pharm quiz (1)
The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse nurse prioritize when assessing for therapeutic effects? Chapter 25: Muscle Relaxants - Page 431
Inspection for muscle spasticity and range of motion assessment
The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include? Chapter 23: Anti-seizure Agents - Page 396
Informing the client and family that seizure control is not gained immediately The nurse should inform the client and family that seizure control is not gained immediately when drug therapy is started. The goal is to avoid unrealistic expectations and excessive frustration while drugs and dosages are being changed in an effort to determine the best regimen for the client.
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?
Drowsiness Chapter 25: Muscle Relaxants - Page 431
A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?
Drowsiness Chapter 25: Muscle Relaxants - Page 431
Which factor should the clinician reassess when combination therapy is ineffective? Chapter 23: Anti-seizure Agents - Page 404
Drug-drug interactions If combination therapy is ineffective, the clinician may need to reassess the patient for type of seizure, medical conditions or drug-drug interactions that aggravate the seizure disorder or decrease the effectiveness of antiseizure drugs, and compliance with the prescribed drug therapy regimen.
A client is to receive ethotoin. The nurse would expect to administer this drug by which route? (chapter 23)
Ethotoin is administered orally.
A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request?
Evaluate the client for adverse reactions from the centrally acting anticholinergics When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.
What is the primary medication prescribed to relieve pain associated with shingles? (chapter 23)
gabapentin
A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response" Chapter 25: Muscle Relaxants - Page 430-431
"This drug causes your urine to change color, so it's not likely blood that you're seeing.
A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer?
*Lorazepam Lorazepam is the drug of choice in the treatment of status epilepticus, an emergency characterized by continual seizure activity with no interruptions. Levetiracetam in an anticonvulsant is used as adjunctive therapy to treat partial onset seizures as well as tonic-clonic seizures. Trimethadione is used to treat epilepsy. Methsuximide is used for focal seizures.
The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage? Chapter 23: Anti-seizure Agents - Page 406
2 mcg/mL Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.
The nurse is caring for a 14 year-old client who has been prescribed metaxalone 800 mg PO t.i.d. by the provider. What is the nurse's best action? Chapter 25: Muscle Relaxants - Page 430
Administer the medication and monitor the client's pain levels closely Metaxalone is approved for use in children over 12 and this dose is within norms. The use of metaxalone does not normally require blood level monitoring. The nurse is justified in administering the drug as prescribed and performing the relevant assessments.
A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action?
Administer the medication as prescribed and monitor for therapeutic and adverse effects
How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?
Administering the analgesics on a regular basis Routine scheduling of the administration of analgesics, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.
An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Chapter 23: Anti-seizure Agents - Page 398
Advise the client to have his blood redrawn today to ensure that it is not at a toxic level.
A client recovering from hip surgery is receiving morphine through a patient-controlled analgesia (PCA) infusion pump with a set basal rate. What action is most important for the nurse to implement?
Assess the client's respiratory status
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping? Chapter 25: Muscle Relaxants - Page 43
Avoid alcohol or other CNS depressants.
Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Chapter 25: Muscle Relaxants - Page 430
Baclofen Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.
A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client? Chapter 25: Muscle Relaxants - Page 437
Baclofen is metabolized in the liver and excreted in urine. The client must be monitored for adverse effects on liver function.
A nurse is treating a patient who is receiving carbamazepine for a seizure disorder. The nurse knows that carbamazepine is contraindicated in patients with which diseases or disorders?
Bone marrow depression
(chapter 23) A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
CNS depression
When administering entacapone, the nurse understands that this drug affects which enzyme?
Catecholamine-O-methyl transferase Entacapone inhibits catecholamine- O-methyl transferase, which eliminates catecholamines including dopamine. Lactic dehydrogenase is a liver enzyme. Rasagiline inhibits monoamine oxidase type B. Acetylcholinesterase breaks down acetylcholine.
When administered with other drugs that enhance stimulation of serotonergic receptors (Demerol, Dextromethorphan, antidepressants), Rasagiline can: Chapter 24: Antiparkinsonism Agents - Page 417
Cause a potentially fatal CNS toxic reaction.
