Pharm 1 Final
The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A 60-year-old woman with an overactive bladder (OAB) A 72-year-old man with glaucoma A 45-year-old woman with peptic ulcer disease (PUD) A 26-year-old man being prepared for surgery today
A 72-year-old man with glaucoma
A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? "Amantadine was developed as an antiviral agent but is now used for treatment of PD." "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." "Amantadine works rapidly and does not lose its effectiveness." "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."
"Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."
Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? "I need to rotate my injection sites, so I'll need to keep a record of them." "I will apply hydrocortisone ointment to the injection site if it is itchy." "Applying a warm compress before giving the injection will reduce the risk of pain at the site." "I can take over-the-counter Benadryl if the injection site itches and is red."
"Applying a warm compress before giving the injection will reduce the risk of pain at the site."
The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching? "I volunteer at a local day care center once a week." "I drink grapefruit juice with breakfast each morning." "I enjoy walking and outdoor activities in the sun." "I understand this drug may cause my urine to turn blue."
"I volunteer at a local day care center once a week."
The nurse is evaluating the teaching done with a patient who has a new prescription for transdermal clonidine [Catapres-TTS]. Which statement by the patient indicates understanding of the nurse's teaching? "I will apply the patch to a hairless, intact skin area on my upper arm." "I need to apply the patch before my evening meal." "The patch will not cause any skin reaction." "I will need to apply a new patch once every 3 to 4 days."
"I will apply the patch to a hairless, intact skin area on my upper arm."
The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? "I will keep my medication in the refrigerator when I'm not using it." "I should take this medication within 30 minutes of the onset of symptoms." "I must remove my pants before injecting the medication into the leg." "I will jab this medication firmly into my outer thigh if needed."
"I will jab this medication firmly into my outer thigh if needed."
The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse's instruction? "I will need to wait for 6 months and then stop this medication." "One missed dose will not affect my blood pressure." "I may experience occasional chest pain and discomfort." "I will not stop taking this drug without the approval of my healthcare provider."
"I will not stop taking this drug without the approval of my healthcare provider."
Which statement made by the patient indicates understanding of teaching related to a new prescription for atenolol [Tenormin]? "I will increase my fluids to prevent constipation." "I will not stop taking this medication abruptly." "I will take the first dose of this medicine at night." "I will wear sunscreen and a hat when I work in the sun."
"I will not stop taking this medication abruptly."
Which statement is most appropriate for the nurse to include in the discharge teaching plan for a 30-year-old woman beginning a new prescription of clonidine [Catapres]? "If you stop taking this drug abruptly, your blood pressure might go up very high." "You will need to have your blood drawn regularly to check for anemia." "Take this medication first thing in the morning to reduce nighttime wakefulness." "This medication often is used to manage hypertension during pregnancy."
"If you stop taking this drug abruptly, your blood pressure might go up very high."
The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? "With proper treatment, we can completely eliminate your seizures." "Our goal is to reduce your seizures to an extent that helps you live a normal life." "Seizure medication does not reduce seizures in most patients." "These drugs will help control your seizures until you have surgery."
"Our goal is to reduce your seizures to an extent that helps you live a normal life."
A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect? "Rasagiline may cause insomnia, so monitor your sleeping habits." "It is important to avoid tyramine-containing foods." "You may be at increased risk for malignant melanoma, so have regular skin checks." "You may experience side effects, such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."
"Rasagiline may cause insomnia, so monitor your sleeping habits."
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? "You may experience a slower heart rate. Call your doctor if it is below 60." "Ditropan is very effective. Most patients experience significant relief." "Sip on water and suck on hard candy to help with the problem of dry mouth." "Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan."
"Sip on water and suck on hard candy to help with the problem of dry mouth."
A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."
"This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor."
A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? "You have apparently developed resistance to your current medication and will have to change to another drug." "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." "You should try to keep taking your medication at the current dose. These effects will go away with time."
