Sunteți pe pagina 1din 23

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 28

Question 1 Type: MCSA The young patient has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shoc ! The patient"s mother says to the nurse, #$ thought shoc %as about heart failure!# &hat is the best response by the nurse' 1. #There are many inds of shoc ( heart failure, nervous system damage, loss of blood, and respiratory failure!# 2. #Allergic response is the most fatal type of shoc ) other types involve loss of blood, heart failure, and liver failure!# 3. #There are many inds of shoc that also include infection, nervous system damage, and loss of blood!# 4. #*eart failure is the most serious ind of shoc ) others include infection, idney failure, and loss of blood!# Correct Answer: + ationa!e 1( ,bvious bleeding suggests hypovolemic shoc , trauma to the brain or spinal cord suggests neurogenic shoc , inade-uate cardiac output %ould suggest cardiogenic shoc , a recent infection may indicate septic shoc , and a history of allergies %ith a sudden onset of symptoms may suggest anaphylactic shoc ! .idney failure is not a type of shoc ! /espiratory failure is not a type of shoc ! 0iver failure is not a type of shoc ! ationa!e 2( ,bvious bleeding suggests hypovolemic shoc , trauma to the brain or spinal cord suggests neurogenic shoc , inade-uate cardiac output %ould suggest cardiogenic shoc , a recent infection may indicate septic shoc , and a history of allergies %ith a sudden onset of symptoms may suggest anaphylactic shoc ! .idney failure is not a type of shoc ! /espiratory failure is not a type of shoc ! 0iver failure is not a type of shoc ! ationa!e 3( ,bvious bleeding suggests hypovolemic shoc , trauma to the brain or spinal cord suggests neurogenic shoc , inade-uate cardiac output %ould suggest cardiogenic shoc , a recent infection may indicate septic shoc , and a history of allergies %ith a sudden onset of symptoms may suggest anaphylactic shoc ! .idney failure is not a type of shoc ! /espiratory failure is not a type of shoc ! 0iver failure is not a type of shoc ! ationa!e 4( ,bvious bleeding suggests hypovolemic shoc , trauma to the brain or spinal cord suggests neurogenic shoc , inade-uate cardiac output %ould suggest cardiogenic shoc , a recent infection may indicate septic shoc , and a history of allergies %ith a sudden onset of symptoms may suggest anaphylactic shoc ! .idney failure is not a type of shoc ! /espiratory failure is not a type of shoc ! 0iver failure is not a type of shoc ! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( $mplementation
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

&earnin$ *utcome: 4786 Question 2 Type: MCSA The patient comes to the emergency department after suffering a bilateral traumatic amputation of his lo%er e9tremities! The physician orders normal serum albumin (Albuminar)! The patient goes into shoc ! &hat %ill the best nursing assessment of this patient reveal' 1. :3P( 6253;5 mm*g, P( 2<, %ea and irregular, /( 42, and shallo%! 2. :3P( =535 mm*g, P( 64<, %ea and thready, /( 62, and shallo%! 3. :3P( 75345 mm*g, P( 644, %ea and thready, /( 47, and shallo%! 4. :3P( 6+5377 mm*g, P( ;5, bounding, /( +4, and shallo%! Correct Answer: + ationa!e 1( The central problem %ith hypovolemic shoc is the inability of the cardiovascular system to send sufficient blood to the vital organs, %ith the heart and brain being affected early in the progression of the disease! Assessing the patient"s cardiovascular status %ill result in a blood pressure that is lo%) a heart rate that may be rapid %ith a %ea , thready pulse) and breathing that is rapid and shallo%! A patient in shoc %ill have a lo% blood pressure and a rapid, %ea , not bounding, pulse! A patient in shoc %ill have rapid respirations, a respiratory rate of 62 is considered normal! A patient in shoc %ill have a lo% blood pressure) the heart rate %ill be rapid, not slo%ed! ationa!e 2( The central problem %ith hypovolemic shoc is the inability of the cardiovascular system to send sufficient blood to the vital organs, %ith the heart and brain being affected early in the progression of the disease! Assessing the patient"s cardiovascular status %ill result in a blood pressure that is lo%) a heart rate that may be rapid %ith a %ea , thready pulse) and breathing that is rapid and shallo%! A patient in shoc %ill have a lo% blood pressure and a rapid, %ea , not bounding, pulse! A patient in shoc %ill have rapid respirations, a respiratory rate of 62 is considered normal! A patient in shoc %ill have a lo% blood pressure) the heart rate %ill be rapid, not slo%ed! ationa!e 3( The central problem %ith hypovolemic shoc is the inability of the cardiovascular system to send sufficient blood to the vital organs, %ith the heart and brain being affected early in the progression of the disease! Assessing the patient"s cardiovascular status %ill result in a blood pressure that is lo%) a heart rate that may be rapid %ith a %ea , thready pulse) and breathing that is rapid and shallo%! A patient in shoc %ill have a lo% blood pressure and a rapid, %ea , not bounding, pulse! A patient in shoc %ill have rapid respirations, a respiratory rate of 62 is considered normal! A patient in shoc %ill have a lo% blood pressure) the heart rate %ill be rapid, not slo%ed! ationa!e 4( The central problem %ith hypovolemic shoc is the inability of the cardiovascular system to send sufficient blood to the vital organs, %ith the heart and brain being affected early in the progression of the disease! Assessing the patient"s cardiovascular status %ill result in a blood pressure that is lo%) a heart rate that may be rapid %ith a %ea , thready pulse) and breathing that is rapid and shallo%! A patient in shoc %ill have a lo% blood pressure and a rapid, %ea , not bounding, pulse! A patient in shoc %ill have rapid respirations, a respiratory rate
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

