MS2 Quiz 8

The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching? a. "This medication will help slow the development of symptoms." b. "I will place the tablet on my tongue before breakfast." c. "I may need to use a stool softener for constipation." d. "I should not push the tablet through the foil."

b. "I will place the tablet on my tongue before breakfast." Selegiline orally disintegrating tablets should be taken in the morning before breakfast, without liquid. This medication is used to slow the development of symptoms and progression of disease. Constipation is a common adverse effect that may require the use of stool softeners. Patients should not attempt to push selegiline orally disintegrating tablets through the foil backing. Patients should peel back the backing of one or two blisters (as prescribed) with dry hands and gently remove the tablet(s).

The ______ of the seizure is characterized by stiffening of the muscles or extremities with loss of consciousness.

tonic phase

Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

a. Topiramate (Topamax) Topiramate has been approved for adults in the prevention (but not treatment) of migraine headaches. Zonisamide, valproic acid, and tiagabine do not affect migraine headaches.

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee.

a. cheese. Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high tyramine content.

A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate? a. "The symptoms are typical and indicate that the medication is at a therapeutic level." b. "The symptoms will tend to resolve with continued therapy." c. "The symptoms are unusual and need to be reported to the healthcare provider immediately." d. "The symptoms are indicative of toxicity."

b. "The symptoms will tend to resolve with continued therapy." Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive central nervous system (CNS) stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy. The therapeutic level can only be determined by analyzing a blood sample. These are common symptoms and should only be reported if they persist. Symptoms of toxicity are chest pain, persistent palpitations, and tachycardia.

A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching? a. "This medication should not be discontinued suddenly." b. "This medication lowers my blood pressure by helping me get rid of fluid." c. "I may not have my usual symptoms of a hypoglycemic reaction while on this drug." d. "This medication may take a few weeks to work."

b. "This medication lowers my blood pressure by helping me get rid of fluid." Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure. Sudden discontinuation of beta-adrenergic blocking agents may result in an exacerbation of angina symptoms. Beta-adrenergic blocking agents may mask symptoms of hypoglycemia. Beta-adrenergic blocking agents may take several days to weeks to show optimal improvement.

A patient is stuporous but reacts by withdrawing from painful stimuli. What term is most appropriate for this patient? a. Comatose b. Lethargic c. Semicomatose d. Somnolent

c. Semicomatose A stuporous patient who reacts to pain is semicomatose. The patient with no reaction to pain is comatose.

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

c. Sudden sleep events Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as "sleep attacks," including daytime sleep. Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines. Tardive dyskinesia is a dystonic adverse effect of neuroleptic drugs such as phenothiazines. Akathisia, associated with neuroleptic drugs used in the treatment of mental disorders, is characterized by motor restlessness accompanied by increased nervous or restless movement. The syndrome may also occur when anti-Parkinson drugs are reduced or discontinued.

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

c. Trigeminal neuralgia pain Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects.

A(n) ______ hematoma forms in the space between the inner surface of the skull and the outermost meningeal covering of the brain.

epidural

Which are normal brain alterations associated with age? (Select all that apply.) a. Decrease in brain weight b. Pigmentation of brain with lipofuscin c. Present of amyloid d. Tiny clot formation e. Tangled nerve fibers

A, B, C, E All brain alterations listed are expected changes that affect the older adult's neurologic function except for tiny clot formations, which are a pathologic change.

Which statement(s) is/are true about efferent nerves? (Select all that apply.) a. They transmit signals to the spinal cord and brain. b. They leave the CNS to carry impulses to other body parts. c. They are part of the peripheral nervous system. d. They transmit signals that control contractions of smooth and skeletal muscles. e. They transmit signals that control contractions of some glandular secretions.

B, C, D, E Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.

The nurse assessing the level of consciousness in a patient will perform the following: (Arrange in order from the simplest to the most complex. Do not separate answers with a space or punctuation. Example: ABCD.) a. Apply pressure to the nail bed. b. Shake the patient. c. Touch the patient. d. Call the patient's name. e. Approach the patient.

