Pharm Test 1

Question 1

A patient will receive isoflurane (Forane) as an anesthetic for a surgical procedure. The nurse caring for this patient during the perioperative period knows that this agent will not cause:

A. Respiratory depression.

B. Muscle relaxation.

C. Myocardial depression.

D. Rapid induction.

Answer 1

C. Myocardial depression

Isoflurane does not cause myocardial depression and does not reduce cardiac output. Isoflurane actually produces more muscle relaxation. Induction with isoflurane is rapid. Isoflurane causes respiratory depression, as do all inhalation anesthetics.

Question 2

The nurse is administering nitrous oxide to a client who is having a surgical procedure. The nurse recognizes that the main action of nitrous oxide is to:

A. Provide total relaxation of skeletal muscles.

B. Cause analgesia by suppressing the pain mechanism in the CNS.

C. Induce stage 3 anesthesia.

D. Induce loss of consciousness.

Answer 2

B. Cause analgesia by suppressing the pain mechanism in the CNS.

It does not produce complete loss of consciousness or profound relaxation of skeletal muscles. Nitrous oxide does not induce stage 3 analgesia or cause loss of consciousness.

Question 3

The nurse is administering medications to Mrs. Utz and the nurse notices that the physician ordered a dose of fentanyl (Sublimaze) 200 mcg IV for the client’s 3/10 right upper extremity pain. You call the physician to clarify the order and he instructs the nurse to administer the medication anyway. The nurse should do which of the following?

A. Refuse to administer the medication, and notify the physician.

B. Ask the physician on-call for a new order.

C. Administer the medication.

D. Consult with your supervisor, refuse to administer the medication, and notify the physician.

Answer 3

D. Consult with your supervisor, refuse to administer the medication, and notify the physician.

The nurse may be held liable for not giving a drug or for giving a wrong drug or a wrong dose. In addition, the nurse is expected to have sufficient drug knowledge to recognize and question erroneous orders. If, from other authoritative sources, the nurse considers that giving a drug is unsafe, the nurse must refuse to give the drug. The fact that a physician wrote an erroneous order does not excuse the nurse from legal liability if he or she carries out that order.

Question 4

Postoperatively, a client has been given morphine sulfate 7mg IV. In the recovery room the nurse assesses that the client is still asleep. The nurse also notes the vital signs are PR: 66, RR: 7, and BP 100/ 60. Which of the following is the priority action of the nurse?

A. Continue monitoring the client’s vital signs.

B. Prepare Atrophine sulfate from the ‘Emergency’-cart.

C. Obtain a 12-lead Electrocardiogram (ECG).

D. Be prepared to administer naloxone (Narcan).

Answer 4

D. Be prepared to administer naloxone (Narcan).

The client is receiving a high dose of morphine sulfate and RR has dropped to

Question 5

Mr. Reed is a 65-year-old male who has a physician’s order for sumatriptan (Imitrex) 25 mg PO for his migraine headache. You enter his room and he states, “I was waiting on my Imitrex dose; you can give it to me now.” Prior to administering the Imitrex, the nurse should do which of the following?

A. Call the physician to clarify the order, because the drug cannot be given via the enteral route.

B. Administer the dose.

C. Clarify the client’s identification by asking his name and date of birth.

D. Clarify the client’s identification by checking his name band.

Answer 5

C. Clarify the client’s identification by asking his name and date of birth.

Verify the client’s identity by asking two identifiers i.e., have patient state his name and date of birth.

Question 6

A nurse has administered a dose of midazolam (Versed) to a client. The nurse would take which important action before leaving the client’s room?

A. Per safety precautions, putting up the side rails on the bed.

B. Giving the client a bedpan.

C. Drawing the shades or blinds closed.

D. Turning down the volume on the television.

Answer 6

A. Per safety precautions, putting up the side rails on the bed.

Midazolam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client’s room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls.

Question 7

A patient will receive intravenous midazolam (Versed) combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching?

