Pharm Exam 3 Questions Practice

A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms? chronic obstructive pulmonary disease (COPD) transient ischemic attacks (TIA) diabetes mellitus cardiac arrhythmias

cardiac arrhythmias Contraindications to cyclobenzaprine include acute myocardial infarction, arrhythmia, heart block, conduction disturbances, heart failure, and hyperthyroidism. The other listed health problems do not contraindicate its use.

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? assessment of deep tendon reflexes pupillary response daily weights bilateral blood pressures

daily weights Imatinib may be associated with edema and significant fluid overload. Patients should be weighed regularly and assessed for signs of fluid retention. Reflexes, bilateral inequalities in blood pressure, and alterations in pupil response are not associated with the use of imatinib.

The nurse should be aware that concomitant use of what drug is contraindicated during tiotropium therapy? fluticasone ipratropium theophylline budesonide

ipratropium A client who is taking ipratropium should not take tiotropium because both drugs are anticholinergics. Theophylline and corticosteroids like budesonide and fluticasone are not necessarily contraindicated.

A client is receiving tamoxifen. Which adverse effect would be most specific to the action of this drug? menopausal effects hepatic dysfunction bone marrow suppression gastrointestinal toxicity

menopausal effects Tamoxifen belongs to the group of drugs that are hormones or hormone modulators. These agents are hormone specific. This drug competes with estrogen at the receptor sites, ultimately blocking estrogen. The adverse effects specific to this action would involve menopause-associated effects. Bone marrow suppression, GI toxicity, and hepatic dysfunction occur with this drug, but these are not specific to the drug's action.

The nurse admits a child who was diagnosed with tetanus after stepping on some old barbed wire fencing. What medication should the nurse expect to administer? cyclobenzaprine baclofen methocarbamol dantrolene

methocarbamol Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Cyclobenzaprine is not used for the treatment of tetanus.

The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize? "On a scale from zero to ten, how would you rate your anxiety level?" "Are you feeling happier today than in the past?" "How are you feeling today?" "How would you describe your mood and energy level today?"

"How would you describe your mood and energy level today?" Mirtazapine is an antidepressant and it is prudent for the nurse to assess the client's mood and level of energy. Anxiety is not synonymous with depression and is not treated with this medication. Asking a client how the client feels is often too vague and open-ended to obtain meaningful data. Asking a client if she or she feels "happier" is a closed-ended (yes/no) question and could easily be interpreted by the client as downplaying the severity of depression.

A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client's concern? "It's important to take salmeterol as soon as you feel the first sensation of an asthma attack." "Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." "It's best to take repeated doses of salmeterol every 5 minutes, until your symptoms subside." "Unfortunately, Serevent (salmeterol) can take up to 15 minutes to relieve your difficulty breathing."

"Remember that your salmeterol isn't effective when you take it at the time of an asthma attack." Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.

A male client is prescribed levodopa for his Parkinson's disease. The dosage has been modified on multiple occasions. The client asks the nurse how the prescriber decides on the optimal dose. What is the nurse's best response? "The optimal dose is the lowest one that allows the client to function adequately." "The optimal dose is the one that allows the client to function adequately." "The optimal dose is the one that maximizes client function." "The optimal dose is the highest one that allows the client to function adequately."

"The optimal dose is the lowest one that allows the client to function adequately." The optimal dose is the lowest one that allows the client to function adequately. Optimal dosage may not be established for 6 to 8 weeks with levodopa.

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline? "Use sugarless hard candies and gum to deal with dry mouth." "Limit your fluid intake so you don't have to urinate during the night." "Be sure to eat a low fiber diet to prevent diarrhea." "Take the drug daily in the morning for maximum benefit."

"Use sugarless hard candies and gum to deal with dry mouth." Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? "I need to inhale my medication and hold my breath for 10 seconds." "When I can do some, but not all of my usual activities, I am in the yellow zone." "When I am short of breath, I will increase the use of my fluticasone." "I will wash my sheets weekly."

"When I am short of breath, I will increase the use of my fluticasone." Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.

