1201 Quiz # 3 Pharm
A client with chronic alcoholism has been admitted to the intensive care unit after overdosing on alcohol. Which medication should the nurse prepare to administer? 1. Disulfiram 250 mg po daily 2. Thiamine 100 mg IV twice a day 3. Naloxone 0.4 mg IV prn 4. Clonidine TTS patch 2.5 mg per week
2. Correct: Thiamine 50-100 mg IV or IM is indicated twice a day for clients with chronic alcholism. It is usually given for several days, followed by 10-20 mg once a day until a therapeutic response is obtained.
A client diagnosed with chronic alcohol use disorder complains of feeling tremulous. The client's BP is now 170/110, P 116, R 30, T 97°F. The nurse anticipates which medication would give the client the most immediate relief from these symptoms? 1) Benztropine (Cogentin), 2 mg PO 2) Oxazepam (Serax), 30 mg PO 3) Lorazepam (Ativan), 1 mg IM 4) Meperidine (Demerol), 100 mg IM
3) Lorazepam (Ativan), 1 mg IMAtivan is frequently used to treat the symptoms of alcohol withdrawal. Because Ativan is ordered parenterally, this medication would give the client the most immediate relief of symptoms.
A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if neccessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need to ask your primary healthcare provider why the medication was changed from lorazepam to buspirone."
3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors.
A client is brought to the ED. The client is aggressive, has slurred speech, and exhibits impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician's orders is thiamine. Which is the rationale for this intervention? 1) To prevent nutritional deficits 2) To prevent pancreatitis 3) To prevent alcoholic hepatitis 4) To prevent Wernicke's encephalopathy
4) To prevent Wernicke's encephalopathy. Wernicke's encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.
A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."
ANS: A Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.
In assessing a client diagnosed with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)
ANS: B If large doses of central nervous system (CNS) depressants (like Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.
The nurse is teaching a group of clients about selective serotonin reuptake inhibitors (SSRI). Which comment by a client in the group indicates adequate understanding of the effects/side effects of the medications? 1. My weight may have decrease while taking this drug. 2. I may expect increased sweating while taking this drug. 3. I may actually feel more depressed while taking this medication. 4. I should feel better within a couple of days after beginning the med.
2. Correct. The drug causes temperature dysregulation, with increased sweating in some clients.
A nurse is assessing a client who has an opioid use disorder. Which of the following medications should the nurse plan to administer? 1. Varenicline 2. Methadone 3. Phenobarbital 4. Disulfiram
2. Methadone
A nurse is providing discharge teaching for a client who takes lithium (Lithane). The nurse should inform the client that which of the following could precipitate lithium toxicity? A. Increasing sodium intake. B. Mild exercise. C. Fasting. D. Carbamazepine (Tegretol) therapy.
C. Fasting.
A nurse is teaching about dietary restrictions for a client who has a new prescription for isocarboxazid. Which of the following foods should the nurse instruct the client to limit? 1. Smoked salmon 2. Chicken 3. Cottage cheese 4. Yogurt
1. Smoked salmon Rationale: A client who is taking isocarboxazid, an MAOI, should restrict foods that contain dietary tyramine, such as smoked salmon, due to the risk of hypertensive crisis. MAOI's allow tyramine to enter the general circulation, enhance norepinephrine release, and cause extensive vasoconstriction and cardiac stimulation.
A nurse in a mental health clinic is caring for a client who has bipolar disorder and reports that she stopped taking lithium 2 weeks ago. The nurse should recognize which of the following as an expected adverse effect that might have caused the client to stop taking the medication? 1. Sore throat 2. Photophobia 3. Hand tremors 4. Constipation
3. Hand tremorsRationale: Fine hand tremors are an expected adverse effect of lithium and can interfere with the client's ADLs, causing the client to stop taking the medication.
The nurse is preparing to discharge a client who has been placed on tranylcypromine. The nurse teaches the client about food to avoid while taking this medication. What food choose by the client confirms appropriate understanding of the teaching? 1. Cottage cheese 2. Salami 3. Baked chicken 4. Potatoes
2. Correct: The client taking a monamine oxidase inhibitor (MAOI) such as tranylcypromine should avoid foods rich in tyramine or tryptophan. These include: cured foods, those that have been aged, pickled, fermented, or smoked. These can precipate a hypertensive crisis.
