EDAPT: Intracranial Regulation
The client called the clinic and reported that phenytoin was causing a skin rash. What is the nurse's best response?
"Skin rash is an adverse effect. Your healthcare provider will follow up with you for further instructions."
Which statement by the client regarding a prescription of controlled-release carbidopa-levodopa requires further education by the nurse?
"Sometimes I have trouble swallowing the pill, so I crush it and put it in applesauce."
The client stated that their antiepileptic drug (AED) caused them to be tired during the day. Which nurse's response is appropriate?
"Take your medication at night."
The nurse is caring for a client who has been prescribed zolpidem, a hypnotic central nervous system (CNS) depressant. At what time should the nurse plan to administer this medication to maximize its sleep-inducing effectiveness?
30-60 minutes before bedtime
What is the therapeutic range for carbamazepine?
4-12 mcg/mL
Match each definition on the left side with the correct term on the right side.
Brief events of abnormal electrical activity in nerve cells of the brain - Seizure Spasmodic contractions of voluntary muscles throughout the body - Convulsion Chronic, recurrent brain activity that causes seizures - Epilepsy
The client has been prescribed methylphenidate for the treatment of narcolepsy. What priority teaching considerations should be included for this client? Select all that apply.
Caffeine should be avoided. Avoid operating hazardous equipment. Nervousness and tremors may occur. Take the medication before meals.
Selegiline is used alone or in conjunction with __________ in the __________ stages of the disease to help with symptom fluctuations.
Carbidopa-levadopa Early
The nurse is reviewing the history of a client who will be starting sumatriptan as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to sumatriptan therapy?
Cardiovascular disease
Which muscle relaxant is commonly misused in combination with an opioid and a benzodiazepine, producing a heroin-like effect?
Carisoprodol
__________ has become a commonly misused drug, particularly in combination with an opioid and a benzodiazepine.
Carisoprodol
Indirect-acting dopaminergic drugs, such as monoamine oxidase inhibitors (MAOIs), enzymes' main purpose is the breakdown of __________.
Catecholamines
Benzodiazepines are contraindicated in pregnancy because they __________. This can subsequently lead to __________ in the neonate.
Cause central nervous system (CNS) depression Respiratory issues
The nurse is providing discharge teaching for a client who is taking a central nervous system (CNS) depressant. The client takes kava for insomnia. The nurse understands that kava __________.
Causes CNS depression
Muscle relaxants are indicated for the use in which of the following? Select all that apply.
Cerebral palsy Arthritis Low back strain Multiple sclerosis
What are the side effects of selegiline? Select all that apply.
Confusion Nausea Dizziness
A pediatric client is on antiepileptic drug therapy for seizures. The client's caregiver states that the client has been lethargic, confused, and sleepy. What is the nurse's next course of action?
Contact the healthcare provider immediately.
Central nervous system (CNS) stimulants are contraindicated for clients with a history of which conditions? Select all that apply.
Coronary artery disease Hypertension Liver failure
A pediatric client has been started on methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What information should the nurse include in the health teaching?
Counseling should be combined with medication.
Which muscle relaxant causes marked sedation?
Cyclobenzaprine
Which drug is a direct-acting skeletal muscle relaxant?
Dantrolene
Which of these muscle relaxants in intravenous (IV) form is used to treat skeletal muscle spasms caused by malignant hyperthermia?
Dantrolene
Bill (pronouns: he/him/his), a 55-year-old, retired male soccer coach, has had Parkinson's disease for 5 years. Bill has been taking his antiparkinsons medications for several years. Selegiline is given to __________ the needed dose of levodopa.
Decrease
Indirect-acting dopaminergic drugs, such as monoamine oxidase inhibitors (MAOIs), are given to __________ the needed dose of levodopa.
Decrease
The nurse is caring for a client who is prescribed phenytoin. The routine blood work drawn at the clinic shows a very low albumin level. The nurse anticipates the phenytoin level to be __________.
High
Valproic acid has a __________ affinity for blood plasma protein.
High
The nurse is providing care for a child admitted with a broken tibia. The child takes amphetamine/dextroamphetamine 20 mg/day. The healthcare provider has prescribed meperidine 25 mg intramuscularly (IM) every 4 hours as needed for pain. What is the best action by the nurse?
Hold the meperidine and contact the healthcare provider.
Phenytoin is classified as a(n) __________.
Hydantoin
Seizures are treated with __________.
Hydantoins
The nurse is developing a plan of care for a client receiving an anorexiant for a client who is overweight. Which nursing diagnosis is most appropriate?
Imbalanced nutrition, more than body requirements
The nurse is developing a plan of care for a client receiving an anorexiant for obesity treatment. Which nursing diagnoses may be appropriate? Select all that apply.
Imbalanced nutrition, more than body requirements Disturbed body image
Nicotine causes __________ benzodiazepine __________ which causes the medication to be __________. For a client who is a smoker and is also taking alprazolam for generalized anxiety disorder, this could mean that their symptoms of anxiety __________.
Increased Metabolism Less effective Do not improve
In reviewing benzodiazepine use in an older adult, which effects should the nurse anticipate? Select all that apply.
Increased central nervous system (CNS) depressive effects. Risk of low respiratory rate and excessive sedation.