of 62 is considered normal! A patient in shoc %ill have a lo% blood pressure) the heart rate %ill be rapid, not slo%ed! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 4784 Question 3 Type: MCSA The patient is recovering from hypovolemic shoc ! The nurse hangs a bag of normal human serum albumin (Albutein) and educates the patient about this fluid! The nurse evaluates that learning has occurred %hen the patient ma es %hich statement' 1. #$t is a protein that pulls %ater into my blood vessels!# 2. #$t is a protein that causes my idneys to conserve fluid!# 3. #$t is a super8concentrated salt solution that helps me conserve body fluid!# 4. #$t is a li-uid that has electrolytes in it to pull %ater into my blood vessels!# Correct Answer: 6 ationa!e 1( Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes! They dra% %ater molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure! Crystalloids are intravenous ($>) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma! They are used to replace lost fluids and promote urine output! 1ormal human serum albumin (Albutein) does not act on the idneys! 1ormal human serum albumin is not a concentrated saline solution! ationa!e 2( Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes! They dra% %ater molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure! Crystalloids are intravenous ($>) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma! They are used to replace lost fluids and promote urine output! 1ormal human serum albumin (Albutein) does not act on the idneys! 1ormal human serum albumin is not a concentrated saline solution! ationa!e 3( Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes! They dra% %ater molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure! Crystalloids are intravenous ($>) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma! They are used to
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

replace lost fluids and promote urine output! 1ormal human serum albumin (Albutein) does not act on the idneys! 1ormal human serum albumin is not a concentrated saline solution! ationa!e 4( Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes! They dra% %ater molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure! Crystalloids are intravenous ($>) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma! They are used to replace lost fluids and promote urine output! 1ormal human serum albumin (Albutein) does not act on the idneys! 1ormal human serum albumin is not a concentrated saline solution! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 4782 Question 4 Type: MCSA The patient is in shoc %ith a blood pressure of <5345 mm*g! The physician orders isoproterenol ($suprel) intravenously ($>)! The family is -uite an9ious and as s %hat #that li-uid# is for! &hat is the best response of the nurse' 1. #This drug is a vasopressor and helps the heart beat more effectively, %hich %ill increase blood pressure!# 2. #>asopressor drugs act on the renin8angiotension system and thus increase blood pressure!# 3. #This drug is a vasopressor and %ill help stabili?e blood pressure by ma ing the blood vessels smaller!# 4. #$t is called a vasopressor and %ill help the idneys increase and maintain blood pressure!# Correct Answer: + ationa!e 1( $n early shoc , the body compensates for the fall in blood pressure by activating the sympathetic nervous system! The body"s ability is limited, so sympathomimetic vasoconstrictors, no%n as vasopressors, have been used to stabili?e blood pressure in shoc patients! >asopressors do not act on the idneys! >asopressors do not increase cardiac contractility! >asopressors do not affect the renin8angiotension system! ationa!e 2( $n early shoc , the body compensates for the fall in blood pressure by activating the sympathetic nervous system! The body"s ability is limited, so sympathomimetic vasoconstrictors, no%n as vasopressors, have been used to stabili?e blood pressure in shoc patients! >asopressors do not act on the idneys! >asopressors do not increase cardiac contractility! >asopressors do not affect the renin8angiotension system! ationa!e 3( $n early shoc , the body compensates for the fall in blood pressure by activating the sympathetic nervous system! The body"s ability is limited, so sympathomimetic vasoconstrictors, no%n as vasopressors, have
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

