Chapters 11,12,13, 44

Front 1

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.)

A) Decreased peristalsis
B) Diarrhea
C) Delayed gastric emptying
D) Urinary retention

Back 1

A: Decreased peristalsis
C: Delayed gastric emptying
D: Urinary retention

Front 2

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 with that of

A) meperidine.
B) fentanyl.
C) codeine.
D) morphine.

Back 2

D: morphine.

Front 3

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

A) Morphine
B) Methadone
C) Meperidine
D) Naloxone

Back 3

B: Methadone

Front 4

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?

A) Renal failure
B) Kidney stones
C) Acute hepatic necrosis
D) Metabolic alkalosis

Back 4

C: Acute hepatic necrosis

Front 5

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

A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) vitamin K

Back 5

B: acetylcysteine (Mucomyst)

Front 6

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

A) massaging muscles decreases the inflammatory response that initiates the painful stimuli.
B) 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.
C) massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.
D) massaging muscles helps relax the contracted fibers and decrease painful stimuli.

Back 6

B: 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

Front 7

When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient’s

A) respiratory rate.
B) heart rate.
C) blood pressure.
D) mental status.

Back 7

A: respiratory rate.

Front 8

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

A) naloxone (Narcan)
B) acetylcysteine (Mucomyst)
C) methylprednisolone (Solu-Medrol)
D) protamine sulfate

Back 8

A: naloxone (Narcan)

Front 9

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?

A) Stimulation of the immune system
B) Cough suppressant
C) Expectorant
D) Bronchodilation

Back 9

B: Cough suppressant

Front 10

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

A) autonomic control over circulation.
B) cough reflex center.
C) chemoreceptor trigger zone.
D) respiratory rate and depth.

Back 10

C: chemoreceptor trigger zone

Front 11

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?

A) Administer a smaller dose and record the findings
B) Notify the physician and delay drug administration
C) Administer the prescribed dose and notify the physician
D) Hold the drug, record the assessment, and recheck in 1 hour

Back 11

B: Notify the physician and delay drug administration

Front 12

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

A) taking Lomotil with each dose.
B) eating foods high in lactobacilli.
C) taking the medication on an empty stomach.
D) increasing fluid and fiber in the diet.

Back 12

D: increasing fluid and fiber in the diet.

Front 13

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

A) When pain recurs
B) Every 24 hours
C) Every 72 hours
D) Once a week

Back 13

C: Every 72 hours

Front 14

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

A) narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction.
B) analgesics should be administered as needed (prn) to minimize side effects.
C) pain relief is best obtained by administering analgesics around the clock.
D) patients should request analgesics when the pain level reaches a “6” on a scale of 1 to 10.

Back 14

C: pain relief is best obtained by administering analgesics around the clock

Front 15

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

A) Acute pain
B) Risk for injury related to central nervous system side effects
C) Impaired gas exchange related to respiratory depression
D) Constipation related to gastrointestinal side effects

Back 15

C: Impaired gas exchange related to respiratory depression

Front 16

Most nonsteroidal antiinflammatory drugs (NSAIDs) work by

A) ameliorating pain perception.
B) inhibiting prostaglandin production.
C) increasing blood flow to painful areas.
D) increasing the supply of natural endorphins.

Back 16

B: inhibiting prostaglandin production.

Front 17

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

A) Dizziness
B) Black tarry stools
C) Nonproductive cough
D) Palpitations

Back 17

B: Black tarry stools

Front 18

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

A) prevent the occurrence of gout.
B) increase uric acid excretion.
C) inhibit bacterial growth and replication.
D) prolong the effectiveness of penicillin therapy.

Back 18

D: prolong the effectiveness of penicillin therapy.

Front 19

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

A) have a longer duration of action.
B) are less likely to cause hepatic toxicity.
C) do not decrease the cytoprotective lining of the stomach.
D) have a more rapid onset of action.

Back 19

C: do not decrease the cytoprotective lining of the stomach.

Front 20

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

A) “Ginkgo biloba has shown tremendous benefit as an antiinflammatory drug.”
B) “High doses of vitamins have been used for many years to help maintain joint health.”
C) “There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications.”
D) “Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain, so consult your health care provider.”

Back 20

D: “Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain, so consult your health care provider.”

Front 21

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

A) decreases motility of leukocytes.
B) increases process of phagocytosis.
C) increases uric acid metabolism.
D) increases production of lactic acid.

Back 21

A: decreases motility of leukocytes

Front 22

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

A) Constipation related to side effect of medication
B) Risk for infection related to medication-induced leukocytosis
C) Risk for injury related to side effect of seizures
D) Deficient fluid volume related to side effects of nausea, vomiting, and diarrhea

Back 22

D: Deficient fluid volume related to side effects of nausea, vomiting, and diarrhea

Front 23

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

A) “Increase your fluid intake to 3 L per day.”
B) “Include salmon and organ meats in your diet on a weekly basis.”
C) “Take the medication with an antacid to minimize gastrointestinal distress.”
D) “This medication may cause your urine to turn orange.”

