A patient is admitted to the emergency department following a motor vehicle accident. The patient is ...

The answer to question 1

D
Noninvasive ventilation, including CPAP and BiPAP, is contraindicated in cardiac or respiratory arrest, nonrespiratory organ failure, facial surgery or trauma, inability to protect the airway and/or high risk for aspiration, and inability to clear secretions. A nasal cannula cannot be used with nasal obstruction from a broken nose.

The answer to question 2

A
The Volutrol is filled with the desired amount of IV fluid (50 to 100 mL) by opening the clamp between the Volutrol and the main IV bag. After the Volutrol is filled with the desired amount of fluid, the clamp is closed and the clamp on the air vent of the Volutrol is checked and opened if necessary. The injection port on the Volutrol is cleaned, and the medication is injected through the port.

The answer to question 3

synergistic effect
A synergistic effect is a drug interaction in which the combined effect of two drugs is greater than the sum of the effects of each individual agent acting independently. In other words, 1+1 = 3 or more. The use of a combination of drugs to treat hypertension is an example of synergism. Each drug lowers blood pressure but in a different way; the summed effect produces a greater reduction in hypertension than is produced by the effects of each medication.

The answer to question 4

D
If the patient experiences cardiac dysrhythmias (light-headedness, syncope), especially if receiving beta-adrenergics, withhold all additional doses of medication, assess vital signs, and notify the prescriber regarding reassessment of the type of medication and delivery method. Coughing, rapid and shallow respirations, and wheezing would be assessed and recorded, but this would not necessarily require discontinuation of treatment. The prescriber would be notified to reassess the type of medication and/or delivery system.

The answer to question 5

physical dependence
Drug dependence can be physical or psychological. Physical dependence is manifested by intense physical disturbance when the medication is withdrawn.

The answer to question 6

D
After connecting the prefilled syringe to the mini-tubing, the nurse carefully applies pressure to the syringe plunger to fill the tubing with fluid and to ensure that the tubing is free of air bubbles to prevent air embolus. After the tubing is filled with fluid, the syringe is placed into the mini-infusion pump and is hung on an IV pole. Then the mini-infusion tubing is connected to the main IV line.

The answer to question 7

B
Drugs must be inhaled sequentially. If bronchodilators are administered with inhaled steroids, the bronchodilators should be given first to dilate the airway passages for the second medication. The patient is instructed to wait 2 to 5 minutes between inhalations when different medications are being given. The patient is instructed to wait 20 to 30 seconds between inhalations if the same medication is being taken.

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