Pharm test 5

The nurse is caring for a patient whose recent ultrasound of the carotids diagnosed a 90% occlusion of the right carotid artery and a 92% occlusion of the left carotid artery. The patient asks the nurse, "If one of these arteries becomes completely occluded will I have a stroke?" What is the nurse's best response?

"A common vessel receiving all blood to the head called the circle of Willis will distribute blood from other arteries to the brain as needed."

The nurse is caring for a patient with a malignant brain tumor. The patient asks the nurse why the tumor is being treated with radiation instead of chemotherapy. The nurse's explanation involves what important information?

"Medications have difficulty crossing the blood-brain barrier."

A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body?

2 to 3 hours

A nurse is working on a surgical unit and has several patients who require preoperative teaching. Which patient demonstrates behavior indicating this is an appropriate time to begin teaching?

A patient who is clearing her throat several times while asking the nurse questions during their conversation and who appears to be slightly stressed

The nurse is caring for a patient in a state of hypnosis, which means the patient is in what state?

A state of extreme sedation in which the person no longer senses or reacts to incoming stimuli.

The nursing instructor is talking about neurotransmitters, including which of these chemicals?

Acetylcholine

Which neurotransmitter communicates between nerves and muscles?

Acetylcholine

The student nurses are learning about the nervous system. What would the students learn are capable of conducting along the entire membrane of the nerve?

Action potentials

What reasons can the nurse give for why barbiturates are no longer considered the mainstay for treatment of anxiety? (Select all that apply.)

Adverse effects are more severe. There is an increased risk of physical tolerance. There is an increased risk of psychological dependence. Hypersensitivity reactions can sometimes be fatal.

A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.)

Agitation, Insomnia, Dry mouth

The nurse is caring for a patient treated with flumazenil (Anexate) for benzodiazepine toxicity. After administering flumazenil what will the nurse carefully assess for?

Agitation, confusion, and seizures

What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression?

An extended release form is available.

A nurse is caring for a patient who is having an adverse drug reaction. The patient is experiencing tremors, is unable to hold his or her head up, and is having difficulty sitting up in bed. The nurse suspects that this is due to what?

An interference with the extrapyramidal system

A patient presents at the free clinic complaining of nervousness, worrying about everything, and feeling very tense. What diagnose would the nurse suspect?

Anxiety

The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action?

Assess the patient for physical problems.

The nurse is caring for a patient who has an injured hindbrain. What would the nurse expect to find altered when assessing the patient?

Basic vital functions

A 75-year-old patient is brought to the emergency department by his family. The family relates that the patient is complaining of confusion, seizures, and abnormal perception of movement. The nurse reviews all of the medication bottles found in the house and suspects the patient overdosed on what medication?

Benzodiazepine

What anxiolytic drugs would be given to a premenopausal patient who is a registered nurse planning to return to work at the hospital after anxiety is controlled?

Buspirone (BuSpar)

A nurse is caring for a 9-year-old patient and has received an order for diazepam (Valium) 10 mg given orally q.i.d. What is the nurse's priority action?

Call the physician and question the order.

The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart before administering the medication. What preexisting condition would require cautious use of this drug?

Cardiovascular disorders

Neurotransmission is important in the function of the central nervous system (CNS). For neurotransmission to occur, how do neurons communicate with other cells?

Chemically

Antidepressants carry a black box warning about the increased risk of suicide in what age group?

Children and adolescents

The nurse is teaching a class for nurses working in prenatal clinics about the danger associated with use of benzodiazepines during pregnancy and explains that what fetal anomalies result from maternal use of benzodiazepines during the first trimester of pregnancy? (Select all that apply.)

Cleft lip or palate, Inguinal hernia, Cardiac defects, Microencephaly.

Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD?

Clomipramine

A patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess this patient for?

Coma

Two nursing students are giving an oral presentation on the forebrain. What information will they include about this area? (Select all that apply.)

Coordinates speech and communication, Area where learning takes place, Houses the extrapyramidal motor system

What part of the neuron carries information into the neuron from other neurons?

Dendrite

An 87-year-old woman undergoes extensive surgery for an acoustic neuroma (a benign tumor of the inner ear), and 6 hours after surgery, she hemorrhages and goes into a coma. After awaking and 2 months of therapy, she is transferred to a long-term care facility. Due to damage in the midbrain, the nurse caring for the patient will expect the patient to exhibit what?

Difficulty in distinguishing hot and cold

The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient?

Disturbed thought processes related to central nervous system (CNS) effects of medication

When a person learns, this action begins as an electrical circuit called what?

Engram

The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what?

Enuresis

The nursing instructor explains the limbic system contains what neurotransmitters?

Epinephrine, norepinephrine, and serotonin

A nurse is caring for a 4-year-old child who is receiving a barbiturate. What common adverse effect would the nurse assess for?

