86Qw/exp *SUPER IMPORTANT* CNS PHARM (seizure, anesthetics, etc.)

The expected outcome for a patient taking benztropine as drug therapy for Parkinson's disease would be what? A) Decrease in rigidity B) Decrease in light-headedness C) Decrease in disorientation D) Decrease in flushing

Ans: A Feedback: Benztropine should cause a decrease in rigidity. Light-headedness, disorientation, and flushing are all adverse effects of benztropine and can be expected with a patient taking this drug.

The nurse should recognize what drug is classified as an amide local anesthetic? A) Lidocaine (Xylocaine) B) Benzocaine (Dermoplast) C) Chloroprocaine (Nesacaine) D) Tetracaine (Pontocaine)

Ans: A Feedback: Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester anesthetics.

What is the nurse's priority assessment when administering narcotics to older adults? (Select all that apply.) A) Central nervous system (CNS) effects B) Gastrointestinal effects C) Cardiovascular effects D) Urinary effects E) Developmental effects

Ans: A, B, C Feedback: Older patients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal (GI), and cardiovascular effects. Urinary and developmental effects are not areas of high concern.

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure?* A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this."

What is one of the registered nurse's primary roles in the administration of general anesthetic? A)Determining the client's most appropriate medication B)Administering intravenous anesthetics as prescribed C)Assessing the client's status during recovery from anesthetic D)Administering inhaled anesthetics as prescribed

Assessing the client's status during recovery from anesthetic

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time? A)30 to 60 minutes B)15 to 30 minutes C)1 to 2 minutes D)10 to 15 minutes

1 to 2 minutes

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication?* A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A. "Every morning I take this medication with a full glass of milk with my breakfast."

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for:* A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A. Respiratory depression D. Hypotension The answers are A and D. This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this

What antiepileptic classification of drugs works by stabilizing nerve membranes by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation? A) Hydantoins B) Benzodiazepines C) Valproic acid D) Carbamazepine

Ans: A Feedback: The hydantoins stabilize nerve membranes throughout the central nervous system directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, they reduce the tonic​clonic, muscular, and emotional responses to stimulation. Valproic acid and benzodiazepines increase gammaaminobutyric acid (GABA) effects and decrease electrical activity. Carbamazepine increases GABA activity and blocks sodium and calcium channels to stop action potentials.

The nurse is speaking to a group at the senior citizen's center about Parkinson's disease and explains the importance of avoiding what when taking an anticholinergic medication? A) Strenuous exercise in high environmental temperatures B) Fluids high in potassium C) Foods high in vitamin K D) Anything containing red dye

Ans: A Feedback: Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do not need to avoid fluids high in potassium, foods high in vitamin K, or anything containing red dye.

A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with long-term use of antipsychotics, can be treated with what drug type? A) Anticholinergic agents B) Monoamine oxidase inhibitors (MAOIs) C) Synthetic antiviral agents D) Dopaminergic drugs

Ans: A Feedback: Anticholinergic drugs that are centrally active are useful in treating parkinsonism. MAOIs, synthetic antiviral agents, and dopaminergic agents are incorrect.

A patient is admitted to the unit with central spasticity after a terrible motor vehicle accident. The doctor places an intrathecal delivery pump. What medication can be administered via this route to treat the central spasticity? A) Baclofen (Lioresal) B) Cyclobenzaprine (Flexeril) C) Dantrolene (Dantrium) D) Carisoprodol (Soma)

Ans: A Feedback: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Flexeril, dantrolene, and Soma are not administered intrathecally

A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed? A) Baclofen (Lioresal) B) Cyclobenzaprine (Flexeril) C) Metaxalone (Skelaxin) D) Orphenadrine (Banflex)

Ans: A Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the child's arms and hands. The nurse would schedule this child for what routine screenings? A) Central nervous system and gastrointestinal (GI) function B) Respiratory and cardiovascular (CV) function C) Growth and development D) Renal and hepatic function

Ans: A Feedback: Children prescribed dantrolene should be routinely and regularly screened for central nervous system and gastrointestinal (including hepatic) toxicity. Growth and development should be routinely screened in all children. Renal, respiratory, and CV screening is not indicated.