A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order? The standard dose of aminophylline A drug other than aminophylline Phenytoin intravenously A modified dose of aminophylline

A modified dose of aminophylline Cigarette smoking and drugs that stimulate drug-metabolizing enzymes in the liver (e.g., phenobarbital, phenytoin) increase the rate of metabolism and, therefore, the dosage requirements of aminophylline.

How long does a patient need to wait after stopping a phenelzine before starting paroxetine? 14 days 1 day 10 days 7 days

14 days Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? A client with a history of myoclonic seizures who takes valproic acid A client with a history of tonic-clonic seizures who takes phenobarbital A client receiving IV phenytoin to prevent seizures post-neurosurgery A client receiving ethosuximide for the prevention of absence seizures

A client with a history of tonic-clonic seizures who takes phenobarbital Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs.

The nurse has just begun administering phenobarbital intravenously to a child within status epilepticus. The nurse would expect this drug to begin working within which time frame? 15 to 20 minutes 5 minutes The time frame depends on the child's body surface area 60 seconds

5 minutes IV phenobarbital has an onset of action of approximately 5 minutes.

What client is most likely to benefit from Botox (incobotulinumtoxin A) injections? A 68 year-old client who has chronic lumbar and thoracic pain following a workplace accident A 16 year-old client with cerebral palsy whose upper body spasticity has worsened in recent months A 54 year-old client who suffers debilitating migraines two to three days per week A 60 year-old client who was diagnosed with myasthenia gravis 18 months ago

A 54 year-old client who suffers debilitating migraines two to three days per week Botox (incobotulinumtoxin A) has been used successfully in some clients with migraines. The injections are not used in the treatment of spasticity, myasthenia gravis or back pain.

An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Advise the client to double the dose for 24 hours because the client is experiencing the symptoms of drug withdrawal. Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Advise the client to decrease the dose because the client is getting too much of the medication. Advise the client that these are normal reactions to the medication and he should continue the medication as ordered.

Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level.

Which would a nurse identify as increasing a client's risk for hepatic disease with dantrolene use? Infection Age over 35 years Respiratory disease Male gender

Age over 35 years The risk for hepatocellular disease is increased in women and all clients over the age of 35 years. Respiratory disease could be exacerbated with the use of dantrolene. Acute infection would be a contraindication to the use of botulinum toxins.

Which would lead the nurse to suspect that a client is experiencing an adverse effect to an anticholinergic agent? Agitation Excess salivation Diarrhea Diaphoresis

Agitation Agitation would be noted due to the blocking of central acetylcholine receptors. Constipation, reduced sweating, and dry mouth may be noted as well.

A nurse is caring for a patient who is going to take ethosuximide. During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started? Partial thromboplastin time (PTT) Blood urea nitrogen (BUN) Alanine aminotransferase (ALT) Blood glucose level

Alanine aminotransferase (ALT) Because an adverse effect of ethosuximide can be liver function impairment, a baseline liver function study that includes the ALT should be done prior to starting ethosuximide. Baseline values will help the nurse determine if the drug is causing the abnormal values, and liver function studies will need to continue throughout the therapy. Blood glucose level would determine the glucose level in the blood. BUN would help determine urinary function. PTT is a test to assess the intrinsic system, which is the common pathway of clot formation in the blood. While these tests are important, they do not have a direct relationship to ethosuximide use.

A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapeutic effect of the treatment in the care of this client? Assessment of the client's behaviors and thought processes Assessing the client's vital signs Monitoring the client's hepatic and renal status Monitoring the client for indications of bone marrow suppression

Assessment of the client's behaviors and thought processes The nurse's priority should be to assess the signs and symptoms of the client's underlying health problem in order to identify therapeutic effects. The client's vital signs are not likely to be volatile, and hepatic and renal status are not commonly affected by Risperidone. Bone marrow suppression is not an expected adverse effect.

A patient with severe spasticity it receiving a medication that is administered intrathecally. Which medication is the client receiving? Baclofen Carisoprodol Dantrolene Diazepam

Baclofen Baclofen is used to treat spasticity in MS and spinal cord injuries. It can be administered intrathecally. Carisoprodol is used to relieve discomfort from acute, painful musculoskeletal disorders. Diazepam is use to relieve muscle spasms but not used intrathecally. Dantrolene is used to treat malignant hyperthermia but not multiple sclerosis.

