Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 19

Question 1 Type: MCMA The nursing instructor teaches the nursing students about the advantages of the newer local anesthetics, such as lidocaine (Xylocaine). What will the best plan of the nursing instructor include !ote" Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. A$ides have fewer side effects than esters. 2. A$ides bloc% potassiu$ entry into the cell. 3. A$ides are si$ilar in structure to cocaine. 4. A$ides tend to last longer than esters. . A$ides bloc% calciu$ entry into the cell. Corre!t Ans"er: &,' #ationa$e 1" A$ides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. A$ides bloc% sodiu$, not potassiu$, entry into the cell. Cocaine is a natural ester, not an a$ide. A$ides bloc% sodiu$, not calciu$, entry into the cell. #ationa$e 2" A$ides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. A$ides bloc% sodiu$, not potassiu$, entry into the cell. Cocaine is a natural ester, not an a$ide. A$ides bloc% sodiu$, not calciu$, entry into the cell. #ationa$e 3" A$ides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. A$ides bloc% sodiu$, not potassiu$, entry into the cell. Cocaine is a natural ester, not an a$ide. A$ides bloc% sodiu$, not calciu$, entry into the cell. #ationa$e 4" A$ides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. A$ides bloc% sodiu$, not potassiu$, entry into the cell. Cocaine is a natural ester, not an a$ide. A$ides bloc% sodiu$, not calciu$, entry into the cell. #ationa$e " A$ides have largely replaced esters because they produce fewer side effects and generally have a longer duration of action. A$ides bloc% sodiu$, not potassiu$, entry into the cell. Cocaine is a natural ester, not an a$ide. A$ides bloc% sodiu$, not calciu$, entry into the cell. %$o&a$ #ationa$e:
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

Co'niti(e )e(e$: Applying C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./* Question 2 Type: MC#A The patient has entered #tage 0 of general anesthesia, %nown as surgical anesthesia. What will the best assess$ent of the nurse reveal 1. 1eart rate and breathing beco$e irregular. 2. )ye $ove$ents are slow, and general sensation is lost. 3. The $edulla region of the brain is paraly2ed. 4. 3ela4ation, stable respiration, and slow eye $ove$ents Corre!t Ans"er: ' #ationa$e 1" -n surgical anesthesia, s%eletal $uscles beco$e rela4ed, cardiovascular and breathing activities stabili2e, and eye $ove$ents are slow. 1eart rate and breathing beco$e irregular in #tage *, not #tage 0. The $edulla region of the brain is paraly2ed in #tage ', not #tage 0. )ye $ove$ents are slow, and general sensation is lost in #tage &, not #tage 0. #ationa$e 2" -n surgical anesthesia, s%eletal $uscles beco$e rela4ed, cardiovascular and breathing activities stabili2e, and eye $ove$ents are slow. 1eart rate and breathing beco$e irregular in #tage *, not #tage 0. The $edulla region of the brain is paraly2ed in #tage ', not #tage 0. )ye $ove$ents are slow, and general sensation is lost in #tage &, not #tage 0. #ationa$e 3" -n surgical anesthesia, s%eletal $uscles beco$e rela4ed, cardiovascular and breathing activities stabili2e, and eye $ove$ents are slow. 1eart rate and breathing beco$e irregular in #tage *, not #tage 0. The $edulla region of the brain is paraly2ed in #tage ', not #tage 0. )ye $ove$ents are slow, and general sensation is lost in #tage &, not #tage 0. #ationa$e 4" -n surgical anesthesia, s%eletal $uscles beco$e rela4ed, cardiovascular and breathing activities stabili2e, and eye $ove$ents are slow. 1eart rate and breathing beco$e irregular in #tage *, not #tage 0. The $edulla region of the brain is paraly2ed in #tage ', not #tage 0. )ye $ove$ents are slow, and general sensation is lost in #tage &, not #tage 0. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&:
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

*ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./5 Question 3 Type: MCMA The nurse teaches the patient about the correct use of a topical anesthetic for a s%in condition. The nurse deter$ines that learning has occurred when the patient $a%es which state$ent(s) !ote" Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. 6This lotion should only be used on s$all areas of s%in.6 2. 6- $ust wear gloves when - apply the lotion.6 3. 6This lotion wor%s well on cuts too.6 4. 6- $ust wash $y hands before touching $y eyes.6 . 6-t7s all right to use a lotion after the e4piration date.6 Corre!t Ans"er: &,' #ationa$e 1" Topical anesthetics $ust be %ept away fro$ the eyes unless they are ophthal$ic preparations, and in8ury could result if topical anesthetics are applied to large areas of s%in. Topical anesthetics should be applied to intact s%in only, not on cuts. 9rugs, including lotions, should not be used past the e4piration date. The nurse, not the patient, $ust wear gloves when applying topical anesthetics. #ationa$e 2" Topical anesthetics $ust be %ept away fro$ the eyes unless they are ophthal$ic preparations, and in8ury could result if topical anesthetics are applied to large areas of s%in. Topical anesthetics should be applied to intact s%in only, not on cuts. 9rugs, including lotions, should not be used past the e4piration date. The nurse, not the patient, $ust wear gloves when applying topical anesthetics. #ationa$e 3" Topical anesthetics $ust be %ept away fro$ the eyes unless they are ophthal$ic preparations, and in8ury could result if topical anesthetics are applied to large areas of s%in. Topical anesthetics should be applied to intact s%in only, not on cuts. 9rugs, including lotions, should not be used past the e4piration date. The nurse, not the patient, $ust wear gloves when applying topical anesthetics. #ationa$e 4" Topical anesthetics $ust be %ept away fro$ the eyes unless they are ophthal$ic preparations, and in8ury could result if topical anesthetics are applied to large areas of s%in. Topical anesthetics should be applied to intact s%in only, not on cuts. 9rugs, including lotions, should not be used past the e4piration date. The nurse, not the patient, $ust wear gloves when applying topical anesthetics. #ationa$e " Topical anesthetics $ust be %ept away fro$ the eyes unless they are ophthal$ic preparations, and in8ury could result if topical anesthetics are applied to large areas of s%in. Topical anesthetics should be applied to
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