EDCBA The assessment begins with simply approaching the patient and progresses to imposing painful stimuli.

Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess? a. Blood pressure b. Lung sounds c. Mental status d. Urine output

a. Blood pressure Beta-adrenergic blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure. Fluid retention may occur as a serious adverse effect but is not the most important assessment prior to the administration of a beta-adrenergic blocking agent. Mental status and urine output are not the most important assessments prior to the administration of a beta-adrenergic blocking agent.

Which describes the Babinski reflex? a. Downward curl of the toes b. Big toe bending upward c. Spreading out of the toes d. Pain in the big toe

a. Downward curl of the toes Normal cortical function causes the toes to curl downward. Abnormal findings would be the toes turning up and spreading.

What should a nurse instruct a patient after a lumbar puncture to prevent a headache? a. Lie flat. b. Lie on left side. c. Stay in semi-Fowler position. d. Ambulate in the room with assistance.

a. Lie flat. Lying flat for a prescribed period will allow the loss of cerebrospinal fluid during the procedure to replenish.

The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. "I need to avoid or limit caffeine intake." b. "I will check with the pharmacist before taking over-the-counter medication." c. "If I develop enlarged gums, I will stop taking the medication." d. "It is important for me to take my medicine at the same time daily."

c. "If I develop enlarged gums, I will stop taking the medication." Medications are not discontinued unless approved by the healthcare provider. Gingival hyperplasia is a common adverse effect that can be reduced by oral hygiene. Limiting caffeine intake, checking with the pharmacist about any additional over-the-counter medications, and taking the medication at the same time every day are appropriate actions by the patient.

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? a. "These drugs help you urinate." b. "These drugs will decrease your eye pressure." c. "These drugs inhibit the action of acetylcholine." d. "These drugs will assist in lowering your heart rate."

c. "These drugs inhibit the action of acetylcholine." Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson's disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate.

The autonomic nervous system can be subdivided into which types of adrenergic receptors? a. Nicotinic and muscarinic b. Afferent and efferent c. Alpha and beta d. Agonists and antagonists

c. Alpha and beta The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors. Nicotine and muscarine are specific agonists of one type of cholinergic receptor. Afferent and efferent are sensory and motor nerves. An agonist is a molecule that activates a receptor by reproducing the effect of the neurotransmitter. An antagonist acts against and blocks a function.

A nurse is evaluating the effectiveness of teaching for a patient with multiple sclerosis (MS). Which statement by the patient indicates that accurate patient learning has taken place? a. "Now that I am taking steroids, I will be able to work like I used to." b. "I'm making a list of things that are important and things I will simply have to let go." c. "I will make a plan to allow for long rest periods at least four times a day." d. "I am working on balancing time among rest, work, and family time."

d. "I am working on balancing time among rest, work, and family time." Balancing time between various activities indicates that the patient with MS understands the need to conserve energy, not just to give up things or attempt to perform at a preillness level.

The nurse is teaching a patient with Parkinson's disease about levodopa. Which statement by the nurse is accurate regarding drug administration? a. "Take this medication in between meals." b. "Take this medication at bedtime to prevent dizziness." c. "Take this medication when your tremors get worse." d. "Take this medication with food or antacids to reduce GI upset."

d. "Take this medication with food or antacids to reduce GI upset." Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in divided doses with food or antacids to decrease gastrointestinal (GI) irritation. Levodopa should be taken with food. Levodopa must be taken on a regular schedule as prescribed to provide therapeutic results.

What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

d. Administer without mixing with other medications. Phenytoin should not be mixed in the same syringe with other medications or added to other intravenous (IV) solutions because a precipitate will form. Phenytoin should be administered slowly at a rate of 25 to 50 mg/min. Patients should be monitored with an ECG closely for bradycardia. Patients should be monitored for hypotension.

Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider.

d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider. The nurse is not authorized to recommend dosage changes to the patient. The nurse should not trivialize the patient's concern about the adverse effect; it is common only in 10% of patients who take lamotrigine and can lead to more serious adverse effects. The nurse should not recommend discontinuing the medication without orders from the healthcare provider. This is not a common adverse effect and should be monitored. Approximately 10% of patients receiving lamotrigine develop a skin rash in the first 4 to 6 months of therapy. The healthcare provider should be notified promptly because the rash could be an indicator of a more serious condition.

A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling "dizzy and weak." The most appropriate action for the nurse is to: a. immediately notify the physician. b. teach the patient to move slowly from standing to sitting. c. discontinue the adrenergic blocker. d. monitor the blood pressure in both the supine and standing positions.

d. monitor the blood pressure in both the supine and standing positions. Although infrequent and generally mild, adrenergic agents may cause some degree of orthostatic hypotension manifested by dizziness and weakness, particularly when therapy is initiated. This is anticipated and does not require the physician to be immediately notified.

The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to: a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician.

d. withhold the next dose and notify the physician. Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a healthcare provider.

The nurse is caring for a patient with symptoms of a migraine headache. What assessment information supports this diagnosis? (Select all that apply.) a. Bilateral pain in temples b. Nausea c. Photosensitivity d. Elevated WBC count e. Tearing

B, C, E Migraine pain is usually unilateral, often begins in the temple or eye area, and is often very intense. Tearing and nausea and vomiting may occur. The patient is hypersensitive to light and sound and prefers a dark, quiet environment. WBC count is not expected to be elevated.

Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) a. "Take the medication with meals." b. "Increase fluids daily." c. "Decrease fiber in the diet." d. "Suck on candy or ice chips." e. "Monitor blood glucose."

B, D Anticholinergic medications cause dryness of mucous membranes. Increasing fluids, sucking on candy or ice chips, or chewing gum helps alleviate the dryness of the mouth, nose, and throat. Taking the medication with meals and decreasing fiber in the diet will not help patients cope with the adverse effects. Anticholinergics do not affect blood glucose levels.

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

b. 30 mg/min Phenytoin is administered slowly at a rate of 25 to 50 mg/min. A rate of 5 mg/min is too slow. A rate of 60 mg/min or 100 mg/min is too fast.

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experiencing? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

b. Hyperglycemia Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects.

Which nursing assessment would indicate a need for suctioning a patient with Guillain-Barré who is experiencing impaired breathing patterns because of neuromuscular failure? a. Decreased pulse rate and respiration of 20 breaths/min b. Increased pulse rate and adventitious breath sounds c. Increased pulse rate and respiration of 16 breaths/min d. Decreased pulse and abdominal breathing

b. Increased pulse rate and adventitious breath sounds Increased pulse rate, adventitious breath sounds, and abdominal breathing indicate an impaired breathing pattern.

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

b. Nystagmus Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood.

Which neurologic finding would be considered abnormal in an 88-year-old patient? a. Slow papillary response to light b. Jerky eye movements c. Dizziness and problems with balance d. Absence of the Achilles tendon jerk

c. Dizziness and problems with balance Dizziness and vertigo, although common, are considered abnormal.

What should the nurse implement before giving an enteral feeding to a patient? a. Palpate the abdomen to check for residual feeding. b. Warm the feeding. c. Elevate the head of the bed 30 degrees. d. Ask the patient to tip his head forward.

c. Elevate the head of the bed 30 degrees.

The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of: a. fat. b. salt. c. carbohydrates. d. vitamin K.

c. carbohydrates. The ketogenic diet is used in children and includes restriction of carbohydrate and protein intake. Fat is the primary fuel that produces acidosis and ketosis in the ketogenic diet. Salt and vitamin K are not restricted in the ketogenic diet.

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of: a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium.

c. ciprofloxacin. Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising rasagiline serum levels and potentially causing significant hypertension. Dextromethorphan, levodopa, and Valium are not related to significant hypertensive changes when used in conjunction with rasagiline.

