Lehne Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum Test Bank

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Lehne Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum Test Bank

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INSTANT DOWNLOAD WITH ANSWERS
Lehnes Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

Chapter 02: Application of Pharmacology in Nursing Practice

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer 2 puffs every 4 hours as needed for coughing or wheezing. The patient reports feeling jittery sometimes when taking the medication, and she doesnt feel that the medication is always effective. Which action is outside the nurses scope of practice?
a. Asking the patient to demonstrate use of the inhaler
b. Assessing the patients exposure to tobacco smoke
c. Auscultating lung sounds and obtaining vital signs
d. Suggesting that the patient use one puff to reduce side effects

 

 

ANS:  D

It is not within the nurses scope of practice to change the dose of a medication without an order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the patients ability to administer the medication properly and is part of the nurses evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment helps the nurse evaluate the patients response to the medication.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 9-10

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct?
a. It is not safe to take over-the-counter drugs with prescription medications.
b. Taking the two medications together poses a risk of drug toxicity.
c. There are no known drug interactions, so this will be safe.
d. Tylenol and Lortab are different drugs, so there is no risk of overdose.

 

 

ANS:  B

Tylenol is the trade name and acetaminophen is the generic name for the same medication. It is important to teach patients to be aware of the different names for the same drug to minimize the risk of overdose. Over-the-counter (OTC) medications and prescription medications may be taken together unless significant harmful drug interactions are possible. Even though no drug interactions are at play in this case, both drugs contain acetaminophen, which could lead to toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 8

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process?
a. Asking the prescriber for an order to monitor serum drug levels
b. Monitoring the patient for drug interactions after giving the medication
c. Questioning the patient about over-the-counter medications
d. Taking the patients blood pressure throughout the course of treatment

 

 

ANS:  C

The assessment part of the nursing process involves gathering information before beginning treatment, and this includes asking about other medications the patient may be taking. Monitoring serum drug levels, watching for drug interactions, and checking vital signs after giving the medication are all part of the evaluation phase.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 6

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.

 

 

ANS:  B

The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication. Asking the patient to tell the nurse what has helped in the past is part of an initial assessment and should be done preoperatively and not when the patient is having severe pain. Because the patient is having severe pain, acetaminophen combined with nondrug therapies will not be sufficient. Increasing the frequency of the dose of a medication for mild pain will not be effective.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 9

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control

 

 

ANS:  A

Because insulin must be given correctly to control symptoms and because an overdose can be fatal, it is most important for the patient to know how to administer it. Asking for a demonstration of technique is the best way to determine whether the patient has understood the teaching. When a patient is receiving a lot of new information, the information presented first is the most likely to be remembered. The other teaching points are important as well, but they are not as critical and can be taught later.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 9

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?
a. Assessing the patients pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was administered
c. Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate
d. Documenting the reason the medication was given in the patients electronic medical record

 

 

ANS:  A

Assessing the patients pain after administering the medication is an important part of the nursing process when giving medications, but it is not part of the six rights of drug administration. Checking to see when the last dose was given helps ensure that the medication is given at the right time. Consulting a drug manual helps ensure that the medication is given in the right dose. Documenting the reason for a pain medication is an important part of the right documentationthe sixth right.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 9

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patients headache pain on a scale from 1 to 10.
c. Report the patients complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.

 

 

ANS:  A

When evaluating the effectiveness of a drug, it is important to determine whether the patient is using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and how often helps the nurse determine compliance. Assessing current pain does not yield information about how well the medication is working unless the patient is currently taking it. The nurse should gather as much information about compliance, symptoms, and drug effectiveness as possible before contacting the prescriber. Biofeedback may be an effective adjunct to treatment, but it should not be recommended without complete information about drug effectiveness.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 9

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
a. A 30-year-old man with kidney disease
b. A 75-year-old woman with cystitis
c. A 50-year-old man with an upper respiratory tract infection
d. A 9-year-old boy with an ear infection

 

 

ANS:  A

The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication. A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the greatest predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 9

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that older-adult patients are at increased risk for hepatic side effects. Which action by the nurse is correct?
a. Contact the provider to discuss an order for pretreatment laboratory work.
b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects.
c. Notify the provider that this drug is contraindicated for this patient.
d. Request an order to give the medication intravenously so that the drug does not pass through the liver.

