what medication is a leukotriene receptor antagonist?
Montelukast
Which statement made by a person regarding hydrochlorothiazide (HCTZ) is correct?
I should take extra care when standing up or changing positions.
A 250mg dose of an oral medication has been ordered. The medication is supplied only in 100mg tablets. How many tablets would you administer?
2.5
What medication is considered a potassium-sparing diuretic?
spironolactione (Aldactone)
You receive report from the off-going nurse that the person being cared for just received their fourth dose of IV vancomycin that was administered over 30 minutes. Upon assessment of them, you notice their face and neck are red and they are itching all over. What would you suspect?
Red man syndrome due to a rapid infusion rate.
Which of the following would you question if prescribed for a person taking sildenafil (Viagra?
nitroglycerin
You are caring for a person with a capillary blood glucose of 33 mg/dL and they are unable to tolerate oral intake. Which of the following would you administer?
dextrose 50% IV push
A physician’s written order for the person you are caring for is as follows: Insulin glargine (Lantus), 10 U, subQ QD. What changes would you suggest for safety and to avoid the use of “do not use” abbreviations?
spell out units and daily
Which statement, if made by the person you are caring for, reflects the need for further education regarding a new prescriptions of warfarin (Coumadin)?
If I get headaches, aspirin is my best options for pain
A person is noted to have a penicillin allergy. What medication would you question of ordered by a physician?
ceftriaxone
You receive and order to start a Heparin drip at 18 units/kg/hr for a person weighing 75 kg. The heparin comes in a 500 mL bag with 25,000 units. what is the starting rate of the infusion?
27 mL/hr
The physician orders 0.5 mg/kg of a medications. The medication is supplied in a 10 mg/mL solution. The person you are caring for weighs 40 kg. How many mL of the drug would you administer?f
2 mL
A person with a hypothyroidism has a serum calcium level of 13 mg/dL. What medication would you expect to administer?
Calcitonin
A person you are caring for has a known GI bleed. What drug is contraindicated?
enoxaparin (Lovenox)
A person has been prescribed nitrofurantoin (Furadantin) for a UTI. What education would you provide for them?
wash your mouth out after taking this medication to avoid staining of the teeth
What is appropriate education to provide to a person who has received a new prescription for a PPI?
You should not take this medicine at the same time as other medicines.
Your patient presents with CHF and has a Potassium level of 5.8. Which diuretic do you anticipate being ordered by the provider?
NOT amiloride
Your patient has been diagnosed with chronic CHF and will be taking Lasix 80 mg PO twice a day. When teaching about high Potassium foods in the diet, which group of foods would you recommend to the patient?
NOT tofu, red meat, beans
which medication would you question if ordered by the provider to treat a person that is complaining of nausea and vomiting?
famotidine
shortly after administering an IV med, person complains of itching and feeling flushed. Hives begun to form on chest. What is the best intervention?
Administer PRN IV diphenhydramine and notify MD
Patient refuses a dose of IV medication. What is the MOST approriate action?
document the refusal and notify the MD
you receive an order to administer 1 tsp of an elixir. What amount of elixir will you prepare?
pt has central line who is receiving TPN. What is the most important action to prevent CLABSI?
perform correct sterile technique
order placed for sublingual medication. Pt has NG. what is the most appropriate action?
administer the med
pt was prescribed a corticosteroid inhaler. What would you include when educating them on the medication?
rinse mouth
what medication is incompatible with LR
diazepam
new onset dysrhythmia. What medication might be prescribed for this condition?
diltiazem
you are educating your patient for cyclosporine and a new diet with a potassium intake restriction. What food would you tell them to avoid?
raisins
pt being treated for pain s/p ortho procedure. what order would you question?
eplerenone
order for 4 mg of dexamethasone IV push. The med is supplied in 10mg/mL vial. How many mL do you give?
0.4 mL
pt is on a morphine PCA without a basal infusion rate and is afraid of overdosing. what ed do you provide?
small dose is delivered only when you push the trigger button
pt has been diagnosted with diabetes and has oral meds ordered. What statement indicates understanding of s&s of hypoglycemia?
sweating, shakes, nervouseness
what class of med would you expect ordered for a person with acid reflux?
PPI
pt has epidural infusing at 6mL/hr. begining BP was 92/58 and now their BP is 130/70. what would you do FIRST?
NOT :::: ask the person to rate their pain
order to give digoxin now. HR is 52. what do you do next?
hold dig and call MD
What is the primary cause of Red man syndrome?
increased histamine production
why would NS be the solution of choice when preparing to administer a blood transfusion?
NS is isotonic
pt with no known risk factors to TB would need further diagnostic testing to rule out TB if the mantoux test showed an induration of what size?
???
what statement is correct for determining you have the correct pt before adminstering a drug?
ask them to state their name and DOB and compare it to the MAR and wrist band
pt is on morphine PCA and is unresponsive. You suspect narcotic OD. what med to give?
narcan
Pt has new script for levothyroxine. What statement made by them is correct?
NOT ::: take at the same time everyday.
MD orders 1000 mL of NS over 6 hrs. whats the rate?
166.67
125 mcg is how many mg?
0.125 mg
pt to receive 5 mg/kg of medication. They weigh 80 kg. how much to give?
400 mg
pt has new order for dig. What would be assessed immediately before administering?