A patient scheduled for surgery is to have a nondepolarizing neuromuscular junction (NMJ) blocker as adjunctive anesthesia. The nurse will have cause for concern about prolonged paralysis if the patient has been taking what medication? Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 454 A) An aminoglycoside B) Aminophylline C) A barbiturate anesthetic D) A cephalosporin .

Ans: A Feedback: Combining nondepolarizing NMJ blockers with aminoglycosides can result in prolonged paralysis, and this combination should be avoided. This interaction does not occur with barbiturate anesthetics, cephalosporins, or aminophylline

A patient has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases? A) Dantrolene (Dantrium) B) Baclofen (Lioresal) C) Carisoprodol (Soma) D) Botulinum toxin type B (Myobloc)

Ans: A Feedback: Dantrolene directly affects peripheral muscle contraction, and has become important in the management of spasticity associated with neuromuscular diseases. Baclofen, carisoprodol, and botulinum toxin type B are not the drugs of choice for management of spasticity in neuromuscular disease.

A patient with severe spasticity sees his physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated? A) Spasticity that contributes to upright position B) Spasticity that involves both legs C) Spasticity that involves the arm and the leg on the same side D) Spasticity that contributes to mobility

Ans: A Feedback: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease, which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. The other options would not contraindicate the medication.

What is the main purpose of the drugs used to treat Parkinson's disease? A) Adjust the balance of neurotransmitters. B) Make the catechol-O-methyltransferase (COMT) inhibitors work better. C) Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists. D) Increase the actions of acetylcholine in the brain.

Ans: A Feedback: Drugs used in Parkinson's disease increase levels of dopamine (levodopa, dopamine agonists, monoamine oxidase [MAO] inhibitors, COMT inhibitors) or inhibit the actions of acetylcholine (i.e., anticholinergic agents) in the brain. Thus, the drugs help adjust the balance of neurotransmitters

How can the nurse assess the degree of neuromuscular blockage the patient is experiencing? A) Peripheral nerve stimulator B) Measure vital signs C) Assess response to painful stimuli D) Test reflexes

Ans: A Feedback: Have a peripheral nerve stimulator on standby to assess the degree of neuromuscular blockade, if appropriate. Vital signs can indicate degree of sedation and assess pain sensation, but they are not an indicator of the degree of neuromuscular blockade. Response to painful stimuli would be more of an indication of effects of sedation and/or analgesic than degree of muscular blockade. Any neuromuscular junction blockage would reduce or eliminate reflexes so it would not be a means of assessing degree of blockage.

When evaluating the effects of narcotic agonist-antagonists on a patient, what adverse effects would the nurse monitor for? A) Hypertension B) Bleeding C) Suppressed bone marrow function D) Increased pulse pressure .

Ans: A Feedback: Monitor for adverse effects (e.g., central nervous system changes, gastrointestinal (GI) depression, respiratory depression, arrhythmias, hypertension). Bleeding, bone marrow suppression, and increased pulse pressure are not normally seen with these drugs

As the nurse settles the patient into his room after returning from the post-anesthesia care unit (PACU), the patient says he is in severe pain. The nurse checks the medical record and sees the patient has an order for morphine 4 to 8 mg every 1 to 2 hour IV as needed for pain. The nurse sees this medication has not been administered yet so the nurse administers 4 mg. After administering the drug, the PACU nurse calls to say a dose of morphine was given and not documented. What drug will the nurse be prepared to administer if the patient's respiratory rate is depressed? A) Naloxone hydrochloride tartrate (Narcan) B) Butorphanol C) Buprenorphine (Buprenex) D) Nalbuphine hydrochloride (Nubain)

Ans: A Feedback: Naloxone is the drug of choice for treatment of opioid overdose. Butorphanol (INN) is amorphinantype synthetic opioid analgesic that would not reverse the effects of an opioid. Buprenex (buprenorphine hydrochloride) is a narcotic-agonist-antagonist and would suppress respirations further. Nalbuphine is a synthetic opioid used commercially as an analgesic that would also depress respirations.

