Questions for Pharm test 2
Which label most aptly described the drug atropine? A. Cholinergic B. Parasympatholytic C. Muscarinic agonist D. Parasympathomimetic
B
What type of neuron would the nurse expect to be blocked earliest when using a local anesthetic? A. pain perception B. perception of cold C. touch D. deep pressure
A
A 7-year-old child is to begin taking methylphenidate (Ritalin SR) twice daily. The nurse should teach the parents to monitor the child closely for which of the following side effects of methylphenidate? A. Insomnia B. Lethargy C. Increased appetitie D. Urticaria
A
A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? A. Parasympathetic activity would increase B. Parasympathetic signals would be depressed C. Sympathetic activity would increase D. Respiratory centers would be depressed
A
A nurse is assessing a patient on benzodiazepines who exhibits drowsiness, lethargy, and confusion and has respirations of 11/minute. The nurse recognizes these signs and symptoms and should prepare to administer which drugs ordered by the prescriber? A. Flumazenil B. Naloxone C. Epinephrine D. Atropine
A
A nurse is caring for an 80 year-old man who just has throat surgery. Which of the concomitant medications would cause the most concern about potential development of urinary retention when the patient is given morphine for post-op pain? A. Tricyclic antidepressants B. Antacids C. Nosteroidal anti-inflammatory agents D. Insulin
A
A patient is experiencing symptoms of the "fight-or-flight" response. Which autonomic process stimulates this response? A. Sympathetic system B. Predominant tone of the organs C. Baroreceptor reflex D. Parasympathetic system
A
Second-generation antipsychotic (SGA) drugs are commonly preferred over first-generation antipsychotics (FGA) primarily because they? A. Are preceived as being more effective B. Cost less C. Do not affect thinking D. Only cause minor adverse effects
A
Second-generation antipsychotics (SGAs) were formerly called: A. atypical antipsychotics B. high-potency C. low-potency D. typical
A
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A. Cardiac rhythm B. Blood urea nitrogen C. CNS tremor D. Lung sounds
A
The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? A. Use as a preanesthesia medication B. Treatment of tachycardias C. Prevention of urinary retention D. Reduction of intraocular pressure in glaucome
A
The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine [Anectine]. The patient develops muscle rigidity and a temperature of 105°F. Which nursing action is essential? A. Prepare to administer dantrolene B. Administer normal saline at 50 mL/hr C. Administer morphine sulfate to relieve pain D. Prepare for intubation and mechanial ventilation
A
The nurse is counseling a 32 year-old male patient who returns for a follow-up visit 3 weeks after starting an alpha antagonist for hypertension. He is upset because the medication has caused problems with ejaculation. The nurse's best response would be: A. the problem will resolve when the drug is discontinued. If this is unacceptable to you, you will need a different drug B. the ejaculatory problem is probably drug to your hypertension and thus is likely to be permanent C. the ejaculatory problem is not as important as uncontrolled hypertension. You will need to cope with this problem D. you should stay on the medication for 12 months before changing, regardless of the side effects
A
The nurse is preparing to give a drug to stimulate activation of adrenergic receptors. Which effects indicate sympathetic stimulation? A. Increase in heart rate B. Constriction of pupils C. Atrioventricular block D. Sinus bradycardia
A
The priority nursing focus for a patient experiencing acute dystonia is? A. Airway clearance B. Anxiety C. Pain D. Safety
A
What is essential for the nurse to confirm before starting vecuronium as a continuous intravenous infusion? A. The patient has been intubated and is on mechanical ventilation B. A Foley catheter has been inserted C. Hourly blood glucose levels have been ordered D. A nasogastric tube is in place for suction
A
What is the primary effect of neuromuscular blockers? A. Flaccid paralysis B. Hypotension C. Loss of consciousness D. Reduction in pain
A
Which of the following is a direct mechanism by which adrenergic agonists activate adrenergic receptors? A. direct receptor binding B. inhibition of norepinephrine release C. promotion of norepinephrine reuptake D. facilitation of norepinephrine inactivation
A
Which of the following is the goal of cancer pain management? A. to reduce pain to a level agreed upon between the patient and the providers B. to completely alleviate pain C. to make the patient comfortable with the least amount of medication D. to use nonpharmacologic pain relief measures until pain reaches a score of 7 out of 10
