NURS 3015 Chapters 14, 48 and 53 Quiz Papers

NURS 3015 Chapters 14, 48 and 53 Quiz Papers – Chapter 14

A patient is receiving acetaminophen (Tylenol) for fever. The patient also has inflammation in the knees & elbows w/ pain. Why will acetaminophen (Tylenol) assist in reducing fever but not in decreasing the inflammatory process?
1. Prostaglandin inhibition is limited to the central nervous system.
2. Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only.
3. Acetaminophen has an antiplatelet effect to decrease edema.
4. Prostaglandins decrease the gastric acid secretion.
  - A
  - The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen doesn’t produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

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2. A patient suffers from pain in the elbow related to inflammation. What are the chemical mediators of inflammation?

1. 1. Insulin, thyroid hormone, and calcitonin
  2. Bradykinin, histamine, and leukotrienes
  3. Phospholipids, arachidonic acid, and platelets
  4. Red blood cells, lymph, and serosa
    - B
    - Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes.

3. A patient is administered acetylsalicylic acid (aspirin) for fever & headache. What is the action of acetylsalicylic acid (aspirin)?

1. 1. 1. 1. Inhibiting prostaglandin synthesis in the central and peripheral nervous system
      2. Providing selective action by inhibiting prostaglandin synthesis in the CNS
      3. Inhibiting the release of norepinephrine to increase blood pressure
      4. Suppressing the function of the hypothalamus to decrease inflammation
        
        A
        
        Aspirin inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Aspirin does not inhibit the release of norepinephrine to increase blood pressure. Aspirin does not suppress the function of the hypothalamus to decrease inflammation.

7. When acetylsalicylic acid (aspirin) is administered in low doses, it blocks the synthesis of thromboxane A₂. What physiological effect results from this action?

1. 1. 1. 1. Inflammation is relieved.
        
        Core body temperature is reduced.
        
        Pain is relieved.
        
        Platelet aggregation is inhibited.
        
        D
        
        At low doses, aspirin blocks the synthesis of thromboxane A₂ to inhibit platelet aggregation; this lasts for the life of the platelet.

8. A patient began taking acetylsalicylic acid (aspirin) several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is most likely appropriate for this patient?

1. 1. 1. 1. 80 mg
        
        180 mg
        
        325 mg
        
        650 mg
        
        A
        
        The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 80 mg daily) are used for the drug’s antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke.

9. A patient is suffering from bursitis in the right elbow. Which of the following orally administered medications is most likely to diminish inflammation and assist in relieving pain?

1. 1. 1. 1. Acetaminophen (Tylenol)
        
        Morphine sulfate
        
        Acetylsalicylic acid (aspirin)
        
        Codeine
        
        C
        
        Aspirin is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders. Aspirin is administered orally. Acetaminophen (Tylenol) will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation. Codeine will relieve pain but not affect inflammation.

10. A patient is diagnosed with familial adenomatous polyposis. Which of the following nonsteroidal anti-inflammatory agents has the potential to reduce the number of polyps and decrease the risk of colon cancer?

1. 1. 1. 1. Ibuprofen (Motrin)
        
        Nabumetone (Relafen)
        
        Celecoxib (Celebrex)
        
        Probenecid (Benemid)
        
        C
        
        Celecoxib (Celebrex), a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen (Motrin) and nabumetone (Relafen) are not recommended for use in preventing familial adenomatous polyposis. Probenecid (Benemid) is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.

11. A patient is taking ibuprofen (Motrin) for knee pain. The patient is admitted to the hospital with abdominal pain. Which of the following assessments should the nurse prioritize?

