Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
1. A geriatric patient received a narcotic analgesic before leaving the post-anesthesia
care unit to return to the regular unit. What is the priority nursing action for the
nurse receiving the patient on the regular unit?
a. Administer a non-steroidal anti-inflammatory drug.
b. Encourage fluids.
c. Create a restful, dark, quiet environment.
d. Put side rails up and place bed in low position.
Ans: D
Feedback:
Older patients are more susceptible to the central nervous system effects of narcotics;
it is important to ensure their safety by using side rails and placing the bed in the low
position in case the patient tries to get up unaided. Postoperative patients are allowed
nothing by mouth until bowel function returns so an oral medication or encouraging
fluids would not be appropriate. This patient will require careful observation for
respiratory depression, so a dark room would be unsafe.
2. A patient who is experiencing severe pain is administered a narcotic. What would
the nurse write in the plan of care as a desirable and measurable outcome for this
patient?
a. A shorter period of time between requests for medication
b. Reduced complaints about limited movement
c. Lack of restlessness and ability to sustain one position
d. Increased autonomy in providing AM care
, Ans: D
Feedback:
Monitor patient response to the drug (e.g., relief of pain, sedation).When pain is being
adequately managed with opioid therapy, a desirable and measurable outcome would
be that the patient is able to be more autonomous in providing care in the morning.
Shorter periods between requests for medication would not be a desirable outcome
because it is not an indicator of pain control given that some patients are reluctant to
ask for medicine even though they are in pain. Patients in pain tend not to move for
fear of exacerbating the pain, so lack of movement can be an indication the patient is
in pain. Just because the patient does not complain of pain doesn’t mean he isn’t
experiencing pain.
3. The health care provider orders oral (PO) codeine as an adjunctive therapy to pain
control medication. What order would be appropriate for the nurse to administer?
a. Codeine 5 mg PO every 6 hour
b. Codeine 10 mg PO every 4 hour
c. Codeine 15 mg PO every 2 hour
d. Codeine 20 mg PO every 4 hour
Ans: D
Feedback:
The correct dosage for codeine administered for pain by mouth is 15 to 60 mg q 4 to 6
hour. The other options are incorrect oral dosages because they are too low a dose or
give an incorrect dosing frequency.
4. A patient with migraine headaches is changed from an ergot to a prescription for a
triptan. The nurse has completed teaching related to the drug. What statement
would indicate she has a clear understanding of the new drug?
a. My life is over. I can’t function not knowing when I’m going to have a
headache.
b. I will not have to avoid driving because this medication isn’t sedating.
c. I should not experience as many adverse effects from my new medication.
d. I take my medication every hour when I have a headache.
Ans: C
Feedback:
Triptans are a new class of selective serotonin receptor blockers that cause
vasoconstriction; they are not associated with as many systemic adverse effects
experienced in ergot therapy. Triptan therapy will enable her to live a near normal life
even during headaches. Although adverse effects are fewer than those associated with
ergot therapy, triptans can still cause dizziness, feelings of strangeness, and vertigo, so
the patient should not drive while taking the drug. Medications are often only taken
once due to prolonged half-lives, but some may be repeated in 2 to 4 hours if the
headache does not subside.
,5. The nurse receives an order for a triptan for a patient diagnosed with cluster
headaches. What drug would be indicated for this purpose?
a. Almotriptan (Axert)
b. Frovatriptan (Frova)
c. Naratriptan (Amerge)
d. Sumatriptan (Imitrex)
Ans: D
Feedback:
Sumatriptan, the first drug of this class, is used for the treatment of acute migraine
attacks and for the treatment of cluster headaches in adults. No other triptans are
approved for treatment of cluster headaches.
6. Before administering an ergot drug to the patient for the first time, the nurse would
assess the patient’s currently prescribed medications for what drug?
a. Antidiabetic agents
b. Beta adrenergic blockers
c. Oral contraceptives
d. Selective serotonin reuptake inhibitors (SSRIs)
Ans: B
Feedback:
The concurrent use of beta blockers and ergot preparations increases the patient’s risk
for peripheral ischemia and gangrene. This combination should be avoided. There is
no indication for concern with the use of antidiabetic agents, SSRIs, and oral
contraceptives with these drugs.
