Midterm Review:
1- A patient is recovering from abdominal surgery, which he had this morning. He is
groggy but complaining of severe pain around his incision. What is the most important
thing for the nurse to consider during an assessment before administering a dose of
morphine sulfate to the patient?
- His respiration rate
2- A patient has been treated for lung cancer for 3 years. Over the past few months, she
has noticed that the opioid analgesic she has been taking is not helping as much as it
had previously and says she needs to take more medication for the same pain relief.
The nurse is aware that this patient is experiencing:
- Opioid Tolerance
- Opioid Addiction: The Pt is asking for more medication.
- Opioid Toxicity: The Pt become very sedated, respiratory rate of 8.
- Opioid Abstinence syndrome : The Pt become irritable. (withdraw symptom)
3- An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse
discovers that the patient has removed her gown and is attempting to get out of bed
without assistance. What type of medication effect is the patient exhibiting?
a. Allergic
b. Hypersensitivity
c. Paradoxical
d. Therapeutic
- A paradoxical effect may occur in older adult patients. This includes periods of
excitement, confusion, restlessness, and euphoria. Allergies to medications tend to
manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic
would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation.
4- The nurse is preparing discharge instructions for a patient with a history of diabetes
who has just been diagnosed with seizure disorder. The patient has been prescribed
hydantoin therapy. What will the patient most likely experience?
- Hyperglycemia
5- What is a guideline for the nurse when administering phenytoin (Dilantin)
intravenously?
a. Deliver rapidly.
b. Monitor for signs of tachycardia.
c. Assess for hypertensive crisis.
d. Administer without mixing with other medications.
, 6- What is the best way for the nurse to evaluate the effectiveness of the patient's opiate
agonist?
- Verbal report of 2 on a 1 to 10 scale
7- A patient experiencing chronic pain as a result of metastatic cancer has a new order
for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on
Monday. At 8 PM on Monday, the patient reports a pain level of 8. The nurse’s best
response is to:
a. Immediately contact the physician.
b. Reassess pain level in 30 to 45 minutes.
c. Remove current patch and reapply a new patch.
d. Provide a PRN analgesic medication as ordered.
- The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial
patch of medication to reach a steady blood level, so other analgesics must be used
during this time. Therefore, it is not necessary to immediately contact the physician.
The patient is reporting severe pain and requires immediate intervention to help
relieve this discomfort.
8- A nursing student asks how nonsteroidal anti-inflammatory drugs (NSAIDs) work to
suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
- NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They
do not have direct action on tissues, nor do they interfere with chemical receptor
sites or neuronal pathways.
9- The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of
a migraine headache. The patient reports moderate improvement in headache pain
and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which
action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.
10- The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a
seizure disorder. The patient appears drowsy, and the nurse notes that the last random
serum drug level was 18 mcg/mL. What action will the nurse take?
a. Administer the dose since the patient is not toxic.
b. Contact the provider to discuss decreasing the phenytoin dose.
c. Give the drug and monitor closely for adverse effects.
d. Report drug toxicity to the providers.
1- A patient is recovering from abdominal surgery, which he had this morning. He is
groggy but complaining of severe pain around his incision. What is the most important
thing for the nurse to consider during an assessment before administering a dose of
morphine sulfate to the patient?
- His respiration rate
2- A patient has been treated for lung cancer for 3 years. Over the past few months, she
has noticed that the opioid analgesic she has been taking is not helping as much as it
had previously and says she needs to take more medication for the same pain relief.
The nurse is aware that this patient is experiencing:
- Opioid Tolerance
- Opioid Addiction: The Pt is asking for more medication.
- Opioid Toxicity: The Pt become very sedated, respiratory rate of 8.
- Opioid Abstinence syndrome : The Pt become irritable. (withdraw symptom)
3- An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse
discovers that the patient has removed her gown and is attempting to get out of bed
without assistance. What type of medication effect is the patient exhibiting?
a. Allergic
b. Hypersensitivity
c. Paradoxical
d. Therapeutic
- A paradoxical effect may occur in older adult patients. This includes periods of
excitement, confusion, restlessness, and euphoria. Allergies to medications tend to
manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic
would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation.
4- The nurse is preparing discharge instructions for a patient with a history of diabetes
who has just been diagnosed with seizure disorder. The patient has been prescribed
hydantoin therapy. What will the patient most likely experience?
- Hyperglycemia
5- What is a guideline for the nurse when administering phenytoin (Dilantin)
intravenously?
a. Deliver rapidly.
b. Monitor for signs of tachycardia.
c. Assess for hypertensive crisis.
d. Administer without mixing with other medications.
, 6- What is the best way for the nurse to evaluate the effectiveness of the patient's opiate
agonist?
- Verbal report of 2 on a 1 to 10 scale
7- A patient experiencing chronic pain as a result of metastatic cancer has a new order
for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on
Monday. At 8 PM on Monday, the patient reports a pain level of 8. The nurse’s best
response is to:
a. Immediately contact the physician.
b. Reassess pain level in 30 to 45 minutes.
c. Remove current patch and reapply a new patch.
d. Provide a PRN analgesic medication as ordered.
- The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial
patch of medication to reach a steady blood level, so other analgesics must be used
during this time. Therefore, it is not necessary to immediately contact the physician.
The patient is reporting severe pain and requires immediate intervention to help
relieve this discomfort.
8- A nursing student asks how nonsteroidal anti-inflammatory drugs (NSAIDs) work to
suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
- NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They
do not have direct action on tissues, nor do they interfere with chemical receptor
sites or neuronal pathways.
9- The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of
a migraine headache. The patient reports moderate improvement in headache pain
and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which
action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.
10- The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a
seizure disorder. The patient appears drowsy, and the nurse notes that the last random
serum drug level was 18 mcg/mL. What action will the nurse take?
a. Administer the dose since the patient is not toxic.
b. Contact the provider to discuss decreasing the phenytoin dose.
c. Give the drug and monitor closely for adverse effects.
d. Report drug toxicity to the providers.