1. 1. 1. 1. Assessment for diarrhea
        
        Assessment for occult blood in the patient’s stool
        
        Assessment of the patient’s urine for hematuria
        
        Assessment for hemoptysis
        
        B
        
        Nonsteroidal anti-inflammatory agents that block COX-1 and COX-2 place the patient at risk for gastrointestinal bleed. Patients who have symptoms of abdominal pain and are taking NSAIDs should be assessed for signs and symptoms of gastrointestinal bleed. Assessing the patient for diarrhea is not related to ibuprofen (Motrin) administration. Assessing the patient for hematuria or hemoptysis is not a priority.

NURS 3015 Chapters 14, 48 and 53 Quiz Papers

12. A child has symptoms of influenza, including a fever. Which of the following medications should not be administered to the child because of the risk of Reye’s syndrome?

1. 1. 1. 1. Acetaminophen (Tylenol)
        
        Acetylsalicylic acid (aspirin)
        
        Ibuprofen (Motrin)
        
        Ascorbic Acid (vitamin C)
        
        B
        
        In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye’s syndrome. Acetaminophen (Tylenol) and ibuprofen (Motrin) are safe to administer for fever reduction and pain relief in children and adolescents. Ascorbic acid (vitamin C) is safe to administer to children but is not used to reduce fever or pain.

13. A perinatal nurse is preparing a dose of IV indomethacin for administration to a neonate. What is the most plausible indication for this treatment?

1. Patent ductus arteriosus
2. Tetralogy of Fallot
3. Patent foramen ovale
4. Cardiomyopathy
  - A
  - The FDA has approved IV indomethacin for treatment of patent ductus arteriosus in premature infants.

14. A patient is admitted to a neurological unit with a confirmed cerebrovascular bleed. Which of the following medications used to treat inflammation is contraindicated in this patient?

1. Furosemide (Lasix)
2. Hydrochlorothiazide w/ triamterene
3. Digoxin (Lanoxin)
4. Ketorolac (Toradol)
  - D
  - Ketorolac (Toradol) should not be administered to a patient with a suspected or confirmed cerebrovascular bleed. Furosemide (Lasix) is administered to reduce fluid volume and is not administered to treat inflammation. Hydrochlorothiazide with triamterene is administered to reduce fluid volume and is not administered to treat inflammation. Digoxin (Lanoxin) is administered to increase cardiac output, not to treat inflammation.

15. An elderly patient has taken ibuprofen (Motrin) 800 mg two times per day for the past 3 years. Which of the following laboratory tests is the priority assessment?

1. Renin and aldosterone levels
2. 24-hour urine for microalbumin
3. Blood urea nitrogen and serum creatinine
4. Complete blood count
  - C
  - Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The patient should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen. A complete blood count may not be necessary.

16. A patient is allergic to acetylsalicylic acid (aspirin). Which of the following medications is contraindicated due to cross-hypersensitivity reactions?

1. Acetaminophen (Tylenol)
2. Naproxen sodium (Naprosyn)
3. Morphine sulfate (MS Contin)
4. Naloxone (Narcan)
  - B
  - In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis. Acetaminophen (Tylenol) does not have cross-sensitivity with acetylsalicylic acid (aspirin) because it is not an NSAID. Morphine sulfate (MS Contin) does not have a cross-sensitivity to aspirin because it is an opioid, not an NSAID. Naloxone (Narcan) is an opioid antagonist and does not have cross-sensitivity with aspirin.

17. A patient with osteoarthritis has been prescribed meloxicam (Mobic). Which of the following instructions should the patient be given?

1. Take the med w/ orange juice
2. Crush enteric-coated tablets to aid swallowing.
3. Take the med w/ food
4. Take the med at bedtime
  - C
  - Meloxicam should be taken with food. Enteric-coated tablets are never crushed, and it is not always necessary to take this medication at bedtime. Orange juice is not of particular benefit.

18. A patient enters the emergency room with complaints of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to which of the following?

1. Acute acetaminophen toxicity
2. Salicylism
3. Ibuprofen overdose
4. Caffeine overdose
  - B
  - Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.

19. A patient is admitted to the emergency department with a suspected overdose of acetaminophen (Tylenol). What adverse effect is most common in acute or chronic overdose of acetaminophen (Tylenol)?

