pvn 106 practice test 2

A practitioner prescribes Alprazolam (Xanax) 0.25 mg by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. For what most common side effect of this drug should the nurse monitor the client? 1.)Drowsiness 2.)Bradycardia 3.)Agranulocytosis 4.)Tardive dyskinesia

1.)Drowsiness

Sildenafil (Viagra) is prescribed for a man with erectile dysfunction. A nurse teaches the client about common side effects of this drug. (Select all that apply.) 1.)Flushing 2.)Headache 3.)Dyspepsia 4.)Constipation 5.)Hypertension

1.)Flushing 2.)Headache 3.)Dyspepsia

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) should the nurse anticipate that the health care provider may prescribe? 1.)Haloperidol (Haldol) 2.)Fluvoxamine (Luvox) 3.)Imipramine (Tofranil) 4.)Benztropine (Cogentin)

2.)Fluvoxamine (Luvox)

A nurse is teaching the parents of a school-aged child with attention deficit-hyperactivity disorder (ADHD) about the prescribed medication methylphenidate (Ritalin). When should the daily dose be administered? 1.)When the child arrives at school 2.)Just after breakfast 3.)Immediately before lunch 4.)When the child arrives home from school

2.)Just after breakfast

Carbidopa/levodopa (Sinemet) is prescribed for a client with Parkinson disease. Which side effects does the nurse expect? (Select all that apply.) 1.)Nausea 2.)Anorexia 3.) Bradycardia 4.) Hypertension 5.) Mental changes

1.) Nausea 2.)Anorexia 5.) Mental Changes Nausea may occur; it reflects a central emetic reaction to carbidopa/levodopa. Anorexia may occur; decreased appetite results from nausea and vomiting. Confusion, agitation, psychosis, hallucinations, and depression may occur. Tachycardia and palpitations, not bradycardia, may occur. Orthostatic hypotension, not hypertension, may occur.

An antidepressant is prescribed for a depressed older client. After 1 week the client's son expresses concern that there does not seem to be much improvement. How should the nurse respond? 1.)"Antidepressant therapy requires several weeks before it becomes effective." 2.)"Antidepressant therapy will be more effective as the physical condition improves." 3.)"Additional medications may be required before behavioral changes will be observed." 4.)"Additional time is needed for the medication to become effective because of the prolonged depression."

1.)"Antidepressant therapy requires several weeks before it becomes effective." The effects of antidepressants are cumulative; it may take 3 to 4 weeks before improvement is identified. Antidepressants do not become more effective as a client's physical condition improves. It is too early to come to this conclusion. Antidepressants become effective after 3 or 4 weeks, regardless of the duration of the depression.

Which statement by the client indicates to the nurse that the teaching about taking an antidepressant medication has been understood? 1.)"I need to take every dose of my medication as prescribed." 2.)"I need to discontinue the medication if I have side effects." 3.)"I don't have to be concerned about taking my medications." 4.)"I can double the dose of the medication if I still feel depressed."

1.)"I need to take every dose of my medication as prescribed."

An agitated, acting-out, delusional client is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately? (Select all that apply.) 1.)Jaundice 2.)Dizziness 3.)Tachycardia 4.)Lethargic behavior 5.)Extrapyramidal symptom

1.)Jaundice 3.)Tachycardia

A health care provider diagnoses attention deficit-hyperactivity disorder (ADHD) in a 7-year-old child and prescribes methylphenidate (Ritalin). The nurse discusses the child's treatment with the parents. What should the nurse emphasize as important for the parents to do? 1.)Monitor the effect of the medication on their child's behavior 2.)Increase or decrease the dosage, depending on the child's behavior 3.)Avoid imposing too many rules, because this will frustrate the child 4.)Point out to their child that he can control this behavior if he wants to

1.)Monitor the effect of the medication on their child's behavior

A client is receiving oxycodone (Oxycontin) postoperatively for pain. The health care provider's prescription indicates that the dose should be administered every three hours for eight doses. What should the nurse assess before administering each dose of oxycodone? 1.)Respiratory rate and level of consciousness 2.)Color, character, and amount of urine output 3.)Intravenous site and patency of the intravenous catheter 4.)Amount and character of drainage in the portable drainage system

1.)Respiratory rate and level of consciousness

Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism? (Select all that apply.) 1.)Rigidity 2.)Tremors 3.)Mydriasis 4.)Photophobia 5.)Bradykinesia

1.)Rigidity 2.)Tremors 5.)Bradykinesia

Methylphenidate (Ritalin) has been prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD) and is to be taken with meals. What rationale should the nurse provide for the parents about the timing of medication administration? 1.)Ritalin depresses the appetite. 2.)This will ensure proper absorption. 3.)It is an oral mucous membrane irritant. 4.)Children tend to forget to take it before meals.