A. “The patient will not remember the procedure.”

B. “The patient may appear anxious and restless during the procedure.”

C. “The patient will not need cardiorespiratory support during the procedure.”

D. “The patient will be unconscious during the procedure.”

Answer 7

A. “The patient will not remember the procedure.”

Question 8

Nursing interventions for a client receiving opioid analgesics over an extended period should include:

A. Monitoring for GI bleeding.

B. Encouraging increased fiber and fluids in the diet.

C. Referring the client to a drug treatment center.

D. Teaching the client to self-assess blood pressure.

Answer 8

B. Encouraging increased fiber and fluids in the diet.

Opioids suppress intestinal contractility, increase anal sphincter tone, and inhibit fluids into the intestines, which can lead to constipation.

Question 9

Which of the following should the nurse consider essential information prior to administering procaine (Novocaine)?

A. Therapeutic effects

B. The client’s insurance

C. The brand name

D. Cost of the drug

Answer 9

A. Therapeutic effects

Learning the essential drug information about a medication to be given includes: indications for use, contraindications, therapeutic effects, adverse effects, any specific instructions about administration).

Question 10

Following hospitalization, the client receives a home visit from the nurse. The client asks if she should continue to take the medications she took before hospitalization. What is the most appropriate response?

A. “Yes, you should continue to take the drugs that you took before going to the hospital.”

B. “You should only take the drugs that have been prescribed upon discharge and not the drugs that you took prior to hospitalization unless otherwise indicated.”

C. “You should continue to take those drugs that have been helpful to you.”

D. “You should take one-half the dosage of each drug that you took prior to hospitalization.”

Answer 10

B. “You should only take the drugs that have been prescribed upon discharge and not the drugs that you took prior to hospitalization unless otherwise indicated.”

Client’s medication list should undergo reconciliation with the health care team to prevent medication errors and/or overdosage/duplicating medications.

Question 11

Normal age physiological changes in the geriatric patient that may affect excretion and promote accumulation of drugs in the body include which of the following?

A. Increased gastric motility.

B. Decreased glomerular filtration rate.

C. Rigidity of the diaphragm.

D. Decreased mentation.

Answer 11

B. Decreased glomerular filtration rate.

Question 12

The nurse is caring for a 78-year-old client who has multiple medications ordered to treat various co-morbidities. The nurse considers which of the following common age physiological change will most likely require a reduction in medication dosage for this client?

A. Increased rate of drug excretion.

B. Increased total body fluid proportionate to body mass.

C. Decreased rate of drug metabolism by the liver.

D. Decreased efficiency in drug distribution.

Answer 12

C. Decreased rate of drug metabolism by the liver.

Elderly clients experience a decreased rate of drug metabolism.

Question 13

The nurse administers fentanyl (Sublimaze) to the wrong client. The appropriate nursing action is to:

A. Report the error to the physician, document the medication in the client record, and complete an incident report.

B. Document the error if the client has an adverse reaction.

C. Monitor the client for an adverse reaction before reporting the incident.

D. Notify the physician and document the error in the incident report only.

Answer 13

A. Report the error to the physician, document the medication in the client record, and complete an incident report.

Question 14

Mrs. Walker requires PRN pain medication for a lower back pain level of 5/10. The physician orders tramadol 50 mg PO and then the phone reception is interrupted and the phone conversation is cut out. When you call the physician back, what information would the nurse need to clarify the verbal physician’s order?

A. Brand name

B. Cost of the medication

C. Generic name of the medication

D. Frequency of administration

Answer 14

D. Frequency of administration

Interpret the prescriber’s order accurately (i.e., drug name, dose, frequency of administration). Question the prescriber if any information is unclear or if the drug seems inappropriate for the client’s condition.

Question 15

Which of the following is the HIGHEST nursing priority when a client has an allergic reaction to a newly prescribed medication?

A. Notify the physician of the allergic reaction.

B. Document the allergy in the medical record.

C. Place an allergy bracelet on the client.

D. Instruct the client to remain calm.

Answer 15

A. Notify the physician of the allergic reaction.

Question 16

A 16-year-old adolescent who is 6 weeks pregnant has acne that has been exacerbated during the pregnancy. She asks the nurse if she can resume taking her tretinoin (Retin-A) prescription. The best response by the nurse is:

A. “you should reduce your Retin-A dose by half during pregnancy”

B. “you should check with your doctor at your next visit”

C. “Retin-A is known to cause birth defects; you should never take it during pregnancy”

D. “since you have a prescription for Retin-A, it is safe to take”

Answer 16

C. “Retin-A is known to cause birth defects; you should never take it during pregnancy”

Retin-A is Category D. Positive evidence of human fetal risk.

