1
A AND R PHARM ASSIGNMENT 3
Answers & rationales (A&R) for Assignment 3,
Pharmacology in Nursing Practice
One of the best ways to assess your knowledge of content in this course is to compare your assignment answers with the
answers and rationales found in this document. Be sure you completely understand the rationales. They are the “why”—
why a correct answer is correct, AND why an incorrect answer is incorrect. Correct answers are highlighted.
(NOTE: If I feel like the answers are self-evident, I don’t put a rationale, but certainly ask if you need clarification).
Academic honesty reminder: It is ok to discuss the assignments with other students as a learning
tool, but it is considered a breach of academic honesty to copy answers directly from each other.
1. What is true of hypnotics?
a. Mechanisms of action include suppression of the reticular activating system that controls
wakefulness in our brains.
b. Nursing implications include warning against an adverse effect of zolpidem in which
some patients sleep-walk and perform activities that are not remembered the next
morning.
c. The effect of benzodiazepines in the motor cortex helps to relax muscles, thus helping
with sleep.
d. All the above.
2. The phrase “start low, go slow” can apply to , because .
a. titration of pain medications for the elderly : the diminished function of liver and kidneys
increase risk of drug toxicity.
b. instructions for patients weaning off of chronic opioid use : if they try to stop cold turkey
it will be immediately life-threatening. Withdrawal from opioids is very distressing and
often painful, but not life-threatening. (On the other hand, withdrawal from alcohol
can be indeed life-threatening, resulting in seizures and death if not managed
correctly, usually with use of a benzo like lorazepam).
c. narcotic abuse definition : it shows that even if you slowly begin opioid use, it can cause
your life to become “low” because of high risk of addiction.
d. use of adjuvant medications : they should only be used by themselves and not with
any other analgesic. This is the opposite from what “adjuvant” means. Examples of
adjuvant drugs are, say, use of non-pain-med-related drugs in addition to pain
meds… A person with chronic neuropathic pain often benefits from use of an opioid
med PLUS an extra medication like an antidepressant. The antidepressant would in
this context be called the adjuvant med.
3. A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested
dose of 14 g over a period of 1 hour. The patient’s nurse will expect
a. lab results showing a high serum creatinine level, indicating renal failure. Much
more likely to see S&S of liver failure, not renal failure… see answer D.
b. joint pain and hyperuricemia, indicating rapid onset of gout. Joint pain and
hyperuricemia are S&S of gout, but have no relevance to what the question is asking.
c. agitation and anxiety, since this drug blocks reuptake of adrenergic neurotransmitters
from neural synapses. Not the mechanism of action for acetaminophen.
d. lab results showing high liver enzyme levels, indicating hepatic failure. Acetaminophen
is notorious for causing liver problems when taken in large amounts either over a long
period of time or in one lump amount, as in this case. We really don’t want people
taking more than 4gms a day, preferably much less. Labs that measure liver enzymes
in the blood, such as AST and ALT are checked, and if the enzymes are high, that
means hepatocyte destruction is occurring & releasing enzymes into the blood.
4. The patient in the previous question will likely receive as an antidote
a. naloxone (Narcan) since it blocks the acetaminophen molecules from attaching to opioid
receptor sites. Naloxone is important in blocking opioid receptors in the body, thus
used when there is opioid overdose (know the name of this drug well, not only for a
test, but for the future when you are giving opioids to your patients and may need to
give a reversal.)
b. acetylcysteine (Mucomyst) since it increases glutathione, a substance which enhances
the ability of the liver cells to metabolize acetaminophen molecules.