A
Which receptors are considered adrenergic receptors? Select all that apply A. Alpha 1 B. Beta 2 C. Dopamine D. Muscarninic 1 E. Beta 1 F. Alpha 2
A, B, C, E, F
Which organs are controlled primarily by the parasympathetic system? select all that apply A. GI tract B. Respiratory tract C. Cardio system D. Skin E. Salivary glands
A, B, D, E
A patient drinks 5 to 6 alcoholic beverages per day and takes acetaminphen for pain relief. The nurse should caution the patient to: A. limit the intake of acetaminophen to less than 2000 mg/day B. avoid taking acetaminophen for pain C. take acetaminphen with food to decrease the risk of liver damage D. avoid taking any pain reliever other than acetaminophen
A. Rationale: Patients who drink 3 or more alcoholic beverages per day should limit acetaminophen dosage to less then 2000 mg/day to prevent hepatic injury
A nurse is teaching a parent about the administration schedule for the amphetamine (Adderall XE) to treat the child's ADHD. The nurse should instruct the parent to: A. give the dose in the morning before school B. have the school nurse administer the dose at lunch C. administer the medication at bedtime D. have the child take the dose before diner
A. Rationale: This long-acting drug should be administered in the morning during or after breakfast
After surgery, a patient has morphine prescribed for postoperative pain. which is the priority assessment in this situation? A. respiratory rate B. heart rate C. pain level D. constipation
A. Rationale: monitoring for respiratory respirations in all patients receiving morphine is a priority. If rate is 12 breaths per minute or fewer, the nurse should withhold medication and notify the prescriber
The following statements about neuromusculer blockers are true except: A. They cannot be absorbed by the GI tract B. They can easily cross the placenta C. They cannot cross the blood-brain barrier D. They have no effect on the CNS
B
Loss of spontaneous respiration signals the beginning of the anesthetic stage of: A. analgesia B. delirium C. surgical anesthesia D. medullary paralysis
D
An adolescent has been prescribed atomoxetine (Strattera) for attention-deficit/hyperactivity disorder. During the health history, the parents state that they hope this medication will improve the girl's ability to make friends, because at times she seems so sad. In the discharge instructions to the patient and family, what teaching would be most important for the nurse to include? A. Atomoxetine can cause nausea and vomiting B. Atomoxetine can cause suicidal thinking C. Atomoxetine can cause difficulty sleeping D. Atomoxetine can cause euphoria
B
Drug interactions may be problematic in patients using phenobarbital. the nurse should monitor for: A. bleeding from decreased metabolism of warfarin B. suboptimal INRs in patients also taking warfarin C. decreased effect of opioids D. decreased phenobarbital effects if also on valproic acid
B
Patient compliance with antidepressant drug therapy is most likely to be increased in the nurse explains? A. drug interactions B. expected timing of therapeutic response C. the reason for limiting the number of units of the drug supplied with each prescription D. the seriousness of adverse effects
B
Stimulation of parasympathetic nerves result in: A. increased heart rate B. urinary retention C. constipation D. pupil constriction
D
A 71 year-old patient has been on Levodopa for this Parkinson's disease for two weeks. He reports that he has not noticed any improvements in his symptoms. The nurse should respond to his concern in which of the following ways? A. stop the drug. if it has not been effective in two weeks, it is not likely to be beneficial B. it may take months for a response to occur. you should continue the medication as prescribed C. double the dose to see if an effect will occur D. another agent will need to be added to the regimen now
B
A cancer patient with a history of alcohol abuse is taking acetaminophen for pain. What organ function is a risk for toxicity from this particular combination? A. sensory B. liver C. kidney D. cardio-respiratory
B
A patient being treated with beta-blockers calls the nurse to describe new shortness of breath and edema. The nurse's best response would be: A. "There are common effects of these drugs. You should restrict fluid intake for several days." B. "You need to come in as there could be signs of early heart failure." C. "Stop the medication and call in five days if you do not feel better." D. "Try doubling the dose and see if the symptoms improve."