The nurse receives an order for morphine sulfate 8 mg IV every 1 hour as needed for pain. For which Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 426 patient would the nurse need to question this order? A) A 78-year-old with osteoarthritis B) A 45-year-old, 1-day postoperative mastectomy C) A 28-year-old with a fractured tibia D) A 17-year-old, 1-day postoperative appendectomy

Ans: A Feedback: Older patients are more likely to experience the adverse effects associated with narcotics, including central nervous system, gastrointestinal, and cardiovascular effects. Furthermore, a strong narcotic analgesic would not be indicated for chronic osteoarthritis pain. For both of these reasons, the nurse would question the large dosage of a narcotic. The other patients could appropriately receive morphine 8 mg unless they were smaller than average adults.

After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm? A) Rest of the affected muscle B) Application of cold C) Physical therapy D) Order of a nonsteroidal anti-inflammatory drug

Ans: A Feedback: Other measures in addition to drugs should be used to alleviate muscle spasm and pain. The nurse can independently encourage rest of the affected muscle and provide heat applications to increase blood flow to the area to remove the pain-causing chemicals.

Why will the nurse administer a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine? A) To reduce discomfort of depolarization of muscles B) To reduce the risk of malignant hyperthermia C) To reduce negative effects of dantrolene D) To increase the duration of effect for succinylcholine

Ans: A Feedback: Succinylcholine is associated with muscle pain related to the initial muscle contraction reaction. A nondepolarizing NMJ blocker may be given first to prevent some of these contractions and the associated discomfort. Administering a small dose of nondepolarizing NMJ blocker will not reduce the risk of malignant hyperthermia or increase the duration of effects. Dantrolene is a drug given to treat malignant hyperthermia.

The nursing instructor asks the student nurse to explain the action of sumatriptan. What is the student's best response? A) Vasoconstrictive on cranial blood vessels B) Depresses pain response in the central nervous system C) Vasodilation of peripheral blood vessels D) Binds to acetylcholine receptors to prevent nerve transmission

Ans: A Feedback: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. The other options are incorrect.

A patient is brought to the emergency department in the midst of an active clonic​tonic seizure. What is the most appropriate antiseizure drug for the nurse to administer intravenously to terminate acute convulsive seizures? A) Diazepam (Valium) B) Phenytoin (Dilantin) C) Ethosuximide (Zarontin) D) Gabapentin (Neurontin)

Ans: A Feedback: The drug of choice for acute seizures is intravenous benzodiazepine, usually diazepam. Phenytoin is administered to control and prevent seizures but is not the drug of choice to stop an active seizure. Gabapentin and ethosuximide are administered for partial seizures.

A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should the instructor respond? A) ​Succinylcholine is not broken down instantly.​ B) ​It results in a prolonged contraction of the muscle.​ C) ​The muscle becomes hyper stimulated by succinylcholine.​ D) Succinylcholine's duration of action is about 2 hours.​

Ans: A Feedback: Unlike endogenous ACh, succinylcholine is not broken down instantly. Succinylcholine, a depolarizing NMJ blocker, attaches to the ACh-receptor site on the muscle cell, causing a prolonged depolarization of the muscle. This depolarization causes stimulation of the muscle and muscle contraction (seen as twitching) and then as flaccid paralysis, so the contraction of the muscle is not prolonged and the muscle is incapable of being stimulated. The duration of effects of succinylcholine is 4 to 6 minutes and not 2 hours.

How does the drug levodopa contrast with dopamine? (Select all that apply.) A) Levodopa is a precursor of dopamine. B) Levodopa crosses the blood​brain barrier. C) Levodopa is converted to dopamine. D) Levodopa is effective for 8 to 10 years. E) Dopamine returns to levodopa for metabolism.

Ans: A, B, C Feedback: Levodopa is a precursor of dopamine, which is deficient in parkinsonism; it crosses the blood​brain barrier, where it is converted to dopamine and acts as a replacement neurotransmitter; it is effective for 2 to 5 years in relieving the symptoms of Parkinson's disease.

The patient is brought to the emergency department in respiratory arrest after overdosing on heroin. The person accompanying the patient says he has been using heroin for years. After being administered one dose of a narcotic antagonist, the patient begins to breathe spontaneously but remains nonresponsive to stimuli so another dose of narcotic antagonist is ordered. What symptoms would indicate the patient is experiencing acute narcotic abstinence syndrome? (Select all that apply.) A) Tachycardia B) Hypertension C) Vomiting D) Confusion E) Sedation

Ans: A, B, C Feedback: The most common adverse effect is an acute narcotic abstinence syndrome that is characterized by nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, and feelings of anxiety. Confusion and sedation are not associated with acute narcotic abstinence syndrome.

