NUR 308 - Chapter 17-21

The patient has been prescribed methylphenidate for narcolepsy. The patient also has migraines and takes amitryptiline as a preventative. What should the nurse advise the patient to do before starting the new medication? A. "Contact your primary health care provider to verify compatibility" B. "Have baseline lab work drawn to assess liver function" C. "Immediately stop taking the amitryptiline" D. "Increase the fluid intake with the next meal"

A. "Contact your primary health care provider to verify compatibility"

The patient is being treated with methylphenidate (Ritalin) for ADHD. What common side/adverse effect(s) should the patient and family be informed might occur? Select all that apply. A. Euphoria B. Headache C. Hypertension D. Irritability E. Orthostatic hypotension F. Vomiting

A, B, C, D, F

The 71-year-old patient presents to the health care provider with complaints of inability to go to sleep and inability to stay asleep. What question(s) will the nurse ask to further evaluate her complaint? Select all that apply. A. "Do you have a bedtime routine?" B. "How many caffeinated beverages do you drink per day?" C. "Do you take naps?" D. "Do you sleep with the windows open?" E. "Are you taking diuretics?"

A, B, C, E

Which statement(s) is/are true of methylphenidate? A. If taken with monoamine oxidase inhibitors (MAOIs), it may increase a hypertensive crisis. B. The effects of anticoagulants may increase C. Hyperglycemia may occur D. Insulin will be more effective E. There may be increased effects if taken with caffeinated beverages

A, B, E

Which medical condition(s) is/are central nervous system stimulants approved to treat? Select all that apply. A. attention deficit/hyperactive disorder (ADHD) B. Anorexia C. Narcolepsy D. Obesity E. Post-traumatic stress disorder (PTSD)

A, C, D

CNS stimulants are absolutely contraindicated for patients with a history of which condition(s)? Select all that apply. A. Coronary artery disease B. Diabetes C. Hypothyroidism D. Hypertension E. Liver failure

A, D, E

The patient is born at 28 weeks gestation and is scheduled to receive caffeine citrate 20 mg IV shortly after birth. the patient's mother asks, "Why are you giving my baby stuff that is in coffee?" What is the nurse's best response? A. "Caffeine can help your baby breathe better" B. "It will help your baby gain weight faster" C. "The baby's temperature will be warmer with caffeine" D. "This isn't the same substance that is in coffee"

A. "Caffeine can help your baby breathe better"

Local anesthetics: Purpose: - ___________ in ________ area

analgesia, limited

Benzodiazepines: Suffix:-________; -___________ Can be used as either a __________ or for ___________ Quickly ___________ or taking with _______________ can be life-threatening

azepam, azolam, hypnotic, anxiety, withdrawing, alcohol

A patient reports difficulty falling asleep most nights and is constantly fatigued. The patient does not want to take medications to help with sleep. What nonpharmacologic measure will the nurse recommend? a. "Exercise in the evening to promote bedtime fatigue." b. "Get out of bed at the same time each morning." c. "Have a glass of wine at bedtime to help you relax." d. "Take daytime naps to minimize daytime fatigue."

b. "Get out of bed at the same time each morning."

The nurse is providing teaching for a patient who will begin taking zolpidem tartrate (Ambien) 10 mg at bedtime as a sleep aid. Which statement by the patient indicates understanding of the teaching? a. "I should take this medication with food to avoid stomach upset." b. "I will take this medication within 30 minutes of bedtime." c. "If this medication is not effective, I may increase the dose to 15 mg." d. "Tolerance and drug dependence do not occur with this medication."

b. "I will take this medication within 30 minutes of bedtime."

To maintain the half-life of methylphenidate (Ritalin), how often should this medication be taken? a. Daily b. Twice per day c. Three times per day d. Every other day

b. Twice per day

A patient asks the nurse about taking over-the-counter sleeping aids. The nurse will tell the patient that the active ingredient in these products is often a(n) a. antiemetic. b. antihistamine. c. barbiturate. d. benzodiazepine.

b. antihistamine.

Spinal Column Nerve Blocks Caudal Block: - placed near the ___________ Saddle block: - administered at the __________ end of the spinal column to block the ______________ area

sacrum, lower, perineal

Benzodiazepines as hypnotics: SAMA: - S- ___________ - A- ____________ - M- ____________ - A- ____________

sedation, anti-convulsive, muscle relaxant, anti-anxiety

Sedative-hypnotics: Drug interactions: - ______________ - _________ depressants Nursing interventions: - first use _____________ methods - Be attentive to ___________ - Avoid ______________ - Take before ___________ - Report _____________ effect - Monitor _________- - Withdraw __________

Alcohol, CNS, nonpharmacologic, safety, CNS depressants, bedtime, hangover, VS, gradually

CNS Stimulants: Categories: - ___________ - ___________, __________ - ____________ Medically approved uses: - _______ - _______ - Reversal of _________________ Commonly ___________

Amphetamines, analeptics, caffeine, anorexiants, ADHD, narcolepsy, respiratory disease

An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue? A. "Take Benadryl pills each evening before bedtime." B. "Drink warm milk or chamomile tea before bedtime." C. "Develop an exercise regimen for the evening hours." D. "Take naps during the day whenever you feel drowsy."

B. "Drink warm milk or chamomile tea before bedtime."

Barbiturates (continued) Withdrawal: -can begin within __________ but depends on severity of addiction - _________ stimulation signs

24 hours, CNS

Anticonvulsants and Pregnancy: - Seizure episodes increase _______ in women with epilepsy who are pregnant - _______ that may occur during seizures places both the pregnant patient and the fetus at risk - Many anticonvulsants have _________ properties - Anticonvulsant drugs tend to act as inhibitors of ____________, contributing to _____________ in infants shortly after birth. - Anticonvulsants also increase the loss of _________ in pregnant patients

25%, hypoxia, teratogenic, vitamin K, hemorrhage, folate (folic acid)

The nurse is helping a family prepare for a grocery shopping trip for a patient who has been prescribed selegilene (Eldepryl) Which food(s) should be avoided? Select all that apply. A. Aged cheeses B. chocolate C. Peanut butter D. wheat bread E. Yogurt

A, B, E

A patient presents to the emergency department in status epilepticus. Which medication would the nurse anticipate to be ordered first? A. Diazepam (Valium) B. Midazolam (Versed) C. Propofol (Diprivan) D. Phenobarbital

A. Diazepam (Valium)

A patient taking carbidopa-levodopa for parkinsonism is complaining of dizziness, diarrhea, anxiety, and nasal stuffiness. Which of these complaints does the nurse recognize as a possible side effect of carbidopa-levodopa? A. Dizziness B. Diarrhea C. Anxiety D. Nasal stuffiness

A. Dizziness

What would the nurse expect to see if the patient is experiencing a common side effect of phenytoin? A. Gingival hyperplasia B. Excessive thirst C. Weight gain D. Muscle tremors

A. Gingival hyperplasia

Which drug group acts on the brainstem and medulla to stimulate respiration? A. Amphetamine B. Analeptic C. Anorexiant D. Triptan

B. Analeptic

The pediatric patient has been started on methylphenidate for ADHD. What information should the nurse include in the health teaching? A. Constipation is a common side effect B. Counseling should be combined with medication C. This medication will only be used for a few weeks D. Weight gain is to be expected

B. Counseling should be combined with medication

Which is a nursing intervention for a patient taking carbitopa-levodopa for Parkinson's disease? A. encourage the patient to adhere to a high-protein diet B. Inform the patient that perspiration may be dark and may stain clothing C. Advise the patient that glucose levels should be checked with urine testing D. Warn the patient that it may take 4 to 5 days before symptoms are controlled

B. Inform the patient that perspiration may be dark and may stain clothing

A nurse is teaching a patient about zolpidem. Which is important for the nurse to include in the teaching of this drug? A. the maximum dose is 20 mg/day B. It is used for short-term treatment less than 10 days C. For older adults, the dose is 15 mg at bedtime D. The drug should only be used for 21 days or less

B. It is used for short-term treatment less than 10 days

The patient has been diagnosed with a seizure disorder. The nurse knows that which drugs may be prescribed to control seizures? A. Intermediate-acting barbiturates B. Long-acting barbiturates C. Short-acting barbiturates D. Ultra-short-acting barbiturates

B. Long-acting barbiturates

The nurse should monitor the patient receiving phenytoin for which adverse effect? A. Psychosis B. Nosebleeds C. Hypertension D. Gum erosion

B. Nosebleeds

The 61-year-old patient will be receiving spinal anesthesia for surgery. She states, "Why do i have to sit a certain way? Why can't I just be comfortable?" What is the nurse's best response? A. "It is easier for the anesthesiologist if you sit this way." B. "Because of your age, you have to sit straight up" C. "The anesthesia is injected in a specific area so it distributes evenly." D. "You can sit however you like."

