CNS that serve as mediators of pain and fever
based on differences in metabolism of alcohol, if both a man and woman consume the same amount of alcohol (on a weight-adjusted basis) and take the drug metronidazole, the disulfiram-like reaction between alcohol and the drug in the woman should be more ____ and last ____than for the man.
intense; longer
celecoxib indications
osteoarthritis, rheumatoid arthritis, acute pain, primary dysmenorrhea
products that have similar or identical brand names that can contain different drugs and can be purchased without a prescription
over-the-counter (OTC) drugs
an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
pain
withdrawal reactions occur when a drug is stopped when a person is _____ ____ on the drug
physically dependent
tue or false: an opiate is a drug that contains compounds found in opium, while an opioid may be a laboratory-created compound
true
a safe environment reduces the risk of possible illness and injury
underlying theory of safety
naloxone adverse reactions/side effects
ventricular arrhythmias
lidocaine indications
ventricular arrhythmias pain
the nurse should instruct patients to dispose of aspirin tablets if they develop an odor that smells like _____
vinegar
originates from the internal body organs and the linings of body cavities; described as dull, deep, or aching
visceral pain
movement into the blood a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
a. absorption
aspirin patient and family teaching
avoid alcohol consumption report unusual bleeding of the gums let physician know if you become pregnant during use
oxycodone pharmacokinetics
absorption: well from the GI tract distribution: widely; crosses the placenta; enters breast milk metabolism: by the liver excreted: renally
chronic alcohol use interferes with the metabolism of excessive doses of _____
acetaminophen
preoperative teaching for knee replacement surgery should include that the patient should discontinue high-dose aspirin therapy for _____ before surgery
1 week
SELECT ALL THAT APPLY which nursing interventions would the nurse implement for a child undergoing treatment with opioid analgesics? 1. assessing the childs level of pain 2. administering oral medications with meals or snacks 3. assessing the childs verbal and nonverbal behaviors 4. documenting the childs age, weight, and height before treatment 5. monitoring and documenting the childs vital signs before they start therapy
1, 2, 3, 4
____ is the antidote for acetaminophen overdose
acetylcysteine
mechanisms of medication action
1. absorption 2. distribution 3. metabolism 4. excretion
rights of medication administration
1. right patient 2. right medication 3. right dose 4. right route 5. right time 6. right documentation 7. right indication
when taking aspirin for its anti-platelet action, other non-steroidal anti-inflammatory drugs (NSAIDs) should be given at least ______ hours before aspirin
2
the recommended maximum dose of acetaminophen for individuals who regularly consume alcohol is ___
2000mg
the half-life of aspirin is 15-20 minutes, but the anti-platelet effects last ______
8 days
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic reduces the risk of toxicity
true
Predictable, unavoidable secondary effect
side effects
ibuprofen pharmacokinetics
absorption: orally is well absorbed; IV admin. results in total bioavailability distribution: does not enter breast milk in significant amounts metabolism: by the liver excretion: small amount renally
celecoxib pharmacokinetics
absorption: unknown distribution: extensively to tissues metabolism: by the hepatic CYP2C9 enzyme excretion: unchanged in urine and feces
hydromorphone assessment
Assess BP, pulse, and respirations before and periodically during administration Assess bowel function routinely assess for risk of opioid addiction
morphine action
Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.
true or false: phase 2 of the dose-response relationship starts at the point when the therapeutic effect does not increase with increasing the dose
false
aspirin pharmacokinetics
absorption: well absorbed from upper small intestine distribution: rapidly and widely; crosses placenta; enters breast milk metabolism: by the liver excreted: renally
true or false: polar drugs can enter fetal circulation and breast milk
false
true or false: powdered drugs can be mixed once they are dissolved in a liquid
false
hydrocodone therapeutic classification
opioid analgesic
hydromorphone pharmacokinetics
absorption: well absorbed with oral, rectal, subcut, and IM administration distribution: widely; crosses the placenta; enters breast milk metabolism: liver excretion: renally
hydromorphone therapeutic class
opioid analgesic
morphine therapeutic classification
opioid analgesic
celecoxib adverse reactions/side effects
HF, myocardial infarction, stroke, thrombosis, drug reaction with eosinophilia, DRESS, exfoliative dermatitis, stevens-johnson syndrome, toxic epidural necrolysis, GI bleeding
hydrocodone contraindications
Hypersensitivity, paralytic ileus, respiratory depression, severe asthma
lidocaine actions
IV/IM: suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes without an effect on the heart Local: produces local anesthesia by inhibiting the transport of ions across neuronal membranes, preventing initiation and conduction of nerve impulses
celecoxib action
Inhibits enzyme COX-2 which is required for prostaglandin synthesis
oxycodone therapeutic classification
opioid analgesic
acetaminophen pharmacokinetics
absorption: well following oral admin. IV results in complete bioavailability distribution: widely; crosses placenta; enters breast milk in low concentrations metabolism: by the liver excretion: renally