 

 

ANS:  A

The drug manual indicates that this drug should be given with caution to elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with post-treatment data to determine whether the drug is affecting the liver. Giving the correct dose at the correct interval helps to minimize risk, but without baseline information, the effects cannot be determined. The drug is not contraindicated.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 7

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5C (101F). Which is the correct action by the nurse?
a. Administer the next dose and continue to evaluate the patients symptoms.
b. Ask the prescriber if an antihistamine can be given to relieve the itching.
c. Contact the prescriber to request an order for a chest radiograph.
d. Hold the next dose and notify the prescriber of the symptoms.

 

 

ANS:  D

Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, the medication should not be given and the prescriber should be notified. When patients are having a potentially serious reaction to a medication, the nurse should not continue giving the medication. Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop the medication. Obtaining a chest radiograph is not helpful.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 10

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN for severe pain and acetaminophen-hydrocodone [Lortab] 7.5 mg PO every 4 to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is appropriate?
a. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours.
b. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours and change to every 4 hours if not effective.
c. Administer morphine sulfate 1 mg IV every 1 hour until pain subsides.
d. Administer morphine sulfate 2 mg IV and evaluate the patients pain in 15 to 30 minutes.

 

 

ANS:  D

With PRN medications, the schedule is not fixed and the administration of these medications depends on the patients condition. It is the nurses responsibility to assess the patients condition and then give the appropriate PRN medication. In this case, the patient has severe pain and should receive MS IV. Either 1 mg or 2 mg may be given, but the nurse must evaluate the effectiveness of the pain medication within 15 to 30 minutes to help determine subsequent doses. Acetaminophen-hydrocodone is not appropriate because it is ordered for moderate pain and this patient reports severe pain. Giving MS IV every hour is not appropriate for a PRN medication unless the patients condition warrants it.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 8

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process?
a. Assessment
b. Evaluation
c. Implementation
d. Planning

 

 

ANS:  D

In the planning step, the nurse delineates specific interventions directed at solving or preventing problems. When creating the care plan, the nurse defines goals, sets priorities, and establishes criteria for evaluating success. The assessment step involves collecting data about the patient. The evaluation step involves evaluating the medication effectiveness. The implementation step identifies actions that are taken to administer the drug.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 9

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. A nurse is reviewing a patients medical record before administering a medication. Which factors can alter the patients physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills
b. Age
c. Genetic factors
d. Gender
e. Height

 

 

ANS:  B, C, D

Age, genetic factors, and gender influence an individual patients ability to absorb, metabolize, and excrete drugs; therefore, these factors must be assessed before a medication is administered. A patients ability to swallow pills, although it may determine the way a drug is administered, does not affect the physiologic response. Height does not affect response; weight and the distribution of adipose tissue can affect the distribution of drugs.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 6-7

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

Chapter 20: Introduction to Central Nervous System Pharmacology

Test Bank

 

MULTIPLE CHOICE

 

  1. A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of:
a. changes in the brain as a result of prolonged drug exposure.
b. direct actions of the drug on specific synaptic functions in the brain.
c. slowed drug absorption across the blood-brain barrier.
d. tolerance to exposure to the drug over time.

 

 

ANS:  A

It is thought that beneficial responses to central nervous system (CNS) drugs are delayed because they result from adaptive changes as the CNS modifies itself in response to prolonged drug exposure, and that the responses are not the result of the direct effects of the drugs on synaptic functions. The blood-brain barrier prevents protein-bound and highly ionized drugs from crossing into the CNS, but it does not slow the effects of drugs that can cross the barrier. Tolerance is a decreased response to a drug after prolonged use.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 173

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching?
a. Adaptation can lead to tolerance of these drugs with prolonged use.
b. Adaptation helps explain how physical dependence occurs.
c. Adaptation often must occur before therapeutic effects develop.
d. Adaptation results in an increased sensitivity to side effects over time.

