Liley's Pharmacology for Canadian Health Care Practice 4th edition

In which step of the nursing process does the nurse determine the outcome of medication administration?

a. Planning

b. Assessment

c. Evaluation

d. Implementation

c. Evaluation

The nurse plans care for a male patient who is 80 years of age. The nursing diagnosis is nonadherence with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next?

a. Assess the impact of home self-management of medications.

b. Collaborate with the health care provider on a new medication regimen.

c. Enlist the help of a home care nurse for pharmacotherapy.

d. Examine the results of nursing help with the medications.

c. Enlist the help of a home care nurse for pharmacotherapy.

Which statement is an example of objective data? (Select all that apply.)

a. The patient says that she has felt tired for almost a week.

b. The patient says that she feels like someone is touching her arm.

c. The patient has had a fever for 5 days.

d. The patient has clear urine.

e. The patient states that she has a headache.

c. The patient has had a fever for 5 days.

d. The patient has clear urine.

What should the nurse check when reviewing a prescription with a patient? (Select all that apply.)

a. The patient's emergency contact

b. The patient's home address

c. The route of administration

d. The age of the patient

e. The signature of the prescriber

c. The route of administration

e. The signature of the prescriber

What information should the nurse chart when documenting medication administration? (Select all that apply.)

a. The dosage of medication administered

b. The time of administration

c. Information about an "incident report" in the patient's chart

d. The patient's age

e. The route of administration

a. The dosage of medication administered

b. The time of administration

e. The route of administration

What is the study of physiochemical properties of drugs and how drugs influence the body called?

a. Pharmacology

b. Pharmacodynamics

c. Pharmacokinetics

d. Pharmacotherapeutics

b. Pharmacodynamics

Which statement best describes pharmacokinetics?

a. Adverse effects and toxic reactions to medications

b. Conversion of medication into its active chemical substance

c. What the body does to the drug after it is administered

d. Physiologic interaction between a drug and body cells

c. What the body does to the drug after it is administered

What is another term for biotransformation of a drug?

a. Metabolism

b. Absorption

c. Excretion

d. Dilution

a. Metabolism

A drug given by which route is altered by the first-pass effect?

a. Oral

b. Sublingual

c. Intravenous (IV)

d. Subcutaneous

a. Oral

Which nursing action will increase the absorption of a medication administered intramuscularly?

a. Massaging the site after injection.

b. Lowering the extremity below the level of the heart.

c. Applying ice packs to the injection site.

d. Administering the medication via the Z-track method.

a. Massaging the site after injection.

When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect?

a. A short duration of medication action

b. Immediate improvement in the patient's condition

c. Increase in the risk of drug-drug interactions

d. Hypovolemic shock caused by a low albumin level

c. Increase in the risk of drug-drug interactions

To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?

a. Intravenous (IV)

b. Subcutaneous (SC)

c. Intramuscular (IM)

d. Intrathecally

a. Intravenous (IV)

Patients with renal failure would most likely have problems with which pharmacokinetic process?

a. Excretion

b. Absorption

c. Distribution

d. Metabolism

a. Excretion

What is the ratio between a drug's therapeutic effects and toxic effects called?

a. Therapeutic index

b. Cumulative effect

c. Tolerance

d. Affinity

a. Therapeutic index

A patient asks the nurse why the dose of IV pain medication being given is lower than that of the patient's previous oral medication. What is the nurse's best response to the patient?

a. "Medications given intravenously are not affected by the first-pass effect."

b. "Medications given orally bypass the portal circulatory system."

c. "Drugs administered intravenously enter the portal system before systemic distribution."

d. "Drugs administered intravenously enter the portal system before systemic distribution."

e. "Drugs administered intravenously enter the portal system before systemic distribution."

a. "Medications given intravenously are not affected by the first-pass effect."