SELECT ALL THAT APPLY which information would the nurse include in the clients medication teaching on the administration of aspirin 650mg q 6hrs PRN for arthritic pain? a. "report persistant abdominal pain" b. "do not chew enteric-coated tablets" c. "take the aspirin with meals or a snack" d. "see a dentist if bleeding gums develop" e. "switch to acetaminophen if tinnitus occurs"
a, b, c
naloxone therapeutic classification
opioid antagonist
cluster headache treatment
Primary therapy directed at prophylaxis Glucocorticoids (prednisone and dexamethasone) Verapamil Lithium
morphine pharmacokinetics
absorption: variably absorbed through oral admin. reliably absorbed following rectal, subcut, and IM sites following epidural administration systemic absorption distribution: widely distributed; crosses placenta; enters breast milk metabolism: by the liver excretion: renally
effects that are nearly unavoidable secondary drug effects at therapeutic doses are called ______ ______
side effects
naloxone pharmacokinetics
absorption: well absorbed after IM or subucut administration distribution: rapidly to tissues; crosses the placenta metabolism: by the liver excretion: renally
SELECT ALL THAT APPLY twenty-four hours after receiving spinal anesthesia during childbirth, a client tells the nurse she has a headache is a reaction to the anesthesia? a. 'my ears are ringing' b. 'it gets better when i lie down' c. 'bright lights really bother my eyes' d. 'my head hurts more when I'm sitting watching television' e. 'my head hurts more when I'm lying on my side breast-feeding'
a, b, c, e
originates from nociceptors located in the skin; usually localized and described as being sharp
somatic pain
SELECT ALL THAT APPLY which action is the nurses responsibility when administering prescribed opioid analgesics? a. count the clients respirations b. document the intensity of the clients pain c. withhold the medication if the client reports pruritus d. verify the number of doses in the locked cabinet before administering the prescribed dose e. discard the medication in the clients toilet before leaving the room if the medication is refused
a, b, d
SELECT ALL THAT APPLY which methods qualify as alternative therapies for pain? a. prayer b. hypnosis c. medication d. aromatherapy e. guided imagery
a, b, d, e
SELECT ALL THAT APPLY after undergoing minor surgery, a postoperative child has recovered from anesthesia. which observations alert the nurse the child may be ready for discharge? a. vital signs are stable b. temp is 101 degrees F c. pain rate is at a baseline level d. the child is alert and oriented e. oxygen saturation is 75% on room air
a, c, d
SELECT ALL THAT APPLY which benefit would be provided by administering PCA to a client after surgery? a. client is able to self-administer pain-relieving medications as necessary b. amount of medication received is determined entirely by the client c. decreases client dependency d. relieves the nurse of monitoring the client e. increases client sense of autonomy
a, c, e
SELECT ALL THAT APPLY when providing comfort to a client during the last hours of life, which would be the nurse's primary concern? a. pain b. nutrition c. elimination d. respiratory status e. cardiovascular status
a, d
SELCT ALL THAT APPLY which action would the nurse take before administering each dose in client who takes oxycodone every 3 hrs for pain after surgery? a. count the clients respiratory rate b. examine the client for petechiae c. observe the client for movement disorders d. ask the client to rate the level of pain e. assess the clients level of consciousness
a, d, e
SELECT ALL THAT APPLY after interacting with a client, the nurse thinks the client is in the prodromal phase of a migraine. which statements made by the client led the nurse to reach this conclusion? a. 'i feel drowsy all the time' b.' i feel sever pain over my ear' c. 'i feel a throbbing pain in my head' d. ' i feel confused at this point in time' e. 'i feel weakness in the left side of my body'
a, d, e
after an amputation of a limb, a client reports extreme discomfort in the area where the limb once was. which goal would the nurse plan to focus interventions? a. Identifying actions to decrease pain in the lost limb b. reversing feelings of hopelessness about the future c. promoting mobility in the residual limb d. facilitating the grieving process for the lost limb
a. Identifying actions to decrease pain in the lost limb
a client is admitted to the hospital with severe back and abdominal pain, nausea, and occasional vomiting, and an oral temp of 101 degrees F. the client reports drinking six to eight beers a day. a diagnosis of acute pancreatitis is made. based on the data presented, which clinical finding is a primary nursing concern for this client? a. acute pain b. Inadequate nutrition c. Electrolyte imbalance d. disturbed self- concept
a. acute pain
numbness and tingling around the mouth and respiratory distress a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
a. anaphylaxis
the nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time? a. at scheduled intervals b. when the child asks for it c. when the pain becomes severe d. before the pain becomes severe
a. at scheduled intervals
tachycardia and hypertension can occur in response to abrupt increase in blood levels a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
a. desflurane
which intervention would the nurse incorporate into the plan of care for the older adult experiencing chronic pain? a. exercise b. distraction c. heat therapy d. trigger point massage
a. exercise
the nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients? a. fentanyl b. morphine c. meperidine d. hydromorphone
a. fentanyl
after obtaining vital sign data of BP 90/60 mm Hg, pulse 96 bpm, and RR 10/breaths per min for a postoperative client receiving hydromorphone by a patient-controlled analgesia (PCA) pump, which priority action would the nurse take? a. give naloxone intravenously per protocol b. assess the clients pain level on a 10-point scale c. document the vital signs in the client record d. notify the hospital rapid response team