Apical HR
antidote for heparin
protamine sulfate
lasix ordered at 50 mg IV push. On hand is 20 mg/mL. How many mL to give?
2.5
pt has 4 new scripts and wants to know which one will help with migraines.
Rizatriptan
pt says they frequently take tylenol at home. which statement is correct?
I should pay attention to OTC drug label
which med is antiplatelet?
clopidogrel
MD ordered atropine sulfate 0.6 mg IM before surgery. med is supplied in 0.8 mg/mL. How many mL to give?
0.75 mL
Which of the following medications is known to cause orange-colored urine?
phenazopyridine (Pyridium)
You are ordered to give digoxin. Your patient’s vital signs are as follows: Blood Pressure 130/75, Temp 97.9 oral, HR 52, O2 Sat 100% room air. What should you do next?
Hold digoxin and call the provider
Normal Saline (NS) is the solution of choice over D5W when preparing to administer a blood transfusion because:
Normal Saline is an isotonic solution and prevents cell hemolysis
Patient is to receive 5mg/kg of medication. Patient weighs 80kg. How much would you administer?
400mg
Your patient taking digoxin (Lanoxin) has an AM Potassium level of 3.0. This level may:
Increase risk of digoxin toxicity
The patient is diagnosed with multiple myeloma. The physician has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the patient?
Increase daily water intake
Which of the following medications will crystalize when mixed with D5NS?
phenytoin (Dilantin)
Which of the following medications should be questioned by the nurse, if ordered by the provider to treat a patient’s complaint of nausea and vomiting?
famotidine (Pepcid)
Your patient has an epidural infusing hydromorphone with bupivacaine at 6ml/hr continuously. The patient’s blood pressure at the beginning of your shift was 92/58 with a heart rate of 68. You noticed the patient’s blood pressures have been around 130/70. What should you do FIRST?
Check infusion rate to confirm 6ml/hr, then notify anesthesia provider
The dosage of which drug must be tapered off slowly to prevent acute adrenal insufficiency?
prednisone (Deltasone)
When teaching a new nurse on how to administer IV push furosemide (Lasix), you emphasize that it should be given over two minutes to avoid:
tinnitus
A nurse is caring for a patient with hyperparathyroidism and notes that the patient’s serum calcium level is 13mg/dl. Which medication should the nurse prepare to administer as prescribed to the patient?
calcintonin (Miacalcin)
A patient has a prescription to take Guaifenesin (Mucinex) every 4 hours, as needed. The nurse determines that the patient understands the MOST effective use of the medication if the patient states that he or she will:
take the medication with a full glass of water
Acetylsalicylic acid (Aspirin) has which of the following pharmacological effects?
Anti-inflammatory, anti-pyretic, decrease platelet aggregation
Your patient is to receive 2 G vancomycin over 2 hours. The medication comes in from the pharmacy as 2 G Vancomycin in 250ml normal saline. At what rate will the IV medication run?
125ml/hr
Sildenafil (Viagra) is prescribed to treat a patient with erectile dysfunction. A nurse reviews the patient’s medical record and would question the prescription if which of the following is noted in the history?
Use of nitroglycerin
While delivering the lunch tray of a patient who is taking warfarin (Coumadin), the nurse notices diversity of food items. Which of the following foods would be a concern?
Spinach
Your patient is receiving vancomycin (Vancocin) 500mg IV every 12 hours. As a nurse, you understand that the PRIMARY rationale for monitoring serum levels of vancomycin is that:
It can cause nephrotoxicity
Convert 1.2 milligrams to micrograms
1200 mcg
You are caring for a patient with diabetes. Humalog insulin is ordered via sliding scale AC and HS. When is the best time to administer Humalog insulin?
15 minutes before meal arrives
A provider orders one liter of NS to be infused over four hours. At what rate would you set the IV pump?
250ml/hr
WRONG Which medication is used to treat iron toxicity?
A) digoxin immune fab (Digibind)
B) Naloxone (Narcan)
C) Mephyton (Vitamin K)
D) WRONG deferoxamine (Digibind)
Your patient presents with CHF and has a Potassium level of 5.8. Which diuretic do you anticipate being ordered by the provider?
bumetanide (Bumex)
Your patient is on a Morphine PCA after a recent exploratory surgery. While doing your rounds, you notice that your patient is slumped over, unresponsive, with delayed and slow respirations. You suspect narcotic overdose. Which reversal medication would you administer?
naloxone (Narcan)
A patient’s capillary blood glucose reading is 33mg/dl. Which of the following medications will the nurse administer if the patient is unable to tolerate PO?
Dextrose 50% IV push
When a patient has pernicious anemia, the nurse would expect to give them:
Vitamin B12
WRONG Which of the following anticoagulant is MOST commonly administered for DVT prophylaxis in a patient who has undergone a hip replacement?
A)WRONG heparin
B) enoxaparin
C) aspirin
D) warfarin
Which of the following is considered an antiplatelet medication?
clopidogrel (Plavix)
Sildenaphil(viagra) is prescribed to treat a patient with erectile dysfuction. A nurse reviews the patient’s medical record and would question the prescription of which of the following is noted in the history?
Use of Nitroglycerin
Which of the following medications should be held today considering that your patient received IV contract two hours ago fir a CT scan?
