Workman: Understanding Pharmacology Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 07: Drugs for Pain and Sleep Problems

Test Bank

MULTIPLE CHOICE

1. Which is the best clinical definition of pain?
a. A state of extreme physical distress or discomfort
b. A condition of sensation caused by tissue damage
c. A cognitive awareness of a change in comfort
d. Whatever the patient says it is
ANS: D
Pain is a personal experience that includes physical and emotional components. What is painful for one person may not be painful to another. Because everyone experiences pain in a different way, the most useful clinical definition is that pain is whatever the patient says it is and exists whenever he or she says it does.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 95 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which statement by a patient indicates the need for more teaching about pain and pain control?
a. If my pain interferes with my usual activities, I will take medication for it.
b. There is no reason for me to take drugs for pain; after all, you cant cure old age.
c. I dont mind taking pain drugs for my sprained ankle because I know it wont hurt this way forever.
d. I will take enough pain medication to make me comfortable without making me too sleepy.
ANS: B
One cause of underreporting pain and undertreating it is that many patients and health care providers believe that pain is a normal part of aging. Pain may occur more frequently among older adults, but is never considered normal. Patients of any age with pain for any reason deserve to have their pain reduced to a manageable level.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance

3. Which statement about pain is true?
a. Each patient perceives a painful event differently.
b. Patients who cannot describe their pain do not really have pain.
c. It is not necessary to assess for pain in patients who are sleeping.
d. Infants and young children feel pain less intensely than adults do.
ANS: A
How we feel and react to pain depends on our emotional makeup along with our previous experiences with pain. Issues like culture, age, gender, and our interactions with society also affect our responses to pain. As a result, no two people perceive pain in exactly the same way.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 95 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Psychosocial Integrity

4. A patient who is paralyzed from the waist down as a result of an injury that completely severed the spinal cord has an open wound on the right heel. Why is this patient unaware of any pain caused from this wound?
a. The nociceptors in the heel are no longer stimulated when injury occurs.
b. The patient has become completely desensitized to this type of chronic pain.
c. The severed spinal cord prevents the sensation of pain from reaching the brain.
d. The spinal cord injury results in chronic pain that can mask any acute pain sensation.
ANS: C
Pain is perceived in the brain, not in the area of tissue injury. When the nociceptors are stimulated by tissue damage, the impulse must be transmitted to the brain before it can be felt as pain. With a completely severed spinal cord, the pain impulses are not transmitted to the brain.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 98 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

5. A patient with arthritis of the left knee reports pain extending from the knee half-way down the lower leg. What type of pain is this patient perceiving?
a. Localized
b. Referred
c. Radiating
d. Phantom
ANS: C
Radiating pain may be felt all around and extending from the damaged area causing the pain.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 99 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

6. Pain is considered to be the fifth vital sign. How does this principle affect nursing care?
a. It ensures that pain assessment occurs on a regular basis for all patients.
b. It helps nurses understand that experiencing pain can change heart rate and respiratory rate.
c. It helps nurses to ensure that vital organ function is adequate before administering drugs to reduce pain.
d. It encourages nurses to assess two parameters during patient contact to improve time management.
ANS: A
Pain is common in patients and undertreated pain remains a major yet avoidable health problem. More frequent and more accurate assessment can improve pain management. Making pain assessment the fifth vital sign assists nurses to both recognize the presence of pain and see how the patient responds to drugs and other interventions. These actions increase the likelihood of appropriate pain management.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 95 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

7. What is the best way for the nurse to determine a patients need for pain medication on the second day after an abdominal laparotomy?
a. Check when the patient last received medication for pain.
b. Assess the patients facial expression and vital signs.
c. Consider the patients age and ethnicity.
d. Ask the patient to rate his or her pain.
ANS: D
Pain experience and pain tolerance are very personal. True assessment of a patients discomfort cannot be determined by and should not be based on the patients behaviors or changes in vital signs. Nor can it be based on how recently the patient received a drug for pain. The only way to know is to ask the patient to rate the pain.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