a. give naloxone intravenously per protocol
a client who had thoracic surgery reports pain at the incision site when coughing and deep breathing. Which action would the nurse take? a. instruct client to splint the wound with a pillow when coughing b. place the client in the supine position and inspect the site of the incision c. assess the intensity of the pain and administer the prescribed analgesic d. notify the health care provider immediately and then check for wound dehiscence
a. instruct client to splint the wound with a pillow when coughing
which pain relief medication would the nurse expect to find in the plan of care of a client with a myocardial infarction admitted to the cardiac intensive care unit? a. morphine b. diazepam c. midazolam d. oxycodone
a. morphine
requires small size a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system
a. passage through channels
collecting baseline data, identifying high-risk patients, and determining the patients capacity for self-care a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
a. pre-administration assessment
which nursing action is beneficial for the client who has pain due to muscle spasm? a. providing heat compresses at the site b. providing a massage to the affected area c. encouraging the client to perform isometric exercises d. encouraging the client to do active ROM exercises
a. providing heat compresses at the site
which action would the nurse take when a client reports pain and burning at a peripheral intravenous (IV) site after the nurse has flushed the saline lock in another site? a. remove the IV catheter and restart the saline lock in another site b. document the findings per protocol and reassess the site in 8 hours c. flush the IV catheter and saline lock again vigorously with normal saline d. change the dressing and apply a new clean dressing per IV care protocol
a. remove the IV catheter and restart the saline lock in another site
the medical use of drugs a. therapeutics b. drug c. pharmacology d. clinical pharmacology
a. therapeutics
a client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. after surgery, the clients pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief? a. tolerance b. habituation c. physical addiction d. psychological dependence
a. tolerance
propofol pharmacokinetics
absorption: administered IV only, complete absorption distribution: rapidly and widely; crosses the blood-brain barrier; crosses placenta; and enters breast milk metabolism: by the liver excretion: by the kidneys
lidocaine pharmacokinetics
absorption: after administration in the deltoid muscle distribution: widely; concentrates in the adipose tissue; crosses blood-brain barrier; crosses placenta; enters breast milk metabolism: by liver excretion: by kidneys
hydrocodone pharmacokinetics
absorption: well absorbed following oral administration distribution: unknown metabolism: by the liver excretion: renally
acetaminophen adverse reactions/side effects
acute generalized exanthematous pustulosis, stevens-johnson syndrome, toxic epidermal necrolysis, hepatotoxicity
has a sudden onset as a result of an identifiable tissue injury
acute pain
unintended, undesirable, and often unpredictable severe responses to medication
adverse effects
acetaminophen patient and family teaching
advise patient to avoid alcohol consumption advise patient to notify health care professional and discontinue use if rash occurs caution patient to check labels on all OTC products
celecoxib patient and family teaching
advise patient to notify health care professional if symptoms of GI toxicity ( abdominal pain, black stools) occur inform patient of increased risk of HF and MI and stroke
factors that effect pharmacokinetics
age, gender, weight, diet, genetics
a(n) ____ reaction is an immune response
allergic
lidocaine therapeutic class
anesthetic (topical/local) antiarrhytmics
aspirin therapeutic classification
anti-platelet antipyretics nonopioid analgesics
celecoxib therapeutic classification
anti-rheumatics
acetaminophen therapeutic classification
antipyretics nonopioid analgesic
ibuprofen therapeutic classification
antipyretics nonopioid analgesics
propofol adverse reactions/side effects
apnea, bradycardia, hypotension, burning, pain, stinging, propofol infusion syndrome
hydrocodone assessment
assess BP, pulse, and reparations before and during administration assess for opioid addiction
oxycodone assessment
assess BP, pulse, and respirations before and during administration assess risk for opioid addiction
morphine assessment
assess level of consciousness, BP, pulse, and respirations before and during administration assess risk of addiction, abuse, or misuse
acetaminophen assessments
assess overall health status and alcohol usage prior to administration assess amount, frequency, and type of drugs taken in patients assess for rash periodically
celecoxib assesment
assess patient for skin rash monitor for signs and symptoms of DRESS ( fever, rash, facial swelling)
aspirin assessment
assess patients who have asthma, allergies, and nasal polyps for anaphylaxis watch for fever, rash, and facial swelling
ibuprofen assessments
assess patients who have asthma, allergy, and nasal polyps for hypersensitivity reactions assess patient for rash monitor symptoms of DRESS (fever, rash, facial swelling)
propofol assessment
assess respiratory status, pulse, and BP throughout administration monitor for propofol infusion syndrome
SELECT ALL THAT APPLY an adolescent is admitted with partial- and full- thickness burns of the arms and upper torso. which are the primary purposes of administering pain medication vi the IV route, rather than the IM route? a. Adolescents are afraid of injections b. it decreases the risk of tissue irritation c. severe pain is reduced more effectively d. impaired peripheral circulation is bypassed e. it provides for more prolonged relief of pain