 

 

ANS:  D

With adaptation of the central nervous system to prolonged exposure to CNS drugs, many adverse effects diminish and therapeutic effects remain. Adaptation helps explain how tolerance and physical dependence occur, as the brain adapts to the presence of the drug. Therapeutic effects can take several weeks to manifest, because they appear to work by initiating adaptive changes in the brain.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 174

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier:
a. prevents some potentially toxic substances from crossing into the central nervous system.
b. causes infants to be less sensitive to CNS drugs and thus require larger doses.
c. allows only ionized or protein-bound drugs to cross into the central nervous system.
d. prevents lipid-soluble drugs from entering the central nervous system.

 

 

ANS:  A

The blood-brain barrier can prevent some drugs and some toxic substances from entering the CNS. The blood-brain barrier in infants is not fully developed, so infants are more sensitive to CNS drugs and often require lower doses. The blood-brain barrier prevents highly ionized and protein-bound drugs from crossing into the CNS and allows lipid-soluble drugs and those that can cross via specific transport systems to enter.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 173

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching?
a. Central nervous system drug development relies on observations of their effects on human behavior.
b. Studies of new central nervous system drugs in healthy subjects can produce paradoxical effects.
c. Our knowledge of the neurochemical and physiologic changes that underlie mental illness is incomplete.
d. These drugs are developed based on scientific knowledge of CNS transmitters and receptors.

 

 

ANS:  D

The deficiencies in knowledge about how CNS transmitters and receptors work make systematic development of CNS drugs difficult. Testing in healthy subjects often leads either to no effect or to paradoxical effects. Medical knowledge of the neurochemical and physiologic changes underlying mental illness is incomplete. The development of CNS drugs depends less on knowledge of how the CNS functions and how these drugs affect that process and more on how administering one of these agents leads to changes in behavior.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 174

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient:
a. has developed a psychologic dependence on the drug.
b. may need increased amounts of the drug over time.
c. will cause an abstinence syndrome if the drug is discontinued abruptly.
d. will have increased sensitivity to drug side effects.

 

 

ANS:  B

When tolerance develops, a dose increase may be needed, because a decreased response may occur with prolonged use. Psychologic dependence involves cravings for drug effects and does not define tolerance. Physical dependence occurs when the drug becomes necessary for the brain to function normally, meaning the patient should be weaned from the drug slowly to prevent an abstinence syndrome. Patients may have a decreased sensitivity to drug side effects over time as the brain adapts to the medication.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 174

TOP:   Nursing Process: N/A

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration

 

 

ANS:  A

The blood-brain barrier is not fully developed at birth, making infants much more sensitive to CNS drugs than older children and adults. CNS symptoms may include sedation and drowsiness. The first-past effect and GI absorption affect metabolism and absorption of drugs, and renal filtration affects elimination of drugs, all of which may alter drug levels.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 173

TOP:   Nursing Process: N/A

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

MULTIPLE RESPONSE

 

  1. Which monoamines act as neurotransmitters in the central nervous system? (Select all that apply.)
a. Acetylcholine
b. Norepinephrine
c. Serotonin
d. Dopamine
e. Epinephrine
f. Histamine

 

 

ANS:  B, C, D, E

Acetylcholine and histamines are not monoamines.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 173

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Which are medical applications of central nervous system drugs? (Select all that apply.)
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control

 

 

ANS:  A, B, E

CNS drugs have medical uses for pain management, anesthesia, and seizure control. Depression and euphoria are side effects that can contribute to abuse of these drugs.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 173

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

Chapter 40: Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is teaching a drug prevention class to a group of parents of adolescents. Which statement by a parent indicates understanding of the teaching?
a. Compared with alcohol, marijuana has little or no long-term adverse effects.
b. Ecstasy causes reversible damage to serotonergic neurons.
c. LSD does not cause an abstinence syndrome when it is withdrawn.
d. Most individuals who abuse opioids began using them therapeutically.

