Pharm Review #2 Chapters 18, 19, 21 and 22,100% CORRECT

Pharm Review #2 Chapters 18, 19, 21 and 22 1) The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)? ...

Pharm Review #2 Chapters 18, 19, 21 and 22 1) The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)? Select all that apply. 1. "Nonpharmacological techniques are a good adjunct to pharmacotherapy." 2. "Nonpharmacological techniques have not reached mainstream yet." 3. "Nonpharmacological techniques may be used in place of drugs." 4. "Nonpharmacological techniques include an aerobic exercise." 5. "Nonpharmacological techniques are not usually valued by nurses." 2) The nursing instructor teaches the nursing students about neural mechanisms of pain. What does the nursing instructor teach about substance P? 1. Substance P modifies sensory information in the spinal cord. 2. Substance P is also known as an endogenous opioid. 3. Substance P stimulates pain receptors in the spinal cord. 4. Substance P controls which pain signals reach the brain. 3) A patient, addicted to heroin, is being treated for opioid dependence. He has been prescribed methadone (Dolophine). The patient asks how this will help because methadone (Dolophine) is another opioid. What is the best response by the nurse? 1. "Methadone (Dolophine) will make you really sick if you use heroin." 2. "Methadone (Dolophine) does not cause euphoria like heroin does." 3. "Methadone (Dolophine) cures your addiction to heroin." 4. "Methadone (Dolophine) causes you to have an allergy to heroin." 4) A nurse is providing community education on the increase in heroin use. Which information would be included? Select all that apply. 1. Heroin is an opioid drug. 2. Heroin is a narcotic drug. 3. Heroin causes CNS agitation. 4. Heroin is the same drug as morphine. 5. Heroin is not as dangerous as oxycodone. 5) The patient receives morphine for pain. He asks the nurse how it works to relieve pain. What is the best response by the nurse? 1. "It inhibits the primary pain neurotransmitters in your brain." 2. "It stimulates the receptors that secrete endorphins in your brain." 3. "It interacts with receptors in your body that produce analgesia." 4. "It promotes the primary pleasure neurotransmitters in your brain." 6) The patient has a patient-controlled analgesia (PCA) pump following surgery. The nurse keeps naloxone (Narcan) in the patient's room as per protocol. What does the nurse recognize as the rationale for this protocol? 1. Naloxone (Narcan) enhances the effect of the opioid in the patient-controlled analgesia (PCA) pump and increases analgesia. 2. Naloxone (Narcan) is the antidote if an anaphylactic reaction to the opioid in the patient-controlled analgesia (PCA) pump occurs. 3. Naloxone (Narcan) is available to treat any systemic side effects, like constipation, of the opioid in the patient-controlled analgesia (PCA) pump. 4. Naloxone (Narcan) will reverse the effects of the narcotic in the patient-controlled analgesia (PCA) pump if an overdose occurs. 7) What is a priority assessment question to ask a postsurgical patient prior to administration of an opioid analgesic? 1. "Have you ever been addicted to prescription pain medications?" 2. "Why do you want to receive this pain medication?" 3. "Would you like me to help you change your position for comfort?" 4. "Would you please rate your pain on a scale of 1 to 10?" 8) The postsurgical patient has an order for morphine 2 mg IV push every 2 hours and propoxyphene 100 (Darvon 100) every 3 hours. He received the morphine 2 hours ago and is complaining of pain again. What will the best plan of the nurse include? 1. Plan to administer the morphine again. 2. Plan to administer the propoxyphene 100 (Darvon 100). 3. Plan to have the patient do some distraction techniques. 4. Plan to assess the patient's level of pain. 9) The patient comes to the emergency department with a head injury, broken ribs, and internal bleeding. Opioid analgesics are contraindicated. What does the nurse recognize as the primary rationale for this? 1. The use of opioid analgesics will depress the patient's blood pressure. 2. The patient may not be able to communicate his level of pain. 3. Opioids will not effectively relieve pain in the patient's periphery. 4. Opioids can mask changes in the patient's level of consciousness 10) The patient receives morphine for pain. Which comment by the patient does the nurse assess to be a side effect of morphine? 1. "My ears are constantly ringing." 2. "My heart feels like it is skipping beats." 3. "I feel like I am going to throw up." 4. "I feel cold shivers all over." 11) The patient receives aspirin. The nurse assesses an adverse effect to this drug when the patient makes which response? 1. "My stools have been dark in color." 2. "My nose is stuffed up." 3. "Bright lights give me a headache." 4. "I have to get up a lot at night to urinate." 12) The nurse provides care for several patients. For which patient would the nurse assess acetaminophen (Tylenol) to be contraindicated? 1. A 2-year-old with a high fever due to the flu 2. A 65-year-old with osteoarthritis 3. A 19-year-old with a bladder infection 4. A 55-year old who drinks alcohol 13) What is an important instruction for the nurse to give to the patient who is taking acetaminophen (Tylenol)? 1. "Check your gums for bleeding when taking acetaminophen (Tylenol)." 