Central nervous system (CNS) depressants are drugs that result in a calming effect by __________ the transmission of nerve impulses to the CNS.
Inhibiting
Gamma-aminobutyric acid (GABA) is an __________ neurotransmitter. Glutamate (glutamic acid) is an __________.
Inhibitory Excitatory
The nurse is caring for a client prescribed valproic acid. What are the common side effects? Select all that apply.
Insomnia Sedation Nausea
The nurse is caring for a client who is prescribed a central nervous system (CNS) depressant. Which nursing interventions should be used to minimize the risks associated with this drug class? Select all that apply.
Instruct the client to avoid driving while taking this medication. Instruct the client to request help with ambulation.
Match each barbiturate drug to its common use.
Methohexital and Thiopental - Induction of anesthesia Pentobarbital and Secobarbital - Prevents hyperbilirubinemia in neonates Butabarbital - Sedation Phenobarbital and Mephobarbital - Prevention of seizures
Which medication is used to treat obstructive sleep apnea?
Modafinil
The nurse is teaching a client to self-administer medications. The nurse knows which drugs can be used to treat narcolepsy? Select all that apply.
Modafinil Methylphenidate
Which statements are true regarding barbiturates? Select all that apply.
Monoamine oxidase inhibitors (MAOIs; antidepressants) result in a longer duration of action of barbiturates. Barbiturates are a type of sedative-hypnotic. An overdose of barbiturates typically leads to respiratory arrest, coma, and death.
The therapeutic effect of muscle relaxants can be assessed by the client's __________.
Muscle spasticity, pain, and stiffness
Which medications are used to treat migraines? Select all that apply.
Naratriptan Sumatriptan Eletriptan
Which medical conditions are central nervous system (CNS) stimulants approved to treat? Select all that apply.
Narcolepsy Obesity Attention-deficit/hyperactivity disorder (ADHD)
A client with narcolepsy will begin treatment with a central nervous system (CNS) stimulant. The nurse expects to see which adverse effect?
Nervousness
Match each term with its definition.
Neuronal activity that originates from both hemispheres - Generalized onset seizure Neuronal activity that originates from one hemisphere or location - Focal onset seizure Neuronal activity that causes full body contractions and then transitions to alternating contractions and relaxation - Tonic-clonic seizure
Which of these is the reversal drug for muscle relaxant overdose?
No reversal drug
Which are currently the more frequently prescribed sedative-hypnotic drugs?
Nonbenzodiazepines
What are the side effects of phenytoin? Select all that apply.
Nystagmus Ataxia Drowsiness
How might the dosage of alprazolam be adjusted in an older adult client and why?
Older adult clients are sensitive to benzodiazepines and, therefore, lower doses may be used in this population.
Alprazolam is a (an) __________ __________ used for its __________ effects by reducing __________.
Oral Benzodiazepine Anxiolytic Anxiety
Alprazolam is administered __________.
Oral (PO)
Sally (pronouns: she/her/hers), a 57-year-old client, is newly diagnosed with Parkinson's disease. She has a history of atrial fibrillation and is currently taking warfarin daily. Which medications would be contraindicated for Sally to take to treat Parkinson's symptoms?
Ropinirole
When giving __________, watch out for somnolence, which means the client can fall asleep during regular activities.
Ropinirole
__________ will affect the activity of any drug utilizing the cytochrome p450 enzyme system.
Ropinirole
__________ duration is 8 hours.
Ropinirole's
The nurse caring for a client who is taking cyclobenzaprine following an injury should include what information in the discharge teaching for this medication?
Sedation is a common side effect.
The nurse caring for an older adult client with arthritis who has started taking cyclobenzaprine should prioritize which nursing assessments? Select all that apply.
Sedation level Fall risk
Which statement is true regarding sedative-hypnotics?
Sedative-hypnotics at high doses calm the CNS and cause sleep.
In educating clients taking benzodiazepines with other central nervous system (CNS) depressants, the nurse indicates this may put the client at risk for __________.
Toxicity
What should be monitored with clients prescribed antiepileptic drugs (AEDs)? Select all that apply.
Toxicity Adherence to drug therapy Plasma concentration and effectiveness
How often should methylphenidate immediate-release be taken?
Twice a day
The nurse caring for a client prescribed a muscle relaxant is aware that there are two subclasses, each with a mechanism of action that is __________.
Unique to this subclass.
Which medications are antiepileptic drugs? Select all that apply.
Valproic acid Carbamazepine Phenytoin
During the start of antiparkinson medication therapy, the client will most likely need assistance with __________.
Walking
Which is the therapeutic range for phenytoin?
10-20 mcg/mL
Select the correct medication type used to treat Parkinson's disease based on their description.
Entacapone is taken with levodopa and begins its effect with the first dose. It benefits clients who experience the wearing-off effect of levodopa and facilitates a lower dose of levodopa being used. - COMT inhibitor Benztropine mesylate is indicated as adjunct pharmacotherapy to manage debilitating motor effects (cogwheel rigidity, muscle tremors, pill-rolling movements, and bobbing of the head) of Parkinson's disease. - Anticholinergic Amantadine is indicated for the early stages of Parkinson's disease and is usually only effective for 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and rigidity. - Dopamine modulator Carbidopa-levodopa has side effects, such as nausea, vomiting, dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis. - Dopamine replacement Bromocriptine nondopamine works by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain. - Dopamine receptor agonist Ropinirole's drug action increases dopamine presynaptic receptors in the brain. It is indicated for early and late stages of Parkinson's disease. - Nondopamine dopamine receptor agonist Selegiline is used in combination with levodopa to reduce the dosage needed for symptom control. Adverse effects appear with doses greater than 10 mg. - MAO-B inhibitor
Which adverse effect(s) are typically seen with muscle relaxants that work on both the central nervous system (CNS) and directly on skeletal muscles? Select all that apply.