b, c, d
SELECT ALL THAT APPLY which nursing concern is a priority when a 6-year-old child with sickle cell disease is admitted with a vasoocclusive crisis? a. nutrition b. hydration c. pain management d. prevention of infection e. oxygen supplementation
b, c, e
SELECT ALL THAT APPLY which therapeutic outcome is expected after administering ibuprofen? a. diuresis b. pain relief c. temperatrue reduction d. bronchodialation e. anticoagulation f. reduced inflammation
b, c, f
SELECT ALL THAT APPLY which factors would the nurse consider when administering opioids to a child with severe pain? a. diet modification b. dosing calculations c. body mass index d. appropriate dosage form e. presence of other symptoms
b, d, e
at which time would the nurse plan to administer morphine 2mg PO q 2 hrs PRN to a client who has burns on 55% of the body surface and requires dressing changes? a. 15 min before the dressing change b. 60 min before the dressing change c. along with a stool softener each time it is administered d. only if the client rates pain between 8 and 10 on the pain scale
b. 60 min before the dressing change
which client would be triaged under emergency severity index (ESI)-1 based on threat to life and stability of vital functions? a. Client A; chest pain resulting from ischemia b. Client B; cardiac arrest c. Client C; simple laceration d. Client D; hip fracture
b. Client B; cardiac arrest
which is the most reliable indicator of a 2.5-year-old child's pain? a. crying and sobbing b. changes in behavior c. verbal exclamations of pain d. changes in pulse and respiratory rate
b. changes in behavior
which client would need a correction in the nursing intervention? a. Client 1: 11 yrs old; distraction and creative imagery during administration of medication b. Client 2: 9 yrs old; administration of analgesics only when pain intensifies c. Client 3: 7 yrs old; administration of opioids (PO) along with medications d. Client 4: 14 yrs old; administration of half the adult dose in case suppositories should not be done
b. client 2
which property would the nurse understands that the medication is being used primarily for when aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis? a. analgesic b. antipyretic c. anti-inflammatory d. anti-platelet
c. anti-inflammatory
which situation would the nurse address first according to Maslow's hierarchy? a. has history of being injured from sudden falls b. complains of sleeplessness due to pain postsurgery c. reports that they feel lonely and socially isolated d. conveys to the nurse that they want to become the manager of the company
b. complains of sleeplessness due to pain postsurgery
which physiological response will occur if a client being treated for myocardial infarction experiences the intended therapeutic effect of morphine? a. increased respiratory rate b. decreased workload of the heart c. dilation of coronary arteries d. diminished metabolites within the ischemic heart muscle
b. decreased workload of the heart
which action would the nurse take when caring for a client using a patient-controlled analgesia pump who identifies attempts to self-administer the analgesic 10 times because the client is still experiencing pain? a. monitor the client's pain level for another hour b. determine the integrity of the intravenous delivery system c. reprogram the pump to deliver a bolus dose every 8 minutes d. arrange for the client to be evaluated by the health care provider
b. determine the integrity of the intravenous delivery system
requires lipid solubility a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system
b. direct penetration of the membrane
which action would the nurse take while giving an injection to a preschooler? a. ask the parent to restrain the child b. distract the child with conversation c. avoid awakening the child if asleep d. avoid using lidocaine ointment over the injection site
b. distract the child with conversation
movement from blood into tissue and cells a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
b. distribution
the rights of drug administration coupled with the knowledge of pharmacology a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
b. dosage and administration
any chemical that can affect living processes a. therapeutics b. drug c. pharmacology d. clinical pharmacology
b. drug
can induce seizures a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
b. enflurane
fatigue and hemoglobin/hematocrit 9.2%/28 mg/dL a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
b. hemolytic anemia
which route would a nurse expect to administer morphine sulfate prescribed for pain in a client admitted to the emergency department with burns to the anterior trunk, entire arm, and anterior left arm? a. orally b. Intravenously c. subcutaneously d. intramuscularly
b. intravenously
which action would be taken by the nurse when caring for a client prescribed transdermal fentanyl 25 mcg/h every 72 hours during the first 24 hours after starting the fentanyl? a. titrate the dose until pain is tolerable b. manage pain with an analgesic by a different route c. assess the client for anticholinergic side effects d. instruct the client to take the medication with food
b. manage pain with an analgesic by a different route
an adolescent client with sickle cell anemia is experiencing a painful episode and has a PCA pump. the current pain rating is 5 on a scale of 1-10 at the right elbow. the nurse observes that the pump is "locked out" for another 10 min. which action would the nurse implement? a. Turning on the television for diversion b. placing the PRN warm, wet compress on the elbow c. calling the primary health care provider for another analgesic prescription d. informing the client gently that they must wait until the pump reactivates to get more medication
b. placing the PRN warm, wet compress on the elbow