intact s%in only, not on cuts. 9rugs, including lotions, should not be used past the e4piration date. The nurse, not the patient, $ust wear gloves when applying topical anesthetics. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" )valuation )earnin' ,ut!ome: &./& Question 4 Type: MC#A What does the nurse recogni2e as the $ost dangerous adverse effect of inhalation anesthesia 1. 1ypertension 2. :entricular tachycardia 3. Malignant hyperther$ia 4. -ncreased intracranial pressure Corre!t Ans"er: 0 #ationa$e 1" Malignant hyperther$ia is rare, but it is fatal if not treated i$$ediately. :entricular tachycardia is serious, but can be treated. -ncreased intracranial pressure is not a co$$on adverse effect, but can be treated. 1ypotension is $ore li%ely to occur than hypertension. #ationa$e 2" Malignant hyperther$ia is rare, but it is fatal if not treated i$$ediately. :entricular tachycardia is serious, but can be treated. -ncreased intracranial pressure is not a co$$on adverse effect, but can be treated. 1ypotension is $ore li%ely to occur than hypertension. #ationa$e 3" Malignant hyperther$ia is rare, but it is fatal if not treated i$$ediately. :entricular tachycardia is serious, but can be treated. -ncreased intracranial pressure is not a co$$on adverse effect, but can be treated. 1ypotension is $ore li%ely to occur than hypertension. #ationa$e 4" Malignant hyperther$ia is rare, but it is fatal if not treated i$$ediately. :entricular tachycardia is serious, but can be treated. -ncreased intracranial pressure is not a co$$on adverse effect, but can be treated. 1ypotension is $ore li%ely to occur than hypertension. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

)earnin' ,ut!ome: &./' Question Type: MC#A The patient receives succinylcholine (Anectine). What will be a priority assess$ent by the nurse 1. #pontaneous bleeding 2. 3espiratory paralysis 3. Anaphylactic shoc% 4. 9eliriu$ Corre!t Ans"er: * #ationa$e 1" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. #pontaneous bleeding is not related to this drug. 9eliriu$ is not related to this drug. Allergic reactions, li%e anaphylactic shoc%, are unco$$on with this drug. #ationa$e 2" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. #pontaneous bleeding is not related to this drug. 9eliriu$ is not related to this drug. Allergic reactions, li%e anaphylactic shoc%, are unco$$on with this drug. #ationa$e 3" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. #pontaneous bleeding is not related to this drug. 9eliriu$ is not related to this drug. Allergic reactions, li%e anaphylactic shoc%, are unco$$on with this drug. #ationa$e 4" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. #pontaneous bleeding is not related to this drug. 9eliriu$ is not related to this drug. Allergic reactions, li%e anaphylactic shoc%, are unco$$on with this drug. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./; Question Type: MC#A The student nurse does an operating roo$ rotation and notes that $any patients receive succinylcholine (Anectine). The student nurse as%s the nursing instructor how the drug wor%s. What is the best response by the nursing instructor
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

1. 6The patient will rapidly lose consciousness when this drug is ad$inistered.6 2. 6The patient7s cardiac $uscle will be i$pacted as well as the respiratory $uscles.6 3. 6The patient will need to be $onitored with an electrocardiogra$ ()C<).6 4. 6The patient will need assistance with breathing= it paraly2es respiratory $uscles.6 Corre!t Ans"er: ' #ationa$e 1" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. !euro$uscular bloc%ers only affect s%eletal $uscles, not cardiac $uscle. !euro$uscular bloc%ers do not affect consciousness. !euro$uscular bloc%ers do not affect cardiac $uscle= there is no need to $onitor the patient with an electrocardiogra$ ()C<). #ationa$e 2" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. !euro$uscular bloc%ers only affect s%eletal $uscles, not cardiac $uscle. !euro$uscular bloc%ers do not affect consciousness. !euro$uscular bloc%ers do not affect cardiac $uscle= there is no need to $onitor the patient with an electrocardiogra$ ()C<). #ationa$e 3" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. !euro$uscular bloc%ers only affect s%eletal $uscles, not cardiac $uscle. !euro$uscular bloc%ers do not affect consciousness. !euro$uscular bloc%ers do not affect cardiac $uscle= there is no need to $onitor the patient with an electrocardiogra$ ()C<). #ationa$e 4" #uccinylcholine (Anectine) is a neuro$uscular bloc%er that paraly2es $uscles, including those of respiration. !euro$uscular bloc%ers only affect s%eletal $uscles, not cardiac $uscle. !euro$uscular bloc%ers do not affect consciousness. !euro$uscular bloc%ers do not affect cardiac $uscle= there is no need to $onitor the patient with an electrocardiogra$ ()C<). %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./; Question . Type: MC#A The patient has a serious laceration to the ar$. The patient receives a local anesthetic $i4ed with epinephrine prior to suturing. What does the nurse recogni2e as the rationale for the epinephrine 1. Constricted blood vessels will e4tend the duration of action of the drug. 2. Constricted blood vessels will decrease the a$ount of pain e4perienced.
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