7. The anatomy and physiology instructor is talking about pain sensations. What
produces pain sensations when stimulated by generating nerve impulses? (Select
all that apply)
a. A-delta fibers
b. D-delta sensory nerves
c. Mu receptors
d. Sigma-receptors
e. C fibers
Ans: A, E
Feedback:
Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by
generating nerve impulses that produce pain sensations. Large-diameter sensory
nerves (i.e., A fibers) transmit sensations associated with touch and temperature. Mu-
receptors are primarily pain-blocking receptors; sigma-receptors cause papillary
dilation and may be responsible for the hallucinations, dysphoria, and psychoses that
, can occur with narcotic use.
8. A nurse is caring for a 6-year-old patient after surgery. The child has an order for
meperidine (Demerol) 1.8 mg/kg IM every 3 to 4 hour as needed for pain. The
child weighs 30 kg and the meperidine is available as 50 mg/mL. How many mL
will the nurse administer per dose?
a. 1 mL
b. 1.8 mL
c. 0.8 mL
d. 1.08 mL
Ans: D
Feedback:
To calculate the correct amount to be administered, first multiply 1.8 mg times 30 kg
(54 mg). Next determine the volume in mL that 54 mg is equal to (50 mg: 1 mL as 54
mg: × mL). Solve forx (50x is equal to 54 mg; 54 divided by 50 is equal to 1.08 mL).
9. A patient with a migraine took a dose of a prescribed triptan, eletriptan (Relpax),
and 1 hour later the headache is still intense. The patient’s husband calls the clinic
and asks the nurse what they should do. What is an appropriate nursing response?
a. Tell her to lie down in a quiet cool room and just wait it out. It will subside.
b. She can take another dose of the drug 2 hours after the initial dose if the
headache continues.
c. Give her a dose of an ergot drug if you have it. It will decrease the intensity
of the pain.
d. Ibuprofen may increase the action of the triptan.
Ans: B
Feedback:
A patient taking eletriptan to relieve a migraine can take another dose in 2 hours if the
headache is not relieved. The combination of ergot drugs with triptans is not indicated
because of the vasoconstriction caused by both. The patient will not get relief by
waiting it out. Ibuprofen is an antiinflammatory that does not affect the mechanism
associated with migraines.
10. The nurse is caring for a patient who is receiving an opioid analgesic. What are the
nurse’s priority assessments?
a. Pain intensity and blood glucose level
b. Level of consciousness and respiratory rate
c. Respiratory rate and electrolytes
d. Urine output and pain intensity
Ans: B
Feedback:
1. A geriatric patient received a narcotic analgesic before leaving the post-anesthesia
care unit to return to the regular unit. What is the priority nursing action for the
nurse receiving the patient on the regular unit?
a. Administer a non-steroidal anti-inflammatory drug.
b. Encourage fluids.
c. Create a restful, dark, quiet environment.
d. Put side rails up and place bed in low position.
Ans: D
Feedback:
Older patients are more susceptible to the central nervous system effects of narcotics;
it is important to ensure their safety by using side rails and placing the bed in the low
position in case the patient tries to get up unaided. Postoperative patients are allowed
nothing by mouth until bowel function returns so an oral medication or encouraging
fluids would not be appropriate. This patient will require careful observation for
respiratory depression, so a dark room would be unsafe.
2. A patient who is experiencing severe pain is administered a narcotic. What would
the nurse write in the plan of care as a desirable and measurable outcome for this
patient?
a. A shorter period of time between requests for medication
b. Reduced complaints about limited movement
c. Lack of restlessness and ability to sustain one position
d. Increased autonomy in providing AM care
, Ans: D
Feedback:
Monitor patient response to the drug (e.g., relief of pain, sedation).When pain is being
adequately managed with opioid therapy, a desirable and measurable outcome would
be that the patient is able to be more autonomous in providing care in the morning.
Shorter periods between requests for medication would not be a desirable outcome
because it is not an indicator of pain control given that some patients are reluctant to
ask for medicine even though they are in pain. Patients in pain tend not to move for
fear of exacerbating the pain, so lack of movement can be an indication the patient is
in pain. Just because the patient does not complain of pain doesn’t mean he isn’t
experiencing pain.
3. The health care provider orders oral (PO) codeine as an adjunctive therapy to pain
control medication. What order would be appropriate for the nurse to administer?
a. Codeine 5 mg PO every 6 hour
b. Codeine 10 mg PO every 4 hour
c. Codeine 15 mg PO every 2 hour
d. Codeine 20 mg PO every 4 hour
Ans: D
Feedback:
The correct dosage for codeine administered for pain by mouth is 15 to 60 mg q 4 to 6
hour. The other options are incorrect oral dosages because they are too low a dose or
give an incorrect dosing frequency.