8. Which event or condition is most likely to result in chronic pain?
a. Severe headache associated with a spinal tap
b. Insertion of a needle for intravenous (IV) therapy
c. Hip replacement surgery
d. Osteoarthritis
ANS: D
The definition of chronic pain involves the length of time that pain is experienced and the progressive nature of the problem causing the pain. Osteoarthritis meets these criteria. A headache caused by fluid loss during a spinal tap is severe but has a duration of only 3 to 5 days. Hip replacement surgery, although resulting in postoperative pain, is time limited and often relieves chronic hip pain. IV needle insertion is considered painful by some patients, but is short procedural pain.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 100 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

9. How do morphine and other opioid pain medications relieve a patients pain?
a. They reduce tissue damage and alter the physical problems causing the pain.
b. They bind to opioid receptors in the central nervous system and alter the perception of pain.
c. They inhibit the generation of impulses along sensory nerve tracts and alter pain transmission.
d. They redirect substance P release from nociceptors and alter the amount of neurotransmitters reaching the brain.
ANS: B
Morphine and other opioid agonists do nothing to change the cause or transmission of pain. They bind to naturally occurring opioid receptor sites and alter a patients perception of the painful experience.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 104 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

10. After surgery, a patient expresses to the nurse the fear of becoming addicted to the opioid analgesic that has been prescribed for pain. What is the nurses best response?
a. Opioid-based drugs are not addictive.
b. Have you or anyone in your family ever been addicted to drugs?
c. When opioid drugs are taken for acute pain, they are rarely addictive.
d. If you take the medication no more frequently than every 4 hours, it is not possible for you to become addicted.
ANS: C
Pain after surgery is acute and temporary pain. The use of opioid drugs, when used for relief of acute pain, even in high doses, rarely results in addiction.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

11. The nurse is assigned to care for a patient with chronic low back pain. What adjustment in pain management does the nurse expect to make?
a. Encouraging the patient to hold off taking a pain drug as long as possible to reduce the potential for addiction.
b. Relying on patient report of pain rather than on changes in heart rate, blood pressure, and pulse rate.
c. Keeping the environment as quiet as possible to avoid distracting or irritating the patient.
d. Using nondrug measures in place of analgesics to relieve the patients pain.
ANS: B
Adaptation to the presence of chronic pain is physiologic, not psychological. Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning MSC: Client Needs Category: Physiological Integrity

12. The nurse checks a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly. The patient is sleeping and has a respiratory rate of 10 breaths per minute. What is the nurses best first action?
a. Attempt to arouse the patient by calling his or her name and lightly shaking the arm.
b. Administer oxygen by mask or nasal cannula and notify the prescriber.
c. Check the patients oxygen saturation and raise the head of the bed.
d. Document the finding as the only action.
ANS: A
Many patients experience some degree of respiratory depression with opioid analgesics. If the patient can be aroused with minimally-intrusive techniques and the respiratory rate increases spontaneously, no further intervention is required.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

13. The nurse prepares to give a patient the next scheduled dose of an opioid analgesic. The patient arouses easily but the respiratory rate remains at 10 breaths per minute. What is the nurses best first action?
a. Hold the dose and notify the prescriber.
b. Hold the dose and apply oxygen by mask or nasal cannula.
c. Check the patients oxygen saturation and ask about his or her pain level.
d. Call the Rapid Response Team and prepare to administer the prescribed opioid antagonist.
ANS: C
Many people experience mild respiratory depression with opioid analgesics. If the patient is easily arousable and the oxygen saturation is at normal levels, it is not necessary to apply oxygen, call the Rapid Response Team, or prepare to administer an opioid antagonist. If the patients oxygen saturation level is acceptable and he or she is in pain, it is alright to give the next scheduled opioid dose. Checking the patients normal respiratory rate is also a good idea. Most people have a usual respiratory rate that is at least 12 breaths per minute, but some patients may have a usual rate of only 10 breaths per minute. Although this is not a customary response and you should document it in the nursing notes, check other indicators of breathing adequacy before notifying the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