which factor would the nurse recognize as a cause of neck pain in a client? a. headache b. poor posture c. low body weight d. sedentary lifestyle
b. poor posture
which nonpharmalogical nursing intervention is effective in helping relieve postoperative pain? a. ambulation b. repositioning c. purse-lipped breathing d. deep breathing and coughing
b. repositioning
which conclusion would the nurse make regarding the client's response to pain medication when a client using a pain scale of 1 to 10 rates the pain as an 8 before receiving an analgesic and at a 7 after being medicated? a. the client has a low pain tolerance b. the medication is not adequately effective c. the medication has sufficiently decreased the pain level d. the client needs more education about the use of the pain scale
b. the medication is not adequately effective
the primary nurse, leaving the unit for lunch, provides a verbal report for the covering nurse. The report included one clients prescription for morphine:2mg intravenously (IV) every 3 hours for abdominal pain secondary to major abdominal surgery that morning. During the primary nurse's lunch, the client complains of pain at a level of 8 out of 10 on the pain scale. Which action would the covering nurse perform first? a. determine the documented time of the last administration of pain medication b. verify that the written prescription matches the administration record c. encourage non pharmacological measures initially to relieve the pain d. explain that the primary nurse will be back from lunch in a few minutes
b. verify that the written prescription matches the administration record
hydrocodone action
bind to opioid receptors in the CNS; alters the perception of and response to painful stimuli
oxycodone action
binds to opiate receptors in the CNS alters perception of and response to pain
hydromorphone action
binds to opiate receptors in the CNS; alters the perception of and response of painful stimuli; supresses cough
____ is the ability of a drug to reach the systemic circulation from its site of administration
bioavalibility
if the nurse is administering warfarin to a malnourished patient with a serum protein level of 2.9 g/dL, the nurse would expect the patient to be at increased risk for _____
bleeding
naloxone action
blocks the effects of opioids
dose requirements for drugs with a narrow therapeutic range are more precisely calculated based on the patients _____
body surface area
the names under which a drug is marketed
brand name
SELECT ALL THE APPLY which assessment finding of a client with chronic pain who has been prescribed opioid treatment indicates the need for a priority nursing intervention? a. prurtis b. constipation c. level 3 sedation d. nausea and vomiting e. respiratory rate of 8 breaths per min
c, e
which response would the nurse give to a client newly diagnosed with multiple sclerosis who asks the nurse, "will i experience pain"? a. "tell me about your fears regarding pain" b. "analgesics will be prescribed to control the pain" c. "pain is not a characteristic symptom of this condition" d. "let's make a list of things to ask your primary health care provider"
c. "pain is not a characteristic symptom of this condition"
which response by the nurse asked "how will they 'knock me out' for this colonoscopy?" describes the route of administration for conscious sedation? a. "the medicine will be injected into your spine" b. "you will receive the anesthesia through a face mask" c. "you will receive medication through an intravenous (IV) catheter" d. "we will give you an oral medication about 1 hour before the procedure"
c. "you will receive medication through an intravenous (IV) catheter"
a school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. breakthrough pain occurs and a fentanyl 'lollipop' is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs? a. 'chew it and then swallow every 4 hours' b. 'suck on it for half an hour every 6 hours' c. 'hold it in your cheek only until the pain is relieved' d. 'place it in your mouth and suck on it until it dissolves'
c. 'hold it in your cheek only until the pain is relieved'
which pain description would the nurse expect a client to report when describing pain associated with a suspected duodenal peptic ulcer? a. an ache radiating to McBurney point b. an intermittent, colicky right-flank pain c. a gnawing sensation in the epigastric area d. a generalized abdominal pain intensified by movement
c. a gnawing sensation in the epigastric area
a client with inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. when operating the TENS unit, which nursing action is appropriate? a. maintain the settings programs by the health care provider b. turn the machine on several times a day for 10 to 20 minutes c. adjust the dial on the unit until the client states that the pain is relieved d. apply the color-coded electrodes on the client where they are most comfortable
c. adjust the dial on the unit until the client states that the pain is relieved
which action would the nurse take first for a post-surgical client who is still intubated but becoming restless, with an increased pulse rate and BP, when it has been 4 hours since the last dose of pain medication? a. notify the provider b. perform a full physical assessment c. administer the prescribed pain medicine d. play soft, relaxing music to help calm the client
c. administer the prescribed pain medicine
which intervention is useful in promoting comfort for the client experiencing a headache? a. massage b. heat therapy c. cold therapy d. relaxation strategies
c. cold therapy
a client has bee receiving oxycodone for moderate pain associated with multiple injuries sustained in a motor vehicle collision. which assessment finding, in addition to the clients slurred speech, leads the nurse to suspect opioid intoxication? a. mood lability b. hyper-vigilance c. constricted pupils d. increased respirations
c. constricted pupils
