ANS Pharm Exam

116) A 65-year-old client is receiving amitriptyline. Which recommendation will the nurse make to the client concerning this medication? 'Obtain a complete cholesterol and lipid profile.' 'Have an eye examination to check for glaucoma.' 'Check your temperature daily for nighttime increases.' 'Watch for excessive sweating and possible weight loss.'

'Have an eye examination to check for glaucoma.' Rationale: In addition to baseline laboratory tests, an older adult should have an eye examination with glaucoma testing when taking amitriptyline. It causes dilation of the pupil (mydriasis), which interferes with drainage of aqueous humor through the canal of Schlemm. Interfering with the outflow of aqueous humor will increase intraocular pressure and may cause a progressive loss of vision in clients with glaucoma. Amitriptyline does not affect cholesterol production or temperature regulation. It does not cause excessive sweating or weight loss, but it can increase appetite especially for sweets, resulting in weight gain.

7) To which nursing home resident could a nurse safely administer tricyclic antidepressants without questioning the health care provider's order? A A client with mild hypertension B A client with narrow-angle glaucoma C A client with coronary artery disease (CAD) D A client with benign prostatic hypertrophy (BPH)

A A client with mild hypertension Rationale: Tricyclics can be safely administered to the hypertensive client. The expected anticholinergic effects of tricyclic antidepressants include difficulty in urination, which is why TCAs are contraindicated with BPH. TCAs are also contraindicated in narrow-angle glaucoma (they can cause elevated pressure in the eyes) and for certain heart abnormalities.

820) When a client exhibits severe bradycardia, which type of medication will the nurse be prepared to administer? Nitrate Anticholinergic Antihypertensive Cardiac glycoside

Anticholinergic Rationale: An anticholinergic medication will block parasympathetic effects, causing an increased heart rate. Nitrates will decrease preload, not increase the heart rate. Antihypertensive medications will lower the blood pressure and may decrease the heart rate. Cardiac glycoside will improve cardiac contractility but will decrease the heart rate.

799) A client suspected of having myasthenia gravis is scheduled for an edrophonium chloride test. To treat a common complication associated with the test, the nurse will have which medication available? Atropine Phenytoin Neostigmine Diphenhydramine

Atropine Rationale: Atropine, an anticholinergic, should always be available to treat a cholinergic crisis (sudden, severe episode of muscle weakness that affects breathing and swallowing) should the edrophonium chloride test trigger this response. Phenytoin is an anticonvulsant that will not avert or treat complications resulting from an edrophonium test. Neostigmine is a cholinergic that has the same action as edrophonium chloride; it is contraindicated if a cholinergic crisis occurs. Diphenhydramine is an antihistamine that will not avert complications or effectively treat a cholinergic crisis.

46. A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? A. Progressive difficulty with swallowing. B. Decreased respiratory effort. C. Improvement in generalized fatigue. D. Decreased muscle weakness.

C. Improvement in generalized fatigue. Rationale: Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort.

1052) A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms. Recently, the client has begun experiencing increased difficulty in swallowing. Which nursing action is effective in preventing aspiration of food? Place a tracheostomy set in the client's room. Assess respiratory status after meals. Request for the diet to be changed from soft to clear liquids. Coordinate mealtimes with the peak effect of the medication.

Coordinate mealtimes with the peak effect of the medication. Rationale: Dysphagia should be minimized during peak effect of pyridostigmine bromide, thereby decreasing the probability of aspiration. A tracheostomy set is a treatment for, rather than equipment to prevent, aspiration. Although it is vital that the client's respiratory function be monitored, assessing the client's respiratory status will not prevent aspiration. There are insufficient data to determine whether changing the diet from soft foods to clear liquids is appropriate; also, liquids are aspirated more easily than semisolids.

7: The nurse is caring for a client who has been prescribed atropine preoperatively. The nurse understands the intended purpose for administering this preoperatively is to induce which effect? A Reduce heart rate B Elevate blood pressure C Enhance sedation D Decrease secretions

D Decrease secretions Rationale: Atropine is a common anesthesia adjunct. It decreases the amount of secretions which, in turn, decreases the risk of aspiration during the operative procedure.