Metformin (Glucophage)
The patient is diagnosed with multiple Myeloma. The physician has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the patient?
Increase daily water intake
Your patient, a Type 1 diabetic with a history of schizophrenia is exhibiting signs and symptoms of tardive dyskinesia, Which of the following long-term medications is more likely the etiology of the problem?
chlorpromazine (Thorazine)
When caring for a patient with a central line who is receiving TPN, what is the MOST important action on the part of the nurse to prevent CLABSI?
Perform correct sterile technique for dressing change at the CVC site
“Red Man” Syndrome may occur during the administration of vancomycin (Vancocin), primarily due to
An increase in histamine production
Your patient has been diagnosed with. chronic CHF and will be taking Lasix 80mg PO twice a day. When teaching about high Potassium foods in the diet, which group of foods would you recommend to the patient?
Bananas, spinach, raisins
true or false: Pernicious anemia is another name for iron deficiency anemia:
false
drugs that are used to dissolve existing thrombus are called:
thrombolytic agents
which of the following are considered antiplatelet drugs?
ASA, Persantine,Ticlid, and plavix
which type of antihypertensive drug acts by relaxing smooth muscle in the blood vessels?
vasodilators
a drug that may be used to control bleeding in a patient with hemophilia is?
proplex
all of the following are signs of digitalis toxicity except:
increased appetite
true or false: heart disease is second only to breast cancer as the leading cause of death in women
false
the usual dose of extentabs is:
200-300 mg tid-qid
the usual dose of lipitor is:
10 mg daily
when administering digitalis, the medication should be withheld if the apical pulse is below:
60
true or false: a patient with a blood pressure of 120/84 would be diagnosed with prehypertension:
true
true or false: all cardiac arrhythmias require immediate medical treatment to prevent long term cardiac injury:
false
all of the following are symptoms of MI except:
warm, dry skin
the usual dose for furosemide is:
20-80 mg daily
an example of a vasopressor:
neo-synephrine
which of the following are risk factors for an MI?
Smoking, diabetes mellitus, male older than 55 ALL OF THESE ARE CORRECT
true or false: age has little relevance to the development of heart disease
false
true or false: elderly patients have faster intestinal motility and therefore may need more cardiac medication than a younger patient
false
patient education for those taking coumadin should include all of the following except:
eat plenty of foods high in vitamin K
analgesic
drug that relieves pain
cutaneous stimulation
stimulation of a person’s skin to prevent or reduce pain perception. A massage, warm bath, hot and cold therapies, and transcutaneous electrical nerve stimulation are some ways to reduce pain perception
endorphins
hormones that act on the mind like morphine and opiates, producing a sense of well-being and reducing pain
epidural infusion
administration of local anesthetic with minimal sedation, by way of a catheter into the epidural space of the spinal column, which is designed to produce anesthesia of the pelvic, abdominal, or genital areas
guided imagery
method of pain control in which the patient creates a mental image, concentrates on that image, and gradually becomes less aware of pain
local anesthesia
loss of sensation at the desired site of action
nociceptor
somatic and visceral free nerve endings of thinly myelinated and unmyelinated fibers. These fibers usually react to tissue injury, but may also be excited by endogenous chemical substances
opioid
drug substance, derived from opium or produced synthetically, that alters perception of pain and that with repeated use may result in physical and psychological dependence (narcotic)
patient-controlled anesthesia (PCA)
drug delivery system that allows patients to self-administer small, continuous doses of intravenous or subcutaneous opioids as they feel the need
prostaglandins
Potent hormonelike substances that act in exceedingly low doses on target organs. They can be used to treat asthma and gastric hyperacidity
relaxation
relief from work or stress that leaves one feeling relaxed or less tense. A cognitive strategy that provides mental and physical pain relief or reduces pain
transcutaneous electrical nerve stimulation (TENS)
mild electrical stimulation that interferes with the transmission of painful stimuli
Assess the characteristics of the pain
A 24-year-old patient is admitted to the trauma unit with a diagnosis of a fractured femur after a motor vehicle accident. He states that he has pain in the injured leg. What should be the first action taken by the nurse?
a. Administer the lowest dose of pain medication.
b. Assess the characteristics of the pain.
c. Call the orthopedic surgeon.
d. Complete the admission assessment.
The patient is the best resource for assessing the pain & should receive the appropriate pain med.
A 7-year-old pediatric patient tells you that he is in pain. The patient rates the pain as 4 on the Faces Pain Scale of 0 to 10. His mother, who is in the room, states that her son is having pain at a level of 8 on the 0 to 10 scale. Which is the most accurate assessment of the pain?
a. The patient is the best resource for assessing the pain & should receive the appropriate pain med.
b. The patient is the best resource for assessing the pain but should not receive the pain med because his pain level is only 4 out of 10.
c. The primary HCP is the best resource for assessing the pain and should be called to determine if the pain medication should be administered.
d. The family member is the best resource for assessing the pain, and the patient should receive the maximum dose of pain medication ordered.