A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient? Chapter 24: Antiparkinsonism Agents - Page 417
Confusion and disorientation The nurse should assess for confusion and disorientation when caring for this elderly patient undergoing anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.
The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? Chapter 23: Anti-seizure Agents - Page 396
Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.
When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? (chapter 23)
Depression of motor nerve output
The nurse is caring for a client after a recent traumatic brain injury and development of tonic clonic seizures. The client is receiving treatment of seizures with anti-epileptic drugs (AEDs). The nurse should perform which assessment(s) for safe administrations of AEDs? Select all that apply. Chapter 23: Anti-seizure Agents - Page 395
Description of seizure activity from family member who witnessed it. Hepatic and metabolic profiles at baseline and subsequent levels. Assessment of client's description of the aura that occurs before a seizure.
The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client? Chapter 25: Muscle Relaxants - Page 431
Discontinue the use of alcohol. In a client experiencing spasticity, the nurse should advise the client to stop drinking alcohol. Alcohol consumption may increase the adverse effect of sedation, causing sleepiness, dizziness, and blurred vision. The client should not drive or walk after taking the drug; the client should learn to self-administer the drug; and constipation is a concern. However, the most important safety concern is to avoid alcohol.
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
Do not drive or operate machinery until individual drug effects are known.
The most common form of epilepsy in children is characterized by what type of seizure? Chapter 23: Anti-seizure Agents - Page 394-395
Febrile seizure Explanation: Febrile seizures are the most common form of epilepsy in children. They are tonic-clonic seizures that occur with fever in the absence of other identifiable causes.
Signs and symptoms of what would necessitate discontinuation of dantrolene therapy? Chapter 25: Muscle Relaxants - Page 437
Hepatic dysfunction Dantrolene therapy must be discontinued at any sign of liver dysfunction. Intermittent GI upset, visual disturbances, and urinary retention are associated adverse effects of the drug and, although problematic, do not necessitate discontinuing the drug.
Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy?
Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine. Chapter 25: Muscle Relaxants - Page 431
What best reflects the action of barbiturates when used to control seizures? Chapter 23: Anti-seizure Agents - Page 398
Inhibition of impulse conduction Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex, depress cerebellar functioning, and depress motor nerve output.
The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? Chapter 12: Pain Management - Page 243
Most patients experience sedation at the beginning of opioid therapy and whenever the opioid dose is increased significantly. If left untreated, excessive sedation can progress to clinically significant respiratory depression (bradypnea, or reduced breathing rate).
The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid filled blisters and purpuric areas all over the client's body. Which actions should the nurse take? Select all that apply.
Notify the primary care provider immediately. Assess vital signs. Document the skin assessment.
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug? (chapter 23)
Observe respirations frequently.
A client is prescribed methsuximide. The nurse should expect to administer this drug by which route? Chapter 23: Anti-seizure Agents - Page 400
Oral Methsuximide is administered orally. Diazepam can be administered rectally. Diazepam or phenobarbital may be administered intramuscularly. Diazepam, fosphenytoin, phenytoin, valproic acid, and phenobarbital can be administered intravenously.
After teaching a group of nursing students about seizures, the instructor determines that the teaching was successful when the group identifies seizures that do not impair consciousness but can involve the senses or motor ability as which type?
Partial seizures Seizures that do not impair consciousness but can involve the senses or motor ability are classified as partial seizures. Generalized seizures involve loss of consciousness during the seizure. Tonic-clonic seizures are a type of generalized seizure involving alternate contraction and relaxation of the muscles, loss of consciousness, and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions of single or multiple groups of muscles.
(chapter 23) A nurse should review a client's medical conditions prior to administering a phenytoin (Dilantin) because its use is contraindicated in some clients. In what clients would its use be contraindicated? (Select all that apply.)
Pregnancy Sinus bradycardia The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, clients with sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block, pregnancy, and lactation.
A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa? Chapter 24: Antiparkinsonism Agents - Page 417
Pyridoxine (vitamin B6) A nurse should counsel clients receiving levodopa to avoid foods high in pyridoxine (vitamin B6) as it reduces the effect of levodopa. Cyanocobalamin is used to treat pernicious anemia, however, if it is taken with Prilosec, the Prilosec can interfere with the absorption of B12. Phylloquinone (vitamin K1) is well known for being crucial for proper blood clotting and is contraindicated if the client is on anticoagulation therapy. When taking ascorbic acid (vitamin C), the client should tell the health care provider as side effects may be increased.