Euphoria Drowsiness Fatigue
The nurse caring for a client taking a central nervous system (CNS) depressant should consider which adverse effect when assessing the client?
Excessive sedation
A client at a weight management clinic who was given a prescription for orlistat calls the clinic hotline reporting a "terrible side effect." The nurse suspects that the client is referring to which problem?
Fecal incontinence
Which of the following can cause seizures? Select all that apply.
Fever in infants and children Trauma Infection Genetics Stroke Idiopathic
What are the advantages of using fosphenytoin over the use of phenytoin in the treatment of tonic-clonic and focal seizures? Select all that apply.
Fosphenytoin can be given as an intramuscular injection. Fosphenytoin causes less irritation to veins than phenytoin. Fosphenytoin can be administered faster than phenytoin.
What are the signs and symptoms of carbamazepine toxicity? Select all that apply.
Generalized seizures Arrhythmia
Which food item should be avoided with carbamazepine?
Grapefruit
An 18-year-old client is brought to the emergency department by roommates. Vital signs are BP 220/136 mm Hg, P 142 beats/minute, and RR 20 breaths/minute. The client is responsive only to deep pain. The roommates say the client has been trying to lose weight and has been taking "these diet pills gotten on the internet." What will the nurse consider the most likely cause of this client's symptoms?
Hemorrhagic stroke
What should be assessed and monitored with clients taking valproic acid? Select all that apply.
Hepatic function Signs and symptoms of pancreatitis Mental health
Which are adverse reactions of valproic acid? Select all that apply.
Hepatotoxicity Suicidal thoughts Pancreatitis
The nurse caring for a client taking cyclobenzaprine, a centrally-acting skeletal muscle relaxant. The clients asks the nurse why they must not drink alcohol while taking this medication. What is the best response?
"Alcohol and this medication both cause central nervous system (CNS) depression."
Which statement by the client indicates that more teaching is needed about phenytoin?
"Any mood changes, erratic behavior, or suicidal ideation is a normal side effect."
Which statement by the client indicates that more teaching is needed about valproic acid?
"Any mood changes, erratic behavior, or suicidal ideation is normal and will go away."
The client is born at 28 weeks gestation and is scheduled to receive caffeine citrate 20 mg intravenously (IV) shortly after birth. The client's mother asks, "Why are you giving my baby stuff that is in coffee?" What is the nurse's best response?
"Caffeine can help your baby breathe better."
The nurse is preparing a teaching plan for a client newly prescribed an antiepileptic drug. Which client instruction is the priority?
"Call your healthcare provider if you experience suicidal ideation."
The client has been prescribed methylphenidate for narcolepsy. The client also has migraines and takes amitriptyline as a preventive medication. What should the nurse advise the client to do before starting the new medication?
"Contact your primary healthcare provider to verify compatibility."
The client called the clinic and reported that valproic acid was causing minor gastrointestinal (GI) upset. What is the best response provided by the nurse?
"GI irritation is a side effect. Try taking your medication after meals."
A client has been brought to the emergency room with the following symptoms: hypotension, bradypnea, diminished reflexes, and extreme drowsiness. The reported medical history notes the client has been taking a prescribed muscle relaxant for a chronic musculoskeletal condition. Which questions should the nurse ask the client? Select all that apply.
"Have you been taking any herbal or non-prescription supplements and, if so, which ones?" "Have you consumed alcohol recently?"
Which statement(s) by the client indicate further education regarding their antiparkinson medication is needed? Select all that apply.
"I can drink alcohol as long as it is no more than one time per week." "If I forget a dose of medication, I will take it as soon as I remember."
Which statement by the client indicates more teaching is needed about carbamazepine?
"I can stop taking carbamazepine when I finish this bottle."
The client is taking carbidopa-levodopa for Parkinson's disease. The nurse just reviewed the discharge instructions with the client and family. Which statement by the client indicates more teaching is needed?
"I can stop taking the medicine once the tremors stop."
The nurse is caring for a client who takes dextroamphetamine. The nurse should be most concerned by which client statement?
"I started taking St. John's Wort this week to help with my depression."
The client called the clinic and reported that carbamazepine is causing nausea. What is the best response provided by the nurse?
"Nausea is a side effect. Try taking your medication with meals."
What should be included as discharge instructions for the client who received a new prescription for selegiline?
"Notify your healthcare provider if you have a severe headache."
Drag each drug to match the therapeutic level.
10-20 mcg/mL - Phenytoin 10-40 mcg/mL - Phenobarbital 4-12 mcg/mL - Carbamazepine 50-100 mcg/mL - Valproic acid
The half-life of carbamazepine is __________ hours.
12
The nurse is reviewing medication therapy with the parents of an adolescent with attention-deficit/hyperactivity disorder (ADHD). Which statements are correct? Select all that apply.