Which three symptoms are characteristic of Cushing triad associated with increased ICP? a. Hypotension, tachycardia, and narrowing pulse pressure b. Hypertension, tachycardia, and headache c. Widening pulse pressure, headache, and seizure d. Bradycardia, hypertension, and widening pulse pressure

d. Bradycardia, hypertension, and widening pulse pressure

What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.) a. Restraining the patient's arms to avoid further injury b. Placing padding around or under the patient's head c. Attempting to insert a tongue depressor into the patient's mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

B, D, E Managing a patient during a seizure includes protecting the patient from further injury, (placing padding around or under the head to help prevent head injury), positioning the patient in the recovery position to facilitate respiratory effort, clearing the airway, and initiating ventilations should the patient lack spontaneous respirations after seizure. Restraining a patient who is having a seizure can cause, rather than prevent, injury. Inserting anything into the mouth of someone who is having a seizure can cause injury.

The nurse conducting a Romberg test will ask the patient to do what? (Arrange in the correct sequence. Do not separate answers with a space or punctuation. Example: ABCD.) a. Touch his or her nose with the index finger with the eyes open. b. Stand with eyes closed. c. Touch his or her nose with the index finger with the eyes closed. d. Touch his or her fingertip to nurse's fingertip. e. Pat the knees with the palms and then the back of the hands rapidly.

BEDAC These simple exercises used to assess balance and perception should be performed in order from least to most difficult.

Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinson's disease e. Preparation for surgery f. Stimulation of the vagus nerve

C, D, E Anticholinergic drugs are used to treat bradycardia and Parkinson's disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.

What should be immediately reported by the nurse caring for a 90-year-old patient with a closed head injury? a. Blood pressure change from 147/72 to 176/70-mm Hg b. Respiration rate increase from 14 to 18 breaths/min c. Slow pupillary reaction bilaterally d. Temperature decrease from 100.2q F to 97.6q F

a. Blood pressure change from 147/72 to 176/70-mm Hg The widening pulse pressure is an indicator of increased ICP. Respirations and temperature are returning to more normal levels. Older adults have a slowed pupillary response as they age.

A patient with a severe head injury begins to assume a posture of flexed upper extremities, with plantarflexed lower extremities. What do these assessments indicate? a. Increasing intracranial pressure (ICP) with decorticate posturing b. Decreasing ICP with decerebrate posturing c. Decreasing ICP with decorticate posturing d. Increasing ICP with decerebrate posturing

a. Increasing intracranial pressure (ICP) with decorticate posturing Increasing pressure on the tissue above the midbrain results in abnormal flexion (decorticate posturing).

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

a. Nausea, vomiting, and indigestion are common during the initiation of therapy. Nausea, vomiting, and indigestion are common during initiation of therapy. Taking the medicine with food or milk reduces the nausea and indigestion. Sedation, drowsiness, and dizziness tend to disappear with continued therapy. Gradual increases in dosage tend to decrease nausea and vomiting.

Which nerve endings liberate norepinephrine? a. Cholinergic b. Adrenergic c. Anticholinergic d. Muscarinic

b. Adrenergic Nerve endings that secrete norepinephrine are called adrenergic fibers. These nerve endings liberate acetylcholine. Anticholinergic describes the action of certain medications that inhibit the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle (e.g., as in the bladder). Muscarinic receptors are those membrane bound acetylcholine receptors that are more sensitive to muscarine than to nicotine.

Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitations

b. Orthostatic hypotension When initiating levodopa therapy, orthostatic hypotension may occur. Although generally mild, patients may experience dizziness and weakness. Symptoms usually resolve within 1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic hypotension increases the risk for injury in Parkinson's patients because they are also experiencing alterations in gait patterns. Although nausea, vomiting, anorexia, and depression are adverse effects of levodopa, they do not contribute to a risk for falling. Tachycardia and palpitations are not common adverse effects of levodopa.