Question 17

After administering an opioid agonist IV to a client, the nurse would make which priority follow-up assessments in addition to pain relief?

A. Assess respiratory rate and level of consciousness.

B. Assess interactions with foods and other prescribed drugs.

C. Monitor blood pressure and heart rate.

D. Monitor IV site and bowel sounds.

Answer 17

A. Assess respiratory rate and level of consciousness.

The primary purpose of administering opioid analgesics is pain relief. Side effects placing the client at greatest risk are respiratory depression and reduced level of consciousness (LOC).

Question 18

The nurse is administering tramadol (Ultram) by the enteral route. Prior to the administration of tramadol, the nurse should evaluate which of the following?

A. Ability of the client to swallow.

B. Compatibility of the drug with IV fluid.

C. Patency of the injection port.

D. Ability of the client to lie supine.

Answer 18

A. Ability of the client to swallow.

The enteral route involves the process of swallowing by definition.

Question 19

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient’s leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:

A. Prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

B. Improve perfusion by increasing blood flow to the area.

C. Allow more systemic absorption to speed up metabolism of the lidocaine.

D. Increase the rate of absorption of the lidocaine.

Answer 19

A. Prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

Epinephrine causes vasoconstriction, which reduces local blood flow and delays systemic absorption of lidocaine, which prolongs local anesthetic effects and reduces the risk of systemic toxicity. Epinephrine slows the rate of absorption. Epinephrine delays systemic absorption of lidocaine, so metabolism is slowed and the effects are prolonged in the periphery. Epinephrine does not increase local blood flow.

Question 20

The nurse, on a medicine unit, is preparing to administer her client’s 10:00 AM medications. After the medication orders are verified, what intervention should the nurse implement prior to opening the client’s medications at the bedside?

A. Take the medication and the Medication Administration Record (MAR) to the bedside.

B. Wash hands before administering medications to the clients.

C. Check the client’s identification band with the Medication Administration Record (MAR).

D. Compare the medication with the Medication Administration Record (MAR)

Answer 20

B. Wash hands before administering medications to the clients.

AND

C. Check the client’s identification band with the Medication Administration Record (MAR).

Everyone received credit for this question; however, please do not forget to wash your hands ;) Washing your hands is essential to avoid contaminating the medication. Although it seems like an obvious step, it is often neglected by the nurse as a result of being busy and in a hurry.

Question 21

The nurse is administering a 9:00 AM medication of hydromorphone (Dilaudid) 1 mg IV to the following clients. Which client should the nurse QUESTION administering the medication to?

A. The client who has a a normal platelet count.

B. The client who drank a full glass water and ate a large meal.

C. The client who has a blood pressure of 88/58 mm/Hg.

D. The client who is complaining of lower back pain.

Answer 21

C. The client who has a blood pressure of 88/58 mm/Hg.

The blood pressure is below 90/60 mm/Hg; therefore, the nurse should question administering hydromorphone (Dilaudid) due to the risk of causing an additional CNS adverse effect of hypotension.

Question 22

The nurse’s legal responsibility when administering medications to clients is to:

A. Ensure the medication is administered and delivered in a safe manner.

B. Be certain that the physician order is accurate.

C. Assure client compliance by watching the client swallow all prescribed medications.

D. Inform the client that prescribed medications need to be taken only if the client agrees with the treatment plan

Answer 22

A. Ensure the medication is administered and delivered in a safe manner.

The primary responsibility of the nurse is to ensure client safety when administering prescribed medications.

Question 23

The nurse observes a coworker preparing to administer a solution of lidocaine and epinephrine IV to a client with an irregular heart rate. The appropriate action by the nurse is to:

A. Notify the nursing supervisor of the error.

B. Prevent administration and question the order with the physician.

C. Do nothing: the drug choice is correct.

D. Document administration of the drug.

Answer 23

B. Prevent administration and question the order with the physician.

Solutions of lidocaine containing preservatives or epinephrine are intended for local anesthesia only and must never be given IV for dysrhythmias.

Question 24

Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction?