1. Nephrotoxicity
2. Hepatotoxicity
3. Pulmonary insufficiency
4. Pancreatitis
  - B
  - In acute or chronic overdose of acetaminophen (Tylenol), the patient can develop hepatotoxicity. Nephrotoxicity is not an adverse effect associated with Tylenol overdose. Pulmonary insufficiency is not an adverse effect associated with Tylenol overdose. Pancreatitis is not an adverse effect associated with Tylenol overdose.

20. A patient suffers from gouty arthritis. Why is probenecid (Benemid) administered?

1. To increase urinary excretion of uric acid
2. To decrease the level of liver enzymes
3. To diminish the temp
4. To increase protein metabolism
  - A
  - Probenecid (Benemid) increases the urinary excretion of uric acid. Probenecid (Benemid) will not decrease the level of liver enzymes, diminish temperature, or increase protein metabolism.

21. A patient is diagnosed with salicylate overdose. Which of the following medications will be administered for the treatment of salicylate overdose?

1. Intravenous meperidine (Demerol)
2. Intravenous sodium bicarbonate
3. Intravenous furosemide (Lasix)
4. Inhaled acetylcysteine (Mucomyst)
  - B
  - Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted in patients with salicylism.

22. Which of the following is the antidote for acetaminophen (Tylenol) poisoning?

1. Acetylcysteine (Mucomyst)
2. Allopurinol (Zyloprim)
3. Diclofenac sodium (Voltaren)
4. Ketorolac (Toradol)
  - A
  - A specific antidote, acetylcysteine (Mucomyst), is a mucolytic agent given for acetaminophen poisoning.

23. A nurse is conducting a medication reconciliation for a 79-year-old man who has just relocated to the long-term care facility. The nurse notes that the man has been taking colchicine (Colcrys) on a regular basis. This aspect of the man’s medication regimen should signal the nurse to the possibility that he has a diagnosis of

1. Osteoarthritis
2. Gout
3. Inflammatory bowel disease
4. Bursitis or tendinitis
  - B
  - Colchicine (Colcrys), the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medication. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis.

NURS 3015 Chapters 14, 48 and 53 Quiz Papers – Chapter 48

A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication?
1. Draw up half of the medication for administration.
2. Notify the physician for a reduced dosage.
3. Assess the patient’s respiratory status.
4. Assess the patient’s pain tolerance.
  - B
  - Morphine and meperidine form pharmacologically active metabolites. Thus, liver impairment can interfere with metabolism, and kidney impairment can interfere with excretion. Drug accumulation and increased adverse effects may occur if dosage is not reduced. The nurse cannot administer half of the medication without a physician’s order. It is important to assess the patient’s respiratory status before administration, but this action is not the primary intervention in this case. Narcotics prior to surgery are administered to increase pain tolerance during the surgical procedure, not during the preoperative phase.

2. An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration?

1. 1. Consume a diet high in fiber
  2. Decrease activity due to pain
  3. Elevate the lower extremities
  4. Take aspirin w/ the med
    - A
    - Hydrocodone is an opioid, which, in the gastrointestinal tract, slows motility. To prevent constipation, the patient should consume a diet high in fiber. A decrease in activity due to pain will increase constipation. Elevating the lower extremities will not increase or decrease pain. Hydrocodone should not be routinely combined with aspirin unless prescribed by the physician.

3. A hospice patient has been ordered morphine (Roxanol) 5 mg sub-Q every 2 hours. Roxanol contains 10 mg/mL. How many milliliters will be administered?

1. 1. 1. 25 mL
    2. 5 mL
    3. 1 mL
    4. 2 mL
      - B
      - 5 mg/X = 10 mg/mL. The calculation results in 0.5 mL. The administration of 0.25, 1, or 2 mL is incorrect.