92) An 80-year-old client with depression requires the prescription of antidepressant medication. Which tricyclic antidepressant medication causes fewer complications in older clients? Doxepin Amoxapine Nortriptyline Trimipramine

Nortriptyline Rationale: Nortriptyline and desipramine are preferred for use in older adults because these antidepressant medications have less anticholinergic activity. Doxepin, amoxapine, and trimipramine have more cholinergic activity than nortriptyline and are not the preferred medications for older adult clients.

358) Which statement accurately describes nortriptyline? Select all that apply. One, some, or all responses may be correct. Overdosage is often lethal. Constipation and urinary retention may occur. It is a selective serotonin reuptake inhibitor (SSRI). Weight gain is a common side effect. It increases effectiveness of monoamine oxidase inhibitors (MAOIs).

Overdosage is often lethal. Constipation and urinary retention may occur. Weight gain is a common side effect. Rationale: Nortriptyline is notoriously lethal; between 70% and 80% of people who die from overdose do so before reaching the hospital. Nortriptyline can cause constipation and urinary retention because it causes blockage of cholinergic receptors, and it tends to increase appetite and cause weight gain. Nortriptyline is not an SSRI; it is a tricyclic antidepressant and affects the balance of neurotransmitters in the brain. The interaction between nortriptyline and MAOIs is severe and possibly fatal.

638) A client with myasthenia gravis begins taking pyridostigmine. Two days later, the client develops loose stools and increased salivation. Which conclusion would the nurse make about these new developments? The client is experiencing a myasthenic crisis. The medication is causing cholinergic side effects. The medication is triggering a paradoxical reaction. The client is exhibiting toxic effects of the medication.

The medication is causing cholinergic side effects. Rationale: Because this medication inhibits the destruction of acetylcholine, parasympathetic activity may increase, resulting in cholinergic side effects such as diarrhea and increased salivation. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, a weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary and not paradoxical; they continue as long as the medication is continued. The dosage may be adjusted or an anticholinergic may be given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration.

668) The health care provider prescribes a cholinergic medication to treat a client's urinary problem. Which effect would the nurse anticipate? Urinary frequency decreases. Urinary retention is prevented. Pain is controlled. Urinary urgency decreases.

Urinary retention is prevented. Feed, breed, pee, poo Rationale: Cholinergics intensify and prolong the action of acetylcholine, which increases tone in the genitourinary tract, preventing urinary retention. Cholinergic antagonists are prescribed for frequency and urgency associated with a spastic bladder; therefore cholinergics would worsen rather than decrease these problems. Cholinergic do not have analgesic effects.

744) Cholinergic agonists are prescribed for which type of urinary condition? Kidney stones Urine retention Spastic bladder Urinary tract infections

Urine retention Rationale: Cholinergics intensify and prolong the action of acetylcholine, which increases the tone in the genitourinary tract, preventing urinary retention. Cholinergics will not prevent renal calculi. Anticholinergics, not cholinergic agonists, are prescribed for the frequency and urgency associated with a spastic bladder. Preventing urinary tract infections is a secondary gain because cholinergics help prevent urinary retention that can lead to a urinary tract infection, but this is not the purpose for administering these medications.

802) Pyridostigmine bromide is prescribed for a client with myasthenia gravis. The nurse evaluates that the medication regimen is understood when the client makes which statement? 'I will take the medication on an empty stomach.' 'I need to set an alarm so I take the medication on time.' 'It will be important to check my heart rate before taking the medication.' 'I should monitor for an increase in blood pressure after taking the medication.'

'I need to set an alarm so I take the medication on time.' Rationale: Pyridostigmine is a vital medication that must be taken on time; a missed or late dose can result in severe respiratory and neuromuscular consequences or even death. Pyridostigmine should be taken with a small amount of food to prevent gastric irritation. It is unnecessary to take the pulse rate before taking pyridostigmine. Pyridostigmine may cause hypotension, not hypertension, which is a sign of cholinergic crisis.

773) The health care provider prescribes neostigmine for a client with myasthenia gravis. Which client statement indicates understanding regarding medication management plans? 'I must keep the medication in a container in the refrigerator.' 'I should take the medication at the exact time that is listed on the prescription.' 'I will plan to take the medication between meals.' 'I expect that the onset of the medication's action will occur several hours after I take it.'

'I will plan to take the medication between meals.' Rationale: Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation; usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs 45 to 75 minutes after administration; the duration of its action is 2.5 to 4 hours.