Which intervention supports nutritional intake in a patient with Parkinson disease? a. Offer large meals with a variety of finger foods. b. Thicken liquids to make them easier to swallow. c. Puree all foods and drink through a straw. d. Offer a diet high in carbohydrates and fat and low in protein.

b. Thicken liquids to make them easier to swallow. Thickened feedings are easier to swallow. Several small, protein-rich meals are preferable to large ones. A pureed diet is unappealing.

Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? a. Hypertension b. Raynaud's phenomenon c. Emphysema d. Cardiac dysrhythmias

c. Emphysema Beta-adrenergic blockers can produce severe bronchoconstriction. Selective beta 1 antagonists are used to treat hypertension. Alpha-adrenergic blocking agents are used to treat patients with Raynaud's disease. Beta-adrenergic blocking agents are indicated for patients with cardiac arrhythmias.

What diagnostic test might be contraindicated for a patient who has a pacemaker? a. Computed tomography (CT) b. Electromyography (EMG) c. Magnetic resonance imaging (MRI) d. Electroencephalography (EEG)

c. Magnetic resonance imaging (MRI) Metal appliances may be affected by the magnetic field during MRI.

What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? a. Slows the deterioration of dopaminergic nerve cells. b. Inhibits the relative excess of dopaminergic activity. c. Reduces the destruction of dopamine in peripheral tissues. d. Enhances the cholinergic symptoms of Parkinson's disease.

c. Reduces the destruction of dopamine in peripheral tissues. Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This significantly increases the amount of dopamine available to reach the brain. Entacapone, when used with carbidopa levodopa therapy, results in more constant dopaminergic stimulation. Entacapone is not effective when used alone. Entacapone does not affect the nerve cells but blocks enzymes that break down levodopa. Parkinson's disease is characterized by a relative deficit of dopaminergic activity. Entacapone does not affect cholinergic symptoms of Parkinson's disease.

An older adult patient is experiencing extreme stress related to an admission to the hospital. What should the nurse expect the patient to demonstrate? a. Decreased heart rate b. Decreased blood pressure (BP) c. Irregular respiration d. Dilation of the pupils

d. Dilation of the pupils Stress stimulates the fight-or-flight reaction with the release of epinephrine and norepinephrine, which causes increased heart rate and BP, reduced peristalsis, and pupil dilation.

What is the most reliable indicator of neurologic status? a. Blood pressure b. Pulse rate c. Temperature d. Level of consciousness

d. Level of consciousness The ability to respond readily and correctly to person, place, and time is good evidence of intact sensorium.

A family member asks the nurse what would be an appropriate gift for a patient with Parkinson disease. What is the most useful suggestion? a. Soft-soled house shoes b. Jigsaw puzzle c. Set of card games d. Satin sheets

d. Satin sheets Satin sheets make moving in bed easier. Card games and jigsaw puzzles are frustrating because of the palsy. Hard-soled shoes provide better support than soft-soled shoes.

A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) a. Palpitation b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors f. Bradycardia

A, B, C, E Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient.

The healthcare provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

A, D, E It is important to monitor the patient for bradycardia during administration of diazepam. During a seizure of any type, it is important to assess for airway patency continuously. Diazepam should be administered slowly by the IV route at a rate of no more than 5 mg/min. For status epilepticus, 5 to 10 mg is typical, preferably by slow IV. The dose may be repeated every 5 to 10 minutes, up to a total dosage of 30 mg. If necessary, repeat therapy in 2 to 4 hours; other drugs are preferable for long-term control. Diazepam is incompatible with most other IV medications and should not be combined.

What action should the nurse implement when a patient falls to the floor in a generalized seizure? a. Cradle the head to prevent injury. b. Insert an object between the teeth to prevent the patient from biting the tongue. c. Manually restrain the limbs. d. Keep the patient on his or her back to prevent aspiration.

a. Cradle the head to prevent injury. Cradling the head and turning it to the side prevents injury and aspiration; restraint of limbs and insertion of an object into a patient's mouth often result in injury.