Assess patient’s vital signs every 15 min for 2 hrs
Your patient developed respiratory depression after her first dose of intravenous (IV) morphine. After giving 0.2 mg of naloxone (Narcan) IV push, the patient’s respiratory rate and depth are within normal limits. Which action do you take now?
a. Leave the patient alone to sleep.
b. Discontinue all pain medications ordered.
c. Administer another dose of naloxone in 1 hour.
d. Assess patient’s vital signs every 15 min for 2 hrs
assess the patient’s level of pain with a Faces Pain Scale
A patient with a history of stroke 4 years ago resulting in aphasia (inability to verbally express thoughts) returns to the surgical unit after a cholecystectomy. The surgeon ordered an intravenous pain medication every 4 hours as needed (prn) for postoperative pain. The best nursing intervention related to pain control after surgery would be to:
a. administer the pain medication when the patient becomes restless.
b. wait until the patient verbalizes that he is experiencing pain to administer the pain medication.
c. assess the patient’s level of pain with a Faces Pain Scale.
d. administer the pain medication every 4 hours.
Respiratory rate of 6 breaths/min
One hour after administering the first dose of an intravenous opioid to your postoperative patient, about which of the following assessments should you be most concerned?
a. Respiratory rate of 6 breaths/min
b. Oxygen saturation of 95%
c. Heart rate of 70
d. Blood pressure of 140/72
Laxative
Your patient is being discharged home on an around-the-clock opioid for chronic rheumatoid arthritis pain. You would expect an order for which of the following classes of medications to accompany this order?
a. Laxative
b. Antibiotic
c. Stool softener
d. Proton pump inhibitor
Only the patient should push the button
Which of the following instructions for use of a patient-controlled analgesia (PCA) pump is most important when educating the patient and family before implementation?
a. Notify the nurse when you need to push the button.
b. Only the patient should push the button.
c. A spouse can push the button when the patient is asleep.
d. Wait for the pain to become severe before pushing the button.
The steroid is an adjuvant to reduce inflammation
You are caring for a patient who receives an opioid analgesic and a corticosteroid for breast cancer that has spread to the bones. The patient’s husband inquires about the purpose of the corticosteroid. What is your best answer?
a. The steroid prevents further spread of the cancer.
b. The steroid is an adjuvant to reduce inflammation.
c. The steroid is an NSAID for enhancing pain control.
d. The steroid is a nonopioid analgesic.
a,b,d
Your patient is recovering from knee surgery and states that her pain level is 5 on a 0- to-10 pain scale. She received a dose of medication 15 minutes ago. Which interventions may be beneficial for this patient at this time? (SATA)
a. Massage her back.
b. Help her be repositioned on her side.
c. Tell her that she cannot have any more pain medication at this time because she may become addicted to it.
d. Take a few minutes and talk to her about the pictures of her family that she brought with her.
a,c
Which of the following nursing interventions can improve the effectiveness of relaxation? (Select all that apply.)
a. When using guided imagery, explain the technique in detail.
b. Make the environment stimulating by being sure that lights are turned on.
c. Describe any sensations that patients will experience as they begin to relax.
d. Explain the relaxation technique when the patient’s pain is most severe.
pain
unpleasant, subjective sensory and emotional experience
radiating pain
extends from the point of injury to another body area
superficial pain
can cause the fight-or flight response of the general adaptation syndrome
acute pain
rapid onset, lasts briefly
exacerbation
increases in the severity of symptoms
chronic pain
prolonged, varying in intensity
transduction, transmission, perception, modulation
4 physiological processes of pain
transduction
Conversion of thermal, chemical, or mechanical stimuli in the periphery, to electrical energy, stimulating an action potential in a nociceptor nerve fiber.
transmission
Pain stimulus travels up afferent (sensory) nerve fibers to the spinal cord. The thalamus then transmits the sensory info to other centers in the brain, where perception and reaction occur.
perception
point at which the person is aware of the pain.
modulation
When the brain perceives the pain, inhibitory neurotransmitters release to inhibit the pain transmission and provide analgesia.
heat, cold, TENS, pharmacological interventions
The gate control theory of pain suggests that pain can be reduced through the use of:
b,d,e
Which of the following are physiological responses to acute pain as a result of sympathetic stimulation?