The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.)

a. Making the cell perform a new function

b. Interacting with receptors

c. Inhibiting the action of a specific enzyme

d. Altering metabolic chemical processes

b. Interacting with receptors

c. Inhibiting the action of a specific enzyme

d. Altering metabolic chemical processes

The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.)

a. pH of the stomach

b. Form of drug preparation

c. Patient in high Fowler's position

d. Time of day

e. Presence of food in the stomach

a. pH of the stomach

b. Form of drug preparation

d. Time of day

e. Presence of food in the stomach

Drug's half-life is defined as the amount of time required for 50% of a drug to

a. be absorbed by the body.

b. reach a therapeutic level.

c. exert a response.

d. be eliminated by the body.

d. be eliminated by the body.

What is the nurse's role in the development of new and investigational drugs?

a. To identify patients who receive a placebo drug during Phase III studies

b. To inform patients of the specific drug they will receive during phase II studies

c. To monitor and report any adverse effects observed during Phase IV studies

d. To select healthy older adult patients to participate in Phase I studies

c. To monitor and report any adverse effects observed during Phase IV studies

It is the professional responsibility of the nurse to do which of the following?

a. Use beneficence (the duty to do no harm to the patient).

b. Transfer the care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.

c. Impose personal values on the patient when doing so would help the patient.

d. Withhold information from the patient as requested by the family.

b. Transfer the care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.

Which of the following, in respect to the patient's cultural practices, must the nurse keep in mind when providing drug therapy and other health practices?

a. Dietary habits and practices can be of little value to the care of a sick adult.

b. Most cultures are fairly standard in regard to the use of medication during illness.

c. The use of some drugs elicits varied responses depending on the patient's cultural practice.

d. Regardless of the patient's cultural background, it is crucial to adhere to recommended medical practices.

c. The use of some drugs elicits varied responses depending on the patient's cultural practice.

New drugs must go through extensive research and testing before approval for use in humans. The nurse knows that the average length of time a medication is researched before being prescribed for humans is how many years?

a. 2 to 4

b. 10 to 12

c. 14 to 16

d. 6 to 8

b. 10 to 12

What federal law governs the collection, use, and disclosure of personal information?

a. Personal Health Information Protection Act

b. Personal Information Protection and Electronic Documents Act

c. Privacy and Confidentiality Act

d. Personal Health Information Access and Protection of Privacy Act

b. Personal Information Protection and Electronic Documents Act

There are multiple factors that the nurse must be respectful of and unrestricted by when providing care. Which factors must the nurse consider? (Select all that apply.)

a. Age

b. Sexual orientation

c. Disability

d. Colour

e. Social status

f. Culture

g. Politics

a. Age

b. Sexual orientation

c. Disability

e. Social status

f. Culture

g. Politics

A pharmaceutical company is voluntarily conducting a postmarketing study to obtain further proof of the therapeutic effects of a new drug. What phase of drug study is this considered to be?

a. Phase III

b. Phase I

c. Phase II

d. Phase IV

d. Phase IV

The nurse is teaching a pregnant patient about the effects of medication on fetal development. The nurse understands that the greatest risk for medication effects on the developing fetus occurs during which time period?

a. First trimester

b. Third trimester

c. Birthing process

d. Second trimester

a. First trimester

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates the health care provider to perform which action to minimize the risk of toxicity?

a. Increase the amount of drug given

b. Decrease the amount of drug given

c. Shorten the time interval between doses

d. Administer the medication intravenously

b. Decrease the amount of drug given

The physiological changes that normally occur in older adult patients have which implication for drug response?

a. Drug elimination is faster.

b. Drug half-life is lengthened.

c. Protein binding is more efficient.

d. Drug metabolism is quicker.

b. Drug half-life is lengthened.