A. Hydrocodone (Lortab)

B. Pentazocine (Talwin)

C. Nalmefene (Revex)

D. Morphine (Duramorph)

Answer 24

D. Morphine (Duramorph)

Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.

Question 25

An elderly client presents to her outpatient clinic and is given a new prescription for tramadol (Ultram) for bilateral hip and lower back pain due to osteoarthritis. Prior to the client receiving this medication, the nurse should perform which of the following FIRST?

A. Inform the client where a medication organizer can be purchased.

B. Give short, simple verbal explanation about the drug and its side effects.

C. Complete a thorough medication assessment to see what other drugs the client is taking.

D. Provide the client with a printed pamphlet describing the drug and its use.

Answer 25

C. Complete a thorough medication assessment to see what other drugs the client is taking.

Older clients often take other prescribed drugs, herbs, or other alternative remedies, and clients may be ingesting an over-the-counter (OTC) remedy for arthritis pain. Because there is a potentially high risk for drug-drug or drug-herb interaction, getting a thorough picture of the client’s current drug regimen is the first step in planning for client education when a new drug is ordered.

Question 26

Mr. Jones is self-administering the OTC herbals valerian and kava. Prior to the client’s sugery, the anesthesiologist asks the client to do which of the following prior to receiving midazolam (Versed)?

A. Continue only the kava according to his current medication regimen.

B. Maintain his current regimen regardless of the herbal supplements taken.

C. Discontinue the herbal medication a few days prior to surgery.

D. Discontinue the herbal medication 2 to 3 weeks prior to surgery.

Answer 26

D. Discontinue the herbal medication 2 to 3 weeks prior to surgery.

The American Society of Anesthesiologist recommends that all herbal products be discontinued 2 to 3 weeks before any surgical procedure. Kava and valerian may increase sedation if the patient receives benzodiazepines while taking the herbal medications.

Question 27

Mrs. Smith is 12 hours post appendectomy. Her husband asks the nurse to reduce the amount of hydromorphone (Dilaudid) that his wife is receiving. He states, “When I had my appendix out, I needed half the pain medication that she does.” Based on the nurse’s knowledge, what is the best nursing response?

A. “I will call the physician for an order to decrease the dose and the frequency of your wife’s pain medication.”

B. “I agree she is taking far too much pain medication.”

C. “You should discuss your wife’s pain management with the physician.”

D. “Pain is a subjective experience, we all feel pain differently.”

Answer 27

D. “Pain is a subjective experience, we all feel pain differently.”

Pain is a subjective experience. Stressors such as anxiety, depression, fatigue, anger, and fear tend to increase pain; rest, mood elevation, and diversionary activities tend to decrease pain. Pain is a complex physiologic, psychological, and sociocultural phenomenon that must be thoroughly assessed if it is to be managed effectively.

Question 28

A 53-year-old client underwent placement of a pin to stabilize her fractured hip. She just returned to the surgical unit form the OR and during the first 48 hours postoperatively, hydromorphone (Dilaudid) IV is ordered for pain control. During the time the client is taking hydromorphone, frequent monitoring of which of the following is top priority?

A. Blood pressure

B. Mobility

C. Pulse

D. Temperature

Answer 28

A. Blood pressure

Opioid agonist medications pose a risk for CNS depression. Due to the client returning from the OR where other sedative medications were received, it is imperative to also monitor the client’s blood pressure while receiving hydromorphone (Dilaudid).

Question 29

The nurse prepared morphine sulfate 2 mg IV for a client who is complaining of 2/10 right lower extremity pain. When the nurse enters the room the client tells the nurse, “I don’t want to take a shot. I would like to have a pain pill.” Which action should the nurse take?

A. Notify the pharmacy that the morphine sulfate 2mg IV was not administered to the client.

B. Ask another nurse to witness the medication being wasted via the sink or sharps container.

C. Explain that the medication must be administered because it has been drawn up.

D. Place the syringe in the sharps container in the client’s room.

Answer 29

B. Ask another nurse to witness the medication being wasted via the sink or sharps container.

The nurse must have another nurse witness when a narcotic is refused by the patient and needs to be discarded and/or wasted.

Question 30

The client with a head injury is ordered a CT scan of the head and the client is requesting to receive morphine sulfate prior to being transported to the radiology department. Which intervention should the nurse include when discussing the administration of morphine sulfate?