a. Decreased respiratory rate
b. Increased heart rate
c. Peripheral vasodilation
d. Increased blood glucose level
e. Diaphoresis
f. Pupil constriction
g. Decreased blood pressure
Fatigue, insomnia, anorexia, weight loss, apathy, hopelessness, and anger
For a patient with chronic pain, identify the associated symptoms
Change of sleep patterns, inability to perform hygienic care, sexual dysfunction, alteration in home or work management, and interrupt of social activities
Lifestyle responses to chronic pain
crying, exhibiting changes in vital signs, facial expressions, or extremity movement
Responses that an infant could have to pain
crying, irritability, loss of appetite, quietness or restlessness, disturbed sleep patterns, or rigid body posture
Responses that a child could have to pain
patient’s self report
The single most reliable indicator of pain is the
suggest a change in medications
Using the PQRSTU assessment guide, identify nursing interventions for quality
Position the patient so that body weight is shifted away from area of pain; apply heat/cold directly to site
Using the PQRSTU assessment guide, identify nursing interventions for region
Administer medication so that the peak effect occurs when pain is most acute
Using the PQRSTU assessment guide, identify nursing interventions for timing
Use of words that the child can understand, pictures, and dolls to act out with, and pointing to areas of discomfort
Identify how a nurse may assess the level of pain for a toddler
Use of an interpreter, pictures, and gestures, and pointing to areas of discomfort
Identify how a nurse may assess the level of pain for a person for whom English is a second language
Vocal response, facial movements, and inactivity
Identify how a nurse may assess the level of pain for a person with dementia
Ask the patient to point to the area, or draw or trace the extent of the pain
To determine the location of a patient’s pain, a nurse should ask the patient to
Stating that pain is located on the R lower abdominal quadrant. Reports that the pain radiates upward slightly, with an intensity of 4 on a scale of 1-10
The patient indicates that the discomfort is located in the right side of the abdomen. Provide an example of how the pain experience could be appropriately documented for this patient
7
A pain rating of _ on a scale of 0 to 10 is an emergency and requires immediate action
administer the pain medication about 30 minutes before painful activities
For a patient who experiences discomfort upon ambulation or during a dressing change, a nurse should plan to
- Using different types of pain relief measures
- Providing pain relief measures before the pain becomes severe
- Using measures that the patient believes are effective
- Using the patient’s ideas for pain relief and scheduling
- Suggesting measures that are within the patient’s capability
- Choosing pain relief measures on the basis of the patient’s responses
- Encouraging the patient to try measures more than once to see if they may work
- Keeping an open mind about nontraditional measures
- Protecting the patient from more pain
- Educating the patient about the pain
Ways a nurse may individualize a patient’s treatment for pain
b,c,e
Which of the following are correct statements regarding transcutaneous electrical nerve stimulation? (SATA)
a. It is an invasive procedure
b. It requires a health care provider’s order
c. Electrodes are applied directly onto skin
d. Controls are adjusted until a patient feels a buzzing sensation
e. It can be very expensive
a,e
Which of the following are indicated for the treatment of mild to moderate pain?
a. Ibuprofen
b. Morphine
c. Codeine
d. Fentanyl
e. Acetaminophen
d. Propoxyphene
Reduction/removal of painful stimuli, cutaneous stimulation, distraction, relaxation, guided imagery, anticipatory guidance, biofeedback, and hypnosis
Nonpharmacological interventions that may be implemented to relieve pain
Sedatives, anticonvulsants, steroids, antidepressants, anti anxiety agents, and muscle relaxants
Adjuvant medications that may be used in conjunction with an analgesic to manage a patient’s pain
1 mg every 10 minutes
The usual dosage of on-demand morphine in the PCA is
assessment of the site and patency of the tube along with maintenance of aseptic technique in site care
A priority nursing intervention specifically for the patient with an epidural analgesic infusion is
patient’s response to the medication, including respiratory status and degree of pain relief
A priority nursing assessment for all patients before and while receiving analgesics is
- Straightening wrinkled bed linen
- Repositioning the patient
- Loosening tight bandages/clothing
- Changing wet dressings/bed linens
- Checking the temperature of hot/cold applications and bathwater
- Lifting the patient up in bed, not pulling
- Positioning the patient correctly on the bedpan
- Avoiding exposure of the skin or mucous membranes to irritants
- Preventing urinary retention by keeping the catheter patent
- Preventing constipation by use of funds, diet, and exercise
- Reducing lighting that glares/shines directly on the patient
- Checking the temperature of the room and the sensation of the patient
- Reducing the level of noise and traffic
interventions that a nurse should implement to adapt or alter the environment to promote a patient’s comfort
lost limbs or had strokes with paralysis
A patient who may experience phantom pain is someone who has
Medication on demand (MOD)
The term for patient-controlled oral analgesia is
Ask patients about their level of pain and/or observe their behavior
Whenever possible, the best way to evaluate the effectiveness of pain management is to
Nausea, headache, dizziness, urinary frequency, constipation, depression, restlessness, and anxiety
Concomitant symptoms associated with pain include
true
Nurses can allow their own misconceptions about or interpretations of the pain experience to affect their willingness to intervene for their patient
TRUE or FALSE
true
The degree and quality of pain are related to the patient’s definition of pain
TRUE or FALSE
false
When patients are experiencing pain, they will not hesitate to inform you
TRUE or FALSE
false
Fatigue decreases a patient’s perception of pain
TRUE or FALSE
true
A nurse should provide descriptive words for a patient to assist in assessing the quality of pain
TRUE or FALSE
false
Pain assessment can be designated to assistive personnel
TRUE or FALSE
false
Large doses of opioids for the terminally ill patient will hasten the onset of death
TRUE or FALSE
true
Health care providers initially order higher doses than needed for patients with cancer pain
TRUE or FALSE
true
The Joint Commission has a standard that requires health care workers to assess all patients for pain
TRUE or FALSE
false
Pain is a normal part of aging
TRUE or FALSE
true
Nurses should anticipate that higher doses of oral opioids will be ordered after patients are converted from the IV form
TRUE or FALSE
true
The least invasive pain management therapy should be tried first
TRUE or FALSE