, 2
c. flumazenil (Romazicon) since it increases GABA, a substance which is important in
CYP450 enzymatic function. flumazenil is the reversal agent for benzodiazepine
overdose… important drug to know, like naloxone, but it doesn’t apply to this
question. Also, GABA’s calming effect is enhanced by benzos, not by benzo-blocker
like flumazenil.
d. midalozam (Versed), a benzodiazepine which will decrease the patient’s agitation and
allow the liver to clear the acetaminophen molecules more quickly. Does this
sentence make sense to you, based on your readings? Hopefully not. An example of
needing to read an answer really closely and realizing that even though it may sound
kind of credible, the statement has no factual basis.
5. An RN is speaking to an addiction-cessation group about ways to decrease or stop their
addictive substance. Which instructions by the nurse are correct?
a. The best way to use a nicotine patch is a step-wise progression of increasing dosage. No
—the progression is in decreasing dosages. Often someone with an addiction is
encouraged to cut down a little at a time. For instance, if I wanted to lessen my ice
cream addiction, I would maybe decrease it by one scoop a day.
b. Chewing nicotine gum will rapidly, temporarily relieve a craving for a tobacco product.
The dose goes straight to the blood stream via the highly vascular mucous membranes,
just like when a person takes a sublingual medication like nitroglycerin.
c. Disulfiram (Antabuse) creates acetaldehyde syndrome and is the best first-line drug for
treating DT’s (delirium tremens) in an alcoholic. Disulfiram will create an unpleasant
reaction when drinking alcohol, thus it is a preventive. The treatment for DTs would be
something that will stop the risk of seizure, so a benzodiazepine such as Ativan is first-
line.
d. The opioid agonist naltrexone (Revia) is a good treatment for alcohol craving. Revia is
a good alcohol-craving treatment for some patients, but it is not an opioid agonist—it
is an opioid antagonist. Read answers closely.
6. Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The
patient asks the nurse how “rubbing my muscles” will help the pain go away. The nurse’s
response is based on the knowledge that massaging muscles
a. decreases the inflammatory response that initiates the painful stimuli. Massage won’t
actually decrease inflammation.
b. activates large sensory nerve fibers (A fibers) that send signals to the spinal cord to
close the gate, thus blocking painful stimuli from reaching the brain. The gate theory of
pain transmission is explained in your book in a simplified fashion, and we’ll keep it
simple! Very simplistically, we are going to associate A fibers with inhibition of pain.
when stimulated, as in massage, they help to alleviate pain (6th edition: see page 156, 3rd
paragraph. 7th edition: pg 144 first paragraph )
c. activates small sensory nerve fibers (C fibers) that send signals to the spinal cord to
open the gate and allow endorphins to reach the muscles and relieve the pain. C
fibers = sensing of pain, so they are associated with being able to assess and feel pain.
This is an important part of the protective aspect of pain, but not a good thing when it
comes to wanting pain relief. The functioning of these fibers is more often associated
with chronic pain issues, whereas A fibers are associated with “normal,” short-lived,
acute pain.
d. enhances the effect of Substance P, which is an endogenous pain-relieving biochemical
modulator. Always associate Substance P with PAIN. It is a neurotransmitter whose
presence is associated with feeling pain, not pain-relief. (See articles cited in RRD).
7. Joe Hardy, RN, is about to give a dose of hydromorphone (Dilaudid) to his patient, Ms Umbridge.
What does this entail?
a. Understanding that as a powerful hypnotic, this drug blocks GABA sites in the brain
and thus can cause hallucinations. Hypnotics are benzos, so they enhance GABA effect
(GABA = calm). Hydromorphone isn’t a benzo.
b. Asking Ms. Umbridge about various aspects of her pain, such as onset, palliation
factors, describing the quality of the pain, and its quantification. Always try to assess
FIRST.
c. Understanding the Margo McCaffery maxim that pain should always be carefully
described and documented exactly as seen by the healthcare provider. Nope—pain
is what the patient says it is, not what the observer “sees.”
d. Knowing that with any SSRI antidepressant like this one, one has to be aware of the
black box warning against increased suicidal tendencies. Very true that many
antidepressants have a blackbox warning about increased suicidal tendencies but
A AND R PHARM ASSIGNMENT 3
Answers & rationales (A&R) for Assignment 3,
Pharmacology in Nursing Practice
One of the best ways to assess your knowledge of content in this course is to compare your assignment answers with the
answers and rationales found in this document. Be sure you completely understand the rationales. They are the “why”—
why a correct answer is correct, AND why an incorrect answer is incorrect. Correct answers are highlighted.