What is the most common first-line therapy for relief of an acute asthma attack? Beta2-adrenergic agonist Inhaled steroid Leukotriene modifier Xanthine

Beta2-adrenergic agonist A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

Which antineoplastic drugs are classified as antineoplastic antibiotics? (Select all that apply.) Dactinomycin (Cosmegen) Carboplatin (Paraplatin) Bleomycin (Blenoxane) Busulfan (Busulfex) Daunorubicin (DaunoXome)

Bleomycin (Blenoxane) Dactinomycin (Cosmegen) Daunorubicin (DaunoXome) Antineoplastic antibiotics have similar action to alkylating drugs and include bleomycin , dactinomycin , and Daunorubicin .

A nurse is caring for a client prescribed gemcitabine. On the morning laboratory results, the nurse discovers the following: white blood cell count 4500/mm3 and platelets 135,000/mm3. The nurse anticipates discovering which sign on the ongoing assessment? Pain on urination Concentrated urine Frequent micturition Bloody urine

Bloody urine Thrombocytopenia is characterized by a platelet count of less than 100,000/mm3. The client is at risk for thrombocytopenia due to bone marrow suppression which is indicated by hematuria. Concentrated urine, frequent micturition, or pain on urination is not indicative of thrombocytopenia. Frequent urination is a potential sign of an infection. Leukopenia or white counts of less than 2500/mm3 would need to be reported to the health care provider.

A patient has been diagnosed with cervical dystonia. The nurse would expect which medication to be ordered for this patient? Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin) Botulinum toxin type B Baclofen (Lioresal)

Botulinum toxin type B The botulinum toxin type B is used to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

A child is prescribed an anthracycline drug. The nurse would teach the parents to observe for signs and symptoms of what adverse effect? Cardiotoxicity Dehydration Esophageal varices Gallbladder disease

Cardiotoxicity Children who receive an anthracycline drug (e.g., doxorubicin) are at increased risk of developing cardiotoxic effects (e.g., heart failure) during treatment or after receiving the drug. Efforts to reduce cardiotoxicity include using alternative drugs when effective, giving smaller cumulative doses of anthracycline drug, and observing clients closely so that early manifestations can be recognized and treated before heart failure occurs.

An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient's chemotherapy. Which cancerous cell is most susceptible to the effects of chemotherapeutic drugs? Cells that have a rapid mitotic rate Cells with a long generation time Cells that lack a blood supply Cells that lack contact inhibition

Cells that have a rapid mitotic rate Cells that have a short generation time or rapid mitotic rate are most sensitive to antineoplastic agents. All cells (both cancerous and noncancerous) have a blood supply. A lack of contact inhibition is characteristic of cancer, but this is not associated with susceptibility to chemotherapeutic drugs.

The nurse should complete which of the following during acute breathing distress before initiation of a bronchodilator? Select all that apply: Check pulse. Check blood pressure. Check blood glucose. Check peak flow Check respiratory rate

Check pulse. Check blood pressure. Check respiratory rate Prior to initiation of a bronchodilator during acute breathing distress, the nurse needs to take a blood pressure, pulse, and respiratory rate.

Which would be most important to monitor in a client receiving ethosuximide? Complete blood count Electrocardiogram Nutritional status Weight

Complete blood count Although weight loss and anorexia may occur, ethosuximide is associated with bone marrow suppression, including potentially fatal pancytopenia, so it would be most important for the nurse to monitor the client's complete blood count. The drug is not associated with any cardiovascular effects that would necessitate an electrocardiogram.

A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer? Calfactant Cromolyn Montelukast Triamcinolone

Cromolyn

A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication? Tizanidine Diazepam Cyclobenzaprine Dantrolene

Dantrolene Dantrolene is a peripherally acting spasmolytic, while tizanidine, diazepam, and cyclobenzaprine are all centrally acting.

The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? Increases the potassium available to the cell to reduce the repolarization of the cell Decreases the calcium available to the cells responsible for electrical activity in the brain Increases the chloride available to promote depolarization of the cells Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus

Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.