4. A patient with migraine headaches is changed from an ergot to a prescription for a
triptan. The nurse has completed teaching related to the drug. What statement
would indicate she has a clear understanding of the new drug?
a. My life is over. I can’t function not knowing when I’m going to have a
headache.
b. I will not have to avoid driving because this medication isn’t sedating.
c. I should not experience as many adverse effects from my new medication.
d. I take my medication every hour when I have a headache.
Ans: C
Feedback:
Triptans are a new class of selective serotonin receptor blockers that cause
vasoconstriction; they are not associated with as many systemic adverse effects
experienced in ergot therapy. Triptan therapy will enable her to live a near normal life
even during headaches. Although adverse effects are fewer than those associated with
ergot therapy, triptans can still cause dizziness, feelings of strangeness, and vertigo, so
the patient should not drive while taking the drug. Medications are often only taken
once due to prolonged half-lives, but some may be repeated in 2 to 4 hours if the
headache does not subside.
,5. The nurse receives an order for a triptan for a patient diagnosed with cluster
headaches. What drug would be indicated for this purpose?
a. Almotriptan (Axert)
b. Frovatriptan (Frova)
c. Naratriptan (Amerge)
d. Sumatriptan (Imitrex)
Ans: D
Feedback:
Sumatriptan, the first drug of this class, is used for the treatment of acute migraine
attacks and for the treatment of cluster headaches in adults. No other triptans are
approved for treatment of cluster headaches.
6. Before administering an ergot drug to the patient for the first time, the nurse would
assess the patient’s currently prescribed medications for what drug?
a. Antidiabetic agents
b. Beta adrenergic blockers
c. Oral contraceptives
d. Selective serotonin reuptake inhibitors (SSRIs)
Ans: B
Feedback:
The concurrent use of beta blockers and ergot preparations increases the patient’s risk
for peripheral ischemia and gangrene. This combination should be avoided. There is
no indication for concern with the use of antidiabetic agents, SSRIs, and oral
contraceptives with these drugs.
7. The anatomy and physiology instructor is talking about pain sensations. What
produces pain sensations when stimulated by generating nerve impulses? (Select
all that apply)
a. A-delta fibers
b. D-delta sensory nerves
c. Mu receptors
d. Sigma-receptors
e. C fibers
Ans: A, E
Feedback:
Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by
generating nerve impulses that produce pain sensations. Large-diameter sensory
nerves (i.e., A fibers) transmit sensations associated with touch and temperature. Mu-
receptors are primarily pain-blocking receptors; sigma-receptors cause papillary
dilation and may be responsible for the hallucinations, dysphoria, and psychoses that
, can occur with narcotic use.
8. A nurse is caring for a 6-year-old patient after surgery. The child has an order for
meperidine (Demerol) 1.8 mg/kg IM every 3 to 4 hour as needed for pain. The
child weighs 30 kg and the meperidine is available as 50 mg/mL. How many mL
will the nurse administer per dose?
a. 1 mL
b. 1.8 mL
c. 0.8 mL
d. 1.08 mL
Ans: D
Feedback:
To calculate the correct amount to be administered, first multiply 1.8 mg times 30 kg
(54 mg). Next determine the volume in mL that 54 mg is equal to (50 mg: 1 mL as 54
mg: × mL). Solve forx (50x is equal to 54 mg; 54 divided by 50 is equal to 1.08 mL).
9. A patient with a migraine took a dose of a prescribed triptan, eletriptan (Relpax),
and 1 hour later the headache is still intense. The patient’s husband calls the clinic
and asks the nurse what they should do. What is an appropriate nursing response?
a. Tell her to lie down in a quiet cool room and just wait it out. It will subside.
b. She can take another dose of the drug 2 hours after the initial dose if the
headache continues.
c. Give her a dose of an ergot drug if you have it. It will decrease the intensity
of the pain.
d. Ibuprofen may increase the action of the triptan.
Ans: B
Feedback:
A patient taking eletriptan to relieve a migraine can take another dose in 2 hours if the
headache is not relieved. The combination of ergot drugs with triptans is not indicated
because of the vasoconstriction caused by both. The patient will not get relief by
waiting it out. Ibuprofen is an antiinflammatory that does not affect the mechanism
associated with migraines.
10. The nurse is caring for a patient who is receiving an opioid analgesic. What are the
nurse’s priority assessments?
a. Pain intensity and blood glucose level
b. Level of consciousness and respiratory rate
c. Respiratory rate and electrolytes
d. Urine output and pain intensity
Ans: B
Feedback:
