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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WITH ANSWERS
Lehnes Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum-Test Bank

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 14: Muscarinic Agonists and Antagonists

Test Bank

 

MULTIPLE CHOICE

 

  1. A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action?
a. Reduction of excessive secretions in a postoperative patient
b. Lowering of intraocular pressure in patients with glaucoma
c. Inhibition of muscular activity in the bladder
d. Prevention of hypertensive crisis

 

 

ANS:  B

Pilocarpine is a muscarinic agonist used mainly for topical therapy of glaucoma to reduce intraocular pressure. Pilocarpine is not indicated for the treatment of excessive secretions and mucus; in fact, pilocarpine is used to treat dry mouth. Pilocarpine does not inhibit muscular activity in the bladder. Pilocarpine is not used to prevent hypertensive crisis.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 118

TOP:   Nursing Process: Planning

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

 

  1. A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication?
a. Atropine [Sal-Tropine] IV
b. Physostigmine [Antilirium]
c. An acetylcholinesterase activator
d. Pseudoephedrine [Ephedrine]

 

 

ANS:  B

Physostigmine is indicated for muscarinic antagonist toxicity. Atropine is a drying agent and would only complicate the drying action that arises from the muscarinic antagonist. An acetylcholinesterase activator would only contribute to dryness that arises from the muscarinic antagonist. Ephedrine is not indicated for muscarinic antagonist toxicity.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 118-119 | pp. 125-126

TOP:   Nursing Process: Planning

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

 

  1. A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patients chart before giving the drug. Which part of the patients history would be a contraindication to using this drug?
a. Asthma as a child
b. Gastroesophageal reflux
c. Hypertension
d. Hypothyroidism

 

 

ANS:  A

Bethanechol is contraindicated in patients with active or latent asthma, because activation of muscarinic receptors in the lungs causes bronchoconstriction. It increases the tone and motility of the gastrointestinal (GI) tract and is not contraindicated in patients with reflux. It causes vasodilation and would actually lower blood pressure in a hypertensive patient. It causes dysrhythmias in hyperthyroid patients.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 116-117

TOP:   Nursing Process: Assessment

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

 

  1. A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching?
a. I can use sugar-free gum for dry mouth.
b. I may need laxatives for constipation.
c. I should keep the site covered to prevent other people from getting the medicine.
d. I will take Benadryl for any itching caused by a local reaction to the patch.

 

 

ANS:  D

Benadryl is an antihistamine, and even though it is not classified as a muscarinic antagonist, it has anticholinergic effects. Giving it with a muscarinic antagonist greatly enhances these effects, so it should not be used. Muscarinic antagonists cause dry mouth, and patients should be taught to use sugar-free gum or candies to help with this. Muscarinic antagonists can cause constipation, and laxatives may be used. Medication applied topically can be transferred to others who come in contact with the skin, so the site should be covered.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 123

TOP:   Nursing Process: Implementation

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

 

  1. An older adult patient who lives alone and is somewhat forgetful has an overactive bladder (OAB) and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient?
a. Oxybutynin short-acting syrup
b. Oxybutynin [Ditropan XL] extended-release tablets
c. Oxybutynin [Oxytrol] transdermal patch
d. Percutaneous tibial nerve stimulation (PTNS)

 

 

ANS:  C

The transdermal patch is applied weekly and may be the best option for a patient who is more likely to forget to take a daily medication. The transdermal preparation has fewer side effects than the systemic dose, so it is less likely to increase this patients constipation. The syrup has a high incidence of dry mouth and other anticholinergic side effects. The extended-release tablets must be given daily, and this patient may not remember to take them. PTNS is used after behavioral and drug therapies have failed.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 121-122

TOP:   Nursing Process: Implementation

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

 

  1. A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order:
a. activated charcoal to minimize intestinal absorption of the antimuscarinic agent.
b. an acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors.
c. an antipsychotic medication to treat the patients central nervous system symptoms.
d. ipratropium bromide [Atrovent] to counter the respiratory effects of the antimuscarinic agent.

