PPT Questions Flashcards
The patient says that the anesthesiologist told her that there were some risks associated with spinal anesthesia regarding blood pressure. She asks the nurse practitioner to explain them. How should the nurse practitionerrespond?
The spinal anesthetic is administered immediately before delivery, when the baby’s head is on the perineum and the cervix is fully dilated. If the patient’s blood pressure drops, fluids can be administered, and the patient can be positioned with a wedge under the hip to help raise the blood pressure.
Chapter 29
The patient asks the nurse practitioner about spinal headaches. She wants to know how the headache would be treated if she got one. How should the nurse practitionerreply?
Headaches after spinal anesthesia usually occur between 6 and 48 hours after the procedure. If a patient experiences a spinal headache, it is most often treated with analgesics, increased fluids, bed rest, and sometimes caffeine. Sometimes a small amount of the patient’s blood is injected into the spinal area; this is known as a blood patch.
Chapter 29
A patient has an allergy to chloroprocaine [Nesacaine]. What local anesthetic would be safe to administer to this patient?
A. Cocaine
B. Benzocaine [Americaine]
C. Lidocaine [Xylocaine]
D. Tetracaine
Answer: C. Lidocaine [Xylocaine]
Rationale: Individuals who are allergic to chloroprocaine should be considered allergic to all other ester-type anesthetics but not to the amides. Chloroprocaine, benzocaine, cocaine, and tetracaine are all esters. Lidocaine is an amide.
Chapter 29
Which patient would be at highest risk for systemic toxicity from the topical administration of a local anesthetic?
A. A 42-year-old patient who receives epinephrine with a local anesthetic
B. A 72-year-old patient who receives a local anesthetic that is topically applied to intact skin
C. A 58-year-old patient who receives a local anesthetic to a 10-cm×20-cm abrasion
D. A 34-year-old patient given an injection of bupivacaine as a nerve block
Answer: C. A 58-year-old patient who receives a local anesthetic to a 10-cm×20-cm abrasion
Rationale: The risk of toxicity is less if epinephrine is administered, because blood flow will be decreased (vasoconstriction), thus delaying the systemic absorption of the anesthetic. The risk of toxicity increases with a large surface area or an abraded area.
Chapter 29
An adult patient receives lidocaine by injection before a procedure. Which finding indicates that the patient is experiencing a systemic reaction and toxicity?
A. Mean arterial pressure of 75 mm Hg
B. Temperature of 100.8F (38.2C)
C. Heart rate of 42 beats/min
D. Respiratory rate of 12 breaths per minute
Answer: C. Heart rate of 42 beats/min
Rationale: Absorption into the general circulation can cause systemic toxicity, and effects on the central nervous system and the heart are of greatest concern. Central nervous system toxicity manifests as a brief period of excitement, possibly including convulsions; this is followed by central nervous system depression, which can result in respiratory depression. Cardiotoxicity can manifest as bradycardia, atrioventricular heart block, and cardiac arrest.
Chapter 29
The APN assesses the patient’s respiratory rate to be 6 breaths per minute. The APN reviews the order for naloxone, which states the following: Administer 0.1 mg naloxone by mouth for a respiratory rate of less than 8 breaths per minute. What is the most appropriate response by the nurse?
The nurse should question this order. Although the 0.1 mg dose of naloxone is the recommended dose for an adult, the drug cannot be administered by mouth. Naloxone cannot be used orally because of its rapid first-pass inactivation.
Routes for naloxone administration include intravenous, intramuscular, and subcutaneous. For the treatment of postoperative opioid effects, initial therapy for adults consists of 0.1 to 0.2 mg given intravenously and repeated every 2 to 3 minutes until an adequate response has been achieved.
Additional doses may be required at 1- to 2-hour intervals.
Chapter 31
After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the APN to make which assessment?
A. Respiratory rate
B. Heart rate
C. Pain level
D. Constipation
Answer: A. Respiratory rate
Rationale: Monitoring the respiratory rate in all patients who are receiving morphine is a priority. If the respiratory rate is 12 or fewer breaths per minute, the nurse should withhold the medication and notify the prescriber.
Chapter 31
A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient?
A. Methadone [Dolophine]
B. Nalbuphine [Nubain]
C. Tramadol [Ultram]
D. Naloxone [Narcan]
Answer: D. Naloxone [Narcan]
Rationale: After surgery, naloxone may be used to reverse the excessive respiratory and central nervous system depression that can be caused by opioids.
Chapter 31
A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question?
A. Promethazine [Phenergan]
B. Pentazocine [Talwin]
C. Methylnaltrexone [Relistor]
D. Dextromethorphan [Delsym]
Answer: B. Pentazocine [Talwin]
Rationale: Pentazocine is an agonist-antagonist opioid. If pentazocine is given to a patient who is physically dependent on a pure opioid agonist such as morphine, withdrawal or abstinence syndrome will occur. Before an agonist-antagonist is administered, the patient should be slowly withdrawn from the opioid agonist.
Promethazine is an antiemetic that may be given with opioids to reduce nausea and vomiting, but it may also result in increased constipation and urinary retention.