2. "Do not take any narcotics with acetaminophen (Tylenol)." 3. "You may experience diarrhea while taking acetaminophen (Tylenol)." 4. "Acetaminophen (Tylenol) can cause drowsiness." 14) The patient is to start on sumatriptan (Imitrex) for migraine headaches. What will the best plan of the nurse include as it relates to this medication? Select all that apply. 1. Plan to teach the patient not to drive until the effects of the medication are known. 2. Plan to teach the patient to avoid pseudoephedrine (Sudafed) with this medication. 3. Plan to teach the patient the importance of taking the medication with protein. 4. Plan to instruct the patient to take the medication with food to avoid ulcers. 5. Plan to teach the patient to increase fluid intake with this medication. 15) A patient complains of dull, aching pain in the lower back. The nurse plans to provide relief from which kind of pain? 1. Acute pain 2. Somatic pain 3. Neuropathic pain 4. Visceral pain 16) Identify the correct statement regarding the neural mechanism of pain. 1. Once the pain impulse reaches the spinal cord, neurotransmitters inhibit the signal. 2. Alpha fibers are wrapped in myelin; C fibers are not. 3. When tissues are damaged, pain impulses go directly to the brain via alpha and beta fibers. 4. Myelin is a substance that slows nerve transmission. 17) The nurse educator is reviewing the process of pain transmission. Students should place these steps in which sequence? 3. Nociceptors are stimulated. 2. A and C fibers transmit the pain signal. 4. Pain impulses reach the spinal cord. 1. Substance P continues pain message. 5. Pain impulses reach the brain. 18) Identify the correct statement regarding opioid receptors. 1. The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint. 2. Drugs that block opioid receptors inhibit the pain impulse. 3. Opioid agonists will activate mu and kappa receptors, producing analgesia. 4. Opioids exert their actions by interacting with a total of three receptors. 19) A patient brought to the emergency department for oxycodone overdose has a respiratory rate of 8 and is difficult to arouse. What is the priority nursing intervention? 1. Administering activated charcoal 2. Administering an opioid agonist 3. Administering an opioid antagonist 4. Preparing for intubation and mechanical ventilation 20) Which finding is an adverse effect associated with morphine and would be the priority if present? 1. The patient is very restless and cannot lie still. 2. The patient has not had a bowel movement in 3 days. 3. The patient’s respiratory effort is slow and shallow. 4. The patient says, “I can’t live without my morphine patches.” 21) Which patient would be at greatest risk for developing opioid dependence? 1. 24-year-old with sickle-cell anemia 2. 33-year-old with diabetes 3. 17-year-old with a broken arm 4. 75-year-old with congestive heart failure 22) Which statement is accurate concerning the management of migraine headaches? 1. Acute treatment and prevention are achieved via the same medications. 2. There are no pharmacologic agents available to prevent migraine headaches. 3. NSAIDs are used to prevent migraine development. 4. Vasoconstriction of cranial arteries helps reduce acute headache pain. 23) For which patient suffering a migraine headache would sumatriptan (Imitrex) be indicated? 1. 73-year-old with angina pectoris 2. 36-year-old female with preeclampsia 3. 45-year-old diabetic male 4. 27-year-old asthmatic male 24) Which statement is accurate concerning the use of aspirin (ASA) to treat pain? 1. High doses are necessary (1 gram) to achieve anticoagulant effects. 2. Enteric-coated capsules are available to reduce GI side effects. 3. Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects. 4. In low doses (325 mg), it significantly reduces inflammation. 25) How should the nurse plan to manage caring for patients in pain? Select all that apply. 1. Treat all patients alike. 2. Listen carefully to the patient's comments about pain. 3. Show respect for the patient's preferences. 4. Ask questions about the patient's beliefs and customs regarding pain management. 5. Watch how other nurses provide care to their patients. 26) The patient has advanced cancer and is experiencing pain. How should the nurse plan to manage this pain? Select all that apply. 1. Monitor for subtle signs of pain. 2. Set up a dosing schedule that provides for around-the-clock doses. 3. Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose. 4. Augment the patient's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain. 5. Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated. 27) During report on a newly assigned patient, the nurse learns that buccal fentanyl has been ordered. What can the nurse learn from this information? Select all that apply. 1. The patient is already on fentanyl. 2. The patient has breakthrough pain. 3. The patient is opioid naïve. 4. The patient has migraine headaches. 5. The patient is a child under 16 years of age. 28) What medication teaching would the nurse provide for a patient who is newly prescribed a nasal medication for migraine headache?Select all that apply. 1. Use the medication at the first sign of migraine. 2. Overusing this medication may result in rebound headaches. 3. Instill the spray into one nostril only. 4. Increase dietary intake of tyramine-containing foods. 