A nurse is caring for a client who was admitted following an overdose of amitriptyline. The nurse should monitor the client for which of the following adverse effects associated with this medication? 1. Loose stools 2. Urinary retention 3. Fever 4. Dyspnea
2. Urinary retentionRationale: Urinary retention is an anticholinergic effect of amitriptyline. Therefore, the nurse should monitor for this as an adverse effect.
A nurse is caring for a client who has a substance use disorder and was involuntarily admitted by court order for 90 days. When the nurse attempts to administer prescribed lorazepam to decrease the manifestations for withdrawal, the client aggressively refuses. Which of the following actions should the nurse take? 1. Place the lorazepam on hold 2. Request a prescription for IM lorazepam 3. Request that another nurse attempt to administer the lorazepam 4. Place the lorazepam in the client's food
1. Place the lorazepam on hold Rationale: Clients who are in a health care facility due to an involuntary admission retain the right to refuse treatment, including prescribed medications. Therefore, the nurse should hold the medication, document the client's wishes in the medical record, and notify the provider of the refusal.
A nurse in an outpatient mental health setting is collecting a health history from a client who is taking paroxetine for depression. The client reports to the nurse that he also takes herbal supplements. The nurse should advise the client that which of the following supplements interacts adversely with paroxetine? 1. St. John's wort 2. Saw palmetto 3. Echinacea 4. Ginkgo
1. St. John's wortRationale: St. John's wort is an herbal preparation that decreases the reuptake of serotonin. The nurse should advise the client that taking St. John's wort with another medication that also inhibits the reuptake of serotonin, such as paroxetine, places the client at risk for serotonin syndrome.
A school nurse is planning a lesson on inhalant abuse for a high school health class. Which information does the nurse need to include? Select all that supply: 1. Substances used for inhaling include lighter fluid, spray paint, and airplane glue. 2. Inhalants are absorbed through the lungs and cause central nervous system depression rapidly. 3. Although inhaling can make a person very ill, death is highly unlikely. 4. Inhaling substances can cause abdominal pain, lethargy, and renal failure. 5. Inhalants cause the heart to beat slowly.
1., 2. & 4. Correct: All of these statements need to be included
When teaching a client diagnosed with alcoholism about nutritional needs, which nutritional concept should the nurse emphasize? 1) Eat a high-protein, low-carbohydrate diet to promote lean body mass. 2) Increase sodium-rich foods to increase iodine levels. 3) Provide multivitamin supplements, including thiamine and folic acid. 4) Restrict fluid intake to decrease renal load.
3) Provide multivitamin supplements, including thiamine and folic acid.Vitamin B deficiencies contribute to the nervous system disorders seen in chronic alcohol abuse. Supplements of these vitamins are important to prevent complications. It is important that vitamin supplements include both thiamine (vitamin B1) and folic acid.
A nurse is teaching a client who wants to stop smoking by using nicotine lozenges. Which of the following statements should the nurse make? 1. "Drink water directly before taking the lozenge." 2. "Place the lozenge under your tongue and let it dissolve." 3. "Limit your use to no more than 20 lozenges per day." 4. "Take 2-4 mg lozenges right after waking up in the morning."
3. "Limit your use to no more than 20 lozenges per day." Rationale: The nurse should instruct the client that users should consume no more than 5 lozenges within 6 hours and should not have more than 20 lozenges per day.
A nurse is assessing a client who is taking buspirone to treat generalized anxiety disorder. Which of the following findings should the nurse identify as an adverse effect of this medication? 1. Arthralgia 2. Photophobia 3. Xerostomia 4. Bradycardia
3.Xerostomia Rationale: Buspirone, a benzodiazepine, can cause xerostomia (dry mouth). Other adverse effects include headaches, nausea, and insomnia.
What information about diet should a nurse give a client taking lithium? A. Sodium and fluid intake should be increased. B. Fluid intake should not exceed 100mL per day. C. Sodium intake should be restricted to 1200mg per day. D. An adequate daily intake of sodium and fluids should be maintained.
D. An adequate daily intake of sodium and fluids should be maintained.
A nurse is caring for a client who is undergoing electroconvulsive therapy (ECT) and will receive succinylcholine. The client asks the nurse about this medication. What is an appropriate response by the nurse? 1. "Succinylcholine will enhance the therapeutic effects of this treatment." 2. "Succinylcholine is given to reduce muscle movements during therapy." 3. "Succinylcholine will decrease the anxiety level that you might experience with this treatment." 4. "Succinylcholine is used as a general anesthetic to make sure you are sleeping during the procedure."
