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Hesi bsn 315 rn pharmacology 35504
Total Questions : 58
Showing 10 questions, Sign in for moreA client with open-angle glaucoma is using pilocarpine ophthalmic solution, a miotic agent. Which action should the nurse at the eye clinic include in evaluating the effectiveness of the medication?
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
The nurse is discussing the client's pain management with a student nurse.
Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.
Morphine is a(n)
Explanation
Non opioid analgesic: Morphine is not a non-opioid analgesic; drugs in this category, like acetaminophen or NSAIDs, work through different pathways and do not bind opioid receptors.
Partial opioid agonist: Partial opioid agonists activate opioid receptors but with limited effect, often producing less analgesia and sometimes antagonistic effects. Morphine fully activates opioid receptors, producing stronger effects.
Pure opioid agonist: Morphine is a pure opioid agonist, meaning it fully stimulates opioid receptors, especially mu receptors, resulting in potent analgesia, sedation, and respiratory depression.
Mu: Morphine primarily activates mu opioid receptors, which are responsible for pain relief, sedation, euphoria, and respiratory depression. These receptors are the main targets for opioid analgesia.
Dopamine: Dopamine receptors regulate reward, motivation, and motor function. Morphine does not directly activate dopamine receptors as part of its mechanism for pain relief.
Muscarinic: Muscarinic receptors are involved in parasympathetic nervous system functions. Morphine does not act directly on these receptors for analgesic effects.
Chronic neuropathic pain: While morphine may be used in some chronic pain situations, neuropathic pain often responds better to other medications such as anticonvulsants or antidepressants due to differing pain mechanisms.
Mild inflammatory pain: Mild inflammatory pain is usually treated with non-opioid analgesics like NSAIDs. Morphine is generally reserved for moderate to severe pain levels.
Acute postoperative pain: Morphine is commonly used to manage acute postoperative pain because of its strong analgesic properties effective against nociceptive pain caused by surgery or injury.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400:
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1400
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
Which actions should the nurse take to assure safety during morphine administration? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400:
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1400:
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
Which other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400:
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1400:
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hr continuous IV infusion via patient controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500:
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
The charge nurse places a fall precautions sign on the client's door.
Which side effects of morphine could contribute to this client's fall risk? Select all that apply
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400:
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1800:
- Heart rate 79 beats/minute
- Respirations 14 breaths/minute
- Blood pressure 114/78 mm Hg
- Oxygen saturation 93% on room air
1900:
Responded to an alarm in the room. The client is not responsive. Respiratory rate is 5 breaths/minute. Heart rate is 92 beats/minute. Pupils are pinpoint. Oxygen saturation 54% on room air.
1400:
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500:
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
Which should the nurse do immediately? Select all that apply.
The client is a 42-year-old female who had a right above-the-knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on postoperative day 1.
1400:
Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site.
- Heart rate 77 beats/minute
- Respirations 16 breaths/minute
- Blood pressure 118/74 mm Hg
- Oxygen saturation 97% on room air
1800:
- Heart rate 79 beats/minute
- Respirations 14 breaths/minute
- Blood pressure 114/78 mm Hg
- Oxygen saturation 93% on room air
1900:
Responded to an alarm in the room. The client is not responsive. Respiratory rate is 5 breaths/minute. Heart rate is 92 beats/minute. Pupils are pinpoint. Oxygen saturation 54% on room air.
1400:
Admit to the surgical floor
Clear liquid diet, advance as tolerated
Continuous cardiorespiratory monitoring
Morphine 1 mg/hour continuous IV infusion via patient-controlled pump (PCA)
Alert surgeon to signs of bleeding or infection in the surgical site
1500:
Docusate sodium 240 mg PO every morning
Naloxone 2 mg IV push PRN for respiratory depression
Ibuprofen 600 mg PO every 6 hours as needed (PRN)
For each statement, click to indicate whether the statements by the student nurse indicate understanding or no understanding of naloxone. Each row must have one option selected.
Explanation
- "When given IV, naloxone starts working immediately and can last several hours.": Although naloxone acts rapidly when given intravenously, its duration of action is relatively short—usually 30 to 90 minutes. Because naloxone’s effects may wear off before the opioid is fully cleared, repeated dosing and close monitoring are essential to prevent recurrence of respiratory depression.
- "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression.": Naloxone dosing can be repeated safely as needed to reverse opioid-induced respiratory depression, especially with long-acting opioids. Proper titration minimizes risk of precipitated withdrawal while ensuring airway safety.
- "Naloxone will not affect the client's level of pain.": This statement shows lack of understanding since naloxone reverses opioid effects including analgesia. Administering naloxone can precipitate acute pain and withdrawal symptoms in opioid-dependent clients by blocking opioid receptors.
- "You can give naloxone intravenously, intramuscularly, or subcutaneously.": Naloxone is versatile and can be administered through various routes IV, IM, SC, and intranasally depending on clinical circumstances and urgency.
- "Naloxone works best on pure agonist opioids.": Naloxone effectively reverses respiratory and CNS depression caused by pure opioid agonists like morphine and fentanyl. Its effectiveness is reduced with mixed agonist-antagonists or partial agonists due to receptor affinity differences.
A client receives a new prescription for somatropin. Which information provided by the client indicates a need for further education by the nurse?
A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?
The nurse is preparing to administer alendronate to a client with osteoporosis. Which laboratory value indicates that the nurse should withhold the medication and contact the healthcare provider?
Reference Range:
- Total Calcium 19 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]
- Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]
- Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]
- Magnesium [1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L)]
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