Methylnaltrexone is a selective mu opioid antagonist indicated for opioid-induced constipation; the drug does not block opioid receptors in the CNS. Methylnaltrexone does not decrease analgesia and cannot precipitate opioid withdrawal.
Dextromethorphan may increase analgesia and reduce tolerance to morphine.
Chapter 31
Which manifestations does the APN associate with tardive dyskinesia?
A. Pacing and squirming, with an uncontrollable need for motion
B. Mask-like face with drooling, tremors, rigidity, and shuffling gait
C. Twisting, worm-like movements of the tongue and face
D. Sudden high fever, sweating, and blood pressure fluctuations
**Answer: C. Twisting, worm-like movements of the tongue and face
Rationale: Tardive dyskinesia is characterized by involuntary twisting, writhing, worm-like movements of the tongue and face.
Parkinsonism is characterized by a mask-like face with drooling, tremors, rigidity, and shuffling gait.
Akathisia is characterized by pacing and squirming, with an uncontrollable need for motion.
Neuroleptic malignant syndrome is characterized by sudden high fever, sweating, and fluctuations in blood pressure.
Chapter 34
A patient is diagnosed with type 2 diabetes mellitus and schizophrenia. The APN will closely monitor the blood sugar if the patient receives which medication for the treatment of schizophrenia?
A. Loxapine [Loxitane]
B. Clozapine [Clozaril]
C. Thiothixene [Navane]
D. Haloperidol [Haldol]
Answer: B. Clozapine [Clozaril]
Rationale: Second-generation antipsychotics such as clozapine carry a higher risk of serious metabolic effects (eg, diabetes and dyslipidemia) than first-generation antipsychotics (eg, loxapine, thiothixene, and haloperidol).
Among the second-generation antipsychotics, the risk of metabolic effects is greatest with clozapine and olanzapine.
Clozapine should be used with caution in patients with diabetes.
Chapter 34
The APN prepares to administer the first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the APN to assess what?
A. The range of motion of the upper and lower extremities
B. The orthostatic blood pressure measurements
C.The abdomen for distention and bowel sounds
D.The tympanic membrane with an otoscope
Answer: B. The orthostatic blood pressure measurements
Rationale: Antipsychotic drugs promote orthostatic hypotension. The blood pressure and pulses should be checked before dosing and 1 hour afterward. Measurements should be taken while the patient is lying down and again after the patient has been sitting or standing for 1 to 2 minutes.
Hypotension is more likely with low-potency first-generation antipsychotics than with high-potency first-generation antipsychotics. Tolerance to hypotension develops after 2 to 3 months.
Chapter 34
A patient with depression has been prescribed fluoxetine [Prozac]. Which statement made by the patient indicates an understanding of the medication teaching?
A. “Disorientation and hallucinations are common.”
B. “The drug may enhance my interest in sex.”
C. “It may take 3 to 4 weeks before my mood is elevated.”
D. “I can stop this medication when I feel less depressed.”
Answer: C. “It may take 3 to 4 weeks before my mood is elevated.”
Rationale: The half-life of this drug is prolonged; therefore, approximately 4 weeks of treatment are required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop after 1 to 3 weeks. Maximal responses develop in 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (eg, impotence, delayed or absent orgasm, delayed or absent ejaculation, and decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor or ritonavir. The abrupt discontinuation of fluoxetine can cause withdrawal syndrome (eg, dizziness, headache, nausea, tremor, anxiety, and dysphoria).
Chapter 35
A patient is prescribed isocarboxazid [Marplan] for the treatment of depression. Which foods should the patient be taught to avoid?
A. Broccoli, shrimp, and yogurt
B. Tomatoes, chicken, and milk
C. Bananas, smoked fish, and cheese
D. Apples, steak, and cottage cheese
Answer: C. Bananas, smoked fish, and cheese
Rationale: Foods that are high in tyramine should be avoided if a patient is taking a monoamine oxidase inhibitor such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine to cause massive vasoconstriction and the excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.
Chapter 35
A patient is prescribed doxepin [Sinequan] for the treatment of depression. Which over-the-counter medication should the nurse practitioner teach the patient to avoid?
A. Glucosamine sulfate
B. Omeprazole [Prilosec]
C. Fish oil (omega-3 fatty acids)
D. Diphenhydramine [Benadryl]
Answer: D. Diphenhydramine [Benadryl]
Rationale: Drugs that are capable of blocking muscarinic receptors will enhance the anticholinergic effects of doxepin and other tricyclic antidepressants.
The nurse should warn patients against the concurrent use of other anticholinergic drugs such as scopolamine, antihistamines, and phenothiazines. Diphenhydramine is an antihistamine.
Chapter 35
The nurse practitioner teaches a patient about bupropion [Wellbutrin]. Which statement by the patient indicates that more teaching is indicated?
A. “I can take the drug with food to reduce nausea.”
B. “This drug will increase my interest in sex.”
C. “I may experience decreased appetite and weight loss.”
D. “I had a serious head injury 3 years ago.”
Answer: D. “I had a serious head injury 3 years ago.”
