NU 115 Final Exam Part 3 PDF

milk in the future. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child?...

milk in the future. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? a. b. c. Give the injection without any advanced preparation. Give the injection, and then explain the reason for the procedure afterward. Offer a brief, concrete explanation of the procedure at the patient‘s level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present. ANS: C If you need any other Test Banks or eTextbooks contact us: [email protected] For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased and may result in reduced renal function. c. d. e. f. g. First-pass elimination is increased because of higher portal circulation. First-pass elimination is reduced because of the immaturity of the liver. Total body water content is much less than in adults. Gastric emptying is slowed because of slow or irregular peristalsis. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) a. b. c. d. e. f. g. The levels of microsomal enzymes are decreased. Fat content is increased because of decreased lean body mass. Fat content is decreased because of increased lean body mass. The number of intact nephrons is increased. The number of intact nephrons is decreased. Gastric pH is less acidic. Gastric pH is more acidic. ANS: A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance COMPLETION If you need any other Test Banks or eTextbooks contact us: [email protected] 1. A 7-year-old child will be receiving amoxicillin (Amoxil) 50 mg/kg/day in two divided doses. The child weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 125 mg/5 mL. Identify how many milliliters will the child receive per dose. ANS: 25 mL per dose Convert pounds to kilograms: 55 pounds = 25 kg. 25 kg 50 mg/kg/day = 1250 mg/day. To get the amount per dose, divide 1250 by 2, which equals 625 mg/dose. To calculate the milliliters: 125 mg:5 mL:: 625 mg:x mL. (125 x) = (5 625); 125x = 3125; x = 25 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 12: Central Nervous System Depressants and Muscle Relaxants Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam b. Zolpidem c. Phenobarbital d. Cyclobenzaprine ANS: A Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that ―the least little thing‖ bothers him now. Which is the correct explanation for this problem? a. b. c. These are adverse effects that usually subside after a few weeks. The drug must be stopped immediately because of possible adverse effects. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress. ANS: D Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation. Rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. c. d. He drank a glass of wine. He took a dose of aspirin. He developed an allergy to the drug. ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has been taking suvorexant for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels ―so tired.‖ Which explanation by the nurse is correct? a. b. c. d. ―Long-term use of this drug results in a sedative effect.‖ ―If you take the drug every night, this hangover effect will be reduced.‖ ―These drugs affect the sleep cycle, resulting in daytime sleepiness.‖ ―These drugs increase the activity of the central nervous system, making you tired the next day.‖ ANS: C Use of suvorexant result in daytime sleepiness. The other statements are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation A patient is taking flurazepam three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime ANS: A Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist ANS: C There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate. If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. 10. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Ramelteon is prescribed for a patient with insomnia. The nurse checks the patient‘s medical history, knowing that this medication is contraindicated in which disorder? a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia ANS: C contraindications. Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse notes in the patient‘s medication history that the patient is taking cyclobenzaprine. Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation ANS: A Cyclobenzaprine is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital, a barbiturate b. Diazepam, a benzodiazepine c. Midazolam, a benzodiazepine d. Eszopiclone, a nonbenzodiazepine sleep aid ANS: D Eszopiclone is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. ―I will not drink wine with the kava tea.‖ ―If I notice my skin turning yellow, I will stop taking the tea.‖ ―I will not take sleeping pills if I have this tea in the evening.‖ ―I will be able to drive my car after drinking this tea.‖ ANS: D Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: Evaluation MULTIPLE RESPONSE 1. 2. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus ANS: B, D, E Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver or renal disease. The other disorders are not contraindications. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient‘s current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin ANS: A, B, D, E The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin. DIF: Cognitive Level: Understanding (Comprehension) If you need any other Test Banks or eTextbooks contact us: [email protected] TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies COMPLETION 1. A patient is about to receive pentobarbital 100 mg IV as preoperative sedation. The medication is available in a concentration of 50 mg/mL. How many milliliters will the patient receive for this dose? ANS: 2 mL 50 mg:1 mL::100 mg:x mL (50 x) = (1 100); 50x = 100; x = 2 mL. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 10: Analgesic Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain ANS: B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient‘s symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 2. A 16-year-old field hockey player fell and twisted her ankle during a game. The nurse will expect to administer which type of analgesic? a. b. c. d. Synthetic opioid, such as meperidine Opium alkaloid, such as morphine sulfate Opioid antagonist, such as naloxone HCL Nonopioid analgesics, such as indomethacin ANS: D If you need any other Test Banks or eTextbooks contact us: [email protected] 3. 4. Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A patient had abdominal surgery this morning. The patient is groggy but complaining of severe pain around the incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. The patient‘s pulse rate b. The patient‘s respiratory rate c. d. ANS: B The appearance of the incision The date of the patient‘s last bowel movement One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient‘s respiratory rate before administering an opioid. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time? a. b. Assessment of the patient‘s pain level Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance If you need any other Test Banks or eTextbooks contact us: [email protected] 5. 6. ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient‘s level of pain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach ANS: C Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more If you need any other Test Banks or eTextbooks contact us: [email protected] 7. medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome ANS: B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal). DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect. If you need any other Test Banks or eTextbooks contact us: [email protected] 8. 9. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Menstrual cramps c. Joint pain d. Incision pain after surgery ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. Possible adverse effects include muscle stiffness and muscle and joint pain. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is to receive acetylcysteine as part of the treatment for an acetaminophen overdose. Which action by the nurse is appropriate when giving this medication? a. b. c. d. Giving the medication undiluted for full effect Avoiding the use of a straw when giving this medication Disguising the flavor with soda or flavored water Preparing to give this medication via a nebulizer ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 12. 13. Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The drug nalbuphine is an agonist-antagonist (partial agonist). The nurse understands that