 

 

ANS:  B

This patient is showing signs of antimuscarinic toxicity, caused by the atropine given during surgery. The most effective antidote is physostigmine, which inhibits acetylcholinesterase, allowing acetylcholine to build up at cholinergic junctions and compete with the antimuscarinic agent for receptor binding. Activated charcoal is useful only if an antimuscarinic agent has been ingested, because it impedes absorption from the GI tract. Because this patients psychotic symptoms are caused by an antimuscarinic agent, physostigmine should be given to treat the cause; an antipsychotic medication would only treat the symptom. Ipratropium bromide is an antimuscarinic agent and would only compound the effects. This patients respiratory rate is only mildly elevated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 124

TOP:   Nursing Process: Evaluation

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

 

  1. Bethanechol [Urecholine] is used to treat urinary retention but is being investigated for use in which other condition?
a. Gastric ulcers
b. Gastroesophageal reflux
c. Hypotension
d. Intestinal obstruction

 

 

ANS:  B

Bethanechol is being investigated for treatment for gastroesophageal reflux disease (GERD) because of its effects on esophageal motility and the lower esophageal sphincter. Bethanechol stimulates acid secretion and could intensify ulcer formation. Bethanechol can cause hypotension. Because bethanechol increases the motility and tone of intestinal smooth muscle, the presence of an obstruction could lead to bowel rupture.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 117

TOP:   Nursing Process: Planning

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

 

  1. A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based on the nurses knowledge that muscarinic antagonists cause:
a. elevation of intraocular pressure.
b. miosis and ciliary muscle contraction.
c. paralysis of the iris sphincter.
d. relaxation of ciliary muscles.

 

 

ANS:  C

By blocking muscarinic receptors in the eye, atropine causes paralysis of the iris sphincter, which prevents constriction of the pupil; consequently, the eye cannot adapt to bright light. This also causes an elevation in intraocular pressure, which increases the risk of glaucoma. However, it is not an indication for wearing darkened glasses. Muscarinic agonists cause miosis; atropine causes mydriasis. The effect of relaxing ciliary muscles focuses the eye for far vision, causing blurred vision.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 118-120

TOP:   Nursing Process: Implementation

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

 

  1. A patient who has esophageal cancer is experiencing dry mouth and the provider orders oral pilocarpine to treat this symptom. What will the nurse expect to teach this patient about this medication?
a. This medication may cause rapid heart rate and elevated blood pressure.
b. This medication may cause constipation and gastric discomfort in large doses.
c. You should experience sweating with this medication and should not have other side effects.
d. You will begin taking 5 mg three times daily and may increase the dose to 10 mg.

 

 

ANS:  D

The dosing for pilocarpine, when used for dry mouth associated with head and neck cancers, is 5 mg three times daily, which may be titrated up to 10 mg three times daily. Tachycardia and constipation are side effects of atropine. Sweating occurs with low doses of pilocarpine. Higher doses, such as this, are associated with the full range of muscarinic effects.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 118

TOP:   Nursing Process: Implementation

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

Chapter 28: Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient asks the nurse what can be given to alleviate severe, chronic pain of several months duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?
a. Fentanyl [Duragesic] transdermal patch
b. Hydrocodone [Vicodin] PO
c. Meperidine [Demerol] PO
d. Pentazocine [Talwin] PO

 

 

ANS:  A

Transdermal fentanyl is indicated only for persistent, severe pain in patients already opioid tolerant. Hydrocodone, a combination product, has actions similar to codeine and is not used for severe, chronic pain. Meperidine is not recommended for continued use because of the risk of harm caused by the accumulation of a toxic metabolite. Pentazocine is an agonist-antagonist opioid and is less effective for pain; moreover, when given to a patient who is already opioid tolerant, it can precipitate an acute withdrawal syndrome.

 

PTS:   1                    DIF:    Cognitive Level: Application

REF:   p. 267 | pp. 270-271 | pp. 272-273 TOP:   Nursing Process: Planning

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

 

  1. A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patients pupils are dilated and that the patient is drowsy and lethargic. The patients heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?
a. Discuss possible opiate dependence with the patients provider.
b. Encourage the patient to turn over and cough and take deep breaths.
c. Note the effectiveness of the analgesia in the patients chart.
d. Prepare to administer naloxone and possibly ventilatory support.

 

 

ANS:  D

Opioid toxicity is characterized by coma, respiratory depression, and pinpoint pupils. Although pupils are constricted initially, they may dilate as hypoxia progresses, which also causes blood pressure to drop. This patient has a respiratory rate of fewer than 12 breaths per minute, dilated pupils, and low blood pressure; the patient also is showing signs of central nervous system (CNS) depression. The nurse should prepare to give naloxone and should watch the patient closely for respiratory collapse. Patients with opioid dependence show withdrawal symptoms when the drug is discontinued. When postoperative patients have adequate analgesia without serious side effects, encouraging patients to turn, cough, and breathe deeply is appropriate. This patient is probably relatively pain free, but providing emergency treatment is the priority.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 265-266

TOP:   Nursing Process: Implementation

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

 

  1. A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:
a. administering a combination opioid analgesic/acetaminophen preparation.
b. changing the medication to a continued-release preparation.
c. confronting the patient about drug-seeking behaviors.
d. withdrawing the medication, because physical dependence has occurred.