C. "The anesthesia is injected in a specific area so it distributes evenly."

What statement by the patient indicates an understanding of how to relive some of the side effects associated with the use of benztropine mesylate (Cogentine)? A. "I can suck on hard candy or chew sugarless gum to prevent dry mouth" B. "I need to take my medication every 6 hours so I don't get constipated" C. "i should decrease the doses of all of my other medications so I don't get dizzy" D. "I should urinate after meals so I do not retain urine"

C. "i should decrease the doses of all of my other medications so I don't get dizzy"

_____________: - Produces mildest form of CNS depression

Sedatives

Which antiviral medication improves symptoms of Parkinson's disease in some patients? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Interferon (INF) d. Zanamivir (Relenza)

b. Amantadine HCl (Symmetrel)

Hydantoins (cont.) Phenytoin: Drug interactions: - increased effects with _______, _____, and _________ - decreased effects with ________ - may inhibit __________ release

cemetidine, INH, sulfonamides, ginkgo, insulin

Epilepsy: - Most people usually have their first seizure before age ______ - Usually a ______, ______ disorder Seizures that are not associated with epilepsy could result from ______, _________ reactions, ________ imbalance, ________ imbalance, and ________ or _______ use. When these conditions are corrected, the seizures ________

20, chronic, lifelong, fever, hypoglycemic, electrolyte, metabolic, alcohol, drug, cease

A patient is admitted to the emergency department with status epilepticus. Which drug should the nurse most likely prepare to administer to this patient? Select all that apply. A. Diazepam B. Midazolam C. Gabapentin D. Levetiracetam E. Topiramate

A, B

A patient is taking rivastigmine to improve cognitive function. What should the nurse teach the patient/family member to do? Select all that apply. A. Rise slowly to avoid dizziness B. Remove obstacles from pathways to avoid injury C. Closely follow the drug dosing schedule D. Have frequent check for hypertension E. Receive regular liver function tests

A, B, C

Which statement(s) is/are true about seizures and anticonvulsant use in pregnancy? Select all that apply. A. Seizures may increase up to 25% in epileptic women B. Many anticonvulsants have teratogenic properties C. Anticonvulsant use increases loss of folic acid D. Anticonvulsants increase the effects of vitamin K E. Valproic acid causes malformation in 40% to 80% of fetuses

A, B, C

What would the nurse teach a patient who is taking anticholinergic therapy for Parkinson's disease? Select all that apply. A. avoid alcohol, cigarettes, and caffeine B. Relieve dry mouth with hard candy or ice chips C. Use sunglasses to reduce photophobia D. Urinate 2 hours after taking the drug E. Receive routine eye examinations

A, B, C, E

The patient has just been diagnosed with a seizure disorder and has been started on valproic acid. What statement(s) by the patient indicate(s) to the nurse the patient needs more instruction regarding his medication? A. "I just have to remember to take it once a day" B. "I have to take it with lots of water" C. "I need to take it at the same times every day." D. "I can't drink grapefruit juice anymore."

A, B, D

A nurse working triage in the emergency department witnesses a patient having a seizure. What information will be included in the nurse's documentation? Select all that apply. A. Type of movements B. Duration of movements C. Ability to stop movements D. Progression of movements E. Preceding events

A, B, D, E

The nurse is administering carbidopa-levodopa to an older adult patient with parkinsonism. Which order(s) would the nurse question before administration? Select all that apply. A. Carbidopa 5 mg/levodopa 50 mg t.i.d/q.i.d. B. Carbidopa 10 mg/levodopa 100 mg t.i.d./q.i.d C. Carbidopa 15 mg/levodopa 150 mg ti.d./q.i.d D. Carbidopa 20 mg/levodopa 200 mg t.i.d/q.i.d E. Carbidopa 25 mg/levodopa 250 mg t.i.d/q.id.

A, C, D

Which anticonvulsant(s) is/are classified as as pregnancy category C? Select all that apply. A. Acetazolamide (Diamox) B. Carbamazepine (Tegretol) C. Phenobarbital D. Pregabalin (Lyrica) E. Topiramate (Topamax)

A, D

Anticholinergics are contraindicated for which patient(s)? Select all that apply. A. A 45-year-old with glaucoma B. A 60-year-old with shingles C. A 65-year-old with urinary frequency D. A 71-year-old with diabetes E. A 77-year-old with angina

A, E

A patient has been started on an anticonvulsant for a seizure disorder and asks how long he will need to take the medication. What is the nurse's best response? A. "you will need to take an anticonvulsant of some type for your lifetime" B. "This medication should be taken until you haven't had a seizure for a month" C. "Seizures are unpredictable and so is the duration of the treatment" D. "You will only need to take it for a short period of time because anticonvulsants will cure the seizure disorder"

A. "you will need to take an anticonvulsant of some type for your lifetime"

The patient has not responded to other oral anticonvulsant drug therapy. Which drug would the nurse expect to be prescribed for this patient? A. Carbamazepine (Tegretol) B. Diazepam (Valium) C. Ethosuximide (Zarontin) D. Valproic acid

A. Carbamazepine (Tegretol)

Dopamine agonists: Drug: ________________ - this is also an __________ drug for ___________________ - Stimulates __________ receptors - taken ________ or in _____________ with levodopa or ____________ Use: - early treatment of _______________ as drug _______________ develops - Improvement of symptoms Side Effects: - _______________ __________ changes - ______________ changes - Headache - ______________ ___________ - ________________ edema

Amantadine, antiviral, influenza A, dopamine, alone, combination, anticholinergic, parkinsonism, tolerance, mental status, sleep, orthostatic hypotension, peripheral

____________: Treatment for narcolepsy. If used for weight loss, the patient must also be educated about lifestyle. Not given to children less than 12 years of age.

Anorexiants

The nurse has received an order to administer an initial dose of IV phenytoin to a patient with new-onset seizures. What will the nurse check before administering this medication? Select all that apply. A. Hourly urine output B. Blood glucose levels C. Cardiac rhythm D. Blood pressure

B, C, D

Which of the following assessment findings could the nurse see in a patient with Parkinson's disease? Select all that apply. A. an abrupt onset of symptoms B. muscle rigidity C. Involuntary tremors D. Bradykinesia E. Bilateral muscle weakness

B, C, D

The nurse is teaching a patient with parkinsonism about carbidopa-levodopa. Which statement(s) by the patient indicate(s) the need for further teaching? Select all that apply. A. "This medication may make my movements smoother." B. ""My skin may turn yellow if I miss too many doses." C. " I need to take vitamin B6 supplements with this medication" D. "I should take this medicine on an empty stomach." E. "I need to check my blood sugar regularly while taking this medication"

B, C, D, E

The patient has just been diagnosed with epilepsy and will be starting phenytoin. The patient's spouse asks how this medication works in the body. What is the nurse's best response? A. "It inhibits the enzyme that destroys one of the neurotransmitters? B. "It helps stop the entry of sodium into the cell." C. "It has not been determined exactly how it prevents seizures." D. "it increases the amount of calcium that enters the cell"

B. "It helps stop the entry of sodium into the cell."

The patient has a seizure disorder and has just discovered that she is pregnant. At her first prenatal visit, she tells the nurse, "I quit taking all of my medications because I don't want anything to be wrong with my baby." What is the nurse's best response? A. "You can't do that. You have to take your medication." B. "What medications have been prescribed for you?" C. "How long have you had seizures?" D. "When was your last seizure?"