"The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep." "Contact the healthcare provider right away if you notice expressions of suicidal thoughts." "We will need to check your child's height and weight periodically to monitor physical growth."
A client is receiving phenytoin medication instructions during discharge planning and is asking why monitoring laboratory values is needed. Which is the best response provided by the nurse?
"We are checking the therapeutic levels of the medication."
Which client statement indicates more education is needed?
"When my seizures stop for at least a month, I can stop taking the medication."
Match the drug to the correct category of muscle relaxant:
*Centrally-Acting Skeletal Muscle Relaxants:* Baclofen Carisoprodol Chlorzoxazone Cyclobenzaprine *Direct-Acting Skeletal Muscle Relaxant:* Dantrolene
Match the mechanism of action to the correct category of muscle relaxant.
*Centrally-Acting Skeletal Muscle Relaxants:* • Provide sedative effects • Act directly on the central nervous system (CNS) • Have no direct effects on the muscles • Have no effect on conduction of nerves • Act at the level of the brainstem and thalamus • Decrease the force of muscle contraction • Relax strained, stiff, and weakened muscles *Direct-Acting Skeletal Muscle Relaxants:* • Small group of muscle relaxants • Act directly on skeletal muscle • Decrease the muscle's response to stimuli • Decrease the amount of calcium released
Select the applicable indications for the use of alprazolam.
Generalized anxiety disorder (GAD) Panic disorder Anxiety associated with depression
The nurse is caring for an older adult who is being discharged home with a prescription for a barbiturate to treat seizures. The medical record indicates that the client takes over-the-counter medications for seasonal allergies, drinks alcoholic beverages on occasion, and has a history of deep vein thrombosis (DVT) and depression. The nurse discusses the adverse effects that may result when taking a barbiturate with other central nervous system (CNS) depressive substances. For each statement, indicate if it should or should not be included in the client teaching.
*Include:* • This medication will likely make you feel dizzy and possibly fall down. • Do not drink alcohol because it will interact with this medication. • The monoamine oxidase inhibitor (MAOI) you have been taking for depression interacts with this medication, so your doctor is going to prescribe a different antidepressant for you. • The anticoagulant you are taking to prevent future deep vein thrombosis (DVTs) is less effective due to this medication, so let's discuss the symptoms of blood clots. *Do Not Include:* • When your seasonal allergies flare up, you can continue to take your over-the-counter antihistamine. • We will be decreasing your dose of the anticoagulant you take for deep vein thrombosis (DVTs) because this medication will cause a decrease in your platelet count and put you at risk for bleeding. • This medication may cause your blood pressure to increase. • You will be taking this medication long-term which can lead to insomnia, so you may need to take an over-the-counter sleep aid.
Drag to match the side effects with the correct medication.
*Rasagiline:* Dizziness Insomnia Nausea *Ropinirole:* Edema Syncope Fatigue
The nurse is preparing discharge instructions for a client being sent home with a prescription for a benzodiazepine. Match the instructions to the potential risks of this medication class.
*Risk for Injury:* • Avoid driving or operating heavy machinery. • May be higher risk for falls. • Can cause confusion or memory loss. *Risk for Sedation:* • Do not use with kava or valerian root. • Do not use with alcohol or opioids. • Do not use with sleep aids. *Risk for Dependence:* • Do not stop taking abruptly after prolonged use. • Many central nervous system (CNS) depressants are schedule intravenous (IV) controlled substances. • Risk for dependence and gradual increasing tolerance.
What is the peak plasma concentration of valproic acid?
1-4 hours
What is the therapeutic range for valproic acid?
50-125 mcg/mL
Which level is within the therapeutic range for valproic acid?
90 mcg/mL
Which statement is true about a high plasma level of an antiepileptic drug (AED)?
A high antiepileptic drug (AED) level may indicate the drug is not being excreted or the dose is too high.
The nurse is completing an assessment of a client who was admitted to the hospital after having a tonic-clonic seizure. The client is prescribed phenytoin. Which assessment finding should be most concerning to the nurse?
Blood pressure 74/50
What is valproic acid indicated for?
Generalized seizures
What are the side effects of carbamazepine? Select all that apply.
Ataxia Fatigue Nausea
What are indications for the use of alprazolam? Select all that apply.
Adjunct in the treatment of acute mania and acute psychosis. Anxiety associated with depression Panic disorder Generalized anxiety disorder (GAD)
Which statements are correct regarding benzodiazepines? Select all that apply.
Affect the hypothalamic, thalamic, and limbic systems of the brain (gamma-aminobutyric acid [GABA] receptors), Reduce excessive sensory stimulation which induces sleep, Induce relaxation of skeletal muscles,
Which laboratory value should be monitored during phenytoin therapy?
Albumin levels
Which should be avoided while taking oral formulations of valproic acid?
Alcohol
As with __________ central nervous system (CNS) depressants, there is a potential for adverse effects and toxicity or overdose when muscle relaxants are taken with __________. Muscle relaxant overdose requires __________ aggressive treatment than does an overdose of other CNS depressants. The priority is airway, breathing, and circulation (ABCs), including airway maintenance, heart rhythm monitoring, and intravenous (IV) fluids.
All Other CNS depressive substances and drugs More
Which medication is an intermediate-acting benzodiazepine used for its anxiolytic effects?
