Exam 3 Review

The nurse is aware that serotonin syndrome can occur when a patient is prescribed Selective Serotonin Reuptake Inhibitors (SNRI's) and Serotonin Norepinephrine Reuptake Inhibitors (SNRI's). What are some common Signs and symptoms of Serotonin Syndrome?

Hyperreflexia Shivering Hyperthermia Tremors Seizures Cardiac Dysrhythmias

A child is diagnosed with ADHD and is to start taking methylphenidate by mouth. What education should the nurse provide to the parents and child about this medication?

Weigh the child 2 times per week to monitor for weight loss associated with methylphenidate Report fast heart rate to health care provider as this can be a serious adverse effect Take before breakfast and lunchProvide child with a nutritious breakfast as they may have decreased appetite for the rest of the day

A client has oral candida albicans infection with throat involvement. The nurse is teaching the client about taking their prescribed swish and swallow medication. What statement made by the client indicates a need for additional teaching?

"I will drink some water directly after swallowing the nystatin to help with the bad flavor in my mouth."

A client is beginning to take cyclobenzaprine for treatment of acute back spasms. Which statement indicates to the nurse that the client needs additional instructions?

"I will take this drug in the evening with a glass of wine."

A client asks the nurse "How does the sumatriptan work to stop my migraine?" What is the best response by the nurse?

"It causes vasoconstriction of your cranial arteries."

The family of a client diagnosed with Alzheimer's disease asks how the newly prescribed donepezil works. What is the best response by the nurse?

"It prevents the breakdown of the neurotransmitter responsible for memory recall."

A client is to have a major in-patient surgery and the nurse administered scopolamine transdermal patch behind the ear. The client asks, "What is that for? Why do I need a band aid behind my ear?" What is the best response by the nurse?

"This medication is used to help dry up secretions to prevent aspiration during surgery."

What are some drug interaction with penicillins?

- decreased effects of oral contraceptive, increases bleeding with anticoagulants, additive effects with amino-glycosides, antagonistic effects with erythromycin

What are the major side effects of antibiotics?

- organ toxicity - allergy - superinfection - blood dycrasias - photosensitivity correct: allergy, superinfection, organ toxicity

What are the symptoms associated with "Red man" or Red neck syndrome" with vancomycin infusion?

- severe hypotension, reflex tachycardia, red flushing of face, neck, chest, and extremities

A client with tuberculosis will be starting on isoniazid, rifampin, and kanamycin for the initial phase of treatment. What education should the nurse provide this client?

-Rifampin can cause discoloration of body fluids, which can stain clothing and soft contact lenses. -Isoniazid and rifampin can cause liver damage, avoid acetaminophen and alcohol while on these medications. -Kanamycin can cause kidney and ear toxicity, therefore, report decrease urine output or hearing or balance disturbances. -Because isoniazid depletes vitamin B6, peripheral neuropathy can occur, and any numbness or tingling should be reported. -Take the medications exactly as prescribed to help prevent multi-drug resistant tuberculosis

The two goals of HAART therapy are for the CD4 count to be greater than ____ cells/mm3, and ideally above ____ if possible and for the viral load to be less than ____ copies/mL(undetectable).

200, 500, 50

Less than ___ mL/hour of urine output would indicate renal impairment

30

Which one of the generations of cephalosporins can be used to treat methicillin resistant Staphylococcus Aureus (MRSA)?

5th generation

A client is to start taking valproic acid. What labs should be monitored periodically throughout therapy?

AST ALT Valproic acid level CBC

The nurse is administering levofloxacin to a client with a severe infection. What issues are included in the black box warning for this classification of drugs?

Achilles tendon rupture CNS effects Exacerbation of myasthenia gravis Peripheral neuropathy

A client is receiving acyclovir by intravenous route for herpes zoster infection. What action should the nurse implement to help prevent phlebitis?

Administer infusion slowly, over 60 minutes

A client with schizophrenia started fluphenazine to help with their symptoms. Today, the client is pacing back and forth and will not participate in group therapy, stating "I need to keep moving." Based on the assessment data, what side effect is this client most likely experiencing?

Akathisia

Because of known adverse effects, when should the nurse administer tricyclic antidepressants, such as nortriptiline and amitriptiline? Fill in the blank with your answer

at bedtime

A client has been prescribed topiramate. What education should the nurse provide?

Avoid alcohol intake within 6 hours of scheduled dose

A client is prescribed metronidazole for an infection. The nurse is providing education to the client prior to discharge. What information should the nurse include in the discharge instructions?

Avoid alcohol, including alcohol hand gel, while on this medication to prevent a known interaction

A client is prescribed lithium for bipolar disorder. What information should the nurse provide to the client when educating the client about this medication?

Avoid caffeine as this can increase manic phases Drink 2-3 liters per day during early therapy, once maintenance therapy is achieved,drink 1.5-2L per day. Lab work will be needed to monitor drug levels

You are caring for a client post-operatively. The indwelling urinary catheter was removed in the post-anesthesia care unit per the surgeon's orders. The client is unable to urinate, and a bladder scan reveals 500 mL in in the bladder. What prescribed medication should you administer?

Bethanechol

Fill in the blank with the electrolyte that lithium depletes from the body.

sodium

An adolescent is newly prescribed phenytoin. What information should the nurse provide in the teaching plan to the client and the parents?

Brush and floss your teeth at least twice very day. Have dental exams done twice per year. Take the drug as close to the same time every day, if possible. Drug levels will be monitored periodically throughout therapy. Pad the corners of tables and try to clear any clutter that can cause harm if patient were to fall and have seizure

A client was brought into the emergency department with symptomatic bradycardia and has received multiple doses of atropine. What clinical manifestations would the nurse identify as being potential symptoms of atropine toxicity?