B. "What medications have been prescribed for you?"

Phenytoin levels must be monitored carefully as there is a narrow therapeutic range. Which result is within therapeutic range? A. 8 mcg/mL B. 18 mcg/mL C. 28 mcg/mL D. 38 mcg/mL

B. 18 mcg/mL

Phenytoin has been prescribed for a patient with seizures. The nurse should include which appropriate nursing intervention in the plan of care? A. report an abnormal phenytoin level of 18 mcg/mL B. Monitor complete blood count levels for early detection of blood dyscrasias C. Encourage the patient to brush teeth vigorously to prevent plaque buildup D. Teach the patient to stop the drug immediately when passing pinkish-red or reddish-brown urine

B. Monitor complete blood count levels for early detection of blood dyscrasias

A patient is having absence seizures. Which of the following does the nurse expect to be prescribed for this type of seizure? Select all that apply. A. Phenytoin B. Phenobarbital C. Valproic acid D. Clonazepam E. Ethosuximide

C, D, E

When administering phenytoin, the nurse realizes more teaching is needed if the patient makes which statement? A. "I must shake the oral suspension very well before pouring it in the dose cup" B. "i cannot drink alcoholic when taking phenytoin" C. "I should take phenytoin 1 hour before meals" D. "I will need to get periodic dental checkups"

C. "I should take phenytoin 1 hour before meals"

The nurse is preparing discharge teaching for a patient who has been started on phenytoin for seizure disorder. What information about side effects of this medication should the nurse provide to the patient and his family? A. "There may be a green discoloration of the patient's urine" B. "it is best to use a hard-bristle toothbrush for dental care" C. "Nosebleeds and sore throats should be reported to the health care provider" D. "The patient should get up slowly to prevent fainting"

C. "Nosebleeds and sore throats should be reported to the health care provider"

A patient is taking rivastigmine. The nurse should teach the patient and family which information about rivastigmine? A. Hepatotoxicity may occur B. The initial dose is 6 mg three times a day C. Gastrointestinal distress is a common side effect D. Weight gain may be a side effect

C. Gastrointestinal distress is a common side effect

A patient with a history of parkinsonism is brought into the emergency department after the family reports the patient is talking to "rabbits coming out of the walls" at home. Which medication does the nurse suspect may have caused this symptom? A. Bromocriptine Mesylate B. Selegiline HCL (Eldepryl) C. Pramipexole dihydrochloride (Mirapex) D. Tolcapone (Tasmar)

C. Pramipexole dihydrochloride (Mirapex)

A patient with parkinsonism currently takes carbidopa-levodopa, and the patient's health care provider adds the medication entacapone to the patient's drug regimen. What would the nurse expect to occur with the carbidopa-levodopa dosing? A. there should be no change in the medication dosage B. both carbidopa and levodopa dosages should be decreased C. The levodopa dosage alone should be decreased D. The carbidopa dosage alone should be decreased

C. The levodopa dosage alone should be decreased

A patient's wandering and hostility levels have increased per family reports. What should concern the nurse in this patient who is taking memantine (Namenda) 10 mg/d? A. The patient is taking too high a daily dose to maintain mental sides B. The patient has taken an overdose of the medication C. The patient is not taking enough of the medication D. The patient needs to take a combination of memantine and amantadine

C. The patient is not taking enough of the medication

The nurse witnesses a patient's seizure involving generalized contraction of the body followed by jerkiness of the arms and legs. The nurse reports this as which type of seizure? A. Myoclonic B. Absence C. Tonic-clonic D. Psychomotor

C. Tonic-clonic

Which anticonvulsant may also be used as prophylaxis for migraine headaches? A. diazepam (valium_ B. phenytoin (dilantin) C. Valproic acid (depakote) D. Clorazepate (Tranxene)

C. Valproic acid (depakote)

A patient is receiving carbidopa-levodopa for Parkinson's disease. What should the nurse know about this drug? A. Carbidopa-levodopa may lead to hypertension B. Carbidopa-levodopa may lead to excessive salivation C. Dopaminergic and anticholinergic therapy may lead to drowsiness and sedation D. Dopaminergic and anticholinergic are contraindicated in patients with glaucoma

D. Dopaminergic and anticholinergic are contraindicated in patients with glaucoma

A patient with Alzheimer's disease is taking rivastigmine (Exelon) and has also been started on medication for depression. Which order will the nurse question prior to administering the new drug? A. atypical antidepressant B. Monoamine oxidase inhibitor (MAOI) depressant C. Selective serotonin reuptake inhibitor (SSRI) antidepressant D. Tricyclic antidepressant

D. Tricyclic antidepressant

The nurse is working on a neurosurgery nit. The patient calls the desk to complain that his arm is really burning and feels hot. The patient is receiving IV phenytoin for his grand mal seizures. What is the nurse's best action? A. Call the health care provider immediately to change the medication to oral. B. continue the infusion and reassure the patient C. Flush the line with 10 mL of normal saline and continue the infusion D. discontinue the IV and restart the IV infusion in a different site

D. discontinue the IV and restart the IV infusion in a different site

A nurse administering valproic acid to a patient checks the laboratory values and finds a serum range for valproic acid of 150 mcg/mL. What should the nurse do? A. Increase the daily dose to get the patient's level into the therapeutic range B. Hold the morning dose but give the other scheduled dosages for the day C. Ask the patient if he or she is having any adverse effects from the medication D. hold the medication and notify the health care provider

D. hold the medication and notify the health care provider

Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors Drug: Rivastigmine Side effects: -GI distress - ____ bleeding - dizziness - _____________ - _____________ edema - _______________ ___________ syndrome - ____________ Adverse Reactions - ___________ - Bradycardia - ______________ ____________ - ______________ - ______________ ____________

GI, depression, peripheral, restless legs, nystagmus, seizures, orthostatic hypotension, cataracts, myocardial infarction

Side Effects of Parkinson Medications: -__________ status and __________ changes -__________________ - _____________ body movements - _____________ pain - _____________ distress - Dries ____________ - __________ disturbances - Orthostatic Hypotension

Mental status, mood, dyskinesia, involuntary, chest, GI, secretions, sleep

What is the prototype drug for central nervous system stimulants?

Methylphenidate

Melotonin Agonists: -__________ -First hypnotic not classified as a _______________ - Not been shown to decrease _______________ - Also used as an ____________ drug

Ramelteon, controlled substance, REM sleep, antianxiety

Monoamine Oxidase B Inhibitors: Drug: ______________ Action: - Inhibit __________ enzyme that interferes with ________ Side Effects: - Dizziness, headache, nausea, dry mouth - Orthostatic hypotension, ______________ - ____________ ____________ disorder, _____________ ideation Interactions: - foods high in ____________ can cause hypertensive crisis

Selegilene, MAO-B, dopamine, hypertension, impulse control, suicidal, tyramine

Catechol-O-methyltransferase Inhibitors: Drug: ____________ Actions: - Inhibit __________ enzyme that inactivates ____________ Side Effects: -Headache - _____ distress - __________ disturbance - Orthostatic hypotension - ______________ _____________ disorder - ______________ dysfunction

Tolcapone, COMT, dopamine, GI, sleep, impulse control, hepatic

The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer's disease (AD). Which statement by the family member indicates understanding of the teaching? a. "Alzheimer's disease is a chronic, progressive condition." b. "Alzheimer's disease affects memory but not personality." c. "The onset of Alzheimer's disease is usually between 65 and 75 years." d. "With proper treatment, symptoms of this disease can be arrested."

a. "Alzheimer's disease is a chronic, progressive condition."