2. "Succinylcholine is given to reduce muscle movements during therapy."Rationale: Succinylcholine is a muscle-paralyzing agent that will decrease muscle movement during the procedure so that injury is less likely to occur.
A nurse is reviewing routine laboratory values for several clients who are taking lithium carbonate. Which of the following clients should the nurse assess further for findings indicating lithium toxicity? 1. A client who has a fasting blood glucose of 80 mg/dL 2. A client who has a sodium level of 128 mEq/L 3. A client who has a BUN of 18 mg/dL 4. A client who has a potassium level of 3.6 mEq/L
2. A client who has a sodium level of 128 mEq/LRationale: A sodium level of 128 mEq/L should alert the nurse that the client is at risk for lithium toxicity because renal excretion of lithium is decreased in the presence of a low sodium level
The nurse is reviewing medications for a client who is being treated for major depression. The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which over the counter medication/supplement taken by the client should be reported to the primary healthcare provider immediately? 1. Daily intake of St. John's Wort. 2. Daily intake of a multi-vitamin. 3. Occasional use of ibuprofen. 4. Twice daily intake of an antacid.
1. Correct: St. John's Wort in combination with a selective serotonin reuptake inhibitor could cause serotonin syndrome which can be fatal.
A nurse is caring for a client who has a history of substance use disorder and was involuntarily admitted to a mental health facility. When the nurse attempts to administer oral lorazepam, the client refuses to take the medication and becomes physically aggressive. Which of the following actions should the nurse take? 1. Do not administer the lorazepam 2. Request a prescription for IV lorazepam 3. Request that another nurse attempt to administer the lorazepam 4. Place the lorazepam in the client's food
1. Do not administer the lorazepam Rationale: Clients who are in a facility due to an involuntary admission retain the right to refuse treatment. Therefore, the nurse should hold the medication and document the client's wishes.
A nurse is assessing a client prior to administering lithium. The client began taking lithium 1 week ago for the treatment of mania. For which of the following findings should the nurse withhold the dose? 1. Report of nausea with frequent episodes of emesis 2. Weight gain of 1.8 kg (4 lb) since the start of treatment 3. Fine hand tremors in both hands 4. Serum lithium level of 1.1 mEq/L
1. Report of nausea with frequent episodes of emesis Rationale: Gastrointestinal upset with nausea and frequent emesis is an early indication of lithium toxicity; therefore, the nurse should withhold the prescribed dose and obtain a serum lithium level. The nurse should assess the client for indications of dehydration, which further increases the risk of lithium toxicity
A client is being discharged on lithium carbonate. The nurse knows that teaching about the drug was successful when the client makes which statements? Select all that apply: 1. "I will notify my primary healthcare provider if I develop severe diarrhea or an excessive urinary output." 2. "I will do my best to maintain a moderate sodium intake in my diet." 3. "I will need to drink between 6-8 glasses of water a day." 4. "I should not drink alcohol while on this medication." 5. "I will avoid strenuous activity."
1., 2., 3., 4., & 5. Correct. All statements are correct and indicate client understanding of this medication. Lithium is similar in chemical structure to sodium, behaving in the body much the same way and competing with sodium at various sites in the body. If sodium intake is reduced or the body is depleted of its normal sodium (due to sweating, fever, diuresis), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity. Diarrhea and excessive urinary output will eliminate sodium as well. The client should consume a diet adequate in sodium. Consuming an adequate amount of water per day will help to maintain an adequate sodium level. Alcohol causes excessive diuresis which can decrease sodium. The client should avoid activities that cause excess sodium loss, such as heavy exertion, exercise in hot weather, or saunas.
An alcoholic client has agreed to take disulfiram 250 mg PO daily. The nurse recognizes that education has been successful when the client makes which statements? Select all that apply: 1. "If I decide to stop taking disulfiram, I should not ingest any alcohol for at least 2 weeks or I will have a reaction." 2. "I must read labels carefully so that I know that alcohol is not an ingredient." 3. "I am allowed to eat chili made with beer since the alcohol evaporates from the chili with prolonged cooking. "4. "This medication is not a cure. I still need to attend therapy sessions." 5. "I should avoid eating a lot of chocolate while on this medication."