been used to stabili?e blood pressure in shoc patients! >asopressors do not act on the idneys! >asopressors do not increase cardiac contractility! >asopressors do not affect the renin8angiotension system! ationa!e 4( $n early shoc , the body compensates for the fall in blood pressure by activating the sympathetic nervous system! The body"s ability is limited, so sympathomimetic vasoconstrictors, no%n as vasopressors, have been used to stabili?e blood pressure in shoc patients! >asopressors do not act on the idneys! >asopressors do not increase cardiac contractility! >asopressors do not affect the renin8angiotension system! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( $mplementation &earnin$ *utcome: 478= Question + Type: MCSA The patient is receiving human serum albumin (Albutein) as treatment for shoc ! &hat is a priority assessment by the nurse' 1. Auscultate breath sounds for hyper8resonance! 2. Auscultate for an absence of breath sounds in the lo%er lobes! 3. Auscultate breath sounds for inspiratory stridor! 4. Auscultate breath sounds for crac les! Correct Answer: 2 ationa!e 1( :ecause human serum albumin (Albutein) pulls fluid into the vascular space, circulatory overload is a serious complication! The nurse must monitor breath sounds) crac les %ill be heard %ith pulmonary congestion! An absence of breath sounds is heard %ith a pneumothora9, not %ith pulmonary edema! *yper8resonance is assessed by percussion, not auscultation! Stridor is auscultated %ith air%ay obstruction, not pulmonary edema! ationa!e 2( :ecause human serum albumin (Albutein) pulls fluid into the vascular space, circulatory overload is a serious complication! The nurse must monitor breath sounds) crac les %ill be heard %ith pulmonary congestion! An absence of breath sounds is heard %ith a pneumothora9, not %ith pulmonary edema! *yper8resonance is assessed by percussion, not auscultation! Stridor is auscultated %ith air%ay obstruction, not pulmonary edema! ationa!e 3( :ecause human serum albumin (Albutein) pulls fluid into the vascular space, circulatory overload is a serious complication! The nurse must monitor breath sounds) crac les %ill be heard %ith pulmonary congestion! An absence of breath sounds is heard %ith a pneumothora9, not %ith pulmonary edema! *yper8resonance is assessed by percussion, not auscultation! Stridor is auscultated %ith air%ay obstruction, not pulmonary edema!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

ationa!e 4( :ecause human serum albumin (Albutein) pulls fluid into the vascular space, circulatory overload is a serious complication! The nurse must monitor breath sounds) crac les %ill be heard %ith pulmonary congestion! An absence of breath sounds is heard %ith a pneumothora9, not %ith pulmonary edema! *yper8resonance is assessed by percussion, not auscultation! Stridor is auscultated %ith air%ay obstruction, not pulmonary edema! "!o#a! ationa!e: Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 478< Question , Type: MCSA A graduate nurse abruptly discontinues the intravenous ($>) norepinephrine (0evarterenol) once it has infused into the patient! &hat is the priority action of the more e9perienced nurse' 1. ,btain an o9ygen saturation reading %ith a pulse o9imeter! 2. 1otify the physician! 3. Assess the patient"s blood pressure! 4. Administer o9ygen via a rebreather mas ! Correct Answer: + ationa!e 1( @iscontinuation of vasopressor therapy is al%ays gradual, due to the possibility of rebound hypotension and undesirable cardiac effects, so the nurse should immediately assess the patient"s blood pressure! The nurse %ill notify the physician, but the physician %ill %ant to no% %hat the blood pressure is, so plan to assess blood pressure first! There is no indication to administer o9ygen at this point! There is no indication to obtain an o9ygen saturation percentage at this point! ationa!e 2( @iscontinuation of vasopressor therapy is al%ays gradual, due to the possibility of rebound hypotension and undesirable cardiac effects, so the nurse should immediately assess the patient"s blood pressure! The nurse %ill notify the physician, but the physician %ill %ant to no% %hat the blood pressure is, so plan to assess blood pressure first! There is no indication to administer o9ygen at this point! There is no indication to obtain an o9ygen saturation percentage at this point! ationa!e 3( @iscontinuation of vasopressor therapy is al%ays gradual, due to the possibility of rebound hypotension and undesirable cardiac effects, so the nurse should immediately assess the patient"s blood pressure! The nurse %ill notify the physician, but the physician %ill %ant to no% %hat the blood pressure is, so plan to assess blood pressure first! There is no indication to administer o9ygen at this point! There is no indication to obtain an o9ygen saturation percentage at this point!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

