Nervous System

a

While completing preoperative patient teaching, which information should the nurse include about surgery with a general anaesthetic?

\
It produces muscle relaxation and loss of consciousness.

It provides moderate sedation that allows the patient to relax.

It affects a specific region of the body to block pain sensation.

It uses only one type of medication to produce sedation.

c

#### A patient expresses concern to the nurse regarding postoperative nausea and vomiting from anaesthesia. Which of the following should the nurse say to the patient as the best response to the patient’s concern?

\
* “I understand your concern, but intermittent vomiting often occurs after surgery.”

\


* “Don’t worry, because you’ll be heavily or completely sedated if that occurs.”

\


* “Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anaesthesia.”

\


* “You will need to notify the charge nurse and health care provider if you feel nauseated after surgery.”

\

a

#### An intubated, mechanically ventilated patient in the Intensive Care Unit (ICU) is becoming increasingly restless and anxious. The nurse expects to administer which intravenous (IV) anaesthetic drug?

\
* propofol (Diprivan®)

\


* halothane

\


* isoflurane (Forane®)

\


* nitrous oxide (“laughing gas”)

.

c

#### What should the nurse do postoperatively to help prevent the patient from having serious complications from general anaesthesia?

\
* Place the patient into a semi-Fowler’s position.

\


* Monitor input and output closely.

\


* Teach the patient to turn, cough, and deep-breathe.

\


* Provide a quiet, calm environment.

\

a

#### Postoperative assessment of a patient reveals a sudden elevation of body temperature to 38.8°C. What will the nurse do in response?

\
* Notify the health care provider.


* Apply a cooling blanket per protocol.
* Administer acetaminophen as prescribed, and recheck temperature in 1 hour.


* Assess for signs and symptoms of infection related to the surgical wound.

\

c

#### A patient questions the use of epinephrine for repair of a laceration, stating, “I thought that was the drug used in the emergency department for someone whose heart is bad.” Which of the following is the best explanation the nurse can provide in response?

\
* Epinephrine is used with lidocaine to prevent adverse effects.


* Epinephrine is metabolized more quickly than lidocaine, so the anaesthetic effect wears off more quickly after the laceration is sutured.


* Vasoconstriction caused by epinephrine enhances the duration of action of lidocaine and minimizes bleeding at the laceration site.


* The systemic absorption of lidocaine is maximized by the epinephrine, and the anaesthetic effect is reached more quickly.

\

a

#### A mechanically ventilated patient receiving a neuromuscular blocking drug has tearing in the eyes and increased heart rate and blood pressure. How does the nurse interpret this clinical finding?

\
* The patient’s level of sedation is inadequate.

\


* The patient is having an adverse reaction to the medication.

\


* The patient’s response to the drug is appropriate.

\


* The patient’s dose of the neuromuscular-blocking drug is insufficient.

#### While the nurse is taking a patient’s history before surgery for a cardiac problem, the patient says, “I am addicted to cocaine.” The nurse notifies the anaesthesiologist of this finding because use of cocaine can cause which effect when a patient is under anaesthesia?

\
* Immediate withdrawal symptoms


* Complications during recovery


* Blood-clotting problems


* Anaesthesia-induced complications

\

d

d

The prescriber has requested “lidocaine with epinephrine”. The nurse recognizes that the most accurate rationale for adding epinephrine is that it:

a) Helps calm the patient before the procedure

b)Minimizes the risk on an allergic reaction

c) Enhances the effect of local lidocaine

d) Reduces bleeding in the surgical area

a

The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from the general anesthesia?

\
a) 79 year old woman about to have her gallbladder removed

b) 49-year-old male athlete who quit heavy smoking 12 years ago

c) 30-year-old woman who is in perfect health but has never had anaesthesia

d) A 50-year-old woman scheduled for outpatient laser eye surgery

d

Which nursing diagnosis is possible for a patient who is now recovering after having been under general anesthesia for 3-4 hours during surgery?

\
a) reduced urinary elimination resulting from the use of vasopressors as anesthetics

b) Increased cardiac output resulting from the effects of general anesthesia

c) Potential for falls resulting from decreased sensorium for 2-4 days postoperatively

d) Reduced gas exchange due to the CNS-depressant effect of general anaesthesia

a

A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse’s response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype?

\
* morphine
* oxycodone
* codeine
* fentanyl

c

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication?

\
* morphine sulphate (MS Contin®)
* meperidine hydrochloride (Demerol®)
* methadone hydrochloride (Metadol®)
* naloxone hydrochloride

a

While admitting a patient for treatment of an acetaminophen (Tylenol®) overdose, the nurse prepares to administer which medication to prevent toxicity?

\
* acetylcysteine
* phytonadione (vitamin K)
* naloxone hydrochloride
* ibuprofen

d

A patient prescribed massage therapy for musculoskeletal pain asks the nurse, “How is rubbing my muscles going to make the pain go away?” What is the nurse’s best response?