Alprazolam
When administering alprazolam to a client with chronic obstructive pulmonary disease (COPD), which is a concern?
Alprazolam is a central nervous system (CNS) depressant.
Which medications are used to treat attention-deficit/hyperactivity disorder (ADHD)? Select all that apply.
Atomoxetine Methylphenidate
Match the sedative-hypnotic central nervous system (CNS) depressant medication to its subclass.
Alprazolam, lorazepam, temazepam - Intermediate-acting benzodiazepines Clonazepam, diazepam, flurazepam - Long-acting benzodiazepines Pentobarbital, secobarbital - Short-acting barbiturates Phenobarbital, mephobarbital - Long-acting barbiturates Midazolam - Benzodiazepine most commonly used for preoperative anxiety and moderate sedation Flumazenil - Gamma-aminobutyric acid (GABA) receptor antagonist that is the antidote to benzodiazepines Zolpidem - Non-benzodiazepine, a short-acting hypnotic with a relatively low incidence of daytime sleepiness Diazepam - Long-acting benzodiazepine can be used to treat status epilepticus
Which of the client's prescribed medications is used to treat dyskinesia related to their medication therapy for Parkinson's disease?
Amantadine
A client is interested in losing weight. The nurse anticipates which medication will be prescribed?
Amphetamine
The nurse works in a pediatric psychiatry unit. Methylphenidate 5 mg 3 times daily is commonly prescribed for many clients. The nurse recognizes this drug needs to be used cautiously in which children?
An 8-year-old client with a history of cardiovascular disease.
Carbamazepine is classified as __________.
An iminostilbene
The nurse is caring for a female client for whom suvorexant is prescribed. The nurse is aware that the client may experience __________.
An increased risk for daytime sleepiness.
Nonbenzodiazepines act on the central nervous system (CNS) __________. Orexin receptor antagonists (also called hypocretins) act on the CNS __________.
And act very much like benzodiazepines And act very much like benzodiazepines
Benzodiazepines are most often used for which effect?
Anxiolytic
The nurse is caring for a client with a prescription for a nonbenzodiazepine drug. The client is allergic to aspirin. The nurse educates the client that those with an allergy to aspirin __________ nonbenzodiazepines.
Are more likely to have an allergy to
Phenytoin is available in intravenous (IV), tablets, chewable capsules, and liquid forms. Chewable tablets and capsules __________ bioequivalent. In addition, liquid suspensions __________ be shaken prior to pouring.
Are not Should
A client who has been taking phenytoin has their repeat phenytoin level monitored with a result of 4 mcg/mL. What actions should the nurse do next? Select all that apply.
Ask the client if they are taking the medication as prescribed. Ask the client if they are taking any new over-the-counter medication not prescribed.
A client presents to the clinic and reports taking several over-the-counter medications, in addition to their prescribed valproic acid. Which over-the-counter medication is contraindicated when taking valproic acid?
Aspirin
The nurse is caring for a client recovering from a surgical procedure who was admitted from the post-anesthesia care unit. The client received diazepam for sedation during the procedure. The client is recovering well and is tolerating drinking liquids. During the assessment, a family member hands the client a glass of grapefruit juice. Based on the nurse's knowledge of diazepam, what is the priority nursing action?
Assess sedation level, respiratory effort, and vital signs.
A nurse administered a client's phenytoin via an intermittent intravenous infusion. The client reported burning at the infusion site. Which is the nurse's priority action?
Assess the intravenous catheter insertion site.
What are the signs and symptoms of phenytoin toxicity? Select all that apply.
Ataxia Confusion Slurred speech
An older female was brought to the emergency department for generalized tonic-clonic seizures. An intravenous (IV) line was started. The client was prescribed diazepam 8 mg IV push, now. The seizures stopped and the client was transferred to a medical-surgical unit. The client was further assessed on the unit, labs were drawn, and diagnostic tests were ordered. The client medication list includes protonix, warfarin, furosemide, and multivitamins. The nurse is caring for this female client experiencing a tonic-clonic seizure. The healthcare provider prescribed intravenous diazepam. Which actions are appropriately taken by the nurse? Select all that apply. You may use a drug reference guide for assistance.
Avoid administering the medication into small veins. Administer the medication slowly over at least 1 minute per 5 milligrams. Monitor the client vital signs closely.
The nurse who is caring for a client prescribed a muscle relaxant is aware that the assessment of this client will include __________.
Awareness of muscle function, pain, and range of motion.
Which muscle relaxant is used to treat muscle spasms and can be used in an implantable pump device?
Baclofen
Pentobarbital is a short-acting __________ now used for preoperative anxiety and to produce __________, to treat symptoms of withdrawal from other barbiturates and nonbarbiturates, to control status epilepticus, and to __________ hyperbilirubinemia in neonates. Phenobarbital is a long-acting __________ used to __________ generalized tonic-clonic seizures and fever-induced convulsions, as well as the __________ of hyperbilirubinemia in neonates. It is no longer used as a sedative or hypnotic.
Barbiturate Sedative effects Prevent Barbiturate Prevent Treatment
Which of the sedative-hypnotic groups carries the highest risk for dependence and is therefore used less?