ationa!e 4( @iscontinuation of vasopressor therapy is al%ays gradual, due to the possibility of rebound hypotension and undesirable cardiac effects, so the nurse should immediately assess the patient"s blood pressure! The nurse %ill notify the physician, but the physician %ill %ant to no% %hat the blood pressure is, so plan to assess blood pressure first! There is no indication to administer o9ygen at this point! There is no indication to obtain an o9ygen saturation percentage at this point! "!o#a! ationa!e: Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( $mplementation &earnin$ *utcome: 4787 Question Type: MCSA The physician orders dopamine (@opastat) intravenous ($>) for the patient in shoc ! &hat is a priority plan of the nurse %ith regard to administration of this drug' 1. *ave phentolamine (/egitine) available in the room! 2. *ave naltre9one (/evia) available in the room! 3. *ave epinephrine (Adrenalin) available in the room! 4. *ave fluma?enil (/oma?icon) available in the room! Correct Answer: 6 ationa!e 1( E9travasation of dopamine (@opastat) can cause severe, locali?ed vasoconstriction resulting in tissue necrosis! The antidote for this is phentolamine (/egitine)! Epinephrine is used for anaphyla9is! 1altre9one (/evia) is used for opiate overdose! Aluma?enil (/oma?icon) is used for ben?odia?epine overdose! ationa!e 2( E9travasation of dopamine (@opastat) can cause severe, locali?ed vasoconstriction resulting in tissue necrosis! The antidote for this is phentolamine (/egitine)! Epinephrine is used for anaphyla9is! 1altre9one (/evia) is used for opiate overdose! Aluma?enil (/oma?icon) is used for ben?odia?epine overdose! ationa!e 3( E9travasation of dopamine (@opastat) can cause severe, locali?ed vasoconstriction resulting in tissue necrosis! The antidote for this is phentolamine (/egitine)! Epinephrine is used for anaphyla9is! 1altre9one (/evia) is used for opiate overdose! Aluma?enil (/oma?icon) is used for ben?odia?epine overdose! ationa!e 4( E9travasation of dopamine (@opastat) can cause severe, locali?ed vasoconstriction resulting in tissue necrosis! The antidote for this is phentolamine (/egitine)! Epinephrine is used for anaphyla9is! 1altre9one (/evia) is used for opiate overdose! Aluma?enil (/oma?icon) is used for ben?odia?epine overdose! "!o#a! ationa!e:
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478< Question 8 Type: MCSA The patient has e9perienced hypovolemic shoc as a result of severe burns! The physician orders a lo% dose of dopamine ($notropin)! &hat is the best evaluation by the nurse' 1. >asoconstriction and increased blood pressure 2. Stabili?ation of fluid loss 3. Brinary output of at least =5 m03hour 4. $ncreased cardiac output Correct Answer: + ationa!e 1( At lo% doses, dopamine ($notropin) stimulates dopaminergic receptors, especially in the idneys, leading to vasodilation and an increased blood flo% through the idneys! $ncreased cardiac output occurs %ith high, not lo%, doses of dopamine ($notropin) %hen beta68adrenergic receptors are stimulated! >asoconstriction and increased blood pressure occurs %ith high, not lo%, doses of dopamine ($notropin) %hen alpha8adrenergic receptors are stimulated! @opamine ($notropin) does not prevent or stabili?e fluid loss! ationa!e 2( At lo% doses, dopamine ($notropin) stimulates dopaminergic receptors, especially in the idneys, leading to vasodilation and an increased blood flo% through the idneys! $ncreased cardiac output occurs %ith high, not lo%, doses of dopamine ($notropin) %hen beta68adrenergic receptors are stimulated! >asoconstriction and increased blood pressure occurs %ith high, not lo%, doses of dopamine ($notropin) %hen alpha8adrenergic receptors are stimulated! @opamine ($notropin) does not prevent or stabili?e fluid loss! ationa!e 3( At lo% doses, dopamine ($notropin) stimulates dopaminergic receptors, especially in the idneys, leading to vasodilation and an increased blood flo% through the idneys! $ncreased cardiac output occurs %ith high, not lo%, doses of dopamine ($notropin) %hen beta68adrenergic receptors are stimulated! >asoconstriction and increased blood pressure occurs %ith high, not lo%, doses of dopamine ($notropin) %hen alpha8adrenergic receptors are stimulated! @opamine ($notropin) does not prevent or stabili?e fluid loss! ationa!e 4( At lo% doses, dopamine ($notropin) stimulates dopaminergic receptors, especially in the idneys, leading to vasodilation and an increased blood flo% through the idneys! $ncreased cardiac output occurs %ith high, not lo%, doses of dopamine ($notropin) %hen beta68adrenergic receptors are stimulated! >asoconstriction and increased blood pressure occurs %ith high, not lo%, doses of dopamine ($notropin) %hen alpha8adrenergic receptors are stimulated! @opamine ($notropin) does not prevent or stabili?e fluid loss! "!o#a! ationa!e:
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 478C Question . Type: MCMA The nurse %or s in a summer camp for children! ,ne of the children says she %as bitten by several %asps! The nurse plans to inDect the child %ith epinephrine (EpiPen) if %hich symptoms are present' Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te/t: Select all that apply! 1. The child"s s in feels cold and clammy! 2. The child is thirsty! 3. The child"s s in feels %arm and dry! 4. The child is restless and confused! +. The child is hyperactive and hyperverbal! Correct Answer: 6,4,2 ationa!e 1( Eeneral symptoms of shoc include behavioral changes such as restlessness, an9iety, confusion, depression, and apathy! Thirst is a common complaint in shoc ! The s in may feel cold and clammy in shoc ! $n shoc , the s in is cold and clammy, not %arm and dry! $n shoc , the patient %ill not be hyperactive or hyperverbal! ationa!e 2( Eeneral symptoms of shoc include behavioral changes such as restlessness, an9iety, confusion, depression, and apathy! Thirst is a common complaint in shoc ! The s in may feel cold and clammy in shoc ! $n shoc , the s in is cold and clammy, not %arm and dry! $n shoc , the patient %ill not be hyperactive or hyperverbal! ationa!e 3( Eeneral symptoms of shoc include behavioral changes such as restlessness, an9iety, confusion, depression, and apathy! Thirst is a common complaint in shoc ! The s in may feel cold and clammy in shoc ! $n shoc , the s in is cold and clammy, not %arm and dry! $n shoc , the patient %ill not be hyperactive or hyperverbal! ationa!e 4( Eeneral symptoms of shoc include behavioral changes such as restlessness, an9iety, confusion, depression, and apathy! Thirst is a common complaint in shoc ! The s in may feel cold and clammy in shoc ! $n shoc , the s in is cold and clammy, not %arm and dry! $n shoc , the patient %ill not be hyperactive or hyperverbal!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