 

 

ANS:  C

Although tolerance to LSD develops rapidly, there is no abstinence syndrome with abrupt withdrawal of the drug, and tolerance fades rapidly. Many adverse behavioral, subjective, and long-term effects are associated with chronic use of marijuana. MDMA [Ecstasy] can cause irreversible damage to serotonergic neurons. Most people who go on to abuse opioids begin their drug use illicitly; only an exceedingly small percentage of those exposed to opioids therapeutically go on to abuse these drugs.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 438-440 | p. 441 | p. 443

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A provider orders clonidine [Catapres] for a patient withdrawing from opioids. When explaining the rationale for this drug choice, the nurse will tell this patient that clonidine [Catapres] is used to:
a. prevent opioid craving.
b. reduce somnolence and drowsiness.
c. relieve symptoms of nausea, vomiting, and diarrhea.
d. stimulate autonomic activity.

 

 

ANS:  C

When administered to an individual physically dependent on opioids, clonidine can suppress some symptoms of abstinence. Clonidine is most effective against symptoms related to autonomic hyperactivity, including nausea, vomiting, and diarrhea. Clonidine does not stimulate autonomic activity; it is effective against symptoms of autonomic hyperactivity. Clonidine does not reduce somnolence and drowsiness. Clonidine does not prevent opioid craving.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 434

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. What is the primary reason for opioid abuse?
a. Ease of access
b. Initial rush similar to orgasm
c. Peer pressure
d. Prolonged sense of euphoria

 

 

ANS:  D

The primary reason for opioid abuse is the prolonged sense of euphoria that occurs after the initial rush. Healthcare professionals have easy access to opioids, which makes them more vulnerable to abuse of these drugs, but this is not the primary reason for abuse in the greater population. The initial rush lasts about 45 seconds and is not the primary reason for opioid abuse. Peer pressure is not the primary reason for opioid abuse.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 431

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is discussing the differences between OxyContin OC and OxyContin OP with a group of nursing students. Which statement by a student indicates understanding of the teaching?
a. OxyContin OC cannot be drawn into a syringe for injection.
b. OxyContin OP has greater solubility in water and alcohol.
c. OxyContin OP is not easily crushed into a powder.
d. Patients using OxyContin OP are less likely to overdose.

 

 

ANS:  C

OxyContin OP is a newer formulation that is designed to reduce OxyContin abuse. The OP formulation is much harder to crush into a powder. The OC preparation can be crushed and dissolved in water or alcohol and can easily be drawn into a syringe. The OP preparation does not dissolve easily in these solutions. Despite the differences in preparation, there is no indication that either form is less subject to abuse or overdose.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 431-432

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The patients friends tell the nurse that they were experimenting with poppers. The nurse will expect to administer which medication?
a. Diazepam [Valium]
b. Haloperidol [Haldol]
c. Methylene blue and supplemental oxygen
d. Naloxone [Narcan]

 

 

ANS:  C

These findings are consistent with volatile nitrate overdose, as evidenced by the venous dilation. The primary toxicity is methemoglobinemia, which can be treated with methylene blue and supplemental oxygen. Diazepam would not be used for patients experiencing volatile nitrate overdose, but it may be used in patients who have overdosed on hallucinogens. Haloperidol would be used in patients who have overdosed on amphetamines. Naloxone would be used to treat an opioid overdose.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 444

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate:
a. a severe abstinence syndrome when the effects of the barbiturates are reversed.
b. minimal respiratory depression, because the patient has developed a tolerance to opioids.
c. observing pinpoint pupils, respiratory depression, and possibly coma in this patient.
d. using naloxone [Narcan] to reverse the effects of the barbiturates, because cross-tolerance is likely.

 

 

ANS:  C

Patients tolerant to opioids do not have cross-tolerance to barbiturates, so this patient will show signs of overdose such as pinpoint pupils, respiratory depression, and coma. Because there is no cross-tolerance, a patient addicted to opioids will not have an abstinence syndrome when the effects of the barbiturates are reversed. Respiratory depression will be severe. Naloxone cannot be used to reverse the effects of the barbiturates.