1., 2., 4., & 5. Correct: Disulfiram works by reacting with alcohol to produce negative side effect which may last up to two weeks after discontinuation of the drug.The client should not consume any alcohol including hidden alcohol such as mouthwash and cough syrups. Disulfiram is not a cure for alcoholism. Disulfiram can increase the side effects of caffeine, so avoid chocolate and other caffeine containing substances.
A nurse is conducting a risk assessment for clients who are prescribed medications that can cause orthostatic hypotension. Which of the following medications requires a follow-up by the nurse? 1. Phenelzine 2. Escitalopram oxalate 3. Galantamine 4. Naltrexone
1.Phenelzine Rationale: Phenelzine is a monoamine oxidase inhibitor that is prescribed for depression and other mental health disorders. An adverse effect of phenelzine is orthostatic hypotension. The nurse should inform the client who is taking phenelzine that dizziness and lightheadedness are indications of hypotension. The nurse should also instruct the client to rise slowly from a lying or sitting position to minimize a drop in blood pressure.
A nurse is teaching a client who has a depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching? 1. "You may notice an increase in saliva while taking this medication." 2. "You may experience difficulties with sexual functioning while taking this medication." 3. "You should expect an improvement in symptoms of depression in 3 to 4 days." 4. "You may notice a temporary ringing in the ears when starting this medication."
2. "You may experience difficulties with sexual functioning while taking this medication."Rationale: Fluoxetine is a selective serotonin reuptake inhibitor that can cause sexual dysfunction such as anorgasmia and impotence. The nurse should instruct the client to notify the provider if sexual dysfunction occurs.
A nurse is caring for a client who is receiving treatment for alcohol detoxification. Which of the following medications should the nurse expect to administer during this phase of the client's care? 1. Buprenorphine 2. Diazepam 3. Varenicline 4. Rimonabant
2.Diazepam Rationale: The nurse should expect to administer diazepam to a client during alcohol detoxification. Anti-anxiety agents like chlordiazepoxide and diazepam are long-acting CNS depressants that are used to minimize the manifestations of alcohol withdrawal.
A nurse in the emergency department is admitting a client who reports a headache along with heart palpitations after having a glass of wine with dinner a few hours ago. The client has a history of depression and has a blood pressure of 210/105 mm Hg. Which of the following questions should the nurse ask first? 1. "Do you have a family history of hypertension?" 2. "When did you last see your primary provider?" 3. "What medications are you currently taking?" 4. "Do you currently use relaxation techniques for increased stress?"
3. "What medications are you currently taking?" Rationale: The nurse should verify what medication the client is currently taking, including MAOI medication to treat depression. The client's history of depression indicates that this client is at the greatest risk for hypertensive crisis from MAOI medications used to treat depression. These medications can precipitate a hypertensive crisis if consumed with tyramine-containing foods, including wine.
The nurse is caring for a client with a diagnosis of major depression. The client began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working." Which reply by the nurse indicates adequate understanding of treatment? 1. "I agree, your medication is not working." 2. "Your treatment may have to be changed." 3. "Most SSRIs take about 5 days to work." 4. "You should reach desired effect in 1-3 weeks."
4. Correct: Therapeutic effect is usually reached in one to three weeks, or longer.
A nurse is assessing a client who is experiencing post-traumatic stress disorder (PTSD) following a traumatic event. Which of the following medications should the nurse expect the provider to prescribe? 1. Buproprion 2. Phenelzine 3. Mirtazapine 4. Paroxetine
4.Paroxetine Rationale: The nurse should expect the provider to prescribe paroxetine, an SSRI that is considered the first-line treatment for PTSD.
A nurse is developing a plan of care for a client who has alcohol use disorder. Which of the following medications should the nurse plan to administer? 1. Methadone 2. Varenicline 3. Buprenorphine 4. Diazepam
4.Diazepam Rationale: The nurse should plan to administer diazepam to a client who has alcohol use disorder to minimize manifestations of alcohol withdrawal.
Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy
ANS: D A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.
A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."
ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.
A patient is receiving lorazepam (Ativan) for anxiety. In reviewing the client's discharge plans, the nurse should emphasize that lorazepam: A. should not be taken during pregnancy. B. Must be discontinued by gradual tapering over time. C. Is contraindicated for clients with asthma. D. Is a safe medication with no known adverse effects.