While the nurse is taking a health history for an older adult patient with heart failure, the patient tells the nurse, "I have chronic constipation." The nurse suspects this gastrointestinal condition is caused by which class of drugs?

a. Anticoagulants

b. Calcium channel blockers

c. Nonsteroidal anti-inflammatory drugs

d. Potassium-sparing diuretics

b. Calcium channel blockers

A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority in relation to polypharmacy?

a. Nonadherence to drug regimen

b. Drug interactions

c. Schedule of medications

d. Cost of medications

b. Drug interactions

A hospital nurse is assessing a newly admitted patient's culture and ethnicity. Which of the following concepts is important for the nurse to understand regarding drug therapy as it relates to an individual's race?

a. Polymorphism

b. Pharmacodynamics

c. Polypharmacy

d. Pharmacokinetics

a. Polymorphism

An emergency department nurse is documenting the medication history of a patient. The patient states, "I am not taking any medications," but the nurse observes a bottle of capsules in the patient's medicine bag. What information should the nurse seek next?

a. The patient's use of herbal remedies or over-the-counter medications

b. The patient's past use of medicine and home remedies

c. The patient's vital signs and pulse oximetry

d. The health care provider's name

a. The patient's use of herbal remedies or over-the-counter medications

When the nurse is calculating pediatric dosages, which of the following methods does the nurse know is most accurate?

a. Increasing calculated doses based on body weight by 10% because of immature renal and hepatic function

b. Using of drug reference recommendations based on mg/kg of body weight

c. Calculating medication dosing according to body weight because this method is based on maturational growth and development

d. Calculating dosage by body surface area because this method takes into account the difference in size for children and neonates

d. Calculating dosage by body surface area because this method takes into account the difference in size for children and neonates

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which of the following factors?

a. Maternal blood type

b. Diet of the mother

c. Fetal sex

d. Drug properties

d. Drug properties

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question?

a. "Only certain medications pass to infants while breastfeeding."

b. "You should not take any medication while breastfeeding."

c. "I will leave the health care provider a message to return your call."

d. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

d. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

The nurse educator is preparing an in-service education course to teach the nursing staff about deoxyribonucleic acid (DNA) and genetic inheritance. During the teaching session, the nurse educator will explain that DNA is the primary molecule in the body that serves to transfer genes from parents to offspring and that it has four different organic bases. Which of the following is not one of the four organic bases of DNA?

a. Cytosine (C)

b. Guanine (G)

c. Adenine (A)

d. Uracil (U)

d. Uracil (U)

Nurses working in a general practice setting will need to have a basic understanding of the role of the nurse in genetics. What is the responsibility of the nurse to do in relation to genetics? (Select all that apply.)

a. Explain the genetic test results.

b. Obtain a personal and family history.

c. Explain that genetic testing information is not kept confidential.

d. Conduct initial and second counselling sessions for the patient.

e. Ask the patient and members of the patient's family about any unusual reactions to drugs.

b. Obtain a personal and family history.

e. Ask the patient and members of the patient's family about any unusual reactions to drugs.

When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?

a. Ask the patient to provide a written list of all medications being taken at home.

b. Ask the patient or family to bring in all medications the patient was taking at home.

c. Call the primary care physician to verify current medications.

d. Ask the patient's family to verify medications the patient was taking at home.

b. Ask the patient or family to bring in all medications the patient was taking at home.

Why are specific medications identified as "high-alert" medications?

a. These medications are responsible for adverse drug events.

b. Registered nurses must administer these medications.

c. These drugs have increased potential for significant patient harm.

d. States require that these drugs be on the high-alert list.

c. These drugs have increased potential for significant patient harm.

In which step of the medication process can a medication error occur? (Select all that apply.)

a. Administration

b. Transcribing

c. Prescribing

d. Procurement

e. Verification

a. Administration

b. Transcribing

c. Prescribing

d. Procurement

The nurse knows that the medication reconciliation process involves which three steps? (Select all that apply.)

a. Clarification

b. Verification

c. Reconciliation

d. Reporting

e. Administration

a. Clarification

b. Verification

c. Reconciliation

The nurse administers a medication to the wrong patient. What nursing actions are required following this error? (Select all that apply.)

a. Document the medication error. No further action is required.

b. Notify the health care provider, and document the error on an incident report.

c. Assess the patient for an adverse reaction and report any adverse event that occurs.

d. Document the medical error by providing only factual information and corrective actions taken.

b. Notify the health care provider, and document the error on an incident report.

c. Assess the patient for an adverse reaction and report any adverse event that occurs.

d. Document the medical error by providing only factual information and corrective actions taken.