3. Constricted blood vessels will pro$ote rela4ation of the patient. 4. Constricted blood vessels will result in decreased bleeding. Corre!t Ans"er: & #ationa$e 1" )pinephrine is often added to local anesthetics to constrict blood vessels and e4tend the duration of action of the drug. The a$ount of vasoconstriction will not significantly decrease bleeding. :asoconstriction does not decrease pain. :asoconstriction will not pro$ote rela4ation in the patient. #ationa$e 2" )pinephrine is often added to local anesthetics to constrict blood vessels and e4tend the duration of action of the drug. The a$ount of vasoconstriction will not significantly decrease bleeding. :asoconstriction does not decrease pain. :asoconstriction will not pro$ote rela4ation in the patient. #ationa$e 3" )pinephrine is often added to local anesthetics to constrict blood vessels and e4tend the duration of action of the drug. The a$ount of vasoconstriction will not significantly decrease bleeding. :asoconstriction does not decrease pain. :asoconstriction will not pro$ote rela4ation in the patient. #ationa$e 4" )pinephrine is often added to local anesthetics to constrict blood vessels and e4tend the duration of action of the drug. The a$ount of vasoconstriction will not significantly decrease bleeding. :asoconstriction does not decrease pain. :asoconstriction will not pro$ote rela4ation in the patient. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" )valuation )earnin' ,ut!ome: &./0 Question / Type: MC#A Which patient is $ost li%ely to e4perience an adverse reaction to inhalation anesthesia 1. A &>/year/old with diabetes $ellitus 2. A 5/year/old with no chronic health proble$s 3. A ;./year/old with arteriosclerosis 4. A >>/year/old with a serious nec% in8ury Corre!t Ans"er: 0 #ationa$e 1" The elderly are $ore sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs $ay not be healthy. Adolescents are si$ilar to adults in ris% factors associated with inhalation anesthesia= they are not at high ris% for an adverse reaction. Children are $ore sensitive to inhalation anesthesia
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

than adults, but this 5 year/old child is healthy and so should not be at high ris% for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the nec% in8ury is not a contraindication to anesthesia. #ationa$e 2" The elderly are $ore sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs $ay not be healthy. Adolescents are si$ilar to adults in ris% factors associated with inhalation anesthesia= they are not at high ris% for an adverse reaction. Children are $ore sensitive to inhalation anesthesia than adults, but this 5 year/old child is healthy and so should not be at high ris% for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the nec% in8ury is not a contraindication to anesthesia. #ationa$e 3" The elderly are $ore sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs $ay not be healthy. Adolescents are si$ilar to adults in ris% factors associated with inhalation anesthesia= they are not at high ris% for an adverse reaction. Children are $ore sensitive to inhalation anesthesia than adults, but this 5 year/old child is healthy and so should not be at high ris% for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the nec% in8ury is not a contraindication to anesthesia. #ationa$e 4" The elderly are $ore sensitive to the effects of inhalation anesthesia and arteriosclerosis indicates that other organs $ay not be healthy. Adolescents are si$ilar to adults in ris% factors associated with inhalation anesthesia= they are not at high ris% for an adverse reaction. Children are $ore sensitive to inhalation anesthesia than adults, but this 5 year/old child is healthy and so should not be at high ris% for an adverse reaction. Adults are usually considered safe for inhalation anesthesia and the nec% in8ury is not a contraindication to anesthesia. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./. Question 9 Type: MC#A The patient is in #tage * of general anesthesia. What are the priority nursing interventions at this ti$e 1. Assist the anesthesiologist in repositioning the patient. 2. Co$plete the surgical scrub. 3. ?eep the environ$ent @uiet and cal$. 4. -nsert the Aoley catheter. Corre!t Ans"er: 0 #ationa$e 1" The patient is hypere4citable in #tage * of anesthesia so the environ$ent $ust be %ept @uiet to $ini$i2e sti$ulation. -t is not appropriate to reposition the patient during #tage * of anesthesia. -t is not appropriate to insert a Aoley catheter during #tage * of anesthesia. -t is not appropriate to co$plete the surgical scrub during #tage * of anesthesia.
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