B
A patient is to be discharged home with a new prescription for prazosin [Minipress]. Which statement is most important for the nurse to include in the teaching plan? A. You should increase your intake of fresh fruits and vegetables B. You should move slowly from a sitting to a standing position C. Be sure to wear a Medic alert bracelet while taking this medicaiton D. Take your first dose of this medication first thing in the morning
B
A patient is to continue taking sustained-released benzodiazepines at home. A nurse has provided patient education about the medication. Which statement made by the patient demonstrates the need for further teaching? A. I can take my medicine with food to reduce stomach upset B. I should take two pills if I miss a dose C. I should not crush or chew my pills D. I should try not to drive if I am sleepy during the day
B
After administering dopamine for a patient who has been hypotensive, which indicator would the nurse use to judge a successful response? A. decrease in pulse and blood pressure B. increase in urine output C. weight gain D. improved gastric motility
B
Since the initiation of an antipsychotic drug, a patient complains of light-headedness and dizziness upon standing. What is the most appropriate comment the nurse can offer the patient? A. This is an unfortunatae and permanent effect of this class of drugs B. Get up slowly. Tolerance to this effect should develop in 2 to 3 months C. The drug must be discontinued immediately to avoid injury D. We need to increase your fluid intake, which should fix the problem
B
The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A. A 60 year-old women with an overactive bladder B. A 72 year-old man with glaucoma C. A 45 year-old women with peptic ulcer disease D. A 26 year-old man being prepared for surgery today
B
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? A. A heart rate of 100 beats/min B. Wheezing C. A glucose level of 180 mg/dL D. Urinary urgency
B
The nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? A. Wheezing decreases due to bronchodilation B. Heart rate decreases to 60 beats/min C. Diarrhea stool count decreases D. Oxygenation improves because of bronchodilation
B
When assessing a patient who is receiving an antidepressant, which of the following questions would be most important for the nurse to ask? A. Are you concerned about weigh gain when you take medications? B. Are you having any thoughts about doing anything that could harm yourself? C. Do you experience dizziness when you stand up? D. Have you had any difficulty voiding?
B
Which of the following statements is true regarding monitoring effectiveness of antiepileptic drugs? A. all seizure medications can be monitored by serum drug levels B. maintenance of a seizure frequency chart is essential for evaluating effectiveness of treatment C. the monitoring period is 30 days for most patients D. it is safe for patients to drive during the monitoring period
B
Which patient undergoing surgery is at greatest risk for an intensified effect from succinylcholine? A. A patient who takes aspirin 81 mg orally daily B. A patient receiving gentamicin 80 mg IV piggyback every 8 hours C. A patient taking isosorbide mononitrate 60 mg orally daily D. A patient receiving a continuous infusion of normal saline solution
B
A nurse recognizes that the actions of benzodiazepines include which of the following findings? (Select all that apply.) A. Sleep deprivation B. Relief of general anxiety C. Suppression of seizures and/or seizure activity D. Development of tardive dyskinesia E. Increase in muscle spasms
B, C, D, E
A nurse assesses the patient for possible lithium toxicity when the serum lithium level reaches 2.5 mEq/L. Which clinical manifestations would the nurse anticipate with lithium toxicity? (Select all that apply.) A. Hyperactivity B. Slurred speech C. Constipation D. Muscle twitching E. Ataxia F. Hypertension
B, C, D, F
A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which of the following answers? (Select all that apply.) A. Amphetamines increase fatigue B. Amphetamines suppress the perception of pain C. Amphetamines increase appetite D. Amphetamines increase the heart rate E. Amphetamines elevate mood
B, D, E
The nurse administers the preoperative medication, midazolam. The nurse will monitor the patient for which intended effect of this medication? A. decreased bronchial secretions B. reduction in anxiety C. respiratory depression D. suppression of cough
B. Rationale: Benzodiazepines are given preoperatively to reduce anxiety and promote amnesia
A patient plans to stop taking prescribed clonidine to treat hypertension because of dry mouth. The nurse should: A. tell the patient that dry mouth is not an adverse effect of clonidine B. give the patient hard candy to suck on to relieve the symptom C. instruct the patient to stop taking the medication immediately D. allow the patient to take a reduced dose of the medication
B. Rationale: Dry mouth is common in patients taking clonidine and is usually temporary (lasting only 2 to 4 weeks). The patient should be instructed to chew gum, suck on hard candy, or take frequent sips of fluids to provide relief of the dry mouth.