ationa!e +( Eeneral symptoms of shoc include behavioral changes such as restlessness, an9iety, confusion, depression, and apathy! Thirst is a common complaint in shoc ! The s in may feel cold and clammy in shoc ! $n shoc , the s in is cold and clammy, not %arm and dry! $n shoc , the patient %ill not be hyperactive or hyperverbal! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 4784 Question 10 Type: MCSA The patient is receiving normal serum albumin (Albuminar)! &hat %ill be a priority outcome %ith this patient' 1. The patient %ill be normotensive, not hypertensive! 2. The patient %ill be free of a rash! 3. The patient %ill e9perience ade-uate breathing patterns! 4. The patient %ill remain alert and oriented! Correct Answer: + ationa!e 1( Albumin is a natural blood product and allergic reactions are possible! A serious symptom of an allergic reaction is dyspnea or difficulty breathing! Alertness and orientation are important, but are not priority outcomes! *ypotension, not hypertension, is a possible adverse outcome %ith normal serum albumin (Albuminar)! A rash is a possible adverse outcome, but is not as much of a priority as dyspnea! ationa!e 2( Albumin is a natural blood product and allergic reactions are possible! A serious symptom of an allergic reaction is dyspnea or difficulty breathing! Alertness and orientation are important, but are not priority outcomes! *ypotension, not hypertension, is a possible adverse outcome %ith normal serum albumin (Albuminar)! A rash is a possible adverse outcome, but is not as much of a priority as dyspnea! ationa!e 3( Albumin is a natural blood product and allergic reactions are possible! A serious symptom of an allergic reaction is dyspnea or difficulty breathing! Alertness and orientation are important, but are not priority outcomes! *ypotension, not hypertension, is a possible adverse outcome %ith normal serum albumin (Albuminar)! A rash is a possible adverse outcome, but is not as much of a priority as dyspnea! ationa!e 4( Albumin is a natural blood product and allergic reactions are possible! A serious symptom of an allergic reaction is dyspnea or difficulty breathing! Alertness and orientation are important, but are not priority outcomes! *ypotension, not hypertension, is a possible adverse outcome %ith normal serum albumin (Albuminar)! A rash is a possible adverse outcome, but is not as much of a priority as dyspnea!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