#ationa$e 2" The patient is hypere4citable in #tage * of anesthesia so the environ$ent $ust be %ept @uiet to $ini$i2e sti$ulation. -t is not appropriate to reposition the patient during #tage * of anesthesia. -t is not appropriate to insert a Aoley catheter during #tage * of anesthesia. -t is not appropriate to co$plete the surgical scrub during #tage * of anesthesia. #ationa$e 3" The patient is hypere4citable in #tage * of anesthesia so the environ$ent $ust be %ept @uiet to $ini$i2e sti$ulation. -t is not appropriate to reposition the patient during #tage * of anesthesia. -t is not appropriate to insert a Aoley catheter during #tage * of anesthesia. -t is not appropriate to co$plete the surgical scrub during #tage * of anesthesia. #ationa$e 4" The patient is hypere4citable in #tage * of anesthesia so the environ$ent $ust be %ept @uiet to $ini$i2e sti$ulation. -t is not appropriate to reposition the patient during #tage * of anesthesia. -t is not appropriate to insert a Aoley catheter during #tage * of anesthesia. -t is not appropriate to co$plete the surgical scrub during #tage * of anesthesia. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./5 Question 10 Type: MC#A A pregnant wo$an has a $alignant $elano$a on her leg, and will need surgery. #he is concerned about anesthesia. What is the best response by the nurse 1. 6Bou will probably have an epidural, and this won7t har$ your baby.6 2. 6There are newer general anesthetics available that are safe for your baby.6 3. 6Bou will $ost li%ely have local anesthesia= this will not affect your baby.6 4. 6-nhalation anesthetics are safe because they re$ain in your lungs.6 Corre!t Ans"er: 0 #ationa$e 1" Cocal anesthetics are $ost co$$only used to re$ove lesions. They stay in the treat$ent area and do not i$pact the baby. There are not any general anesthetics that are considered safe, and this patient will $ost li%ely have local anesthesia. )pidural anesthesia is not indicated in this situation. -nhalation anesthesia is not indicated in this situation, and even though it re$ains pri$arily in the lungs, it can affect the baby. #ationa$e 2" Cocal anesthetics are $ost co$$only used to re$ove lesions. They stay in the treat$ent area and do not i$pact the baby. There are not any general anesthetics that are considered safe, and this patient will $ost li%ely have local anesthesia. )pidural anesthesia is not indicated in this situation. -nhalation anesthesia is not indicated in this situation, and even though it re$ains pri$arily in the lungs, it can affect the baby.
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

#ationa$e 3" Cocal anesthetics are $ost co$$only used to re$ove lesions. They stay in the treat$ent area and do not i$pact the baby. There are not any general anesthetics that are considered safe, and this patient will $ost li%ely have local anesthesia. )pidural anesthesia is not indicated in this situation. -nhalation anesthesia is not indicated in this situation, and even though it re$ains pri$arily in the lungs, it can affect the baby. #ationa$e 4" Cocal anesthetics are $ost co$$only used to re$ove lesions. They stay in the treat$ent area and do not i$pact the baby. There are not any general anesthetics that are considered safe, and this patient will $ost li%ely have local anesthesia. )pidural anesthesia is not indicated in this situation. -nhalation anesthesia is not indicated in this situation, and even though it re$ains pri$arily in the lungs, it can affect the baby. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./; Question 11 Type: MC#A The patient is scheduled for a surgical procedure. The nurse plans to teach the patient about anesthesia. Which state$ent would be included in the best plan of the nurse 1. 6An inhaled agent needs to be followed by an intravenous (-:) agent if it is ineffective.6 2. 6An inhaled agent is used to induce sleep, followed by an intravenous (-:) agent for rela4ation.6 3. 6An intravenous (-:) agent to induce sleep is usually all that is re@uired.6 4. 6An intravenous (-:) agent will be used first to induce sleep= then, an inhaled agent will be used.6 Corre!t Ans"er: ' #ationa$e 1" -ntravenous agents are usually ad$inistered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to $aintain the anesthesia. ,atients re@uire $ore anesthesia than 8ust intravenous (-:) anesthesia. An intravenous (-:) agent, not an inhaled agent, is used to induce sleep. -nhaled agents are given after intravenous (-:) agents to $aintain anesthesia, not if the intravenous (-:) agent is ineffective. #ationa$e 2" -ntravenous agents are usually ad$inistered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to $aintain the anesthesia. ,atients re@uire $ore anesthesia than 8ust intravenous (-:) anesthesia. An intravenous (-:) agent, not an inhaled agent, is used to induce sleep. -nhaled agents are given after intravenous (-:) agents to $aintain anesthesia, not if the intravenous (-:) agent is ineffective. #ationa$e 3" -ntravenous agents are usually ad$inistered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to $aintain the anesthesia. ,atients re@uire $ore anesthesia
Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