4. A patient who suffers from cancer pain is receiving morphine every 2 hours. For which of the following should the family be taught to assess while the patient is on morphine?

1. 1. 1. 1. Diarrhea
      2. Respiratory depression
      3. Lung sounds
      4. Urinary incontinence
        
        B
        
        The administration of morphine can result in respiratory depression. The family should be taught to assess the patient for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. The patient’s lung sounds are important to assess, but only after the nurse assesses for respiratory depression.

5. A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine. Which of the following interventions is most appropriate to teach the patient?

1. 1. 1. 1. “The pump will administer all of the doses, so you don’t have to worry.”
        
        “If you follow the instructions, that won’t happen to you.”
        
        “The device is preset, so you cannot receive more than you need.”
        
        “The device will give you a placebo when you press it often.”
        
        C
        
        PCA pumps deliver a basic amount of analgesic by continuous infusion, with the patient injecting additional doses when needed. The amount of the drug is preset and limited. The pump will administer a basal rate, but the patient can administer the medication at preset intervals. Telling the patient not to worry is not effective teaching or use of therapeutic communication. Telling the patient to follow the instructions is not effective teaching or use of therapeutic communication. Instructing the patient on a placebo is not effective teaching or use of therapeutic communication.

6. A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient? NURS 3015 Chapters 14, 48 and 53 Quiz Papers

1. 1. 1. 1. Naloxone (Narcan)
        
        Capsaicin (Zostrix)
        
        Butorphanol (Stadol)
        
        Nalbuphine (Nubain)
        
        A
        
        Naloxone (Narcan) has long been the drug of choice to treat respiratory depression caused by an opioid. Capsaicin is made from cayenne pepper and applied topically for pain relief. Butorphanol (Stadol) is a synthetic, Schedule IV agonist similar to morphine in analgesic effects and ability to cause respiratory depression. Nalbuphine (Nubain) is a synthetic analgesic used for moderate to severe pain.

7. A patient has been administered an opioid. For which of the following effects should the patient be assessed?

1. 1. 1. 1. Oliguria
        
        Decreased level of consciousness
        
        Edema
        
        Tachycardia
        
        B
        
        Opioids will produce decreased LOC. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.

8. A nurse is teaching a patient about her prescription for Tylenol #3 that she will take at home. This medication consists of acetaminophen and what other drug?

1. 1. 1. 1. Codeine
        
        Acetylsalicylic acid (aspirin)
        
        Methadone (Dolophine)
        
        Tramadol (Ultram)
        
        A
        
        Tylenol #3 is acetaminophen (Tylenol) and codeine. Acetylsalicylic acid (aspirin) is not combined with acetaminophen (Tylenol). Methadone (Dolophine) is not combined with Tylenol. Tramadol (Ultram) is not combined with Tylenol.

9. A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms?

1. 1. 1. 1. Meclizine (Antivert)
        
        Ampicillin
        
        Naloxone (Narcan)
        
        Morphine sulfate
        
        D
        
        Morphine is used for the treatment of acute pulmonary edema. Meclizine (Antivert) is given for dizziness. Ampicillin is used to treat infection. Naloxone (Narcan) is the opioid antidote.

10. A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development?

1. She has developed a dependency on the morphine.
2. She has metastatic cancer and is dying.
3. She has greater pain with inactivity.
4. She has developed tolerance to morphine.
  - D
  - Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The patient has not developed a dependence on morphine. A patient with metastatic cancer will require increasing pain management, but this feature is not the rationale for the patient’s statement. The increased pain is not related to inactivity.

11. n which of the following patients should the nurse question the physician’s order for IV morphine?

1. An 88-year-old female w/ failure to thrive
2. A 45-year-old female, 1-day postoperative mastectomy
3. An 8-year-old male with a fractured femur
4. A 17-year-old female, 1-day postoperative appendectomy
  - A
  - Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after mastectomy is appropriate for pain management. The treatment of pain with morphine is appropriate for a patient with a fractured femur. The treatment of pain with morphine is appropriate for a patient who is 1-day postoperative for an appendectomy.