"!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478< Question 11 Type: MCSA The physician has prescribed phenylephrine (1eo8Synephrine) for an elderly patient! &hat is an important nursing assessment prior to administration of this drug' 1. A history of type 6 diabetes mellitus 2. A history of narro% angle glaucoma 3. A history of di??iness 4. A history of human immunodeficiency virus (*$>) infection Correct Answer: 4 ationa!e 1( >asoconstrictors may increase intraocular pressure, so the nurse should assess for narro% angle glaucoma! @i??iness is a general symptom and not specific to this drug! Type 6 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug! *uman immunodeficiency virus (*$>) infection is not adversely affected by administration of a vasoconstrictor drug! ationa!e 2( >asoconstrictors may increase intraocular pressure, so the nurse should assess for narro% angle glaucoma! @i??iness is a general symptom and not specific to this drug! Type 6 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug! *uman immunodeficiency virus (*$>) infection is not adversely affected by administration of a vasoconstrictor drug! ationa!e 3( >asoconstrictors may increase intraocular pressure, so the nurse should assess for narro% angle glaucoma! @i??iness is a general symptom and not specific to this drug! Type 6 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug! *uman immunodeficiency virus (*$>) infection is not adversely affected by administration of a vasoconstrictor drug! ationa!e 4( >asoconstrictors may increase intraocular pressure, so the nurse should assess for narro% angle glaucoma! @i??iness is a general symptom and not specific to this drug! Type 6 diabetes mellitus is not adversely affected by administration of a vasoconstrictor drug! *uman immunodeficiency virus (*$>) infection is not adversely affected by administration of a vasoconstrictor drug! "!o#a! ationa!e: Co$niti%e &e%e!: Applying
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 4787 Question 12 Type: MCSA The patient %ill be receiving dopamine (@opastat)! &hat e-uipment %ill the nurse plan to obtain prior to infusion of this drug' 1. ,9ygen cannula 2. $ntravenous ($>) pump 3. Pulse o9imeter 4. Se-uential compression devices Correct Answer: 4 ationa!e 1( $notropic medications are administered as a continuous infusion based on micrograms per ilograms per minute! Al%ays infuse these medications via an intravenous ($>) pump! A pulse o9imeter is an important piece of e-uipment, but not as important as an intravenous ($>) pump! An o9ygen cannula is an important piece of e-uipment, but not as important as an intravenous ($>) pump! Se-uential compression devices are important pieces of e-uipment, but not as important as an intravenous ($>) pump! ationa!e 2( $notropic medications are administered as a continuous infusion based on micrograms per ilograms per minute! Al%ays infuse these medications via an intravenous ($>) pump! A pulse o9imeter is an important piece of e-uipment, but not as important as an intravenous ($>) pump! An o9ygen cannula is an important piece of e-uipment, but not as important as an intravenous ($>) pump! Se-uential compression devices are important pieces of e-uipment, but not as important as an intravenous ($>) pump! ationa!e 3( $notropic medications are administered as a continuous infusion based on micrograms per ilograms per minute! Al%ays infuse these medications via an intravenous ($>) pump! A pulse o9imeter is an important piece of e-uipment, but not as important as an intravenous ($>) pump! An o9ygen cannula is an important piece of e-uipment, but not as important as an intravenous ($>) pump! Se-uential compression devices are important pieces of e-uipment, but not as important as an intravenous ($>) pump! ationa!e 4( $notropic medications are administered as a continuous infusion based on micrograms per ilograms per minute! Al%ays infuse these medications via an intravenous ($>) pump! A pulse o9imeter is an important piece of e-uipment, but not as important as an intravenous ($>) pump! An o9ygen cannula is an important piece of e-uipment, but not as important as an intravenous ($>) pump! Se-uential compression devices are important pieces of e-uipment, but not as important as an intravenous ($>) pump! "!o#a! ationa!e: Co$niti%e &e%e!: Applying
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478< Question 13 Type: MCSA The patient comes to the emergency department %ith a severe allergic reaction to peanuts, and is in serious respiratory distress! The patient"s spouse tells the nurse that the patient has a no%n hypersensitivity to epinephrine (Adrenalin)! &hat is the best response by the nurse' 1. #$ %ill let the physician no% about this immediately) %e %ill need to choose an alternative medication!# 2. #$"m not sure %hat %e can use then! @o you no% %hat has been used before %ith this allergic response'# 3. #This is a life8threatening situation) a prior hypersensitivity is not an absolute contraindication!# 4. #This is a problem) %e %ill need to use $> diphenhydramine (:enadryl)!# Correct Answer: + ationa!e 1( Although epinephrine is contraindicated for no%n hypersensitivity to the drug, in life8threatening situations there are no absolute contraindications to its use! @iphenhydramine (:enadryl) may not be the best choice, and the nurse must spea %ith conviction to decrease an9iety in the patient and spouse! ationa!e 2( Although epinephrine is contraindicated for no%n hypersensitivity to the drug, in life8threatening situations there are no absolute contraindications to its use! @iphenhydramine (:enadryl) may not be the best choice, and the nurse must spea %ith conviction to decrease an9iety in the patient and spouse! ationa!e 3( Although epinephrine is contraindicated for no%n hypersensitivity to the drug, in life8threatening situations there are no absolute contraindications to its use! @iphenhydramine (:enadryl) may not be the best choice, and the nurse must spea %ith conviction to decrease an9iety in the patient and spouse! ationa!e 4( Although epinephrine is contraindicated for no%n hypersensitivity to the drug, in life8threatening situations there are no absolute contraindications to its use! @iphenhydramine (:enadryl) may not be the best choice, and the nurse must spea %ith conviction to decrease an9iety in the patient and spouse! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( $mplementation &earnin$ *utcome: 478C Question 14
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

Type: MCSA The patient is receiving norepinephrine (0evophed)! &hen monitoring the patient"s blood pressure, the nurse notes a pressure of 4+53645 mm*g! &hat is the priority nursing action' 1. Assess the patient for signs3symptoms of a stro e! 2. 1otify the physician! 3. Slo% the rate of the infusion until the physician assesses the patient! 4. Stop the infusion! Correct Answer: 2 ationa!e 1( @iscontinuing the infusion results in a reversal of adverse effects such as hypertension! The nurse %ould notify the physician, but this should occur after discontinuing the infusion! The infusion must be stopped, not slo%ed, before the patient e9periences the adverse effects of e9treme hypertension! ationa!e 2( @iscontinuing the infusion results in a reversal of adverse effects such as hypertension! The nurse %ould notify the physician, but this should occur after discontinuing the infusion! The infusion must be stopped, not slo%ed, before the patient e9periences the adverse effects of e9treme hypertension! ationa!e 3( @iscontinuing the infusion results in a reversal of adverse effects such as hypertension! The nurse %ould notify the physician, but this should occur after discontinuing the infusion! The infusion must be stopped, not slo%ed, before the patient e9periences the adverse effects of e9treme hypertension! ationa!e 4( @iscontinuing the infusion results in a reversal of adverse effects such as hypertension! The nurse %ould notify the physician, but this should occur after discontinuing the infusion! The infusion must be stopped, not slo%ed, before the patient e9periences the adverse effects of e9treme hypertension! "!o#a! ationa!e: Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( $mplementation &earnin$ *utcome: 478< Question 1+ Type: MCSA *ypovolemic shoc is different from neurogenic shoc in that it relates to 1. an infectious process! 2. a brain or spinal cord trauma!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

