Test 4 Chapters 22-27 (In class questions)
A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication?
Review the client's laboratory blood work
Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What symptoms, if described by the family, would support their conclusion?
"He hears and interacts with voices no one else can hear."
The nurse provides client teaching about use of levodopa for treatment of Parkinson's disease. What statement by the client would indicate a good understanding of levodopa?
"I should take this drug with food to avoid an upset stomach."
A client with migraine headaches is changed from an ergot to a prescription for a triptan. The nurse has provided health education related to the new medication. What statement would indicate that the client has a clear understanding of the new medication?
"I shouldn't experience as many adverse effects from my new medication."
A client diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has completed client teaching regarding the use of lithium. What statement by the client best indicates an understanding of drug therapy?
"I will make sure I drink plenty of fluids."
An 11-year-old male client has been diagnosed with epilepsy and prescribed phenytoin 100 mg PO b.i.d. What statement by the client's parents suggests an accurate understanding of the client's medication regimen?
"I will make sure he has routine visits to the dentist."
The parents of a child diagnosed with attention deficit syndrome receive a prescription for a central nervous system (CNS) stimulant to treat their child. One of the parents asks the nurse, "I don't understand why we're giving a stimulant to calm our child down?"
"It helps the reticular activating system, a part of the brain, to be more selective in response to incoming stimuli."
A client has developed drug-induced Parkinson's disease following prolonged treatment with metoclopramide. The nurse should anticipate the use of what drug that is also classified as an antiviral?
Amantadine
The nurse receives a client into the postanaesthesia care unit who has had surgery using the anesthetic agent methohexital. The nurse anticipates the client's need for waht in the postoperative period?
Analgesia to control the client's pain
A client, newly diagnosed with Parkinson's disease, has been prescribed an anticholinergic drug. What assessment should the nurse perform when monitoring for adverse effects of anticholinergic agents used for the treatment of Parkinson's disease?
Assessment of the client's bowel pattern
The nurse is caring for a client who has Parkinson's disease. This client most likely has:
Deficient levels of dopamine
A client is brought to the emergency department in the midst of acute alcohol withdrawal accompanied by seizure activity. What drug is most likely to meet this client's needs?
Diazepam
The nurse is assessing a client prior to the client's scheduled tooth extraction. The client is anxious about the possibility of pain during the procedure. The nurse should provide what description of anesthesia?
"An anesthetic will be injected to all of the nerves that are near your tooth."
The nurse is teaching the parents of a child diagnosed with attention deficit hyperactivity disorder how to administer extended release methylphenidate. What should the nurse teach the parents?
"It's best to give it at breakfast everyday."
The nurse is caring for an adolescent client who began taking an antipsychotic drug that last month to treat newly diagnosed schizophrenia. The client's symptoms have improved only slightly and the client's parents wonder if the client is "beyond hope." What is the nurse's best response?
"It's common for clients to have to try different drugs until the most effective one is identified."
When describing Parkinson's disease to a client with a new diagnosis, what statement made by the nurse would be accurate?
"Symptoms management through drug therapy is the current mainstay of treatment."
A client is brought into the emergency department in status epilepticus, and the nurse is administering phenobarbital 300 mg IV as prescribed. Family members ask the nurse how long it will take to stop the seizures. What is the nurse's best response?
"The seizures will probably stop in around 5 minutes."
A female client attends a "Botox party" and is injected with botulinum toxin type A to decrease frown lines between her eyebrows. Later that evening, the client is admitted to the emergency department and is distraught because she cannot move her eyebrows. The nurse explains that the toxin causes what?
"The toxin causes muscle paralysis, preventing movement and relieving wrinkles."
Which client should the nurse identify as having an absence seizure?
A client whose alterations in consciousness last a few seconds
A client has a forearm laceration following a workplace accident. The care provider has administered lidocaine to facilitate stitches. What should the nurse teach the client about the use of this medication?
"You'll feel fully numb in about 10 to 15 minutes."
A 79-year-old client has been diagnosed with dementia. Haloperidol has been ordered for this client due to the client's worsening agitation. What nursing considerations should inform the nurse's administration of this medication?