After an intramuscular injection of penicillin, the patient develops severe difficulty breathing and a swollen tongue. The nurse will prepare to administer: A. dopamine B. epinephrine C. isoproterenol D. phenylephrine
B. Rationale: Epinephrine is the drug of choice for patients in anaphylactic shock
Which of the following opioids is available in a transdermal patch formulation? A. meperidine B. morphine C. fentanyl D. hydromophone
C
A patient taking levodopa plus carbidopa for Parkinson's disease experiences frequent "on-off" episodes (or abrupt loss of effect). The nurse should teach the patient to: A. take the medication on an empty stomach B. avoid high-protein meals C. increase intake of vitamin B6 D. discontinue the drug for 10 days (for a "drug holiday")
B. Rationale: Meals high in protein can reduce the therapeutic responses to levodopa and may trigger an abrupt loss of effect
When administering a neuromuscular blocking agent to an alert patient before a procedure, the nurse should: A. teach the patient relaxation exercises B. administer a sedating agent C. assess for the presence of a gag reflex D. check for allergies to the aminoglycosides
B. Rationale: Neuromuscular blockers do not diminish consciousness or perception of pain even with complete paralysis
A patient is receiving a drug that blocks adrenergic receptors. The most serious adverse response to this drug is: A. nasal congestion B. orthostatic hypotension C. inhibition of ejaculation D. reflex tachycardia
B. Rationale: Orthostatic hypotension can reduce blood flow to the brain, causing dizziness, lightheadedness, and syncope
Clozapine (Clozaril) is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient? A. Strategies to manage breast enlargement and nipple discharge B. The importance of promptly reporting flulike symptoms C. Contraceptive measures and expected changes in menstruation D. Proper technique for measuring blood pressure
B. Rationale: Patients taking clozapine should be informed about the risk of agranulocytosis and must have a weekly blood test.
A patient with diabetes requires a beta blocker. Which of the following drugs would be appropriate for this patient? A. Propranolol B. metoprolol C. Carvedilol D. Terazosin
B. Rationale: Patients with diabetes who are prescribed beta blockers should receive a beta 1 selective agent such as metoprolol. Propranolol blocks both beta 1 and beta 2 receptors; carvedilol blocks beta 1, beta 2, and alpha 1 receptors. Terazosin is an alpha 1 receptor blocker
An adult patient suddenly cries out. A nurse sees the patient's head twisted to the side and arched back and the eyes rolled up. The patient has been newly diagnosed with schizophrenia, and therapy with a traditional antipsychotic medication was started yesterday. Based on the nurse's assessment, what would be the next nursing action? A. Obtain the patient's vital signs and pulse oximetry B. Administer a prn dose of diphenhydramine (Benadryl) C. Administer a prn dose of haloperidol D. Obtain a serum drug level and reassure the patient
B. Rationale: The patient is displaying symptoms of intense dystonia, a crisis that can occur after administration of an antipsychotic medication. The crisis should be managed with a dose of diphenhydramine.
A patient with depression is prescribed an antidepressant. The nurse should instruct the patient that the medication will reach full therapeutic effect in: A. 7 to 10 days B. 2 to 3 weeks C. 2 to 4 months D. 6 months