Excitability

The nurse is caring for a resident in a long-term care facility who is African American with a history of an anxiety disorder. The patient is receiving oral lorazepam (Ativan) 2 mg t.i.d. When developing this patient's plan of care, what priority assessment will the nurse include?

Extreme sedation

A 72-year-old patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening. The nurse suspects benzodiazepine overdose and would expect what drug to be ordered?

Flumazenil

A patient arrives at the emergency room after attempting suicide by taking an entire bottle of diazepam. What antidote will the nurse most likely administer?

Flumazenil (Romazicon)

A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD?

Fluvoxamine

A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child?

Fluvoxamine (Prozac)

What neurotransmitter inhibits overexcitability and is important in preventing seizure activity in a patient?

GABA

While discussing the central nervous system (CNS), the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what?

GABA

The nurse is caring for a patient in intensive care unit receiving IV lorazepam (Ativan) to reduce anxiety related to mechanical ventilation. While injecting the medication the nurse notes a decrease in blood pressure and bradycardia. What is the nurse's priority action?

Give the IV drug more slowly.

The nurse assesses the patient who had an abrupt withdrawal of benzodiazepines for withdrawal syndrome and would recognize what symptoms as part of the syndrome? (Select all that apply.)

Headache, Nightmares, Malaise

A nurse is about to administer a parenteral benzodiazepine to a female patient in the hospital before the performance of a procedure. What is the priority nursing action before administration of the drug?

Help the patient out of bed to the bathroom and encourage her to void.

While diagramming the brain for their anatomy and physiology class, the nursing students would place the swallowing center where?

Hindbrain

The nurse evaluates teaching as effective when a patient taking a benzodiazepine states,

I should not stop taking this drug without talking to my health care provider first

A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient?

Implement suicide precautions.

A female patient has experienced a stroke affecting the right side of her brain. What will the nurse expect to assess in this patient?

Inability to distinguish a spoon from a fork

A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse assess for with this drug combination?

Increased risk of hypoglycemia

What is the physiological action of tricyclic antidepressants (TCAs)?

Inhibiting reuptake of norepinephrine and serotonin

When compared with benzodiazepines, buspirone (BuSpar) stands out as unique among antianxiety drugs because of what factor?

Lacks muscle relaxant and anticonvulsant effects.

It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Select all that apply.)

Limbic system, Reticular activating system (RAS), Basal ganglia.

The nurse is caring for a patient who has a sedative hypnotic ordered. The nurse would consider this drug contraindicated if the patient had what disorder?

Liver failure

The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects?

Measure and record your blood pressure daily.

A 46-year-old male patient sustained a closed-head injury 4 hours ago. He presents to the emergency department with difficulty breathing. What area of the brain does the nurse suspect is injured based on the patient's symptoms?

Medulla oblongata

What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.)

Monitor blood pressure. Do not take over-the-counter (OTC) drugs without talking to physician. Reduce tyramine intake,

The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking?

Monoamine oxidase inhibitors (MAOIs)

The physiology instructor is discussing the limbic system. What would the instructor say occurs with stimulation of this area?

Mood

The patient is diagnosed with myasthenia gravis, a condition in which antibodies block, alter, or destroy the receptors for acetylcholine. What symptom would the nurse expect this patient to display?

Muscle dysfunction

The sensory nerves enter the brain and react with related nerves to cause a reaction. What mediates this reaction?

Muscles or glands

A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.)

Myocardial Infarction, Stroke, Dry mouth,

What would the nurse assess for when benzodiazepines are abruptly stopped?

Nausea, headache, vertigo, malaise, and nightmares

What would a nurse describe to a peer as a factor in increasing synaptic transmission?

Neurotransmitter

The nurse is caring for a newborn who was delivered from a woman who took benzodiazepines for anxiety during the last 2 months of her pregnancy after her husband was killed in war. What will the nurse assess for in this newborn?

Newborn withdrawal syndrome

The anatomy and physiology instructor is discussing neurotransmitters with the prenursing anatomy and physiology class. What neurotransmitter would the instructor tell the students is a catecholamine classified as a hormone when it is released from the adrenal medulla?

Norepinephrine

The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression?

Norepinephrine, dopamine, and serotonin

A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child?

Nortriptyline

As the nursing students learn about the functioning of the nervous system, they learn that the energy required by the nerves is provided by what?

Oxygen and glucose

The physiology instructor explains to the students that some substances increase actual learning. What is one of these substances?

Oxytocin

The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient?

Paroxetine (Paxil) 10 mg once daily orally

The nurse is caring for a 36-year-old man who experienced a seizure 30 minutes before coming into the emergency room, where he begins to have another. What barbiturate has the fastest onset and would be most appropriate to give to the patient to quickly stop the seizure?

