Chapter 59: Adult and Pediatric Emergency Drugs Nursing School Test Banks

Chapter 59: Adult and Pediatric Emergency Drugs
Test Bank

MULTIPLE CHOICE

1. A patient who is experiencing chest pain and shortness of breath is brought to the emergency department. The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 93%. What drug will the nurse expect to administer initially to this patient?
a. Albuterol
b. Aspirin
c. Nitroglycerin
d. Oxygen
ANS: D
The patient has signs of pulmonary edema, which can cause chest pain, crackles, and shortness of breath along with compensatory tachycardia and low oxygen saturations. The initial drug of choice is oxygen, which can minimize chest pain and open up the alveoli. The other drugs are given for specific underlying causes and may be necessary after the patient is evaluated further.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient with suspected myocardial infarction is seen in the emergency department. The nurse is preparing to administer 325 mg of aspirin. The nurse will perform which action?
a. Administer an enteric-coated tablet.
b. Ask the patient to chew the tablet.
c. Give the tablet with a small sip of water.
d. Place the tablet under the patients tongue.
ANS: B
To speed the absorption of aspirin, in a cardiac emergency, the patient should chew the tablet when given. An enteric-coated tablet will slow the absorption. Giving the aspirin with water or sublingually will slow the absorption rate.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient with angina has been given 0.4 mg of nitroglycerin SL. The patient reports continued chest pain 5 minutes later. The nurse assesses a heart rate of 84 beats per minute and a blood pressure of 88/68 mm Hg. The nurse will take which action?
a. Administer 0.4 mg of nitroglycerin SL.
b. Administer 0.3 mg of nitroglycerin SL.
c. Give nitroglycerin by translingual spray.
d. Notify the provider of the patients vital signs.
ANS: D
Nitroglycerin should be held if the patient has a systolic blood pressure less than 90 mm Hg. The nurse should notify the provider.

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4. A patient with congestive heart failure and pulmonary edema is experiencing chest pain. The patient has an order for morphine sulfate IV 4 mg every 5 to 30 minutes PRN until chest pain is relieved. The last dose of 4 mg was 15 minutes prior, and the patient is complaining of chest pain and exhibiting increased work of breathing. The nurse notes a heart rate of 82 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 135/88 mm Hg. What will the nurse do next?
a. Administer morphine sulfate IV 4 mg over 1 to 5 minutes.
b. Administer naloxone (Narcan) to reverse respiratory depression.
c. Request an order for morphine sulfate IV 2 mg over 1 to 5 minutes.
d. Hold the next dose and notify the provider of the patients symptoms.
ANS: A
Morphine acts to relieve pain, dilate venous vessels, and decrease the workload on the heart to treat acute cardiogenic pulmonary edema and can relieve the dyspnea caused by this condition. The nurse should administer 4 mg since the patients pain has not abated. Respiratory depression would be characterized by a decreased respiratory rate.

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TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A patient is brought to the emergency department after coming in contact with organophosphate insecticides while at work. The nurse will expect to administer which medication to reverse the toxic effects of this substance?
a. Atropine sulfate
b. Diazepam
c. Epinephrine
d. Flumazenil
ANS: A
Atropine is used to counter the toxic effects of organophosphate insecticides. Diazepam is given for seizures and for acute alcohol withdrawal. Epinephrine is used for anaphylactic shock. Flumazenil is given as an antidote for benzodiazepine overdose.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. An 18-month-old toddler is in the emergency department with poor feeding and lethargy. The nurse assesses a rapid, thready pulse, which is too fast to count. The nurse will expect the provider to order which medication to treat this condition?
a. Adenosine
b. Albuterol
c. Atropine
d. Theophylline
ANS: A
Adenosine is given for supraventricular tachycardia. Albuterol and theophylline are bronchodilators, and both will increase the heart rate. Atropine is given for bradycardia and is contraindicated.

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7. The nurse is administering amiodarone to a patient who is being treated for a ventricular arrhythmia. The patient has received a bolus of 150 mg of amiodarone IV and is now receiving a continuous infusion of 1 mg/minute. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 88/54 mm Hg. The nurse will notify the provider and perform which other action?
a. Continue the amiodarone infusion at 1 mg/minute.
b. Decrease the rate of the amiodarone infusion to 0.5 mg/minute.
c. Increase the rate of the amiodarone infusion to 1.5 mg/minute.
d. Stop the infusion of amiodarone.
ANS: B
Amiodarone has significant adverse effects of hypotension and bradycardia. When these occur, the nurse should slow the infusion rate to prevent or treat these effects.

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8. The nurse is caring for a patient who is receiving magnesium sulfate for ventricular tachycardia. The nurse assesses a heart rate of 68 beats per minute, a respiratory rate of 10 breaths per minute, a blood pressure of 90/60 mm Hg, and decreased deep tendon reflexes. The nurse understands that these are signs of which condition?
a. Hyperkalemia
b. Hypermagnesemia
c. Impending cardiac arrest
d. Renal compromise
ANS: B
Patients with hypermagnesemia will exhibit hypotension, bradycardia, and respiratory depression, along with decreased reflexes. Hyperkalemia causes ventricular arrhythmias.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. During resuscitation of a 5-year-old child, the provider requests an intravenous dose of 1 mL of epinephrine to be given STAT. The nurse will perform which action?
a. Ask the provider to clarify the dose and the concentration.
b. Draw up the dose and give it as a rapid intravenous bolus.
c. Give the dose as a slow intravenous bolus and monitor vital signs.
d. Request an order to give the dose via endotracheal tube.
ANS: A
Epinephrine is available in two primary concentrations: 1:1,000 and 1: 10,000 mL. The 1:10,000 concentration is used when giving a single IV dose of epinephrine. The 1:1,000 concentration is used for other routes. The nurse should clarify the dose and the concentration.

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10. An unconscious patient is brought to the emergency department and intubated after respiratory arrest. The patient has a regular pulse. The patients spouse suspects an overdose of drugs but does not know which drug may have been taken. The nurse will anticipate giving which medication or performing which treatment?
a. Activated charcoal
b. Flumazenil
c. Gastric lavage
d. Naloxone
ANS: D
Naloxone is given to reverse the respiratory depression caused by opioid medications. It may also be given to patients brought to an emergency department in a coma of unknown etiology to see if they will respond. If there is no improvement within 10 minutes, a nonopiate cause should be suspected. Activated charcoal is given to alert patients who have recently ingested a substance. Gastric lavage is no longer used for therapy. Flumazenil is given for benzodiazepine overdose.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A patient is brought to the emergency department with severe wheezing, dyspnea, and peripheral edema. The nurse assesses a respiratory rate of 30 breaths per minute, a heart rate of 88 beats per minute, and a blood pressure of 88/54 mm Hg. Which medication does the nurse expect to be given initially?
a. Albuterol
b. Diphenhydramine
c. Dopamine
d. Epinephrine
ANS: D
The patient has signs of anaphylactic shock, and the first medication given will be epinephrine because it treats both bronchoconstriction and hypotension. Albuterol may be given later to help with respiratory distress. Diphenhydramine is an antihistamine to treat tissue-induced swelling. Dopamine will be given if hypotension persists.

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TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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