After teaching a group of students about antineoplastic antibiotics, the instructor determines that the teaching was successful when the students identify which drug as an example? Imatinib Methotrexate Vincristine Doxorubicin

Doxorubicin Doxorubicin is the prototype antineoplastic antibiotic. Vincristine is the prototype mitotic inhibitor. Imatinib is the prototype protein tyrosine kinase inhibitor. Methotrexate is the prototype antimetabolite.

The client is prescribed an anticonvulsant medication. After administering the medication, the nurse should monitor for which adverse reactions? Select all that apply. Gingival hyperplasia Drowsiness Ataxia Weight gain Urticaria

Drowsiness Ataxia Urticaria Gingival hyperplasia Adverse reactions that may occur with the administration of an anticonvulsant drug include drowsiness, ataxia, anorexia, gingival hyperplasia, and urticarial. Weight gain is not a common adverse reaction. Since anorexia is an adverse effect, the client will likely suffer weight loss versus weight gain.

A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Educate the client about taking the medication at the first sign of impending seizure activity Teach the client how to self-administer subcutaneous injections Establish intravenous access Educate the client about the need to take the pills as scheduled

Educate the client about the need to take the pills as scheduled Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.

Which of the following would be most important to assess before administering calfactant? (Select all that apply.) Abdominal girth Bowel sounds Endotracheal tube placement Oxygen saturation levels Lung sounds

Endotracheal tube placement Oxygen saturation levels Lung sounds Before administering calfactant, it would be important to ensure proper endotracheal tube placement because the drug is instilled directly into the trachea. In addition, lung sounds and oxygen saturation levels would be important as a baseline to evaluate effectiveness of the drug.

Which are classified as catechol-O-methyltransferase (COMT) inhibitor drugs? (Select all that apply.) Bromocriptine (Parlodel) Amantadine (Symmetrel) Biperiden (Akineton) Tolcapone (Tasmar) Entacapone (Comtan)

Entacapone (Comtan) Tolcapone (Tasmar) Entacapone (Comtan) and tolcapone are classified as COMT inhibitors.

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? Erythropoietin Heparin Normal saline 0.9% intravenously Antidiuretic hormone

Erythropoietin Clients may receive parenteral cytotoxic drugs as outpatients and return home, or these and other antineoplastic drugs may be administered at home by the client or a caregiver. If a client is receiving erythropoietin or oprelvekin subcutaneously, the client or a caregiver may need to be taught injection technique

A male patient has been on long-term bicalutamide therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor: Visual function Blood counts Pap test results Liver function

Liver function It is important for the nurse to monitor the client's liver function closely if the client is on prolonged therapy with an antiandrogenic agent. Adverse effects of the therapy include gynecomastia, diarrhea, hot flashes, breast pain, impotence, loss of libido, and abnormal liver functions. Monitoring of blood counts, an annual pap smear, and regular visual function tests are advised for clients undergoing tamoxifen therapy.

A client diagnosed with a seizure disorder has had a recent change in medication. What assessment(s) should the nurse perform in order to evaluate the effectiveness of the new drug? Select all that apply. Assess for adverse effects. Evaluate laboratory drug level. Assess for changes in mood. Assess for change in seizure activity. Evaluate the client's bowel pattern.

Evaluate laboratory drug level. Assess for adverse effects. Assess for change in seizure activity. The nurse should interview and assess for any change in seizure activity; interview and assess for the avoidance of adverse drug effects, especially those that impair safety; when available, check laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. Mood and bowel patterns are unlikely to be affected, and neither parameter suggests success or failure of treatment.

The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition? Cardiac dysfunction Falls Seizure activity Renal dysfunction

Falls In older adults, decreased elimination by the liver and kidneys may lead to drug accumulation, with subsequent risks of dizziness, impaired coordination, and injuries due to falls.

An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan? Falls prevention measures Seizure precautions Deep breathing and coughing exercises Continuous pulse oximetry

Falls prevention measures The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.