12. A 30-year-old male patient has been ordered Demerol 75 mg IM every 4 hours after a fractured femur. What action should the nurse take?

1. Give the med as ordered
2. Admin half the dose
3. Call the physician for a smaller dose.
4. Give dose by mouth
  - A
  - The patient should be administered the full dose of medication, which is within dosing recommendations. A male patient with a fractured femur who has adequate hepatic and renal function should not receive a lower dose of Demerol and should not receive the medication by mouth.

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13. A nurse is instructing a patient on the administration of an opioid medication. What medication effect will most likely develop?

1. Lower extremity paresthesia
2. Drowsiness
3. Occipital headache
4. Polyuria
  - B
  - Drowsiness and sedation are results of central nervous system depression. The patient will not develop lower extremity paresthesia, occipital headache, or polyuria. If these effects develop, they are not related to the opioid medication.

14. A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family?

1. Remove patch every 3 days
2. Apply to chest only
3. Apply it for breakthrough pain
4. Remove daily and clean skin
  - A
  - Duragesic has a slow onset of action but lasts about 72 hours. Duragesic can be applied to other areas of the skin, not solely on the chest. Duragesic is not applied for breakthrough pain. Duragesic is not removed daily.

15. What is the most effective way to evaluate the patient’s pain response after administering an opioid analgesic?

1. Observe the patient when he/she is not aware you are assessing him/her.
2. Ask another nurse to assess the patient’s response to the medication.
3. Using a pain scale, ask the patient to describe the pain.
4. Ask the family to determine the patient’s response to the pain.
  - C
  - Asking the patient to describe the pain using a pain scale is the most effective assessment of pain response. Observing the patient when he/she is unaware is an objective assessment and does not represent a true pain experience. Asking another nurse to assess the patient’s response will not provide accurate data. Asking the family to determine the patient’s response will not provide accurate data.

16. Nonopioid analgesics may sometimes be added to a narcotic analgesic. What action will result?

1. Antagonism
2. Additive effect
3. Interference
4. Increased excretion
  - B
  - Aspirin and Tylenol are added to narcotic analgesics for additive effects of pain relief without the addition of narcotic adverse effects. Aspirin and Tylenol do not provide an antagonistic effect. Aspirin and Tylenol do not cause an interference of action. Aspirin and Tylenol will not increase excretion.

17. A 16-year-old has been brought to the emergency department by his football coach after twisting his ankle during a practice drill. Diagnostic testing reveals a fracture. This patient is experiencing what type of pain?

1. Acute somatic pain
2. Acute cutaneous pain
3. Visceral pain
4. Neuropathic pain
  - A
  - Sprains and other traumatic injuries are examples of acute somatic pain. Somatic pain results from stimulation of nociceptors in skin, bone, muscle, and soft tissue. Visceral pain, which is diffuse and not well localized, results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues. Neuropathic pain is caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the central nervous system. Cutaneous pain is not a recognized category.

18. A patient with traumatic injuries describes his current pain as being “unbearable.” The pathophysiology of pain begins with a signal from

1. Myelin sheaths
2. Nociceptors
3. Baroceptors
4. Synapses
  - B
  - For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroceptors are not directly involved in pain transmission.

19. A 54-year-old woman is being admitted to the postsurgical unit following a transverse rectus abdominis myocutaneous (TRAM) flap. The patient’s care plan specifies the use of preemptive analgesia. This approach to pain control will involve

1. frequent administration of high-dose opioids.
2. simultaneous use of analgesics from different drug classes.
3. alternating administration of opioid antagonists with opioid agonists.
4. patient-controlled analgesia.
  - B
  - Preemptive analgesia is used to reduce postsurgical pain by simultaneously administering medications from different drug classes to suppress pain by blocking multiple pain pathways. It is not synonymous with PCA and does not require alternation between opioid agonists and antagonists.