urinary retention
A patient is experiencing pain that is not being managed by analgesics given by the oral or intramuscular routes. Epidural analgesia is initiated. The nurse is alert for a complication of this treatment and observes the patient for:
- Diarrhea
- Hypertension
- Urinary retention
- A increased respiratory rate
Respirations = 9 per minute, shallow
A patient had a laparoscopic procedure this morning and is requesting a pain medication. The nurse assesses the patient’s vital signs and decides to withhold the medication based on the finding of
- Temperature = 99° F, rectally
- Pulse rate = 90 beats per minute, regular
- Respirations = 9 per minute, shallow
- Blood pressure = 130/80 mm Hg, consistent with prior reading
Give the medication before activities or procedures
A nurse is working with an older adult population in the extended care facility. Many of the patients experience discomfort associated with arthritis and have analgesics prescribed. In administering an analgesic medication to an older adult patient, the nurse should:
- Give the medication when the pain increases in severity
- Combine opioids for a greater effect
- Use the IM route whenever possible
- Give the medication before activities or procedures
indomethacin
One of the patients that a nurse is working with on an out-patient basis at the local clinic has rheumatoid arthritis. The patient has no known allergies to any medications, so the nurse anticipates that the physician will prescribe
- Amitriptyline
- Butorphanol
- Indomethacin
- Morphine
diaphoresis
An adolescent has been carried to the sidelines of the soccer field after experiencing a twisted ankle. The level of pain is identified as low to moderate. The nurse observes that the patient has
- Pupil constriction
- Diaphoresis
- A decreased heart rate
- A decreased respiratory rate
Disturbances in their sleep patterns
A nurse on the pediatric unit is finding that it is sometimes difficult to determine the presence and severity of pain in very young patients. The nurse recognizes that toddlers may be experiencing pain when they have
- An increased appetitie
- A relaxed posture
- An increased degree of cooperation
- Disturbances in their sleep patterns
An increase in the opioid dose
A patient on the oncology unit is experiencing severe pain associated with his cancer. Although analgesics have been prescribed and administered, the patient is having “break through pain.” The nurse anticipates that his treatment will include
- The use of a placebo
- Experimental medications
- An increase in the opioid dose
- Administration of medications every hour
Avoid exposure to the sun
A patient is experiencing pain that is being treated with a fentanyl transdermal patch. The nurse advises this patient to
- Avoid exposure to the sun
- Change the patch site every 2 hours
- Apply a heating pad over the site
- Expect immediate pain relief when the patch is applied
naloxone
A patient is experiencing severe pain and has been placed on a morphine drip. During the patient’s assessment, the nurse finds that the patient’s respiratory rate is 6 breaths per minute and shallow. The nurse anticipates that the patient will receive
- Naloxone
- Morphine
- Incentive spirometry
- No additional treatment for this expected response
Verbal Descriptor Scale
An assessment tool that has the patient select words from a list that most accurately reflect his/her pain severity is the
- Brief Pain Inventory
- Visual Analog Scale
- Verbal Descriptor Scale
- Critical Care Pain Observation Tool
depression
A nurse is working for an oncology unit in the medical center. All of the patients experience pain that requires management. The nurse should first visit with the patient who is also exhibiting signs of
- Anxiety
- Fatigue
- Distraction
- Depression
around the clock
For a patient with a consistent level of discomfort, the most effective pain relief is achieved with administration of analgesics
- PRN
- Every 3 to 4 hours
- Every 12 hours
- Around the clock
cramping
A nurse anticipates that the patient with visceral pain will describe the pain as
- Sharp
- Cramping
- Burning
- Shooting
An order for a sedative
Which of the following orders would the nurse question for the patient who has an epidural infusion for pain relief?
- Use of pulse oximetry
- Tubing changes every 24 hours
- An order for a sedative
- Use of fentanyl in the infusion
Propoxyphene
Because of the possible cardiovascular and neurological effects, which of the following analgesic orders for an older adult patient should be questioned?
- Acetaminophen
- Aspirin
- Ibuprofen
- Propoxyphene
A client receiving hydrochlorothiazide (Microzide) asks the nurse why they are urinating so frequently. Which statement should the nurse provide the client?
1. “Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure.”
2. “Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure.”
3. “Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases.”
4. “Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases.”
The nurse is providing education for nonpharmacological interventions to manage hypertension. Which information should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Increase your dietary intake of fruits and vegetables.
2. Decrease the consumption of alcohol.
3. Reduce the dietary intake of potassium.
4. Increase physical activity.
5. Restrict your intake of sodium.
Which clients should the nurse anticipate will require a pharmacological intervention to manage their blood pressure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy
2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes
3. A 56-year-old woman whose blood pressure is 135/84 mmHg who also has Cushing’s disease
4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy
5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy
1. Kidney damage
2. Stroke
4. Heart failure
5. Blindness
The nurse reviewing the records of a client diagnosed with hypertension notes a weight of 200 lbs, height 5′ 4″, dietary intake includes primarily starches, an alcohol intake of three beers per week, and stressors include 60-hour workweeks. Based on this information, which should the nurse identify as a priority outcome?
1. Patient will eliminate alcohol from the diet.
2. Patient will decrease stress by limiting work to 40 hours/week.
3. Patient will balance diet according to the food pyramid.
4. Patient will achieve and maintain optimum weight.
4. Patient will achieve and maintain optimum weight.
The nurse has prescribed dietary education for a client prescribed nifedipine (Procardia XL). Which dietary choice should the nurse recognize requires further education?
1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice
2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice
3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice
4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice
2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice
Which statement made by a client newly prescribed a beta-adrenergic blocker should the nurse be concerned about?