The nurse is caring for a patient who is having a pump placed to deliver intrathecal baclofen and another patient who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? (Select all that apply.) A) Acute pain related to GI effects of drug B) Risk for injury related to central nervous system (CNS) effects C) Disturbed body image related to muscle pain D) Disturbed thought processes related to CNS effects E) Deficient knowledge related to procedure

Ans: A, B, D Feedback: Acute pain related to GI effects of drug, risk for injury related to CNS effects, and disturbed thought processes related to CNS effects all apply to both patients. Disturbed body image may apply to the patient having the pump placed, but this is not related to muscle pain. Only the patient having the pump placed would need information related to the procedure.

The nurse, working in the preoperative holding area, is caring for a 70-year-old patient who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what condition would require the nurse to notify the anesthesiologist of the need for caution? A) Bone fracture B) Malnutrition C) Fluid volume overload D) Narrow-angle glaucoma E) Pregnancy .

Ans: A, B, D Feedback: Succinylcholine should be used with caution in patients with fractures because the muscle contractions it causes might lead to additional trauma; in patients with narrow-angle glaucoma or penetrating eye injuries because intraocular pressure increases. Extreme caution is necessary in the presence of genetic or disease-related conditions causing low plasma cholinesterase levels (e.g., cirrhosis, metabolic disorders, carcinoma, burns, dehydration, malnutrition, hyperpyrexia, thyroid toxicosis, collagen diseases, exposure to neurotoxic insecticides)

What are the primary uses of neuromuscular junction blockers (NMJ) blockers? (Select all that apply.) A) To facilitate endotracheal intubation B) To sedate patient for general anesthesia C) To prevent injury during electroconvulsive therapy D) To provide greater ease in extubating patient E) To facilitate mechanical ventilation

Ans: A, C, E Feedback: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate the patient who will be paralyzed after administration but will remain alert unless another medication is given. These medications would not be given before extubation because respiratory muscles would be paralyzed, resulting in the inability to breathe.

Narcotic agonists-antagonists have what function? (Select all that apply.) A) Relief of moderate-to-severe pain B) Adjunctive therapies to nonsteroidal anti-inflammatory drugs (NSAIDs) C) Relief of pain during labor and delivery D) Relief of orthopedic pain E) Adjuncts to general anesthesia

Ans: A, C, E Feedback: These drugs have three functions: (1) relief of moderate-to-severe pain, (2) adjuncts to general anesthesia, and (3) relief of pain during labor and delivery. Adjunctive therapies to NSAIDs or specificity for orthopedic pain are not functions of this classification of medication

The pharmacology instructor is discussing nondepolarizing neuromuscular junction blockers (NMJ) blockers with the nursing class. How would the instructor explain the action of nondepolarizing NMJ blockers? A) Blocks acetylcholine (ACh) from acting B) Acts like ACh then prevents repolarization C) Takes the place of ACh in the depolarizing/repolarizing process D) Stops depolarization in the axion

Ans: B Feedback: Depolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation. Options A, C, and D are incorrect

The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be administered by what method? A) Topical Administration B) Infiltration C) Field block D) Nerve block

Ans: B Feedback: Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2-inch laceration.

The nurse is teaching a new patient about levodopa (L-dopa). What is important to instruct the patient to avoid using concurrently with L-dopa? A) Aspirin compounds B) Multivitamin-mineral preparations C) Alcohol D) Antianginal agents

Ans: B Feedback: Iron preparations and multivitamin​mineral preparations containing iron should not be given with Ldopa. Aspirin compounds, alcohol, and antianginal agents are not contraindicated in concurrent therapy with L-dopa.

The nurse is caring for a patient taking dantrolene. How would the nurse assess the therapeutic effects of this drug? A) Observe the patient when emotionally stressed to assess for exacerbation of spasticity. B) Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity. C) Measure the amount of spasticity before and after administration of medication. D) Collect a thorough history to ask the patient any improvement has been noticed.

Ans: B Feedback: Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and justifies continued use of the drug. It would not be ethical to stress the patient, there is no known measurement of spasticity, and the patient may not be able to relate how much improvement was felt because it is unlikely all spasticity will be eliminated.

