Module 5

What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant?

Monitor the patient for seizure activity Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant

Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy?

Administer by slow IV push. The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.

What is the primary information the nurse should teach a patient who has just started taking mephobarbital (Mebaral)?

"Do not drive until you determine how you react to the medication." This medication can cause drowsiness. The nurse must teach the patient to be safe while taking this medication.

A child has been taking methylphenidate (Ritalin) for two months. The child's parent tells the nurse, "Each time I go to get my child's medication, the pharmacist asks me to get a new prescription. Why is this so?" What will the nurse explain to the parent?

"This drug has the risk of causing abuse."

The nurse is caring for a patient who states, "I probably shouldn't take aspirin. Won't it make my stomach hurt? What is the nurse's best response to the patient?

"You can try enteric-coated aspirin."

A patient has been admitted after overdosing on acetaminophen (Tylenol). The nurse plans to monitor this patient for development of which complication related to the overdose?

Acute hepatic necrosis

Which assessment finding in a patient taking NSAIDs requires immediate intervention?

Black, tarry stools

What is common to both celecoxib (Celebrex) and ibuprofen?

Both are more effective than aspirin in reducing pain

How does ibuprofen (Motrin) relieve pain?

By blocking the action of cyclooxygenase (COX)

What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home?

Wait to see how you react to the medication before driving. Antiepileptic medications suppress the central nervous system. The patient should know how they respond to the medication before attempting tasks such as driving.

A client is in status epilepticus. What is an appropriate nursing action?

Administer intravenous antiepileptic drug therapy.

What is the primary use of prostaglandin inhibitors?

Antiinflammatory

When a nurse notices a patient taking aspirin as an over-the-counter pain medication, the nurse suggests changing to ibuprofen. What differences between aspirin and ibuprofen does the nurse need to explain to inform the patient's decision?

Aspirin is associated with more gastric bleeding than ibuprofen The risk of gastrointestinal bleeding increases with aspirin. Ibuprofen causes gastric irritation, but it is less severe than that caused by aspirin. Consumption of both aspirin and ibuprofen can lead to life-threatening conditions such as liver or kidney damage. Likewise, blood disorders can be caused by aspirin as well as ibuprofen, and both aspirin and ibuprofen have the same duration of action of 4 to 6 hours

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?

Notify the health care provider and delay drug administration

Which symptom indicates blood dyscrasia due to the use of anticonvulsant drugs?

Sore throat, bruising, and nosebleeds

A patient with attention deficit/hyperactivity disorder (ADHD) has been prescribed methylphenidate HCl (Ritalin). The patient has a history of hypertension as well and is taking an antihypertensive medication. What drug interaction can be identified in the patient?

The patient will receive a reduced effect of antihypertensive.

The patient has recently been prescribed a benzodiazepine and reports experiencing vivid dreams. What does this symptom indicate?

Therapeutic effect of the medication The benzodiazepine medications are known to delay REM sleep and thus generate vivid dreams. Such a symptom is not indicative of overdosage, an allergic reaction, or inadequate dosage.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she is free of pain. What is the most appropriate response from the nurse?

This medication will help decrease your coughing

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?

"Most drugs produce sedation at low doses, and sleep, the hypnotic effect, at higher doses."

A patient who has been taking morphine for pain is assessed by the nurse. The patient's respiratory rate is 7 per minute, and pupils are 1 mm and unreactive. What is the nurse's immediate action?

Administer naloxone (Narcan)

The nurse is caring for a pediatric patient who has been taking phenytoin (Dilantin) for the past week. The patient develops a rash. What is the nurse's highest priority action?

Notify the prescribing health care provider of this development. Development of a rash is evidence of a reaction to the drug. The drug should be discontinued and the prescribing healthcare provider should be notified.

The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's highest priority action?

Notify the primary healthcare provider.

The nurse is assessing a patient who is receiving antiepileptic drug therapy with phenytoin. What assessment finding requires immediate action?

Nystagmus

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effective?

Pain has decreased from "a 6 to a 1" on a scale of 10 Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins.

The nurse is assessing a patient taking morphine sulfate. Which assessment requires immediate action?

Pinpoint pupils

During a history assessment and physical examination, a primary health care provider determines that a patient is at risk of heart stroke. Which action performed by the primary health care provider may reduce the risk of heart stroke?

Providing aspirin therapy Aspirin helps reduce the risk of stroke. It thins the blood and dissolves blood clots. Therefore, a low dose of aspirin should be given to the patient.

A child with attention deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin). Which instruction should the nurse include while teaching the client's family regarding drug administration?

"Administer the drug 45 minutes before meals." Food affects the rate of absorption of methylphenidate (Ritalin). Therefore, it should be taken 30-45 minutes before meals. Methylphenidate (Ritalin) should not be taken before sleep or in the evening because it may cause insomnia. Methylphenidate (Ritalin) is usually administered twice daily, once in the morning and then during the early afternoon.

A female patient who is at risk of stroke is on aspirin therapy. A nurse provides instructions regarding the correct use of aspirin to ensure effective outcome of the treatment. Which statement made by the patient indicates effective understanding?

"I should take aspirin at mealtime." Aspirin is used to prevent blood clotting. It should be administered at mealtime or with plenty of fluids to avoid gastrointestinal disturbances. This is because aspirin inhibits cyclooxygenase-1 (COX-1), which protects the stomach lining. Administration of aspirin with warfarin (Coumadin) should be strictly avoided, because aspirin increases the effect of warfarin (Coumadin). This will result in increased anticoagulant levels. Aspirin administration should be discontinued for 2 days before menstrual periods and for the first 2 days of menstrual periods because it can cause heavy menstrual bleeding. During this period, the patient can take acetaminophen. A large dose of vitamin C will not cause any effect during aspirin therapy; it should be avoided during the administration of allopurinol (Zyloprim) because it can cause kidney stones.