 

PTS:   1                    DIF:    Cognitive Level: Evaluation           REF:   pp. 435-436

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is a heroin addict is admitted to a methadone substitution program. After administering the first dose of methadone, the nurse notes that the patient shows signs of euphoria and complains of nausea. What will the nurse do?
a. Administer nalmefene [Revex].
b. Contact the provider to obtain an order for naloxone [Narcan].
c. Question the patient about heroin use that day.
d. Suspect that the patient exaggerated the amount of heroin used.

 

 

ANS:  D

Patients entering a methadone substitution program must be carefully questioned about the amount of heroin used; patients may exaggerate the amount used to obtain higher doses of methadone or may minimize the amount used to downplay the extent of their addiction. In patients who exaggerate use, the amount of methadone given may cause euphoria, nausea, and vomiting. Nalmefene and naloxone are used to treat overdose and are not indicated. A patient receiving methadone along with a usual heroin dose would be likely to have signs of toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 432-433

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient asks the nurse why the drug was changed. Which response by the nurse is correct?
a. Suboxone has a lower risk of abuse.
b. Suboxone has a longer half-life.
c. Subutex causes more respiratory depression.
d. Subutex has more buprenorphine.

 

 

ANS:  A

The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse, because with IV use, the naloxone precipitates withdrawal; this effect does not occur with sublingual dosing [Subutex]. Suboxone does not differ from Subutex in terms of drug half-life. Subutex does not cause more respiratory depression and does not contain more buprenorphine.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 435

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is caring for a patient who is addicted to barbiturates and who will begin receiving phenobarbital. The nurse discusses the care of this patient with a nursing student. Which statement by the student indicates understanding of the teaching?
a. Phenobarbital acts as an antagonist to barbiturates and prevents toxicity.
b. Phenobarbital has a long half-life and can be tapered gradually to minimize abstinence symptoms.
c. Phenobarbital can be administered on an as-needed basis to treat withdrawal symptoms.
d. Phenobarbital prevents respiratory depression associated with barbiturate withdrawal.

 

 

ANS:  B

Phenobarbital has a long half-life and can be given to ease barbiturate withdrawal and suppress symptoms of abstinence. Phenobarbital is not an antagonist to barbiturates. It is not used on a PRN basis. Phenobarbital does not prevent respiratory depression associated with acute toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 436

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient arrives in the emergency department acutely intoxicated and difficult to arouse. The patients friends tell the nurse that the patient took a handful of diazepam [Valium] pills while at a party several hours ago. The nurse will expect to administer which drug?
a. Buprenorphine [Subutex]
b. Flumazenil [Romazicon]
c. Nalmefene [Revex]
d. Naloxone [Narcan]

 

 

ANS:  B

Flumazenil can reverse signs and symptoms of benzodiazepine overdose. Buprenorphine, nalmefene, and naloxone are all used to treat opioid addiction or toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 436

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who is agitated and profoundly anxious is brought to the emergency department. The patient acts paranoid and keeps describing things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the nurse expect to administer?
a. Anticocaine vaccine
b. Diazepam [Valium]
c. Disulfiram [Antabuse]
d. Vigabatrin [Sabril]

 

 

ANS:  B

This patient is showing signs of acute cocaine toxicity. Diazepam can be given to reduce anxiety and suppress seizures, which may occur. Anticocaine vaccine, disulfiram, and vigabatrin are drugs under investigation for treating cocaine addiction.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 437

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patients blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance?
a. Cocaine
b. Ecstasy
c. Marijuana
d. Methamphetamine

 

 

ANS:  D

Methamphetamine causes all of the symptoms shown by this patient. These are not symptoms associated with cocaine, Ecstasy, or marijuana.

 

PTS:   1                    DIF:    Cognitive Level: Evaluation           REF:   pp. 437-438

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A school nurse is teaching a high school health class about the effects of marijuana use. Which statement by a student indicates a need for further teaching?
a. Chronic use of marijuana can result in irreversible brain changes.
b. Higher doses of marijuana are likely to produce increased euphoria.
c. Marijuana is unique in that it produces euphoria, sedation, and hallucinations.
d. Marijuana has more prolonged effects when it is ingested than when it is smoked.