1. “I don’t handle stress well; I have a lot of diarrhea.”
2. “When I have a migraine headache, I need to have the room darkened.”
3. “My father died of a heart attack when he was 48 years old.”
4. “I have always had problems with my asthma.”
4. “I have always had problems with my asthma.”
2. Take the client’s blood pressure.
3. Hypotension and tachycardia
The nurse has completed the education for a client prescribed hydrochlorothiazide (Microzide). Which statement made by the client indicates an understanding of the teaching?
1. “I really need to avoid grapefruit juice when I take this medication.”
2. “I need to avoid salt substitutes and potassium-rich foods.”
3. “I take my medication early in the morning.”
4. “If I develop a cough, I should call my physician.”
3. “I take my medication early in the morning.”
The nurse has discussed lifestyle modifications to help manage the client’s hypertension. Which statement made by the client indicates an understanding of the information?
1. “I need to get started on my medications right away.”
2. “My father had hypertension, did nothing, and lived to be 90 years old.”
3. “I know I need to give up my cigarettes and alcohol.”
4. “I won’t be able to run in the marathon race anymore.”
3. “I know I need to give up my cigarettes and alcohol.”
3. Periorbital edema
5. Difficulty swallowing
4. Auscultate breath sounds for crackles.
A client prescribed doxazosin (Cardura) asks how the medication works. Which information should the nurse provide the client?
1. “Doxazosin causes the kidneys to excrete more urine.”
2. “Doxazosin helps the heart work more efficiently.”
3. “Doxazosin helps dilate the blood vessels.”
4. “Doxazosin decreases the release of the stress hormones.”
3. “Doxazosin helps dilate the blood vessels.”
The nurse is preparing to administer clevidipine (Cleviprex) to a client experiencing a hypertensive crisis. Which interventions should the nurse implement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Monitor bowel sounds
2. Administer the drug intravenously
3. Continually monitor blood pressure
4. Crush caplets for administration
5. Infuse prescription in normal saline at 125 mL/h
2. Administer the drug intravenously
3. Continually monitor blood pressure
2. Cardiac output, blood volume, and peripheral vascular resistance
2. It can result from chronic renal impairment.
The nurse has provided education for a client prescribed nifedipine (Adalat CC). Which statement made by the client indicates an understanding of the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “If I drink alcohol while taking this medication, I will get very sick to my stomach.”
2. “I should stop taking my melatonin sleep medication.”
3. “I should no longer drink grapefruit juice.”
4. “I should no longer drink sports drinks with caffeine in them.”
5. “I should stop taking my vitamin C supplement.”
1. “If I drink alcohol while taking this medication, I will get very sick to my stomach.”
The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “I have incorporated yoga into my exercise program.”
2. “I will monitor my daily sodium intake.”
3. “I will drink a glass of red wine daily to help lower my blood pressure.”
4. “I am receiving acupuncture to help me stop smoking.”
A male client states to the nurse, “I am going to stop taking my metoprolol (Lopressor). I have been experiencing problems having sex.” Which responses should the nurse include in the discussion with the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “I understand sexual dysfunction can be a common problem with this drug.”
2. “Perhaps it would be better if you took atenolol (Tenormin).”
3. “I cannot stop you from discontinuing the drug.”
4. “Stopping the prescription abruptly may cause your blood pressure to elevate even higher.”
5. “Try taking the drug early in the morning.”
4. Administer an intravenous solution of normal saline
The nurse is preparing to discuss the use of primary hypertensive agents with a client. Which prescriptions should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Thiazide diuretics
2. Angiotensin-II receptor blockers (ARBs)
3. Beta-adrenergic antagonists
4. Direct-acting vasodilators
5. Peripheral adrenergic antagonists
1. Thiazide diuretics
2. Angiotensin-II receptor blockers (ARBs)
A client asks the nurse how hypertension can lead to heart failure. Which response should the nurse provide the client?
1. “Hypertension increases the resistance in the blood vessels causing the heart to work harder to pump the blood out against the resistance of the arteries.”
2. “Hypertension limits the ability of the heart to stretch before emptying resulting in the heart working harder to pump the blood out into the arterial system.”
3. “Hypertension causes resistance in the venous system requiring the heart to work harder to pump the blood forward.”
4. “Hypertension limits the amount of blood entering the left ventricle increasing the workload of the heart to pump an adequate amount of blood into the circulatory system.”
A client in heart failure asks the nurse how difficulty breathing is related to a heart problem. Which information should the nurse provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “The right side of your heart has weakened and blood has entered your lungs.”
2. “The right side of your heart has enlarged and cannot effectively pump blood.”
3. “What you have is called congestive heart failure.”
4. “The left side of your heart is weak and pumps blood too quickly.”
5. “The left side of your heart has weakened and blood has entered your lungs.”
Which statements made by a client indicates an understanding of the education provided by the nurse regarding digoxin (Lanoxin) toxicity?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “I should limit my fluids while taking this medication.”
2. “It is okay to keep taking my ginseng.”
3. “If I have nausea, it means I must stop the medication.”
4. “I can drink orange juice every morning.”
5. “I must check my pulse and not take the medication if it is less than 60.”
The nurse has provided education for a client prescribed lisinopril (Prinivil). Which statement made by the client indicates further teaching is required?