Barbiturates
__________ are the subclass of central nervous system (CNS) depressants that inhibit nerve impulses by acting on the brainstem and gamma-aminobutyric acid (GABA) receptors, resulting in the inhibition of nerve impulses in the cerebral cortex.
Barbiturates
Barbiturates carry with them many contraindications, the risk of dependence and overdose, as well as many drug-to-drug interactions. Drag each statement that applies to barbiturates to the right side column.
Barbiturates are contraindicated in pregnancy. Barbiturates cause enzyme stimulation in the liver, leading to a shortened duration of action of many drugs. An overdose of barbiturates typically leads to respiratory arrest, coma, and death. Long-term use can lead to harmful effects on sleep due to deprivation of rapid eye movement (REM) sleep. Pentobarbital and phenobarbital help treat insomnia, withdrawal symptoms, and control status epilepticus.
Which substances have central nervous system (CNS) depressive effects and should be used with caution in clients taking alprazolam? Select all that apply.
Benzodiazepines Alcohol Antipsychotics Anxiolytics Opioids Muscle relaxants
Which is the most accurate statement related to the increased risk for dependence and addiction when benzodiazepines are taken with other central nervous system (CNS) depressants?
Benzodiazepines administered to clients who have uncontrolled, severe pain will cause an increased risk for dependence, especially when taken with other CNS depressants.
The nurse is caring for a client with a history of hypertension, glaucoma, and deep vein thrombosis (DVT). The client has been prescribed a benzodiazepine. Which possible contraindications and drug-to-drug interactions may occur? Select all that apply.
Benzodiazepines are contraindicated in clients with narrow-angle glaucoma. Verapamil and diltiazem can cause a decrease in benzodiazepine metabolism.
Why are benzodiazepines contraindicated in pregnancy and for lactating mothers? Select all that apply.
Benzodiazepines cause central nervous system (CNS) depression. Benzodiazepines cross into breast milk. Benzodiazepines may cause sedation and respiratory issues in newborns. Benzodiazepines may cause teratogenic effects.
The client's medication list has valproic acid. The client has no history of seizures. The client is taking valproic acid for which condition?
Bipolar disorder
When administering phenytoin intravenously (IV), what should be assessed and monitored? Select all that apply.
Blood pressure Cardiac rhythm IV infusion site
Which medications should the nurse anticipate being prescribed for a client with narcolepsy? Select all that apply.
Dextroamphetamine Methylphenidate Methamphetamine
Muscle relaxants and other central nervous system (CNS) depressants have __________ indications for use including insomnia and sedation.
Different
Match each drug to the correct category.
Direct-acting dopamine receptor agonists - Ropinirole Indirect-acting dopaminergic - Rasagiline
What are the possible side effects of valproic acid? Select all that apply.
Dizziness Gastrointestinal (GI) upset Drowsiness Weight gain
Which should be included when educating clients about antiparkinson medications? Select all that apply.
Do not abruptly stop taking the prescribed medication. A decrease in Parkinson's symptoms is a therapeutic response. Take the medication exactly as ordered to maintain consistent blood levels.
Carbamazepine __________ affect the metabolism of other drugs that utilize the cytochrome P450 enzyme system.
Does
Phenytoin __________ affect the metabolism of other drugs that utilize the hepatic microsomal cytochrome P450 enzyme system.
Does
Parkinson's disease is the deficit of a __________ neurotransmitter.
Dopamine
The nurse is caring for a client taking a muscle relaxant for the treatment of muscle spasms and pain. The nurse should assess for which side effect?
Drowsiness and dizziness if taking cyclobenzaprine.
A client's drug level for an antiepileptic drug (AED) was found to be very high. The client is at risk for __________.
Drug toxicity
Direct-acting dopamine receptor agonists are most effective in the __________ stages of Parkinson's disease.
Early
The client is receiving phenytoin intravenously (IV). What should be carefully monitored? Select all that apply.
Electrocardiogram (ECG) Hypotension Respiratory rate Central nervous system (CNS) depression
An older female was brought to the emergency department for generalized tonic-clonic seizures. An intravenous (IV) line was started. The client was prescribed diazepam 8 mg IV push, now. The seizures stopped and the client was transferred to a medical-surgical unit. The client was further assessed on the unit, labs were drawn, and diagnostic tests were ordered. The client medication list includes protonix, warfarin, furosemide, and multivitamins. What laboratory and diagnostic tests would the nurse anticipate for the client with seizures? Select all that apply.
Electroencephalogram (EEG) Liver enzymes Electrocardiogram (ECG) Brain magnetic resonance imaging (MRI)
Which characteristics describe alprazolam? Select that all apply.
Intermediate-acting benzodiazepine Central nervous system (CNS) depressant Anxiolytic Sedative-hypnotic
Which statement is true about intermediate-acting benzodiazepines?
Intermediate-acting benzodiazepines have a typical onset of 1-2 hours.
The client is being treated with methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What common side or adverse effects might occur? Select all that apply.
Irritability Euphoria Vomiting Headache Hypertension
The nurse is caring for a client with a prescription for a barbiturate. The nurse should check the client's lab results to ensure the client __________.
Is not pregnant
A client is prescribed benztropine, an anticholinergic. Which teaching point(s) should the nurse include when providing client education? Select all that apply.