B. Rationale: antidepressants must be taken for several weeks before full therapeutic effects develop.
A patient who takes oxybutynin for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity? A. Cool, moist skin; confusion; and bradycardia B. Dry mouth, increased temperature, and blurred vision C. Hallucinations, increased salivation, and diaphoresis D. Hypothermia, increased respiratory rate, and pupil constriction
B. Rationale:Symptoms of muscarinic antagonist toxicity include dry mouth; blurred vision; photophobia; hyperthermia; respiratory depression; and hot, dry and flushed skin
A patient is newly prescribed carbamazepine for seizure control. Which food should the patient be taught to avoid? A. tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit
B. Rationale: Grapefruit juice can inhibit the metabolism of carbamazepine, thereby causing the plasma levels to rise. Grapefruit juice may increase peak and trough levels of carbamazepine by 40%
Which is the priority of care in the patient with moderate to severe pain from cancer? A. prevention of addiction and physical dependence B. adequate pain relief with opioid medications C. avoiding constipation by increasing dietary fiber D. using transcultaneous electrical nerve stimulation or massage to treat cancer pain
B. Rationale: pain relief is a primary goal in patients with cancer. Opioids are the most effective analgesics available and are the primary drugs for treating moderate to severe cancer pain
A nurse is caring for a patient who just started on an antipsychotic drug and who begins to complain of severe muscle spasms of the tongue, face, and back. Based on these manifestations, which class of drugs should the nurse anticipate that the prescriber will order? A. Narcotic antagonist B. Anticholinergic agent C. Neuroleptic agent D. Tricyclic agent
B. Rationale: the patient shows clear evidence of extrapyramidal symptoms involving acute dystonia, such as severe spasms of the muscles of the tongue, face, neck, back
Which of the following signs would the nurse expect in a patient receiving a drug that activates alpha 1 receptors? A. vasodilation B. constricted pupils C. elevated blood pressure D. bleeding
C
A nurse counsels an 8-year-old child and the parents about the methylphenidate (Concerta LD) that was just prescribed for attention-deficit/hyperactivity disorder. What information should the nurse provide regarding administration of the drug? A. chew one tablet twice daily B. dissolve a tablet in juice or milk in the morning C. do not crush or chew the medication D. crush the medicine and mix it in apple sauce
C
A nurse is discussing a patient's lithium levels with another nurse. The laboratory findings show a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels? A. The patient's plasma level is below the toxic level of 3 mEq/L and is considered therapeutic B. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic C. The patient's plasma level is between 0.4 and 1 mEq/L and is considered therapeutic D. The patient's plasma level is below the 2.5 mEq/L level that would indicate toxicity
C
A patient taking valproic acid for his seizures tells the nurse that he drinks a six-pack of beer daily and two to three six-packs each weekend. Based on this information, what further priority assessment should the nurse recommend? A. plasma level of valproic acid B. determining whether the patient takes the drug with meals C. liver function studies D. the dosage of the medication the patient is currently taking as the dose may need to be increased
C
A patient with a history of bipolar disorder has been on lithium therapy for 3 years. The patient begins to develop hypertension. Which class of drugs, if given concurrently with lithium, would result in an adverse drug-to-drug interaction? A. ACE inhibitors B. Vasdilators C. Diuretics D. Calcium channel blockers
C
The most appropriate drug for the nurse to administer for a patient with spinal card compression is: A. morphine B. ibuprofen C. dexamethasone D. amitriphtylien
C
The most common cause of lithium toxicity is? A. Overdose of medication B. Renal failure C. Sodium depletion D. Sex
C
The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin [Ditropan] for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan? A. You may experience a slower heart rate. Call your doctor if it is below 60 B. Ditropan is very effective. Most patients experience significant relief C. Sip on water and suck on hard candy to help with the problem of dry mouth D. Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan
C
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? A. Cardiac dysrhythmias B. Hypertension C. Diabetes D. Angina
C
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A. Topical phenylephrine B. Subcutaneous terbutaline C. Intravenous epinephrine D. Inhaled albuterol
C
The patient who has been taking propranolol for 18 months reports that he is stopping the medication because his blood pressure has been normal for the past 3 months. The nurse should counsel him to: A. stop the medication and keep an accurate record of his pressures B. stop the medication and report any uncomfortable symptoms C. the drug needs to be tapered over a 2 week period to prevent rebound hypertension D. continue the medication until another can be started to avoid withdrawal symptoms
C
What normally occurs after physical dependence has developed in the use of CNS drugs? A. continued use is not required B. it can be avoided by dosing more frequently C. continued use is required for life for the brain to function normally D. physical dependence is not a problem with CNS agents
C
When drugs interfere with the process that terminates transmitter action, the result is a(n): A. significant alteration in the release of transmitters B. decrease in the concentration of transmitters in the synaptic gap C. increase in the concentration of transmitters in the synaptic gap D. increase in the transmitter reuptake
C
When pancuronium (pavulon), a long-acting nondepolarizing neuromuscular blocker is used the nurse may expect prolonged muscle relaxation in patients with: A. heart failure B. chronic obstructive pulmonary disease C. renal insufficiency D. hepatitis
C
Which condition is an indication for the use of succinylcholine? A. Pain relief after major surgery B. Loss of consciousness during surgery C. Facilitation of endotracheal intubation D. Relief of status epilepticus
C
Which of the following interventions for neuroleptic malignant syndrome would most likely reduce body temperature by treating the cause of the hyperthermia? A. Acetaminophen B. Acetylsalicylic acid C. Dantrolene D. Increasing fluid intake
C
Which of the following nursing actions is important before the administration of bethanechol? A. determine whether the patient has a history of glaucome B. determine whether the patient has received corticosteroids within the past year C. determine whether the patient has asthma D. determine whether the patient has a history of urinary tract infections
C
Succinylcholine is contraindicated in a patient with which condition? A. Diabetes mellitus B. Hyperthyroidism C. Chronic obstructive pulmonary disease (COPD) D. Major burns during the emergent phase
D
A patient comes to the clinic complaining of insomnia. In his health history, the patient reveals that he works in a coffee shop, and as a snack he has been eating a cup of chocolate-covered coffee beans daily in the late afternoon. Based on the patient's statement, the nurse should assess for what other clinical manifestations? (Select all that apply.) A. Vasodilation of blood vessels in the CNS B. Elevated serum sodium levels C. Diuresis D. Bronchodilation E. Nervousness
C, D, E
A patient with bipolar disorder is taking lithium. Which of the following signs and symptoms exhibited by the patient would indicate lithium toxicity? A. Anuria, increased appetite, and abdominal distention B. Nonproductive cough, increased deep tendon reflexes, and hypertension C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema
C.
