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Question 26 1 out of 1 pointsA homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin?Response Feedback: A protein deficit puts the patient at greater risk for having greater amounts of free, active drug in the blood because less protein albumin is available for binding than would normally be expected. Alcohol does not compete with phenytoin for binding sites and the drug is not necessarily contraindicated with recent alcohol intake, though alcohol does influence the metabolism of phenytoin. Oral phenytoin would not significantly minimize the risk of adverse effects.
Question 27 1 out of 1 pointsA nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware thatResponse Feedback: Applying lidocaine preparations to severely traumatized mucosa (large skin abrasions, eczema, and burns) can increase its absorption, which in turn increases the risk of systemic toxicity. Intravenous lidocaine is not normally used for analgesia. The destruction of nerve endings in a burn site does not mitigate the need for topical pain control and lidocaine does not need to be potentiated with another anesthetic. Question 28 1 out of 1 pointsMorphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse will advise the patient to avoidResponse Feedback: The nurse should advise the patient to avoid alcohol and any other CNS depressants while taking morphine. These combinations can cause serious respiratory depression and sedation. Vitamin C, fatty foods, and dairy products are not known to interact with morphine. Question 29 1 out of 1 pointsNurs 6521 PharmacologyA patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect byResponse Feedback: Phenytoin reversibly binds to sodium channels while they are in the inactive state. This binding delays the return of the channel to an active state. Because sodium can enter the cell to initiate an action potential only when the channelsare active, the time between action potentials is greatly lengthened, the neurons cannot fire at an excessive rate, and excessive muscle contractions that occur in grand mal-type seizures are prevented. Phenytoin does not directly affect the function of calcium channels or levels of GABA and glutamate.
Question 30 1 out of 1 pointsAn elderly woman is slated for a hemiarthroplasty (hip replacement surgery) after falling and breaking her hip on the stairs outside her home. The woman's pain in the time since her injuryhas been severe, and her care team has been treating it with morphine. Which of the followingadministration schedules is most likely to control the patient's pain?Response Feedback: The use of long-acting analgesia combined with short-acting opioids for breakthrough pain is a proactive pain management technique that maximizes therapeutic benefit while minimizing the risks of adverse effects. Question 31