"This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect."
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? "You should increase your intake of fresh fruits and vegetables." "You should move slowly from a sitting to a standing position." "Be sure to wear a Medic Alert bracelet while taking this medication." "Take your first dose of this medication first thing in the morning."
"You should move slowly from a sitting to a standing position."
The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer? 1 mL 10 mL 100 mL 0.1 mL
10 mL
The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? 800 mg 1400 mg 1600 mg 3200 mg
1600 mg
The healthcare provider orders donepezil [Aricept] 10 mg PO every day. The tablets available are donepezil 5 mg. How many tablets will the patient receive? 0.5 2 5 10
2
The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? Norepinephrine Serotonin Acetylcholine Dopamine
Acetylcholine
The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? 2 mL 5 mL 10 mL 20 mL
5 mL
Which patient undergoing surgery is at greatest risk for an intensified effect from succinylcholine? A patient who takes aspirin 81 mg orally daily A patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours A patient taking isosorbide mononitrate [Imdur] 60 mg orally daily A patient receiving a continuous infusion of normal saline solution
A patient receiving gentamicin [Garamycin] 80 mg IV piggyback every 8 hours
Which statements about the anticholinergic drug scopolamine are true? (Select all that apply.) A side effect is sedation. It is used for motion sickness. A side effect is nausea and vomiting. It is used for preanesthetic sedation. It causes CNS excitation.
A side effect is sedation. It is used for motion sickness. It is used for preanesthetic sedation.
The nurse is caring for a patient with depression who takes citalopram [Celexa], an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process? Adaptive changes in the brain Drug tolerance and dependence A wide therapeutic index Improved neuronal transmission
Adaptive changes in the brain
Which receptors are considered adrenergic receptors? (Select all that apply.) Alpha1 Beta2 Dopamine Muscarinic1 Beta1 Alpha2
Alpha1 Beta2 Dopamine Beta1 Alpha2
The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? Tonic-clonic Absence Atonic Myoclonic
Absence
The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient? Obtain blood glucose. Observe for lower leg edema. Assess the heart rate. Apply a pulse oximeter.
Assess the heart rate.
The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) Check the blood urea nitrogen (BUN) and creatinine levels. Obtain insulin from the medication cart. Assess the patency of the IV line. Review the allergy history. Assess the vital signs.
Assess the patency of the IV line. Review the allergy history. Assess the vital signs.
The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine [Prostigmin], 75 mg PO twice daily. What is the most important initial nursing action? Obtain a measurement of the plasma level of neostigmine. Teach the patient to wear a Medic Alert bracelet. Assess the patient's ability to swallow. Check the patient's deep tendon reflexes (DTRs).
Assess the patient's ability to swallow.
A nurse prepares to administer a new prescription for bethanechol [Urecholine]. Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? Constipation Hypertension Psoriasis Asthma
Asthma
The nurse prepares to administer the antidote to a patient in cholinergic crisis. Which medication does the nurse anticipate the healthcare provider to order? Neostigmine [Prostigmin] Atropine Pralidoxime [DuoDote] Dobutamine [Dobutrex]
Atropine
The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease? (Select all that apply.) Dilation and inflammation of cranial blood vessels Beta-amyloid and neuritic plaques Neurofibrillary tangles and tau Autoimmune changes in the myelin sheath Firing of hyperexcitable neurons throughout the brain Neuronal degeneration and decreased acetylcholine
Beta-amyloid and neuritic plaques Neurofibrillary tangles and tau Neuronal degeneration and decreased acetylcholine
The nurse is administering diphenhydramine [Benadryl], a neuropharmacologic agent that works by doing what? Preventing mast cells from releasing histamine Preventing axonal conduction Binding to histamine receptors, preventing receptor activation Acting as an agonist to H1 histamine receptors
Binding to histamine receptors, preventing receptor activation
The nurse is monitoring a patient prescribed with reserpine for the treatment of hypertension. Which assessment parameter indicates that this medication is effective? Decrease in diarrhea Blood pressure of 118/72 mm Hg Absence of bladder distention Improved symptoms of depression
Blood pressure of 118/72 mm Hg
A patient has an infection affecting a central nervous system (CNS) component. Which structure makes the delivery of antibiotic therapy more difficult? Blood-brain barrier Chemotherapeutic trigger zone Neuropeptide receptors Thalamic synapses
Blood-brain barrier
Which symptom is the most indicative of muscarinic poisoning? Constipation Heart rate of 140 beats/min Blood pressure of 180/110 mm Hg Blurred vision
Blurred vision
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? Cardiac rhythm Blood urea nitrogen Central nervous system (CNS) tremor Lung sounds
Cardiac rhythm
Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? Take the medication on a full stomach. Change positions slowly. The drug may cause the urine to be very dilute. Carbidopa has many adverse effects.