14. A patient taking oxycodone with acetaminophen (Percocet) for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain. What is the nurses best advice?
a. Either increase the time between drug doses or take only half the dose at each scheduled time.
b. Stop taking the Percocet and switch to acetaminophen alone.
c. Wrap your foot tightly and walk for at least 30 minutes daily.
d. Drink at least 3 liters of fluid daily and increase fiber intake.
ANS: D
This patient still needs the Percocet. Most patients taking opioids for 2 days or longer have constipation. Urge the patient to drink plenty of fluids. Increasing fiber intake, either with food containing fiber or with over-the-counter fiber supplements, can help reduce constipation. Although increasing activity can help reduce constipation, walking for 30 minutes with a fractured ankle is not permitted at this time.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

15. An older adult is taking an oral opioid drug at home for pain control. Which precaution to prevent injury is important for the nurse to teach this patient?
a. Increase room lighting to reduce the risk for tripping.
b. Sleep in a sitting position to reduce respiratory problems.
c. Drink at least 3 liters of fluids daily to reduce constipation.
d. Avoid drinks containing caffeine to prevent inactivating the drug.
ANS: A
In addition to the usual side effects and adverse effect of opioids, an older adult is at risk for low vision. The pupil of the older adult does not dilate fully and less light enters the eye, reducing vision. When the older patient takes an opioid drug, the pupil is even smaller than usual, reducing vision even more. This problem increases the older patients risk for tripping over objects and falling.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. How do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve a patients pain?
a. By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts.
b. By binding to opioid receptors in the central nervous system and altering the perception of pain.
c. By reducing the amount of bradykinin at the site of injury and altering the stimulation of nociceptors.
d. By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission.
ANS: C
When pain mediators are released from damaged tissue, especially substance P and bradykinin (which is also an inflammatory mediator), they bind to the nociceptors and activate them. NSAIDs reduce pain by suppressing some part of the inflammatory pathway and reducing the amounts of pain-mediating chemicals, especially bradykinin, present. With less bradykinin present, less stimulation of the nociceptors occurs. As a result, pain is reduced.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 108 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

17. What is the most important question for the nurse to ask before administering the first dose of celecoxib (Celebrex) to a patient?
a. Do you floss your teeth daily?
b. Are you allergic to sulfa drugs?
c. Do you have diabetes mellitus?
d. Have you ever had glaucoma?
ANS: B
Celecoxib is similar to the class of antibiotics known as sulfa drugs. An allergic reaction to celecoxib is more likely if the patient is also allergic to sulfa drugs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

18. A patient taking warfarin (Coumadin) has mild to moderate pain after exercising. Which over-the-counter pain reliever does the nurse recommend?
a. aspirin (Bufferin)
b. ibuprofen (Advil)
c. naproxen (Aleve)
d. acetaminophen (Tylenol)
ANS: D
Only acetaminophen does not interfere with blood clotting. The other drugs do interfere with blood clotting, and so does warfarin. Taking warfarin with any other drug that interferes with blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

19. A patient is taking acetaminophen (Tylenol). Which precaution is most important for the nurse to teach the patient?
a. Avoid alcoholic beverages while taking this drug.
b. Avoid coffee and other caffeinated drinks while taking this drug.
c. If any decrease in vision occurs, stop the drug and notify your prescriber immediately.
d. Do not drive or operate dangerous machinery until you know how this drug affects you.
ANS: A
Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often. This adverse reaction is much more likely to occur in people who drink alcoholic beverages while on acetaminophen therapy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

20. The nurse notes all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor) for chronic pain. For which problem does the nurse immediately notify the prescriber?
a. Heart rate decreased from 80 to 72 beats per minute
b. Respiratory rate decreased from 20 to 16 breaths per minute
c. Weight increased from 128 to 137 pounds
d. Morning blood glucose increased from 86 to 94 mg/dL
ANS: C
Nortriptyline is an antidepressant. These drugs can make heat failure worse and can cause urinary retention. Fluid retention with weight gain is a symptom of worsening heart failure. A weight gain of 9 pounds in a week is significant and an indicator of rapidly worsening heart failure.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