478) Which instruction would the nurse give to clients prescribed psychotropic medications who are experiencing anticholinergic-like side effects? 'Restrict fluid intake.' 'Eat a diet high in carbohydrates.' 'Suck on sugar-free hard candies.' 'Avoid products that contain aspirin.'

'Suck on sugar-free hard candies.' Rationale: Hard candy may produce salivation, which helps alleviate the anticholinergic-like side effect of dry mouth that is experienced with some psychotropics. Dry mouth increases the risk for cavities; candy with sugar adds to this risk. Fluids should be encouraged, not discouraged; fluids may alleviate dry mouth. Eating a diet high in carbohydrates and avoiding aspirin are unnecessary. Think: atropine. anti-cholinergic

68) Nortriptyline is prescribed for a depressed client. Which time period identifies when the nurse would expect a therapeutic response? 1 to 3 days 12 to 24 hours 30 minutes to 2 hours 2 to 3 weeks

2 to 3 weeks

1156) A client with myasthenia gravis has been receiving neostigmine and asks about its action. Which information would the nurse consider when formulating a response? Stimulates the cerebral cortex Blocks the action of cholinesterase Replaces deficient neurotransmitters Accelerates transmission along neural sheaths

Blocks the action of cholinesterase Rationale: Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex. Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

19) The nurse in a urology office is developing a plan of care for a client newly diagnosed with urge urinary incontinence due to an overactive bladder. Which interventions should the nurse include? A Administer anti-seizure medications B Administration of cholinergic drugs C Administration of anticholinergic drugs D Administration of loop diuretics

C Administration of anticholinergic drugs Rationale: Incontinence is an involuntary loss of urine severe enough to cause social or hygienic problems. It is not a normal consequence of aging or childbirth and can have several possible causes and can be either temporary or chronic. Urge incontinence is often referred to as overactive bladder (OAB). Nocturnal frequency and incontinence are common with OAB. Interventions include treatment with drugs that relax the smooth muscle and increase the bladder's capacity including anticholinergics, not anti-seizure, loop diuretics or cholinergic drugs.

6) The nurse is teaching a client diagnosed with depression about a new prescription of nortriptyline. What information would be essential for the nurse to emphasize about this medication? A Episodes of diarrhea can be expected B The medication must be stored in the refrigerator C The use of alcohol should be avoided D Symptom relief occurs in a few days

C The use of alcohol should be avoided Rationale: Nortriptyline is a tricyclic antidepressant used to manage chronic neurogenic pain and depression. Adverse reactions include central nervous system (CNS) side effects such as suicidal thoughts, drowsiness, fatigue, lethargy, and confusion. Clients who are prescribed this medication should be educated to avoid the use ofalcohol consumption or other CNS depressant drugs as this can worsen the adverse reactions of the medication and cause injury.

604) The nurse is teaching a client about tricyclic antidepressants. Which potential side effects would the nurse include? Select all that apply. One, some, or all responses may be . Dry mouth Drowsiness Orthostatic Hypotension Constipation Severe Hypotension

Dry mouth Drowsiness Orthostatic Hypotension Constipation Rationale: Dry mouth is a common anticholinergic side effect of tricyclic antidepressants. Drowsiness can be a common side effect but usually decreases with continued treatment. Constipation is a common side effect that usually can be managed with stool softeners and a high-fiber diet. Orthostatic hypotension is a common side effect oftricyclic antidepressants; the client should be instructed to rise slowly from a sitting to a standing position. Hypertension of any type is not a side effect of tricyclic antidepressants.

74) Which action would the nurse perform when beginning pyridostigmine bromide therapy for a client with myasthenia gravis? Administer the medication after meals. Administer the medication on an empty stomach. Evaluate the client's psychological responses between medication doses. Evaluate the client's muscle strength every hour after the medication is given.

Evaluate the client's muscle strength every hour after the medication is given. Rationale: The onset of action of pyridostigmine is 30 to 45 minutes after administration, and the effects last up to 6 hours; the client's response will influence dosage levels. Pyridostigmine usually is administered before meals to promote mastication. Pyridostigmine should be administered with food to prevent gastric irritation. There are no psychological side effects associated with pyridostigmine.

346) Which nursing action is appropriate when administering imipramine? Telling the client steroids will not be prescribed Warning the client not to eat cheese Monitoring the client for increased tolerance Having the client checked for increased intraocular pressure

Having the client checked for increased intraocular pressure Rationale: Glaucoma is one of the side effects of imipramine, and the client should be taught about the symptoms. The prescribing of steroids and avoiding cheese are true of monoamine oxidase inhibitors (MAOIs); imipramine is not an MAOI. Tolerance is not an issue with tricyclic antidepressants such as imipramine.