What should the nurse assess when a patient is scheduled for an angiogram? a. Dizziness b. Allergy to shrimp c. Increased BP d. Irregular heartbeat

b. Allergy to shrimp Allergy to shrimp and other shellfish also indicates a probable allergy to contrast medium.

Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D

b. B6 Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to 10mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore are not restricted. The ingredients in multivitamins, however, must be assessed. Vitamins A, C, and D do not affect therapy with levodopa.

Why are beta blockers used cautiously in patients with respiratory conditions? a. They mask the signs and symptoms of acute hypoglycemia. b. They cause extensive vasodilation and cardiac overload. c. They may produce severe bronchoconstriction. d. They increase hypertensive episodes.

c. They may produce severe bronchoconstriction. Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose by inducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects.

Which cholinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

c. Tremors and drooling Anticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson's disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics have little effect on rigidity or on postural abnormalities.

What is the primary response to alpha-1-receptor stimulation? a. Bronchodilation b. Tachycardia c. Vasoconstriction d. Uterine relaxation

c. Vasoconstriction Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body. Alpha-1-receptor stimulation causes bronchoconstriction. Alpha-1-receptor stimulation does not cause tachycardia. Beta-2-receptor stimulation produces relaxation of smooth muscle tissue, such as the uterus.

Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma

d. Closed-angle glaucoma The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.

Neurotransmitter(s) include: (Select all that apply.) a. gamma aminobutyric acid. b. acetylcholine. c. serotonin. d. glucose. e. histamine. f. epinephrine.

A, B, C, E, F The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the body's main source of energy.

The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs.

A, B, D, E Premedication assessment prior to apomorphine therapy should include baseline vital signs, patient's degree of mobility, alertness, and orientation to name, place, and time. It is not necessary to assess intellectual ability prior to apomorphine therapy.

Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

A, B, D, F Phenytoin may cause blood dyscrasias, gingival hyperplasia, and sedation and may elevate blood glucose levels, especially if higher doses are used. Urinary retention and insomnia are not adverse effects of phenytoin.

Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.) a. Blood pressure b. Skeletal muscle contraction c. GI secretion d. Body temperature e. Urination

A, C, D, E Blood pressure, GI secretion, body temperature, and urinary bladder function are body functions controlled by the autonomic nervous system. The autonomic nervous system maintains control over most tissue function, with the exception of skeletal muscle.

Which neurotransmitters support smooth neural transmission? (Select all that apply.) a. Acetylcholine b. CSF c. Dopamine d. Dendrite e. Epinephrine

A, C, E Acetylcholine, dopamine, and epinephrine are neurotransmitters. CSF bathes the brain and spinal cord but has no transmission activity; the dendrite is the locus of the synapse.

A nurse caring for an immobilized patient with a brain tumor stimulates the patient several times a day with range-of-motion exercises and changes his position every 2 hours to try to prevent a disuse syndrome. What signs and symptoms does disuse syndrome include? (Select all that apply.) a. Pooling of pulmonary secretions b. Paralysis c. Muscle tremor d. Pressure ulcers e. Altered visual perceptions

A, D A disuse syndrome includes pooling of pulmonary secretions, pressure ulcers, weakness, and stiff joints.

What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease? (Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors is permanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

C, D, E, F Apomorphine has no opioid activity, is commonly injected by a reusable multidose pen, and may cause nausea, vomiting, or sleepiness. Apomorphine brings temporary relief from hypomobility. Apomorphine must not be administered intravenously. It may crystallize in the vein and form a thrombus or embolism.

How can the nurse help reduce ICP in caring for the patient after a craniotomy? a. Keeping the patient flat in bed b. Elevating the head of the bed 30 degrees c. Closely monitoring the IV rate d. Turning the patient to the right side

b. Elevating the head of the bed 30 degrees

The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. "I may feel tired at first, but this should improve with continued use." b. "Once my pain improves, I will stop taking this medication." c. "Taking sleeping aids will increase the sedative effect of this medication." d. "This drug may affect my mental alertness, so I need to be careful around machinery."

b. "Once my pain improves, I will stop taking this medication." When discontinuing therapy, taper over at least 1 week to minimize the potential for withdrawal symptoms. Drowsiness tends to disappear with continued use of the medication. Sleeping aids enhance the sedative effects of pregabalin. Pregabalin causes sedation, so people who work around machinery, drive a car, or perform other duties in which they must remain mentally alert should be particularly cautious.