The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. "Avoid any products containing pseudoephedrine or caffeine." b. "Never give over-the-counter medications with Adderall." c. "Sudafed is a safe and effective decongestant." d. "Use any over-the-counter medication from the local pharmacy."

a. "Avoid any products containing pseudoephedrine or caffeine."

The nurse is caring for a patient who has migraine headaches. The patient reports having these headaches more frequently. Which is an appropriate recommendation for this patient? a. "Avoid chocolate and caffeine." b. "Engage in strenuous exercise." c. "Have a glass of red wine with dinner." d. "Take ibuprofen prophylactically."

a. "Avoid chocolate and caffeine."

A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? a. "Avoid consuming foods that are high in tyramine." b. "This drug will prevent the need to take levodopa." c. "You may have red wine with dinner on occasion." d. "You will not have serious drug interactions with this drug."

a. "Avoid consuming foods that are high in tyramine."

The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should consult a pharmacist when giving my child OTC medications." b. "I will only give my child diet soft drinks while administering this medication." c. "Medication therapy means that behavioral therapy will not be necessary." d. "Weight gain is a common side effect of this medication."

a. "I should consult a pharmacist when giving my child OTC medications."

The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patient's provider.

a. Ask the child whether the drug is being taken as prescribed.

An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? a. Carbidopa-levodopa (Sinemet) b. Donepezil (Aricept) c. Rivastigmine (Exelon) d. Tacrine (Cognex)

a. Carbidopa-levodopa (Sinemet)

A patient reports having recurring headaches described as 1 to 2 headaches per day for several weeks. The nurse understands that these headaches are most likely descriptive of which type of headache? a. Cluster headache b. Migraine headache c. Simple headache d. Tension headache

a. Cluster headache

A college-age student is brought to the emergency department by friends after consuming NoDoz tablets along with several cups of coffee and a few energy drinks. The patient is complaining of nausea and diarrhea and appears restless. The nurse understands that a. arrhythmias and convulsions may occur. b. caffeine dependence does not occur. c. effects of the substances will wear off shortly. d. severe adverse effects do not occur.

a. arrhythmias and convulsions may occur.

A patient has been using an amphetamine drug as an anorexiant for several weeks and asks the nurse about long-term adverse effects of this type of medication. The nurse will explain to the patient that these drugs a. can cause cardiac dysrhythmias. b. contribute to the development of narcolepsy. c. do not have severe effects when used properly. d. will cause orthostatic hypotension.

a. can cause cardiac dysrhythmias.

Benzodiazepines as anticonvulsants: Clonazepam: - treats ______ and _________ seizures - _________ may occur in ________ - therapeutic range = ____________ Clorazepate Dipotassium: - treats __________ seizures Diazepam: - treats _______ _________ - Must be administered _________ for ________ __________ -Short-term effect - other antiseizure drugs must be given ______ or immediately _______ administration of diazepam Side effects: - sedation, drowsiness, dizziness - _________ vision - _________ dyscrasias -__________ toxicity - med _______ and __________ If given through an IV it should be administered __________ to avoid ____________

absence, myoclonic, tolerance, 6 months, 20 to 80 ng/mL, partial, status epilepticus, IV, status epilepticus, before, after, blurred, blood, liver, tolerance, dependence, slowly, bradycardia

Acetylcholinesterase Inhibitors/ Cholinesterase Inhibitors Action: - allow more ___________ in neuron receptors - Increase ____________ function in early disease Use: - ________ to __________ Alzheimer's disease Side Effect: - _______ distress Drug:_____________ Side effect: can slow heart rate Drug: ______________ Side effect: bronchoconstriction Drug:_______________ Side effects: dizziness, headache, confusion Drug:_______________ Side effectsL ataxia, heptotoxicity

acetylcholine, cognitive, mild, moderate, GI, Donepezil, Galantamine, Mematine, Tacrine

Parkinsonism (Cont.) Treatment regimen: ______________ - block cholinergic receptors ______________ - convert to dopamine ______________ - stimulate dopamine receptors ________________________ - Inhibit MAO-B enzyme that interferes with dopamine ______________________ - Inhibit COMT enzyme that inactivates dopamine

anticholinergics, dopaminergics, dopamine agonists, MAO-B inhibitors, COMT inhibitors

The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should give this drug to my child at bedtime." b. "My child should avoid products containing caffeine." c. "The drug should be stopped immediately if my child develops aggression." d. "We should monitor my child's weight since weight gain is common."

b. "My child should avoid products containing caffeine."

A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication? a. "Call your health care provider immediately if your urine or perspiration turn a dark color." b. "Rise slowly from your bed or your chair to avoid dizziness and falls." c. "Take the drug with foods high in protein to improve drug delivery." d. "Discontinue the drug if you experience insomnia."

b. "Rise slowly from your bed or your chair to avoid dizziness and falls."

The nurse is caring for an 80-year-old patient who has Alzheimer's disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient? a. Administer the drug once daily. b. Assist the patient to stand and walk. c. Give the drug with food to increase absorption. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.

b. Assist the patient to stand and walk.

The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin)

b. Caffeine (Cafcit)

The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient's provider if the patient had a history of which condition? a. Asthma b. Glaucoma c. Hypertension d. Irritable bowel disease

b. Glaucoma

The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child? a. Heart rate, respiratory rate, and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Nausea, vomiting, and gastrointestinal upset

b. Height, weight, and blood pressure

A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient's urine is orange in color. The nurse will a. notify the provider of possible drug toxicity. b. reassure the patent that this is a harmless side effect. c. request an order for liver function tests. d. request an order for a urinalysis.

b. reassure the patent that this is a harmless side effect.

The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson's disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will a. counsel the spouse that parkinsonism is a normal part of the aging process in some people. b. recommend exercise, nutritional counseling, and group support to help manage the disease. c. tell the spouse that the disease will not progress if mild symptoms are treated early. d. tell the spouse that medication therapy can be curative if drugs are begun in time.

b. recommend exercise, nutritional counseling, and group support to help manage the disease.

Antiparkinsonism Drugs: Anticholinergic Side Effects: - ___________ vision - ___________ secretions - ___________ pulse, _________, __________ - ___________ status and ________ changes - ___________

blurred, dries, increased, palpitations, dysrhthmias, mental, mood, photophobia

The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response by the nurse is correct? a. "Anorexiants are often used to 'jump start' a weight loss regimen in children." b. "Children are able to use over-the-counter anorexiants on a long-term basis." c. "Children under 12 years of age should not use weight loss drugs." d. "Side effects of anorexiants occur less often in children."

c. "Children under 12 years of age should not use weight loss drugs."

A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the provider to order for this patient to replace carbidopa-levodopa? a. Amantadine HCl (Symmetrel) b. Benztropine (Cogentin) c. Bromocriptine mesylate (Parlodel) d. Tacrine (Cognex)

c. Bromocriptine mesylate (Parlodel)

A patient is brought to the emergency department with a drug overdose causing respiratory depression. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin)

c. Doxapram (Dopram)

The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of the head b. Electrocardiogram (ECG) c. Electroencephalogram (EEG) d. Magnetic resonance imaging (MRI) of the brain

c. Electroencephalogram (EEG)

The nurse is caring for a patient in the post-anesthesia care unit who has received a spinal anesthetic. Which action will the nurse perform? a. Ambulate the patient as soon as consciousness returns. b. Elevate the head of the bed to a semi-Fowler's position. c. Have the patient lay flat for 6 to 8 hours after the surgery. d. Turn the patient from side to side every 15 minutes.

c. Have the patient lay flat for 6 to 8 hours after the surgery.