1.)Ritalin depresses the appetite.

Amitriptyline (Elavil) is an antidepressant medication used to treat anxiety disorders. Which class of antidepressant medications does it belong to? 1.)Tricyclics 2.)Monoamine oxidase inhibitors (MAOIs) 3.)Selective serotonin reuptake inhibitors (SSRIs) 4.)Serotonin-norepinephrine reuptake inhibitors (SNRIs)

1.)Tricyclics

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? (Select all that apply.) 1.)Vomiting 2.)Anorexia 3.)Slow heart rate 4.)Changes in mood 5.)Peripheral edema

1.)Vomiting 2.) Anorexia 4.)Changes in mood

An older adult living in a long-term care facility has been receiving lithium 600 mg twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. What is the most appropriate nursing intervention? 1.)Withholding the next dose of lithium and drawing blood to test it for toxicity 2.)Obtaining a prescription for the antidote to lithium and administering it immediately 3.)Suggesting that the practitioner replace the lithium for an antiepileptic that will control the mania 4.)Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water

1.)Withholding the next dose of lithium and drawing blood to test it for toxicity

A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic antidepressant. The client asks the nurse what the medication will do. What is the best response by the nurse? 1.)"This drug will help you forget why you're lonely and depressed." 2.)"The medication will increase your appetite and make you feel better." 3.)"You'll start to feel much better after taking this medication for 2 or 3 days." 4.)"You'll feel less depressed when you take this with the monoamine oxidase inhibitor."

2.)"The medication will increase your appetite and make you feel better."

Methylphenidate (Ritalin SR) is ordered for a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD). The nurse teaches the father about the safe administration of the medication and concludes that the instructions have been understood when the father says that he should administer it: 1.)At bedtime 2.)After breakfast 3.)When the child gets hungry 4.)When the child's behavior is out of control

2.)After breakfast

A client is found to have paranoid schizophrenia, and the practitioner prescribes a typical antipsychotic medication. After a 1-month hospitalization the client is discharged home with instructions to continue the antipsychotic and a referral for weekly mental health counseling. The picture illustrates the client's physical status as observed by the nurse on the client's first visit to the community mental health clinic. What extrapyramidal side effect has developed? 1.)Dystonia 2.)Akathisia 3.)Tardive dyskinesia 4.)Pseudoparkinsonism

2.)Akathisia Akathisia, an extrapyramidal side effect of typical antipsychotics, is motor restlessness. The client is unable to sit or stand still and feels the need to move, pace, rock, swing the legs, or tap the feet. The condition occurs within 5 to 90 days of the initiation of therapy. Dystonia is muscle spasms of the face, tongue, head, neck, jaw, or back, usually resulting in exaggerated posturing. This extrapyramidal side effect of typical antipsychotics occurs within 1 hour to 1 week of the initiation of therapy. Tardive dyskinesia is facial, ocular, oral/buccal, lingual/masticatory, and systemic movements. This extrapyramidal side effect of typical antipsychotics may occur 6 months or more after the initiation of therapy. Pseudoparkinsonism has characteristics similar to those of Parkinson's disease (e.g., shuffling gait, tremors, rigidity, bradykinesia). This extrapyramidal side effect of typical antipsychotics may occur anytime after the initiation of therapy.

A nurse is reviewing a newly admitted client's medication administration record (MAR). The nurse identifies that it is incomplete when the record is lacking information regarding the client's: 1.)Height 2.)Allergies 3.)Body weight 4.)Medical diagnosis

2.)Allergies

What should the nurse include in a teaching plan to help reduce the side effects associated with diltiazem (Cardizem)? 1.)Lie down after meals. 2.)Change positions slowly. 3.)Avoid dairy products in diet. 4.)Take the drug with an antacid.