B. Must be discontinued by gradual tapering over time.
A nurse plans to teach important information about the anxiolytic agent diazepam (Valium) to a client for whom it has just been prescribed. The nurse should include in the teaching plan which of the following? A. Side effects include insomnia and seizures. B. Valium can be habit forming. C. This medication is administered solely by mouth. D. It takes 2 to 3 weeks to reach full therapeutic effect.
B. Valium can be habit forming.
A nurse is providing teaching to a client who is taking disulfiram (Antabuse) for the management of alcohol dependence. Which of the following should the nurse encourage the client to avoid? A. Peppermint candy. B. Vanilla extract. C. Salt. D. Chocolate.
B. Vanilla extract.
A nurse is providing medication teaching to a client who is prescribed the MAOI Phenelzine (Nardil). The nurse should caution the client against concurrent use of which of the following over the counter medications? A. Acetaminophen (Tylenol). B. Ranitidine (Zantac). C. Benztropine (Cogentin). D. Pseudophedrine (Sudafed).
D. Pseudophedrine (Sudafed).
A client who has bipolar disorder is to be discharged home with a prescription for lithium. Which of the following statements indicates that client teaching regarding the medication has been effective? 1. "I should eat a regular diet with normal amounts of salt and fluids." 2. "I should discontinue the lithium when I begin to feel better." 3. "I need to be careful to avoid becoming addicted to the lithium." 4. "I can skip a dose of medication if my stomach is upset."
1. "I should eat a regular diet with normal amounts of salt and fluids."Rationale: This statement indicates that the client understands the teaching because normal levels of sodium and fluid need to be maintained to ensure adequate excretion of lithium. If sodium levels are low, the body compensates by decreasing lithium excretion, which can lead to toxicity.
A nurse is obtaining a history from a client who has major depressive disorder and a new prescription for paroxetine. Which of the following statements by the client indicates a contraindication to this medication? 1. "I take phenelzine tablets every day." 2. "I was just diagnosed with type 2 diabetes mellitus." 3. "I take glucosamine sulfate." 4. "I have had osteoarthritis for several years."
1. "I take phenelzine tablets every day." Rationale: The nurse should recognize the concurrent use of paroxetine with phenelzine and other MAOIs is contraindicated due to an increased risk for serotonin syndrome.
A nurse is teaching a client who has bipolar disorder and a prescription for lithium. Which of the following instructions should the nurse include in the teaching? 1. "Take this medication with food." 2. "Reduce sodium intake to 1,000 milligrams each day." 3. "Limit fluid intake to 1,200 milliliters each day." 4. "Be aware that this medication can be addictive."
1. "Take this medication with food."
A nurse is assessing a client who has major depressive disorder and has been receiving amitriptyline for 1 week. Which of the following outcomes should the nurse expect? 1. Rapid improvement in affect within 30 to 60 min after taking the medication 2. Greater risk of attempting suicide as affect and energy improve 3. Onset of frequent loose stools 4. Development of physiologic dependence on the medication
2. Greater risk of attempting suicide as affect and energy improveRationale: An initial response to amitriptyline can develop in 1 week. For a client who has been severely depressed with suicidal ideation, the energy to carry out a plan is more possible after 1 week of treatment
A client with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? 1) Carbamazepine (Tegretol) 2) Clonidine (Catapres) 3) Disulfiram (Antabuse) 4) Folic acid (Folvite)
3) Disulfiram (Antabuse)Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high enough. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol are strictly prohibited when taking this drug.
A nurse is providing medication teaching with a client who has a depressive disorder and a new prescription for transdermal therapy with selegiline. Which of the following instructions should the nurse include? 1. "Replace the patch every 3 days." 2. "Discontinue the patch if you develop a rash." 3. "Cover the patch with an adhesive dressing." 4. "Apply the patch to dry, intact skin."
4. "Apply the patch to dry, intact skin." Rationale: The client should apply the patchy to dry, intact skin and use the palm to press down firmly for approximately 10 seconds to promote medication absorption
The primary healthcare provider prescribes glycopyrrolate 0.2 mg IM thirty minutes prior to electroconvulsive therapy (ECT). What should be the nurse's response when the client asks why this drug is being given? 1. You wouldn't understand what it is for. Just roll over so I can give you the shot. 2. This drug will prevent you from having a seizure. 3. This medication will relax your muscles so that you do not break a bone. 4. Glycopyrrolate will decrease secretions and could slow your heart rate.