20. Following the administration of pentazocine (Talwin) to a patient with moderate pain, the nurse should assess for what change in the patient’s vital signs?

1. Increased BP
2. Decreased o2 saturation
3. Increased temp
4. Increased RR
  - A
  - Talwin may cause increased blood pressure. It does not typically cause deoxygenation, fever, or tachypnea.

NURS 3015 Chapters 14, 48 and 53 Quiz Papers – Chapter 53

A patient is having seizure activity, and the physician has ordered diazepam (Valium) to be given parenterally. If this medication is administered intravenously, when will its onset of action be observed?
1. 1 to 5 min
2. 7 to 10 min
3. More than 10 min
4. Less than 1 min
  - A
  - Intravenous diazepam (Valium) is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action. Diazepam (Valium) decreases seizure activity in less than 7 to 10 minutes. Diazepam (Valium) should decrease seizure activity in less than 10 minutes. Diazepam (Valium) will take more than 1 minute to begin working.

2. A patient suffers from insomnia and is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which of the following contributes to the long half-life of this medication and other benzodiazepines?

1. 1. Metabolism by cytochrome P450
  2. Presence of active metabolites
  3. Excretion by the renal system
  4. Movement of calcium in the cell
    - B
    - Benzodiazepines differ mainly in their plasma half-lives, production of active metabolites, and clinical uses. Drugs with half-lives longer than 24 hours form active metabolites that also have long half-lives and tend to accumulate, especially in older adults and people with impaired liver function. Flurazepam is not metabolized by cytochrome P450. Flurazepam is excreted in the renal system but does not contribute to the effect on the half-life. Flurazepam does not contribute to movement of calcium in the cell.

3. A patient is given midazolam (Versed) in combination with an opioid in the preoperative phase before a laparoscopic cholecystectomy. What does the administration of midazolam (Versed) assist in minimizing?

1. 1. 1. Oral secretions
    2. Anxiety
    3. Hypotension
    4. Muscle tone
      - B
      - Midazolam (Versed) provides preoperative sedation and mechanical ventilation. It does not reduce secretions, increase blood pressure, or reduce muscle tone.

4. A patient’s medication regimen for treatment of anxiety has been changed from a benzodiazepine. The patient asks the nurse what likely prompted his care provider to change his medication. What is the nurse’s best response?

1. 1. 1. 1. “Your doctor may have been concerned about causing depression.”
      2. “Your doctor may have been worried about the possibility of convulsions.”
      3. “Long-term use of benzodiazepines can result in dependency.”
      4. “Long-term use of benzodiazepines can cause insomnia.”
        
        C
        
        Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

5. A patient has developed excessive sedation and respiratory depression. The patient has been taking a benzodiazepine and has diminished liver function. Which of the following medications will reduce the effects of sedation and respiratory depression in this patient?

1. 1. 1. 1. Olmesartan medoxomil (Benicar)
        
        Pancrelipase (Pancrease)
        
        Pamidronate disodium (Aredia)
        
        Flumazenil (Romazicon)
        
        D
        
        Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Romazicon) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Olmesartan medoxomil (Benicar) is an angiotensin II receptor antagonist that is used to treat hypertension. Pancrelipase (Pancrease) is used for enzyme replacement therapy. Pamidronate disodium is used as a bone metabolism regulator.

6. A patient is being observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is characteristic of this problem? NURS 3015 Chapters 14, 48 and 53 Quiz Papers

1. 1. 1. 1. Bradycardia
        
        Agitation
        
        Lethargy
        
        Diaphoresis
        
        B
        
        Common signs and symptoms of withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Bradycardia, lethargy, and diaphoresis are uncharacteristic.

7. A patient is administered a benzodiazepine for anxiety. Which of the following will place the patient at risk for benzodiazepine toxicity?