The nurse is caring for a patient in the post-anesthesia care unit and notes that the patient received isoflurane (Forane) to induce anesthesia. When will the nurse expect the patient to recover consciousness? a. Immediately b. In 15 to 30 minutes c. In 1 hour d. In hours

c. In 1 hour

A patient reports difficulty staying awake during the daytime in spite of getting adequate sleep every night. Which medication will the nurse expect the provider to order for this patient? a. Caffeine (NoDoz) b. Methylphenidate (Ritalin) c. Modafinil (Provigil) d. Theophylline

c. Modafinil (Provigil)

A nursing student asks the nurse to differentiate the pathology of Alzheimer's disease from that of Parkinson's disease. Which description is correct? a. Alzheimer's disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimer's disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinson's disease involves increased dopamine production and decreased acetylcholine.

c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine.

The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer's disease. The patient will be taking a new medication. Which is a realistic goal for this patient? a. Demonstrate improved cognitive function. b. Exhibit improved ability to provide self-care. c. Receive appropriate assistance for care needs. d. Show improved memory for recent events.

c. Receive appropriate assistance for care needs.

The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform? a. Encourage increased oral fluids. b. Obtain an order for intravenous fluids. c. Report the urine output to the provider. d. Request an order for renal function tests.

c. Report the urine output to the provider.

The nurse is teaching a family member about an elderly parent's new prescription for tacrine (Cognex) to treat Alzheimer's disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will a. demonstrate improved ambulation. b. have reversal of all symptoms. c. have decreased deterioration of cognition. d. show improved communication ability.

c. have decreased deterioration of cognition.

The nurse is performing a medication history on a patient who reports using phentermine HCl (Suprenza) 15 mg/day for the past 3 months as an appetite suppressant. The nurse will contact the patient's provider to discuss a. changing the medication to phentermine-topiramate (Qsymia). b. increasing the dose to 37.5 mg/day since tolerance has likely occurred. c. initiating a slow taper of the phentermine. d. stopping the drug immediately since long-term use is not recommended.

c. initiating a slow taper of the phentermine.

Iminostilbenes: Drug - ________________ Use: - effective in treating _______ seizure disorders that have not responded to other anticonvulsant therapies - Control _______ ______ and ________ seizures and a combination of these seizures - ___________ disorders - ___________ ___________ - ___________ withdrawal Therapeutic serum range: ___________ Interaction with grapefruit juice may cause ____________ Side effects: - drowsiness, dizziness - ______ distress - _______ ________ - rash - ____________ abnormalities - _____________ dyscrasias - ___________

carbamazepine, refractory, grand mal, partial, psychiatric, trigeminal neuralgia, alcohol, 5 to 12 mcg/mL, toxicity, GI, dry mouth, visual, blood, headache

Acetylcholinesterase inhibitors/Cholinesterase Inhibitors Drug: Rivastigmine - prescribed to improve ________ function for patient with ________ to _________ Alzheimer's disease - Increases the amount of ______ at the cholinergic _________ - Slows the disease process - Fewer drug interactions than __________ and _____________ -Caution with _________, ______________, urinary ___________, ___________ disease

cognitive, mild, moderate, acetylcholine, synapses, donepezil, tacrine, PUD, bradycardia, obstruction, lung

International classification of Seizures: Generalized Absence: - Brief loss of ___________ (_________ or less) - Usually occurs in __________

consciousness, 10 seconds, children

Seizures: - characterized by a loss or disturbance of _________ and __________ - _____% of seizure are considered to be _______, or _________, and the remaining are ________ to other causes.

consciousness, convulsions, 75, primary, idiopathic, secondary

Anticonvulsants and Status Epilepticus: Status Epilepticus: - a __________ seizure state - medical emergency - treatment must begin __________ Treatment: 1. _________ 2. _________ followed by Phenytoin IV 3. for continued seizures: _________, _________ 4. Slow IV administration to avoid ________ depression

continuous, immediately, diazepam, lorazepam, midazolam, propofol, respiratory

The nurse is teaching a patient who has Parkinson's disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching? a. "I may experience urinary retention, dry mouth, and constipation." b. "I may feel dizzy at first, but this side effect will go away with time." c. "I should report nightmares and mental disturbances to my provider." d. "I should take the drug with food to increase absorption."

d. "I should take the drug with food to increase absorption."

The nurse has initiated teaching for a family member of a patient with Alzheimer's disease. The nurse realizes more teaching is needed if the family member makes which statement? a. As the disease gets worse, the memory loss will get worse. b. There are several theories about the cause of the disease. c. Personality changes and hostility may occur. d. It may take several medications to cure the disease.

d. It may take several medications to cure the disease.

A patient who has Parkinson's disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect? a. Helping the patient to walk faster b. Improving mental function c. Minimizing symptoms of bradykinesia d. Reducing some of the tremors

d. Reducing some of the tremors

An older adult has difficulty falling asleep. The nurse understands that which sedative hypnotic is appropriate for this patient? a. Butabarbital (Butisol) b. Flurazepam (Dalmane) c. Secobarbital (Seconal) d. Temazepam (Restoril)

d. Temazepam (Restoril)

A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product a. allows larger doses of levodopa to be given without causing increased adverse reactions. b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier. c. eliminates almost all drug side effects of both levodopa and carbidopa. d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.

d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.

Antiparkinsonism Drugs (Cont) Dopaminergics: Drug: carbidopa-levodopa Action- converted to ______; leads to increased _________ Side Effects: - Fatigue; __________ - Dry _____________ - ___________ vision - Orthostatic hypotension, __________, _______________ - __________ distress - Dyskinesia, _____________, severe ___________

dopamine, motility, insomnia, secretions, blurred, palpitations, dysrhythmias, GI, psychosis, depression

Epilepsy: Seizure disorder: - abnormal ___________ from __________ Characteristics: - Loss of __________ - _____________ movements Cause: - _________ - Secondary to _______, ________, __________, ________ - Isolated seizures due to _________, _________, or ___________ imbalance

electric discharge, cerebral neurons, consciousness, convulsive, unknown, trauma, anoxia, infection, stroke, fever, electrolyte, acid-base

Succinimides Drug: ______________ Action: - decreases _________ influx Use - ___________ seizures Therapeutic serum rang: - _______________ Adverse effects: -_______ dyscrasias - ___________ and ________ impairment - Systemic ___________ _____________

ethosuximide, calcium, absence, 40 to 100 mcg/mL, blood, renal, liver, lupus erythematosus

Antiparkinsonism drugs: Nursing Interventions: - monitor vs - Monitor _______ output - Increased ________ intake, ______, and ________ to avoid constipation. Monitor _________ function. - Observe for _________ movement - Advise patient to avoid alcohol, cigarettes, _________, and _________ to decrease _________ acidity. - Encourage patient to relieve ______ _______ with ice chips, hard candy, and sugarless chewing gum. - Suggest use of __________ for photophobia. Routine ______ exams. - Assess risk for _______

fluid, fiber, exercise, bowel, involuntary, caffeine, aspirin, gastric, dry mouth, sunglasses, eye, injury

International Classification of Seizures: Generalized Tonic-clonic (______ _______) - _________ common - Generalized __________ spasms and _________

grand mal, most, muscle, jerkiness

Sedative-hypnotics: -Residual drowsiness (_________) - Drug __________ - Drug __________ - Excessive __________- especially ________- may not be able to wake them up - ____________ depression - ____________ symptoms These drugs are generally ______-term

hangover, dependence, tolerance, depression, elderly, respiratory, withdrawal, short

Interventions for Parkinson Medications: - VS - Assess risk for ________ - Take meds _______ food if nausea occurs - Monitor for Parkinson's signs and improvement - Report side effects - Change __________ slowly - Do not ____________ d/c - ___________ urine and ______________ is normal - Administer drug with ______________ foods - Avoid vitamin ___________, _________, and other ________ - Assess for __________ tendencies - Monitor blood cell counts, _______ and _______ function

injury, with, position, abruptly, discolored, perspiration, low-protein, B6, alcohol, depressants, suicidal, liver, kidney