Phenobarbital (Luminal)

A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction?

Phentolamine

The nurse is caring for a patient who received a new diagnosis of cancer. The patient exhibits signs of a sympathetic stress reaction. What signs and symptoms will the nurse assess in this patient consistent with an acute reaction to stress? (Select all that apply.)

Profuse sweating, Fast heart rate, Rapid breathing

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?

Reassuring the patient that a decrease in weight is a common adverse effect with this medication

The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patient's plan of care? (Select all that apply.)

Recent suicide attempts, Gastrointestinal (GI) obstruction, Affect,

Hypnotic drugs are used to aid people in falling asleep. What physiological system does a hypnotic act on to be effective in helping a patient to sleep?

Reticular activating system

The nurse is caring for a patient who experiences anxiety and insomnia and is prescribed benzodiazepines. When developing the plan of care, what would be an appropriate nursing diagnosis related to potential adverse effects of the drug?

Risk for injury related to central nervous system (CNS) effects.

A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurse's best response is what?

Sarafem and Prozac are different brand names for the same generic medication

The nurse administers promethazine (Phenergan) to the patient before sending the patient to the preoperative holding area. What is the rationale for administration of this drug?

Sedation

The anatomy and physiology instructor discusses the thalamus with the nursing class. The instructor tells the students that the thalamus does what?

Sends information into the cerebrum to transfer sensations

What brings information from the central nervous system (CNS) to the peripheral nervous system (PNS)?

Sensory Nerves

When a neuron is stimulated and causes depolarization of the nerve, what occurs?

Sodium rushes into the cell.

What is the purpose of the myelin sheath?

Speeds electrical conduction

An older adult African American patient comes to the clinic and is diagnosed with generalized anxiety disorder (GAD). The physician orders oral flurazepam 30 mg. What is the nurse's priority action?

Talk to the physician about the dosage.

The nursing instructor is teaching the new nursing students about patient teaching. Where in the brain would the instructor tell the student nurses is the area where learning takes place?

The areas that coordinate speech and communication

The nurse is caring for a patient with meningitis who is not responding to the prescribed antibiotic and whose condition continues to deteriorate. What rationale will the nurse give the family to explain why the antibiotic is not as effective as it was hoped?

The blood-brain barrier prevents the antibiotics from crossing into the brain.

An elderly patient has been taking zolpidem (Ambien) as a sleep aid for the past 2 months. On admission to the assisted-living facility, it is determined that the drug is no longer needed. What is an important nursing consideration concerning this drug?

The drug needs to be withdrawn gradually.

Why would the nurse expect the patient with liver disease to receive a smaller dose of benzodiazepines?

The drugs are metabolized extensively in the liver.

A student asks the anatomy and physiology instructor to explain the two hemispheres of the brain and what they regulate. What statement, if made by the instructor, is accurate?

The hemispheres regulate communication between sensory and motor neurons.

The nurse is caring for a patient whose emotions often swing from one extreme to the other. The patient's spouse tells the nurse these mood swings started when the patient awoke from a coma following a serious head trauma. What area of the brain does the nurse suspect was damaged?

The limbic system

A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication?

The medication should be taken once a day before bedtime.

A patient who nearly drowned is brought to the emergency department. The paramedics tell the nurse the patient was anoxic for approximately 5 minutes. Because of this anoxia, what might happen to the nerve cells?

The nerves might not be able to maintain the sodium potassium pump.

The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist?

The number or sensitivity of postsynaptic receptors may increase.

A 75-year-old male patient is brought to the emergency department by his family because he is talking to people who aren't there. During the initial admission assessment, his daughter mentions that her mother died 4 months ago and Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication. What would the nurse suspect is happening to this patient?

The patient is having hallucinations as an adverse effect of his antidepressant medication.

A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what?

These drugs are similar but some patients respond better to one drug than another.

The nurse is caring for a patient who has not been able to sleep. The physician orders a barbiturate medication for this patient. What adverse effect should the nurse teach the patient about?

Thinking abnormalities

A nurse is discussing the use of alprazolam (Xanax) with a 68-year-old patient. What statement indicates that the patient has an understanding of the drug?

This drug will calm me down in about 30 minutes after I take it.

For what purpose would the nurse choose to administer a hypnotic instead of another classification of antianxiety drug?

Treating confusion and agitation

The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should be used when administering a benzodiazepine to the elderly because of what possible adverse effect?

Unpredictable reactions

What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors?

Venlafaxine (Effexor)

A patient is being discharged home from the hospital after receiving treatment for pneumonia. The patient is going home and continuing to take the same drugs he or she was taking before he or she was hospitalized. These drugs include an antianxiety medication and a medication for insomnia. The home care nurse is following this patient. On the initial visit what is the nurse's priority teaching point?

Warning signs that may indicate serious adverse effects