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately? Chapter 23: Anti-seizure Agents - Page 408
Rash Lamotrigine has been associated with very serious to life-threatening rashes, and the drug should be discontinued at the first sign of any rash. Somnolence and confusion are typical CNS effects; anorexia is a common gastrointestinal effect.
The nurse is monitoring a client who is in the hospital and has a fentanyl patch in place for the control of breakthrough pain for breast cancer. What would be a concern for the nurse when she obtains vital signs for this client? Chapter 12: Pain Management - Page 241
Respiratory rate of 10 breaths/minute A fentanyl patch should not be administered if the client's respiratory rate is less than 12 breaths/minute. The temperature, blood pressure, and heart rate are within normal range.
A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses? (chapter 23)
Risk for Falls
A 40-year-old client with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize for the nursing care plan for this client? Chapter 25: Muscle Relaxants - Page 432
Risk for Injury related to CNS depressant effects The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.
A client who diagnosed with Parkinson's disease is being treated with levodopa/carbidopa. Which disorder will result in the discontinuation of this drug based on a disease-related contraindication? Chapter 24: Antiparkinsonism Agents - Page 420-421
Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. Levodopa is not contraindicated in clients with human immune deficiency virus, human papillomavirus, or TIAs.
A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient? Chapter 23: Anti-seizure Agents - Page 398
Slurred speech The nurse should monitor the patient for slurred speech which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are not signs of toxicity of ethotoin. Constipation and diarrhea are adverse reactions of barbiturates. Urinary frequency is an adverse reaction of succinimides.
A client diagnosed with Parkinson's disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death? Chapter 24: Antiparkinsonism Agents - Page 417
St. John's wort
A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed? (chapter 23)
Status epilepticus
In order to maximize therapeutic benefit while reducing the risk of adverse effects of sumatriptan, the nurse should encourage the client to implement which intervention? Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 174
Take the medication as soon as the earliest symptoms of migraine are sensed.
The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: Chapter 12: Pain Management - Page 230
The patient's perception of pain severity should always be the primary consideration. It forms the baseline for all management.
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to: Chapter 25: Muscle Relaxants - Page 431
avoid drinking alcohol for the duration of treatment.
A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms? Chapter 24: Antiparkinsonism Agents - Page 413
There is an imbalance between dopamine and acetylcholine. In Parkinson's disease, degeneration of the neurons that supply dopamine to the striatum occurs, resulting in reduced dopamine in the nerve terminals of the nigrostriatal tract. Consequently, an imbalance exists between dopamine inhibition and acetylcholine excitation. Additionally, unopposed acetylcholine stimulates the release of gamma-aminobutyric acid (GABA). The combination of excessive acetylcholine and GABA is the basis for most symptoms of Parkinson's disease, such as the physical manifestations seen such as muscle rigidity, tremor at rest, akinesia (loss of voluntary movement) or bradykinesia (abnormal slowness of movement), and postural instability.
Centrally acting skeletal muscle relaxants lyse or destroy the spasm.
True The centrally acting skeletal muscle relaxants work in the CNS to interfere with the reflexes that are causing the muscle spasm. Because these drugs lyse or destroy spasm, they are often referred to as spasmolytics.
A client has a diagnosis of Parkinson disease, and the health care provider will prescribe carbidopa-levodopa. Before drug therapy, the client should be carefully assessed for the presence of: Chapter 24: Antiparkinsonism Agents - Page 416
closed-angle glaucoma.
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? Chapter 25: Muscle Relaxants - Page 436
dantrolene *Dantrolene acts directly on skeletal muscle to inhibit muscle contraction. It is used to relieve spasticity in neurologic disorders (e.g., MS, spinal cord injury) and to prevent or treat malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis. None of the other medications are prescribed for this emergency.
The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: Chapter 24: Antiparkinsonism Agents - Page 419
falls. Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.
A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with: (chapter 23)
renal impairment.