A patient is transferred from an Critical Care Unit (CCU) to a general medical unit. Which nursing action is the most appropriate to prevent a medication error?

a. Communicate a verbal report face-to-face from the transferring nurse.

b. Ask the patient what medications need to be taken while in hospital.

c. Contact the health care provider to rewrite all medication prescriptions.

d. Perform a medication reconciliation for the patient during care transition.

d. Perform a medication reconciliation for the patient during care transition.

Which action helps the nurse to prevent a medication error?

a. Administering any medications that the patient had on admission or transfer

b. Asking the patient what condition the medication is for before administering

c. Using the patient's own supply of medications to administer to the patient while the patient is in hospital.

d. Encouraging the patient to ask questions if the medication is different than expected

d. Encouraging the patient to ask questions if the medication is different than expected

What organization(s) in Canada suggested the use of bar codes for labelling pharmaceutical medications? (Select all that apply.)

a. World Health Organization (WHO)

b. Canadian Patient Safety Institute (CPSI)

c. Health Canada

d. Institute for Safe Medication Practices Canada (ISMP)

d. Institute for Safe Medication Practices Canada (ISMP)

Which statement best supports the nursing diagnosis of "Deficient knowledge related to medication therapy"?

a. Patient is not reporting adverse effects as directed.

b. Patient is unable to verbalize reason for taking the medication.

c. Patient is not taking medication as directed.

d. Patient is unwilling to comply with medication therapy.

b. Patient is unable to verbalize reason for taking the medication.

The nurse is educating a patient with newly diagnosed type 1 diabetes mellitus. When the nurse has the patient demonstrate self-injection of insulin, which domain of learning is the nurse assessing?

a. Psychomotor domain

b. Physical domain

c. Cognitive domain

d. Affective domain

a. Psychomotor domain

What phase of the nursing process provides a framework for the nurse to provide the patient and the patient's family education about a new medication?

a. Evaluation

b. Assessment

c. Implementation

d. Planning

b. Assessment

What is the most appropriate time for the nurse to begin the patient's education and the teaching-learning process?

a. Upon the patient's admission to the health care setting

b. At the time discharge planning is begun

c. After the medical diagnosis is established

d. When there are written prescriptions for teaching

a. Upon the patient's admission to the health care setting

The nurse is providing discharge teaching to an older patient with short-term memory problems. Which will the nurse do in educating the patient? (Select all that apply.)

a. Provide written instructions for home use.

b. Instruct the patient to take all medications in the morning.

c. Repeat information frequently.

d. Encourage the use of daily medication containers with alarms.

e. Perform several short teaching-learning sessions.

a. Provide written instructions for home use.

c. Repeat information frequently.

d. Encourage the use of daily medication containers with alarms.

e. Perform several short teaching-learning sessions.

When planning care for an assigned patient, the nurse identifies the outcome "Patient will be able to safely self-administer enoxaparin (Lovenox®) subcutaneously upon discharge." Which method is best for the nurse to use in evaluating the patient's achievement of this outcome?

a. Asking the patient to verbalize the correct administration procedure, step by step.

b. Demonstrating the correct administration procedure to the patient

c. Giving the patient detailed written instructions for the procedure

d. Observing the patient's return demonstration of the administration procedure

d. Observing the patient's return demonstration of the administration procedure

How does the nurse best evaluate the patient's understanding of a new medication?

a. Observe the patient taking the medication.

b. Document the education session and the most used teaching strategy.

c. Assess the patient for response to the medication.

d. Ask specific questions to assess the patient's understanding.

d. Ask specific questions to assess the patient's understanding.

What information should the nurse provide a patient wanting to take herbal medicines?

a. Herbal medicines are safe to use as long as they is taken daily and continuously.

b. Herbal medicines are not standardized, and components vary between producers.

c. Herbal medicines must be taken with water and clear fluids to ensure safety.

d. Caffeinated and alcohol beverages should be avoided with all herbal medicines.

b. Herbal medicines are not standardized, and components vary between producers.