(NOTE: If I feel like the answers are self-evident, I don’t put a rationale, but certainly ask if you need clarification).
Academic honesty reminder: It is ok to discuss the assignments with other students as a learning
tool, but it is considered a breach of academic honesty to copy answers directly from each other.
1. What is true of hypnotics?
a. Mechanisms of action include suppression of the reticular activating system that controls
wakefulness in our brains.
b. Nursing implications include warning against an adverse effect of zolpidem in which
some patients sleep-walk and perform activities that are not remembered the next
morning.
c. The effect of benzodiazepines in the motor cortex helps to relax muscles, thus helping
with sleep.
d. All the above.
2. The phrase “start low, go slow” can apply to , because .
a. titration of pain medications for the elderly : the diminished function of liver and kidneys
increase risk of drug toxicity.
b. instructions for patients weaning off of chronic opioid use : if they try to stop cold turkey
it will be immediately life-threatening. Withdrawal from opioids is very distressing and
often painful, but not life-threatening. (On the other hand, withdrawal from alcohol
can be indeed life-threatening, resulting in seizures and death if not managed
correctly, usually with use of a benzo like lorazepam).
c. narcotic abuse definition : it shows that even if you slowly begin opioid use, it can cause
your life to become “low” because of high risk of addiction.
d. use of adjuvant medications : they should only be used by themselves and not with
any other analgesic. This is the opposite from what “adjuvant” means. Examples of
adjuvant drugs are, say, use of non-pain-med-related drugs in addition to pain
meds… A person with chronic neuropathic pain often benefits from use of an opioid
med PLUS an extra medication like an antidepressant. The antidepressant would in
this context be called the adjuvant med.
3. A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested
dose of 14 g over a period of 1 hour. The patient’s nurse will expect
a. lab results showing a high serum creatinine level, indicating renal failure. Much
more likely to see S&S of liver failure, not renal failure… see answer D.
b. joint pain and hyperuricemia, indicating rapid onset of gout. Joint pain and
hyperuricemia are S&S of gout, but have no relevance to what the question is asking.
c. agitation and anxiety, since this drug blocks reuptake of adrenergic neurotransmitters
from neural synapses. Not the mechanism of action for acetaminophen.
d. lab results showing high liver enzyme levels, indicating hepatic failure. Acetaminophen
is notorious for causing liver problems when taken in large amounts either over a long
period of time or in one lump amount, as in this case. We really don’t want people
taking more than 4gms a day, preferably much less. Labs that measure liver enzymes
in the blood, such as AST and ALT are checked, and if the enzymes are high, that
means hepatocyte destruction is occurring & releasing enzymes into the blood.
4. The patient in the previous question will likely receive as an antidote
a. naloxone (Narcan) since it blocks the acetaminophen molecules from attaching to opioid
receptor sites. Naloxone is important in blocking opioid receptors in the body, thus
used when there is opioid overdose (know the name of this drug well, not only for a
test, but for the future when you are giving opioids to your patients and may need to
give a reversal.)
b. acetylcysteine (Mucomyst) since it increases glutathione, a substance which enhances
the ability of the liver cells to metabolize acetaminophen molecules.