than 8ust intravenous (-:) anesthesia. An intravenous (-:) agent, not an inhaled agent, is used to induce sleep. -nhaled agents are given after intravenous (-:) agents to $aintain anesthesia, not if the intravenous (-:) agent is ineffective. #ationa$e 4" -ntravenous agents are usually ad$inistered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to $aintain the anesthesia. ,atients re@uire $ore anesthesia than 8ust intravenous (-:) anesthesia. An intravenous (-:) agent, not an inhaled agent, is used to induce sleep. -nhaled agents are given after intravenous (-:) agents to $aintain anesthesia, not if the intravenous (-:) agent is ineffective. %$o&a$ #ationa$e: Co'niti(e )e(e$: Applying C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./> Question 12 Type: MC#A The */year/old child co$es to the e$ergency depart$ent with a laceration to the lower leg. The physician plans to use a local anesthetic, but the child screa$s at the sight of the needle. What is the best action by the nurse 1. Wrap the child in a blan%et to restrain hi$ and ensure safety during suturing. 2. 3ub a local anesthetic crea$ on the s%in so the child will not feel the needle. 3. Ad$inister a s$all dose of a $edication such as lora2epa$ (Ativan). 4. As% the parents to leave the roo$ so the child will @uiet down. Corre!t Ans"er: * #ationa$e 1" The child will be $ore cooperative if there isn7t any pain fro$ an in8ection. There isn7t any indication to ad$inister lora2epa$ (Ativan). 3estraining the child will terrify hi$ and is not indicated at this ti$e. The presence of parents usually decreases a child7s an4iety and increases cooperation. #ationa$e 2" The child will be $ore cooperative if there isn7t any pain fro$ an in8ection. There isn7t any indication to ad$inister lora2epa$ (Ativan). 3estraining the child will terrify hi$ and is not indicated at this ti$e. The presence of parents usually decreases a child7s an4iety and increases cooperation. #ationa$e 3" The child will be $ore cooperative if there isn7t any pain fro$ an in8ection. There isn7t any indication to ad$inister lora2epa$ (Ativan). 3estraining the child will terrify hi$ and is not indicated at this ti$e. The presence of parents usually decreases a child7s an4iety and increases cooperation.

Ada$s, Pharmacology for Nurse: A Pathophysiologic Approach, '() Copyright *+&' by ,earson )ducation, -nc.