Side effects of stimulants: CNS - ________, ________, _________ Cardiac - ________, __________, __________, ___________ GI - _________, __________, _________, __________ _______ Failure ____________ - especially if the patient already has mental health issues Sexual __________ ____________ and __________

jitters, irritable tremors, insomnia, palpitations, tachycardia, arrhythmias, raised BP, dry mouth, loss of appetite, weight loss, abdominal cramping, liver, psychoses, impotence, dependence and tolerance

Spinal Anesthesia: -______________ anesthetic injected in the ___________ space at the ________ or _______ lumbar space Side effects/adverse reactions: - ____________ distress - ____________ - ____________

local, subarachnoid, third, fourth, respiratory, headache, hypotension

Alzheimer's Disease Pathophysiology: - chronic, progressive __________________ conditions - Marked ____________ dysfunction - ___________ plaques form and ____________________ tangles in neurons - Cholinergic neurotransmitter _____________

neurodegenerative, cognitive, neuritic, neurofibrillary, abnormality

Parkinsonism Patho: - Chronic _________ disorder - Imbalance of the neurotransmitters __________ and __________ - Marked by _____________ of neurons of the _____________ _________ tract - Reason for the __________ of neurons is _____________ Three Parkinson-associated Symptoms: - ___________ -____________ -____________

neurological, dopamine, acetylcholine, degeneration, extrapyramidal motor, degeneration, unknown, bradykinesia, musculorigidity, tremors

Antiparkinsonism Drugs: ____________ - inhibit the release of acetylcholine Drug: _________ Action: - reduce the rigidity and some of the tremors that are characteristic of parkinsonism - Minimal effect on _________, _________, and __________ - Used to treat ______________ parkinsonism, or _________________

parasympatholitic, benztropine, bradykinesia, rigidity, balance, drug-induced, pseudoparkinsonism

Valproate: Drug- Valproic acid Use: - treat _______ ________ - treat _______ ________ - treat mixed types of seizures Safety and efficacy: - Not established for children younger than __________ Caution in patients with __________ disorders Therapeutic serum range: 50 to 150 mcg/mL Side effects: - ________ distress - ________________ - blood __________ - ___________ toxicity - N/V - Indigestion

petit mal, grand mal, 2 years old, liver, GI, pancreatitis, dyscrasias, hepatotoxicity

Hydantoins Contraindications: - ___________ Therapeutic serum level - _____ to ______ Side effects/adverse reactions: - _________ hyperplasia - _________, __________ - Changes in ________ - __________, __________ - __________ or alopecia, _____, __________ - blood ____________ - ______ distress

pregnancy, 10 to 20 mcg/mL, gingival, nystagmus, diplopia, loc, headache, dizziness, hirsutism, rash, pruritis, dyscrasias, GI

International classification of seizures Partial- Psychomotor: - __________ behavior - _________ or _______ motions - ____________ changes - Motor __________

repetitive, chewing, swallowing, behavioral, seizures

Antiseizure Medications: Interventions: - __________ precautions - Labs - Monitor I&O - Monitor for signs of _________ (_____ depression, ________, n/v, __________, _________, _________, ____________ disturbances) - Document _________ activity, ________, _________

seizure, toxicity, cns, ataxia, vomiting, drowsiness, dizziness, restlessness, visual, seizure, location, duration

Barbiturate as Anticonvulsant: Treats- - partial _______ -_______ ______ seizures - acute episodes of ________ ________ seizures -___________ -_______ reactions - ___________ Therapeutic serum range: -_______________ Risks: -____________ and patient ___________ to the drug Discontinuance should be ________ to avoid recurrence of __________ Side effects: -__________ -__________ -___________ changes -_____________________

seizures, grand mal, status epilepticus, meningitis, toxic, eclampsia, 20 to 40 mcg/mL, sedation, tolerance, gradual, seizures, sedation, dizziness, mood, hypertension

Anticonvulsants/Antiepileptic Drugs (AEDs) Suppress _________ influx - ___________ Suppress ___________ influx - ______ _______ Enhance action of GABA -____________ and ____________ Promote _________ release - __________

sodium, phenytoin, calcium, valproic acid, barbiturates, benzodiazepines, GABA, Gabapentin

Dopaminergics: Carbidopa-levodopa- Drug interactions: Decreases effect of levodopa when combined with: - anticholinergics - phenytoin - _________ antidepressants - _________ inhibitors - _______________________ - _______________________ - Vitamin ______

tricyclic, MAO, benzodiazepines, phenothiazines, B6

Rivastigmine Interventions - safety when ___________ - Assess ________ and ________ abilities - Caution with ________ and _______ disease - _______ coping Teach Family: - ________ of meds - Schedule - Safety - __________ groups - Rise slowly to keep balance - Routine __________ - Give meds ___________ food

wandering, physical, motor, liver, renal, family, purpose, support, LFTs, without

Education for client on seizure medications: - Take exactly as prescribed - Take ______ food to prevent GI upset but not with __________ or _______ - Do not __________ - Avoid _______ and ________ meds - Wear medic alert - Caution with __________ - Good _______ hygiene and _______ check-ups - Routine labs for ________ levels - Urine may turn _______-________ - Report signs of sore throat, ________, ________ bleeds - Inform provider if ________ _________ - ____________ precautions

with, antacids, milk, discontinue, ETOH, OTC, driving, oral, dental, drug, pink, red, bruising, nose, side effects, seizure

A patient is to receive conscious sedation for a minor surgical procedure. Which drug administration should the nurse expect? Select all that apply. A. propofol to reduce anxiety B. lidocaine to provide local anesthetic C. Midazolam to promote sedation and following of commands D. Ketamine for rapid induction and prolonged duration of action E. Phenobarbital for short-acting duration of sleep

A, B, C

The patient has been prescribed methylphenidate for the treatment of narcolepsy. What priority teaching consideration(s) should be included for this patient? Select all that apply. A. Avoid operating hazardous equipment B. Caffeine should be avoided C. Nervousness and tremors may occur D. Take the medication before meals E. Report any weight gain

A, B, C, D

The patient works 12-hour night shifts one week and 12-hour day shifts the next week. He tells the nurse he has been taking "some kind of sleeping pill from the drugstore." What does the nurse suspect is the most likely main ingredient in the over-the-counter sleep medication? A. antihistamines B. barbiturates C. Benzodiazepines D. Melatonin

A. antihistamines

It is important for the nurse teaching the patient regarding secobarbital to include which information about the drug? A. it is a short-acting drug that may cause one to awaken early in the morning B. It is an intermediate-acting drug that frequently causes rapid eye movement rebound C. it is an intermediate-acting drug that frequently causes a hangover effect D. It is a long-acting drug that is frequently associated with dependence

A. it is a short-acting drug that may cause one to awaken early in the morning

The nurse is teaching a patient to self-administer medications. The nurse knows that which drug is used to treat narcolepsy? A. Modafinil B. Atomoxetine C. Lisdexamfetamine D. Phendimetrazine

A. modafinil

What would indicate to the nurse that the child taking methylphenidate requires more teaching? A. the child is seen drinking a cola product B. The child checks his weight twice a week C. The child takes the drug 45 minutes before a meal D. The child takes the drug before breakfast and lunch

A. the child is seen drinking a cola product

Non-benzodiazepines as hypnotics: - ___________ Action -____________ inhibition -Its duration of action is ___________ with a short half-life of _____________ Use - treat short-term (less than __________) ___________

Zolpidem, neurotransmitter, 6 to 8 hours, 2 to 4.5 hours, 10 days, insomnia

A patient is taking ramelteon for insomnia. The nurse prepares a care plan that includes monitoring of the patient for side effects/adverse reactions of this drug. Which is a side effect of ramelteon? A. insomnia B. bradycardia C. laryngospasm D. sleep-related behaviors

B. bradycardia

Sedative-hypnotics: - ______________ -_______________ -_______________ OTC -_________ (Tylenol PM) -_________________ (Benadryl)