4. Correct: Glycopyrrolate reduces secretions in the mouth, throat, airway, and stomach. It is used prior to procedures to decrease the risk of aspiration.
A client diagnosed with arachnophobia is prescribed alprazolam 0.5 mg orally three times daily. The nurse knows that teaching about this medication is successful when the client makes what statement? 1. Alprazolam will take up to two weeks to start working. 2. The drug does not cause drowsiness, so my daily activities will not suffer. 3. This medication cannot be taken with food. 4. I should not stop taking alprazolam suddenly.
4. Correct: Suddenly stopping could produce serious withdrawal symptoms, such as depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium.
A nurse is administering an oral sedative to a client who is receiving care following an involuntary admission. The client states, "I'm not taking any more medication." Which of the following actions should the nurse perform? 1. Administer the medication by another route 2. Refer the client's refusal to the facility's ethics committee 3. Inform the client that, due to her involuntary admission, she cannot refuse a sedative 4. Document the client's refusal of the medication in the medical record
4. Document the client's refusal of the medication in the medical record Rationale: The nurse should respect the client's right to refuse medication, even if the client is receiving treatment due to an involuntary admission. The nurse should document this refusal in the medical record and assess the reasons for the client's refusal.
A nurse is planning care for a client with panic disorder who is taking alprazolam (Xanax) 0.25mg t.i.d.. Which of the following instructions should the nurse give the client? A. You should increase your fluid intake to prevent dry mouth. B. You should take this medication with food to prevent GI upset. C. You will need to watch your caloric intake to prevent weight gain. D. You will have to read food labels careful to eliminate tyramine from your diet.
A. You should increase your fluid intake to prevent dry mouth.
A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports getting to sleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium
ANS: C Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.
A nurse is caring for a client who is experiencing acute alcohol withdrawal. Which of the following medications should the nurse expect to administer to the client to prevent complications? 1. Carbamazepine 2. Clonidine 3. Buproprion 4. Naltrexone
1.Carbamazepine Rationale: The nurse should expect to administer carbamazepine to a client who is experiencing acute alcohol withdrawal to prevent seizures
A client was prescribed a monoamine oxidase inhibitor (MAOI) for the treatment of depression. Which comment by the client indicates adequate understanding of the dietary restrictions that apply? 1. I cannot eat avocados or bananas. 2. I can eat sausage for breakfast, but not bacon. 3. At least I can still have my beer. 4. I can have blue cheese on my salad but not ranch dressing.
1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. Bananas and avocados are high in tyramine.
The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test? 1. Alanine aminotransferase (ALT) 2. Serum glucose 3. Serum creatinine 4. Serum electrolytes
1. Correct: ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis.
A nurse is caring for a client who is experiencing withdrawal from prescription oxycodone use. Which of the following medications should the nurse expect the provider to prescribe? 1. Varenicline 2. Lorazepam 3. Buprenorphine 4. Hydromorphone
3.Buprenorphine Rationale: The nurse should expect the provider to prescribe buprenorphine, which is a partial opioid agonist that is prescribed for up to 1 year to assist clients who are withdrawing from opioids, such as oxycodone.
A nurse is providing teaching to a client who has generalized anxiety disorder and a new prescription for buspirone. Which of the following manifestations is a common adverse effect of this medication? 1. Confusion 2. Bradycardia 3. Dizziness 4. Insomnia
3.Dizziness Rationale: The nurse should inform the client that dizziness is a common adverse effect of buspirone
Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)
ANS: D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.
A nurse should understand that a common side effect of benzodiazepine antianxiety medications is which of the following? A. Seizures B. Dizziness C. Flatulence D. Insomnia
B. Dizziness
A client with a history of psychosis is prescribed quetiapine fumarate (Seroquel) 150mg four times a day. Which of the following statements should the nurse include when providing the client education about this medication? A. You will need to be careful of exposure to the sun and wear sunscreen when outdoors. B. While you are taking Seroquel, you will need to have weekly blood counts. C. Weight gain is less common with Seroquel than with other atypical antipsychotics. D. Seroquel is effective in managing rapid-cycling manic episodes.
