NR 293 PHARMACOLOGY COMPREHENSIVE ALL
QUESTIONS AND ANSWERS SURE A+
✔✔What are the contraindications for opiod analgesics? - ✔✔Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
✔✔A patient is recovering from an appendectomy. She also has asthma and allergies to
shellfish and iodine. To manage her postoperative pain, the physician has prescribed
patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of
greatest concern?
Pulse
Blood pressure
Temperature
Respirations - ✔✔Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be receiving a
drug that can depress respirations.
✔✔Adverse effects of Opiod analgesics? - ✔✔CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in CNS.
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
,Constipation - slows peristalsis and increase water absorption from intestinal contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads to
high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and
orthostatic hyper tension
✔✔A patient who has metastasized bone cancer has been on transdermal fentanyl
patches for pain management for 3 months. He has been hospitalized for tests and has
told the nurse that his pain is becoming "unbearable." The nurse is reluctant to give him
the ordered pain medication because the nurse does not want the patient to get
addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly. - ✔✔Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may need
higher and higher doses of analgesics. The nurse is responsible for ensuring that the
patient experiences adequate pain relief.
✔✔Opioid Analgesics:
Toxicity and Management of Overdose - ✔✔Naloxone (Narcan) - bind to all receptor
sites -> competive antagonists ->
binds to these site.
Withdrawal symptoms directly related to half-life of opioid
Naltrexone (ReVia)
Regardless of withdrawal symptoms, when a patient experiences severe respiratory
depression, an opioid antagonist should be given.
✔✔Opioid Analgesics: Interactions - ✔✔Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors
Others
✔✔What are some Nursing implications for Analgesics? - ✔✔Before beginning therapy,
perform a thorough history regarding allergies and use of other medications, including
alcohol, health history, and medical history.
Obtain baseline vital signs and I&O.
Assess for potential contraindications and drug interactions.
,Perform a thorough pain assessment, including pain intensity and character, onset,
location, description, precipitating and relieving factors, type, remedies, and other pain
treatments.
Patients should not take other medications or OTC preparations without checking with
their physicians.
Instruct patients to notify physician about signs of allergic reaction or adverse effects.
✔✔What are some nursing implications for opiod analgesics? - ✔✔Oral forms should be
taken with food to minimize gastric upset.
Ensure safety measures, such as keeping side rails up, to prevent injury.
Withhold dose and contact physician if there is a decline in the patient's condition or if
vital signs are abnormal, especially if respiratory rate is less than 10 to 12 breaths/min.
Check dosages carefully.
Constipation is a common adverse effect and
may be prevented with adequate fluid and
fiber intake.
Patients should be instructed to change positions slowly to prevent possible orthostatic
hypotension.
Respiratory depression may be manifested by respiratory rate of less than 10
breaths/min, dyspnea, diminished breath sounds, or shallow breathing.
✔✔What are anesthetics? - ✔✔Drugs that reduce or eliminate pain by depressing nerve
function in the central nervous system (CNS) and peripheral nervous system
✔✔What are the 3 types of anesthesia? - ✔✔General anesthesia: complete loss of
consciousness and loss of body reflexes, including paralysis of respiratory muscles.
Local anesthesia: no paralysis of respiratory function; elimination of pain sensation in
the tissues innervated by anesthetized nerves
Balanced anesthesia
✔✔The nurse anesthetist is planning to use balanced anesthesia during a surgical
procedure. A characteristic of this type of anesthesia is the
administration of minimal doses of multiple anesthetic drugs.
administration of inhaled anesthetics.
, intravenous (IV) administration of anesthetics.
administration of anesthetics to cause muscle relaxation. - ✔✔Correct answer: A
Rationale: The use of a combination of drugs allows less of each drug to be used and a
more balanced, controlled state of anesthesia to be achieved.
✔✔When assessing a patient under general anesthesia, which change to organ
systems does the nurse expect?
Nystagmus
Skeletal muscle contraction
Hypertension
Decreased intracranial pressure - ✔✔Correct answer: A
Rationale: Nystagmus can occur as a result of the use of general anesthesia. Other
findings include skeletal muscle relaxation, hypotension, and increased intracranial
pressure.
✔✔What are some indications for anesthetic? - ✔✔General anesthetics are used during
surgical procedures to produce:
Unconsciousness
Skeletal muscular relaxation
Visceral smooth muscle relaxation
Also used in electroconvulsive therapy treatments for depression
✔✔What are adverse effects of anesthesia? - ✔✔Vary according to dosage and drug
used
Sites primarily affected
Heart, peripheral circulation, liver, kidneys, respiratory tract
Myocardial depression is commonly seen
Malignant hyperthermia
✔✔DEscribe Malignant hyperthermia - ✔✔Occurs during or after volatile inhaled
general anesthesia or use of the neuromuscular blocking drug (NMBD) succinylcholine
Sudden elevation in body temperature (greater than 104° F)
Tachypnea, tachycardia, muscle rigidity
Life-threatening emergency
Treated with cardiorespiratory supportive care and dantrolene (skeletal muscle relaxant)
QUESTIONS AND ANSWERS SURE A+
✔✔What are the contraindications for opiod analgesics? - ✔✔Known drug allergy
Severe asthma
Use with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
✔✔A patient is recovering from an appendectomy. She also has asthma and allergies to
shellfish and iodine. To manage her postoperative pain, the physician has prescribed
patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of
greatest concern?