It may take up to several weeks for the client to have an improvement in tremors. Anticholinergics block the effect of acetylcholine. Anticholinergics can cause dry mouth, urinary retention, and constipation. Increasing fiber and fluid consumption will help with side effects.
A client taking alprazolam, or any central nervous system (CNS) depressant, should avoid which drinks or supplements? Select all that apply.
Kava Grapefruit juice Valerian root
Which laboratory findings should be monitored while on valproic acid? Select all that apply.
Liver enzymes Complete blood count
A client has a new order for carbamazepine for seizure management. The nurse is correct when recognizing autoinduction as which response?
Lower-than-expected drug levels
Valproic acid is used in the treatment of seizures and is most effective in the __________ phase of bipolar disorder.
Mania
Muscle relaxants are categorized by their __________.
Mechanism of action
The nurse is reviewing the medication history of a client diagnosed with Parkinson's disease who is prescribed selegiline. Which other medication prescription on the client's medication list is the most concerning to the nurse?
Meperidine
Carbamazepine is prescribed for __________ seizures.
Partial
Valproic acid is prescribed for __________ seizures.
Partial
Carbamazepine is prescribed for __________ seizures. Carbamazepine is not usually used in __________ seizures.
Partial Absence
Phenytoin is prescribed for __________.
Partial seizures
Muscle relaxants are found to be the most effective when combined with __________.
Physical therapy
A nurse is admitting a client who has received doxapram. The nurse recognizes that this is which type of medication?
Postanesthetic respiratory stimulant
Which condition is a contraindication of phenytoin?
Pregnancy
Which is a contraindication for carbamazepine?
Pregnancy
What are the contraindications for valproic acid? Select all that apply.
Pregnancy Hepatic impairment
The nurse is caring for a client hospitalized for muscle spasms associated with multiple sclerosis. The healthcare provider is prescribing baclofen for long-term use. Based on the nurse's knowledge of this medication, which should be considered? Select all that apply.
Prepare to administer a test dose as ordered by the healthcare provider. Prepare the client for an implantable baclofen pump device.
The nurse is caring for a client who has just arrived on the unit from post-op. The client is exhibiting signs of malignant hyperthermia, and the healthcare provider prescribed a directly-acting skeletal muscle relaxant for treatment. Which action by the nurse indicates an understanding of the prescribed order?
Prepare to administer dantrolene and monitor the heart rhythm, vital signs, electrolyte levels, and urine output continuously.
__________ is the clinical indication for theophylline.
Preterm apnea
What are the overall goals of antiepileptic drug (AED) therapy? Select all that apply.
Prevent or control seizures Prevent drug toxicity
Why is it important to try to control seizure activity with one drug therapy if possible? Select all that apply.
Prevents toxicity Reduces side effects and adverse effects Increases adherence
Which statements are correct regarding sedative-hypnotics? Select all that apply.
Prolonged use of sedative-hypnotics can cause rapid eye movement (REM) interference resulting in daytime fatigue. Sedative-hypnotics can be ultrashort-, short-, intermediate-, or long-acting. Discontinuation of a sedative-hypnotic can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams.
Which drugs can affect antiepileptic drugs (AEDs) if they are taken together? Select all that apply.
Proton pump inhibitors (PPI) Antacids
What is a side effect of phenytoin?
Rash
What are the adverse reactions of carbamazepine? Select all that apply.
Rash Pancreatitis Suicidal ideation
The nurse is caring for a client who has been diagnosed with Parkinson's disease and is prescribed a centrally-acting skeletal muscle relaxant. Based on this drug class and its indications for use, the nurse assesses the client for therapeutic effects such as __________.
Reduction of the rigidity associated with Parkinson's disease
Most muscle relaxants work on the central nervous system (CNS). What additional effects do most muscle relaxants have on the body? Select all that apply.
Relax strained, stiff, and weakened muscles Decrease the force of muscle contraction
The nurse is caring for a client taking dantrolene for malignant hyperthermia resulting from a recent surgical procedure. Which assessment item evaluates the therapeutic effect for this client?
Relief of muscle rigidity
When receiving carbamazepine therapy for seizures, blood levels are __________ to monitor therapeutic effectiveness.
Required
A nurse is completing an assessment of a client taking central nervous system (CNS) depressant medication. The nurse will monitor for symptoms of CNS depression such as __________ associated with the inhibition of nerve impulse transmission to the CNS.
Respiratory depression
The nurse is caring for a client taking a central nervous system (CNS) depressant. Which assessment priority should the nurse include in the plan of care?
Respiratory depression
Choose the correct central nervous system (CNS) depressant based on the degree to which it causes the inhibition of nerve impulses in the CNS. __________ produce a sense of calm and reduce nervousness, excitability, and irritability without causing sleep unless given at a large enough dose. __________ cause sleep with a much more potent CNS effect than __________. __________ can act as either a sedative or a hypnotic depending on the dose and client responsiveness. In low doses, they calm the CNS without causing sleep. In high doses, they calm the CNS and cause sleep.
Sedatives Hypnotics; sedatives Sedative-Hypnotics
Antiepileptics are used for the long-term maintenance treatment of what condition?
Seizures
The nurse is caring for a client taking pentobarbital, a short-acting barbiturate. Based on the knowledge of the indications for this medication, this client may have a history of __________.
Seizures
Do not consume large amounts of tyramine-containing foods when taking __________.