A. Explain to the client that morphine sulfate is contraindicated because this could put the client at potential risk of increased cerebrospinal fluid (CSF) pressure.

B. Morphine sulfate can not be taken with any routine medications; therefore, the client should not receive the drug.

C. Ask about allergies to nonsteriodal anti-inflammatory medication.

D. Inform the client that an intravenous line (IV) will be started prior to the procedure and the client can receive the morphine sulfate at that time.

Answer 30

A. Explain to the client that morphine sulfate is contraindicated because this could put the client at potential risk of increased cerebrospinal fluid (CSF) pressure.

Morphine sulfate reduces the sensitivity of the respiratory center to CO2 thus decreasing tidal volume and rate and producing respiratory depression. The resulting increase in CO2 produces vasodilation and increases CSF pressure.

Question 31

The nurse administers morphine sulfate 2 mg IV at 11:00 AM to a client diagnosed with pancreatic cancer. During the nurse’s hourly rounds, the nurse reassesses the client’s pain. Which data indicates the medication was effective?

A. The client is lying as still as possible in the bed.

B. The client keeps his or her eyes closed and the drapes drawn.

C. The client uses guided imagery to help with pain control.

D. The client is snoring lightly when the nurse enters the room.

Answer 31

D. The client is snoring lightly when the nurse enters the room.

Keeping the eyes closed and drapes drawn would not indicate the pain medication is effective. These actions may be the client’s way of dealing with the pain. Using guided imagery is an excellent method to assist with the control of pain, but its use does not indicate effectiveness of the medication. This action of lying still may be the client’s way of dealing with the pain, but it does not indicate the medication is effective.

Question 32

Miss Smith presents to the emergency department after stubbing her right toe on her coffee table. She reports her pain as mild aching and rated 2/10. The physician orders to administer hydromorphone (Dilaudid) 0.2mg IV for treatment of Miss Smith’s right foot pain. Prior to administering the pain medication, the appropriate nursing action is to:

A. Question the physician about the order.

B. Administer one tablet only.

C. Hold the drug until the physician arrives.

D. Administer the drug as ordered.

Answer 32

A. Question the physician about the order.

The client’s pain rating is mild at 2/10. The client’s pain management can be controlled with non-opioid analgesics.

Question 33

The client is taking morphine sulfate for pain after a procedure. He has asked for pain medication. This will be his fourth dose of morphine sulfate. The nurse goes to his room to administer the drug. His respiratory rate is 10 breaths per minute. What is the best action by the nurse?

A. Hold the medication and contact the health care provider about his respiratory rate.

B. Give the medication and contact the client’s health care provider about his respiratory rate.

C. Hold the medication and contact the client’s health care provider about his pain.

D. Give the medication and contact the client’s health care provider about his pain.

Answer 33

A. Hold the medication and contact the health care provider about his respiratory rate.

The client’s respiratory rate is s respiratory rate.

Question 34

Prior to administering medication to a hospitalized client who is awake and carrying on a conversation with visitors, what would be the most accurate way for the nurse to check the client’s identity?

A. Ask the client, “Are you Dale Jones.”

B. Match the medication with the client’s diagnosis.

C. Check the client’s room number and bed assignment.

D. Ask the client, “Can you tell me your name and date of birth?”

Answer 34

D. Ask the client, “Can you tell me your name and date of birth?”

Asking the client to state his or her name is an accurate way to identify a client, provided the client is alert. A second unique identifier, such as date of birth or medical record number, should also be used. This information may be found on the client’s indentification bracelet, although the client may be asked to state date of birth.

Question 35

Mr. Jones is receiving morphine sulfate IV in the Medical ICU. What potential adverse effect should the nurse assess to determine if the client is experiencing side effects of morphine sulfate?

A. Urinary retention

B. Headaches

C. Increased coughing

D. Increased blood pressure

Answer 35

A. Urinary retention

Urinary retention may occur due to increasing bladder sphincter tone.

Question 36

Mr. Dow is a 67-year-old client who works the evening shift. The physician orders a medication that must be taken three times a day on an empty stomach. He asks the nurse if he can take his evening dose with his evening dinner due to convenience with his work schedule. What is the nurse’s best response?