The nurse is caring for a very anxious 33-year-old female patient scheduled for abdominal surgery today. The patient says the anesthesiologist said she would receive succinylcholine (Anectine) during surgery and asks the nurse how long it will take before the medicine starts to work. What is the nurse's best response? A) 1 to 2 minutes B) 30 to 60 seconds C) 5 to 10 minutes D) 30 minutes

Ans: B Feedback: Succinylcholine has an onset of action of 30 to 60 seconds. The other options are incorrect

The postanesthesia care unit (PACU) nurse is caring for a patient that had succinylcholine (Anectine) as an adjunct to anesthesia. What is the nurse's priority assessment while caring for this patient? A) Movement B) Temperature C) Mental status D) Heart rate

Ans: B Feedback: Succinylcholine is more likely to cause malignant hyperthermia than other drugs so it is very important that the nurse carefully monitor the patient's temperature while in the PACU. Movement, mental status, and heart rate monitoring are all routine components of PACU care, but after receiving this medication, temperature monitoring becomes the priority.

The student asks the physiology instructor where the motor neuron communicates with a skeletal muscle fiber. What would the instructor respond? A) Synapse B) Neuromuscular junction C) Synaptic cleft D) Afferent junction

Ans: B Feedback: The neuromuscular junction (NMJ) simply is the point at which a motor neuron communicates with a skeletal muscle fiber. The synapse and synaptic cleft are part of the NMJ. The afferent junction is a distracter for this question.

The nurse is caring for a patient who is receiving an opioid analgesic. What are the nurse's priority assessments? A) Pain intensity and blood glucose level B) Level of consciousness and respiratory rate C) Respiratory rate and electrolytes D) Urine output and pain intensity

Ans: B Feedback: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

The nurse evaluates the patient's serum phenytoin (Dilantin) level and determines the level is therapeutic when it is within what range? A) Between 5 and 12 mcg/mL B) Between 10 and 20 mcg/mL C) Between 15 and 50 mcg/mL D) Between 40 and 100 mcg/mL

Ans: B Feedback: The therapeutic serum level range for phenytoin is between 10 and 20 mcg/mL. The other options are incorrect.

Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.) A) Coronary artery disease B) Hypotension C) Urinary frequency D) Dizziness E) Bone marrow suppression

Ans: B, C, D Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow suppression and coronary artery disease are not associated with therapy involving these drugs

Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.) A) Coronary artery disease B) Hypotension C) Urinary frequency D) Dizziness E) Bone marrow suppression

Ans: B, C, D Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow suppression and coronary artery disease are not associated with therapy involving these drugs.

When caring for a patient taking dantrolene, what adverse effects would the nurse monitor for? (Select all that apply.) A) Bradycardia B) Hepatitis C) Urinary retention D) Fatigue E) Rash

Ans: B, D, E Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention

When caring for a patient taking dantrolene, what adverse effects would the nurse monitor for? (Select all that apply.) A) Bradycardia B) Hepatitis C) Urinary retention D) Fatigue E) Rash

Ans: B, D, E Feedback: Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention.

The certified registered nurse anesthetist documents the anesthesia plan as using a depolarizing neuromuscular junction (NMJ) blocker as adjunct to other anesthetics on the patient when they go to surgery. The nurse would understand from this note that the patient will receive what drug? A) Rocuronium (Zemuron) B) Pancuronium (Pavulon) C) Succinylcholine (Anectine, Quelicin) D) Cisatracurium (Nimbex) .

Ans: C Feedback: Currently the only agent classified as a depolarizing NMJ blocker is succinylcholine. rocuronium, pancuronium, and cisatracurium are all nondepolarizing NMJ blockers

A very anxious patient asks the nurse what type of anesthesia they will have for a scheduled tooth extraction. The nurse would describe what type of local anesthetic in laymen's terms? A) Topical B) Infiltration C) Field block D) Nerve block

Ans: C Feedback: Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery.

When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa must be reduced. What would the reduction of L-dopa cause? A) Heightened levels of sedation B) Prolonged effect of medications C) Decreased adverse effects D) Decreased effectiveness of symptom control

Ans: C Feedback: Because carbidopa decreases the amount of L-dopa needed to reach a therapeutic level in the brain, the dosage of L-dopa can be decreased, which reduces the incidence of adverse effects. Other options are incorrect.