5. Pain relief will not begin for up to an hour after administration. 29) The patient has been started on morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?Select all that apply. 1. Use the prn order of MiraLax routinely every night. 2. Ask the dietary department to add bran cereal to the patient's breakfast trays. 3. Ask the health care provider to write an order for an indwelling urinary catheter. 4. Review the trending of the patient's daily weights. 5. Check the medical record for a prn order for an antiemetic. 30) The patient has been keeping a "headache diary" of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The patient reports that she "generally just lies down until they pass" but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed? Select all that apply. 1. Ibuprofen 2. Acetaminophen 3. Sumatriptan (Imitrex) 4. Ergotamine (Ergostat) 5. Amitriptyline (Elavil) 31) The nursing instructor teaches the nursing students about the advantages of local anesthetics, such as lidocaine (Xylocaine). What will the best plan of the nursing instructor include? Select all that apply. 1. Amides have fewer side effects than esters. 2. Amides block potassium entry into the cell. 3. Amides are similar in structure to cocaine. 4. Amides tend to last longer than esters. 5. Amides block calcium entry into the cell. 32) The patient has entered Stage 3 of general anesthesia, known as surgical anesthesia. What will the best assessment of the nurse reveal? 1. Heart rate and breathing become irregular. 2. General sensation is lost, but the patient remains conscious. 3. The medulla region of the brain is paralyzed. 4. Relaxation, stable respiration, and slow eye movements 33) The nurse teaches the patient about the correct use of a topical anesthetic for a skin condition. The nurse determines that learning has occurred when the patient makes which statements? Select all that apply. 1. "This lotion should only be used on small areas of skin." 2. "I must wear gloves when I apply the lotion." 3. "This lotion works well on cuts too." 4. "I must wash my hands before touching my eyes." 5. "It's all right to use a lotion after the expiration date." 34) What does the nurse recognize as the most dangerous adverse effect of volatile liquid inhalation anesthesia? 1. Hypertension 2. Ventricular tachycardia 3. Malignant hyperthermia 4. Increased intracranial pressure 35) The patient receives succinylcholine (Anectine). What will be a priority assessment by the nurse? 1. Spontaneous bleeding 2. Respiratory paralysis 3. Anaphylactic shock 4. Delirium 36) The student nurse does an operating room rotation and notes that many patients receive succinylcholine (Anectine). The student nurse asks the nursing instructor how the drug works. What is the best response by the nursing instructor? 1. "It causes the patient to rapidly lose consciousness." 2. "It increases cardiac output by raising the heart rate." 3. "It interferes with impulse transmission, resulting in total anesthesia from the pain of surgery." 4. "It reduces the amount of general anesthetic needed for procedures." 37) The patient has a serious laceration to the arm. The patient receives a local anesthetic mixed with epinephrine prior to suturing. What does the nurse recognize as the rationale for the epinephrine? 1. Constricted blood vessels will extend the duration of action of the drug. 2. Constricted blood vessels will decrease the amount of pain experienced. 3. Constricted blood vessels will promote relaxation of the patient. 4. Constricted blood vessels will result in decreased bleeding. 38) Which patient is most likely to experience an adverse reaction to inhalation anesthesia? 1. A 15-year-old with diabetes mellitus 2. A 6-year-old with no chronic health problems 3. A 79-year-old with arteriosclerosis 4. A 55-year-old with a serious neck injury 39) The patient is in Stage 2 of general anesthesia. What are the priority nursing interventions at this time? 1. Assist the anesthesiologist in repositioning the patient. 2. Complete the surgical scrub. 3. Keep the environment quiet and calm. 4. Insert the indwelling urinary catheter. 40) A pregnant woman has a malignant melanoma on her leg and will need surgery. She is concerned about anesthesia. What is the best response by the nurse? 1. "You will probably have an epidural, and this won't harm your baby." 2. "There are newer general anesthetics available that are safe for your baby." 3. "You will most likely have local anesthesia; this will not affect your baby." 4. "Inhalation anesthetics are safe because they remain in your lungs." 41) The patient is scheduled for a surgical procedure. The nurse plans to teach the patient about anesthesia. Which statement would be included in the best plan of the nurse? 1. "An inhaled agent needs to be followed by an intravenous (IV) agent if it is ineffective." 2. "An inhaled agent is used to induce sleep, followed by an intravenous (IV) agent for relaxation." 3. "An intravenous (IV) agent to induce sleep is usually all that is required." 4. "An intravenous (IV) agent will be used first to induce sleep; then, an inhaled agent will be used." 42) The 2-year-old child comes to the emergency department with a laceration to the lower leg. The physician plans to use a local anesthetic, but the child screams at the sight of the needle. What is the best action by the nurse? 