prolongs QT interval a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
c. droperidol
change in drug structure and movement out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
c. elimination
a child is experiencing pain after abdominal surgery and is given an opioid analgesic. which statement is correct regarding children in pain and their response to opioid analgesics when they are prescribed? a. addiction to opioids is more of a risk for children than adults b. analgesics are not needed as frequently because pain is not strongly felt by children as it is by adults c. even though children do not like taking medicines, analgesics will make them more comfortable d. children do not need analgesics because they are easily distracted and will quickly return to play or sleep
c. even though children do not like taking medicines, analgesics will make them more comfortable
clay-colored stool with nausea and vomiting a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
c. hepatotoxicity
a client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which interference will the nurse make? a. the half-life of the medication has decreased b. an idiosyncratic reaction has occurred c. higher doses are needed to achieve pain relief d. an emotional dependence on the medication has developed
c. higher doses are needed to achieve pain relief
the nurse is planning the discharge of a 9-year-old child who has undergone tonsillectomy. in addition to the prescribed analgesic, which would the nurse recommend the parent use to ease their childs pain? a. warm saline gargles b. heating pad to the neck c. light-colored ice pops d. peppermint candy for sucking
c. light-colored ice pops
may require energy or pores a. passage through channels b. direct penetration of the membrane c. passage with the aid of a transport system
c. passage with the aid of a transport system
for which involuntary physiologic response would the nurse monitor development in a client experiencing pain? a. crying b. splinting c. perspiring d. grimacing
c. perspiring
the study of drugs and their interactions with the living systems a. therapeutics b. drug c. pharmacology d. clinical pharmacology
c. pharmacology
enhancing drug therapy through non-pharmacologic measures a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
c. promoting therapeutic effects
which group of clients who were in a bus accident and admitted to the emergency department with injuries is considered urgent according to the three-tier triage system? a. sprains b. simple fractures c. severe abdominal pain d. chest pain with diaphoresis
c. severe abdominal pain
_____ means cancer-causing
carcinogenic
lidocaine adverse reactions/side effects
cardiac arrest, stinging, confusion, drowsiness, seizures, anaphylaxis
ibuprofen patient and family teaching
caution patient that drinking 3 or more glasses of alcohol a day with treatment may increase GI bleeding advise patient to consult health care prof. if rash, itching, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stool, or influenza-like symptoms or cardiovascular events arise
pain caused by damage to the nerves
central pain
a description of a drug using the nomenclature of chemistry
chemical name
the property of an ideal drug: the nurse teaches the patient that the medicine cabinet is a bad place to store medications because the heat and humidity can damage the drug
chemical stability
chronic pain that is always present, but varies in intensity
chronic intractable benign pain
pain that lasts beyond the expected time of healing; usually at-least 6 months
chronic pain
pain associated with a chronic condition that worsens over time
chronic progressive pain
intense episodes of pain interspersed with periods of no pain
chronic recurrent pain
based on the information in this chart, which adolescent may require a modified treatment plan? Client 1: menorrhea; treatment: chaste tree fruit Client 2: endometriosis; treatment: oral contraceptive pills Client 3: breast pain; treatment: ibuprofen Client 4: dysmenorrhea; treatment: acetaminophen
client 4
pulse 52 beats/min and unexplained fainting a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
d. QT prolongation
when, during the first 24 hours postoperatively, will analgesics be administered to a client who undergoes an abdominal cholecystectomy for gangrene of the gallbladder? a. if repositioning is ineffective b. when the pain becomes severe c. in gradually increasing doses d. as prescribed by the health care provider
d. as prescribed by the health care provider
the nurse applies a cold pack to relieve musculoskeletal pain. which rationale explains the analgesic properties of cold therapy? a. promotes analgesia and circulation b. numbs the nerves and dilates the blood vessels c. promotes circulation and reduces muscle spasms d. causes local vasoconstriction, preventing edema and muscle spasms
d. causes local vasoconstriction, preventing edema and muscle spasms
which recommendation would the nurse give to the client with trigeminal neuralgia? a. drink iced liquids b. avoid oral hygine c. apply warm compresses d. chew on the unaffected side
d. chew on the unaffected side
the study of drugs in humans a. therapeutics b. drug c. pharmacology d. clinical pharmacology
d. clinical pharmacology
according to the nursing process, which action would the nurse take after administering pain medication to a postoperative client? a. administer nonpharmalogical comfort measures b. inform the health care provider of nursing actions c. create a care plan that addresses the clients pain level d. determine whether the pain medication relieved the clients pain
d. determine whether the pain medication relieved the clients pain
assessment findings of a client who is admitted to the emergency department include cramping pain in the left lower quadrant, weakness, bloating, malaise, and a low grade fever. The nurse suspects which condition? a. pancreatitis b. appendicitis c. cholecystitis d. diverticulitis