The nurse is caring for a patient diagnosed with attention deficit/hyperactivity disorder (ADHD) who has been prescribed methylphenidate HCl (Ritalin). What instruction will the nurse provide for this patient? Select all that apply.

"Monitor your weight twice a week and report weight loss." "Refrain from consuming over-the-counter (OTC) products with high caffeine content." Anorexia is one of the adverse effects of methylphenidate HCl (Ritalin). So, the nurse will instruct the patient to monitor his or her weight twice a week and report weight loss. The nurse should encourage the patient to read labels on OTC products, because many contain caffeine. A high plasma caffeine level could be fatal. The patient should be taught to take the drug before meals. The nurse should encourage the use of sugarless gum to relieve dry mouth. The patient should be taught not to abruptly discontinue the drug. The dose must be tapered off to avoid withdrawal symptoms. The dose should be modified only by the health care provider.

A nurse is teaching a patient being treated for seizures with phenytoin (Dilantin) about necessary precautions that need to be taken during the course of treatment. What is the most important instruction to reduce the risk of status epilepticus in the patient?

"Never stop taking the drug abruptly; please take each dose as scheduled." Stopping the drug therapy abruptly increases the risk of seizure rebound and status epilepticus. Therefore the patient should take each dose as scheduled in order to maintain drug therapeutic levels. During the initiation of anticonvulsant therapy, the patient should not drive or perform hazardous activities, because drowsiness may occur. This does not help to prevent status epilepticus. Alcohol and other central nervous system (CNS) depressants might lead to added depressive effects on the body if taken with anticonvulsants. Caffeinated products are CNS stimulants. If a female patient being treated with phenytoin (Dilantin) is contemplating pregnancy, she should consult the primary health care provider regarding the teratogenic effects of the drug. This instruction, however, is not relevant to preventing status epilepticus.

The nurse is teaching a patient with decreased hepatic function about taking pain relievers. What is the most important information to teach this patient?

"Take no more than 2 grams of acetaminophen per day." The patient with decreased hepatic function should decrease the dose of acetaminophen. The decreased liver function can lead to hepatic toxicity. The other information is not correct and should not be taught to the patient

Which specific nursing instruction is relevant for a patient who is taking both anticonvulsants and oral contraceptives?

"Use an additional contraceptive method."

What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin (Dilantin)?

"Use birth control while on this medication."

The nurse is assessing patients who are scheduled for surgery. Which patient will the nurse expect to be at higher risk while undergoing anesthesia?

A 50-year-old alcoholic patient who is scheduled for hernia surgery Excessive intake of alcohol alters a patient's response to general anesthesia. In addition, patients with hernias are at greater risk of having malignant hyperthermia. Therefore, the 50-year-old alcoholic who is scheduled for hernia surgery is at higher risk.

The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common side effect is the nurse educating the patient about for this medication?

Gingival hyperplasia

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment?

Assess lung sounds

A client receiving phenytoin (Dilantin) complains of "blurred vision." What is the priority nursing action?

Assess serum phenytoin levels

Which antiinflammatory agent inhibits only cyclooxygenase-2 (COX-2), but not cyclooxygenase-1 (COX-1)?

Celecoxib (Celebrex)

A patient has diarrhea and pain in the back. What is the most appropriate drug of choice for the patient?

Celecoxib (Celebrex) Celecoxib (Celebrex) is a cyclooxygenase-2 (COX-2) inhibitor that relieves pain and inflammation. Celecoxib (Celebrex) does not affect the lining of the stomach, so it does not cause gastric bleeding or ulcers. Aspirin and ibuprofen are also analgesics and can be given to relieve pain, but their side effects include diarrhea and gastric irritation. Indomethacin (Indocin) also causes gastric irritation.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? Select all that apply.

Decreased peristalsis Delayed gastric emptying Urinary retention Nausea

What adverse effects are associated with nonsteroidal antiinflammatory drugs (NSAIDs)? Select all that apply.

Dyspepsia Anorexia Tinnitus

A patient is admitted to the emergency department with an overdose of a benzodiazepine. Which antidote will the nurse expect to administer?

Flumazenil (Romazicon)

The client's serum phenytoin (Dilantin) level is 31 mcg/ml. What is the nurse's best action?

Hold the medication A therapeutic drug level for phenytoin is 10 to 20 mcg/ml. The nurse should hold the medication then call the health care provider.

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?

Impaired Gas Exchange related to respiratory depression

What will the nurse teach the patient to minimize gastrointestinal (GI) side effects of opioid analgesics for chronic pain?

Increase fluid and fiber in the diet

A nurse is monitoring a patient in the anesthetic unit who was administered droperidol and fentanyl (Innovar). Which nursing intervention would be priority for this patient?

Monitoring respiratory rate regularly Droperidol and fentanyl (Innovar) are neuroleptic analgesics, which are used as a preanesthetic medication. Monitoring blood pressure and respiratory rate is beneficial because this drug can cause hypotension and respiratory depression as side effects. Ensuring a patent airway and monitoring respiratory rate is the priority action of the nurse.

Which medication is used to treat a patient experiencing severe adverse effects of an opioid analgesic?

Naloxone (Narcan)

What are the functions of cyclooxygenase-1 (COX-1)? Select all that apply.

Regulates blood platelets Protects the stomach lining

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic?

Respiratory rate

Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?

Risk for injury Sedative-hypnotics cause central nervous system (CNS) depression, putting the patient at risk for injury.