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NSG 313 Exam 4 With
Complete Solution
What are the properties of salicylates? - ANSWER Antipyretic properties
Analgesic properties
Antiinflammatory properties
What is the prototype for salicylates? - ANSWER Aspirin
Which antiinflammatory drug works by inhibiting the synthesis of prostaglandin and both COX enzymes? - ANSWER Aspirin
What drug has an irreversible effect on COX 1? - ANSWER Aspirin
Why would a patient be given a low dose of aspirin? - ANSWER To decrease the risk of MIs and CV events
Why would a patient be given a high dose of aspirin? - ANSWER To treat pain, fever, and inflammation
Why does aspirin work to prevent MIs and CV events? - ANSWER It inhibits platelet aggregation, increasing bleeding
How long does aspirin inhibit platelet aggregation? - ANSWER Until the platelet dies; about 7 days
What is the method of action of salicylates? - ANSWER Inhibit synthesis of prostaglandin and inhibit platelet aggregation
What is aspirin indicated for? - ANSWER Treatment of mild to moderate pain
Fever
Some inflammatory conditions
Where is aspirin absorbed? - ANSWER Stomach
What is the purpose of enteric coated aspirin? - ANSWER Aspirin is absorbed in the stomach, but it is very irritating. EC aspirin prevents stomach irritation/bleeding by allowing the aspirin to be absorbed in the intestines.
What allergies contraindicates the use of aspirin? - ANSWER Allergy to salicylates, NSAIDs, or tartrazine
What antiinflammatory drug is contraindicated for use in children? - ANSWER Aspirin
Why should children not receive aspirin? - ANSWER Increases the risk of Reye syndrome
A patient has a surgery scheduled in 1 week. What medication should the nurse advise the patient not to take? - ANSWER Aspirin
What occurs if a patient takes high levels of aspirin? - ANSWER Salicylism
What are the differences between salicylism and salicylate toxicity? - ANSWER Salicylism- Dizziness, tinnitus, difficulty hearing, n/v/d, and confusion
Salicylate Toxicity- Hyperpnea, tachypnea, hemorrhage, excitement, pulmonary edema, convulsions, metabolic acidosis, and coma
A patient presents with metabolic acidosis, high RR, tachypnea, and agitation. What is the patient experiencing? - ANSWER Salicylate toxicity
What allergy contraindicates the use of celecoxib? - ANSWER Sulfonamides
Which drug does not have as many adverse effects as NSAIDs and salicylates? - ANSWER Acetaminophen
When NSAIDs are combined with ibuprofen, what adverse effect can occur? - ANSWER Lithium toxicity
What will occur if NSAIDs are taken with loop diuretics? - ANSWER There will be a decreased diuretic effect
What will occur if NSAIDs are taken with beta-blockers? - ANSWER There will be a decreased antihypertensive effect
What indicates the use of ibuprofen? - ANSWER Rheumatoid arthritis and osteosarthritis, mild to moderate pain, and fever
What drug is a selective COX-2 inhibitor? - ANSWER Celecoxib
What is the major adverse effect associated with celecoxib? - ANSWER MIs or CV events
Why doesn't celecoxib cause GI distress? - ANSWER Celecoxib should not cause any GI distress because it does not inhibit COX-1. COX-1 protects the gastric mucosa.