A client has been receiving a chemotherapeutic agent for a diagnosis of leukemia. The nurse will prioritize which factor(s) on the ongoing assessment of this client? Select all that apply. General condition Any adverse reactions Individual response to the drug Guidelines established by evidence-based practice Laboratory and radiographic reports

General condition Individual response to the drug Any adverse reactions Laboratory and radiographic reports After the administration of a chemotherapeutic drug, the nurse bases the ongoing assessment on the following factors: client's general condition, client's individual response to the drug, adverse reactions that may occur, results of periodic laboratory tests and radiographic scans, and guidelines established by the oncology health care provider or clinic not by evidence-based practice. Each client's progress must be monitored on an individual basis and planned around that client's progress and response to the therapy.

A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe? Change in libido Skin rash Photosensitivity Hypertensive crisis

Hypertensive crisis Hypertensive crisis is an adverse reaction of MAOIs. Photosensitivity is an adverse reaction of tricyclic antidepressants. Change in libido and skin rash are adverse reactions of desvenlafaxine and bupropion.

The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI? Renal dysfunction Orthostatic hypotension Hypoglycemia Diabetic ketoacidosis

Hypoglycemia MAOIs interact with oral antidiabetic agents, increasing the client's risk for hypoglycemia. Diabetic ketoacidosis would be associated with hyperglycemia. Orthostatic hypotension, urinary retention, dysuria, and incontinence may occur with MAOI therapy, but these are not associated with the interaction of an oral antidiabetic agent and an MAOI.

A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome? Prevention of hemorrhagic cystitis Increased leukocytes Increased platelet levels Resolution of mucositis

Increased leukocytes Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis).

A health care prescriber recently ordered a change in medication for a patient with a seizure disorder. Which action would the nurse take in evaluating the new drug's control of the seizure disorder? Check laboratory reports for evidence of hypernatremia Interview and observe for evidence of underdosing or overdosing Interview and observe for adverse effects Evaluate vital signs

Interview and observe for adverse effects Evaluation of the drug's effectiveness includes interviewing and observing for decrease in or absence of seizure activity; interviewing and observing for avoidance of adverse drug effects, especially those that impair safety; and, when available, checking laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing

A female client begins tolcapone therapy, and her health care provider arranges for laboratory testing to be completed on a routine basis. The nurse expects which laboratory study to be ordered? Hemoglobin and hematocrit BUN and creatinine CBC Liver transaminase enzymes

Liver transaminase enzymes Tolcapone therapy should not be initiated for any person with liver disease or elevated liver enzymes. Liver transaminase enzymes should be monitored frequently on the schedule described in the text.

A client comes to the emergency department. The client is experiencing continuous seizure activity without any interruptions. Which anticonvulsant would the nurse anticipate that the primary health care provider would most likely prescribe initially? Phenytoin Fosphenytoin Lorazepam Clorazepate Valproic acid

Lorazepam Lorazepam (Ativan) is the drug of choice for this condition. However, because the effects of lorazepam last less than 1 hour, longer-lasting anticonvulsants such as phenytoin or fosphenytoin may be given to continue to control the seizure activity. Valproic acid is used to treat epilepsy, migraine headache, and mania. Clorazepate is used to treat focal seizures, anxiety disorders, and alcohol withdrawal.

An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family? Administer the medication with meals. Give the medication at the same time each day. Monitor the client before ambulating. Instruct on how to assess client's pain level.

Monitor the client before ambulating. Safety is the top priority concern, because skeletal muscle relaxants can cause drowsiness. Administering the medication with meals can reduce GI distress but is not the top priority safety concern. Checking the client's pain level is important but not the top priority safety concern. Giving the medication at the same time each day may help the caregivers remember it, but is not the top priority safety concern.

A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions? Monitor the client for tetany and review serum calcium levels when available. Monitor the client closely for bleeding and review coagulation indices when available. Assess the client's blood pressure every six hours for the first week of therapy. Ask the client at each meal about any episodes of gastresophageal reflux.

Monitor the client closely for bleeding and review coagulation indices when available. Combining TCAs with warfarin creates a risk for bleeding, which should be addressed in the nursing care plan. There is no known interaction between TCAs and calcium supplements or bisphosphonates that would create a risk for hypocalcemia. TCAs do not heighten the risk of gastresophageal reflux. TCAs can affect blood pressure, but this is unrelated to any known drug-drug interactions.

