Pharmacology and the Nursing Process 8e by Linda Lane Collins Julie S. Snyder test bank

Pharmacology and the Nursing Process  8e by Linda Lane Collins Julie S. Snyder  test bank
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Chapter 11: General and Local Anesthetics
Lilley: Pharmacology and the Nursing Process, 8th Edition

MULTIPLE CHOICE

1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine

ANS: D
Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of no anesthesia is incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 176
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia

ANS: D
A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 174
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?
a. The 21-year-old patient who has never had surgery before
b. The 35-year-old patient who stopped smoking 8 years ago
c. The 40-year-old patient who is to have a kidney stone removed
d. The 82-year-old patient who is to have gallbladder removal

ANS: D
The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 173
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?
a. Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c. Decreased cardiac output related to systemic effects of local anesthesia
d. Impaired gas exchange related to central nervous system depression produced by general anesthesia

ANS: D
The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 183
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. When administering a neuromuscular blocking drug, the nurse needs to remember which principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

ANS: D
Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 178
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia

ANS: B
Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patients ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 175
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103 F (39.4 C). The nurse will prepare for what immediate treatment?
a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
c. An anticholinesterase drug, such as neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation

ANS: B
Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 174
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.)
a. Procedural sedation
b. Surgeries of short duration
c. Surgeries of long duration
d. Postoperative anxiety
e. Sedation of mechanically ventilated patients

ANS: A, B, E
Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 174
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

COMPLETION

1. A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is available in a strength of 1 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe for this dose. _______

ANS:
2 mL

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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