What is the method of action for acetaminophen? - ANSWER Unknown, but does work directly on the thermoregulatory cells of the hypothalamus to reduce fever
How is acetaminophen different than NSAIDs? - ANSWER Does not have antiinflammatory properties
What does acetaminophen treat? - ANSWER Pain and fever
Why does acetaminophen not have antiinflammatory properties? - ANSWER It inhibits COX in the CNS, not in the PNS like NSAIDs, so inflammation will not be reduced
What is included in percocet? - ANSWER 5 mg of oxycodone, 325 mg of acetaminophen
What is the major adverse effect with chronic acetaminophen use? - ANSWER Hepatotoxicity
What is the risk of administering acetaminophen to a patient with chronic alcoholism? - ANSWER Hepatotoxicity
What is the antidote for acetaminophen? - ANSWER Acetylcysteine
How is acetylcysteine given? - ANSWER Usually given in fruit juice every 4 hours prn
What organ function will we monitor with a patient on acetaminophen? - ANSWER Liver function
What is the purpose of antiarthritis agents? - ANSWER Prevent and suppress arthritis
What is another name for chrysotherapy? - ANSWER Gold compound/salts
What antiarthritis agent is used as a last resort in patients who are unresponsive to other therapies? - ANSWER Gold compound
What is the method of action of gold compound? - ANSWER Absorbed by macrophages so inhibits phagocytosis -> decreased tissue destruction
What age group should not receive gold salts? - ANSWER Elderly
Gold salts are often recommended for what age group? - ANSWER Children
Why would a patient be prescribed a low dose of a benzodiazepine? - ANSWER Assist with anxiety
Why would a patient be prescribed a high dose of a benzodiazepine? - ANSWER Cause sedation and hypnosis
What medication can be given preoperatively to decrease anxiety? - ANSWER Benzodiazepines
What drug class will be given to a patient going through alcohol withdrawal?
What baseline vital sign is important to get before administering a benzodiazepine? - ANSWER Respiratory rate
What should CNS drugs NOT be taken with? - ANSWER Alcohol
If a patient takes a benzodiazepine and drinks alcohol, what are they at risk of? - ANSWER Respiratory depression
After administering a benzodiazepine, what is a major nursing intervention to reduce fall risk? - ANSWER Make sure patients remain in bed for 3 hours after administration
What is the prototype for barbiturates? - ANSWER Phenobarbital
Why are barbiturates rarely used? - ANSWER they have a high potential for abuse
What is the action of phenobarbital? - ANSWER Inhibit impulse conduction in the RAS, depressing the cerebral cortex and motor output
What type of anxiolytic can be used to treat seizures? - ANSWER barbituates
Why should barbituates be used with caution for patients with pain? -
ANSWER Can mask the symptoms
Why should barbituates be used with caution for patients with seizure disorders? - ANSWER abrupt cessation can cause seizures
What drug is preferred for patients with anxiety that must remain alert? - ANSWER buspirone
What muscular abnormality occurs when there is injury to the musculoskeletal system that results in involuntary muscle contractions? - ANSWER Muscle spasms
What muscular abnormality occurs when there is damage to neurons in the CNS that causes involuntary muscle contractions? - ANSWER Spasticity
Why do muscle spasms occur? - ANSWER There is a flood of sensory impulses coming to the spinal cord from the injured area
What muscle relaxant is given to older patients or those with hepatic or renal impairment? - ANSWER Carisoprodol
What benzodiazepine can also be used as a muscle relaxant? - ANSWER Diazepine
What is the prototype for centrally acting skeletal muscle relaxants? - ANSWER Baclofen
Why would Baclofen be given? - ANSWER If a patient had s/s of spasticity
What is the method of action of Baclofen? - ANSWER Works in the CNS to interfere with reflexes causing muscle spasm
Why are rheumatic disorders contraindicated with Baclofen? - ANSWER Spasms from these disorders cannot be treated with Baclofen
Why should we be cautious when giving dantrolene to women or people over the age of 35? - ANSWER Increased risk of hepatocellular disease
What drug dangerously interacts with dantrolene to increase the risk of hepatocellular toxicity? - ANSWER Estrogen
If someone reports that their pain is a 1-3 on a scale of 1-10, what type of drug will be used to treat the pain? - ANSWER Non-opioids including NSAIDs or acetaminophen
If someone reports that their pain is a 4-6 on a scale of 1-10, what type of drug will be used to treat the pain? - ANSWER Can be treated with NSAIDs, acetaminophen, or weak opioids
If someone reports that their pain is a 7-10 on a scale of 1-10, what type of drug will be used to treat the pain? - ANSWER Can be treated with strong opioids
What is pain that is felt somewhere other than the actual source? - ANSWER Referred pain
What type of regimen should be in place for a patient on opioids? - ANSWER Bowel regimen
What does a bowel regimen include? - ANSWER Increased fiber intake and fluid intake
What is the most common symptom of opioids? - ANSWER Constipation
What is the prototype for narcotic agonists? - ANSWER Morphine
What is the action of narcotic agonists? - ANSWER Acts at specific opioid receptor sites in the CNS to produce analgesia, sedation, and euphoria
When is morphine indicated? - ANSWER If a patient has severe pain or during anesthesia
What is breakthrough pain? - ANSWER Involves a long-acting pain medication with additional orders for short acting pain medications to cover any pain that comes along between the doses of the long-acting medication
What is commonly prescribed for breakthrough pain and why? - ANSWER Fentanyl; because it is easy to administer since it is available sublingually, buccally, etc.