2.)Change positions slowly.

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? (Select all that apply.) 1.)Jaundice 2.)Diaphoresis 3.)Hyperrigidity 4.)Hyperthermia 5.) Photosensitivity

2.)Diaphoresis 3.)Hyperrigidity 4.)Hyperthermia Diaphoresis, hyperrigidity, and hyperthermia occur with neuroleptic malignant syndrome as a result of dopamine blockade in the hypothalamus. Jaundice and photosensitivity are not associated with neuroleptic malignant syndrome.

A health care provider prescribes psyllium (Metamucil) 3.5 g twice a day for constipation. What is most important for the nurse to teach this client? 1.)Urine may be discolored. 2.)Each dose should be taken with a full glass of water. 3.)Use only when necessary because it can cause dependence. 4.)Daily use may inhibit the absorption of some fat-soluble vitamins.

2.)Each dose should be taken with a full glass of water.

A health care provider prescribes bed rest, loperamide (Imodium), and esomeprazole (Nexium) for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. The nurse concludes that the most likely cause of the diarrhea is: 1.)Loperamide 2.)Esomeprazole 3.)Bed rest 4.)Diet alteration

2.)Esomeprazole, Is a proton pump inhibitor, has diarrhea as its major adverse effect. Loperamide is a medication used to treat diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

A client receiving morphine is being monitored by the nurse for signs and symptoms of overdose. Which clinical findings support a conclusion of overdose? (Select all that apply.) 1.)Polyuria 2.)Lethargy 3.)Bradycardia 4.)Dilated pupils 5.)Slow respirations

2.)Lethargy 3.)Bradycardia 5.)Slow respirations

Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. It is most appropriate for the nurse to ask which member of the health care team to be the witness? 1.)Nursing supervisor 2.)Licensed practical nurse (LPN) 3.)Client's health care provider 4.)Designated nursing assistant

2.)Licensed practical nurse (LPN)

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the drug, the client complains of feeling dizzy. What action should the nurse take? 1.)Determine if this is an allergic reaction 2.)Place the client in the supine position and take the vital signs 3.)Elevate the client's head and keep the extremities warm 4.)Tell the client that this is not a typical sensation after receiving morphine sulfate

2.)Place the client in the supine position and take the vital signs

Morphine via an epidural catheter is prescribed for a client after abdominal surgery. The client asks the nurse why this medicine is necessary. What primary rationale does the nurse give for the administration of an opioid analgesic after abdominal surgery? 1.)Facilitates oxygen use 2.)Relieves abdominal pain 3.)Decreases anxiety and restlessness 4.)Dilates coronary and peripheral blood vessels

2.)Relieves abdominal pain

A client who is hospitalized after a myocardial infarction asks the nurse why the client is receiving morphine. The nurse replies that morphine: 1.)Dilates coronary blood vessels 2.)Relieves pain and prevents shock 3.)Decreases anxiety and restlessness 4.)Helps prevent fibrillation of the heart

2.)Relieves pain and prevents shock Morphine is a specific central nervous system depressant used to relieve the pain associated with myocardial infarction; it also decreases apprehension and prevents cardiogenic shock. Dilating coronary blood vessels is not the reason for the use of morphine. Decreasing anxiety and restlessness is not the primary reason for the use of morphine. Lidocaine is given intravenously to prevent fibrillation of the heart.

A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? 1.)Akathisia 2.)Tardive dyskinesia 3.)Parkinsonian syndrome 4.)Acute dystonic reaction

2.)Tardive dyskinesia

A client is receiving morphine sulfate (MS Contin) for severe metastatic bone pain. To prevent complications from a common, serious side effect of morphine, the nurse should: 1.)Monitor for diarrhea 2.)Observe for an opioid addiction 3.)Assess for altered breathing patterns 4.)Check for a decreased urinary output

3.)Assess for altered breathing patterns Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Although morphine sulfate may cause urinary retention, it is not a common side effect and is not life threatening.