C. Weight gain is less common with Seroquel than with other atypical antipsychotics.
A client is in counseling for generalized anxiety disorder and is prescribed buspirone (BuSpar) to control extreme restlessness and irritability. During client teaching about the medication, the nurse should inform the client that the most common side effect of BuSpar is: A. Confusion. B. Arrhythmias. C. Drowsiness. D. Ataxia.
C. Drowsiness.
A client taking a tricyclic antidepressant is seen at the clinic. The client reports experiencing several side effects from the medication. Which of the following is the most common side effect associated with tricyclic antidepressants? A. Skin rashes. B. Excessive sweating. C. Drowsiness. D. Muscle breakdown.
C. Drowsiness.
The nurse is caring for an adolescent client diagnosed with depression. The client is prescribed fluoxetine. What is the best response by the nurse when the client says, "What will this medicine do to me?" 1. It will regulate a neurotransmitter called serotonin. 2. It will help you feel less depressed. 3. It will raise your level of the brain hormone norepinephrine. 4. It will balance blood glucose and dopamine levels in your head.
1. Correct: The action of the drug should be explained to the adolescent in a manner that will be understood.
A nurse is assessing a client who takes phenelzine for treatment of depression. Which of the following findings is the priority for the nurse to report to the provider? 1. Elevated blood pressure 2. Weight gain 3. Muscle twitching 4. 2+ peripheral edema
1. Elevated blood pressure Rationale: The greatest risk to this client is an elevated blood pressure, which increases the risk of a hypertensive crisis that can result from taking an MAOI like phenelzine. The nurse should apply the safety and risk reduction priority-setting framework when assessing this client, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the risk posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.
A client diagnosed with serotonin syndrome is admitted to the unit. The nurse is familiar with this adverse reaction to the serotonin reuptake inhibitors. Which symptoms can the nurse expect on assessment?Select all that apply: 1. Fever and shivering 2. Agitation 3. Decreased body temperature 4. Constipation 5. Increased heart rate
1., 2. & 5. Correct: The client is likely to have a fever and may also experience shivering. The client is usually agitated. Increased heart rate and blood pressure are expected.
The nurse is assisting with a client who will receive electroconvulsive therapy (ECT). The anesthesiologist administers succinylcholine chloride intravenously. What adverse effects should the nurse monitor for post procedure? Select all that apply: 1. Malignant hyperthermia 2. Hpokalemia 3. Apnea 4. Tetany 5. Arrhythmias
1., 3., & 5. Correct: To relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias.
A nurse in a mental health clinic is planning care for a client who has a new prescription for olanzapine. Which of the following interventions should the nurse identify as the priority? 1. Advise the client to take frequent sips of water. 2. Instruct the client to avoid driving during initial therapy 3. Consult a dietitian for a calorie-controlled diet plan 4. Recommend that the client exercise regularly
2. Instruct the client to avoid driving during initial therapy Rationale: The greatest risk to this client is injury resulting from drowsiness or dizziness. Therefore, the nurse's priority intervention is to instruct the client to avoid activities that require mental alertness during initial medication therapy.
A nurse is teaching a client who wants to stop smoking by using nicotine gum. The nurse should inform the client that which of the following adverse effects can occur from using nicotine gum? 1. Itching 2. Throat irritation 3. Hiccups 4. Teary eyes
2. Throat itch Rationale: The nurse should instruct the client that throat irritation is an adverse effect of chewing nicotine gum. Other adverse effects include mouth irritation, aching jaw muscles, and dyspepsia.
A nurse is planning care for a client who has completed detoxification from opioid abuse disorder. The nurse should plan to teach about which of the following medications? 1. Methadone 2. Naltrexone 3. Buprenorphine 4. Disulfiram
2.Naltrexone Rationale: The nurse should plan to educate the client on the medication naltrexone, an opioid antagonist that is used for the long-term maintenance of opioid use disorder. Naltrexone is the usual medication choice following detoxification from opioids.
A nurse is caring for a client who has a depressive disorder and a new prescription for an antidepressant. The client tells the nurse that he does not want to take any kind of medication. Which of the following responses should the nurse make? 1. "Why don't you want to take an antidepressant?" 2. "You are not going to get better unless you follow your doctor's recommendations." 3. "What are your concerns about taking the medication?" 4. "I agree with you about the use of medication."