Rationale: Bupropion is generally well tolerated, but it can cause seizures. Therefore, bupropion should be avoided in patients with prior head trauma, because their risk for seizures is increased.
Bupropion does not cause weight gain or sexual dysfunction, and it appears to increase sexual desire and pleasure.
Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset.
Chapter 35
A 24-year-old woman has been diagnosed with BPD. The patient has an order to receive lithium. Before administering the medication, it is most appropriate for the nurse practitioner to assess what?
Answer: In addition to standard practice performed before the administration of any drug, before administering lithium, the nurse should make baseline determinations of the patient’s cardiac status, serum electrolyte levels, renal function, hematologic status, and thyroid function.
The nurse should also assess whether the patient is pregnant or plans to become pregnant, because lithium should be avoided during the first trimester of pregnancy.
Chapter 36
When providing patient teaching regarding lithium therapy, what are some of the specifics the nurse practitionershould include related to this medication?
Answer: Take with meals or milk. Swallow sustained-release tablets whole, without crushing or chewing them. Take the medication as prescribed, even when you are feeling well. Encourage family members to oversee lithium administration.
Chapter 36
The patient tells the nurse practitioner that she is afraid to take lithium because she has heard that she must have blood work done every day she takes the medication, and she doesn’t like needles. What is the most therapeutic response by the nurse practitioner?
Answer: The NP should explain that lithium levels are monitored to ensure that they remain within the therapeutic range (0.8 to 1.4 mEq/L for initial therapy and 0.4 to 1 mEq/L for maintenance).
Levels should be measured every 2 to 3 days during initial therapy and only every 3 to 6 months during maintenance.
Chapter 36
A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse practitioner should observe the patient for which signs and symptoms?
A. Insomnia, increased appetite, and abdominal distention
B. Dry cough, hyperactive reflexes, and hypertension
C. Polydipsia, slurred speech, and fine hand tremors
D. Constipation, asterixis, and generalized edema
Answer: C. Polydipsia, slurred speech, and fine hand tremors
Rationale: Signs and symptoms of lithium toxicity include polydipsia (excess thirst), slurred speech, and fine hand tremors. They also include nausea, vomiting, persistent gastrointestinal upset, diarrhea, clonic movements, hyperirritability of muscles, muscle weakness, and hypotension.
Chapter 36
A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching?
A. “I can take the medication with milk or a snack.”
B. “I will call my doctor if I feel hyperactive.”
C. “I should drink at least 8 to 10 glasses of water every day.”
D. “I will reduce my salt intake while taking this medication.”
Answer: D. “I will reduce my salt intake while taking this medication.”
Rationale:
* Lithium may be taken with milk or food to decrease gastric upset.
* Feelings of mania should be reported promptly; patients may need a mood stabilizer in addition to lithium.
* Patients who are taking lithium often experience polyuria and should drink 8 to 10 glasses of water each day.
* Lithium will accumulate if sodium is restricted in the diet.
Chapter 36
The nurse practitioner cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse practitioner question?
A. Levothyroxine [Synthroid]
B. Sulindac [Clinoril]
C. Furosemide [Lasix]
D. Propranolol [Inderal]
Answer: C. Furosemide [Lasix]
Rationale: Diuretics (such as furosemide) promote sodium loss. If the sodium level is low, the renal excretion of lithium is reduced; lithium levels are thus increased, which may result in toxicity.
Nonsteroidal anti-inflammatory drugs can increase lithium levels by suppressing prostaglandin synthesis in the kidney and increasing renal reabsorption of lithium. NSAIDs known to increase lithium levels include ibuprofen, naproxen, piroxicam, indomethacin, and celecoxib. However, sulindac does not increase lithium levels.
Anticholinergics can cause urinary hesitancy; lithium-induced polyuria may result in considerable discomfort. Patients should avoid drugs with prominent anticholinergic actions (eg, antihistamines, phenothiazine antipsychotics, tricyclic antidepressants).
Levothyroxine is safe to administer with lithium, and lithium may cause hypothyroidism.
Propranolol should be administered with caution, because lithium toxicity can cause hypotension, and propranolol may also cause hypotension.
Chapter 36
The nurse practitioner prepares to administer lithium to a patient. Which laboratory result should first be assessed?
A. Urinary creatinine clearance
B. Serum troponin I and T levels
C. Fasting blood glucose level
D. Serum lipid profile
Answer: A. Urinary creatinine clearance
Rationale: Renal function (eg, serum creatinine level, creatinine clearance, urinalysis) should be evaluated before the administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include a complete blood count with differential, serum electrolyte levels, renal function, and thyroid function.
Chapter 36
The nurse practitioner teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective?
A. “I should take the drug 1 hour before bedtime.”
B. “The drug may leave a bitter taste in my mouth.”
C. “I may experience amnesia with prolonged use.”
D. “My body may build up a tolerance to this drug.”
Answer: B. “The drug may leave a bitter taste in my mouth.”
Rationale: The most common adverse effect of eszopiclone is a bitter aftertaste.
* Eszopiclone should be taken just before bedtime.
* Amnesia is not an adverse effect of eszopiclone.
* Studies of eszopiclone have not indicated the presence of tolerance.
Chapter 37