A. “It does not matter if the food is taken on a full stomach.”

B. “If it is only one meal, the food will not make a difference.”

C. “Food may slow down the absorption of the drug.”

D. “Food may increase the effectiveness of the medication.”

Answer 36

C. “Food may slow down the absorption of the drug.”

Question 37

Ms. Batten is prescribed retinoids for her moderate acne. She returns to the office 1 week later, disappointed because she does not see improvement in her condition. You explain to the client that improvement may not be seen for up to how many weeks?

A. 12
B. 10
C. 7
D. 5

Answer 37

A. 12

Couple of sources also read 4-8 weeks. Credit given for all choices. Retinoids, in both systemic and topical forms, may be used for moderate to severe acne. All topical retinoids reduce acne lesions, usually within 12 weeks.

Question 38

A client refuses a PRN medication of hydromorphone (Dilaudid) PO; you document the reason for the refusal in the medication administration record and dispose of the medication according to facility policy. By documenting the client’s refusal and reason for declining the medication, you are adhering to which of the “rights” of medication administration?

A. Right dose

B. Right documentation

C. Right medication

D. Right patient

Answer 38

B. Right documentation

Question 39

The client with liver dysfunction experiences toxicity to midazolam (Versed) following administration of several doses while undergoing an endoscopy procedure. This adverse reaction may have been prevented if the nurse had followed which phase of the nursing process?

A. Planning

B. Evaluation

C. Implementation

D. Assessment

Answer 39

D. Assessment

Prior to administering medications, the nurse should assess renal and liver function and impairments of other body systems that may affect pharmacotherapy. This is especially important when administering medications to elderly and severely debilitated clients.

Question 40

The charge nurse is making rounds and notices that Mr. Jacksons’s primary nurse left his medication cup with three tablets inside at the client’s bedside. Which action should the charge nurse implement?

A. Administer the client’s medication.

B. Request for the primary nurse to come to the room.

C. Remove the medication cup from the room.

D. Leave the cup at the bedside and do nothing.

Answer 40

C. Remove the medication cup from the room.

The charge nurse cannot administer medications that were not prepared by him/her and the medications should not be left at the bedside. No one should administer medication dispensed by another person. The charge nurse should not correct the primary nurse in front of the client; therefore, this would not be an appropriate intervention. The charge nurse should confront the nurse and provide feedback at another location that is not in front of the client. The charge nurse is also a vital role of the health care team and is expected to maintain safety for the client.

Question 41

Because of the physiologic and biochemical changes of aging, the nurse recognizes which adjustment in medications may be necessary?

A. Medications will need to be given more frequently.

B. Dosages will need to be decreased.

C. The parental route of administration is preferred.

D. Drugs should be given in the early AM.

Answer 41

B. Dosages will need to be decreased.

Question 42

Nurses should be aware that older adults are at risk of underrated pain. Nursing assessment and management of pain should address the following beliefs EXCEPT:

A. Older adults seldom report pain when compared to the younger population.

B. Older adults do not believe in analgesics, they are tolerant.

C. Complaining of pain will lead to be labelled as a bad patient.

D. Pain is a sign of weakness.

Answer 42

B. Older adults do not believe in analgesics, they are tolerant.

– Partially correct: D. Pain is a sign of weakness.

Question 43

The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with 4/10 back pain. Which health care provider order should the charge nurse question?

A. CBC and CMP (complete metabolic panel) lab work.

B. Morphine sulfate, an opioid agonist, 2 mg IV every 4 hours.

C. Carisoprodol (SOMA), a muscle relaxant, PO, twice daily.

D. tramadol (Ultram), centrally acting nonopioid analgesic, 50 mg PO every 6 hours PRN.

Answer 43

B. Morphine sulfate, an opioid agonist, 2 mg IV every 4 hours.

Many medications can affect the kidneys or the liver and the blood counts. Baseline data should be obtained. There is no reason to question this order. This medication order is an appropriate order. The nurse would not question this order. Soma comes in one strength, so this order is complete. There is no reason to question this order.

Question 44

Jane is a 43-year-old client who is receiving morphine sulfate IV for acute 8/10 pain. When the nurse assesses the client’s pain, the client states that she is feeling nauseated. What is the best response from the nurse?