 

 

ANS:  B

Oxycodone is useful for moderate to severe pain, and a continued-release preparation may give more continuous relief. Dosing is every 12 hours, not PRN. A combination product is not recommended with increasing pain, because the nonopioid portion of the medication cannot be increased indefinitely. This patient does not demonstrate drug-seeking behaviors. Physical dependence is not an indication for withdrawing an opioid, as long as it is still needed; it indicates a need for withdrawing the drug slowly when the drug is discontinued.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 271

TOP:   Nursing Process: Evaluation

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

 

  1. A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?
a. PRN dosing of the drug may be more effective.
b. The risk of respiratory depression increases over time.
c. The patient should discuss increasing the dose with the provider.
d. The patient should request the addition of a benzodiazepine to augment pain relief.

 

 

ANS:  C

This patient is developing tolerance, which occurs over time and is evidenced by the need for a larger dose to produce the effect formerly produced by a smaller dose. This patient should be encouraged to request an increased dose. PRN dosing is less effective than scheduled, around-the-clock dosing. The risk of respiratory depression decreases over time as patients develop tolerance to this effect. Benzodiazepines are CNS depressants and should not be given with opioids, because they increase the risk of oversedation.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 264-266

TOP:   Nursing Process: Planning

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

 

  1. A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for:
a. congenital anomalies.
b. excessive crying and sneezing.
c. respiratory depression.
d. tremors and hyperreflexia.

 

 

ANS:  C

Use of morphine or other opioids during delivery can cause respiratory depression in the neonate, because the drug crosses the placenta. Infants should be monitored for respiratory depression and receive naloxone if needed. Opioids given during delivery do not contribute to birth defects in the newborn. Excessive crying and sneezing and tremors and hyperreflexia are signs of neonatal opioid dependence, which occurs with long-term opioid use by the mother during pregnancy and not with short-term use of these drugs during labor.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 277 | p. 284

TOP:   Nursing Process: Evaluation

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

 

  1. A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct?
a. Administer the ibuprofen as ordered.
b. Contact the provider to discuss nonpharmacologic pain measures.
c. Request an order for meperidine [Demerol].
d. Request an order for morphine sulfate.

 

 

ANS:  C

Opioids can induce spasm of the common bile duct and can cause biliary colic. For patients with existing biliary colic, morphine may intensify the pain. It is important to treat pain, however, and certain opioids, such as meperidine, which cause less smooth muscle spasm, may be given. Ibuprofen is used for mild to moderate pain and is not appropriate for this patient. Nonpharmacologic methods are appropriate when used as adjunctive therapy with an opioid.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 263

TOP:   Nursing Process: Implementation

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

 

  1. A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patients arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patients pupils are dilated. The nurse recognizes these symptoms as signs of:
a. a mild opioid overdose.
b. decreased opioid drug levels.
c. improved ventilation.
d. worsening hypoxia.

 

 

ANS:  D

The classic triad of symptoms of opioid overdose are coma, respiratory depression, and pinpoint pupils. The pupils may dilate as hypoxia worsens, and this symptom, along with continued respiratory depression (fewer than 12 breaths per minute), indicates worsening hypoxia. Fentanyl is a strong opioid, so this is not likely to be a mild overdose, because the patient was wearing two patches. Fentanyl continues to be absorbed even after the patches are removed because of residual drug in the skin, so the drug levels are not likely to be decreasing. The patient does not have improved ventilation, because the respiratory rate is still fewer than 12 breaths per minute.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 267

TOP:   Nursing Process: Evaluation

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

 

  1. A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for:
a. euphoria.
b. hypotension.
c. respiratory depression.
d. yawning and sweating.

 

 

ANS:  D

Pentazocine is an agonist-antagonist opioid, and when given to a patient who is physically dependent on morphine, it can precipitate withdrawal. Yawning and sweating are early signs of opioid withdrawal. Pentazocine does not produce euphoria, hypotension, or respiratory depression.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 264-265 | pp. 272-273

TOP:   Nursing Process: Planning

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

 

  1. A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?
a. Avoid prolonged exposure to the sun.
b. Cleanse the site with soap or alcohol.
c. Remove the patch daily at bedtime.
d. Remove hair by shaving before applying the patch.

 

 

ANS:  A

Patients using the buprenorphine transdermal patch should be cautioned against heat, heating pads, hot baths, saunas, and prolonged sun exposure. The skin should be cleaned with water only. The patch should stay on for 7 days before a new patch is applied. Patients should remove hair by clipping, not shaving.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 273

TOP:   Nursing Process: Implementation

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

 

  1. A nurse is preparing a pediatric patient for surgery and is teaching the patient and the childs parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do?
a. Instruct the parents not to activate the device when their child is sleeping.
b. Reassure the parents that drug overdose is not possible with PCA.
c. Suggest that the child use the PCA sparingly.
d. Tell the patient that the pump can be programmed for PRN dosing only.

