Saunders Neurological Medications

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking two to three aspirin every 4 hours for the last week, and it hasn't helped my back." Since aspirin intoxication is suspected, the nurse should assess the client for which manifestation? a) Tinnitus b) Diarrhea c) Constipation d) Photosensitivity

a) Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is experienced commonly when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production. Options 2, 3, and 4 are not associated specifically with toxicity.

The nurse has given medication instructions to a client receiving phenytoin (Dilantin). Which statement indicates that the client has an adequate understanding of the instructions? a) "Alcohol is not contraindicated while taking this medication." b) "Good oral hygiene is needed, including brushing and flossing." c) "The medication dose may be self-adjusted, depending on side effects." d) "The morning dose of the medication should be taken before a serum drug level is drawn."

b) "Good oral hygiene is needed, including brushing and flossing." Rationale: Typical anticonvulsant medication instructions include taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a Medic-Alert bracelet.

The nurse is caring for a client with severe back pain. Codeine sulfate has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? a) Monitor radial pulse. b) Monitor bowel activity. c) Monitor apical heart rate. d) Monitor peripheral pulses.

b) Monitor bowel activity. Rationale: While the client is taking codeine sulfate, the nurse would monitor vital signs and assess for hypotension. The nurse also should increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency because the medication causes constipation. The nurse should monitor respiratory status and initiate deep-breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

Meperidine hydrochloride (Demerol) has been prescribed for a client to treat pain. Which are side/adverse effects of this medication? Select all that apply. a) Diarrhea b) Tremors c) Drowsiness d) Hypotension e) Urinary frequency f) Increased respiratory rate

b, c, d Rationale: Meperidine hydrochloride is an opioid analgesic. Side/adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication? a) Sodium level of 140 mEq/L b) Prothrombin time of 12 seconds c) Direct bilirubin level of 2 mg/dL d) Platelet count of 400,000 cells/mm3

c) Direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen causes liver damage. The correct option is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin level is 0 to 0.3 mg/dL. The normal sodium level is 135 to 145 mEq/L. The normal prothrombin time is 10 to 13 seconds. The normal platelet count is 150,000 to 400,000 cells/mm3.

A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result? a) Hypotension b) Tachycardia c) Slurred speech d) No abnormal finding

c) Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? a) Pregnancy should be avoided while taking phenytoin. b) The client may stop the medication if it is causing severe gastrointestinal effects. c) There is the potential of decreased effectiveness of birth control pills while taking phenytoin. d) There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

c) There is the potential of decreased effectiveness of birth control pills while taking phenytoin. Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions.

A client with myasthenia gravis has become increasingly weaker. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis? a) No change in the condition b) Complaints of muscle spasms c) An improvement of the weakness d) A temporary worsening of the condition

d) A temporary worsening of the condition Rationale: An edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement in the weakness indicates myasthenia crisis. Muscle spasms are not associated with this test.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. Which antidote should the nurse anticipate to be prescribed? a) Pentostatin (Nipent) b) Auranofin (Ridaura) c) Fludarabine (Fludara) d) Acetylcysteine (Mucomyst)

d) Acetylcysteine (Mucomyst) Rationale: The antidote for acetaminophen is acetylcysteine (Mucomyst). The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL. A toxic level is higher than 50 mcg/mL, and levels higher than 200 mcg/mL could indicate hepatotoxicity. Auranofin (Ridaura) is a gold preparation used to treat rheumatoid arthritis. Pentostatin (Nipent) and fludarabine (Fludara) are antineoplastic agents.

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for side/adverse effects to the medication. Which finding indicates that the client is experiencing an adverse effect? a) Pruritus b) Tachycardia c) Hypertension d) Impaired voluntary movements

d) Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol), 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? a) Uric acid level, 5 mg/dL b) Sodium level, 140 mEq/L c) Blood urea nitrogen level, 15 mg/dL d) White blood cell count, 3000 cells/mm3

d) White blood cell count, 3000 cells/mm3 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances including thrombophlebitis and dysrhythmias; and dermatological effects. The low white blood cell count reflects agranulocytosis. The laboratory values in options 1, 2, and 3 are normal values.