A patient with depression is prescribed fluoxetine (Prozac). Which of the following statements made by the patient indicates an understanding of the medication teaching? A. Disorientation and hallucinations are common adverse effects B. I may experience sexual fantasies while taking this medication C. it may take 3 to 4 weeks before my mood is elevated D. I can stop this medication when I feel less depressed
C.
Amphetamines (Adderall XR) cause growth suppression in children. To decrease this adverse effect, the nurse should teach the parent to: A. administer the medication on an empty stomach B. not administer the medication during the summer months C. provide a snack or meal before administering the medication D. give the medication at bedtime
C.
A patient is prescribed Phenelzine MAOI for treatment of depression. Which foods should the patient be taught to avoid? A. Broccoli, shrimp, and yogurt B. Tomatoes, chicken, and milk C. Bananas, smoked fish, and cheese D. Apples, steak, and cottage cheese
C. Rationale: Foods high in tyramine should be avoided if a patient is taking monoamine oxidase inhibitors.
A patient with cancer complains of bone pain rated 8. Which as needed (PRN) medication should the nurse administer? A. Ibuprofen B. Acetaminophen C. Hydromorphone D. Meperidine
C. Rationale: Hydromorphone is a pure opioid agonist and suggested for moderate to severe cancer pain.
A nurse is checking on patients. The nurse enters the room of a patient who takes an antipsychotic agent. The patient is confused, has a sudden fever, and develops "lead pipe" rigidity. The nurse recognizes these as symptoms of which of the following? A. Tardive dyskinesia B. Acute dystonia C. Neuroleptic malignant syndrome D. Parkinsonism
C. Rationale: Neuroleptic malignant syndrome is rare but serious. The primary symptoms are "lead-pipe" rigidity, sudden high fever, and confusion.
A patient with myasthenia gravis is prescribed pyridostigmine. Which of the following will the nurse include in patient teaching? A. the medication is an irreversible cholinesterase inhibitor that may cause a cholinergic crisis B. an extra dose should be administered if the patient feels extreme weakness or muscle paralysis C. the patient should wear medical identification to alert medical personnel of the condition D. the condition is curable, and the medication will be taken for 2 to 3 months
C. Rationale: Pyridostihmine is a reversible cholinesterase inhibitor. Emergency medical assistance should be attained for symptoms of weakness or muscle paralysis to determine whether the episode is a myasthenic or cholinergic crisis.
