Chapter 6

The preferred route of administration of analgesic medications is: 1\. intravenous. 2\. sublingual/buccal. 3\. rectal. 4\. oral.

Your patient has been on a narcotic analgesic for chronic pain from cancer. The dose she has been receiving is no longer bringing about the same pain relief as it once did. The patient asks you why the medicine doesn’t work anymore. You explain to her about: 1\. tolerance. 2\. potency. 3\. receptor agonists. 4\. efficacy.

. A patient returns from the recovery room following surgery. The nurse assesses the patient and determines he is in pain and administers an opiate analgesic for pain control. The patient suddenly exhibits respiratory distress and oxygen desaturation followed by decreasing heart rate. The patient’s deterioration may be caused by: 1\. chest wall rigidity. 2\. rapid elimination of anesthetic gases. 3\. vagal response. 4\. hypothermia.

Which of the following patients should refrain from therapy with the thiazide diuretic hydrochlorothiazide (HCTZ)? 1\. a patient with renal impairment 2\. a patient with hypertension 3\. a patient with diabetes mellitus, Type II 4\. a patient with renal calculi (kidney stones)

A patient has a seizure disorder and is receiving an anticonvulsant agent to treat her seizures. She has developed gingival hyperplasia while on anticonvulsant therapy. Which of the following medications is responsible for this side effect? 1\. phenytoin (Dilantin) 2\. phenobarbital (Luminal) 3\. carbamazepine (Tegretol) 4\. valproic acid (Depakene)

A side effect of one of the following hyperlipidemia drug classes is a reduction in the absorption of other oral drugs. Which group has this effect? 1\. statins 2\. bile acid resins 3\. niacin 4\. fibrates

. Which class of drugs has the side effect of slowing gastric emptying and blocking intestinal hypermotility and bladder spasms? 1\. cholinergic receptor agonists 2\. adrenergic receptor agonists 3\. cholinergic receptor antagonists 4\. adrenergic receptor antagonists

. Metronidazole (Flagyl) is used to treat anaerobic protozoa infections such as Entamoeba histolytica (amebiasis), Giardia lamblia (giardiasis), and Trichomonas vaginalis (trichomoniasis). The nurse should educate the patient that a common side effect of this medication is: 1\. sleepiness. 2\. tremors. 3\. tinnitus. 4\. a metallic taste.

A patient takes the anticonvulsant carbamazapine (Tegretol). She calls the clinic today and complains of a sore throat and easy bruising. The nurse should advise the patient to: 1\. come to the clinic to be seen today. 2\. stop taking the drug and make an appointment to be seen next week. 3\. continue taking the drug so the blood level will remain stable. 4\. increase the intake of green leafy vegetables (vitamin K) and call if symptoms continue.

The physician initiates a systemic glucocorticoid medication for a patient. When performing a dip stick on this patient’s urine, the nurse detects glycosuria. What is the association between systemic steroid administration and glycosuria? 1\. Renal sodium reuptake and potassium excretion are increased. 2\. Hyperglycemia and glycosuria are side effects of glucocorticoid administration. 3\. The patient has developed diabetes mellitus, Type II. 4\. Renal disease is present

. Inhaled glucocorticoids prescribed for treatment of reactive airway disease (asthma) may have local side effects. The most common side effect is: 1\. elevated blood glucose level. 2\. oral candiasis. 3\. cough. 4\. dysphonia.

. When caring for a patient receiving amphoteracin B (Fungizone, Amphocin) what laboratory values should be monitored closely? 1\. potassium and magnesium 2\. sodium and calcium 3\. chloride and BUN 4\. phosphate and serum creatitine

Your patient comes to clinic today and is started on simvastatin (Zocor) to treat his high cholesterol. He asks you what side effects he should expect. You tell him simvastatin may cause: 1\. GI distress (nausea, diarrhea, dyspepsia). 2\. back pain or muscle tenderness. 3\. flushing or itching of the skin. 4\. a decrease the absorption of other drugs (warfarin, digoxin, levothyroxine).

A 14-year-old with Type I diabetes mellitus has responsibility for taking his insulin. Because of after-school activities today, he takes his entire daily dose of insulin at breakfast. At school, he loses consciousness and has a seizure. The school nurse in the school-based clinic will administer what therapeutic agent while awaiting the Emergency Medical Service arrival? 1\. rapid acting regular insulin 2\. orange juice 3\. glucagon 4\. bicarbonate

Bovine and porcine preparations of insulin can result in: 1\. diminished insulin antibody production. 2\. a significant reduction in insulin requirements. 3\. less chance of allergic reactions. 4\. lipodystrophy at injection sites

Fat emulsions are frequently administered as a part of total parenteral nutrition. Which statement is true regarding fat emulsions? 1\. They have a high energy to fluid volume ratio. 2\. Even though hypertonic, they are well tolerated. 3\. They are a basic solution secondary to the addition of sodium hydroxide (NaOH). 4\. The pH is alkaline making them compatible with most medications.