Change positions slowly.
A patient who abuses cocaine, opioids, and other drugs frequently abuses which drug? Guanfacine Reserpine Methyldopa Clonidine
Clonidine
The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) Blood urea nitrogen Complete blood count Hemoglobin A1c Alkaline phosphatase Immunoglobulin G levels
Complete blood count Alkaline phosphatase
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? Cardiac dysrhythmias Hypertension Diabetes Angina
Diabetes
Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? Hair loss Backache Dizziness and fatigue Blue-green tint to the skin
Dizziness and fatigue
The nurse is assessing a patient in a clinic who has been taking clonidine [Catapres] for hypertension. Which clinical findings are most indicative of an adverse effect of this drug? Cough and wheezing Epigastric pain and diarrhea Drowsiness and dry mouth Positive Coombs' test result and anemia
Drowsiness and dry mouth
A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? Diarrhea Dyskinesia Wheezing Headache
Dyskinesia
Overdose of cholinesterase inhibitors causes which of the following? (Select all that apply.) Xerostomia Excessive muscarinic stimulation Constipation Respiratory depression Cholinergic crisis
Excessive muscarinic stimulation Respiratory depression Cholinergic crisis
Which condition is an indication for the use of succinylcholine [Anectine]? Pain relief after major surgery Loss of consciousness during surgery Facilitation of endotracheal intubation Relief of status epilepticus
Facilitation of endotracheal intubation
What is the primary effect of neuromuscular blockers? Flaccid paralysis Hypotension Loss of consciousness Reduction in pain
Flaccid paralysis
Which organs are controlled primarily by the parasympathetic system? (Select all that apply.) Gastrointestinal tract Respiratory tract Cardiovascular system Skin Salivary glands
Gastrointestinal tract Respiratory tract Skin Salivary glands
Prior to discharge, the nurse provides teaching related to adverse effects of terazosin [Hytrin] to the patient and caregivers. Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) Headache Hypoglycemia Nasal congestion Erectile dysfunction Orthostatic hypotension
Headache Nasal congestion Erectile dysfunction Orthostatic hypotension
The nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug? Wheezing decreases due to bronchodilation. Heart rate decreases to 60 beats/min. Diarrhea stool count decreases. Oxygenation improves because of bronchodilation.