d. diverticulitis
movement out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
d. excretion
hypotension can occur from peripheral vasodilation a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
d. isoflurane
Knowing the major adverse reactions of a drug, when they are likely to occur, early signs of development, and interventions to minimize discomfort and harm. a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
d. minimizing adverse effects
which consideration is the nurses concern when responding to the request of a hospice client who has severe pain and asks for another dose of oxycodone? a. prevent addiction b. determine why the medication is needed c. provide alternative comfort measures d. reduce the clients pain
d. reduce the clients pain
which caring intervention helps provide comfort, dignity, respect, and peace to a client? a. listening b. spiritual caring c. providing presence d. relieving pain and suffering
d. relieving pain and suffering
in which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed PRN oxycodone? a. just as a last resort b. before going to sleep c. as the pain becomes intense d. when the discomfort begins
d. when the discomfort begins
aspirin adverse reactions/side effects
drug reaction w/ eosinophilia, GI bleeding, epigastric distress, nausea, anaphylaxis
delirium and unpleasant psychologic reactions can occur postoperatively a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
e. ketamine
change in drug structure a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
e. metabolism
taking a thorough drug history, advising the patient to avoid drugs that may interact with prescribed medication, and monitoring for adverse reactions a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
e. minimizing adverse interactions
eGFR 50 mL/min and urinary output 750 mL/day; fluid intake 1500 mL/day a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
e. nephrotoxicity
the property of an ideal drug: during discharge teaching, the nurse assesses if the patient will be able to take a prescribed drug four times a day as ordered
ease of administration
the property of an ideal drug: the nurse reassesses the patient 20-30 minutes after administering an opiate analgesic
effectiveness
factors that trigger migraines
emotions (stress, anticipation, anxiety, depression, excitement, frustration) food (tyramine, nitrates, pheylethylamine, monosodium, aspartame, yellow food coloring), drugs ( alcohol, analgesics, caffine, cimetidine, cocaine, estrogens, nitroglycerin)
knowing the reason for drug use and being able to assess the patients medication needs a. pre-administration assessment b. dosage and administration c. promoting therapeutic effects d. minimizing adverse effects e. minimizing adverse interactions f. making as-needed (PRN) decisions g. evaluating responses to medication h. managing toxicity
f. making as-needed (PRN) decisions
frequent infections or infection with rare microbe and WBC count fewer than 5000/mm3 a. anaphylaxis b. hemolytic anemia c. hepatotoxicity d. QT prolongation e. nephrotoxicity f. neutropenia
f. neutropenia
movement into and out of the body a. absorption b. distribution c. elimination d. excretion e. metabolism f. pharmacokinetics
f. pharmacokinetics
high risk of bacterial infection a. desflurane b. enflurane c. droperidol d. isoflurane e. ketamine f. propofol g. sevoflurane
f. propofol
true or false: a depot intramuscular (IM) injection of an antibiotic to treat syphilis will be completely effective within 24 hours after administration
false
true or false: a drug that is selective for specific receptors will produce more unintended effects than a nonselective drug
false
true or false: activation of delta receptors is responsible for the delusions and delirium that are seen with certain opioids
false
true or false: adding potassium clavulanate to amoxicillin prevents the body's beta-lactamase enzyme from destroying the amoxicillin
false
true or false: an agonist drug blocks the stimulation of a receptor
false
true or false: an agonist-antagonist blocks pain when taken alone but improves the pain-relieving effect of another opioid if in the blood at the same time
false
true or false: antacids increase urinary excretion of alkaline drugs
false
true or false: aspirin, like most drugs, is primarily absorbed in the small intestine
false
true or false: buprenorphine has less constipation and sedative effects than morphine
false
true or false: first-pass effect means most of the drug is activated by the liver, so it must be administered orally
false
true or false: if a drug is selective for specific receptors, it is safe
false
true or false: ionization is a process that allows a drug to enter a cell
false
true or false: most drugs enter cells through channels or pores
false
the property of an ideal drug: the nurse explains that a generic form of a newly prescribed drug is available to a patient who has limited insurance coverage for drugs
low cost
hydrocodone indications
management of severe pain antitussive
acetaminophen indications
mild to moderate pain, fever
ibuprofen indications
mild to moderate pain, fever, inflammation
hydromorphone indications
moderate to severe pain
oxycodone indications
moderate to severe pain
tension-type headache characteristics
moderate, non-throbbing pain
lidocaine assessments
monitor ECG continuously and BP and respiratory status frequently during administration
naloxone assessment
monitor respiratory rate, rhythm, and depth; pulse, ECG, BP; and level of consciousness frequently for 3-4
migraine pathophysiology
neurovascular disorder that involves the dialation and inflammation of inter-cranial blood vessels nuerons of trigeminal vascular system calcitonin gene-related peptide serotonin
what are some examples of professional sources of drug information?