A patient with atrial fibrillation requests a cup of chamomile tea. The nurse denies the patient's request because of the medication the patient is taking. What is the medication?

a. Cardiac glycoside

b. Calcium channel blocker

c. Anticoagulant

d. β-Adrenergic blocker

c. Anticoagulant

A male patient who misuses alcohol tells the nurse that he is treating himself with kava. Which of the following instructions should the nurse include in patient teaching?

a. Use another herb besides kava.

b. Stop taking the kava now.

c. Use either the kava or the alcohol.

d. Avoid using the kava with alcohol.

b. Stop taking the kava now.

A patient who takes ginseng to improve memory takes many prescription medications as well. To assess the pharmacokinetic effect of ginseng in this patient, which laboratory parameter should the nurse check before administering medication?

a. Serum creatinine

b. Liver enzymes

c. Urine bilirubin

d. Mental status

b. Liver enzymes

A concern among the older adult population is polypharmacy. What is the rationale for the avoidance of cranberry-based beverages by this population?

a. It decreases the circulating inactive drugs

b. It decreases the elimination of drugs excreted by the kidneys

c. It reduces the capacity for liver enzyme to filter drug molecules

d. It enhances the elimination of sodium by the kidneys

b. It decreases the elimination of drugs excreted by the kidneys

Which descriptions apply to the market for natural health products (NHPs) in Canada? (Select all that apply.)

a. NHPs are used by less than 40% of the population.

b. The number of users is growing.

c. Consumers use NHPs to prevent diseases.

d. NHPs are used with conventional pharmaceutical therapies.

e. Increasingly, the use of NHPs is the sole method for treating major illnesses.

b. The number of users is growing.

c. Consumers use NHPs to prevent diseases.

d. NHPs are used with conventional pharmaceutical therapies.

Which entity regulates over-the-counter (OTC) medications?

a. World Health Organization (WHO)

b. Ministry of Health and Long-Term Care

c. Canadian Medical Association (CMA)

d. Health Canada

d. Health Canada

When administering intravenous magnesium sulphate, the nurse will monitor for which signs and symptoms of hypermagnesemia?

a. Hyperthermia

b. Excessive perspiration or sweating

c. Decrease in deep tendon reflexes

d. Tachycardia

c. Decrease in deep tendon reflexes

Cyanocobalamin (vitamin B12) is indicated for the treatment of which condition?

a. Pernicious anemia

b. Optic nerve atrophy

c. Acute lymphocytic leukemia

d. Bone marrow suppression

a. Pernicious anemia

Patient teaching regarding the administration of vitamin C would include monitoring for which signs or symptoms that may indicate vitamin C toxicity?

a. Nausea and abdominal cramping

b. Focal or generalized seizures

c. Lightheadedness and dizziness

d. Easy bleeding, bruising, or both

a. Nausea and abdominal cramping

A client receiving vitamin K most likely has which of the following abnormal clinical findings?

a. Diarrhea

b. Sudden severe confusion

c. Altered coagulation studies

d. Seizure activity

c. Altered coagulation studies

The nurse would question a health care provider's prescription for vitamin D for a patient with which condition?

a. Chronic renal failure

b. Hyperparathyroidism

c. Graves' disease

d. Hypothyroidism

b. Hyperparathyroidism

The nurse is educating a patient on vitamin supplementation. The patient states, "I take a lot of vitamins every day to stay healthy." Based on a knowledge and understanding of vitamin supplements, what is the nurse's best response?

a. "Keep taking these vitamin pills, because they are essential to any diet."

b. "That's good. You do not want to get sick from nutrient deficiencies."

c. "Can you tell me what vitamins you take and how many and how often?"

d. "You need to make certain that is okay with your health care provider."

c. "Can you tell me what vitamins you take and how many and how often?"