21. A child who is taking gabapentin (Neurontin) for pain control has begun demonstrating all of the following behaviors. Which behavior represents a common side effect of this drug?
a. Fighting at school
b. Difficulty sleeping
c. Wetting the bed 3 to 4 nights per week
d. Crying more frequently for no apparent reason
ANS: A
Gabapentin is an anticonvulsant drug that can reduce certain types of pain. Children taking gabapentin often demonstrate an increase in aggressive behavior.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 111 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

22. What is the most common sleep problem?
a. Inappropriate sleeping
b. Sleep deprivation
c. Insomnia
d. Napping
ANS: C
Insomnia, the inability to go to sleep or stay asleep, occurs at some time in most people. It can occur at any age, and in most cases is acute and short-term.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 112 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

23. Which drug for insomnia can cause amnesia?
a. amitriptyline (Elavil)
b. diphenhydramine (Benadryl)
c. temazepam (Restoril)
d. trazodone (Desyrel)
ANS: C
Temazepam is a benzodiazepine receptor antagonist that works by causing a general depression of the central nervous system, including the areas that process new or immediate information. As a result, the patient may have amnesia for events that occur while he or she is under the influence of this drug.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 114 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

24. A patient is prescribed a drug for insomnia. Which precaution is most important for the nurse to teach the patient?
a. Avoid drinking fluids with caffeine before bedtime.
b. Rinse your mouth frequently with water or saline.
c. Avoid driving within 8 hours of taking this drug.
d. Do not take this drug for more than 1 week.
ANS: C
All drugs for insomnia produce drowsiness, blurred vision, and can impair judgment. Driving or operating dangerous equipment within 6 to 8 hours after taking any of these drugs can result in accident or injury. Tasks that require mental alertness also should be delayed until these effects have subsided.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

25. A patient who has been taking flurazepam (Dalmane) for insomnia is now prescribed zolpidem (Ambien) instead. The patient asks the nurse why the prescription was changed. What is the nurses best response?
a. Zolpidem (Ambien) is a first-line drug for the treatment of insomnia.
b. Flurazepam (Dalmane) is a benzodiazepine drug that can be habit-forming.
c. Zolpidem (Ambien) is also used to treat any anxiety or stress that may contribute to your insomnia.
d. Flurazepam (Dalmane) has both hypnotic and sedative effects that are less effective in the treatment of insomnia.
ANS: B
Flurazepam (Dalmane) is a benzodiazepine with hypnotic and sedative effects, used mostly to treat anxiety or stress. The benzodiazepines are schedule IV drugs, which means that abuse of these drugs or their long-term use may lead to limited physical dependence or psychological dependence. These drugs can be habit-forming when used for prolonged periods (2 to 4 weeks) and are no longer first-line drugs for treatment of insomnia. Zolpidem (Ambien) is a benzodiazepine receptor agonist and is less likely to be addictive.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

26. A patient taking a drug for insomnia reports becoming sunburned even when only minimally exposed to the sun. What is the nurses best action?
a. Ask the patient whether he or she usually burns when exposed to the sun.
b. Instruct the patient to stop the drug and notify the prescriber immediately.
c. Teach the patient to use sunscreen and wear protective clothing when outdoors.
d. Document the report as the only action and reassure the patient that this problem is temporary.
ANS: C
Most drugs for insomnia cause an increase in sensitivity to the sun or other sources of ultraviolet light and the patient can become severely sunburned. Even patients with dark skin who usually do not burn with sun exposure can have problems. This expected side effect is temporary and usually resolves within weeks after the patient stops taking the drug; however, it is most important for the patient to learn about sun protection while on the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