1. 1. 1. 1. Decreased albumin
        
        Increased calcium
        
        Decreased potassium
        
        Low bicarbonate
        
        A
        
        Patients with liver disease are at risk for adverse effects with drugs that are highly bound to plasma proteins. Increased calcium will not contribute to benzodiazepine toxicity. Decreased potassium will not have a direct impact on benzodiazepine toxicity. The normal bicarbonate will not contribute to benzodiazepine toxicity.

8. An older adult patient suffers from generalized anxiety disorder. The use of benzodiazepines in this patient population creates a risk for what adverse effect?

1. 1. 1. 1. Seizures
        
        Falls
        
        Dysrhythmias
        
        Sexual dysfunction
        
        B
        
        Adverse effects of benzodiazepines may contribute to falls and other injuries unless patients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.

. A 77-year-old patient is suffering from insomnia. Which of the following medications can be most safely administered to this patient to induce sleep?

1. 1. 1. 1. Alprazolam (Xanax)
        
        Clonazepam (Klonopin)
        
        Diazepam (Valium)
        
        Temazepam (Restoril)
        
        D
        
        Temazepam (Restoril) is eliminated by conjugation with glucuronide. Thus, temazepam (Restoril) is the drug of choice for patients who are elderly, have liver disease, or are taking drugs that interfere with hepatic drug–metabolizing enzymes. Alprazolam (Xanax) is not administered for insomnia. Clonazepam (Klonopin) is not administered for insomnia. Diazepam (Valium) is not administered for insomnia.

10. A child with night terrors is administered a benzodiazepine agent. Why must the nurse follow the child’s health status closely?

1. The child is more likely to develop insomnia.
2. The child is more likely to develop dependence.
3. The child is more vulnerable to adverse effects.
4. The child is more vulnerable to hepatotoxicity.
  - C
  - Children may be more sensitive to its effects of this drug, namely mood and/or mental changes. Hepatotoxicity, insomnia, and dependence are not among the most common adverse effect.

11. When administering benzodiazepines, which of the following medications should be considered the drug of first choice?

1. Lorazepam (Ativan)
2. Estazolam (Prosom)
3. Temazepam (Restoril)
4. Triazolam (Halcion)
  - A
  - Lorazepam (Ativan) is probably the benzodiazepine of first choice. The drug provides rapid tranquilization of patients experiencing agitation. Administered intravenously, it reduces nausea and vomiting as well as anxiety and induces procedural amnesia. Lorazepam has a slow onset of action (5 to 20 minutes) because of delayed brain penetration but an intermediate to prolonged duration.

12. A patient is admitted to the intensive care unit with a diagnosis of septicemia. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill patient?

1. Increased diffusion and perfusion
2. Decreased cardiac workload
3. Increased level of consciousness
4. Decreased blood pH
  - B
  - Antianxiety and sedative–hypnotic drugs are often useful in critically ill patients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase LOC.

13. A patient is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? NURS 3015 Chapters 14, 48 and 53 Quiz Papers

1. Triazolam (Halcion)
2. Midazolam (Versed)
3. Oxazepam (Serax)
4. Chlordiazepoxide (Librium)
  - B
  - Midazolam (Versed) is frequently used for conscious sedation during invasive procedures. Halcion, Serax, and Librium are not typically used for this purpose.

14. A middle-aged woman has become increasingly debilitated by anxiety, to the extent that she has sought medical help. After a thorough assessment, her care provider has diagnosed her with an anxiety disorder. The etiology of anxiety involves which of the following physiological processes?

1. Stimulation of the parasympathetic nervous system
2. Stimulating effects of somatotropin
3. Increased activation of the autonomic nervous system
4. Adrenocortical suppression
  - C
  - Clinical manifestations of anxiety include overactivity of the autonomic nervous system, such as dyspnea, palpitations, tachycardia, sweating, dry mouth, dizziness, nausea, and diarrhea. Somatotropin is not directly involved, and the adrenal cortex is not suppressed during times of anxiety. The parasympathetic nervous system is not stimulated during times of anxiety.