Confusion and Flushing of the face and neck

A client has taken several doses of intravenous gentamicin for a severe infection and is scheduled for another dose this morning. The client is unsteady while walking to the bathroom this morning and complains of having some trouble hearing the nurse. The nurse notes that this is new behavior from what was shared in shift report. What action should the nurse implement?

Contact the health care provider and request trough level before giving the scheduled dose

A client is receiving vancomycin and experiences a sudden drop in blood pressure and increase in heart rate. The nurse also notes that the client is red on their face, neck and chest. What is the best action by the nurse?

Decrease the rate of infusion as this is a known reaction to rapid vancomycin infusions

A client is prescribed an anticholinergic medication. What information in the past medical history would be of most concern to the nurse?

Glaucoma

An older-adult patient experiences acute psychosis at night during their hospitalization. What prescribed medication should the nurse administer for this problem?

Haloperidol

A client with schizophrenia appears disheveled and will not attend group therapy today. The nurse administers the scheduled morning tablets of the atypical antipsychotic medication. What priority intervention should the nurse implement?

Have the client open their mouth and stick out their tongue after swallowing the tablet

A client is prescribed a cholinergic medication. What assessment finding would be of most concern to the nurse?

Heart rate of 50 beats per minute

A client is prescribed alprazolam as needed for anxiety. What nonpharmacologic interventions can the nurse encourage the client to implement to help with anxiety in addition to taking their prescribed alprazolam?

Join a support group Seek counseling from a trained professional Guided imagery Deep breathing Listening to music

A client is to start zolpidem. What non-pharmacologic interventions can help promote sleep and rest to help this medication be more effective?

Listen to music Read a book Avoid caffeine 6 hours before bedtime Start a routine, get up at the same time every day

A client has been taking lithium for the last month and have arrived for their monthly lab work. Which lab values are would be concerning to the nurse?

Lithium 2.1 mEq/L Creatinine 4.2 mg/dL Sodium 121 mEq/L

A client has been diagnosed with myasthenia gravis and is placed in pyridostigmine. Thirty minutes after taking the first dose of medication, the nurse suspects cholinergic crisis. What clinical manifestations would the nurse identify as being potential symptoms of cholinergic crisis?

Miosis Diaphoresis Excessive salivation Lacrimation

A client is prescribed phenelzine for the diagnosis of major depressive disorder. When providing education to the client, what are some foods that the nurse should teach the patient to avoided while taking this medication?

Red wine Cheddar cheese Pepperoni Fried rice

A client is prescribed carbidopa-levodopa and the nurse is providing education on this new medication. What information should the nurse provide to help prevent injury?

Rise slowly, in stages

A client has been placed on high-dose therapy of selegiline. What foods should the nurse educate the client to avoid or limit while on this treatment regimen?

Sharp cheddar cheese Summer sausage Red wine

What is the primary use for butobarbital?

Short-term treatment of insomnia

What herbal supplement should the nurse teach the client to avoid while on fluoxetine?

St. John's Wort

A client is experiencing status epilepticus and is in the emergency department. What is the correct order for administration of the prescribed medications?

Step 1 Administer IV diazepam Step 2 Administer IV phenytoin Step 3 Administer IV midazolam Step 4 Administer IV phenobarbital

A client has seen the physician due to severe anxiety and has received a prescription for alprazolam for anxiety. What priority assessment should the nurse preform prior to discharging the client home?

Suicidal thoughts or ideation

The nurse is providing education to a client prescribed an antibiotic. What are some general teaching points to remember with any antibiotic?

Take the entire course of the prescribed antibiotic. Increase fluids to help with excretion of the antibiotic Taking an antibiotic puts you at risk for a super infection so you need to take action to re-establish your normal flora by taking probiotics, either with yogurt, buttermilk or oral probiotic supplements Organ toxicity is a common adverse effect of antibiotics, knowing the signs of the specific organ toxicity is important to prevent long term organ damage.

A young-adult, female client is to start a tetracycline antibiotic for treatment of acne. What teaching points should the nurse include in the education provided to this client?

This medication can make oral contraceptives less effective and some other form of birth-control is recommended to prevent pregnancy. Tetracycline antibiotics can cause birth defects in developing fetuses. Complete the full course of therapy, as prescribed. Take on an empty stomach with a full glass of water, either 1 hour before meals or 2 hours after meals. Avoid sunlight and wear sun block and protective clothing because this drug can increase the chance of severe sunburns, also known as, a photosensitive reaction.

The 2 main organ toxicities associated with the aminoglycosides are ototoxicity and nephrotoxicity.

True

A client is prescribed scopolamine transdermal patch to help with motion sickness while on a cruise. What education should the nurse provide the client to alleviate the common side effects of the medication?

Wear sunglasses when going outside Chew sugar free gum Increase fluid and fiber

dyskinesia

abnormal involuntary movements

miosis

constricted pupils

mydriasis

dilation of the pupil

Buspirone can be given "as needed" for anxiety and the patient will not be scheduled for a daily dose of this medication to treat their anxiety.

false

What are the symptoms of the disulfiram-like reaction that can occur with metronidazole if alcohol is used?

flushing, throbbing headache, tachycardia, confusion

The nurse realizes that there are two main reasons for antibiotic resistance. Taking antibiotics ______ , and not completing the _____ course of therapy.

unnecessarily, full

the cheese effect

when a person on an MAOI ingests foods containing tyramines which results in severe hypertension