Selegiline
__________ stimulates dopamine receptors in the brain.
Selegiline
The client has a history of migraines, depression, and hypertension and has started on phentermine-topiramate. For which condition is phentermine-topiramate used?
Short-term weight management
Valproic acid is available in intravenous (IV), tablet, chewable capsule, and liquid forms. In addition, liquid suspensions __________ be shaken prior to pouring.
Should
The client is receiving discharge instructions on carbidopa-levodopa. Which client manifestations should the nurse tell the family to notify the healthcare provider immediately?
Significant behavior changes
What are some adverse effects of ropinirole? Select all that apply.
Sleep attacks Edema Syncope
What is the goal of drug therapy in treating Parkinson's disease?
Slow the progression of the disease.
Bill (pronouns: he/him/his), a 55-year-old, retired male soccer coach, has had Parkinson's disease for 5 years. Bill has been taking his antiparkinsons medications for several years. Bill is preparing to attend a holiday party with his family. The nurse realizes that since Bill is taking carbidopa-levodopa and selegiline there may be a need for education regarding the consumption of which of the following? Select all that apply.
Smoked fish Sourdough bread Smoked cheese Smoked meat
Carbamazepine prevents neuron excitation by blocking __________ channels from recovering from the __________ state.
Sodium Inactivated
Phenytoin prevents seizures by blocking __________ channels from recovering from the __________ state.
Sodium Inactivated
Which signs and symptoms are adverse effects of phenytoin? Select all that apply.
Suicidal ideation Rash
What is the black box warning for all clients prescribed antiepileptic drugs?
Suicidal ideations
Which actions of antiepileptic medications reduce seizure activity? Select all that apply.
Suppress nerve response to stimulation Suppress the transmission of nerve impulses Increase effects of gamma-aminobutyric acid (GABA)
A client has a new prescription for sumatriptan. The nurse providing client teaching on self-administration should include what information?
Take the medication before the headache worsens.
Bill (pronouns: he/him/his), a 55-year-old, retired male soccer coach, has had Parkinson's disease for 5 years. Bill has been taking his antiparkinsons medications for several years. Bill started taking selegiline for Parkinson's disease. What should be included in the discharge instructions about this medication?
Take with food to decrease gastrointestinal (GI) upset.
The nurse is caring for a client who has come to the emergency room reporting muscle spasms and pain following an injury. The client was discharged yesterday for the same complaint with a prescription for a muscle relaxant. Based on knowledge of this drug class, the nurse knows that __________.
The client has not allowed enough time for the medication to take effect.
The nurse is caring for a client with Parkinson's disease who is prescribed tolcapone. Which assessment finding is most concerning?
The client has yellowing of eyes and skin.
The nurse caring for a client taking cyclobenzaprine, a centrally-acting muscle relaxant, should include which instruction when preparing the client for discharge?
The client should see how they do on cyclobenzaprine for a few days before they go back to driving.
The nurse is caring for a client who has come to the emergency room reporting confusion, restlessness, and an increase in muscle spasms. Cyclobenzaprine is a noted medication on the health history. Aside from this change in neurological status, the physical assessment is within normal limits. Which would the nurse suspect?
The client stopped taking cyclobenzaprine abruptly.
Benzodiazepines carry a black box warning regarding what?
The combined use of benzodiazepines and opioids can cause extreme central nervous system (CNS) depression.
The nurse is providing discharge instructions to an older adult client taking cyclobenzaprine. Which should be included in the teaching? Select all that apply.
The medication should not be stopped abruptly. To avoid dizziness, do not stand up from a seated position too quickly. The client should see how they do on cyclobenzaprine for a few days before driving.
A newborn client is in respiratory distress. The nurse anticipates preparing for which medication to be given?
Theophylline
Safety of a drug is determined by the degree between:
Therapeutic and toxic doses
Which statements are true regarding central nervous system (CNS) depressants? Select all that apply.
There are significant drug-to-drug interactions with benzodiazepines, especially with other CNS depressants. Barbiturates carry a high risk for dependency. Alcohol should not be used with CNS depressants because the combination multiplies the CNS depressive effects. There is a black box warning regarding the combination of all opioids with all benzodiazepines.
Which statements are true of methylphenidate? Select all that apply.
There may be increased effects if taken with caffeinated beverages. If taken with monoamine oxidase inhibitors (MAOIs), it may increase a hypertensive crisis. The effects of anticoagulants may increase.
An older female was brought to the emergency department for generalized tonic-clonic seizures. An intravenous (IV) line was started. The client was prescribed diazepam 8 mg IV push, now. The seizures stopped and the client was transferred to a medical-surgical unit. The client was further assessed on the unit, labs were drawn, and diagnostic tests were ordered. The client medication list includes protonix, warfarin, furosemide, and multivitamins. The client was prescribed phenytoin. Based on the client's medication list, which medication may have a negative drug interaction? You may use a drug reference guide for assistance.
Warfarin
A child with attention-deficit/hyperactivity disorder (ADHD) is prescribed atomoxetine. What negative side effects would the nurse assess closely for? Select all that apply.
Weight loss Suicidal thoughts
What is the wearing-off phenomenon related to Parkinson's disease?
When Parkinson's disease medications are at maximum doses and the drug loses its effectiveness.