710) The anticholinesterase medication pyridostigmine is prescribed for the client with myasthenia gravis. When providing medication teaching, the nurse explains that the client should expect a decrease in which function? Bowel function Heart rate Skeletal muscle contraction Urinary frequency

Heart rate Homer's: relax. Bradycardia. Rationale: Anticholinesterase medications inactivate cholinesterase, the enzyme that mediates breakdown of acetylcholine. As a result of increased cholinergic activity, the heart rate will typically decrease. As a result of the increased cholinergic activity, the client can anticipate increased (not decreased) bowel movements and increased (not decreased) urinary frequency. Skeletal muscle contractions are increased (not decreased); this is the reason the medication is administered for myasthenia gravis.

An 11-year-old client reports having bedwetting issues (enuresis). Which medication would the nurse anticipate when developing a teaching plan ? Alprazolam Imipramine Lithium salts Clomipramine

Imipramine Rationale: Certain conditions of pediatric clients necessitate the usage of tricyclic antidepressant medications as an adjuvant. Childhood enuresis is one such condition that necessitates the administration of imipramine. Alprazolam is the medication of choice for treating anxiety disorders. Lithium salt is prescribed to treat bipolar disorders. Clomipramine is a tricyclic antidepressant medication prescribed for treating obsessive-compulsive disorder.

896) A client presents to the clinic for a follow-up appointment after starting pyridostigmine for management of myasthenia gravis. Which new client problems are adverse effects of pyridostigmine? Select all that apply. One, some, or all responses may be . Respiratory depression Increased urinary frequency Diplopia Muscle twitching Diarrhea

Increased urinary frequency Muscle twitching Diarrhea Rationale: Pyridostigmine is an acetylcholinesterase inhibitor. By inhibiting the enzyme that breaks down acetylcholine, it increases cholinergic activity. The increased cholinergic activity is responsible for the most common adverse effects of pyridostigmine such as diarrhea and increased urinary frequency. Another adverse effect is muscle twitching that occurs as pyridostigmine affects the muscle weakness that is characteristic of myasthenia gravis. Respiratory depression is a clinical manifestation of myasthenia gravis that can occur due to respiratory muscle weakness. Weakness of eye muscles results in ptosis or diplopia in about half of clients with myasthenia gravis.

423) The nurse is teaching a nursing student about tricyclic antidepressant medications. Which statement made by the student indicates the need for further teaching? Select all that apply. One, some, or all responses may be . Nortriptyline is contraindicated in older adult clients. Desipramine is preferred for use in older adult clients. Imipramine is used as an adjunct in the treatment of childhood enuresis. Tricyclic antidepressant medications are prescribed for clients with seizure disorders. Tricyclic antidepressant medications are contraindicated in clients with a history of seizures.

Nortriptyline is contraindicated in older adult clients. Tricyclic antidepressant medications are prescribed for clients with seizure disorders. Rationale: Nortriptyline is a preferred tricyclic antidepressant that can be administered safely in older adult clients. Antiepileptic medications are prescribed to clients with seizures. Desipramine and nortriptyline are preferred tricyclic antidepressants for use in older adult clients. Childhood enuresis necessitates the administration of imipramine. Clients with epilepsy should not be prescribed tricyclic antidepressants to avoid the risk of medical complications.

208) Which adverse effect of imipramine requires further assessment and possible immediate medical intervention? Dry mouth Weight gain Blurred vision Urinary hesitancy

Urinary hesitancy Rationale: Urinary hesitancy and retention are adverse effects of imipramine that may require immediate medical intervention. Dry mouth, weight gain related to increased appetite, and blurred vision may occur as side effects of imipramine; they usually decrease over time or can be managed through nursing interventions.

Which medication class includes amitriptyline? SSRI MAOI TCA SNRI

TCA

1053) Pyridostigmine is prescribed for a client with myasthenia gravis. Why would the nurse instruct the client to take pyridostigmine about 1 hour before meals? This timing limits first pass metabolism. Taking it on an empty stomach increases absorption. Taking it before meals decreases gastric irritation. Taking it before meals improves the ability to chew.

Taking it before meals improves the ability to chew.