You are caring for patients who receive propofol extended (Diprivan). What are important nursing considerations for these patients? (Select all that apply, one, some or all)
Using a local anesthetic at the IV site prior to infusing the drug
Refrigerating open vials of the drug up to 24 hours
Maintaining the rate of intravenous infusion at mg/kg/hr
Stopping the infusion if a patient's CPK is greater than 5000 units/L
Ensuring that respiratory support equipment is readily available
Correct Answer : C,D,E
A. Propofol itself can cause pain at the injection site, but the use of a local anesthetic prior to infusion is not routinely recommended. Pain can sometimes be minimized by using a larger vein, slower administration, or lidocaine mixed with the propofol, but prophylactic local anesthetic at the IV site is not standard practice.
B. Propofol is a lipid emulsion and is highly prone to bacterial contamination. Open vials should not be refrigerated for extended periods; they are generally discarded within 6 hours of opening to reduce the risk of infection, especially propofol-related sepsis.
C. Propofol dosing for continuous sedation is weight-based, typically administered as mg/kg/hr, to maintain appropriate sedation levels and minimize adverse effects such as hypotension or oversedation. Close monitoring of infusion rates is essential.
D. Extended propofol infusions can cause propofol infusion syndrome, a rare but life-threatening condition characterized by rhabdomyolysis, hyperkalemia, metabolic acidosis, and cardiac failure. A CPK >5000 units/L may indicate rhabdomyolysis, and the infusion should be discontinued immediately to prevent further complications.
E. Propofol can cause respiratory depression and hypotension, even at standard doses. Nurses must ensure airway management and resuscitation equipment are readily available, and continuous monitoring of respiratory status, oxygen saturation, and hemodynamics is required during administration.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E"]
Explanation
A. MAC is indeed an index of inhalation anesthetic potency. It represents the concentration of anesthetic in the alveoli needed to prevent movement in 50% of patients in response to a standard surgical stimulus. A lower MAC indicates a more potent anesthetic.
B. MAC approximates the alveolar concentration of inhaled anesthetic requiredto achieve surgical anesthesia in 50% of patients. This helps guide anesthesiologists in dosing inhalational agents effectively.
C. MAC can be applied to all inhalational anesthetics, so the statement that it cannot is false. MAC is a standard measure used to compare the potency of all volatile anesthetic agents and nitrous oxide.
D. MAC provides a correlation between anesthetic dose and immobility, which is the primary endpoint it measures. It is widely used to assess anesthetic effectiveness for preventing motor responses during surgery.
E. This is false because a low MAC actually indicates high anesthetic potency, not low potency. Potent anesthetics require a smaller concentration to achieve immobility, while less potent agents require a higher MAC.
Correct Answer is C
Explanation
A. Methimazole crosses the placenta and is considered teratogenic, especially during the first trimesterof pregnancy. It can cause congenital malformations such as choanal or esophageal atresia and aplasia cutis. Patients planning pregnancy should discuss alternativeswith their provider. Often, propylthiouracil (PTU)is preferred during early pregnancy because it has a lower teratogenic risk, though it carries a higher risk of liver toxicity. After the first trimester, methimazole may be used if necessary. This statement shows a lack of understanding of safe pregnancy practices while on this medication.
B. Although methimazole can rarely cause hepatotoxicity, it is much less hepatotoxic than PTU. Routine liver function tests are not typically requiredunless the patient shows symptomsof liver dysfunction (e.g., jaundice, dark urine, abdominal pain). Overemphasis on routine LFTs may cause unnecessary anxiety or testing.
C. Methimazole carries a risk of agranulocytosis, a severe reduction in white blood cells that can increase susceptibility to infections. Early warning signs include sore throat, fever, malaise, or other signs of infection. Prompt reporting is critical because agranulocytosis can develop suddenly and requires immediate discontinuation of the drug and medical evaluation. This statement reflects correct understanding of patient safety and monitoringwhile on methimazole.
D. Routine CBC monitoring is not recommendedunless the patient exhibits symptoms suggestive of infection. Frequent testing without clinical indication is unnecessary and does not improve safety outcomes. Symptom-driven monitoring is the current standard of care.
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