3. inade-uate cardiac output! 4. volume depletion! Correct Answer: 2 ationa!e 1( $nfectious process can indicate septic shoc ! ationa!e 2( :rain or spinal cord trauma is possibly neurogenic shoc ! ationa!e 3( $nade-uate cardiac output suggests cardiogenic shoc ! ationa!e 4( >olume depletion occurs in hypovolic shoc ! "!o#a! ationa!e: Co$niti%e &e%e!: /emembering C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 4786 Question 1, Type: MCSA A patient %ith cardiogenic shoc %ould e9hibit %hich of the follo%ing symptoms' 1. :radycardia 2. 0o% temperature 3. /estlessness and an9iety 4. Tachycardia and lo% blood pressure Correct Answer: 2 ationa!e 1( :radycardia is not associated %ith symptoms of shoc ! ationa!e 2( 0o% temperature is not associated %ith metabolic changes ationa!e 3( /estlessness and an9iety are typically associated %ith a neurogenic shoc reaction! ationa!e 4( Tachycardia and lo% blood pressure are associated %ith cardiogenic shoc ! "!o#a! ationa!e: Co$niti%e &e%e!: Bnderstanding
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 4784 Question 1Type: MCSA &hat %ould be the e9pected first treatment of shoc ' 1. Start an intravenous line! 2. Assess level of consciousness! 3. Ta e the blood pressure! 4. Maintain the air%ay! Correct Answer: 2 ationa!e 1( Starting an $> %ould be dependent on the type of shoc being treated! ationa!e 2( Assessing level of consciousness is important in neurological assessment, but not the first priority! ationa!e 3( Ta ing the blood pressure is critical, but not first priority! ationa!e 4( Maintaining the air%ay is the first priority and intervention of maintaining the A:Cs of life support! "!o#a! ationa!e: Co$niti%e &e%e!: /emembering C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478+ Question 18 Type: MCSA Colloids differ from crystalloids in that 1. they contain electrolytes! 2. they readily leave the blood and enter cells! 3. they are too large to cross membranes!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

4. they promote urine output! Correct Answer: + ationa!e 1( Colloids are made up of protein and other large molecules! ationa!e 2( Crystalloids, not colloids, readily cross into cells! Colloids contain proteins that are too large to leave the blood! ationa!e 3( Colloids contain proteins that are too large to leave the blood! ationa!e 4( Crystalloids promote urine output, %hereas colloids increase oncotic pressure! "!o#a! ationa!e: Co$niti%e &e%e!: Bnderstanding C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 47865 Question 1. Type: MCSA E9amples of vasoconstrictors used to treat shoc include all of the follo%ing e9cept 1. propranolol ($nderal)! 2. dobutamine (@obutre9) 3. norepinephrine (0evophed)! 4. phenylephrine (1eo8synephrine)! Correct Answer: 6 ationa!e 1( Propranolol is a beta bloc er used to treat hypertension! ationa!e 2( @obutamine is a vasoconstrictor used to treat vasodilatation and hypotension, %hich occur in shoc ! ationa!e 3( 1orepinephrine is a vasoconstrictor used to treat vasodilatation and hypotension, %hich occur in shoc ! ationa!e 4( Phenylephrine is a vasoconstrictor used to treat vasodilatation and hypotension, %hich occur in shoc ! "!o#a! ationa!e:
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

Co$niti%e &e%e!: /emembering C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 478= Question 20 Type: MCSA The mechanism of action of norepinephrine is to 1. cause increased blood flo%! 2. increase heart rate! 3. decrease cardiac output! 4. produce vasoconstriction! Correct Answer: 2 ationa!e 1( >asoconstrictors do not cause increased blood flo%! ationa!e 2( These drugs can decrease heart rate %ith inotropic effect! ationa!e 3( >asoconstrictors do not decrease cardiac output! They can help %ith inotropic effect! ationa!e 4( >asoconstrictors such as norepinephrine produce vasoconstriction of the vessels, thereby increasing blood pressure! "!o#a! ationa!e: Co$niti%e &e%e!: /emembering C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 478C Question 21 Type: MCMA The nurse is concerned that a patient receiving dobutamine (@obutre9) is e9periencing adverse effects from the medication! &hat did the nurse assess in the patient' 1ote( Credit %ill be given only if all correct choices and no incorrect choices are selected! (tandard Te/t: Select all that apply!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