A. “This is a severe adverse effect of morphine sulfate and all additional doses should be held.”

B. “The nausea will go away on its own so there is no need to worry.”

C. “I will notify your physician to request an antiemetic to be administered as this is a common side effect of morphine sulfate.”

D. “You are experiencing an allergic reaction to morphine sulfate.”

Answer 44

C. “I will notify your physician to request an antiemetic to be administered as this is a common side effect of morphine sulfate.”

Morphine sulfate stimulates the chemoreceptor trigger zone in the medulla, producing nausea and vomiting, which may require the administration of an antiemetic drug during the first few days of therapy.

Question 45

The nurse is preparing to administer Mr. Brown’s PO 10:00 PM medications. Prior to administering Mr. Brown’s PO medications, the nurse should FIRST:

A. Assess that the client is alert and has the ability to swallow.

B. Open the medication and place it in the medication cup.

C. Offer a glass of water to facilitate the swallowing of the medication.

D. Remain with the client until all medications are swallowed.

Answer 45

A. Assess that the client is alert and has the ability to swallow.

The nurse should determine if the client can swallow the PO medication.

Question 46

The medication administration record (MAR) shows that a client is to receive tramadol (Ultram) 50 mg PO at 09:00 AM. On hand are tramadol (Ultram) 200 mg tablets. What action should the nurse take FIRST?

A. Give the 200 mg tablet of tramadol (Ultram) from the drug supply.

B. Give 1/4 of the 200 mg tablet of tramadol (Ultram) from the drug supply.

C. Re-check the original physician order to verify the dosage againist the medication administration record (MAR).

D. Ask the client if the 200 mg tablet of tramadol (Ultram) looks familiar to what they have taken before.

Answer 46

C. Re-check the original physician order to verify the dosage againist the medication administration record (MAR).

This is an example of the importance of double checking the original prescriber order and giving the medication that is the correct dosage.

Question 47

Naloxone (Narcan) is administered to a client with severe respiratory depression who was brought into the Emergency Department for a suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is:

A. The dose of naloxone was inadequate.

B. The client did not ingest an opioid drug.

C. The client is resistant to this drug.

D. The drug overdose is irreversible.

Answer 47

B. The client did not ingest an opioid drug.

Question 48

A client is receiving hydromorphone (Dilaudid) IV for acute pain and tells the nurse, “I get dizzy when I stand up.” Which of the following is the most appropriate response by the nurse?

A. “This is an expected side effect of the drug, and you should use caution and move slowly when standing up.”

B. “Dizziness is not related to the drug, but I will need to ask you a few more questions.”

C. “Episodes of dizziness when moving are common symptoms of acute pain.”

D. “You may be experiencing a toxic effect of the drug and I will notify the physician.”

Answer 48

A. “This is an expected side effect of the drug, and you should use caution and move slowly when standing up.”

Feeling dizzy when moving from lying or sitting to standing position is referred to as orthostatic hypotension and is a potential side effect of opioid agonist. The client should be instructed to change positions slowly.

Question 49

The physician has ordered benzocaine spray for the treatment of discomfort related to a client’s mild burn. When caring for a client who is prescribed this medication, what teaching would you want the client to be informed of?

A. You do not need to report severe or persistent pain.

B. Avoid additional sun exposure while receiving treatment.

C. It is okay to apply the medication to open or infected ares of skin.

D. You do not need to re-apply the medication after swimming or sweating

Answer 49

B. Avoid additional sun exposure while receiving treatment.

Question 50

Mr. Gray calls the nurses’ station and request for an order of fentanyl (Sublimaze) for his chronic 6/10 lower back pain. When the nurse enters the room with the Mr. Gray’s fentanyl, the nurse finds the client laughing and talking with visitors. Which action should the nurse implement FIRST?

A. Wait until the visitors leave to administer any medication.

B. Administer the client’s prescribed pain medication.

C. Check the MAR to see if there is an non-narcotic medication ordered.

D. Assess the client’s perception of pain on a 1-10 pain scale.

Answer 50

D. Assess the client’s perception of pain on a 1-10 pain scale.

– Partially correct:
B. Administer the client’s prescribed pain medication.

The first action is always to assess the client in pain to determine if the client is having a complication that requires medical intervention rather than PRN pain medication.