lOMoAR cPSD| 26582732
NR341 Exam 1 Concept Review -- 60 questions
Complex care (Chamberlain University)
Chapters for this exam 11th edition
Chapter 65: Critical Care, pages 1533-1536 (Overview of Critical Care)
Chapter 9: Palliative Care at the end of Life
Chapter 18: Intraoperative Care, pages 322-324 Table 18-6 and 18-7 (Opioids, Benzodiazepines,
Neuromuscular Blocking Agents, Dexmedetomidine, Propofol)
Chapter 16: Fluid, Electrolyte, and Acid-Base Imbalances pages 286-291.
Chapter 26: Upper Respiratory Problems,pages 485-490
Chapter 65: Critical Care, pages 1547-1563 Beginning with Non-invasive
ventilation.
Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome, pages 1588-1603
Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome
Chapter 34: Heart Failure
Chapter 35: Dysrhythmias
⭐MEDS
Pain Medications and reversal agents
● For opioid analgesics the antidote for overdose is nalaxone (Narcan)
● Morphine
○ Reversal agent: Narcan (naloxone)
■ Narcan half-life is shorter than morphine
■ Wears off before morphine
■ Must reassess patient RR
○ Side effects
■ Drowsiness, dizziness, constipation
○ Adverse effect
■ Hypotension, bradycardia, and respiratory depression
○ Nursing interventions
■ reassess : IV 5-15 min, PO 30-45 min, IM 15-30 min
○ Education
■ 1 .Change position slowly
■ 2 .Use the call light, do not try to get out of bed without help.
■ 3 .What for nausea and vomiting--antiemetics (ondansetron )
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■ 4 .May cause itching, call immediately if rash develops or throat starts swelling.
■ 5 . May cause constipation (increase fluids and fiber, stool softener )
● Benzodiazepines
○ Sedative -- NO ANALGESIC EFFECTS
○ Used for ventilator/anesthesia adjunct
○ AE: Monitor for respiratory depression
○ Reversal: flumazenil (Romazicon)
● Propofol (Diprivan) - non barbiturate hypnotic ○ Reversal agent: NONE
○ Sedative -- NO ANALGESIC EFFECTS
○ Used for ventilator/anesthesia adjunct
○ Very short half life
○ AE:
■ Resp depression (pt must be on ventilator or have someone in the room who can
intubate)
■ Severe hypotension
■ CNS depression
■ Hyperlipidemia
■ Infection risk (tubing changed q12h)
○ Interventions
■ MAINTAIN PATENT AIRWAY
● Dexmedetomidine (Precedex) -sedative
○ Antidote: Atipamezole
○ Adverse Effects: Hypotension, Nausea, Bradycardia
○ Should be used for no longer than 24 hours. Monitor HR, Liver, and Renal function.
○ No respiratory depression and anti-anxiety, can be used prior to surgery.
○ Analgesic and hypnotic, patient semi-arousable.
○ Rebound hypertension.
■
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Drugs to know: (therapeutic effects, adverse effects) -- WHEN THE QUESTION ASKS WHAT THE
MED IS FOR REMEMBER TO READ THE SCENARIO CAREFULLY -- SOME MEDS ARE
GENERALLY KNOWN TO DO 1 THING BUT CAN DO SOMETHING ELSE PERTAINING TO
THE SITUATION
● Dopamine
○ Inotropic, vasopressor
○ Therapeutic effect: increase BP, HR, cardiac output
○ ADVERSE EFFECTS
■ CNS: Headache, anxiety
■ CV: Palpitations, tachycardia, hypertension, ectopic beats, angina, wide QRS
complex, peripheral vasoconstriction, hypotension
■ GI: Nausea, vomiting, diarrhea
■ INTEG: Necrosis, tissue sloughing with extravasation, gangrene
■ RESP:Dyspnea
● Nitroglycerin
○ Nitrate
○ Treat or prevent angina (chest pain) -- caused by vasoconstriction of coronary arteries
○ Causes vasodilation in coronary arteries
■ SE: headache, orthostatic hypotension
○ 3 nitro 5 min in between SUBLINGUAL (Nitrostat)
■ Call 911 during 2nd nitro
○ Do not give with viagara (this drug causes vasodilation as well) -- if taken together will
be fatal
○ ADVERSE EFFECTS
■ CNS: Headache, flushing, dizziness
■ CV: Postural hypotension, tachycardia, collapse, syncope, palpitations
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■ GI: Nausea, vomiting
■ INTEG: Pallor, sweating, rash
● Atropine--antidysrhythmic
○ Blocks acetylcholine → increase cardiac output & HR by blocking vagal stimulation to
the heart
■ Increase HR in sinus bradycardia < 40-50*
○ Anticholinergic -- Dry up secretions
○ ADVERSE EFFECTS
■ CNS: Headache, dizziness, involuntary movement, confusion, psychosis,
anxiety, coma, flushing, drowsiness, insomnia, weakness, delirium (geriatric)
■ CV: Hypo/hypertension, paradoxical bradycardia, angina, PVCs, tachycardia,
ectopic ventricular beats, bradycardia, palpitations
■ EENT: Blurred vision, photophobia, glaucoma, eye pain, pupil dilatation, nasal
congestion, increased intraoccular pressure
■ GI: Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation,
paralytic ileus, abdominal distention, altered taste GU: Retention,
hesitancy, impotence, dysuria
■
Downloaded by NELSON
KIIRU
()
NR341 Exam 1 Concept Review -- 60 questions
Complex care (Chamberlain University)
Chapters for this exam 11th edition
Chapter 65: Critical Care, pages 1533-1536 (Overview of Critical Care)
Chapter 9: Palliative Care at the end of Life
Chapter 18: Intraoperative Care, pages 322-324 Table 18-6 and 18-7 (Opioids, Benzodiazepines,
Neuromuscular Blocking Agents, Dexmedetomidine, Propofol)
Chapter 16: Fluid, Electrolyte, and Acid-Base Imbalances pages 286-291.