\
* “Massaging muscles activates small sensory nerve fibres that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.”
* “Massaging muscles helps relax the contracted fibres and decrease painful stimuli.”
* “Massaging muscles decreases the inflammatory response that initiates the painful stimuli.”
* “Massaging muscles activates large sensory nerve fibres that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.”

a

When assessing for the most serious adverse effect of an opioid analgesic, what does the nurse monitor for?

\
* Respiratory rate
* Blood pressure
* Heart rate
* Mental status

b

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

* methylprednisolone (Solu-Medrol®)
* naloxone hydrochloride
* flumazenil
* acetylcysteine

a

A patient with a diagnosis of pneumonia asks the nurse, “Why am I receiving codeine when I have no pain?” The nurse’s response is based on knowledge that codeine sulphate also does or has the effect of which of the following?

\
* A cough suppressant
* Increases sputum production
* A bronchodilator
* An expectorant

a

In monitoring a patient for adverse effects related to morphine sulphate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system?

\
* The chemoreceptor trigger zone
* The cough reflex center
* Sympathetic baroreceptors
* Autonomic control over circulation

a

The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform?

\
* Withhold the medication and notify the health care provider.
* Check the pulse oximeter reading and re-evaluate respiratory rate in 1 hour.
* Administer a smaller dose and document it in the patient’s record.
* Administer the next prescribed dose intramuscularly.

c

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

\
* taking the medication on an empty stomach.
* eating foods high in lactobacilli.
* increasing fluid and fibre in the diet.
* taking Lomotil® with each dose.

a

A patient is prescribed an opioid analgesic for chronic pain. Which should the nurse tell the patient to do to minimize the GI adverse effects?

\
* Increase fluid intake and fibre in the diet.
* Avoid eating foods high in lactobacilli.
* Take diphenoxylate–atropine (Lomotil) with each dose.
* Take the medication on an empty stomach.

b

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

\
* Every 12 hours
* Every 72 hours
* When pain recurs
* Every 24 hours

d

The nurse plans pharmacological management for a patient with pain. The nurse should administer the pain medication on the basis of which of the following?

\
* The analgesic should be administered when the pain level reaches a 6 on a scale of 1 to 10.
* Analgesics should be administered as needed (prn) to minimize adverse effects.
* To prevent drug addiction, opioid analgesics should not be used for more than 24 hours.
* Pain relief is best obtained by administering analgesics around the clock.

c

In developing a plan of care for a patient receiving morphine sulphate (MS Contin), which nursing diagnosis has the highest priority?

\
* Constipation related to decreased GI motility
* Acute pain related to metastatic tumour cancer
* Impaired gas exchange related to respiratory depression
* Risk for injury related to central nervous system adverse effects

c

A patient is admitted to hospital with a diagnosis of benzodiazepine overdose. The nurse anticipates that the health care provider will prescribe which antidote for benzodiazepine overdose?

* naloxone
* naltrexone
* flumazenil
* nalmefene

a

An older adult patient who is prescribed a benzodiazepine for treatment of insomnia should be monitored for which potential adverse effect?

\
* Unsteady gait
* Red rash
* Shortness of breath
* Muscle spasms

d

Which nursing diagnosis is appropriate for a patient who has just been administered a sedative–hypnotic drug?

\
* Deficient knowledge
* Risk for infection
* Imbalanced nutrition
* Risk for injury and falls

b

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed?

\
* Naloxone
* Charcoal (activated charcoal)
* Ipecac (syrup)
* Flumazenil

a

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

\
* “Most drugs produce sedation at low doses and produce sleep, the hypnotic effect, at higher doses.”
* “Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
* “There really is no difference; the terms are used interchangeably.”
* “Whereas sedative drugs induce sleep, hypnotic drugs induce a state of hypnosis.”

d

The health care provider prescribes dantrolene (Dantrium®) to a patient immediately after surgery. What condition does the nurse expect the patient to have experienced?

\
* Delirium tremens
* Tonic-clonic seizure
* Respiratory arrest
* Malignant hyperthermia

b

An intravenous dose of midazolam has been prescribed for a patient before a colonoscopy. The nurse informs the patient that one of the most common adverse effects of this medication is which of the following?

* Chest pain
* Amnesia
* Dry mouth
* Constipation

a

The nurse explains to a patient that using caffeine may exacerbate which health condition?

\
* Cardiac dysrhythmias
* Heart block
* Myelin degeneration
* Constipation

b

#### A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants?

\
* CNS stimulants activate cyclic adenosine monophosphate.

\


* CNS stimulants increase the release of neurotransmitters and block reuptake of neurotransmitters.

\
* CNS stimulants decrease the production of excitatory neurotransmitters.

\


* CNS stimulants block or reduce the activity of inhibitory neurons.

\

b

While completing discharge teaching for a patient who is prescribed an antiepileptic drug, what must the nurse tell the patient will occur if the medication is suddenly withdrawn?

\
* Confusion and delirium
* Rebound seizure activity
* Orthostatic hypotension
* Acute withdrawal syndrome