27. A patient with insomnia also has liver disease. What precaution does the nurse include in this patients care plan?
a. Monitor carefully for increased side effects and adverse effects.
b. Teach the patient that a higher dose is needed for effective action.
c. Check the patients electrolytes before administering the drug.
d. Assess the patients mental status every four hours.
ANS: A
Drugs for insomnia are metabolized by the liver. When liver function is reduced, the drug levels can become very high and cause more side effects and adverse effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning MSC: Client Needs Category: Physiological Integrity

28. The nurse is preparing to teach a patient who has been prescribed zaleplon (Sonata) for insomnia. What does the nurse include in the teaching plan related to the action of this drug?
a. This drug may take from 30 minutes to an hour to work.
b. Go to bed immediately after taking a dose of this drug.
c. Be sure to report any side effects to your prescriber.
d. There is a danger of becoming dependent on this drug.
ANS: B
Benzodiazepine receptor agonists have a very rapid onset of action (15 to 30 minutes). Patients should be instructed to go to bed immediately after taking these drugs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

29. A patient is scheduled for a procedure to test mental function at 6 a.m. At 3 a.m. the patient requests something for sleep. What is the nurses best response?
a. Ill call your prescriber and request an order for something to help you sleep.
b. Your prescriber has ordered temazepam (Restoril). I will give you a dose now.
c. Im sorry, but there is not enough time for sleep now before your procedure.
d. Im sorry, but you already received a dose of temazepam last evening at 9.
ANS: C
Drugs for insomnia should not be taken unless there is adequate time to sleep (4 to 8 hours). Inadequate time for sleep can cause side effects including drowsiness or adverse effects such as amnesia. This is especially important when the patient needs to be alert.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

30. Which statement about narcolepsy is true?
a. Narcolepsy is an acute neurologic disorder.
b. With narcolepsy, the brain cannot regulate sleep-wake cycles.
c. The underlying problem in narcolepsy is increased oxygenation.
d. Sleep episodes with narcolepsy usually occur during the evening hours.
ANS: B
Narcolepsy is a sleep problem with uncontrollable urges to sleep. It is a chronic neurologic disorder in which the brain cannot regulate sleep-wake cycles; it occurs in patients with respiratory illnesses that cause carbon dioxide retention. Episodes caused by narcolepsy can occur at any time during the day.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 116 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

31. How does oxybate (Xyrem) prevent or treat narcolepsy?
a. It increases sedation to ensure a good nights sleep.
b. It increases general central nervous system stimulation.
c. It antagonizes the sleep induction receptors of the brain.
d. It causes a paradoxical reaction resulting in hyperactivity.
ANS: A
Although the drug oxybate induces a deep sleep, it is used to prevent or treat narcolepsy. The mechanism is to ensure the person obtains adequate sleep during the night to prevent daytime sleepiness rather than directly causing brain stimulation for wakefulness.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 116 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

32. A patient is prescribed methylphenidate (Ritalin). The patient asks the nurse how this drug will help treat narcolepsy. What is the nurses best response?
a. This drug reduces the input to your central nervous system sleep centers.
b. This drug sedates you so that you can get a good nights sleep and be less drowsy during the day.
c. This drug stimulates your brain to keep you awake and decrease daytime episodes of sudden sleep.
d. This drug continuously stimulates the brain stem areas ensuring that you breathe more deeply at night.
ANS: C
Drugs in the same category as Ritalin increase general central nervous system (CNS) stimulation in adults. The increased stimulation promotes wakefulness and reduces the sudden sleepiness of narcolepsy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

33. A patient is taking modafinil (Provigil) for narcolepsy. Which precaution is most important for the nurse to teach the patient?
a. Take this drug 1 hour before or 2 hours after a meal.
b. Report episodes of sleepwalking to your prescriber.
c. Check your pulse for rate and regularity twice daily.
d. Avoid eating grapefruit or drinking grapefruit juice.
ANS: D
The substances in grapefruit and grapefruit juice decrease the activity of the enzymes involved in the metabolism of modafinil. As a result, the drug blood level stays high longer, increasing the risk for side effects and adverse effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