The immediate nursing priority when administering long-acting benzodiazepine as prescribed is? A. Gastric distress B. Potential for abuse C. Respiratory depression D. Safety
D
A nurse is preparing a neuromuscular blocking agent to be used for endotracheal intubation. The drug most often used is: A. tubocurarine B. pancuronium C. succinylcholine (Anectine) D. vecuronium (Norcuron)
C. Rationale: Succinylcholine is the preferred agent for endotracheal intubation because of its short duration of action
Which assessment best determines tardive dyskinesia in a patient taking antipsychotic agents? A. pacing and squirming with an uncontrollable need for motion B. mask-like face with drooling, tremors, rigidity, and shuffling gait C. twisting, writing, worm-like movements of the tongue and face D. sudden high fever, sweating, and fluctuations in blood pressure
C. Rationale: Tardive dyskinesia is characterized by involuntary twisting, writhing, worm-like movements of the tongue and face. Parkinson's is characterized by mask-like face with drooling, tremors, rigidity and shuffling gait. Akathisia is pacing and squirming with an uncontrollable need for motion. Neuroleptic malignant syndrome is sudden high fever, sweating, and fluctuations in blood pressure
A patient is prescribed Bupropion (Wellbutrin). If the patient asks the purpose of this medication, the nurse should: A. ask the patient to take to the healthcare provider B. refer the patient to the pharmacist C. tell the patient the medication will decrease anxiety and can help with smoking cessation D. give the patient a pamphlet on anxiety disorders and treatment
C. Rationale: The nurse should respond to the patient's concern or questions honestly.
Which of the following patients would be at highest risk for systemic toxicity from topical administration of a local anesthetic? A. A 42 year-old patient who receives epinephrine with the local anesthetic B. A 72 year-old patient who receives a local anesthetic topically to intact skin C. A 58 year-old patient who receives a local anesthetic to a 10-x 20-cm abrasion D. A 34 year-old patient with an injection of bupivacaine as a nerve block
C. Rationale: the risk of toxicity is less if epinephrine is administered, because the blood flow will be decreased (vascoconstriction) and delay systemic absorption of the anesthetic. The risk for toxicity increases with a large surface area or an abraded area
The nurse is assessing a patient who is experienced anaphylaxis from an insect sting. The drug most suited for treating this condition is: A. ephedrine B. diphendydramine C. dopamine D. epinephrine
D
Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A. Epilepsy B. Diabetic coma C. Meningitis D. Psychosis
D
In a patient at risk for respiratory depression, how long after the nurse administers a dose of morphine IV would the respiratory depressant effects last? A. 7 minutes B. 30 minutes C. 60 minutes D. 4-5 hours
D
A nurse is assessing a patient taking a monoamine oxidase inhibitor who complains of a headache, nausea, and vomiting. The patient's vital signs are: pulse 128/minute, blood pressure 194/106 mm Hg, and, respiration 30/minute. The patient admits to the nurse that she has been drinking a glass of red wine with dinner each night. The nurse would be correct to suspect that the patient is experiencing which of the following health alterations? A. allergic reaction B. Reflex tachycardia C. Rebound hypertension D. Hypertensive crisis
D
A nurse is preparing to give a medication that stimulates the beta2 receptors. Which response will the nurse expect from this drug? A. Increased peristalsis B. Constriction of pupil C. Hypoglycemia D. Brochodilation
D
A patient taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn't had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 78/minute, blood pressure 130/79 mm Hg, and respirations 20/minute. Based on this assessment, the nurse should suspect which of the following causes? A. Possible toxicity B. Cholinergic effects C. Dehydration D. Anticholinergic effects
D
The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system? A. Norepinephrine B. Epinephrine C. Dopamine D. Acetylcholine
D
What instruction should the nurse give a diabetic patient on insulin when propranolol is prescribed? A. you need to increase your insulin to allow for the effect of the propranolol B. propranolol may potentiate the effects of the insulin so the dose should be reduced C. propanaolol has not effects on diabetics or on insulin D. propanolol may mask the signs of hypoglycemia so you need to use signs other than rapid heart rate to know when your glucose is too low
D
When administering lithium carbonate, which of the following assessments would indicate that therapy has achieved the desired effect? A. Displays flight of ideas B. Exhibits pressured speech C. Sits and watches TV for 8 hours per day D. Sleeps 8 hours per night
D
Which of the following statements is true regarding the impact of prolonged CNS drug exposure on the CNS? A. side effects generally increase over time B. when tolerance develops, drugs dosage should be decreased C. these drugs usually act immediately and do not require structural changes in the nervous system D. these drugs may take some time to exert the adaptive changes that produce the desired effects
D
Which of the following statements is true regarding the use of dopamine agonists in Parkinson's disease: A. dopamine agonists are more effective than levodopa B. dopamine agonists compete with dietary proteins in the intestines C. these agents are more likely to cause disabling dyskinesthesias D. the newer non-ergot derivatives cause less side effects that the ergot derivatives such as bromocriptine
D
Which symptom is the most indicative of muscarinic poisoning? A. Constipation B. Heart rate of 140 beats/min C. Blood pressure of 180/110 mm Hg D. Blurred vision
D
While the patient is paralyzed with neuromuscular blockers: A. he is essentially unconscious B. he is heavily sedated though conscious C. he is stuporous but can be aroused D. he remains conscious
D
A nurse is reviewing a patient's laboratory findings prior to medication administration. The most recent serum lithium level is 2.2 mEq/L and was drawn yesterday. The patient takes 300 mg of lithium carbonate four times a day. Which of the following is the nurse's most appropriate action? A. Administer the drug as prescribed B. Recognize that the dose is subtherapeutic C. Administer half of the dose D. Hold the next dose and notify prescriber
D Rationale: The lithium level is toxic, therefore the dose should be held and the prescriber notified.