 

 

ANS:  A

The nurse should instruct parents not to activate the PCA when their child is sleeping because that can lead to drug overdose. Postoperative pain should be treated appropriately with medications that are effective. Nonopioid medications are not sufficient to treat postoperative pain. Patients should be encouraged to use the PCA as needed so that pain can be controlled in a timely fashion. PRN dosing is not as effective as dosing that is continuous, so a basal dose should be given as well as a PRN dose.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 264 | pp. 276-277

TOP:   Nursing Process: Planning

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

 

  1. A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes?
a. Prolonged QT interval
b. Prolonged P-R interval
c. AV block
d. An elevated QRS complex

 

 

ANS:  A

Methadone prolongs the QT interval. It does not prolong the P-R interval, cause AV block, or produce an elevated QRS complex.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 270

TOP:   Nursing Process: Assessment

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

 

  1. A patient who has developed opioid tolerance will experience which effect?
a. Decreased analgesic effect
b. Decreased constipation
c. Increased euphoria
d. Increased respiratory depression

 

 

ANS:  A

Patients who develop tolerance to opioids will develop tolerance to its analgesic, euphoric, and sedative effects and will also develop tolerance to respiratory depression. Very little tolerance develops to constipation.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 264

TOP:   Nursing Process: Assessment

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

 

MULTIPLE RESPONSE

 

  1. A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? (Select all that apply.)
a. Counting respirations before and after giving the medication
b. Encouraging physical activity and offering increased fluids
c. Monitoring the patients blood pressure closely for hypertension
d. Palpating the patients lower abdomen every 4 to 6 hours
e. Requesting an order for methylnaltrexone [Relistor] to prevent constipation

 

 

ANS:  A, B, D

Respiratory depression, constipation, and urinary retention are common adverse effects of opioid analgesics. It is important to count respirations before giving the drug and periodically thereafter to make sure that respiratory depression has not occurred. Increased physical activity, increased fluid intake, and increased fiber help alleviate constipation. It is important to assess the patients abdomen and palpate the bladder to make sure that urinary retention has not occurred. Patients taking morphine often experience hypotension, not hypertension. Methylnaltrexone is given as a last resort to treat constipation, because it blocks mu receptors in the intestine.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 261-264

TOP:   Nursing Process: Evaluation

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

 

  1. Which side effects of opioid analgesics can have therapeutic benefits? (Select all that apply.)
a. Biliary colic
b. Cough suppression
c. Suppression of bowel motility
d. Urinary retention
e. Vasodilation

 

 

ANS:  B, C, E

Individual effects of morphine may be beneficial, detrimental, or both. Cough suppression is usually beneficial; suppression of bowel motility and vasodilation can be either beneficial or detrimental. Biliary colic and urinary retention are always detrimental side effects.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 262-262

TOP:   Nursing Process: Assessment

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

Chapter 42: Agents Affecting the Volume and Ion Content of Body Fluids

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient who is a chronic alcoholic is admitted to the hospital. Admission laboratory work reveals a magnesium level of 1.2 mEq/L. The prescriber orders intravenous magnesium sulfate in a 10% solution at a rate of 10 mL/min. What will the nurse do?
a. Administer the IV dose as ordered and have calcium gluconate on hand.
b. Administer the IV dose and make preparations for mechanical ventilation.
c. Hold the IV dose until the infusion rate has been clarified with the provider.
d. Request an order for renal function tests before administering the IV dose.

 

 

ANS:  C

This patient has hypomagnesemia and should be given magnesium sulfate intravenously. The percent of magnesium in solution is correct; however, magnesium should not be infused faster than 1.5 mL/min, so the nurse is correct to question the rate of infusion. Calcium gluconate should be available when magnesium is given, but the nurse needs to clarify the rate of infusion first. Mechanical ventilation is necessary with excessive magnesium. Renal function tests are not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 462

TOP:   Nursing Process: Diagnosis

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

 

  1. A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute. The injuries are minor, but the patient is inconsolable and hysterical. The nurse expects that initial management will include:
a. administering a gas mixture of 5% carbon dioxide (CO2).
b. providing 100% oxygen via nasal cannula.
c. giving sodium bicarbonate IV.
d. providing sedatives to calm the patient.

 

 

ANS:  A

The patient is at risk for respiratory alkalosis as a result of hyperventilation, and giving the patient a gas mixture containing CO2 will help correct the alkalosis. Administering oxygen would worsen the problem. Sodium bicarbonate is given to correct metabolic acidosis. Sedatives may be necessary if initial measures fail.

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