1. Palpitations 2. @rop in blood pressure 3. Cold e9tremities 4. *eadache +. :lurred vision Correct Answer: 6,4,+ ationa!e 1( Palpitations are an adverse effect of dobutamine (@obutre9)! ationa!e 2( *ypotension is an adverse effect of dobutamine (@obutre9)! ationa!e 3( Cold e9tremities are an adverse effect of dobutamine (@obutre9)! ationa!e 4( *eadache is an adverse effect of digo9in (0ano9in)! ationa!e +( :lurred vision is an adverse effect of digo9in (0ano9in!) "!o#a! ationa!e: Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: Pharmacological and Parenteral Therapies 'ursin$/)nte$rated Concepts: 1ursing Process( Evaluation &earnin$ *utcome: 478= Question 22 Type: MCMA The nurse is directed to prepare norepinephrine for administration to a patient! Aor %hich health problems is this medication indicated' 1ote( Credit %ill be given only if all correct choices and no incorrect choices are selected! (tandard Te/t: Select all that apply! 1. Acute shoc 2. Cardiac arrest 3. Septic shoc 4. *ypovolemic shoc
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

+. Cardiogenic shoc Correct Answer: 6,4,+ ationa!e 1( The primary indication for norepinephrine is acute shoc ! ationa!e 2( The primary indication for norepinephrine is cardiac arrest! ationa!e 3( 1orepinephrine is the vasopressor of choice for septic shoc ! ationa!e 4( @opamine is the medication of choice for hypovolemic shoc ! ationa!e +( @opamine is the medication of choice for cardiogenic shoc ! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: Pharmacological and Parenteral Therapies 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478< Question 23 Type: MCMA A patient comes into the emergency department %ith systemic manifestations of anaphyla9is caused by a %asp sting! Aor %hich health problems %ould the nurse be concerned prior to administering epinephrine' 1ote( Credit %ill be given only if all correct choices and no incorrect choices are selected! (tandard Te/t: Select all that apply! 1. Premature ventricular contractions 2. *ypertension 3. *yperthyroidism 4. Pheochromocytoma +. *ypotension Correct Answer: 6,4,+ ationa!e 1( The drug must be used %ith caution in patients %ith dysrhythmias because epinephrine may %orsen this condition!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

ationa!e 2( The drug must be used %ith caution in patients %ith hypertension because epinephrine may %orsen this condition! ationa!e 3( The drug must be used %ith caution in patients %ith hyperthyroidism because epinephrine may %orsen this condition! ationa!e 4( @opamine is contraindicated for pheochromocytoma! ationa!e +( 1orepinephrine should not be administered to patients %ith hypotension! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: Pharmacological and Parenteral Therapies 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478= Question 24 Type: MCMA The paramedics are transporting to the emergency department a patient %ho is e9periencing shoc ! &hat %ill the nurse prepare in anticipation of the patientFs arrival' 1ote( Credit %ill be given only if all correct choices and no incorrect choices are selected! (tandard Te/t: Select all that apply! 1. Cardiac monitor 2. Pulse o9imeter 3. ,9ygen 4. &hole blood +. @e9tran 25 Correct Answer: 6,4 ationa!e 1( &hen treating shoc , the patient should be immediately connected to a cardiac monitor! ationa!e 2( &hen treating shoc , the patient should be immediately connected to a pulse o9imeter! ationa!e 3( Bnless contraindicated, o9ygen is administered via a nonrebreather mas ! ationa!e 4( The use of %hole blood %ill be decided after the type of shoc is determined!
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

ationa!e +( The use of de9tran 25 %ill be decided after the type of shoc is determined! "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: Physiological $ntegrity C!ient 'eed (u#: /eduction of /is Potential 'ursin$/)nte$rated Concepts: 1ursing Process( Planning &earnin$ *utcome: 478+ Question 2+ Type: MCMA Prior to administering dopamine the nurse revie%s a patientFs current medication history! Aor %hich medications %ould dopamine cause a drugGdrug interaction' 1ote( Credit %ill be given only if all correct choices and no incorrect choices are selected! (tandard Te/t: Select all that apply! 1. MA, inhibitor 2. Phenytoin 3. :eta bloc er 4. @igo9in +. Aspiring Correct Answer: 6,4,+,2 ationa!e 1( Concurrent administration %ith MA, inhibitors increases the alpha8adrenergic effects of dopamine! ationa!e 2( Phenytoin may decrease the action of dopamine! ationa!e 3( A beta bloc er may inhibit the inotropic effect of dopamine! ationa!e 4( @igo9in may increase the ris of dysrhythmias in the patient! ationa!e +( There is no evidence to suggest a drugGdrug interaction %ill occur if dopamine is administered to a patient %ho ta es aspirin! "!o#a! ationa!e: Co$niti%e &e%e!: Analy?ing C!ient 'eed: Physiological $ntegrity
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!

C!ient 'eed (u#: Pharmacological and Parenteral Therapies 'ursin$/)nte$rated Concepts: 1ursing Process( Assessment &earnin$ *utcome: 478<

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 23E Copyright 4562 by Pearson Education, $nc!