A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of daily living. Which medication should the nurse anticipate the health care provider will prescribe? 1.)Benztropine (Cogentin) 2.)Amantadine (Symmetrel) 3.)Clomipramine (Anafranil) 4.)Diphenhydramine (Benadryl)

3.)Clomipramine (Anafranil)

A client has been receiving oxycodone (OxyContin) for moderate pain associated with multiple injuries sustained in a motor vehicle collision. The client has returned three times for refills of the prescription. What behavior, in addition to the client's slurred speech, leads the nurse to suspect opioid intoxication? 1.)Mood lability 2.)Hypervigilance 3.)Constricted pupils 4.)Increased respirations

3.)Constricted pupils Pupil constriction is a physical response to opioid intoxication; the pupils will dilate with opioid overdose. Opioids cause apathy or a depressed, sad mood (dysphoria); lability of mood is associated with the use of anabolic-androgenic steroids. Opioids cause drowsiness and psychomotor retardation; alertness is associated with the use of stimulants such as caffeine and amphetamines. Opioids depress the respiratory center of the brain, causing slow, shallow respirations; increases in temperature, pulse, respirations, and blood pressure are associated with cocaine use.

On the first day of the month a practitioner prescribes an antipsychotic medication for a client with schizophrenia. The initial dosage is 25 mg once a day, to be titrated in increments of 25 mg every other day to a desired dosage of 175 mg daily. On what day of the month will the client reach the desired daily dose of 175 mg? 1.)Day 7 2.)Day 9 3.)Day 13 4.)Day 15

3.)Day 13

Valsartan (Diovan), an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? (Select all that apply.) 1.)Constipation 2.)Hypokalemia 3.)Irregular pulse rate 4.)Change in visual acuity 5 .)Orthostatic hypotension

3.)Irregular pulse rate 5.)Orthostatic hypotension

A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which most frequently prescribed antidiarrheal drug does the nurse expect the health care provider to prescribe? 1.)Bisacodyl (Dulcolax) 2.)Psyllium (Metamucil) 3.)Loperamide (Imodium) 4.)Docusate sodium (Colace)

3.)Loperamide (Imodium)

Methylphenidate (Ritalin) is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children for its: 1.)Diuretic effect 2.)Synergistic effect 3.)Paradoxical effect 4.)Hypotensive effect

3.)Paradoxical effect

Which relationship does the nurse consider reflective of the relationship of naloxone (Narcan) to morphine sulfate? 1.)Aspirin to warfarin (Coumadin) 2.)Amoxicillin (Amoxil) to systemic infection 3.)Protamine sulfate to parenteral heparin 4.)Enoxaparin (Lovenox) to dalteparin (Fragmin)

3.)Protamine sulfate to parenteral heparin

A nurse is caring for a 3-month-old infant who was admitted to the pediatric unit with severe dehydration caused by diarrhea. After fluid and electrolyte balance is restored, Lactobacillus granules (Lactinex) are prescribed. The nurse expects this medication to: 1.)Help expel gas 2.)Relieve pain caused by hyperacidity 3.)Recolonize flora in the intestinal tract 4.)Diminish inflammatory mucosal edema

3.)Recolonize flora in the intestinal tract

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1.)One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. 2.)Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. 3.)Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. 4.)The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

3.)Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

A client with schizophrenia is taking benztropine (Cogentin) in conjunction with an antipsychotic. The client tells a nurse, "Sometimes I forget to take the Cogentin." What should the nurse teach the client to do if this happens again? 1.)Take 2 pills at the next regularly scheduled dose. 2.)Notify the health care provider about the missed dose immediately. 3.)Take a dose as soon as possible, up to 2 hours before the next dose. 4.)Skip the dose, then take the next regularly scheduled dose 2 hours early.

3.)Take a dose as soon as possible, up to 2 hours before the next dose.