1. Wrap the child in a blanket to restrain him and ensure safety during suturing. 2. Rub a local anesthetic cream on the skin so the child will not feel the needle. 3. Administer a small dose of a medication such as lorazepam (Ativan). 4. Ask the parents to leave the room so the child will quiet down. 43) The patient has gastroesophageal reflux disease and receives lidocaine viscous prior to an endoscopy. What will be the nurse’s priority assessment immediately after the procedure? 1. Assess for a return of the gag reflex. 2. Assess for nausea and vomiting. 3. Assess for any damage to the teeth or gums. 4. Assess for a headache. 44) Which clinical technique for administering anesthesia is common for pregnant women during labor and delivery? 1. Nerve block 2. Topical 3. Infiltration 4. Epidural 45) Local anesthetics work by 1. enhancing the influx of calcium into the cell. 2. occupying potassium receptors. 3. increasing nerve impulse transmission. 4. blocking sodium channels. 46) Which local anesthetic agent would be considered for use first due to its lower rate of adverse effects? 1. Tetracaine (Pontocaine) 2. Procaine (Novocain) 3. Lidocaine (Xylocaine) 4. Chloroprocaine (Nesacaine) 47) A patient with severe cardiac disorder requires closure of a deep laceration. The nurse would advocate for which plan for analgesia? 1. Plain epinephrine 2. Laceration repair without anesthesia 3. Topical application of lidocaine gel 4. Injected lidocaine without epinephrine 48) Which statement correctly identifies a sign of general anesthesia? 1. A sleeping state that can be awakened easily 2. An unconscious state, without analgesia 3. A total loss of body movements 4. A conscious but sleepy state of being 49) Which statement correctly identifies the initial use for an IV in a patient undergoing a lengthy abdominal surgery that requires general anesthesia? 1. To administer agents that will produce rapid unconsciousness 2. To administer reversal agents or other medications used to treat the adverse effects associated with general anesthesia 3. To administer large amounts of colloid solutions following surgical blood loss 4. To administer a volatile liquid that will keep the patient asleep 50) Which description correctly identifies a state of general anesthesia desirable for surgery? 1. The patient is unconscious, with arm and leg movement. 2. The patient is not responsive to pain, and has no spontaneous breathing. 3. The patient is unconscious with slow eye movements. 4. The patient loses sensation, but is awake. 51) A patient undergoing surgery is receiving general anesthesia as well as a neuromuscular blocking agent. Which statement best indicates the primary reason for the neuromuscular blocking agent? 1. To potentiate analgesic effects 2. To prevent adverse effects associated with inhaled gases 3. To cause total skeletal muscle relaxation 4. To induce unconsciousness 52) Midazolam (Versed) may be administered as part of surgical anesthesia. This drug is recognized as having which effects? Select all that apply. 1. Producing effects consistent with those observed in administering other benzodiazepines 2. Reducing anxiety and stress associated with surgery 3. Producing central nervous system depression and skeletal muscle relaxation 4. Maintaining stable cardiac and respiratory activity 5. Preventing cardiac dysrhythmias 53) Balanced anesthesia is the use of a combination of medications to produce general anesthesia. Which drugs may be used in combination? Select all that apply. 1. Benzodiazepines 2. Neuromuscular blockers 3. Inhaled anesthetics 4. Proton-pump inhibitors 5. Intravenous anesthetics 54) Preoperative adjunct medications are used for which reasons? Select all that apply. 1. To reduce anxiety and facilitate sedation 2. To facilitate a faster recovery 3. To reduce the risk of aspiration pneumonia 4. To reduce the risk of a postoperative ileus 5. To manage pain 55) The nurse explaining epidural anesthesia to a patient would indicate which area as the placement for this type of anesthesia? 1. A 2. B 3. C 4.D 56) A patient who has history of severe arteriosclerosis has sustained a laceration on the forearm that will be repaired in the emergency department. The nurse would plan to obtain a local anesthetic with which properties? Select all that apply. 1. With no epinephrine 2. With sodium bicarbonate 3. Without lidocaine 4. With a volatile liquid 5. With proparacaine (Alcaine) 57) A novice nurse says, "We want to keep our patients in Stage 4 anesthesia during their surgery." How should the supervising nurse interpret this statement? Select all that apply. 1. The novice nurse has made an error in this statement. 2. Stage 4 anesthesia is avoided. 3. This is a good description of the goal of anesthesia. 4. The novice nurse should have said Stage 3 anesthesia. 5. A more accurate statement would be that the patient is maintained in anxiolysis anesthesia. 58) A patient has multiple lacerations following a motor vehicle accident. The nurse will be certain that lidocaine without epinephrine is used for local anesthesia when lacerations of which areas are repaired? Select all that apply. 1. Laceration to the cheek 2. Laceration to the earlobe 3. Laceration to the end of the nose 4. Laceration on the top of the foot 5. Laceration on the fingertip 59) A patient has inadvertently received two doses of propofol (Diprivan) within 2 minutes of one another. What nursing actions are indicated? Select all that apply. 