Which assessment on a patient on mannitol therapy for cerebral edema indicates the medication is effective in decreasing ICP? a. Increased BP b. Increased urinary output c. Decreased pulse d. Widening pulse pressure

b. Increased urinary output Mannitol is a hyperosmolar diuretic that draws fluid from brain tissue into the bloodstream, which is then excreted by the kidneys. Decreasing pulse and widening pulse pressure indicate increased ICP.

Why is a patient with amyotrophic lateral sclerosis (ALS) uniquely prone to depression? a. Nutritional intake is poor. b. Intellectual capacity is not affected. c. Mobility is limited. d. Communication is altered.

b. Intellectual capacity is not affected. Because of their unimpaired intellect, patients with ALS are able to assess their deterioration, which increases their risk for depression. Altered mobility, nutrition, and communication are common to many disorders.

Parkinson's disease has which characteristic symptom(s)? (Select all that apply.) a. Muscle tremors b. Posture alterations c. Muscle flaccidity d. Tachycardia e. Slow body movement

A, B, E Symptoms of Parkinson's disease include muscle tremors, posture and equilibrium alterations, and slow body movement or bradykinesia. Muscle flaccidity is not a symptom of Parkinson's disease. Symptoms of Parkinson's disease do not include alterations in heart rate.

Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation

A, C, D Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping.

A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

A, C, D Pregnancy considerations include encouraging the patient to consult with an obstetrician, provide a list of seizure medications, and carry an identification card. Medications should not be discontinued unless told to do so by the healthcare provider. If pregnancy is suspected, oral contraceptives should not be encouraged.

The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

A, D, E Zonisamide should not be administered without specific approval if the patient has an allergy to Bactrim or a dermatologic reaction such as a skin rash and/or pruritus. Urinary frequency is not associated with zonisamide. Drowsiness is a common adverse effect of zonisamide.

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patient's ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

a. Determine patient's ancestry. The nurse needs to review the patient's history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescriber's attention so that genetic testing may be completed. BP monitoring is important and hypotension is an adverse effect, but it is not as significant to monitor prior to the initiation of therapy. Lung sound assessment and smoking history assessment are important assessments, but not prior to the initiation of carbamazepine therapy.

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications.

a. Dopamine does not cross the blood-brain barrier when administered orally. When administered orally, dopamine does not enter the brain. Levodopa does cross into the brain and is metabolized into dopamine. Dopamine is not available as an oral medication. The half-life of levodopa is approximately 50 minutes; the half-life of dopamine is approximately 4 days. Dopamine does not react with medications.

A nurse is caring for a patient with meningitis who has a positive Brudzinski sign. Which assessment led to this conclusion? a. Flexed hips when the neck is flexed by the nurse b. Inability to extend the flexed leg fully because of hamstring pain c. Resisting efforts of the nurse to flex his or her neck d. Flexing the big toe upward and fan out the other toes

a. Flexed hips when the neck is flexed by the nurse Inflamed meninges will stimulate hip flexion to reduce meningeal discomfort.

A nurse is careful about limb position in caring for an unconscious patient who sustained a head injury 10 days ago. What is the nurse trying to prevent? a. Flexion deformities b. Atrophy c. Paralysis d. Pathologic fracture

a. Flexion deformities An unconscious patient should be positioned in anatomic alignment to prevent flexion deformities. Passive range of motion and frequent position changes are essential to maintain the limbs in a functional position.