Which mineral is essential for energy metabolism but may also be used in higher doses to treat certain seizures and pre-eclampsia?

a. Phosphorus

b. Calcium

c. Magnesium

d. Zinc

c. Magnesium

What vitamin can be synthesized by the skin when skin is exposed to sunlight but can also be supplemented as needed?

a. Vitamin D

b. Vitamin B complex

c. Vitamin K

d. Vitamin C

a. Vitamin D

What vitamins are most likely to lead to toxic levels (hypervitaminosis) when administered in megadoses? (Select all that apply.)

a. Vitamin D

b. Vitamin B complex

c. Vitamin K

d. Vitamin A

e. Vitamin C

a. Vitamin D

c. Vitamin K

d. Vitamin A

In which of the following cases will the nurse use a Z-track technique when giving an intramuscular (IM) injection?

a. When massaging the area after medication administration is contraindicated

b. With medications that are known to be irritating, painful, or staining to tissues

c. When there is insufficient muscle mass in the landmarked area

d. With any injection that is given into the ventrogluteal muscle

b. With medications that are known to be irritating, painful, or staining to tissues

A nursing student is planning to administer a medication intramuscularly into the dorsogluteal region. As a preceptor, what is your best description of where she should inject the medication?

a. A hand-breadth below the greater trochanter and the sacroiliac joint

b. As the dorsogluteal region is no longer recommended for injection, a different site should be selected.

c. Below the iliac spine and between the greater trochanter and the iliac crest

d. A "V" formation between the anterior superior iliac spine and the greater trochanter

b. As the dorsogluteal region is no longer recommended for injection, a different site should be selected.

Which nursing intervention is most appropriate when crushing oral medications to administer to a patient with dysphagia?

a. Crush only enteric-coated medication.

b. Crush and administer each medication separately.

c. Open sustained-release capsules before crushing them.

d. Mix medications together for ease of administration.

b. Crush and administer each medication separately.

When administering ophthalmic eye drops, the nurse will

a. drop the prescribed number of drops into the conjunctival sac.

b. hold the eyedropper 4 to 5 cm above the eye to avoid contamination.

c. place the eye drops directly on the cornea.

d. document that a smaller dose was absorbed if the patient blinked during administration.

a. drop the prescribed number of drops into the conjunctival sac.

The nurse is preparing to administer an IM medication by using an airlock to prevent leakage of the medication into the subcutaneous space. What amount of air should the nurse withdraw for the air lock?

a. 0.05 mL

b. 0.5 mL

c. 0.2 mL

d. 0.1 mL

c. 0.2 mL

How many patient identifiers will the nurse check before administering a medication to a patient?

a. One

b. Two

c. Three

d. Four

b. Two

Which of the following will the nurse do when administering a medication subcutaneously?

a. Use a 25-gauge, 25- to 30-mm needle.

b. Aspirate with heparin and insulin injections.

c. Use the landmark between the greater trochanter and superior iliac crest for the vastus lateralis site.

d. Insert the needle at a 45- or 90-degree angle, depending on the patient's size, to penetrate subcutaneous tissue.

d. Insert the needle at a 45- or 90-degree angle, depending on the patient's size, to penetrate subcutaneous tissue.

When administering a sublingual medication, which of the following will the nurse do?

a. Ask the patient to chew the medication so that it will be absorbed faster.

b. Have the patient swallow several times while the tablet dissolves.

c. Instruct the patient to drink room-temperature water to enhance dissolution.

d. Wear gloves when placing the tablet under the patient's tongue.

d. Wear gloves when placing the tablet under the patient's tongue.

In which position is it best for the nurse to place a patient when administering medications via a nasogastric (NG) tube?

a. On the left side

b. Supine

c. Trendelenburg position

d. Fowler's position

d. Fowler's position

When planning to administer an intradermal medication, the nurse knows that which location is the preferred site of injection on the forearm?

a. Just above the wrist

b. Two to four finger-widths above the wrist

c. Just below the antecubital space

d. Three to four finger-widths below the antecubital space

d. Three to four finger-widths below the antecubital space

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?

a. morphine

b. oxycodone

c. codeine

d. fentanyl

a. morphine

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

a. morphine sulphate (MS Contin®)

b. meperidine hydrochloride (Demerol®)

c. methadone hydrochloride (Metadol®)

d. naloxone hydrochloride

c. methadone hydrochloride (Metadol®)