34. A drug for narcolepsy is prescribed for a 70-year-old nursing home patient. What adjustment in drug administration does the nurse expect to make for this patient?
a. Ensuring that the drug is taken with a meal to prevent nausea.
b. Giving the drug earlier in the day to prevent nighttime incontinence.
c. Giving a lower-than-normal dose to avoid changes in thinking patterns.
d. Crushing the capsule and mixing it with gelatin to make swallowing easier.
ANS: C
Older adults are more sensitive to drugs for narcolepsy and often have greater-than-expected intended responses, as well as more severe side effects, including changes in thinking patterns and problems with movement. Prescribed doses are usually lower than normal, at least when first prescribed, until it is known how the patient responds to the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Safe and Effective Care Environment

35. The nurse is preparing to teach a patient about oxybate (Xyrem) for the treatment of narcolepsy. Which precaution does the nurse stress?
a. Avoid drinking alcohol while taking this drug.
b. Be sure to take this drug with food or milk.
c. Report constipation to your prescriber.
d. Use mints to prevent dry mouth.
ANS: A
Sodium oxybate (Xyrem) works by increasing sedation to ensure a good night sleep and preventing daytime sleepiness. A side effect this drug may cause is sleep-walking without any memory of the event. It should never be taken with alcohol because this will dramatically increase the CNS effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

36. The nurse is teaching a young adult female about modafinil (Provigil) for narcolepsy. Which precaution does the nurse stress to the patient?
a. Provigil increases your susceptibility to sexually transmitted infections.
b. Loss of inhibition while taking this drug can increase sexual behavior.
c. Provigil can be used during pregnancy but not while breastfeeding.
d. This drug reduces the effectiveness of birth control pills.
ANS: D
Modafinil can decrease the effectiveness of birth control pills. Women of childbearing age should be taught that another form of birth control should be used while taking this drug to prevent an unplanned pregnancy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (Select all that apply.)
a. Bleeding
b. Constipation
c. Drowsiness
d. Dry mouth
e. Gastrointestinal ulcers
f. Hypertension
g. Memory loss (temporary)
ANS: A, E, F
NSAIDs disrupt platelet action and reduce clotting, which increases the risk for bleeding in response to minor trauma. NSAIDs also reduce the thick, gel-like coating of the stomach, allowing normal stomach acids to irritate the stomach lining and form ulcers. Finally, NSAIDs cause the kidneys to retain more sodium and water. These enter the bloodstream and raise blood pressure.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 108 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which symptoms are expected to be seen in a patient with insomnia? (Select all that apply.)
a. Difficulty falling asleep
b. Sleeping too much
c. Waking often during the night
d. Feeling unrested after sleep
e. Uncontrollable urge to sleep
f. Sleepwalking at least once per week
g. Nightmares most of the night
ANS: A, C, D
Typical symptoms of insomnia include difficulty falling asleep, waking often during the night or early morning, and not feeling rested after sleep. Uncontrollable urges to sleep are typical of narcolepsy.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 112 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. What are the major symptoms of narcolepsy? (Select all that apply.)
a. Amnesia for events occurring after narcolepsy
b. One-sided seizure activity
c. Cataplexy
d. Total paralysis at beginning or end of sleep
e. Incontinence of urine
f. Frequently waking up at night
g. Colorful hallucinations
h. Loss of involuntary muscle tone
ANS: C, D, F
The three major symptoms of narcolepsy include sudden loss of voluntary muscle tone and reflexes (cataplexy), and total paralysis at the beginning or end of the sleep episode. Other symptoms include falling asleep suddenly and frequently waking up at night.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 116 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

ESSAY

1. A 2-year-old patient weighs 15 kg and is prescribed 50 mcg/kg of morphine (morphine sulfate) intravenously. How many micrograms of morphine does the correct dose contain?
_____ mcg

ANS:
750 mcg
The child weighs 15 kg and the drug is prescribed at a dose of 50 mcg/kg.
50 mcg 15 (kg) = 750 mcg.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Safe and Effective Care Environment

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