A patient with Parkinson disease is depressed because his drug protocol of L-dopa and Sinemet is no longer controlling his symptoms. What is the best response by the nurse? a. Other drugs can be combined with L-dopa to increase its effectiveness. b. The effect of these drugs has an uneven course; symptoms will begin to subside again soon. c. The two drugs can be given in higher doses to control the symptoms. d. Surgical interventions have been very effective in the control of parkinsonian symptoms.

a. Other drugs can be combined with L-dopa to increase its effectiveness. The addition of other drugs to L-dopa may improve the conversion of L-dopa to dopamine. Palliative surgical implementations all have had little effect on controlling the symptoms.

A patient with generalized convulsive disorder is unaware about the side effects of phenytoin (Dilantin). Which instruction would be most appropriate? a. Take medication with food. b. Brush teeth vigorously to encourage gingival growth. c. Limit fluids and eats foods that reduce diarrhea. d. Reduce stimuli and take warm baths to induce drowsiness.

a. Take medication with food. Dilantin is irritating to GI tissues. Dilantin causes gingival hyperplasia, constipation, and drowsiness.

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud's disease? a. Adrenergic agents b. Alpha-adrenergic blocking agents c. Beta-adrenergic blocking agents d. Cholinergic agents

b. Alpha-adrenergic blocking agents Alpha-adrenergic blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha-receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction. Adrenergic drugs cause vasoconstriction. Beta-adrenergic blocking agents are used to treat hypertension and dysrhythmias. Cholinergic drugs are used to treat ocular diseases such as glaucoma, respiratory tract disease, and urinary system diseases.

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient's response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain.

b. Dosage is adjusted according to the patient's response. Dosage must be adjusted according to the patient's response and tolerance. Entacapone may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic effects of levodopa. Entacapone does not increase the production of dopamine in the brain.

A patient in the emergency department states that she fell and hit her head and blacked out for a while but became alert again. The nurse suspects an epidural hematoma. For what should the nurse be diligent to assess? a. Headache b. Drowsiness c. Increasing respiration rate d. Vomiting

b. Drowsiness Increasing BP, drowsiness, and a widening pulse pressure are indicators of increased ICP.

What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

c. Valproic acid (Depakene) Anticonvulsant therapy should start with the use of a single agent selected from a group of first-line agents based on the type of seizure. Valproic acid is indicated for generalized tonic-clonic seizures. Diazepam is not the drug of choice for treatment of tonic-clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.

A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to: a. report development of alterations to the charge nurse. b. assess blood glucose. c. provide for resident's safety. d. medicate with antianxiety medication.

c. provide for resident's safety. Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.

The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the healthcare provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness

d. Dizziness Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered. Constipation is an expected adverse effect of this medication. Brownish orange urine is an expected adverse effect of this medication. Drowsiness is an expected adverse effect that occurs when therapy is initiated.

Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

d. Gingival hyperplasia Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic-clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold.

A patient with Parkinson disease is considering taking St. John's wort, an herbal remedy for depression, in addition to Sinemet and L-dopa. What is the most appropriate nursing response? a. Depression is reduced by the use of herbal remedies such as St. John's wort. b. Doses of St. John's wort and parkinsonian drugs should be taken on alternate days. c. St. John's wort must be taken in large doses to reduce depression. d. Herbal remedies can interfere with the effectiveness of the parkinsonian drugs.

d. Herbal remedies can interfere with the effectiveness of the parkinsonian drugs.

To what does the neural synapse refer? a. Length of time it takes for afferent neurons to carry impulses to the central nervous system (CNS) b. Length of time it takes for efferent neurons to carry impulses to the motor neurons c. Space between the axons and the dendrites of a neuron d. Space between the axons of one neuron and the dendrites of the next

d. Space between the axons of one neuron and the dendrites of the next Smooth, coordinated transmission must travel from one neuron to another across the neural synapse.

An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? a. Determine the therapeutic blood level. b. Encourage the patient to decrease water intake. c. Elevate the patient's legs. d. Withhold the medication.

d. Withhold the medication. These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a healthcare provider. Determining the therapeutic blood level, encouraging the patient to decrease water intake, and elevating the patient's legs are not the first actions that should be taken.