Prepare for your test with
1. Question
Category: Psychosocial Integrity
A client with a history of abusing barbiturates abruptly stops taking the medication.
The nurse should give priority to assessing the client for:
A. Depression and suicidal ideation
B. Tachycardia and diarrhea
C. Muscle cramping and abdominal pain
D. Tachycardia and euphoric mood
Correct Answer: B. Tachycardia and diarrhea
Barbiturates create a sedative effect. When the client stops taking barbiturates, he
will experience tachycardia, diarrhea, and tachypnea. When given in IV
,anesthetics, barbiturates will produce a reduction in blood pressure and an increase
in heart rate. Respiratory depression and apnea may occur. Given the potential for
severe adverse events including death, a pharmacist should verify the dosing, and
perform a thorough medication reconciliation to ensure there are no drug
interactions, in particular, additive CNS depression effects.
Option A: Enough depression and suicidal ideation go along with barbiturate use; it
is not the priority. Barbiturates cause postsynaptic enhancement of GABA,
interacting with alpha and beta subunits of the GABA-A receptor. Barbiturates
increase chloride ion flux which results in GABA-induced postsynaptic inhibition.
Phenobarbital and pentobarbital affect the GABA-A receptors with a dose-
dependent response.
Option C: Muscle cramps and abdominal pain are vague symptoms that could be
associated with other problems. Barbiturate classification is according to the
duration of their action, IV formulations of thiopental and methohexital are in the
ultra short-acting class. The short and intermediate-acting have an effect lasting 2
to 6 hours. This classification includes sleeping medications pentobarbital,
secobarbital, amobarbital, and butabarbital. Long-acting barbiturates have an effect
of longer than 6 hours and include barbital and phenobarbital.
,Option D: Tachycardia is associated with stopping barbiturates, but euphoria is not.
At higher micromolar concentrations associated with anesthetic levels, these drugs
directly activate chloride channels. Both barbiturates and benzodiazepines interact
with GABA-A receptors, but barbiturates are unique in that they potentiate GABA-
A receptors while increasing chloride ion influx even with very low concentrations
of the GABA neurotransmitter.
2. Question
Category: Physiological Adaptation
During the assessment of a laboring client, the nurse notes that the FHT are loudest
in the upper-right quadrant. The infant is most likely in which position?
A. Right breech presentation
B. Right occiput anterior presentation
C. Left sacral anterior presentation
D. Left occiput transverse presentation
Correct Answer: A. Right breech presentation
If the fetal heart tones are heard in the right upper abdomen, the infant is in a
breech presentation. A breech position is not ideal for delivery. Though the
majority of breech babies are born healthy, they may have a higher risk of birth
, defects or trauma during delivery. This position can also be problematic because it
increases the risk of forming a loop in the umbilical cord that could cause injury to
the baby if they’re delivered vaginally.
Option B: If the infant is positioned in the right occiput anterior presentation, the
FHTs will be located in the right lower quadrant, so answer B is incorrect. The
baby is head down, with their face facing the mother’s back. The baby’s chin is
tucked into their chest and their head is ready to enter the pelvis. The baby is able
to flex their head and neck, and tuck their chin into their chest. This is usually
referred to as occipito-anterior, or the cephalic presentation.
Option C: If the fetus is in the sacral position, the FHTs will be located in the
center of the abdomen, so answer C is incorrect. Left Sacrum Anterior (LSA)
means the fetal sacrum is closest to the mother’s symphysis and rotated slightly to
the mother’s left (clockwise from direct SA).
Option D: If the FHTs are heard in the left lower abdomen, the infant is most likely
in the left occiput transverse position, making answer D incorrect. This LOT (Left,
Occiput, Transverse) position and its’ mirror image, ROT, are common in early
labor. As labor progresses and the fetal head descends, the occiput usually rotates
anteriorly, converting this LOT to an LOA or OA as the head delivers.