Heart rate decreases to 60 beats/min
The nurse is caring for a patient prescribed methyldopa [Aldomet]. Which laboratory test is most important to obtain before treatment? Creatinine level Serum glucose level White blood cell count Hematocrit
Hematocrit
The nurse knows that the advantage of patients having multiple types of receptors to regulate bodily functions is what? Improved maximal efficacy Reduction of side effects and toxicity Higher degree of selectivity Lower therapeutic index
Higher degree of selectivity
The nurse is preparing to give a drug to stimulate activation of adrenergic receptors. Which effects indicate sympathetic stimulation? Increase in heart rate Constriction of pupils Atrioventricular block Sinus bradycardia
Increase in heart rate
The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? (Select all that apply.) Increased heart rate Excessive drowsiness Increased force of heart contraction Decreased cardiac output Bronchial dilation Decreased glucose levels
Increased heart rate Increased force of heart contraction Bronchial dilation
A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? An imbalance of dopamine and acetylcholine in the central nervous system Inflammation and myelin destruction in the central nervous system An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone High-frequency discharge of neurons from a specific focus area of the brain
Inflammation and myelin destruction in the central nervous system
The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? Flu-like symptoms with fever Decreased neutrophil count Jaundice and elevated bilirubin Injection site pain and redness
Injection site pain and redness
What is the pathophysiology for a myasthenic crisis? Insufficient ACh at the NMJ Excessive ACh at the NMJ Overdose with a cholinesterase inhibitor None of the above
Insufficient ACh at the NMJ
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? Topical phenylephrine Subcutaneous terbutaline Intravenous epinephrine Inhaled albuterol
Intravenous epinephrine
Which best describes the rationale for using neostigmine [Prostigmin] in the treatment of myasthenia gravis? It promotes neuromuscular blockade in the periphery. It promotes emptying of the bladder and sphincter relaxation. It reduces intraocular pressure and protects the optic nerve. It increases the force of skeletal muscle contraction.
It increases the force of skeletal muscle contraction.
Which of the following statements about Pralidoxime are true? (Select all that apply.) It is an antidote to organophosphate poisoning. It is an antidote to reversible cholinesterase inhibitors. It cannot cross the blood-brain barrier. It reverses cholinesterase inhibition in the CNS. Doses should be infused slowly.
It is an antidote to organophosphate poisoning. It cannot cross the blood-brain barrier. Doses should be infused slowly.
The nurse is preparing to give neostigmine [Prostigmin]. Which best describes the action of this drug? It inhibits acetylcholine at all cholinergic synapses. It prevents inactivation of acetylcholine. It prevents activation of muscarinic receptors. It stimulates activation of adrenergic receptors.
It prevents inactivation of acetylcholine.
The nurse is preparing to administer a dose of clonidine [Catapres]. Which is the best description of the action of this drug? It selectively activates alpha2 receptors in the central nervous system (CNS). It causes peripheral activation of alpha1 and alpha2 receptors. It depletes sympathetic neurons of norepinephrine. It directly blocks alpha and beta receptors in the periphery.
It selectively activates alpha2 receptors in the central nervous system (CNS).
The nurse knows that which drug acts by decreasing axonal conduction? Lidocaine [Xylocaine], a local anesthetic Citalopram [Celexa], an antidepressant Morphine [Duramorph], a pain reliever Halothane [Fluothane], a general anesthetic
Lidocaine [Xylocaine], a local anesthetic
Which characteristic improves a drug's ability to reach the central nervous system (CNS)? Protein binding Lipid solubility Electrical charge Ionization
Lipid solubility
Succinylcholine [Anectine] is contraindicated in a patient with which condition? Diabetes mellitus Hyperthyroidism Chronic obstructive pulmonary disease (COPD) Major burns during the emergent phase
Major burns during the emergent phase
Which statement about memantine [Namenda] is false? Memantine is indicated for moderate or severe AD. Memantine modulates the effects of glutamate. Memantine does not slow the decline in function. The most common side effects are dizziness, headache, confusion, and constipation.
Memantine does not slow the decline in function.