Barbiturates, benzodiazepines, nonbenzodiazepines, sominex, diphenhydramine

Methylphenidate: Interventions: - Give ______ breakfast and lunch - Report ________ heartbeat - Record _______, ________, and _______ of children - Avoid ________ and ________ - Use _________ to relieve dry mouth - __________ to avoid withdrawal - __________ must also be used - Avoid _________ if experiencing __________

Before, irregular, height, weight, growth, caffeine, ETOH, sugarless gum, taper off, counseling, driving, tremors

A patient taking lorazepam asks the nurse how this drug works. The nurse should respond by stating that it is a benzodiazepine that acts by which mechanism? A. Depressing the central nervous system, leading to a loss of consciousness B. Depressing the central nervous system, including the motor and sensory activity C. Increasing the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to GABA receptors D. Creating an epidural block by placement of the local anesthetic into the epidural space

C. Increasing the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to GABA receptors

A patient returns to the unit after having surgery with spinal anesthesia. What does the nurse know is/are the best action(s) to take to decrease possibility of spinal headache? Select all that apply. A. administer morphine 1 to 2 mg IV B. ambulate the patient as soon as she gets feeling back C. Encourage the patient to stay flat in bed D. Increase fluid intake E. Position the patient in high-fowler's position

C, D

The 18-year-old patient is brought to the emergency department by her roommates. Her blood pressure is 220/136 mm Hg, heart rate 142 beats/minute, and respiratory rate 20 breaths.minute. She is responsive only to deep pain. Her roommates say she has been trying to lose weight and has been taking "these pills she gets over the Internet." What will the nurse consider as the most likely cause for this patient's symptoms? A. cardiac symptoms B. Food poisoning C. Hemorrhagic stroke D. Pregnancy-induced hypertension

C. Hemorrhagic stroke

A newborn patient is in respiratory distress. The nurse anticipates preparation for which medication to be given? a) modafinil b) armodafinil c) theophylline d) amphetamine

C. Theophylline

A patient received spinal anesthesia. Which is most important for the nurse to monitor? A.loss of consciousness B. hangover effects and dependence C. hypotension and headaches D. excitement or delirium

C. hypotension and headaches

What is the most serious adverse effect of spinal anesthesia? A. hypotension. B. headache. C. respiratory distress. D. tachycardia.

C. respiratory distress.

What is the most commonly prescribed medication to aid patients with sleep disorders? A. analeptic B. anesthetic C. sedative-hypnotic D. triptan

C. sedative-hypnotic

The nurse monitoring a patient for methylphenidate withdrawal should observe the patient for which condition? A. tremors B. Insomnia C. Weakness D. tachycardia

C. weakness

Barbiturates (continued): Side effects: -_______ -________ reaction -_________________ OD: -_____________ -__________, __________ skin -Change in ______________ - CNS - ____________ disappear -_______________ and ___________

CNS, allergic, hematological, cardiac, cool, clammy, respirations, reflexes, coma, death

CNS Stimulant Interventions: - Document degree of _____ activity - Assess ____, _____, ______ - especially in kids - Monitor ______ patterns - take last dose of day at least _____ hours before ________ - Avoid _______ and _______ - Take meals _______ food - Discuss with your child's _______ - Takes _____ to _____ weeks to notice calming effects on children

CNS, height, weight, growth patterns, sleep, 6, bedtime, caffeine, ETOH, with, school nurse, 3 to 4

General Anesthetics: Purpose: - depress the _______, alleviate __________, and cause a loss of __________

CNS, pain, loss of consciousness

Methylphenidate: Interactions: - __________ - ___________ effects of _________, ___________, __________ - May alter ________ effects

Caffeine, decreased, decongestants, antihypertensives, barbiturates, insulin

A child has been diagnosed with attention deficit/hyperactivity disorder (ADHD). Which drug does the nurse anticipate the health care provider will prescribe? A. Zolmitriptan B. Doxapram HCl C. Benzphetamine HCl D. Methylphenidate HCl

D. Methylphenidate HCl

Methylphenidate (Ritalin) Side effects/adverse reactions: -_______ -_______ -________ -__________________ Contraindications: -_______ problems, __________, ___________, ___________, __________

Cardiac, CNS, GI, thrombocytopenia, cardiac, hypertension, hyperthyroid, parkinson's, glaucoma

Which type(s) of anesthesia is/are administered using lidocaine? Select all that apply. A. general B. inhaled C. intravenous D. local E. spinal

D, E

A patient is taking triazolam. Which instructions about this drug are important for the nurse to include? A. it may be used as a barbiturate for only 4 weeks B. Use as a nonbenzodiazepine to reduce anxiety C. It may cause agranulocytosis and thrombocytopenia D. Avoid alcohol and smoking while taking this drug

D. Avoid alcohol and smoking while taking this drug

Methylphenidate should not be taken by patients with a history of which condition? A. Renal failure B. Cataracts C. Hypothyroidism D. Coronary artery disease

D. Coronary artery disease

When providing teaching to a group of parents regarding attention deficit/ hyperactivity disorder (ADHD), which information will the nurse include? A. Children with ADHD have low intelligence. B. Children with ADHD have an infection in their spinal fluid. C. EEG results are typically normal in children with ADHD. D. Learning disabilities are often present in the child who has ADHD.

D. Learning disabilities are often present in the child who has ADHD.

A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. What may this be associated with? A. hangover. B. tolerance. C. hypersensitivity. D. REM rebound.

D. REM rebound.

The patient has a history of migraines, depression, and hypertension and has been started on phentermine-topiramate (Qsymia). For which condition is phentermine-topiramate used? A. ADHD B. Asthma C. Narcolepsy D. Short-term weight management

D. Short-term weight management

What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching? A. The patient wants to listen to music on the radio. B. The patient has saved her urine to be measured. C. The patient says she has taken 1800 mL of fluid today. D. The patient requests a cup of kava kava tea to help her get to sleep faster.

D. The patient requests a cup of kava kava tea to help her get to sleep faster.

The patient is postoperative day 3 from major orthopedic surgery and is unable to sleep. If non-pharmacologic measures have not been effective, what medication does the nurse anticipate may be ordered? A. Flumazenil (Romazicon) B. Phenobarbital (Luminal) C. Triazolam (Halcion) D. Zolpidem (Ambien)

D. Zolpidem (Ambien)

Several children are admitted for diagnosis with possible attention-deficit/hyperactive disorder. Which is most important for the nurse to observe? A. A girl who is lethargic B. a girl who lacks impulsivity C. A boy with smooth coordination D. A boy with an inability to complete tasks

D. a boy with an inability to complete tasks

When a 12-year-old child is prescribed methylphenidate, which is most important for the nurse to monitor? a) temperature b) respirations c) intake and output d) height and weight

D. height and weight

Which nursing intervention would be most appropriate for a patient taking temazepam? A. monitor for fever B. give drug IV only C. monitor daily weight D. tell patient to ask for help before standing

D. tell patient to ask for help before standing

Respiratory CNS Stimulants: -___________ Uses: - _________ depression caused by _________, pre- and postanesthetic _________ depression, and _______ Onset of Action: - ______ to _______ seconds, peak within _________________ Side effects: -_____________, _____________, ____________, __________

Doxapram, respiratory, overdose, respiratory, COPD, 20, 40, 2 minutes, hypertension, tachycardia, trembling, convulsions

Attention Deficit/Hyperactivity Disorder (ADHD) Patho: - ________ of transmitters Epidemiology: - Usually occurs in ________ before age _____ - More common in _______

Dysregulation, children, 7, boys

What is/are the possible complication(s) of spinal anesthesia? Select all that apply. A. Drowsiness B. Dysrhythmias C. Dizziness D. Headache E. Hypertension F. Respiratory distress

F. Respiratory distress

Insomnia More common in _________ patients Nonpharmacologic management: -Avoid _______ - Warm ________ - No _________ - Heavy _______ and ________ avoided before bedtime - Relax - Cut down on _______ time

Female, naps, fluids, caffeine, meals, exercise, screen

Sedatives and Hypnotics for Older Adults: 1. ________________ 2. use ________________ methods first 3. Use _________ to _________-acting _____________________ such as estazolam, temazepam, and triazolam. 4. Avoid ______________ such as flurazepam, quazepam, and diazepam.