#ationa$e 4" The child will be $ore cooperative if there isn7t any pain fro$ an in8ection. There isn7t any indication to ad$inister lora2epa$ (Ativan). 3estraining the child will terrify hi$ and is not indicated at this ti$e. The presence of parents usually decreases a child7s an4iety and increases cooperation. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./D Question 13 Type: MC#A The patient has gastroesophageal reflu4 disease and receives lidocaine viscous prior to an endoscopy. What will the best assess$ent of the nurse include i$$ediately after the procedure 1. Assess for a return of the gag refle4. 2. Assess for nausea and vo$iting. 3. Assess for any da$age to the teeth or gu$s. 4. Assess for a headache. Corre!t Ans"er: & #ationa$e 1" The gag refle4 $ust be assessed before giving the patient anything to eat or drin%. 9a$age to the teeth or gu$s is rare following an endoscopy. !ausea and vo$iting is not co$$on after an endoscopy. 1eadaches are not co$$on after an endoscopy. #ationa$e 2" The gag refle4 $ust be assessed before giving the patient anything to eat or drin%. 9a$age to the teeth or gu$s is rare following an endoscopy. !ausea and vo$iting is not co$$on after an endoscopy. 1eadaches are not co$$on after an endoscopy. #ationa$e 3" The gag refle4 $ust be assessed before giving the patient anything to eat or drin%. 9a$age to the teeth or gu$s is rare following an endoscopy. !ausea and vo$iting is not co$$on after an endoscopy. 1eadaches are not co$$on after an endoscopy. #ationa$e 4" The gag refle4 $ust be assessed before giving the patient anything to eat or drin%. 9a$age to the teeth or gu$s is rare following an endoscopy. !ausea and vo$iting is not co$$on after an endoscopy. 1eadaches are not co$$on after an endoscopy. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing
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C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./. Question 14 Type: MC#A Which clinical techni@ue for ad$inistering anesthesia is co$$on for pregnant wo$en during labor and delivery 1. !erve bloc% 2. Topical 3. -nfiltration 4. )pidural Corre!t Ans"er: ' #ationa$e 1" Anesthesia via the epidural route is the $ost co$$on for wo$en during labor and delivery. #ationa$e 2" Anesthesia via the epidural route is the $ost co$$on for wo$en during labor and delivery. #ationa$e 3" Anesthesia via the epidural route is the $ost co$$on for wo$en during labor and delivery #ationa$e 4" Anesthesia via the epidural route is the $ost co$$on for wo$en during labor and delivery. %$o&a$ #ationa$e: Co'niti(e )e(e$: 3e$e$bering C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./& Question 1 Type: MC#A Cocal anesthetics wor% by 1. enhancing the influ4 of calciu$ into the cell. 2. occupying potassiu$ receptors. 3. increasing nerve i$pulse trans$ission.
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4. bloc%ing sodiu$ channels. Corre!t Ans"er: ' #ationa$e 1" Cocal anesthetics bloc% sodiu$ channels, resulting in di$inished $otor and sensory i$pulse trans$ission. #ationa$e 2" Cocal anesthetics bloc% sodiu$ channels, resulting in di$inished $otor and sensory i$pulse trans$ission. #ationa$e 3" Cocal anesthetics bloc% sodiu$ channels, resulting in di$inished $otor and sensory i$pulse trans$ission. #ationa$e 4" Cocal anesthetics bloc% sodiu$ channels, resulting in di$inished $otor and sensory i$pulse trans$ission. %$o&a$ #ationa$e: Co'niti(e )e(e$: 3e$e$bering C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./D Question 1Type: MC#A Which of the following local anesthetic agents would be considered first due to its lower rate of adverse effects 1. Tetracaine (,ontocaine) 2. ,rocaine (!ovocain) 3. Cidocaine (Xylocaine) 4. Chloroprocaine (!esacaine) Corre!t Ans"er: 0 #ationa$e 1" All e4cept lidocaine are classified as esthers. Cidocaine is classified as an a$ide, and a$ides produce fewer side effects than do esthers. #ationa$e 2" All e4cept lidocaine are classified as esthers. Cidocaine is classified as an a$ide, and a$ides produce fewer side effects than do esthers. #ationa$e 3" All e4cept lidocaine are classified as esthers. Cidocaine is classified as an a$ide, and a$ides produce fewer side effects than do esthers.
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#ationa$e 4" All e4cept lidocaine are classified as esthers. Cidocaine is classified as an a$ide, and a$ides produce fewer side effects than do esthers. %$o&a$ #ationa$e: Co'niti(e )e(e$: Enderstanding C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./* Question 1. Type: MC#A Which state$ent correctly identifies why epinephrine is used with local anesthetic agents 1. )pinephrine use produces higher analgesia levels. 2. )pinephrine use prolongs surgical ti$e. 3. )pinephrine use lowers the ris% of bacterial infection. 4. )pinephrine use reduces the occurrence of hypertension. Corre!t Ans"er: * #ationa$e 1" )pinephrine causes vasoconstriction, prolonging the ti$e the anesthetic is present, and therefore prolongs procedure ti$e. )pinephrine would cause hypertension, not prevent it. )pinephrine is not antibacterial and is not an analgesic. #ationa$e 2" )pinephrine causes vasoconstriction, prolonging the ti$e the anesthetic is present, and therefore prolongs procedure ti$e. )pinephrine would cause hypertension, not prevent it. )pinephrine is not antibacterial and is not an analgesic. #ationa$e 3" )pinephrine causes vasoconstriction, prolonging the ti$e the anesthetic is present, and therefore prolongs procedure ti$e. )pinephrine would cause hypertension, not prevent it. )pinephrine is not antibacterial and is not an analgesic. #ationa$e 4" )pinephrine causes vasoconstriction, prolonging the ti$e the anesthetic is present, and therefore prolongs procedure ti$e. )pinephrine would cause hypertension, not prevent it. )pinephrine is not antibacterial and is not an analgesic. %$o&a$ #ationa$e: Co'niti(e )e(e$: Enderstanding C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" )valuation
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)earnin' ,ut!ome: &./0 Question 1/ Type: MC#A Which of the following correctly identifies a sign of general anesthesia 1. A sleeping state that can be awa%ened easily 2. An unconscious state, without analgesia 3. A total loss of body $ove$ents 4. A conscious but sleepy state of being Corre!t Ans"er: 0 #ationa$e 1" <eneral anesthesia involves total analgesia and loss of consciousness, $e$ory, and body $ove$ents. #ationa$e 2" <eneral anesthesia involves total analgesia and loss of consciousness, $e$ory, and body $ove$ents. #ationa$e 3" <eneral anesthesia involves total analgesia and loss of consciousness, $e$ory, and body $ove$ents. #ationa$e 4" <eneral anesthesia involves total analgesia and loss of consciousness, $e$ory, and body $ove$ents. %$o&a$ #ationa$e: Co'niti(e )e(e$: 3e$e$bering C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./' Question 19 Type: MC#A Which of the following correctly identifies the initial use for an -: in a patient undergoing a lengthy abdo$inal surgery that re@uires general anesthesia 1. To ad$inister agents that will produce rapid unconsciousness 2. To ad$inister reversal agents or other $edications used to treat the adverse effects associated with general anesthesia