A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? Decaffeinated tea, gelatin cubes, and ginger ale when alert Docusate 100 mg orally daily Meperidine 50 mg IM every 4 hours as needed for pain Acetaminophen 650 mg every 6 hours as needed for temperature
Meperidine 50 mg IM every 4 hours as needed for pain
The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? Interferon beta-1a [Avonex] IM Methylprednisolone [Solu-Medrol] IV Glatiramer acetate [Copaxone] subQ Natalizumab [Tysabri] IV infusion
Methylprednisolone [Solu-Medrol] IV
Which medications can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) Modafinil [Provigil] Clonazepam [Klonopin] Amantadine [Symmetrel] Carbamazepine [Tegretol] Dalfampridine [Ampyra]
Modafinil [Provigil] Amantadine [Symmetrel]
Which medication used for the management of multiple sclerosis cannot be self-administered? Fingolimod [Gilenya] Natalizumab [Tysabri] Glatiramer acetate [Copaxone] Interferon beta-1b [Betaseron]
Natalizumab [Tysabri]
The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent? Neostigmine [Prostigmin] Atropine Pralidoxime [DuoDote] Dobutamine [Dobutrex]
Neostigmine [Prostigmin]
Which receptors mediate responses to the neurotransmitter acetylcholine? (Select all that apply.) Alpha1 Beta2 Dopamine Nicotinic Muscarinic
Nicotinic Muscarinic
A nurse is preparing to give bethanechol [Urecholine]. What is an expected outcome of this drug? Nondistended bladder Increased heart rate and blood pressure Improved pulse oximetry reading Relief of cardiac rhythm problems
Nondistended bladder
Which neurotransmitter is active in both the peripheral and central nervous systems (CNS)? Norepinephrine Serotonin Substance P Dynorphins
Norepinephrine
A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a priority because of which associated adverse effect? Reflex tachycardia Heart palpitations Cardiac dysrhythmias Orthostatic hypotension
Orthostatic hypotension
A patient goes to the emergency department after using organophosphate insecticides improperly. Which assessment finding would the nurse expect? Urinary retention Stool incontinence Mydriasis Flushed, dry skin
Stool incontinence
The nurse is working with a group of patients receiving drugs that work in the central nervous system (CNS). Nursing care of these patients is based on which facts? (Select all that apply.) Overall knowledge of the workings of CNS agents is limited. The CNS has many more neurotransmitters than the periphery. Animal studies in progress will greatly enhance knowledge of CNS medications. When CNS drugs are taken long term, their effects differ from initial use. The blood-brain barrier is permeable to water-soluble drugs.
Overall knowledge of the workings of CNS agents is limited. The CNS has many more neurotransmitters than the periphery. When CNS drugs are taken long term, their effects differ from initial use.
A patient with acute renal failure requires continuous NM blockade to facilitate oxygenation and mechanical ventilation. Which agent prescribed by the physician should the nurse question? Atracurium [Tracrium] Cisatracurium [Nimbex] Pancuronium [Pavulon] Vecuronium [Norcuron]
Pancuronium [Pavulon]
A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity? Parasympathetic activity would increase. Parasympathetic signals would be depressed. Sympathetic activity would increase. Respiratory centers would be depressed.
Parasympathetic activity would increase
Which label most aptly describes the drug atropine [Sal-Tropine]? Cholinergic Parasympatholytic Muscarinic agonist Parasympathomimetic
Parasympatholytic
Which assessments are essential before a patient receives a second dose of mitoxantrone [Novantrone]? (Select all that apply.) Pregnancy test Echocardiogram Complete blood count T3, T4, and TSH levels Ophthalmic examination Magnetic resonance imaging (MRI)
Pregnancy test Echocardiogram Complete blood count
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? Prepare to administer dantrolene [Dantrium]. Administer normal saline at 50 mL/hr. Administer morphine sulfate to relieve pain. Prepare for intubation and mechanical ventilation.
Prepare to administer dantrolene [Dantrium].
The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first? Prepare to administer phentolamine [Regitine]. Ensure that naloxone [Narcan] is available. Institute the protocol for congestive heart failure (CHF). Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels.
Prepare to administer phentolamine [Regitine].
Why does the nurse anticipate administering metoprolol [Lopressor] rather than propranolol [Inderal] for diabetic patients who need a beta-blocking agent? Metoprolol is less likely to cause diabetic nephropathy. Propranolol causes both beta1 and beta2 blockade. Metoprolol helps prevent retinopathy in individuals with diabetes. Propranolol is associated with a higher incidence of foot ulcers.