Identify cause, nonpharmacologic, short, intermediate, benzodiazepines, benzodiazepines

Anesthetic routes: - ___________ - _____ - __________ - ___________ - __________

Inhalation, IV, topical, local, spinal

Anesthetics Nursing interventions: - monitor patent's _______ - Monitor VS, especially __________ and ______ status - Monitor _______________ - Administer __________ cautiously until patient fully recovers - dosage may need to be _____________

LOC, respiratory, cardiac, urine output, analgesics, decreased

Amphetamine-like drugs for ADHD

Methylphenidate (Ritalin) and dexmethylphenidate (Focalin)

Amphetamine-like drugs for Narcolepsy

Methylphenidate (Ritalin) and modafinil (Provigil)

IV Anesthetics: ____________ and __________ - ___________ and ___________ of anesthesia or conscious ___________ for minor surgery or procedures like mechanical ___________ or _________ - Patients are ________ and ___________ but ____________ to commands

Midazolam, propofol, induction, maintenance, sedation, ventilation, intubation, sedated, relaxed, responsive

Benzodiazepines: - _____________ - ______________ - diminished ___________ and ___________ If toxicity or OD is suspected: - _____________ is benzodiazepine antagonist and can reverse intoxication within _________ if administered IV

Somnolence, confusion, reflexes, coma, flumazenil, 5 mins

The nurse is teaching a patient who will begin taking butabarbital (Butisol). What information will the nurse include when teaching this patient? a. "Avoid alcohol while taking this drug." b. "This drug may be used long-term." c. "This medication will take effect immediately." d. "You will not experience a hangover effect."

a. "Avoid alcohol while taking this drug."

A patient describes having vivid dreams to the nurse. The nurse understands that these occur during which stage of sleep? a. Rapid eye movement (REM) sleep b. Stage 2 nonrapid eye movement sleep c. Stage 3 nonrapid eye movement sleep d. Stage 4 nonrapid eye movement sleep

a. Rapid eye movement (REM) sleep

The nurse is caring for a patient who reports being able to fall asleep but has difficulty staying asleep. The nurse will contact the provider to obtain an order for which medication? a. Butabarbital (Butisol) b. Flurazepam (Dalmane) c. Secobarbital (Seconal) d. Temazepam (Restoril)

a. Butabarbital (Butisol)

The nurse is caring for a young adult patient who is receiving a first dose of flurazepam (Dalmane) as a sedative-hypnotic medication. What intervention will be included in the nurse's plan of care for this patient? a. Instituting a bed alarm system to prevent falls b. Reassuring the patient that nightmares are not a usual effect c. Reporting a urine output greater than 1500 mL/day d. Teaching the patient that this drug may be used for 6 to 8 weeks

a. Instituting a bed alarm system to prevent falls

The nurse is preparing a patient for surgery. The patient received a hypnotic medication the night prior and the nurse is administering midazolam (Versed) and atropine. The patient asks why all of these medications are necessary. The nurse will tell the patient that they are given for which reason? a. To decrease the amount of general anesthesia needed b. To minimize post-operative drowsiness c. To prolong the anesthetized state d. To speed up anesthesia induction

a. To decrease the amount of general anesthesia needed

A patient who has been taking butabarbital (Butisol) for several weeks reports being drowsy and having difficulty performing tasks at work most mornings. The nurse suspects that which drug effects have occurred? a. Dependence b. Hangover c. Tolerance d. Withdrawal

b. Hangover

Children who experience nightmares have these during which stage of sleep? a. Early morning sleep b. Nonrapid eye movement sleep c. Rapid eye movement sleep d. Sleep induction

b. Nonrapid eye movement sleep

Barbiturates: - ends in -__________ - Long to ultrashort-acting - Restricted to _______-term use (_____ weeks or less) because of side effects, including drug tolerance -Interactions:__________, __________, other sedative-hypnotics

barbital, short, 2, alcohol, opioids

A new nurse is admitting a patient who has received doxapam (Dopram). The nurse recognizes that this is which type of drug? a.) inhaled respiratory stimulant b.) narcotic antagonist c.) post anesthetic respiratory stimulant d.) long-acting narcotic

c. post anesthetic respiratory stimulant

Analeptics: -__________- used to stimulate respiratory actions Use: - stimulate __________ in __________ Side effects: -_______ -_______ -________ -________, ________ -_________ dependence

caffeine, respiration, newborns, cns, cardiac, GI, diuresis, tinnitus, psychological

During balanced anesthesia, which type of medication is given while the surgery is performed? a. Anticholinergics b. Benzodiazepines c. Hypnotics d. Inhaled anesthetic

d. Inhaled anesthetic

An older adult patient reports frequent nighttime awakening because of arthritis pain and asks the nurse about taking an over-the-counter product to help with this problem. The nurse will recommend that the patient discuss which medication with the provider? a. Ibuprofen (Motrin) b. Nytol c. Sominex d. Tylenol PM

d. Tylenol PM

A patient who has been taking a benzodiazepine as a sleep aid for several months wishes to stop taking the medication. The nurse will suggest that the patient taper the dose gradually to avoid which effect? a. Depression b. Hangover c. Hypnotic rebound d. Withdrawal

d. Withdrawal

The nurse performs a preoperative assessment on a patient and asks about alcohol use. The patient asks why this information is important. The nurse will explain that patients who consume increased amounts of alcohol a. may have a prolonged postoperative recovery time. b. may not be eligible for surgery. c. may not receive inhaled gases for anesthesia. d. may require changes in anesthesia drug doses.

d. may require changes in anesthesia drug doses.

Benzodiazepines: Side effects: - ___________ sedation - ___________ - _____________ - ________________ vision - Cardiac - ______________ -______________ speech - GU - ___________ -___________ -___________ changes

daytime, ataxia, headache, blurred, amnesia, slurred, GI, CNS, behavior

Inhalation Anesthetics: Adverse effects: - respiratory ___________ - _______________ - _______________ - _____________ dysfunction - _____________ hyperthermia

depression, hypotension, dysrhythmias, hepatic, malignant

Spinal Column Nerve Blocks Epidural block: - placement of the ________ anesthetic in the ________ covering of the spinal cord, or the ______________

local, outer, dura mater

Barbiturates interventions: - __________ doses for _________ clients - caution with _______ tendencies or history of drug addiction - avoid __________ activities - avoid _______ - for __________, take 30 minutes before bedtime - Avoid taking with food to help _________ - Warn patient about _________ - Do not ___________ abruptly - Barbiturates are mostly used for ___________

lower, older, suicidal, hazardous,s ETOH, insomnia, digestion, hangovers, discontinue, seizures

Benzodiazepines: - monitor ________ CNS - monitor for _____________ response - Monitor for ___________ disturbances with ____________ - Monitor labs - ___________ precautions - Assist ____________ if ________ or ______________-headed - Avoid ____________ and ________ - Avoid ______________ - Do not stop abruptly

motor, autonomic, visual, glaucoma, falls, ambulation, drowsy, light, driving, machinery, ETOH

Topical Anesthetics: Use: - ________ membranes - _________ or __________ skin surfaces - _________ Decrease the ____________ of ______________ of the affected area

mucous, broken, unbroken, burns, sensitivity, nerve endings

Amphetamines: Action - stimulate release of ___________ and ___________ Side effects/adverse reactions: - _________ - __________ - _________ - __________ Causes sense of ________ and _______ Used for ______ or ______

norepinephrine, dopamine, cardiac, CNS, GI, impotence, euphoria, restlessness, ADD, ADHD

Spinal Column Nerve Blocks Spinal Block: - ___________ of the ___________ into the _________________ membrane, the _________ layer of the spinal cord

penetration, anesthetic, subarachnoid, second