Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 68-year-old patient with a history of hypertension and mild
cognitive impairment is scheduled for a total knee arthroplasty.
The anesthesia provider plans to use propofol for induction and
maintenance of general anesthesia.
Question Stem:
The nurse is preparing to assist with the administration of
propofol. Which assessment finding would be of greatest
concern and should be immediately reported to the anesthesia
provider?
Answer Options:
A. Serum potassium of 4.2 mEq/L
B. Blood pressure of 142/88 mmHg
C. Serum triglyceride level of 350 mg/dL
D. Hemoglobin of 12.8 g/dL
Correct Answer: C. Serum triglyceride level of 350 mg/dL
Comprehensive Rationale:
Propofol is formulated as a lipid emulsion containing soybean
oil, egg lecithin, and glycerol. Patients with elevated triglyceride
levels are at risk for hyperlipidemia and pancreatitis when
,receiving propofol, particularly with prolonged infusion. The
lipid emulsion provides approximately 1.1 kcal/mL, which can
significantly increase caloric intake and triglyceride levels. The
manufacturer recommends monitoring serum triglyceride levels
and adjusting the propofol infusion rate or considering
alternative agents if levels exceed 250 mg/dL. This patient's
triglyceride level of 350 mg/dL exceeds safe parameters and
requires notification of the anesthesia provider for possible
alternative anesthetic selection. Additionally, propofol can
cause bradycardia, hypotension, and respiratory depression.
The egg lecithin component poses a potential risk for patients
with egg allergies, though this is not absolute.
Distractor Analysis:
• A. Serum potassium of 4.2 mEq/L: This is within normal
range (3.5-5.0 mEq/L) and does not present a specific
concern with propofol administration.
• B. Blood pressure of 142/88 mmHg: While elevated, this
represents mild hypertension and is not the most critical
finding for propofol administration. Propofol actually
causes vasodilation and may lower blood pressure.
• D. Hemoglobin of 12.8 g/dL: This is slightly below normal
for males but not critically low and does not pose a specific
contraindication to propofol.
, Nursing Process Integration: Assessment - The nurse must
perform a thorough preoperative assessment including
laboratory values, medication history, and allergy status to
identify potential contraindications to anesthetic agents. This
assessment guides the planning and implementation of safe
anesthetic care.
Clinical Judgment Measurement Model (NCJMM): Recognize
Cues; Analyze Cues
Difficulty Level: Moderate
Bloom's Cognitive Level: Analyze
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies; Reduction of Risk Potential
Key Learning Objective: Identify critical laboratory parameters
and patient characteristics that may contraindicate the use of
specific anesthetic agents and require modification of the
anesthetic plan.
Question 2
Item Type: MCQ
Clinical Scenario:
A 45-year-old patient is undergoing surgery under general
anesthesia with sevoflurane. During the procedure, the patient
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 68-year-old patient with a history of hypertension and mild
cognitive impairment is scheduled for a total knee arthroplasty.
The anesthesia provider plans to use propofol for induction and
maintenance of general anesthesia.
Question Stem:
The nurse is preparing to assist with the administration of
propofol. Which assessment finding would be of greatest
concern and should be immediately reported to the anesthesia
provider?
Answer Options:
A. Serum potassium of 4.2 mEq/L
B. Blood pressure of 142/88 mmHg
C. Serum triglyceride level of 350 mg/dL
D. Hemoglobin of 12.8 g/dL
Correct Answer: C. Serum triglyceride level of 350 mg/dL
Comprehensive Rationale:
Propofol is formulated as a lipid emulsion containing soybean
oil, egg lecithin, and glycerol. Patients with elevated triglyceride
levels are at risk for hyperlipidemia and pancreatitis when
,receiving propofol, particularly with prolonged infusion. The
lipid emulsion provides approximately 1.1 kcal/mL, which can
significantly increase caloric intake and triglyceride levels. The
manufacturer recommends monitoring serum triglyceride levels
and adjusting the propofol infusion rate or considering
alternative agents if levels exceed 250 mg/dL. This patient's
triglyceride level of 350 mg/dL exceeds safe parameters and
requires notification of the anesthesia provider for possible
alternative anesthetic selection. Additionally, propofol can
cause bradycardia, hypotension, and respiratory depression.
The egg lecithin component poses a potential risk for patients
with egg allergies, though this is not absolute.
Distractor Analysis:
• A. Serum potassium of 4.2 mEq/L: This is within normal
range (3.5-5.0 mEq/L) and does not present a specific
concern with propofol administration.
• B. Blood pressure of 142/88 mmHg: While elevated, this
represents mild hypertension and is not the most critical
finding for propofol administration. Propofol actually
causes vasodilation and may lower blood pressure.
• D. Hemoglobin of 12.8 g/dL: This is slightly below normal
for males but not critically low and does not pose a specific
contraindication to propofol.
, Nursing Process Integration: Assessment - The nurse must
perform a thorough preoperative assessment including
laboratory values, medication history, and allergy status to
identify potential contraindications to anesthetic agents. This
assessment guides the planning and implementation of safe
anesthetic care.
Clinical Judgment Measurement Model (NCJMM): Recognize
Cues; Analyze Cues
Difficulty Level: Moderate
Bloom's Cognitive Level: Analyze
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies; Reduction of Risk Potential
Key Learning Objective: Identify critical laboratory parameters
and patient characteristics that may contraindicate the use of
specific anesthetic agents and require modification of the
anesthetic plan.
Question 2
Item Type: MCQ
Clinical Scenario:
A 45-year-old patient is undergoing surgery under general
anesthesia with sevoflurane. During the procedure, the patient