Propranolol causes both beta1 and beta2 blockade.
Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? Epilepsy Diabetic coma Meningitis Psychosis
Psychosis
Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? Increased risk of sudden cardiac death Documented reports of necrotizing colitis Increased risk of Stevens-Johnson syndrome Rare cases of dangerous brain infections
Rare cases of dangerous brain infections
The nurse is preparing to administer medication to the following patients. Which medication should the nurse question before administering? Clonidine [Duraclon] to a patient with severe pain Guanfacine [Intuniv] to a patient with attention-deficit/hyperactivity disorder (ADHD) Reserpine to a patient with a history of depression Methyldopa [Aldomet] to a patient with a diagnosis of hypertension
Reserpine to a patient with a history of depression
The nurse understands that which adverse effect is most significant for the botulinum toxin? Sedation Internal bleeding Respiratory failure Increased risk for infection
Respiratory failure
Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? Donepezil [Aricept] Rivastigmine [Exelon] Galantamine [Reminyl] Memantine [NMDA]
Rivastigmine [Exelon]
The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? Relapsing-remitting Secondary progressive Primary progressive Progressive-relapsing
Secondary progressive
The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures? Nausea Sedation Fatigue Dry mouth
Sedation
Following the administration of guanfacine [Tenex], the nurse should assess for which effects? Constipation and tachycardia Sweating and vivid dreams Skin rash and headache Sedation and dry mouth
Sedation and dry mouth
The nurse administering succinylcholine knows that the paralysis effect only lasts a few minutes because of which pathophysiologic action? Succinylcholine is rapidly degraded by pseudocholinesterase. Succinylcholine is rapidly metabolized by the liver. Succinylcholine is rapidly excreted by the kidneys. Succinylcholine is rapidly degraded by cholinesterase.
Succinylcholine is rapidly degraded by pseudocholinesterase.
A patient is experiencing symptoms of the "fight-or-flight" response. Which autonomic process stimulates this response? Sympathetic system Predominant tone of the organs Baroreceptor reflex Parasympathetic system
Sympathetic system
What is essential for the nurse to confirm before starting vecuronium [Norcuron] as a continuous intravenous infusion? The patient has been intubated and is on mechanical ventilation. A Foley catheter has been inserted. Hourly blood glucose levels have been ordered. A nasogastric tube is in place for suction.
The patient has been intubated and is on mechanical ventilation.
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) Terbutaline must be given by a parenteral route. The selectivity of terbutaline is dose dependent. The patient may experience tremor with terbutaline. Terbutaline is a sympathomimetic drug. Bronchoconstriction is a potential adverse effect of terbutaline.
The selectivity of terbutaline is dose dependent. The patient may experience tremor with terbutaline. Terbutaline is a sympathomimetic drug.
The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? They carry a positive charge. They compete with acetylcholine (ACh) for binding sites. They cause muscle relaxation. They interact with potassium.
They carry a positive charge.
What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? To increase the amount of acetylcholine at the presynaptic neurons To reduce the amount of dopamine available in the substantia nigra To balance cholinergic and dopaminergic activity in the brain To block dopamine receptors in presynaptic and postsynaptic neurons
To balance cholinergic and dopaminergic activity in the brain
The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? Use as a preanesthesia medication Treatment of tachycardias Prevention of urinary retention Reduction of intraocular pressure in glaucoma
Use as a preanesthesia medication
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? A heart rate of 100 beats/min Wheezing A glucose level of 180 mg/dL Urinary urgency
Wheezing
The following statements about neuromuscular blockers are true except: they cannot be absorbed by the GI tract. they easily cross the placenta. they cannot cross the blood-brain barrier. they have no effect on the CNS.
they easily cross the placenta.