1. Increase intravenous fluid rate. 2. Monitor the patient closely for development of an allergic skin reaction. 3. Monitor the patient closely for respiratory depression. 4. Have serum calcium levels drawn immediately. 5. Administer a benzodiazepine. 60) A patient is scheduled for an operative procedure in which isoflurane (Forane) will be used as the anesthetic agent. The nurse would immediately collaborate with the anesthesiologist if the patient makes which statements?Select all that apply. 1. “I stopped taking my vitamin C supplement last week because it upset my stomach.” 2. “I have been so depressed about having this surgery. I don’t think my St. John’s wort is helping at all.” 3. “I have not eaten anything since before my CT scan yesterday.” 4. “My brother ran a high fever and had seizures after his surgery.” 5. “My last dose of levodopa was yesterday.” 61) The nurse teaches a class about muscle movement to a group of patients who have neuromuscular disorders. What will the best plan of the nurse include? Select all that apply. 1. Body movement depends on an intact spinal cord. 2. Body movement depends on proper functioning of muscles. 3. Body movement depends on intact nerves. 4. Body movement depends on proper endocrine functioning. 5. Body movement depends on the level of consciousness. 62) The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include? Select all that apply. 1. Application of heat or cold 2. Ultrasound 3. Massage 4. Relaxation techniques 5. Guided imagery 63) The patient is started on a medication to treat a neuromuscular disorder. What does the nurse teach as the primary therapeutic goal of the medication? 1. To stop the patient's muscle spasms 2. To improve the patient's appearance 3. To promote exercise in the patient 4. To allow the patient increased independence 64) The patient receives dantrolene (Dantrium) for muscle spasticity. Which lab result is a priority for the nurse to assess? 1. Creatinine clearance 2. Serum amylase 3. Hemoglobin and hematocrit 4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 65) The patient takes a skeletal muscle relaxer for back pain. A consulting physician orders hydroxyzine (Vistaril) for the patient and he begins taking it. What will the best assessment by the nurse reveal? 1. Confusion 2. Hypertension 3. Respiratory depression 4. Delirium 66) The physician has ordered dantrolene (Dantrium) for a patient. What is a priority assessment by the nurse prior to administering this medication? 1. Does the patient have gastric ulcer disease? 2. Does the patient have psoriasis? 3. Does the patient have gallbladder disease? 4. Is the patient pregnant or lactating? 67) The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include? 1. Increase the intake of fiber while taking this medication. 2. Restrict the intake of sodium while taking this medication. 3. Increase the intake of protein while taking this medication. 4. Do not drink any caffeine while taking this medication. 68) The patient is treated for muscle spasms following a spinal cord injury. What is the best outcome for this patient? 1. Patient will have stabilized vital signs. 2. Patient will have an improved self-concept. 3. Patient will sleep without pain. 4. Patient will have increased bladder tone. 69) The patient tells the nurse that she awakens frequently during the night because of leg and foot cramps. What is the best response by the nurse? 1. "Ask your physician for a muscle relaxant." 2. "Increase your intake of vitamin B6." 3. "Take a warm bath before going to bed." 4. "Apply heat to relieve the cramping." 70) The patient receives dantrolene (Dantrium). Which medication would the nurse evaluate as being contraindicated with dantrolene (Dantrium)? 1. Verapamil (Calan) 2. Insulin 3. Clarithromycin (Biaxin) 4. Methylphenidate (Concerta) 71) The patient receives dantrolene (Dantrium) intravenously (IV). What will a priority assessment by the nurse include? 1. Assessing the patient's urinary output 2. Assessing the patient's blood glucose 3. Assessing the patient's breath sounds 4. Assessing the patient's intravenous (IV) site 72) Which list of treatment options would be considered optimal for treating a muscle spasm with an unknown cause? 1. Anti-inflammatory agents, casting, and ultrasound 2. Analgesics, antibiotics, and heat application 3. Analgesics, muscle relaxants, and massage 4. Anti-inflammatory agents, immobilization, and fluid and electrolyte replacement 73) Which statement about skeletal muscle relaxants is correct? 1. They inhibit upper motor neuron activity within the central nervous system. 2. They work primarily by stimulating the peripheral nervous system. 3. They increase the amount of neurotransmitter within the muscles. 4. They stimulate motor activity within the brainstem. 74) The nurse identifies a patient with a repeating pattern of muscle contraction of the leg for 5 seconds followed by 2 seconds of relaxation as experiencing 1. a clonic spasm. 2. a tonic spasm. 3. spasticity. 4. dystonia. 75) Which change is a common adverse effect of cyclobenzaprine (Flexeril)? 1. Alopecia 2. Tongue swelling 3. Drowsiness 4. Hypotension 76) Which statement describes the primary difference between centrally acting muscle relaxants and direct-acting antispasmodics? 1. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents stimulate neurons of the central nervous system. 2. Centrally acting agents stimulate neurons of the central nervous system, while direct-acting agents stimulate neurons of the peripheral nervous system. 3. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles. 4. Centrally acting agents stimulate the central nervous system, while direct-acting agents inhibit neuronal conduction of the central nervous system. 77) Which patient suffering from muscle spasms should not receive the direct-acting antispasmodic medication dantrolene sodium (Dantrium)? 1. 20-year-old suffering from a spinal cord injury 2. 57-year-old suffering from congestive heart failure 3. 40-year-old suffering from multiple sclerosis 4. 65-year-old suffering from a cerebral vascular accident 78) Spasticity is most commonly caused by damage to what area of the body? 1. Cerebral cortex 2. Peripheral nerves 3. Brainstem 4. Spinal cord 79) Which statement is correct in regard to the muscle relaxant botulinum toxin type B (Myobloc)? 1. It can be classified as a cholinergic agonist. 2. Increased muscle strength is often seen within a couple of weeks. 3. It can take 6 months for the effects to be seen. 4. In high doses, it is poisonous, causing the same symptoms food poisoning does. 80) A patient tells the nurse, "I have been reading about using capsaicin as a treatment for muscle pain. Do you know anything about that?" How should the nurse respond to this question? Select all that apply. 1. "Why don't you ask the doctor about whether it works or not?" 2. "I think you take a tablespoon twice a day." 3. "You should use a hot pad on the site prior to applying the capsaicin." 4. "Some patients report that capsaicin stings." 5. "Be certain to wash your hands after applying the capsaicin." 81) A nurse is providing discharge instruction for a patient who had onabotulinumtoxinA (Botox) injected to smooth the wrinkles across his forehead. The nurse would advise this patient to monitor for which changes?Select all that apply. 1. Chest pain 2. Urinary retention 3. Heart palpitations 4. Difficulty swallowing 5. Eye spasm 82) The parents of a 2-year-old who has cerebral palsy are only now beginning to accept that their child will have a permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions? Select all that apply. 1. "At some point, our child may require surgery to correct this spasticity." 2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 4. "We should repeat the exercises several times with each muscle group." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month." 83) The patient tells the nurse, "The doctor is going to start me on Botox for the muscle spasms in my neck. I've always wanted to try that. It will make my face look younger." What information should the nurse provide to this patient regarding onabotulinumtoxinA (Botox)? Select all that apply. 1. "Once you start on the medication, it may take a week or so before you notice a change in your skin." 2. "Be certain you take the medication with a full glass of water because it can be hard on your kidneys." 3. "There are many different uses for that drug, depending on how it is administered." 4. "You may need additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment." 84) The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patient's health care provider? Select all that apply. 1. The dosage amount is too low for the type of injury this patient sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food. 85) The nurse would plan to most closely observe which patients for the development of liver toxicity after dantrolene (Dantrium) is initiated? Select all that apply. 1. A 49-year-old woman who has a history of esophagitis. 2. A 60-year-old man with pneumonia. 3. A 38-year-old woman who has type 2 diabetes. 4. An 18-year-old who injured his leg playing soccer. 5. A 26-year-old woman who has an ostomy. 86) A patient experienced malignant hyperthermia after receiving anesthesia and is being maintained on dantrolene (Revonto). The nurse would increase assessment for which findings?Select all that apply. 1. Swelling at the IV site 2. Muscle weakness 3. Sore throat 4. Irritability 5. Anorexia 87) The nurse is managing care for a group of patients with substance use disorder. The patients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the patients make which statements? Select all that apply. 1. "Heroin addicts often die from heroin withdrawal." 2. "Substance abuse depends on complex variables." 3. "Most addicts became addicted from pain medication in a hospital." 4. "Addiction includes a compulsion to use a mood-altering substance." 5. "There is most likely a genetic component to addiction." 88) The adolescent patient is in a drug rehabilitation program. The mother of this patient says to the nurse, "The doctor said my son has a physical addiction to alcohol. What does this mean?" What is the best response by the nurse? 1. "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it." 2. "He will have an intense craving for alcohol; this is best managed in group therapy." 3. "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped." 4. "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide." 89) The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon? 1. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient. 2. The patient has developed a paradoxical reaction to the anesthesia and will require a different drug. 3. The patient has developed a resistance to the anesthesia, so it will not work very well. 4. The patient has developed cross-tolerance to the anesthesia and will require higher amounts. 90) The patient comes to the emergency department and tells the nurse, “I am going to get clean. I haven’t had any drugs or any alcohol for 2 days.” The nurse plans care based on the knowledge that withdrawal from which substance can be life threatening? 1. Heroin 2. Alcohol 3. Cocaine 4. Marijuana 91) The mother of an adolescent patient says to the nurse, "I think my son is staying up too late studying. He seems listless, and I see him using eye drops all the time for his red eyes. Should I have his vision checked?" What is the best response by the nurse? 1. "He might be depressed; insomnia is common with depression." 2. "He could be smoking marijuana, and I would talk to him." 3. "Sounds like he is using cocaine; I have seen this before." 4. "Yes, that is a great idea; he may need some glasses." 92) The patient has been abusing alcohol for several years and tells the nurse, "I used to drink a pint of whiskey every day. Now I get sick and pass out after just two drinks." What does the nurse correctly recognize about this patient? 1. The patient's symptoms are related to hyperglycemia; he may have pancreatic damage. 2. The patient may have liver damage, resulting in an inability to metabolize large amounts of alcohol. 3. The patient is in denial and is most likely minimizing the amount of alcohol he consumes. 4. The patient has brain damage from the alcohol and cannot remember how much he consumes. 93) The patient is withdrawing from opioids. Which symptoms best describe the results of the nurse's assessment? Select all that apply. 1. Abdominal cramping and pain 2. Positional fluctuations in blood pressure 3. Hot, dry skin 4. Goose bumps 5. Agitation 94) What is a priority outcome for the patient who has chronic alcoholism with liver damage? 1. The patient will switch to a safer drug, like a benzodiazepine. 2. The patient will become involved in Alcoholics Anonymous (AA). 3. The patient will keep all appointments with the doctor treating his liver damage. 4. The patient will learn to drink more responsibly. 95) The patient is admitted to the in-patient substance abuse unit. She tells the nurse she has been buying "yellow jackets" (pentobarbital, [Nembutal]) on the street but hasn't had any for a few days. What is the best plan by the nurse at this time? 1. Prepare to manage the depression and suicidal thoughts the patient will have. 2. Prepare to do frequent room searches, as the patient's friends will most likely bring drugs in for her. 3. Prepare to manage a withdrawal that could be life threatening. 4. Prepare to manage a withdrawal that will likely be minimal. 96) The patient had been abusing cocaine for several years. Recently, the patient snorted cocaine that was much purer than was thought, resulting in an overdose. The patient died in the emergency department. What does the nurse recognize as the most likely cause of death? 1. Cardiac arrest 2. Rhabdomyolysis 3. Impurities in the cocaine 4. Bowel ischemia 97) The patient has smoked a pack of cigarettes per day for 20 years. The patient also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include? 1. “You are at a higher risk for a heart attack than nonsmokers.” 2. “The nicotine will decrease the effectiveness of your birth control pills.” 3. “You are at a higher risk for developing diabetes than smokers who do not use birth control pills.” 4. “You are at a higher risk for emphysema than nonsmokers.” 98) The patient has been prescribed disulfiram (Antabuse) to discourage a return to drinking alcohol. The patient tells the nurse that after stopping disulfiram (Antabuse) for a week, he returned to drinking alcohol. What will the nurse most likely assess in the patient? 1. Headache, nausea, and vomiting 2. Confusion and fine tremors 3. An absence of symptoms, as the drug was discontinued 4. Severe hyperglycemia and dry skin 99) The patient tells the nurse that her 12-year-old child asks to use her nail polish remover several times a day. When her friends come to visit, this seems to occur more frequently. What is the best response by the nurse? 1. "Your daughter may be 'huffing'; that is really scary." 2. "Your daughter may be 'huffing' or inhaling the remover." 3. "Your daughter may be 'huffing' or drinking small amounts of the remover." 4. "Your daughter may be 'huffing' or rubbing the remover on her skin." 100) Which questions would the nurse ask to assess for the presence of user-related factors in a patient with substance use disorder?Select all that apply. 1. “How many friends do you consider to be reliable?” 2. “Does anyone in your family have a substance use disorder?” 3. “Have you had any disorders for which you have taken prescription pain medications?” 4. “What is the highest level of education you completed?” 5. “How much disposable income do you have?” 101) A patient expresses concern about becoming addicted to a prescription pain medication ordered postoperatively. What nursing responses are indicated? Select all that apply. 