A client with chronic undifferentiated schizophrenia is receiving an antipsychotic medication. For which potentially irreversible extrapyramidal side effect should a nurse monitor the client? 1.)Torticollis 2.)Oculogyric crisis 3.)Tardive dyskinesia 4.)Pseudoparkinsonism

3.)Tardive dyskinesia

A nurse administers an antipsychotic medication to a client. For which common manageable side effect should the nurse evaluate the client? 1.) Jaundice 2.)Melanocytosis 3.)Drooping eyelids 4.)Unintentional tremor

4.) Unintentional Tremor Unintentional tremor is one of the extrapyramidal side effects of the antipsychotic medications; it is considered common and manageable. Jaundice is a severe but not a common occurrence; periodic liver function tests should be performed. An excessive number of melanocytes is not a side effect of antipsychotics. Drooping of the eyelids is not a common side effect.

A 7-year-old boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) is receiving methylphenidate (Concerta). His mother asks about its action and side effects. What is the nurse's initial response? 1.)"This medicine increases the appetite." 2.)"This medicine must be continued until adulthood." 3.)"It is a short-acting medicine that must be given with each meal." 4.)"It is a stimulant that has a calming effect on children with your son's disorder."

4.)"It is a stimulant that has a calming effect on children with your son's disorder."

A client is extremely depressed, and the practitioner prescribes a tricyclic antidepressant, imipramine (Tofranil). The client asks the nurse what the medication will do. The nurse responds: 1.)"It will help you forget why you are depressed." 2.)"It will help keep you alert and cure your insomnia." 3.)"It will help you feel better after taking it for several days." 4.)"It will help increase your appetite and make you feel better."

4.)"It will help increase your appetite and make you feel better."

A client has become increasingly depressed, and the practitioner prescribes an antidepressant. After 20 days of therapy, the client returns to the clinic. The client appears relaxed and smiles at the nurse. The most significant conclusion that the nurse can draw from this behavior is that the client: 1.)Wants to please the staff 2.)Has resolved her conflicts 3.)May be in denial of her problems 4.)Is responding to the antidepressant therapy

4.)Is responding to the antidepressant therapy

A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to a family member that this drug primarily is used to: 1.)Keep the client quiet and relaxed 2.)Control the client's behavior and reduce stress 3.)Reduce the client's need for physical restraints 4.)Make the client more receptive to psychotherapy

4.)Make the client more receptive to psychotherapy

A nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which prescription should the nurse question? 1.)Oral psyllium (Metamucil) 2.)Oral potassium supplement 3.)Parenteral half normal saline 4.)Parenteral albumin (Albuminar)

4.)Parenteral albumin (Albuminar)

A man is found to have paranoid schizophrenia, and the practitioner prescribes a typical antipsychotic medication. After taking the medication for 1 month the client comes to the clinic and says, "I feel stiff, my hands shake, and I started drooling. The picture illustrates the client's physical status observed by the nurse in the clinic. What extrapyramidal side effect does the nurse conclude has developed? 1.)Dystonia 2.)Akathisia 3.)Tardive dyskinesia 4.)Pseudoparkinsonism

4.)Pseudoparkinsonism

When reviewing the medications for a group of clients on a psychiatric unit, the nurse concludes that the pharmacotherapy for anxiety disorders is moving away from benzodiazepines and moving toward: 1.)Anticholinergics 2.)Lithium carbonate 3.)Antipsychotic medications 4.)Selective serotonin reuptake inhibitorst

4.)Selective serotonin reuptake inhibitors

A health care provider prescribes bisacodyl (Dulcolax) for a client with cardiac disease. The nurse explains to the client that this drug acts by: 1.)Producing bulk 2.)Softening feces 3.)Lubricating feces 4.)Stimulating peristalsis

4.)Stimulating peristalsis

A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a health care provider prescribes an antipsychotic medication for these clients? 1.)To improve judgment 2.)To promote social skills 3.)To diminish neurotic behavior 4.)To reduce the positive symptoms of psychosis

4.)To reduce the positive symptoms of psychosis Antipsychotics are used to decrease positive signs and symptoms associated with psychoses, including hallucinations, delusions, paranoia, and disorganized speech. These drugs are used to minimize psychotic, not neurotic, signs and symptoms. Improved judgment and social skills are not prime reasons that antipsychotic drugs are used

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, the nurse should advise the client to take the prescribed as needed oxycodone and acetaminophen (Percocet): 1.)Just as a last resort 2.)Before going to sleep 3.)As the pain becomes intense 4.)When the discomfort begins

4.)When the discomfort begins