15. A patient’s current medical status includes multiple comorbidities. In recent months, the patient has been complaining of insomnia that has begun to have a significant impact on his quality of life. What aspect of this patient’s health is most likely to cause insomnia?

1. The patient has hypothyroidism.
2. The patient is morbidly obese.
3. The patient has chronic pain.
4. The patient has type 2 diabetes.
  - C
  - Chronic pain is commonly associated with insomnia. Diabetes, obesity, and hypothyroidism are not normally associated with insomnia.

16. In the 18 months following the death of his wife, a middle-aged man has been taking benzodiazepines on a daily basis. He has expressed to the nurse his desire to stop taking these medications. In order to minimize the chances of withdrawal symptoms, the nurse knows that the patient will likely be advised to

1. taper down his dose of benzodiazepines over a prolonged period of time.
2. replace the benzodiazepine with a herbal supplement in anticipation of stopping the medication.
3. replace the immediate-acting form of the drug with a long-acting form.
4. replace the benzodiazepine with an anticonvulsant.
  - A
  - To avoid withdrawal symptoms, it is necessary to taper benzodiazepines gradually before discontinuing them completely. Long-acting benzodiazepines, anticonvulsants, and herbal remedies are not recommended in the effort to prevent withdrawal.

17. A patient with a history of alcoholism is being treated in the intensive care unit for multiple trauma following a motor vehicle accident. The patient is currently being treated with lorazepam (Ativan) to treat signs of alcohol withdrawal as well as hydromorphone (Dilaudid) for the pain of injuries. The intensive care nurse should prioritize what assessments? NURS 3015 Chapter 14 Quiz Paper

1. Arterial blood gases
2. RR and o2 sat
3. Deep tendon reflexes and pupillary response
4. Cardiac rate and rhythm
  - B
  - The combination of opioids and benzodiazepines creates a significant risk for CNS depression; respiratory function is consequently an important focus of assessment. It would likely supersede other assessments, even though each may be warranted.

18. A 77-year-old woman who experiences significant anxiety has been taking diazepam for several months. She was brought to the clinical earlier this week by her daughter, who stated that her mother had been behaving in an uncharacteristically confused manner. The clinician discontinued the patient’s diazepam. Three days later, the daughter states that her mother has still been having problems with impaired memory and confusion. The nurse should consider what possible explanation for the patient’s current status?

1. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness.
2. The patient may have decreased liver function.
3. The patient may have been experiencing a hypersensitivity to the drug, rather than an adverse effect.
4. The adverse effects of benzodiazepines can persist for several days after stopping the drug.
  - D
  - Both therapeutic effects and adverse effects of diazepam are more likely to occur after 2 or 3 days of therapy than initially. Such effects accumulate with chronic usage and persist for several days after the drug is discontinued. Hypersensitivity and decreased liver function are unlikely. Benzodiazepines do not cause permanent changes in cognition.

19. A patient’s severe family tragedy 1 year ago resulted in depression and insomnia. Which of the following hypnotics may be safely taken for longer-term treatment of insomnia?

1. Lorazepam (Ativan)
2. Eszopiclone (Lunesta)
3. Chloral hydrate
4. Oxazepam (Serax)
  - B
  - Eszopiclone (Lunesta) is the first oral nonbenzodiazepine hypnotic to receive FDA approval for long-term use (≤12 months).

20. A nurse has noted that a newly admitted patient has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this patient was experiencing what problem prior to starting this drug?

1. Somnambulism (sleepwalking)
2. Difficulty falling asleep at night
3. Early morning waking
4. Frequent nighttime awakenings
  - B
  - Ramelteon (Rozerem), the newest oral nonbenzodiazepine hypnotic, has received FDA approval for the long-term treatment of insomnia characterized by difficulty with sleep onset. NURS 3015 Chapters 14, 48 and 53 Quiz Papers