A patient, 6 days postoperative, is being weaned off an opioid analgesic. The patient reports he is getting no relief from the pain with the new non-opioid medication he is receiving. What might the nurse suspect is causing this patient's pain? A) The patient needs a higher dose of the opioid analgesic. B) The patient has become addicted to the opioid medication. C) The patient has developed withdrawal syndrome. D) The patient has developed a cross-hypersensitive reaction.

Ans: C Feedback: Caution should be used in cases of physical dependence on a narcotic because a withdrawal syndrome may be precipitated, the narcotic antagonistic properties can block the analgesic effect, and so intensify the pain. It is important to differentiate between addiction and dependence because addiction generally does not occur in patients receiving narcotics for medical reasons. There is no indication of a hypersensitivity reaction. Giving a higher dose of the opioid would eliminate the progress made to date on weaning the patient from the narcotic, so attempts should be made to avoid this intervention.

1. Degeneration in neurons that release a neurotransmitter leads to Parkinson's disease. What neurotransmitter is involved? A) Gamma-aminobutyric acid (GABA) B) Acetylcholine C) Dopamine D) Serotonin

Ans: C Feedback: Degeneration of dopamine-releasing neurons in the substantia nigra leads to Parkinson's disease. When dopamine is decreased in the area of the corpus striatum, a chemical imbalance allows the cholinergic or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and cerebellar components of the extrapyramidal motor system. This system provides coordination for unconscious muscle movements, including those that control position, posture, and movement. The result of the imbalance produces the signs and symptoms of Parkinson's disease. The corpus striatum in the brain is connected to the substantia nigra by a series of neurons that use the inhibitory neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of the corpus striatum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is not involved in these functions.

Richard, 15 years old, has been diagnosed with epilepsy. He is to be sent home on oral phenytoin 100 mg b.i.d. What statement by Richard's mother leads the nurse to believe she has understood drug teaching? Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 377 A) ​I will make sure he takes the medication on an empty stomach.​ B) ​I will stop the drug immediately if any side effects occur.​ C) ​I will make sure he has routine visits to the dentist.​ D) ​I will weigh him daily and feed him a high-calorie diet.​

Ans: C Feedback: Gingival hyperplasia is common in patients, especially children, who take phenytoin, which makes regular dentist visits important to oral health. Taking the medication on a full stomach or with meals reduces gastrointestinal (GI) adverse effects. The mother should call the health care provider if adverse effects are noted and needs to understand the risks associated with abrupt withdrawal of the medication. Daily weight taking and high-calorie diets are not associated with phenytoin administration.

The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from dantrolene (Dantrium)? A) An 87-year-old man who is taking a cardiac glycosideh B) A 32-year-old man who is taking an antipsychotic drug C) A 65-year-old woman who is on hormone replacement therapy D) A 48-year-old woman who is taking an antihypertensive agent

Ans: C Feedback: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that patients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

The nurse is providing patient teaching about a prescribed opioid analgesic. What is an important teaching point related to a possible adverse effect of this drug? A) Ataxia B) Blurred vision C) Hypotension D) Dysrhythmias

Ans: C Feedback: Orthostatic hypotension is commonly seen in association with some narcotics. Ataxia, blurred vision, and dysrhythmias are not commonly seen adverse effects of an opioid analgesic.

While providing patient education for a patient newly diagnosed with Parkinson's disease and his or her family, the nurse will explain that Parkinson's disease is characterized by what? A) Reduced cognitive function B) Abnormalities in stature C) Postural instability D) Reduced nerve transmission

Ans: C Feedback: Parkinson's disease is a chronic, progressive, and degenerative disorder of the central nervous system (CNS) characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).