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3. To ad$inister large a$ounts of colloid solutions following surgical blood loss 4. To ad$inister a volatile li@uid that will %eep the patient asleep Corre!t Ans"er: & #ationa$e 1" -: lines are started prior to surgical procedures re@uiring general anesthesia to ad$inister agents that will cause rapid loss of consciousness. The -: also $ay be used to treat adverse effects and ad$inister replace$ent fluids, but these would not be initial uses. :olatile li@uids are inhaled gases. #ationa$e 2" -: lines are started prior to surgical procedures re@uiring general anesthesia to ad$inister agents that will cause rapid loss of consciousness. The -: also $ay be used to treat adverse effects and ad$inister replace$ent fluids, but these would not be initial uses. :olatile li@uids are inhaled gases. #ationa$e 3" -: lines are started prior to surgical procedures re@uiring general anesthesia to ad$inister agents that will cause rapid loss of consciousness. The -: also $ay be used to treat adverse effects and ad$inister replace$ent fluids, but these would not be initial uses. :olatile li@uids are inhaled gases. #ationa$e 4" -: lines are started prior to surgical procedures re@uiring general anesthesia to ad$inister agents that will cause rapid loss of consciousness. The -: also $ay be used to treat adverse effects and ad$inister replace$ent fluids, but these would not be initial uses. :olatile li@uids are inhaled gases. %$o&a$ #ationa$e: Co'niti(e )e(e$: Enderstanding C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./> Question 20 Type: MC#A Which of the following correctly identifies a state of general anesthesia desirable for surgery 1. The patient is unconscious, with ar$ and leg $ove$ent. 2. The patient is not responsive to pain, and has no spontaneous breathing. 3. The patient is unconscious with slow eye $ove$ents. 4. The patient loses sensation, but is awa%e. Corre!t Ans"er: 0 #ationa$e 1" #urgical anesthesia occurs at #tage 0, where the patient is not conscious and is rela4ed, eye $ove$ent has slowed, and vital signs have stabili2ed.
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#ationa$e 2" #urgical anesthesia occurs at #tage 0, where the patient is not conscious and is rela4ed, eye $ove$ent has slowed, and vital signs have stabili2ed. #ationa$e 3" #urgical anesthesia occurs at #tage 0, where the patient is not conscious and is rela4ed, eye $ove$ent has slowed, and vital signs have stabili2ed. #ationa$e 4" #urgical anesthesia occurs at #tage 0, where the patient is not conscious and is rela4ed, eye $ove$ent has slowed, and vital signs have stabili2ed. %$o&a$ #ationa$e: Co'niti(e )e(e$: Enderstanding C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" )valuation )earnin' ,ut!ome: &./5 Question 21 Type: MC#A A patient undergoing surgery is receiving general anesthesia as well as a neuro$uscular bloc%ing agent. Which state$ent best indicates the pri$ary reason for the neuro$uscular bloc%ing agent 1. To potentiate analgesic effects 2. To prevent adverse effects associated with inhaled gases 3. To cause total s%eletal $uscle rela4ation 4. To induce unconsciousness Corre!t Ans"er: 0 #ationa$e 1" The pri$ary purpose of ad$inistering neuro$uscular bloc%ing agents is to cause total s%eletal $uscle rela4ation. !euro$uscular bloc%ing agents do not potentiate analgesia or induce unconsciousness. They do allow for lower a$ounts of anesthetics to be used, which can reduce adverse effects, but this is not the pri$ary reason. #ationa$e 2" The pri$ary purpose of ad$inistering neuro$uscular bloc%ing agents is to cause total s%eletal $uscle rela4ation. !euro$uscular bloc%ing agents do not potentiate analgesia or induce unconsciousness. They do allow for lower a$ounts of anesthetics to be used, which can reduce adverse effects, but this is not the pri$ary reason. #ationa$e 3" The pri$ary purpose of ad$inistering neuro$uscular bloc%ing agents is to cause total s%eletal $uscle rela4ation. !euro$uscular bloc%ing agents do not potentiate analgesia or induce unconsciousness. They do allow for lower a$ounts of anesthetics to be used, which can reduce adverse effects, but this is not the pri$ary reason.
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#ationa$e 4" The pri$ary purpose of ad$inistering neuro$uscular bloc%ing agents is to cause total s%eletal $uscle rela4ation. !euro$uscular bloc%ing agents do not potentiate analgesia or induce unconsciousness. They do allow for lower a$ounts of anesthetics to be used, which can reduce adverse effects, but this is not the pri$ary reason. ( %$o&a$ #ationa$e: Co'niti(e )e(e$: 3e$e$bering C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./5 Question 22 Type: MCMA Mida2ola$ (:ersed) $ay be ad$inistered as part of surgical anesthesia. This drug is recogni2ed as having which effects Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. ,roducing effects consistent with those observed in ad$inistering other ben2odia2epines 2. 3educing an4iety and stress associated with surgery 3. ,roducing central nervous syste$ depression and s%eletal $uscle rela4ation 4. Maintaining stable cardiac and respiratory activity . ,reventing cardiac dysrhyth$ias Corre!t Ans"er: &,*,0 #ationa$e 1" Mida2ola$ (:ersed) can produce serious cardiovascular side effects, including hypotension, tachycardia, and cardiovascular collapse. Mida2ola$ (:ersed) can produce laryngospas$. #ationa$e 2" Mida2ola$ (:ersed) reduces an4iety and stress associated with surgery. #ationa$e 3" Mida2ola$ (:ersed) produces central nervous syste$ depression and s%eletal $uscle rela4ation. #ationa$e 4" Mida2ola$ (:ersed) is not associated with $aintaining stable cardiac and respiratory activity. #ationa$e " Mida2ola$ (:ersed) does not prevent cardiac dysrhyth$ias. %$o&a$ #ationa$e:
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Co'niti(e )e(e$: Applying C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning )earnin' ,ut!ome: &./* Question 23 Type: MCMA Falanced anesthesia is the use of a co$bination of $edications to produce general anesthesia. Which drugs $ay be used in co$bination Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. Fen2odia2epines 2. !euro$uscular bloc%ers 3. -nhaled anesthetics 4. ,roton/pu$p inhibitors . -ntravenous anesthetics Corre!t Ans"er: &,*,0,> #ationa$e 1" Fen2odia2epines reduce an4iety, produce central nervous syste$ depression, and rela4 s%eletal $uscle. #ationa$e 2" !euro$uscular bloc%ers provide s%eletal $uscle rela4ation, which is an i$portant co$ponent of general anesthesia. #ationa$e 3" -nhaled agents are used to $aintain an anestheti2ed state. #ationa$e 4" ,roton/pu$p inhibitors are not used in balanced anesthesia #ationa$e " -ntravenous anesthetics rela4 $uscles, di$inish pain, and produce sleep. %$o&a$ #ationa$e: Co'niti(e )e(e$: Applying C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" ,lanning
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)earnin' ,ut!ome: &./* Question 24 Type: MCMA ,reoperative ad8unct $edications are used for which reasons Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. To reduce an4iety and facilitate sedation 2. To facilitate a faster recovery 3. To reduce the ris% of aspiration pneu$onia 4. To reduce the ris% of a postoperative ileus . To $anage pain Corre!t Ans"er: &,0,> #ationa$e 1" Fen2odia2epines or short/acting barbiturates are used to reduce an4iety and facilitate sedation. #ationa$e 2" ,reoperative ad8uncts are not associated with a faster recovery. #ationa$e 3" ,reoperative ad8unct $edications such as hista$ine/* receptor agonists or anticholinergics are used to reduce the ris% of aspiration pneu$onia. #ationa$e 4" ,reoperative ad8uncts are not associated with a reduced ris% of a postoperative ileus. #ationa$e " -f the pain level is $oderate or $ild, nonsteroidal anti/infla$$atory drugs are ad$inistered because they cause fewer serious adverse reactions than opioids. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./; Question 2 Type: MCMA