Back 23

A: “Increase your fluid intake to 3 L per day.”

Front 24

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

A) COPD
B) Gastroesophageal reflux disease (GERD)
C) Pregnancy
D) Peptic ulcer

Back 24

C: Pregnancy

Front 25

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

A) 45-year-old man with a history of heart attack
B) 28-year-old woman with a history of sports injury
C) 14-year-old boy with a history of flulike symptoms
D) 62-year-old woman with a history of stroke

Back 25

C: 14-year-old boy with a history of flulike symptoms

Front 26

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

A) allopurinol (Zyloprim)
B) indomethacin (Indocin)
C) ketorolac (Toradol)
D) diclofenac (Cataflam)

Back 26

C: ketorolac (Toradol)

Front 27

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

A) produces deep muscle relaxation and loss of consciousness.
B) results in moderate sedation in which the patient can follow commands but will not remember anything following the procedure.
C) provides anesthesia to a specific region of the body and generalized sedation.
D) typically is achieved using only one type of medication.

Back 27

A: produces deep muscle relaxation and loss of consciousness.

Front 28

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

A) “I understand your concern; that is one of the pitfalls of surgery.”
B) “Don’t worry, because you’ll be heavily sedated if that occurs.”
C) “Nausea and vomiting occur much less frequently than in the past related to the use of a balanced approach to anesthesia.”
D) “You will need to speak to both the surgeon and the anesthesiologist in order to identify possible allergies to drugs that may be causing this side effect.”

Back 28

C: “Nausea and vomiting occur much less frequently than in the past related to the use of a balanced approach to anesthesia.”

Front 29

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

A) isoflurane (Forane)
B) nitrous oxide
C) propofol (Diprivan)
D) halothane (Fluothane)

Back 29

C: propofol (Diprivan)

Front 30

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

A) Ambulating once a day
B) Turning, coughing, and deep breathing every 2 hours
C) Forcing fluids to 400 mL per shift
D) Administering loperamide (Imodium) as needed

Back 30

B: Turning, coughing, and deep breathing every 2 hours

Front 31

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

A) Administer acetaminophen as ordered and recheck in 1 hour
B) Apply a cooling blanket per protocol
C) Notify the physician
D) Assess for signs and symptoms of infection related to the surgical wound

Back 31

C: Notify the physician

Front 32

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?

A) “Epinephrine is used with lidocaine to prevent side effects.”
B) “The systemic absorption of lidocaine is maximized by the epinephrine, and the anesthetic effect is reached more quickly.”
C) “Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site.”
D) “Epinephrine is metabolized more quickly than lidocaine so that the anesthetic effect wears off more quickly once the laceration is sutured.”

Back 32

C: “Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site.”

Front 33

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

A) patient is having an adverse reaction to the medication.
B) patient’s level of sedation is inadequate.
C) patient’s dose of the neuromuscular-blocking drug is insufficient.
D) patient’s response to the drug is appropriate.

Back 33

B: patient’s level of sedation is inadequate.

Front 34

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 under anesthetic?

A) Immediate withdrawal symptoms
B) Blood-clotting problems
C) Anesthetic-induced complications
D) Complications during recovery

Back 34

C: Anesthetic-induced complications

Front 35

A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?

A) naloxone (Narcan)
B) naltrexone (ReVia)
C) nalmefene (Revex)
D) flumazenil (Romazicon)

Back 35

D: flumazenil (Romazicon)

Front 36

Older adults who are prescribed a benzodiazepine for treatment of insomnia need to be monitored for

A) hallucinations.
B) ataxia.
C) alertness.
D) dyspnea.

Back 36

B: ataxia

Front 37

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?

A) Ineffective peripheral tissue perfusion
B) Fluid volume excess
C) Risk for injury
D) Risk for infection

Back 37

C: Risk for injury

Front 38

A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?

A) Naloxone HCl (Narcan)
B) Activated charcoal
C) Flumazenil (Romazicon)
D) Ipecac syrup

Back 38

B: Activated charcoal

Front 39

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?

A) “Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
B) “Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
C) “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”
D) “There really is no difference; the terms are used interchangeably.”

Back 39

C: “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”

Front 40

The patient’s chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced

A) delirium tremens.
B) malignant hyperthermia.
C) a tonic-clonic seizure.
D) respiratory arrest.

Back 40

B: malignant hyperthermia.

Front 41

A 25-year-old female patient asks the nurse about a new drug advertised on television. The patient wants to know if Ambien would be better for her to use than her current medication, Restoril, for periodic insomnia. The nurse's response is based on knowledge that zolpidem (Ambien) (Select all that apply.)

A) is less likely to cause grogginess in the morning.
B) is a pregnancy category C medication.
C) is contraindicated with asthma.
D) should be limited to 7 to 10 days of treatment.

Back 41

A: is less likely to cause grogginess in the morning.
B: is a pregnancy category C medication.
D: should be limited to 7 to 10 days of treatment.

Front 42

Midazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect?

A) Decreased heart rate
B) Amnesia
C) Constipation
D) Dry mouth

Back 42

B: Amnesia