Which receptors mediate responses to the neurotransmitter acetylcholine? Select all that apply A. Alpha 1 B. Beta 2 C. Dopamine D. Nicotinic E. Muscarinic
D, E
A nurse is providing nursing education about the use of atypical antipsychotic agents and their effects on the body. Which statement made by a nurse best demonstrates an accurate understanding of the effects of atypical antipsychotic agents? A. They cause a higher rate of relapse B. They affect only the negative symptoms of schizophrenia C. They cause more extrapyramidal symptoms D. They pose a risk of weight gain and diabetes mellitus
D.
A patient comes to the clinic for a routine blood pressure check. After reviewing the patient's medications, a nurse recognizes that the patient is taking a monoamine oxidase inhibitor. The nurse provides patient education regarding diet. Which breakfast choice made by the patient would indicate the need for additional teaching? A. orange juice B. carbonated beverages C. fried eggs D. yogurt
D.
A patient is prescribed phenytoin for epileptic seizures. Which of the following is a priority nursing action? A. warn the patient against using alcohol B. tell the patient to take the medication with meals to prevent gastric upset C. inform the patient about prevention of gingival hyperplasia D. teach the patient to avoid abrupt cessation of treatment
D. Rationale: All the interventions should be included in patient teaching; however, the most important is to avoid abrupt cessation of treatment. This could lead to a life-threatening seizure or status epilepticus
A patient is prescribed bethanechol for urinary retention. If the patient exhibits signs of an overdose (increased salivation and sweating, bradycardia, and hypotension), the nurse will administer: A. physostigmine B. acetylcholine C. cholinesterase inhibitor D. atropine
D. Rationale: Atropine is a selective muscarinic blocking agent and will reverse most signs of toxicity
A patient is prescribed a dopamine agonist, pramipexole. Which of the following statements made by the patient indicates a need for further teaching? A. "I can take the medication with food to avoid nausea and vomiting" B. "I may experience hallucinations while taking this medication" C. "I should rise slowly to avoid fainting spells" D. "This medication will stop the progression of Parkinson's disease"
D. Rationale: Dopamine agonists will improve patients' abilities to complete activities of daily living but are not a cure and will not delay progression of Parkinson's disease
A patient is receiving dopamine for treatment of shock. What parameter offers the best indicator of improved clinical status? A. mean arterial pressure B. daily weight C. systemic venous resistance D. urine output
D. Rationale: Dopamine is used in the treatment of shock. Improved clinical status will best be monitored by the UO. Dopamine will dilate renal blood vessels and improve renal perfusion and increase UO.
A patient with bipolar disorder is taking lithium. Which statement made by the patient indicates a need for further teaching? A. I should take the medication with milk to decrease stomach upset B. I will notify my doctor if I feel hyperactive C. I should drink at least 8 to 10 glasses of water every day D. I will restrict my sodium intake while taking this medication
D. Rationale: Lithium will accumulate if sodium is restricted in the diet
The nurse determines that a patient is experiencing a decreased response to the prolonged use of a drug. This manifestation is called: A. withdrawal syndrome B. physical dependence C. psychologic dependence D. tolerance
D. Rationale: tolerance is defined as a decreased response occurring in the course of prolonged drug use
A postoperative patient who has an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as needed medication should the nurse administer to the patient? A. methadone B. nalbuphine C. tramadol D. naloxone
D. Rationale: following surgery, naloxone may be used to reverse excessive respiratory and CNS depression caused by opioids