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A nurse is assessing a postoperative patient who has a fa$ily history of $alignant hyperther$ia. Which findings would be of $ost concern to the nurse Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. Mild spas$s of the patient7s 8aw $uscles 2. 9ar% urine 0 hours after surgery 3. Tachycardia in the first hour after surgery 4. Te$perature elevation 0 hours after the procedure . 3espiratory rate increase to &D breaths per $inute * hours after the procedure Corre!t Ans"er: &,*,0 #ationa$e 1" Mild 8aw spas$s often herald the develop$ent of $alignant hyperther$ia. #ationa$e 2" 9ar%ened urine $ay signify rhabdo$yolysis, which occurs with $alignant hyperther$ia. #ationa$e 3" Tachycardia is a potential herald of $alignant hyperther$ia. #ationa$e 4" Te$perature elevation $ore than * hours after anesthesia is not a precursor of $alignant hyperther$ia. #ationa$e " 3espiratory rate $ay increase as anesthesia passes, but this is a rate still within nor$al ranges. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" Assess$ent )earnin' ,ut!ome: &./5 Question 2Type: MCMA A patient has 8ust been visited by the anesthesiologist who will provide anesthesia during the patient7s abdo$inal surgery the ne4t day. The patient says, 6- thin% - heard the doctor say so$ething about hypnosis. - don7t believe in all of that.6 1ow should the nurse respond Note: Credit will be given only if all correct choices and no incorrect choices are selected.
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Standard Text: #elect all that apply. 1. 61ypnosis is a standard $ethod of rela4ing the patient before anesthesia is started.6 2. 6That 8ust $eans the drugs are going to $a%e you unaware of what is happening.6 3. 6The doctor needs to bloc% all of your refle4es so the surgeon can do the surgery.6 4. 6This is not the sa$e as the %ind of hypnosis you $ight see on television.6 . 6The doctors do not want you to re$e$ber the pain of your procedure.6 Corre!t Ans"er: *,' #ationa$e 1" This is not the interpretation of the word hypnosis as it applies to general anesthesia. #ationa$e 2" This state$ent is a good description of hypnosis as it applies to general anesthesia. #ationa$e 3" Floc%ing of refle4es is the 6loss of refle4es6 portion of balanced anesthesia and is not the sa$e as the hypnosis portion. #ationa$e 4" This is a true state$ent. #ationa$e " While this is a true state$ent, it does not reflect the concept of hypnosis as it pertains to general anesthesia. %$o&a$ #ationa$e: Co'niti(e )e(e$: Analy2ing C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" -$ple$entation )earnin' ,ut!ome: &./* Question 2. Type: MCMA A novice nurse says, 6We want to %eep our patients in #tage ' anesthesia during their surgery.6 1ow should the supervising nurse interpret this state$ent Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that apply. 1. The novice nurse has $ade an error in this state$ent. 2. #tage ' anesthesia is avoided.
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3. This is a good description of the goal of anesthesia. 4. The novice nurse should have said #tage 0 anesthesia. . A $ore accurate state$ent would be that the patient is $aintained in an4iolysis anesthesia. Corre!t Ans"er: &,*,' #ationa$e 1" #tage ' is not the goal for anesthesia. #ationa$e 2" -n #tage ', the $edulla is paraly2ed and breathing and circulation could stop. This stage is avoided. #ationa$e 3" This is not the goal of anesthesia. #ationa$e 4" The goal of anesthesia is rapid induction through #tages & and * with the patient re$aining in #tage 0 until the end of the procedure. #ationa$e " An4iolysis is a ter$ used to describe $ini$al sedation, not general anesthesia. %$o&a$ #ationa$e: Co'niti(e )e(e$: )valuating C$ient *eed: ,hysiological -ntegrity C$ient *eed Su&: ,har$acological and ,arenteral Therapies *ursin'/+nte'rated Con!epts: !ursing ,rocess" )valuation )earnin' ,ut!ome: &./*

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