The nurse has taught a client who is receiving lamotrigine about possible adverse effects. The nurse determines that the client has understood the teaching when the client identifies a need to promptly report what adverse effect? (chapter 23)
Lamotrigine has been associated with very serious to life-threatening rashes and the drug should be discontinued at the first sign of any rash. Anorexia is a common adverse GI effect. Fatigue is a common adverse CNS effect. Upper respiratory infection is an adverse effect of the drug, but it is not life threatening and does not need to be reported immediately.
For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated? Chapter 24: Antiparkinsonism Agents - Page 416
Levodopa Levodopa is contraindicated in clients with known hypersensitivity to the drug. Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma (because it increases intraocular pressure).
An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?
Malignant hyperthermia
Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine?
Patient response to morphine depends on the route of administration and the dosage.
Which phase of pain transmission occurs when the one is made aware of pain? Chapter 12: Pain Management - Page 229
Perception Perception is the pain process where one becomes aware of the pain as a result of neural activity. Modulation involves the response to noxious stimuli. Transduction refers to the processes by which noxious stimuli activate primary afferent neurons called nociceptors. Transmission describes the action potential that is created by transduction being transmitted along fibers.
A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse be most likely to administer? Chapter 23: Anti-seizure Agents - Page 396
Phenytoin Hydantoins like phenytoin elicit their effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Valproic acid increases the levels of GABA to help stabilize the membranes. Ethosuximide depresses the motor cortex, creating a higher threshold before the nerves react to the convulsive stimulus. Lorazepam elevates the seizure threshold by decreasing postsynaptic excitation.
Baclofen (Lioresal) is used in the treatment of muscle spasticity associated with which disease processes? (Select all that apply.) Chapter 25: Muscle Relaxants - Page 430
Spinal cord injury Muscle rigidity Multiple sclerosis
A nurse is performing a neuromuscular assessment on a client with Parkinson's disease and is being treated with medication. The nurse expects to see which symptom while performing the assessment? Select all that apply. Chapter 24: Antiparkinsonism Agents - Page 419
Tremors Drooling Monotone speech pattern Mask-like facial expression
Spinal reflexes are the simplest nerve pathways that monitor movement and posture.
True The spinal reflexes are the simplest nerve pathways that monitor movement and posture.
Which type of pain arises from an internal organ, such as the kidneys?
Visceral pain arises from internal organs, such as the heart, kidneys, and intestines, that are diseased or injured. Neuropathic pain is pain that is processed abnormally by the nervous system. Nociceptive pain is the noxious stimuli that are transmitted from the point of cellular injury over peripheral sensory nerves to pathways between the spinal cord and thalamus, and eventually from the thalamus to the cerebral cortex of the brain.
A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction? Chapter 25: Muscle Relaxants - Page 434
Wear appropriate clothing and sunscreen whenever he is in direct sunlight. The nurse will need to caution the patient about the adverse effect of photosensitivity, especially considering his work. He should be advised to wear protective clothing and sunglasses and to use sunscreen whenever he is outside on the job site. A complete blood cell count should be done before therapy begins but would not be needed again unless indicated. A nurse must check with the prescriber before advising a patient to decrease a drug dosage. A diet high in protein is not necessary with this drug.
A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine? Chapter 24: Antiparkinsonism Agents - Page 419
With amantadine, excretion is primarily via the kidneys.
A client with diagnoses of Parkinson's disease and hepatic disease is to begin tolcapone therapy. What monitoring intervention should be included in the client's plan of care?
a baseline liver function test The FDA has issued a black box warning stating that clients who take tolcapone risk potentially fatal acute fulminant liver failure. It is important to monitor liver function tests before therapy begins and every 2 weeks thereafter. Tolcapone is not associated with health risks that would require any of the other proposed interventions.
A postsurgical client has been receiving morphine by patient-controlled analgesic for 2 days. What action by the nurse best addresses potential adverse effects?
administering a stool softener as prescribedo
A client prescribed dantrolene therapy requires monitoring for what serious adverse effect? Chapter 25: Muscle Relaxants - Page 436
hepatitis Dantrolene may cause potentially fatal hepatitis, with jaundice and other symptoms that usually occur within 1 month of starting drug therapy. Liver function tests should be monitored periodically in all clients receiving dantrolene. None of the other options are associated with dantrolene therapy.