, 2
c. flumazenil (Romazicon) since it increases GABA, a substance which is important in
CYP450 enzymatic function. flumazenil is the reversal agent for benzodiazepine
overdose… important drug to know, like naloxone, but it doesn’t apply to this
question. Also, GABA’s calming effect is enhanced by benzos, not by benzo-blocker
like flumazenil.
d. midalozam (Versed), a benzodiazepine which will decrease the patient’s agitation and
allow the liver to clear the acetaminophen molecules more quickly. Does this
sentence make sense to you, based on your readings? Hopefully not. An example of
needing to read an answer really closely and realizing that even though it may sound
kind of credible, the statement has no factual basis.
5. An RN is speaking to an addiction-cessation group about ways to decrease or stop their
addictive substance. Which instructions by the nurse are correct?
a. The best way to use a nicotine patch is a step-wise progression of increasing dosage. No
—the progression is in decreasing dosages. Often someone with an addiction is
encouraged to cut down a little at a time. For instance, if I wanted to lessen my ice
cream addiction, I would maybe decrease it by one scoop a day.
b. Chewing nicotine gum will rapidly, temporarily relieve a craving for a tobacco product.
The dose goes straight to the blood stream via the highly vascular mucous membranes,
just like when a person takes a sublingual medication like nitroglycerin.
c. Disulfiram (Antabuse) creates acetaldehyde syndrome and is the best first-line drug for
treating DT’s (delirium tremens) in an alcoholic. Disulfiram will create an unpleasant
reaction when drinking alcohol, thus it is a preventive. The treatment for DTs would be
something that will stop the risk of seizure, so a benzodiazepine such as Ativan is first-
line.
d. The opioid agonist naltrexone (Revia) is a good treatment for alcohol craving. Revia is
a good alcohol-craving treatment for some patients, but it is not an opioid agonist—it
is an opioid antagonist. Read answers closely.
6. Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The
patient asks the nurse how “rubbing my muscles” will help the pain go away. The nurse’s
response is based on the knowledge that massaging muscles
a. decreases the inflammatory response that initiates the painful stimuli. Massage won’t
actually decrease inflammation.
b. activates large sensory nerve fibers (A fibers) that send signals to the spinal cord to
close the gate, thus blocking painful stimuli from reaching the brain. The gate theory of
pain transmission is explained in your book in a simplified fashion, and we’ll keep it
simple! Very simplistically, we are going to associate A fibers with inhibition of pain.
when stimulated, as in massage, they help to alleviate pain (6th edition: see page 156, 3rd
paragraph. 7th edition: pg 144 first paragraph )
c. activates small sensory nerve fibers (C fibers) that send signals to the spinal cord to
open the gate and allow endorphins to reach the muscles and relieve the pain. C
fibers = sensing of pain, so they are associated with being able to assess and feel pain.
This is an important part of the protective aspect of pain, but not a good thing when it
comes to wanting pain relief. The functioning of these fibers is more often associated
with chronic pain issues, whereas A fibers are associated with “normal,” short-lived,
acute pain.
d. enhances the effect of Substance P, which is an endogenous pain-relieving biochemical
modulator. Always associate Substance P with PAIN. It is a neurotransmitter whose
presence is associated with feeling pain, not pain-relief. (See articles cited in RRD).
7. Joe Hardy, RN, is about to give a dose of hydromorphone (Dilaudid) to his patient, Ms Umbridge.
What does this entail?
a. Understanding that as a powerful hypnotic, this drug blocks GABA sites in the brain
and thus can cause hallucinations. Hypnotics are benzos, so they enhance GABA effect
(GABA = calm). Hydromorphone isn’t a benzo.
b. Asking Ms. Umbridge about various aspects of her pain, such as onset, palliation
factors, describing the quality of the pain, and its quantification. Always try to assess
FIRST.
c. Understanding the Margo McCaffery maxim that pain should always be carefully
described and documented exactly as seen by the healthcare provider. Nope—pain
is what the patient says it is, not what the observer “sees.”
d. Knowing that with any SSRI antidepressant like this one, one has to be aware of the
black box warning against increased suicidal tendencies. Very true that many
antidepressants have a blackbox warning about increased suicidal tendencies but