-A lowered dosage is indicated for older adult -It should not be used to control behavior with dementia
The nurse is caring for a client who is having a pump placed to deliver intrathecal baclofen and another client who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans?
-Acute pain related to GI effects of drug -Risk for injury related to central nervous system (CNS) effects -Disturbed thought processes related to CNS effects
The nurse is giving discharge instructions to a client who just had botulinum toxin type A injection around her eyes. The nurse should caution the client about what potential adverse effects?
-Development of respiratory infections -Flu-like symptoms -Droopy eyelids
A client with a seizure disorder has had a recent change in medication. What assessments should the nurse perform in order to evaluate the effectiveness of the new drug?
-Evaluate laboratory drug levels -Assess for adverse effects -Assess for change in seizure activity
The nurse is caring for a client newly diagnosed with schizophrenia and whose medical history requires a typical antipsychotic. When explaining possible anticholinergic effects to the client, the nurse should address what potential problems related to these effects?
-Gum ulceration -Constipation -Urinary retention -Blurred vision
An older adult client was diagnosed with Parkinson's disease 2 years ago, and the client's symptoms have gradually worsened. What nursing diagnoses are likely to apply to this client?
-Impaired physical mobility related to extrapyramidal symptoms -Self-care deficit: dressing/grooming related to ataxia
A client who is 84 years old is experiencing chronic lower back that has not responded to NSAIDs. The provider has prescribed a transdermal fentanyl patch. What should the nurse do to ensure safe and effective care?
-Monitor the client's respiratory status closely -Keep the client's bed in the lowest position -Ensure that the client has access to the call light
The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene? -An 87-year-old man who is taking a cardiac glycoside -A 32-year-old man who is taking an antipsychotic drug -A 60-year-old woman who is on hormone replacement therapy -A 48-year-old woman who is taking a loop diuretic
A 60-year-old woman who is on hormone replacement therapy
The nurse receives a prescription for morphine sulfate 8 mg IV every hour as needed for pain. For which client would the nurse need to question this order? -A 78-year old with osteoarthritis -A 45-year-old, 1-day postoperative mastectomy -A 28-year-old with a fractured tibia -A 17-year-old, 1-day postoperative appendectomy
A 78-year old with osteoarthritis
For what client would the administration of an epidural block be most appropriate. What procedure is this client most likely to be having? -A client who requires suturing of a laceration on the palm of the hand -A client who is in the second stage of labor -A client who requires neurosurgery for the removal of a brain tumor -A client needing closed reduction of the right humerus
A client who is in the second stage of labor
A school-aged child is brought to the clinic by her parents. The parents state that the child will be engaged in some activity at home and then will stop suddenly for a few seconds an then pick up the activity again as if there had been no break in what she was doing. This child should be assessed for what neurological disorder?
Absence seizures
A client is newly diagnosed with parkinsonism and has been prescribed levodopa. After several weeks, no appreciable reduction in symptoms has been noted. The nurse should anticipate what change in the client's medication regimen?
Adding carbidopa to the client's medication regimen
The health care provider prescribes codeine 20 mg PO q4h as an adjunctive therapy to a client's NSAID. What is the nurse's best action?
Administer the medication as prescribed, and monitor the client's pain
A postsurgical client has been receiving morphine by patient-controlled analgesic for 2 days. What action by the nurse best addresses potential adverse effects?
Administering a stool softener as prescribed
A hospital client's pain is rated at 9/10, and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. Before administering the medication, the nurse should:
Assess the client's baseline respiratory rate
A female client has been experiencing increased muscle spasticity since being diagnosed with mulitple sclerosis. What drug is most likely to meet the client's needs?
Baclofen
The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen?
Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations
The nurse is caring for a client who has Parkinson's disease and whose symptoms are worsening. The health care provider has added selegiline to the client's drug regimen. What is the nurse's priority assessment after this drug is administered?
Blood pressure
The nurse is providing client teaching about a prescribed opioid analgesic. When monitoring the client for potential adverse effects, what assessment should the nurse prioritize?