1. “I will monitor my blood pressure until my next appointment.”
2. “I will avoid using salt substitutes for seasoning.”
3. “It takes a while for this medication to take effect.”
4. “I will not need to worry about having additional blood tests done.”
4. “I will not need to worry about having additional blood tests done.”
3. The client with chronic bronchitis
3. A 69-year-old African American male with hypertension
A client prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. Based on this information, which effect should the nurse be concerned about?
1. Hyponatremia
2. Hypermagnesemia
3. Increased effectiveness of furosemide (Lanoxin)
4. Decreased effectiveness of digoxin (Lanoxin)
4. Decreased effectiveness of digoxin (Lanoxin)
1. Angiotensin-converting enzyme (ACE) inhibitor
The nurse has provided education for a client with diabetes mellitus prescribed metoprolol (Lopressor) for hypertension. Which statement made by the client indicates an understanding of the information?
1. “I might not need to check my blood sugars as often with metoprolol (Lopressor).”
2. “I might be able to change from insulin to a pill with metoprolol (Lopressor).”
3. “I might need less insulin when I take metoprolol (Lopressor).”
4. “I might need more insulin when I take metoprolol (Lopressor).”
3. “I might need less insulin when I take metoprolol (Lopressor).”
Which information should the nurse include in the discharge plan for a client prescribed digoxin (Lanoxin)?
1. “Report the development of a metallic taste in the mouth.”
2. “Report mental changes such as feelings of depression.”
3. “Stop the prescription if your pulse is irregular.”
4. “If you miss a dose, take two doses.”
3. “Stop the prescription if your pulse is irregular.”
The nurse completes the dietary education for a client prescribed digoxin (Lanoxin). Which dietary choice indicates the client understood the teaching?
1. Cottage cheese, peach salad, and blueberry pie
2. Baked fish, sweet potatoes, and banana pudding
3. Green bean soup, whole-wheat bread, and an apple
4. Hamburger, French fries, and chocolate chip cookies
2. Baked fish, sweet potatoes, and banana pudding
Which client has the greatest risk for developing heart disease?
1. A 35-year-old with diabetes mellitus and prehypertension
2. A 75-year-old with Parkinson’s disease and normal blood pressure
3. A 52-year-old with osteoporosis and stage 1 hypertension
4. A 68-year-old with stage 2 hypertension and recent myocardial infarction
4. A 68-year-old with stage 2 hypertension and recent myocardial infarction
Which statement is accurate regarding the physiological changes associated with heart failure?
1. Blood backs up into the lungs due to right ventricular hypertrophy.
2. The walls of the heart shrink, leading to lower cardiac output.
3. Cardiac remodeling occurs after prolonged ventricular hypertrophy.
4. Blood pressure increases, resulting in lowered afterload.
3. Cardiac remodeling occurs after prolonged ventricular hypertrophy.
Which action of Lisinopril (Prinivil) results in a decrease in the blood volume?
1. Antagonistic effect on angiotensin-converting enzyme.
2. Decrease aldosterone secretion.
3. Causes hypernatremia and increased renal tubule permeability resulting in a diuretic effect.
4. Causes a diuretic effect by lowering the amount of sodium lost in the urine.
2. Decrease aldosterone secretion.
Which statement is accurate regarding the use of beta-adrenergic blockers for use in clients with heart failure?
1. Higher doses are used initially until optimal vital signs are achieved.
2. Dosage changes are done on a daily basis for the first 2 weeks.
3. This drug class does not have an effect on the bronchioles of the lungs.
4. They are generally used in combination with other heart-failure drugs.
4. They are generally used in combination with other heart-failure drugs.
Which findings should the nurse anticipate when assessing a client developing right-sided heart failure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Ankle edema
2. Enlarged liver
3. Displaced apical heart rate
4. Shortness of breath
5. Coughing
1. Ankle edema
2. Enlarged liver
3. Displaced apical heart rate
1. Uncontrolled hypertension
2. Coronary artery disease (CAD)
3. Diabetes (DM)
5. Mitral stenosis
Which statements made by the client indicate an understanding of the compensatory mechanisms associated with heart failure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. “My heart enlarged in order to compensate for the effects of heart failure.”
2. “My nervous system kicks in to compensate for the effects of heart failure.”
3. “My body will decrease blood flow to other organs in order to compensate for heart failure.”
4. “My body will increase urine output in order to compensate for the effects of heart failure.”
5. “My body will produce anti-inflammatory agents to compensate for heart failure.”
Which classifications of prescriptions are used to increase cardiac output by increasing the force of myocardial contractions?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Angiotensin receptor blockers
2. Cardiac glycosides
3. Adrenergic blockers
4. Phosphodiesterase inhibitors
5. Angiotensin-converting enzyme inhibitor
2. Cardiac glycosides
4. Phosphodiesterase inhibitors
2. Blood urea nitrogen (BUN)
3. Serum bilirubin
4. ALT/AST
3. Improve cardiac contractility
Which statement made by the client indicates an understanding of self-care while taking prescriptions to treat their heart failure?
1. “I will cut back on my smoking.”
2. “I will check my pulse every few days.”
3. “I will schedule my lab work if I am not feeling well.”
4. “I will weigh myself every day in the morning after I wake up.”
4. “I will weigh myself every day in the morning after I wake up.”