3. Question
1. Question
Category: Psychosocial Integrity
A client with a history of abusing barbiturates abruptly stops taking the medication.
The nurse should give priority to assessing the client for:
A. Depression and suicidal ideation
B. Tachycardia and diarrhea
C. Muscle cramping and abdominal pain
D. Tachycardia and euphoric mood
Correct Answer: B. Tachycardia and diarrhea
Barbiturates create a sedative effect. When the client stops taking barbiturates, he
will experience tachycardia, diarrhea, and tachypnea. When given in IV
,anesthetics, barbiturates will produce a reduction in blood pressure and an increase
in heart rate. Respiratory depression and apnea may occur. Given the potential for
severe adverse events including death, a pharmacist should verify the dosing, and
perform a thorough medication reconciliation to ensure there are no drug
interactions, in particular, additive CNS depression effects.
Option A: Enough depression and suicidal ideation go along with barbiturate use; it
is not the priority. Barbiturates cause postsynaptic enhancement of GABA,
interacting with alpha and beta subunits of the GABA-A receptor. Barbiturates
increase chloride ion flux which results in GABA-induced postsynaptic inhibition.
Phenobarbital and pentobarbital affect the GABA-A receptors with a dose-
dependent response.
Option C: Muscle cramps and abdominal pain are vague symptoms that could be
associated with other problems. Barbiturate classification is according to the
duration of their action, IV formulations of thiopental and methohexital are in the
ultra short-acting class. The short and intermediate-acting have an effect lasting 2
to 6 hours. This classification includes sleeping medications pentobarbital,
secobarbital, amobarbital, and butabarbital. Long-acting barbiturates have an effect
of longer than 6 hours and include barbital and phenobarbital.
,Option D: Tachycardia is associated with stopping barbiturates, but euphoria is not.
At higher micromolar concentrations associated with anesthetic levels, these drugs
directly activate chloride channels. Both barbiturates and benzodiazepines interact
with GABA-A receptors, but barbiturates are unique in that they potentiate GABA-
A receptors while increasing chloride ion influx even with very low concentrations
of the GABA neurotransmitter.
2. Question
Category: Physiological Adaptation
During the assessment of a laboring client, the nurse notes that the FHT are loudest
in the upper-right quadrant. The infant is most likely in which position?
A. Right breech presentation
B. Right occiput anterior presentation
C. Left sacral anterior presentation
D. Left occiput transverse presentation
Correct Answer: A. Right breech presentation
If the fetal heart tones are heard in the right upper abdomen, the infant is in a
breech presentation. A breech position is not ideal for delivery. Though the
majority of breech babies are born healthy, they may have a higher risk of birth
, defects or trauma during delivery. This position can also be problematic because it
increases the risk of forming a loop in the umbilical cord that could cause injury to
the baby if they’re delivered vaginally.
Option B: If the infant is positioned in the right occiput anterior presentation, the
FHTs will be located in the right lower quadrant, so answer B is incorrect. The
baby is head down, with their face facing the mother’s back. The baby’s chin is
tucked into their chest and their head is ready to enter the pelvis. The baby is able
to flex their head and neck, and tuck their chin into their chest. This is usually
referred to as occipito-anterior, or the cephalic presentation.
Option C: If the fetus is in the sacral position, the FHTs will be located in the
center of the abdomen, so answer C is incorrect. Left Sacrum Anterior (LSA)
means the fetal sacrum is closest to the mother’s symphysis and rotated slightly to
the mother’s left (clockwise from direct SA).
Option D: If the FHTs are heard in the left lower abdomen, the infant is most likely
in the left occiput transverse position, making answer D incorrect. This LOT (Left,
Occiput, Transverse) position and its’ mirror image, ROT, are common in early
labor. As labor progresses and the fetal head descends, the occiput usually rotates
anteriorly, converting this LOT to an LOA or OA as the head delivers.
3. Question