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

a. acetylcysteine

b. phytonadione (vitamin K)

c. naloxone hydrochloride

d. ibuprofen

a. acetylcysteine

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

a. Respiratory rate

b. Blood pressure

c. Heart rate

d. Mental status

a. Respiratory rate

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

a. methylprednisolone (Solu-Medrol®)

b. naloxone hydrochloride

c. flumazenil

d. acetylcysteine

b. naloxone hydrochloride

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?

a. The chemoreceptor trigger zone

b. The cough reflex center

c. Sympathetic baroreceptors

d. Autonomic control over circulation

a. The chemoreceptor trigger zone

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?

a. Withhold the medication and notify the health care provider.

b. Check the pulse oximeter reading and re-evaluate respiratory rate in 1 hour.

c. Administer a smaller dose and document it in the patient's record.

d. Administer the next prescribed dose intramuscularly.

a. Withhold the medication and notify the health care provider.

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

a. taking the medication on an empty stomach.

b. eating foods high in lactobacilli.

c. increasing fluid and fibre in the diet.

d. taking Lomotil® with each dose.

c. increasing fluid and fibre in the diet.

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?

a. Increase fluid intake and fibre in the diet.

b. Avoid eating foods high in lactobacilli.

c. Take diphenoxylate-atropine (Lomotil) with each dose.

d. Take the medication on an empty stomach.

a. Increase fluid intake and fibre in the diet.

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

a. Every 12 hours

b. Every 72 hours

c. When pain recurs

d. Every 24 hours

b. Every 72 hours

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

a. Constipation related to decreased GI motility

b. Acute pain related to metastatic tumour cancer

c. Impaired gas exchange related to respiratory depression

d. Risk for injury related to central nervous system adverse effects

c. Impaired gas exchange related to respiratory depression

When assessing a patient for adverse effects related to morphine sulphate (MS Contin), which clinical finding is the nurse most likely to observe? (Select all that apply.)

a. Excessive bruising

b. Constipation

c. Weight gain

d. Inability to void

e. Diarrhea

b. Constipation

d. Inability to void

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?

a. "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."

b. "Massaging muscles helps relax the contracted fibres and decrease painful stimuli."

c. "Massaging muscles decreases the inflammatory response that initiates the painful stimuli."

d. "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."

d. "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."

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?

a. The analgesic should be administered when the pain level reaches a 6 on a scale of 1 to 10.

b. Analgesics should be administered as needed (prn) to minimize adverse effects.

c. To prevent drug addiction, opioid analgesics should not be used for more than 24 hours.

d. Pain relief is best obtained by administering analgesics around the clock.

d. Pain relief is best obtained by administering analgesics around the clock.

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

a. It produces muscle relaxation and loss of consciousness.

b. It provides moderate sedation that allows the patient to relax.

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

d. It uses only one type of medication to produce sedation.

a. It produces muscle relaxation and loss of consciousness.

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?

a. "I understand your concern, but intermittent vomiting often occurs after surgery."

b. "Don't worry, because you'll be heavily or completely sedated if that occurs."

c. "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anaesthesia."

d. "You will need to notify the charge nurse and health care provider if you feel nauseated after surgery."

c. "Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anaesthesia."

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?

a. propofol (Diprivan®)

b. halothane

c. isoflurane (Forane®)

d. nitrous oxide ("laughing gas")

a. propofol (Diprivan®)

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

a. Place the patient into a semi-Fowler's position.

b. Monitor input and output closely.

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

d. Provide a quiet, calm environment.

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

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

a. Notify the health care provider.

b. Apply a cooling blanket per protocol.

c. Administer acetaminophen as prescribed, and recheck temperature in 1 hour.

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

a. Notify the health care provider.

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?

a. Epinephrine is used with lidocaine to prevent adverse effects.

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

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

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

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

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?

a. The patient's level of sedation is inadequate.

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

c. The patient's response to the drug is appropriate.

d. The patient's dose of the neuromuscular-blocking drug is insufficient.

a. The patient's level of sedation is inadequate.

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?

a. Immediate withdrawal symptoms

b. Complications during recovery

c. Blood-clotting problems

d. Anaesthesia-induced complications

d. Anaesthesia-induced complications