 

 

ANS:  B

With higher doses of marijuana, euphoria may be displaced by intense anxiety. Chronic use may cause irreversible brain changes. Euphoria, sedation, and hallucinations can all occur with marijuana use. Ingesting marijuana causes prolonged effects.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 438-439

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A pregnant patient reports using marijuana during her pregnancy. She asks the nurse whether this will affect the fetus. What should the nurse tell her?
a. Children born to patients who use marijuana will have smaller brains.
b. Neonates born to patients who use marijuana will have withdrawal syndromes.
c. Preschool-aged children born to patients who use marijuana are more likely to be hyperactive.
d. School-aged children born to patients who use marijuana often have difficulty with memory.

 

 

ANS:  D

School-aged children born to patients who use marijuana may show deficits in memory, attentiveness, and problem solving. Chronic marijuana use alters brain size in individuals who use marijuana but not in children born to parents who use marijuana. Newborns will not show withdrawal symptoms. Preschool-aged children have difficulty with memory and sustained attention.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 438-439

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A college student admits frequent use of LSD to a nurse and reports plans to stop using it. What will the nurse tell this student?
a. Flashback episodes and episodic visual disturbances are common.
b. Tolerance to the effects of LSD will fade quickly once use of the drug has stopped.
c. Withdrawal symptoms can be mitigated with haloperidol [Haldol].
d. Withdrawal from LSD is associated with a severe abstinence syndrome.

 

 

ANS:  B

Tolerance to the effects of LSD develops rapidly but fades quickly when the drug is stopped. Flashback episodes may occur but are not common. Haloperidol may actually intensify symptoms associated with an acute panic reaction; it is not indicated for LSD withdrawal. Abstinence syndrome does not occur when LSD is stopped.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 441

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The patient has a temperature of 105F and shows jaw clenching and confusion. The nurse will expect to administer which medication?
a. Dantrolene [Dantrium]
b. Haloperidol [Haldol]
c. Methadone
d. Naloxone [Narcan]

 

 

ANS:  A

This patient shows signs of Ecstasy toxicity. Dantrolene can be given to relax skeletal muscle to reduce heat generation and prevent the risk of rhabdomyolysis. The other medications are not used to treat Ecstasy toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 443-444

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. In discussing the rationale for using methadone to ease opioid withdrawal, the nurse would explain that it has which pharmacologic properties or characteristics?
a. Methadone can prevent abstinence syndrome.
b. Methadone has a shorter duration of action than other opioids.
c. Methadone is a nonopioid agent.
d. Methadone lacks cross-tolerance with other opioids.

 

 

ANS:  A

Methadone is used to ease opioid withdrawal and can prevent abstinence syndrome. Methadone does not have a shorter duration of action. Methadone is not a nonopioid agent. Methadone does not lack cross-tolerance with other opioids.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 434-435

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A college student tells the nurse that several friends have been using synthetic marijuana to get high. What will the nurse tell this patient about this type of substance?
a. These substances are fairly safe because they are derived from herbs.
b. They can cause hypertension, nausea, vomiting, and hallucinations.
c. These substances do not have mind-altering affects.
d. These substances produce a high and they are not illegal.

 

 

ANS:  B

Synthetic marijuana can produce severe symptoms including hypertension, nausea, vomiting, and hallucinations. Although once thought safe, it is no longer considered safe. It produces a high and can cause hallucinations. Many types of synthetic marijuana are now illegal.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 440

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. Which factors make meperidine an opioid of choice among nurses and physicians who abuse opioids? (Select all that apply.)
a. Easy access to syringes for administration of the drug
b. Highly effective oral dosing
c. Increased effects on smooth muscle function
d. Less pupillary constriction than other opioids
e. Shorter half-life than other opioids

 

 

ANS:  B, D

Meperidine is often abused by medical personnel because oral dosing is highly effective, so telltale injection marks are unnecessary. Also, the drug causes less pupillary constriction than other opioids. Access to syringes is not necessary with oral dosing. Meperidine has fewer effects on smooth muscle function, causing less constipation and urinary retention.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 431-43

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