Lilley Pharmacology Ch 10-29 Final
Review
For best results when treating severe pain associated with pathologic spinal fractures related to
metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to
administer the pain medication
a. as needed.
b. around the clock.
c. on schedule during waking hours only.
d. around the clock, with additional doses as needed for breakthrough pain. - ANSd. around the
clock, with additional doses as needed for breakthrough pain.
A patient is receiving an opioid via a PCA pump as part
of his postoperative pain management program. During rounds, the nurse finds him
unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After
stopping the opioid infusion, what should the nurse do next?
a. Notify the charge nurse
b. Draw arterial blood gases
c. Administer an opiate antagonist per standing orders
d. Perform a thorough assessment, including mental status examination - ANSc. Administer an
opiate antagonist per standing orders
A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl
patches. The patient asks the nurse what benefits these patches have. The nurse's best
response includes which of these features?
a. More constant drug levels for analgesia
b. Less constipation and minimal dry mouth
c. Less drowsiness than with oral opioids
d. Lower dependency potential and no major adverse effects - ANSa. More constant levels for
analgesia
Several patients have standard orders for acetaminophen as needed for pain. When the nurse
reviews their histories and assessments, the nurse discovers that one of the patients has a
contraindication to acetaminophen therapy. Which patient should receive an alternate
medication?
a. A patient with a fever of 103.4° F (39.7° C)
b. A patient admitted with deep vein thrombosis
c. A patient admitted with severe hepatitis
d. A patient who had abdominal surgery 1 week earlier - ANSc. a patient with severe hepatitis
,The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old
postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The
medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this
dose? - ANS0.75 mL
Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the
patient that which common adverse effects can occur with this medication? (Select all that
apply.)
a. Diarrhea
b. Constipation
c. Pruritus
d. Urinary frequency
e. Nausea - ANSb. constipation, c. pruritis, e. nausea
An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history
knowing this medication is contraindicated in which disorder?
a. Renal insufficiency
b. Severe asthma
c. Liver disease
d. Diabetes mellitus - ANSb. severe asthma
The physician has requested "lidocaine with epinephrine." The nurse recognizes that the most
important reason for adding epinephrine is that it
a. helps to calm the patient before the procedure.
b. minimizes the risk of an allergic reaction.
c. enhances the effect of the local lidocaine.
d. reduces bleeding in the surgical area. - ANSd. reduces bleeding in the surgical area
The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients
is more prone to complications from general anesthesia?
a. A 79-year-old woman who is about to have her gallbladder removed
b. A 49-year-old male athlete who quit heavy smoking
12 years ago
c. A 30-year-old woman who is in perfect health but has
never had anesthesia
d. A 50-year-old woman scheduled for outpatient laser surgery for vision correction - ANSa. A
79-year-old woman who is about to have her gallbladder removed
Which nursing diagnosis is possible for a patient who is now recovering after having been under
general anesthesia for 3 to 4 hours during surgery?
a. Impaired urinary elimination related to the use of vasopressors as anesthetics
b. Increased cardiac output related to the effects of general anesthesia
c. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively
, d. Impaired gas exchange due to the CNS depressant effect of general anesthesia - ANSd.
Impaired gas exchange due to the CNS depressant effect
A patient is recovering from general anesthesia. What is the nurse's main concern during the
immediate postoperative period?
a. Airway
b. Pupillary reflexes
c. Return of sensations
d. Level of consciousness - ANSa. Airway
A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and
explaining moderate sedation. The patient asks, "I am afraid of feeling it when they shock me?"
What is the nurse's best response?
a. "You won't receive enough of a shock to feel anything."
b. "You will feel the shock but you won't remember any of the pain."
c. "The medications you receive will reduce any pain and help you not to remember the
procedure."
d. "They will give you enough pain medication to prevent you from feeling it." - ANSc. "The
medications you receive will reduce any pain and help you not to remember the procedure."
The nurse is administering an NMBD to a patient during a surgical procedure. Number the
following phases of muscle paralysis in the order in which the patient will experience them.
(Number 1 is the first step.)
a. Paralysis of intercostals and diaphragm muscles
b. Muscle weakness
c. Paralysis of muscles of the limbs, neck, and trunk
d. Paralysis of small rapidly moving muscles (fingers, eye) - ANSb. Muscle weakness = 1
d. Paralysis of small rapidly moving muscles (fingers, eye) = 2
c. Paralysis of muscles of the limbs, neck, and trunk
=3
a. Paralysis of intercostals and diaphragm muscles = 4
During a patient's recovery from a lengthy surgery, the nurse monitors for signs of malignant
hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would
indicate the possible presence of this condition?