A patient is admitted to the emergency department with severe recurrent convulsive seizures. What drug would the nurse expect to be ordered for use in emergency control of status epilepticus? A) Phenytoin (Dilantin) B) Diazepam (Valium) C) Phenobarbital (Luminal) D) Ethosuximide (Zarontin)

Ans: C Feedback: Phenobarbital is used for emergency control of status epilepticus. This barbiturate inhibits impulse conduction in the ascending reticular activating system (RAS), depresses the cerebral cortex, alters cerebellar function, and depresses motor nerve output. Phenobarbital stabilizes nerve membranes throughout the central nervous system (CNS) directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, it reduces the tonic​clonic, muscular, and emotional responses to stimulation. Phenobarbital depresses conduction in the lower brainstem and the cerebral cortex and depresses motor conduction. Phenytoin is used to prevent status epilepticus but is not used to stop seizures after they have started; diazepam is used for short-term treatment of status epilepticus. Ethosuximide is used for absence seizures.

During what stage of anesthesia would the nurse see the patient's skeletal muscles relax and return of regular respirations? A) Stage 1: Analgesia stage B) Stage 2: Excitement stage C) Stage 3: Surgical anesthesia stage D) Stage 4: Medullary paralysis

Ans: C Feedback: Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.

What drug would the nurse expect to administer to the patient experiencing malignant hyperthermia? A) Orphenadrine B) Metaxalone C) Chlorzoxazone D) Dantrolene

Ans: D Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible patients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.

The nurse is administering morphine to a trauma patient for acute pain. Before administering the morphine, what common adverse effect should the nurse inform the patient about? A) Paresthesia in lower extremities B) Occipital headache C) Increased intracranial pressure D) Drowsiness

Ans: D Feedback: Common adverse effects include dizziness, drowsiness, and visual changes. Morphine does not commonly cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.

The nurse is caring for a patient who is receiving pancuronium (Pavulon) to facilitate mechanical Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 458 ventilation. The patient is also receiving a barbiturate. How will the nurse administer these two medications? A) They can be mixed and given in the same syringe. B) Administer IM quickly after mixing the two drugs. C) Shake vigorously when mixed in one syringe. D) If given together, a precipitate may form.

Ans: D Feedback: Do not mix this drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use. Pancuronium is only given IV. Shaking does not prevent precipitation

What drug would the nurse expect to administer to the patient experiencing malignant hyperthermia? A) Orphenadrine B) Metaxalone C) Chlorzoxazone D) Dantrolene

Ans: D Feedback: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible patients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.

A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia? A) Induction B) Maintenance C) Recovery D) Medullary paralysis

Ans: D Feedback: Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the patient is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C is a distracter.

A mother brings her 9-year-old son to the clinic for a routine check up. The 9-year-old boy has cerebral palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What is the nurse's best response? A) ​Your son's spasticity is caused by injury to the muscle tissue.​ B) ​Your son's spasticity is caused by deficiency of a neurotransmitter called serotonin.​ C) ​Your son's spasticity is caused by damaged sensory neurons.​ D) ​Your son's spasticity is caused by damaged motor neurons.​

Ans: D Feedback: Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. Although acetylcholine is released and increases muscle cell membrane permeability to sodium, which eventually leads to the release of calcium, this process does play a vital part in muscle contraction and relaxation

A geriatric patient received a narcotic analgesic before leaving the post-anesthesia care unit to return to the regular unit. What is the priority nursing action for the nurse receiving the patient on the regular unit? A) Administer a non-steroidal anti-inflammatory drug. B) Encourage fluids. C) Create a restful, dark, quiet environment. D) Put side rails up and place bed in low position.

Ans: D Feedback: Older patients are more susceptible to the central nervous system effects of narcotics; it is important to ensure their safety by using side rails and placing the bed in the low position in case the patient tries to get up unaided. Postoperative patients are allowed nothing by mouth until bowel function returns so an oral medication or encouraging fluids would not be appropriate. This patient will require careful observation for respiratory depression, so a dark room would be unsafe.

To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used? A) Antihistamines B) Antiemetics C) Narcotics D) Sedative-hypnotics

Ans: D Feedback: Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic and sedative effects.

The nurse receives an order for a triptan for a patient diagnosed with cluster headaches. What drug Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 421 would be indicated for this purpose? A) Almotriptan (Axert) B) Frovatriptan (Frova) C) Naratriptan (Amerge) D) Sumatriptan (Imitrex)

Ans: D Feedback: Sumatriptan, the first drug of this class, is used for the treatment of acute migraine attacks and for the treatment of cluster headaches in adults. No other triptans are approved for treatment of cluster headaches.