1. “The dose of your medication is as low as possible.” 2. “You will only take the medication for a short time.” 3. “If you follow the suggested schedule, you have little risk of addiction.” 4. “If you need this medication, you cannot become addicted to it.” 5. “Take the medication now, and we will worry about addiction later.” 102) When an individual wants to stop using a drug but can’t, she would be suffering from 1. psychological dependence. 2. substance dependence. 3. physical dependence. 4. withdrawal syndrome. 103) The nurse would expect to see which withdrawal symptoms from a patient who abuses alcohol? 1. Lethargy, constipation, light sensitivity, and weight loss 2. Anxiety, seizures, hearing loss, and alopecia 3. Tremors, anxiety, confusion, and delirium 4. Abdominal pain, chills, pupil dilation, and lethargy 104) A hospice patient has been receiving oral pain medication for several weeks. The patient started with 4 mg of the drug, and each week has had to increase the amount by 2–3 mg to obtain adequate pain relief. The nurse recognizes that the patient 1. has developed immunity to the drug. 2. has developed a tolerance to the drug. 3. has developed a physiologic addiction to the drug. 4. has developed a psychological addiction to the drug. 105) Which drug is least likely to produce physical dependence or tolerance? 1. Marijuana 2. Morphine 3. Nicotine 4. Ethyl alcohol 106) During a health history, the nurse should use therapeutic communication when asking about substance abuse. Which of the following is essential to establish a trusting nurse–patient relationship? 1. Informing the patient that substance abuse is a sin 2. Avoiding communicating disapproval of indicated substance abuse 3. Ensuring that the patient's mother and father are at the bedside 4. Avoiding shocked facial expressions 107) A patient suffering from tachycardia and palpitations would most likely be experiencing the signs of drug toxicity from which of the following? 1. Nicotine 2. Alcohol 3. Benzodiazepines 4. Marijuana 108) The nurse manager is presenting an educational session on the issue of substance use disorder and nurses. The manager would focus information on which substances?Select all that apply. 1. Barbiturates 2. Benzodiazepines 3. Alcohol 4. Hallucinogens 5. Opioids 109) A nurse is preparing to admit a patient suspected of overdose. The nurse knows to suspect which drugs as being the most commonly abused? Select all that apply. 1. Methylphenidate (Ritalin) 2. Nicotine 3. Marijuana 4. Amobarbital (Amytal) 5. Secobarbital (Seconal) 110) The nurse is reinforcing factors that contribute to addiction to a group of patients recovering from addiction and their family members. Which statement made by a patient or family member would indicate the need for additional teaching? Select all that apply. 1. "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction." 2. "I can still see my friends as long as I stay away from alcohol." 3. "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to." 4. "I realize now that I was just looking for ways to help me feel good about myself." 5. "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills." 111) A patient has been abusing an antianxiety medication. Which assessment by the nurse would confirm this is psychological dependence instead of physical dependence? Select all that apply. 1. The patient's history reveals the long-term use of high doses of an antianxiety medication. 2. The patient describes the "need" to use the antianxiety medication despite not feeling anxious. 3. The patient describes feeling nauseous with abdominal cramping. 4. The patient tells you her family has "disowned" her because of her need for the antianxiety medication. 5. The patient complains she has not slept in days, feels anxious, and is tired. 112) The nurse is preparing care for a patient diagnosed with substance abuse of a Schedule I drug. Which drugs could be implicated?Select all that apply. 1. Methcathinone (Cat) 2. Ritalin 3. LSD 4. Cocaine 5. Mescaline 113) The nurse is providing education for a patient who desires to stop taking heroin. Which information should be included?Select all that apply. 1. “You are probably going to have some withdrawal symptoms, but there are medications that can help you.” 2. “Expect to remain on methadone for a long while.” 3. “Methadone will give you the same high as the heroin you have been using.” 4. “You will need a supply of syringes and needles for your methadone treatment.” 5. “Methadone will not cause any withdrawal symptoms” 114) A patient in the emergency department says, “I am having bad effects from the marijuana I smoked this morning.” The nurse formulates a response based on knowledge that effects of marijuana may last up to ____ hours. Record your answer rounding to the nearest whole number.24 hours 115) The nurse is providing community education regarding marijuana. Which information should be included?Select all that apply. 1. THC is the ingredient that causes most of the psychoactive effects. 2. Metabolites of marijuana can be detected in the urine for several days after last use. 3. Metabolites of marijuana can be detected in the body for months to years after last use. 4. The only medical use for marijuana is for glaucoma. 5. Smoking marijuana results in a greater accumulation of tar in the lungs than does cigarette smoking.