3. "What are your concerns about taking the medication?" Rationale: The nurse is encouraging the client to describe his feelings about the use of antidepressants, which allows the nurse to better understand him and offer support
A client calls the clinic to ask the nurse if it would be okay to take the herbal medication kava-kava to help reduce anxiety. What is the nurse's best response? 1. "Why do you want to take kava-kava?" 2. "I really doubt your primary healthcare provider will approve your taking kava-kava." 3. "Kava-kava can cause liver damage, so we need to consult your healthcare provider." 4. "Do not take Kava-kava for more than a year without a primary healthcare providers supervision."
3. Correct: Kava-kava can cause liver damage.
The nurse is teaching a client about foods containing tyramine which should be avoided while taking a monoamine oxidase inhibitor (MAOI). Which meal selection, if chosen by the client, indicates successful teaching? 1. Smoked turkey and dressing, sweet peas and carrots, milk. 2. Baked chicken over pasta with parmesan sauce, asparagus tips, tea. 3. Fried catfish, French fries, coleslaw, apple juice. 4. Liver smothered in gravy and onions, rice, squash, water.
3. Correct: These foods are not high in tyramine.
A nurse is reviewing the medical record of a client who takes lithium carbonate to treat bipolar disorder. The nurse should identify which of the following laboratory values as the priority? 1. Lithium level 0.8 mEq/L 2. Sodium 142 mEq/L 3. Creatinine 2.3 mg/dL 4. TSH 4.5 milliunits/L
3. Creatinine 2.3 md/dL Rationale: A serum creatinine level of 2.3 mg/dL is an indication that the client is at greatest risk for renal dysfunction, an adverse effect of long term use of lithium; therefore, the nurse should identify this as the priority laboratory value.
A nurse in an acute care facility is planning discharge for a client who has alcohol use disorder and just experienced alcohol withdrawal with several severe complications. The client requires continued nursing care and supervised medication monitoring. Which of the following resources should the nurse recommend? 1. An intensive outpatient program 2. Standard outpatient treatment 3. A residential half-way house facility 4. A residential rehabilitation facility
4. A residential rehabilitation facility Rationale: A residential rehabilitation facility provides around-the-clock nursing care and supervised medication monitoring, as well as either short-term or long-term rehabilitation for lost physical or mental function. This is an appropriate referral for the nurse to make for this client.
A nurse is caring for a client with alcohol use disorder who has undergone detoxification. Which of the following medications should the nurse expect the provider to prescribe to assist the client with maintaining sobriety? 1. Varenicline 2. Clonidine 3. Buprenorphine 4. Disulfiram
4.Disulfiram Rationale: Disulfiram is a type of aversion therapy that helps clients abstain from alcohol. Drinking alcohol while taking this medication produces a toxic reaction that cause vomiting, confusion, headaches, breathing difficulties, and other manifestations.
A nurse is helping a client who has an anxiety disorder select a nonpharmacological stress-reduction therapy for home use. Which of the following therapies engages the insular cortex of the brain to allow the client to focus on a single thought that is important to the client in the present moment? 1. Guided imagery 2. Progressive relaxation 3. Cognitive reframing 4. Mindfulness
4. Mindfulness Rationale: The practice of mindfulness engages the insular cortex as the person focuses on the sensations and surroundings of the present moment. The client learns to stop the mind from wandering to multiple thoughts and worries and to concentrate on a single thought or situation that is important at that time.
A nurse is caring for a client who is taking a tricyclic antidepressant. Which of the following adverse effects should the nurse report to the client's provider immediately? 1. Dry mouth 2. Constipation 3. Drowsiness 4. Urinary retention
4. Urinary retention Rationale: Urinary retention can lead to a bladder infection and, ultimately, a loss of bladder tone. The nurse should apply the safety and risk reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.
A nurse is planning discharge teaching for a client who has undergone alcohol detoxification. The nurse should plan to teach the client about which of the following medications? 1. Buprenorphine 2. Methadone 3. Varenicline 4. Acamprosate
4.Acamprosate Rationale: The nurse should teach the client about how acamprosate can assist with an alcohol abstinence management program. Acamprosate decreases the unpleasant manifestations of abstinence, such as anxiety, tension, and dysphoria, and can help to prevent relapse.