newsletters, reference books, and the internet
tension-type headache treatment
nonopioid analgesic (acetaminophen) nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen) analgesic-sedative combination (aspirin)
migraine treatment
nonspecific analgesics, aspirin-like drugs, opioid analgesics Senatorin receptor agonists ergot alkaloids beta-blockers antiepileptic drugs antidepressants
cluster headaches characteristics
occur in cluster attacks (lasts 15 min-2 hrs) severe, throbbing, unilateral pain near the eye one or two attacks a day for 2-3 months
the property of an ideal drug: the nurse explains that quinapril and accupril are names for the same drug
possession of a simple generic name
the property of an ideal drug: the nurse is aware that African Americans often do not respond as well as caucasian to angiotensin-converting enzyme inhibitors (ACEIs) prescribed for hypertension
predictably
aspirin action
produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins decreases platelet aggregation
pain associated with psychological factors (emotional or mental) as opposed to physiological factors (injury or disease)
psychogenic pain
is sensed in a region other than the site of origin
referred pain
naloxone indication
reversal of CNS depression and respiratory depression due to opioid overdose
the property of an ideal drug: the nurse researches if an antidote is available when administering drugs that have the potential to cause significant harm or death
reversible action
aspirin should not be taken by children, especially for symptoms of viral illness, because of the risk of _____
reye's syndrome
freedom from accidental injury
safety
the property of an ideal drug: when a patient is, or could be pregnant, the nurse researches the pregnancy and lactation information for every drug administered
safety
the property of an ideal drug: The nurse teaches a patient to avoid engaging in hazardous activities when taking an antihistamine for allergy symptoms.
selectivity
morphine indications
severe pain, pulmonary edema, pain associated with MI
propofol action
short-acting hypnotic produces amnesia
____ is the reduction in drug responsiveness brought on by repeated dosing over a short time
tachyphylaxis
drugs that are _____ can harm a fetus if the patient takes the drug while she is pregnant
teratogenic
expected physiological response
therapeutic effects
migraine characteristics
throbbing head pain nausea and vomiting sensitivity to light and sound
when a medication accumulates in the blood due to impaired metabolism or excretion; excess amounts of medication within the body
toxic effects
____ is the detrimental physiologic effects caused by excessive drug dosing
toxicity
true or false: a patient who suddenly stops taking an antagonist drug may experience hypersensitivity of the receptor and overstimulation
true
true or false: a drug that stimulates the transcription factor receptors may not reach a peak therapeutic effect until taken regularly for days to weeks
true
true or false: a drug with extensive first-pass effect may be given sublingually to allow the drug to be absorbed directly into the systemic circulation
true
true or false: a prescriber may prescribe a drug solely because of its interaction with another drug
true
true or false: a transport mechanism is needed for water-soluble drugs to enter a cell
true
true or false: adding a drug to a patients drug regimen can cause the other drugs to be metabolized more slowly or more rapidly
true
true or false: affinity is the strength of attraction between a drug and its receptor
true
true or false: alcohol, bananas, cigarette smoking, chewing tobacco, chocolate candy, garlic, and grapefruit juice can interact with drugs and cause adverse effects
true
true or false: cell membranes are composed of fat with phosphate
true
true or false: chemotherapy is administered through a central intravenous line because chemotherapy is caustic to the vein and a large central vein has rapid blood flow, which dilutes and moves the medication quickly
true
true or false: drugs with high intrinsic activity cause an intense response
true
true or false: enkephalins, endorphins, and dynorphins are body substances with opioid properties
true
true or false: enteric drugs should not be crushed because crushing these preparations can cause stomach distress or cause the acid in the stomach to alter the drug
true
true or false: if a quaternary ammonium compound drug is injected into a vein it will produce effects, but it will not if taken orally
true
true or false: if a receptor is constantly bombarded by a drug, the cell can down-regulate and decrease the response to the drug
true
true or false: intestinal enzymes can release drugs from bile in the duodenum, causing the drug to be reabsorbed
true
true or false: maximal efficacy is defined as the largest effect that a drug can produce
true
true or false: p-glycoprotein transports many drugs out of the cell
true
true or false: pharmacodynamics includes the study of how drugs work
true
true or false: potency is defined as the dose of drug needed to get the desired effect
true
true or false: the ED50 is usually the recommended dose for the drug
true
true or false: the dose of oral morphine is higher than the intravenous (IV) dose because hepatic first pass metabolizes some of the drug before it reaches the central nervous system
true
true or false: the nurse should consult with the prescriber regarding adequate blood levels of oral drugs when a patient has persistent diarrhea
true
true or false: the protein-bound portion of a drug in circulation is not able to exert its action
true
true or false: the respiratory depression, physical dependence, and euphoria that occur with opioid analgesics are related to activation of mu opioid receptors
true
true or false: two drugs in the same therapeutic class with different recommended doses can have equal effects
true
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic allows for the use of less anesthetic
true
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic can cause adverse effects from the systemic absorption of the vasoconstrictor
true
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic causes local vasoconstriction
true
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic delays systemic absorption
true
true or false: using a vasoconstrictor, such as epinephrine, with a local anesthetic reduces blood flow to the affected area
true