Pulse
Blood pressure
Temperature
Respirations - ✔✔Correct answer: D
Rationale: This patient has a history of asthma and allergies, and she will be receiving a
drug that can depress respirations.
✔✔Adverse effects of Opiod analgesics? - ✔✔CNS depression
Leads to respiratory depression
Most serious adverse effect
Nausea and vomiting - irritation of GI tract stimulates chemoreceptors zone in CNS.
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
,Constipation - slows peristalsis and increase water absorption from intestinal contents.
Itching
Strong affinity for mu receptors for rapid onset and produce euphoria which leads to
high addiction.
Cause histamine relaease -> itching, rash, hemodynamic changes, flushing and
orthostatic hyper tension
✔✔A patient who has metastasized bone cancer has been on transdermal fentanyl
patches for pain management for 3 months. He has been hospitalized for tests and has
told the nurse that his pain is becoming "unbearable." The nurse is reluctant to give him
the ordered pain medication because the nurse does not want the patient to get
addicted to the medication. The nurse's actions reflect
appropriate concern for the patient's best welfare.
appropriate caution for a patient who is already on a long-term opioid.
an uncaring attitude toward the patient.
a failure to manage the patient's pain properly. - ✔✔Correct answer: D
Rationale: Patients with severe pain, including metastatic pain or bone pain, may need
higher and higher doses of analgesics. The nurse is responsible for ensuring that the
patient experiences adequate pain relief.
✔✔Opioid Analgesics:
Toxicity and Management of Overdose - ✔✔Naloxone (Narcan) - bind to all receptor
sites -> competive antagonists ->
binds to these site.
Withdrawal symptoms directly related to half-life of opioid
Naltrexone (ReVia)
Regardless of withdrawal symptoms, when a patient experiences severe respiratory
depression, an opioid antagonist should be given.
✔✔Opioid Analgesics: Interactions - ✔✔Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors
Others
✔✔What are some Nursing implications for Analgesics? - ✔✔Before beginning therapy,
perform a thorough history regarding allergies and use of other medications, including
alcohol, health history, and medical history.
Obtain baseline vital signs and I&O.
Assess for potential contraindications and drug interactions.
,Perform a thorough pain assessment, including pain intensity and character, onset,
location, description, precipitating and relieving factors, type, remedies, and other pain
treatments.
Patients should not take other medications or OTC preparations without checking with
their physicians.
Instruct patients to notify physician about signs of allergic reaction or adverse effects.
✔✔What are some nursing implications for opiod analgesics? - ✔✔Oral forms should be
taken with food to minimize gastric upset.
Ensure safety measures, such as keeping side rails up, to prevent injury.
Withhold dose and contact physician if there is a decline in the patient's condition or if
vital signs are abnormal, especially if respiratory rate is less than 10 to 12 breaths/min.
Check dosages carefully.
Constipation is a common adverse effect and
may be prevented with adequate fluid and
fiber intake.
Patients should be instructed to change positions slowly to prevent possible orthostatic
hypotension.
Respiratory depression may be manifested by respiratory rate of less than 10
breaths/min, dyspnea, diminished breath sounds, or shallow breathing.
✔✔What are anesthetics? - ✔✔Drugs that reduce or eliminate pain by depressing nerve
function in the central nervous system (CNS) and peripheral nervous system
✔✔What are the 3 types of anesthesia? - ✔✔General anesthesia: complete loss of
consciousness and loss of body reflexes, including paralysis of respiratory muscles.
Local anesthesia: no paralysis of respiratory function; elimination of pain sensation in
the tissues innervated by anesthetized nerves
Balanced anesthesia
✔✔The nurse anesthetist is planning to use balanced anesthesia during a surgical
procedure. A characteristic of this type of anesthesia is the
administration of minimal doses of multiple anesthetic drugs.
administration of inhaled anesthetics.
, intravenous (IV) administration of anesthetics.
administration of anesthetics to cause muscle relaxation. - ✔✔Correct answer: A
Rationale: The use of a combination of drugs allows less of each drug to be used and a
more balanced, controlled state of anesthesia to be achieved.
✔✔When assessing a patient under general anesthesia, which change to organ
systems does the nurse expect?
Nystagmus
Skeletal muscle contraction
Hypertension
Decreased intracranial pressure - ✔✔Correct answer: A
Rationale: Nystagmus can occur as a result of the use of general anesthesia. Other
findings include skeletal muscle relaxation, hypotension, and increased intracranial
pressure.
✔✔What are some indications for anesthetic? - ✔✔General anesthetics are used during
surgical procedures to produce:
Unconsciousness
Skeletal muscular relaxation
Visceral smooth muscle relaxation
Also used in electroconvulsive therapy treatments for depression
✔✔What are adverse effects of anesthesia? - ✔✔Vary according to dosage and drug
used
Sites primarily affected
Heart, peripheral circulation, liver, kidneys, respiratory tract
Myocardial depression is commonly seen
Malignant hyperthermia
✔✔DEscribe Malignant hyperthermia - ✔✔Occurs during or after volatile inhaled
general anesthesia or use of the neuromuscular blocking drug (NMBD) succinylcholine
Sudden elevation in body temperature (greater than 104° F)
Tachypnea, tachycardia, muscle rigidity
Life-threatening emergency
Treated with cardiorespiratory supportive care and dantrolene (skeletal muscle relaxant)