What is the action of Talwin? - ANSWER Act at a specific opioid receptor sites in the CNS to produce analgesia, sedation, euphoria, and hallucinations. Also blocks other opioid receptors
Which opioid type can be used as pain relief during labor and delivery? - ANSWER narcotic agonists-antagonists
When are narcotic agonists-antagonists contraindicated? - ANSWER In patients that are on narcotic agonists
If a patient on a narcotic agonist is given a narcotic agonist-antagonist, what will happen? - ANSWER They will go through a quick withdrawal
What is the brand name for naloxone? - ANSWER Narcan
What is the brand name for naltrexone? - ANSWER `Revia
What is the action of narcotic antagonists? - ANSWER bind strongly to opioid receptors, but they do not activate the receptors to reverse the effects of opioids
What is naloxone used for? - ANSWER Reverses adverse effects of narcotics
What is naltrexone used for? - ANSWER Used in the management of alcohol or narcotic dependence
What are the three s/s that indicate a patient needs naloxone? - ANSWER Constricted pupils (myosis), severely decreased RR (<10), unconscious or unable to respond
What are the common adverse effects of narcotic antagonists? - ANSWER Tachycardia
Blood pressure changes
Dysrhythmias
Acute narcotic abstinence syndrome (nausea, vomiting, sweating, tachycardia, hypertension, and anxiety)
When would a patient need a larger dose of a narcotic antagonist? - ANSWER If they needed reversal of narcotic agonists-antagonists
What are the s/s of a migraine headache? - ANSWER Severe, throbbing headache on one side of the head
Can have aura
What are the differences in adverse effects between ergot derivatives and triptans? - ANSWER Triptans are not associated with the vascular and GI effects of the ergot derivatives
What is the action of triptans? - ANSWER Bind to selective serotonin receptors sites to cause vasoconstriction of cranial vessels
What condition of the neck can be treated with Botox? - ANSWER Cervical dystonia
What are some s/s of withdrawal? - ANSWER Tachycardia, sweating, hypertension, tremors, anxiety, and N&V
What drug can be given to suppress alcohol cravings? - ANSWER Naltrexone
Why do we need to be cautious when giving CNS medications to infants and children? - ANSWER The blood brain barrier is not fully developed in infants/children, so we need to be cautious with CNS medications in pediatrics.
What three types of adverse effects are seen with valium? - ANSWER
CNS/PNS effects
GI effects
CV effects
What CNS/PNS adverse effects can occur with Valium? - ANSWER Sedation, drowsiness, dizziness, depression, lethargy, blurred vision
What GI adverse effects can occur with Valium? - ANSWER Dry mouth, constipation, nausea, vomiting, elevated liver enzymes
What CV adverse effects can occur with Valium? - ANSWER Blood pressure changes, arrhythmias, palpitations, respiratory difficulties
What are barrier defenses? - ANSWER • Skin
- Mucous membranes
- Stomach acid
- Major histocompatibility complexes
If a patient will be on opioids long term, what should be included in the nursing care plan? - ANSWER Bowel regimen