A complication of total parenteral nutrition (TPN) is the development of cholestasis. What is this condition? 1\. an inflammatory process of the extrahepatic bile ducts 2\. an arrest of the normal flow of bile 3\. an inflammation of the gall bladder 4\. the formation of gall stones

The physician wants to know whether the patient is tolerating his total parenteral nutrition. He orders which of the following laboratory tests? 1\. triglyceride level 2\. liver function tests 3\. a glucose tolerance test 4\. a complete blood count

. In the adult population, total parenteral nutrition (TPN) may be administered for a certain number of hours per day. However, in the neonatal population, typically the solution is ordered to run continuously 24 hours per day. What is the rationale for infusing TPN continuously to neonates? 1\. It doesn’t interfer with nursing care. 2\. Babies don’t need nutrition in boluses to mimick meals. 3\. All neonates get all IV fluids on a continuous basis. 4\. It provides a constant energy and fluid source.

Which of the following facts about total parenteral nutrition (TPN) is true? 1\. It is expensive. 2\. Complications are very rare. 3\. Hospitalization is required while receiving TPN. 4\. It has few uses in modern medicine.

A patient has been receiving chemotherapy to shrink a thoracic tumor. Chemotherapeutic side effects have made eating difficult. The date for surgical removal of his tumor is approaching. Why would the physician initiate total parenteral nutrition (TPN) at this point? 1\. He wouldn’t. TPN will cause the tumor to grow. 2\. To treat malnutrition and optimize the surgical outcome. 3\. Because the patient is depressed about his cancer and the chemotherapy side effects. 4\. It is the standard of all surgeons to initiate TPN prior to surgery.

. A patient has inflammatory bowel disease and has lost approximately 20 percent of his prior body weight. The physician initiates total parenteral nutrition (TPN). The patient asks the nurse whether he will have to remain hospitalized to receive TPN until he regains the weight. The nurse responds: 1\. “Yes. The doctor has to ensure you are stable.” 2\. “You will have to ask your doctor that question.” 3\. “Many times patients can be managed on TPN at home.” 4\. “Probably. It would not be safe to discharge you with home TPN.”

A patient is receiving total parenteral nutrition (TPN). Today the physician orders an electrolyte panel. What would this laboratory test be used for in a patient on TPN? 1\. It wouldn’t. A more appropriate test would be liver function studies. 2\. It gives the physician a picture of the patient’s renal status. 3\. It provides information on the patient’s ability to manage the glucose load in his TPN. 4\. The physician can adjust the TPN solution electrolytes to meet the patient’s needs.

A patient has been receiving total parenteral nutrition (TPN) therapy at home. Today he calls the clinic nurse and reports his next bag of TPN contains small white particles floating throughout the solution. The nurse: 1\. instructs the patient to discard the bag and use only clear solutions. 2\. tells the patient that this is normal; it is a reaction between the calcium and the phosphorus. 3\. instructs the patient to warm the fluid in the microwave until the crystals are dissolved. 4\. tells the patient it is safe to use as long as the expiration date has not been reached.

A patient is started on total parenteral nutrition (TPN). The physician orders blood glucose checks every 8 hours. What is the rationale for these checks? 1\. to determine whether the patient is developing diabetes mellitus, Type II 2\. to evaluate patient tolerance of the glucose infusion rate of the TPN 3\. to allow the addition of insulin to the TPN if hyperglycemia occurs 4\. to prevent dehydration caused by an osmotic overload caused by hyperglycemia

Your patient has cholestatic liver disease from prolonged total parenteral nutrition administration and hepatic herpes (HSV) infection. What process of pharmacokinetics may be affected by his disease? 1\. absorption 2\. distribution 3\. metabolism 4\. elimination

Which of the following types of patients will likely receive total parenteral nutrition (TPN)? 1\. a body builder with a torn ligament 2\. a patient who underwent a cholecystectomy 3\. a patient with gastroesophageal reflux disease (GERD) 4\. a patient with third degree burns

A primary complication of total parenteral nutrition (TPN) administration is: 1\. infection. 2\. that the patient is tethered to an infusion pump. 3\. that the risk for hepatic complications is increased. 4\. that it requires continuous hospitalization.