Author Question: A 72-year-old patient is admitted to the hospital for surgery. After the patient returns to the ... (Read 132 times)

jazziefee · **on:** Jul 23, 2018

A 72-year-old patient is admitted to the hospital for surgery.

After the patient returns to the floor, the patient's daughter tells the nurse she is concerned that her mother will overdose on morphine because she keeps pressing the button on her patient-controlled anesthesia (PCA) pump. What is the nurse's best response? A) You should control how often she presses the button.
B) If she will follow the directions she was given, that will not happen.
C) The PCA device always provides the correct amount, so pressing the button is just for placebo effect.
D) The device is preset, so your mother cannot get more than a specific amount.

Question 2

The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed.

What drug will the nurse expect to be ordered? A) Anticoagulant
B) Digoxin
C) Quinidine
D) Ibutilide

xthemafja · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

D
Feedback:
A PCA system using morphine provides a baseline, constant infusion of morphine and gives the patient control of the system to add bolus doses of morphine if the patient believes that pain is not being controlled. The system prevents overdose by locking out extra doses until a specific period of time has elapsed. The PCA is for the patient to control the analgesia, not for a family member to control it because the patient will fall asleep when adequate pain control is reached. If the family keeps pushing the button while the patient's level of consciousness continues to decline, serious overdosage could occur. Not following directions could result in inadequate pain management but not overdosage. The button delivers small bolus dosages so it is not a placebo effect.

Answer to Question 2

A
Feedback:
If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversio n. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. In 2011, the American Heart Association and American College of Cardiology endorsed dabigatran (Pradaxa) as the anticoagulant of choice for prophylaxis in AF. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics would not be indicated.