Chapter 26: Upper Respiratory Problems,pages 485-490
Chapter 65: Critical Care, pages 1547-1563 Beginning with Non-invasive
ventilation.
Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome, pages 1588-1603
Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome
Chapter 34: Heart Failure
Chapter 35: Dysrhythmias
⭐MEDS
Pain Medications and reversal agents
● For opioid analgesics the antidote for overdose is nalaxone (Narcan)
● Morphine
○ Reversal agent: Narcan (naloxone)
■ Narcan half-life is shorter than morphine
■ Wears off before morphine
■ Must reassess patient RR
○ Side effects
■ Drowsiness, dizziness, constipation
○ Adverse effect
■ Hypotension, bradycardia, and respiratory depression
○ Nursing interventions
■ reassess : IV 5-15 min, PO 30-45 min, IM 15-30 min
○ Education
■ 1 .Change position slowly
■ 2 .Use the call light, do not try to get out of bed without help.
■ 3 .What for nausea and vomiting--antiemetics (ondansetron )
Downloaded by NELSON KIIRU
()
, lOMoAR cPSD| 26582732
■ 4 .May cause itching, call immediately if rash develops or throat starts swelling.
■ 5 . May cause constipation (increase fluids and fiber, stool softener )
● Benzodiazepines
○ Sedative -- NO ANALGESIC EFFECTS
○ Used for ventilator/anesthesia adjunct
○ AE: Monitor for respiratory depression
○ Reversal: flumazenil (Romazicon)
● Propofol (Diprivan) - non barbiturate hypnotic ○ Reversal agent: NONE
○ Sedative -- NO ANALGESIC EFFECTS
○ Used for ventilator/anesthesia adjunct
○ Very short half life
○ AE:
■ Resp depression (pt must be on ventilator or have someone in the room who can
intubate)
■ Severe hypotension
■ CNS depression
■ Hyperlipidemia
■ Infection risk (tubing changed q12h)
○ Interventions
■ MAINTAIN PATENT AIRWAY
● Dexmedetomidine (Precedex) -sedative
○ Antidote: Atipamezole
○ Adverse Effects: Hypotension, Nausea, Bradycardia
○ Should be used for no longer than 24 hours. Monitor HR, Liver, and Renal function.
○ No respiratory depression and anti-anxiety, can be used prior to surgery.
○ Analgesic and hypnotic, patient semi-arousable.
○ Rebound hypertension.
■
Downloaded by NELSON
KIIRU
()
, lOMoAR cPSD| 26582732
Drugs to know: (therapeutic effects, adverse effects) -- WHEN THE QUESTION ASKS WHAT THE
MED IS FOR REMEMBER TO READ THE SCENARIO CAREFULLY -- SOME MEDS ARE
GENERALLY KNOWN TO DO 1 THING BUT CAN DO SOMETHING ELSE PERTAINING TO
THE SITUATION
● Dopamine
○ Inotropic, vasopressor
○ Therapeutic effect: increase BP, HR, cardiac output
○ ADVERSE EFFECTS
■ CNS: Headache, anxiety
■ CV: Palpitations, tachycardia, hypertension, ectopic beats, angina, wide QRS
complex, peripheral vasoconstriction, hypotension
■ GI: Nausea, vomiting, diarrhea
■ INTEG: Necrosis, tissue sloughing with extravasation, gangrene
■ RESP:Dyspnea
● Nitroglycerin
○ Nitrate
○ Treat or prevent angina (chest pain) -- caused by vasoconstriction of coronary arteries
○ Causes vasodilation in coronary arteries
■ SE: headache, orthostatic hypotension
○ 3 nitro 5 min in between SUBLINGUAL (Nitrostat)
■ Call 911 during 2nd nitro
○ Do not give with viagara (this drug causes vasodilation as well) -- if taken together will
be fatal
○ ADVERSE EFFECTS
■ CNS: Headache, flushing, dizziness
■ CV: Postural hypotension, tachycardia, collapse, syncope, palpitations
Downloaded by NELSON KIIRU ()
, lOMoAR cPSD| 26582732
■ GI: Nausea, vomiting
■ INTEG: Pallor, sweating, rash
● Atropine--antidysrhythmic
○ Blocks acetylcholine → increase cardiac output & HR by blocking vagal stimulation to
the heart
■ Increase HR in sinus bradycardia < 40-50*
○ Anticholinergic -- Dry up secretions
○ ADVERSE EFFECTS
■ CNS: Headache, dizziness, involuntary movement, confusion, psychosis,
anxiety, coma, flushing, drowsiness, insomnia, weakness, delirium (geriatric)
■ CV: Hypo/hypertension, paradoxical bradycardia, angina, PVCs, tachycardia,
ectopic ventricular beats, bradycardia, palpitations
■ EENT: Blurred vision, photophobia, glaucoma, eye pain, pupil dilatation, nasal
congestion, increased intraoccular pressure
■ GI: Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation,
paralytic ileus, abdominal distention, altered taste GU: Retention,
hesitancy, impotence, dysuria
■
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