VATI RN 2ND COMPREHENSIVE PREDICTOR FOCUSED REVIEW,Latest 2019/2020 (Download To Score An A)

a. Mechanisms of action include suppression of the reticular activating system that controls wakefulness in our brains. b. Nursing implications include warning against an adverse effect of zolpidem in which some patients sleep-walk and perform activities that are not remembered the next morning. c. The effect of benzodiazepines in the motor cortex helps to relax muscles, thus helping with sleep. d. All the above. 2. The phrase “start low, go slow” can apply to , because . a. titration of pain medications for the elderly : the diminished function of liver and kidneys increase risk of drug toxicity. b. instructions for patients weaning off of chronic opioid use : if they try to stop cold turkey it will be immediately life-threatening. Withdrawal from opioids is very distressing and often painful, but not life-threatening. (On the other hand, withdrawal from alcohol can be indeed life-threatening, resulting in seizures and death if not managed correctly, usually with use of a benzo like lorazepam). c. narcotic abuse definition : it shows that even if you slowly begin opioid use, it can cause your life to become “low” because of high risk of addiction. d. use of adjuvant medications : they should only be used by themselves and not with any other analgesic. This is the opposite from what “adjuvant” means. Examples of adjuvant drugs are, say, use of non-pain-med-related drugs in addition to pain meds… A person with chronic neuropathic pain often benefits from use of an opioid med PLUS an extra medication like an antidepressant. The antidepressant would in this context be called the adjuvant med. 3. A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The patient’s nurse will expect a. lab results showing a high serum creatinine level, indicating renal failure. Much more likely to see S&S of liver failure, not renal failure… see answer D. b. joint pain and hyperuricemia, indicating rapid onset of gout. Joint pain and hyperuricemia are S&S of gout, but have no relevance to what the question is asking. c. agitation and anxiety, since this drug blocks reuptake of adrenergic neurotransmitters from neural synapses. Not the mechanism of action for acetaminophen. d. lab results showing high liver enzyme levels, indicating hepatic failure. Acetaminophen is notorious for causing liver problems when taken in large amounts either over a long period of time or in one lump amount, as in this case. We really don’t want people taking more than 4gms a day, preferably much less. Labs that measure liver enzymes in the blood, such as AST and ALT are checked, and if the enzymes are high, that means hepatocyte destruction is occurring & releasing enzymes into the blood. 4. The patient in the previous question will likely receive as an antidote a. naloxone (Narcan) since it blocks the acetaminophen molecules from attaching to opioid receptor sites. Naloxone is important in blocking opioid receptors in the body, thus used when there is opioid overdose (know the name of this drug well, not only for a test, but for the future when you are giving opioids to your patients and may need to give a reversal.) b. acetylcysteine (Mucomyst) since it increases glutathione, a substance which enhances the ability of the liver cells to metabolize acetaminophen molecules. c. flumazenil (Romazicon) since it increases GABA