Blood pressure
A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one are of the client's brain. The nurse should anticipate the adminstration of what drug?
Carbamazepine
The nurse is providing teaching about a typical antipsychotic newly prescribed for the client. The nurse cautions the client against actions that may cause increased central nervous system (CNS) depression. What should the nurse caution the client against?
Consumption of alcohol
A client has been prescribed benztropine as drug therapy for Parkinson's disease. What assessment finding would suggest a therapeutic effect to the nurse?
Decreased rigidity and tremors
The nurse is caring for a client taking dantrolene on a long-term basis for the treatment of cerebral palsy. The care team is considering a change in the client's medication regimen. How should the therapeutic effects of this drug best be assessed?
Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity
A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action?
Ensure all members of the care team are aware of the risk for hepatotoxicity
A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client?
Extrapyramidal effects (Physical symptoms, including tremor, slurred speech, akathisia, dystonia, anxiety, distress, paranoia, and bradyphrenia, that are primarily associated with improper dosing of or unusual reactions to neuroleptic (antipsychotic) medications.)
The operating room nurse is taking the client into the operating room when the client says his grandmother almost died from a high fever in surgery 15 years ago. What is the nurse's best action?
Immediately ensure that the anesthesiologist is aware of this
A client with a recent history of seizures has been prescribed carbamazepine. The nurse should recognize that this medication will achieve a therapeutic effect by what means?
Increasing gamma-aminobutyric acid (GABA) activity and blocking sodium and calcium channels
The postsurgical client appears to be awake but is in fact unconscious and has no response to painful stimuli. What nonbarbiturate anesthetic may the client have received?
Ketamine
The nurse is caring for a client who is receiving morphine via patient-controlled analgesia (PCA). In addition to pain assessment. what assessments should the nurse prioritize?
Level of consciousness and respiration rate
The nurse in an ambulatory client is reviewing the use of local anesthetic agents, which many of the clinic's client's require. How should the nurse differentiate lidocaine and procaine as a local anesthetic agent?
Lidocaine is an amide that is broken down slowly, and this can lead to toxicity.
A client is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist begin anesthesia, what is the next phase of anesthesia?
Maintenance
A client stepped on a rusty nail 2 days ago and is now exhibiting signs of muscle rigidity and contractions. The ED nurse should have which drug available for administration when the client arrives?
Methocarbamol
The nurse admits a child diagnosed with tetanus after stepping on some old barbed wire fencing. What medication should the nurse expect to administer?
Methocarbamol
The client in labor receives morphine every 2 hours to manage labor pain. After 22 hours of labor, the woman delivers a healthy neonate. What is the nurse's priority action related to the newborn?
Monitor for opioid effects
The nurse is providing care for a 72-year-old female client whose diagnosis of bipolar disorder is treated with lithium. What nursing responsibility should be prioritized?
Monitor the client's fluid balance and sodium intake
The nurse is collecting a nursing history from a preoperative client who is to receive local anesthesia. While taking the admission history, the client reports an allergy to lidocaine. What is the nurse's priority action?
Notify the anesthesiologist
The client, newly diagnosed with epilepsy begins to show signs of seizure activity. What is the nurse's priority action?
Protect the client's safety
A geriatric client received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?
Put side rails up and place bed in low position
The nurse is admitting a client to the postanethesia care unit (PACU) who received general anesthesia for the removal of a bunion. The nurse should prioritize what assessments?
Respirations and airway
The nurse, working in the emergency room, admits an 18-month-old toddler with influenza symptoms reported by the parents to have had a seizure. Further questioning of the parents indicates that the toddler likely had a clonic-tonic seizure, which has never happened before. What is the nurse's priority action?
Take the child's temperature
An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states, "My arms and legs feel like tree trunks and my head feels fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client?
Stay with client as much as possible and provide reassurance
An older adult client began treatment for Parkinson's disease several months ago and the nurse is assessing the client. What assessment finding should suggest that the client's medications are becoming less effective?
The client has begun drooling while he eats
The nurse admits a client newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history?
The client may not be able to provide a sufficient history.