The nurse is teaching a group of student nurses about Parkinson's disease. The nurse would determine teaching was successful if the students identified what neurotransmitters as imbalanced in Parkinson's disease? A) Cholinergic and anticholinergic neurotransmitters B) Gamma-aminobutyric acid (GABA) and dopamine C) GABA and anticholinergic neurotransmitters D) Dopamine and acetylcholine

Ans: D Feedback: The correct balance of dopamine and acetylcholine is important in regulating posture, muscle tone, and voluntary movement. People with Parkinson's disease have an imbalance in these neurotransmitters, resulting in a decrease in inhibitory brain dopamine and a relative increase in excitatory acetylcholine.

A home health nurse is visiting an elderly patient with Parkinson's disease. What would the nurse assess this man for related to common adverse effects? A) Blood dyscrasias B) Increased dopamine activity C) Pliability D) Urinary retention

Ans: D Feedback: The nurse would assess the patient for urinary retention because this reaction is caused by loss of muscle tone in the bladder and is most likely to occur in elderly men who have enlarged prostate glands. Parkinson's does not generally cause blood dyscrasias. The nurse cannot assess for increased dopamine activity except to assess for reduced symptoms caused by medication therapy. Pliability is a distracter for this question.

The nurse is assessing a patient who was prescribed levodopa 1 week earlier. How might the nurse evaluate the effectiveness of drug therapy? A) Stable mood B) Psoriasis C) Drug​drug interactions with dopaminergic agents D) Improvement in handwriting

Ans: D Feedback: The nurse would evaluate the patient for improvement in function and reduction in symptoms. With preparations containing levodopa and with dopaminergic agents, assess for improvement in mobility, balance, posture, gait, speech, handwriting, and ability to provide self-care. Drooling and seborrhea may be abolished, and mood may be elevated. Stable mood and psoriasis are not findings associated with Parkinson's disease. Assessing for drug​drug interactions is an important nursing assessment but it is not related to evaluating effectiveness of the drug.

The nurse is caring for a patient receiving intrathecal baclofen via pump while participating in rigorous rehabilitation therapy. What is the nurse's priority to monitor related to adverse effects of this drug? A) Blood pressure B) Pulse pressure C) Spasticity D) Respiratory status

Ans: D Feedback: The priority to monitor is respiratory status. One of the primary adverse effects of this drug is central nervous system (CNS) depression. If the patient receives too much medication, or reaches toxic levels, respiratory rate will decline as the result of excessive CNS depression and the drug dosage will either be adjusted downward or the drug may be held until the patient's respirations improve. Monitoring other vital signs including blood pressure and pulse is indicated but is not the priority

The nurse is caring for a patient receiving intrathecal baclofen via pump while participating in rigorous rehabilitation therapy. What is the nurse's priority to monitor related to adverse effects of this drug? A) Blood pressure B) Pulse pressure C) Spasticity D) Respiratory status

Ans: D Feedback: The priority to monitor is respiratory status. One of the primary adverse effects of this drug is central nervous system (CNS) depression. If the patient receives too much medication, or reaches toxic levels, respiratory rate will decline as the result of excessive CNS depression and the drug dosage will either be adjusted downward or the drug may be held until the patient's respirations improve. Monitoring other vital signs including blood pressure and pulse is indicated but is not the priority.

The home care nurse administers oral morphine to the patient with cancer pain. When will the nurse expect this medication to reach peak activity? A) 10 minutes B) 30 minutes C) 45 minutes D) 60 minutes

Ans: D Feedback: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

The nurse is ordered to administer diazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby?* A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B. Flumazenil

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?* A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. Initiate seizure precautions

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to?* A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Lay the patient down on their side with a pillow underneath the head.

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure?* A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. Absence

What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)? A)Check the client's pulse and blood pressure. B)Administer pain medication. C)Ensure the client has adequate respirations. D)Position the client on his side to prevent aspiration of vomitus.

Ensure the client has adequate respirations

A client is prescribed Ethosuximiden. The nurse should expect to administer this drug by which route? A)Rectal B)Intramuscular C)Oral D)Intravenous

Oral

The nurse is aware that midazolam is administered prior to surgery for what reason? A)To prevent hyperthermia B)To prevent respiratory depression C)To produce analgesia D)To produce amnesia

To produce amnesia