(Select all that apply.)
a. Respiratory depression
b. Tachypnea
c. Tachycardia
d. Seizure activity
e. Muscle rigidity - ANSb. Tachypnea
c. Tachycardia
e. Muscle rigidity
Review
For best results when treating severe pain associated with pathologic spinal fractures related to
metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to
administer the pain medication
a. as needed.
b. around the clock.
c. on schedule during waking hours only.
d. around the clock, with additional doses as needed for breakthrough pain. - ANSd. around the
clock, with additional doses as needed for breakthrough pain.
A patient is receiving an opioid via a PCA pump as part
of his postoperative pain management program. During rounds, the nurse finds him
unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After
stopping the opioid infusion, what should the nurse do next?
a. Notify the charge nurse
b. Draw arterial blood gases
c. Administer an opiate antagonist per standing orders
d. Perform a thorough assessment, including mental status examination - ANSc. Administer an
opiate antagonist per standing orders
A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl
patches. The patient asks the nurse what benefits these patches have. The nurse's best
response includes which of these features?
a. More constant drug levels for analgesia
b. Less constipation and minimal dry mouth
c. Less drowsiness than with oral opioids
d. Lower dependency potential and no major adverse effects - ANSa. More constant levels for
analgesia
Several patients have standard orders for acetaminophen as needed for pain. When the nurse
reviews their histories and assessments, the nurse discovers that one of the patients has a
contraindication to acetaminophen therapy. Which patient should receive an alternate
medication?
a. A patient with a fever of 103.4° F (39.7° C)
b. A patient admitted with deep vein thrombosis
c. A patient admitted with severe hepatitis
d. A patient who had abdominal surgery 1 week earlier - ANSc. a patient with severe hepatitis
,The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old
postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The
medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this
dose? - ANS0.75 mL
Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the
patient that which common adverse effects can occur with this medication? (Select all that
apply.)
a. Diarrhea
b. Constipation
c. Pruritus
d. Urinary frequency
e. Nausea - ANSb. constipation, c. pruritis, e. nausea
An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history
knowing this medication is contraindicated in which disorder?
a. Renal insufficiency
b. Severe asthma
c. Liver disease
d. Diabetes mellitus - ANSb. severe asthma
The physician has requested "lidocaine with epinephrine." The nurse recognizes that the most
important reason for adding epinephrine is that it
a. helps to calm the patient before the procedure.
b. minimizes the risk of an allergic reaction.
c. enhances the effect of the local lidocaine.
d. reduces bleeding in the surgical area. - ANSd. reduces bleeding in the surgical area
The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients
is more prone to complications from general anesthesia?
a. A 79-year-old woman who is about to have her gallbladder removed
b. A 49-year-old male athlete who quit heavy smoking
12 years ago
c. A 30-year-old woman who is in perfect health but has
never had anesthesia
d. A 50-year-old woman scheduled for outpatient laser surgery for vision correction - ANSa. A
79-year-old woman who is about to have her gallbladder removed
Which nursing diagnosis is possible for a patient who is now recovering after having been under
general anesthesia for 3 to 4 hours during surgery?
a. Impaired urinary elimination related to the use of vasopressors as anesthetics
b. Increased cardiac output related to the effects of general anesthesia
c. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively
, d. Impaired gas exchange due to the CNS depressant effect of general anesthesia - ANSd.
Impaired gas exchange due to the CNS depressant effect
A patient is recovering from general anesthesia. What is the nurse's main concern during the
immediate postoperative period?
a. Airway
b. Pupillary reflexes
c. Return of sensations
d. Level of consciousness - ANSa. Airway
A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and
explaining moderate sedation. The patient asks, "I am afraid of feeling it when they shock me?"
What is the nurse's best response?
a. "You won't receive enough of a shock to feel anything."
b. "You will feel the shock but you won't remember any of the pain."
c. "The medications you receive will reduce any pain and help you not to remember the
procedure."
d. "They will give you enough pain medication to prevent you from feeling it." - ANSc. "The
medications you receive will reduce any pain and help you not to remember the procedure."
The nurse is administering an NMBD to a patient during a surgical procedure. Number the
following phases of muscle paralysis in the order in which the patient will experience them.
(Number 1 is the first step.)
a. Paralysis of intercostals and diaphragm muscles
b. Muscle weakness
c. Paralysis of muscles of the limbs, neck, and trunk
d. Paralysis of small rapidly moving muscles (fingers, eye) - ANSb. Muscle weakness = 1
d. Paralysis of small rapidly moving muscles (fingers, eye) = 2
c. Paralysis of muscles of the limbs, neck, and trunk
=3
a. Paralysis of intercostals and diaphragm muscles = 4
During a patient's recovery from a lengthy surgery, the nurse monitors for signs of malignant
hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would
indicate the possible presence of this condition?
(Select all that apply.)
a. Respiratory depression
b. Tachypnea
c. Tachycardia
d. Seizure activity
e. Muscle rigidity - ANSb. Tachypnea
c. Tachycardia
e. Muscle rigidity