After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which as possible adverse effects? (Select all that apply.) Chills Myalgia Constipation Vomiting Dizziness

Myalgia Dizziness Vomiting Myalgia is a possible adverse effect of zafirlukast. Dizziness is a possible adverse effect of zafirlukast. Vomiting is a possible adverse effect of zafirlukast. Constipation is not associated with zafirlukast. Chills are not associated with zafirlukast.

The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid-filled blisters and purpuric areas all over the client's body. Which action(s) should the nurse take? Select all that apply. Administer the dose of lamotrigine. Notify the primary care provider immediately. Assess vital signs. Cleanse affected areas with soap and water. Document the skin assessment.

Notify the primary care provider immediately. Assess vital signs. Document the skin assessment. The nurse observes that the client is exhibiting a severe hypersensitivity rash that is potentially fatal, called Stevens-Johnsons Syndrome, and must notify the health care provider (HCP) immediately, and hold the dose of lamotrigine awaiting orders from the PCP. The nurse should assess vital signs for signs and symptoms of infection, which may occur from bacteria entering large areas of compromised skin. The nurse should document the skin assessment and the actions taken, including holding the drug and calling the primary care provider immediately. The nurse should not cleanse the skin with soap and water because the soap will dry out the skin leading to further breakdown.

A client has developed a hepatic injury related to the administration of tolcapone. Which activity does the nurse anticipate will be added to the plan of care for this client? Monitor the client for signs of tactile hallucinations. Perform regular blood tests of the client. Monitor the client for signs of dystonic movements. Perform serum transaminase level testing every day.

Perform regular blood tests of the client. A serious and potentially fatal adverse reaction to tolcapone is hepatic injury. The nurse should, therefore, perform regular blood testing to monitor liver function of the client as prescribed. The testing of serum transaminase levels may be ordered at frequent intervals such as every 2 weeks for the first year and every 8 weeks thereafter. The nurse does not need to perform serum transaminase level testing every day. The nurse should monitor for signs of dystonic movements when caring for a client receiving carbidopa and levodopa, not tolcapone. The nurse should monitor for signs of tactile hallucinations when caring for an elderly client receiving tolcapone.

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten? Phenelzine Paroxetine Triazolam Diazepam

Phenelzine MAOIs are drugs used in the treatment of mood disorders. They require that the client follow a strict diet that restricts tyramine to prevent a hypertensive crisis. Nardil is an MAOI. Diazepam and triazolam are benzodiazepines and paroxetine is an SSRI.

Which anticonvulsants exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain? (Select all that apply.) Zonisamide (Zonegran) Ethotoin (Peganone) Phenytoin (Dilantin) Valproic acid (Depakote) Ethosuximide (Zarontin)

Phenytoin (Dilantin) Ethotoin (Peganone) Hydantoins, like phenytoin (Dilantin) and ethotoin , exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain.

A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription? Question the prescriber about the dose Question the prescriber about the timing Question the prescriber about the frequency Teach the client about possible anticholinergic effects

Question the prescriber about the dose Fluoxetine is usually prescribed at 20 mg/day in the morning, with a ceiling of 60 mg per day. Consequently, the nurse should clarify the dose with the prescriber. Anticholinergic effects are not expected with SSRIs such as fluoxetine.

A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure? A sustained contraction of the skeletal muscles Abnormal posturing Loss of consciousness Rapid rhythmic and symmetric jerking movements

Rapid rhythmic and symmetric jerking movements The tonic phase of a tonic-clonic seizure involves sustained contraction of skeletal muscles, abnormal postures, and absence of respiration. The clonic phase of the seizure is characterized by rapid rhythmic and symmetric jerking movements of the body.

When reviewing a client's history, which condition would the nurse identify as contraindicating the use of a centrally acting skeletal muscle relaxant? Rheumatic disorder Hypertension Depression Epilepsy

Rheumatic disorder Centrally acting skeletal muscle relaxants would be contraindicated for treatment of muscle spasms related to a rheumatic disorder. Epilepsy, depression, or hypertension would not necessitate cautious use.

The nurse is caring for a client who has taken hydantoins for several years. The nurse noted that the client has an unsteady gait, dizziness, nystagmus, acute confusion, and a nonraised red rash on one arm and has not been to the dentist for 2 years. Based upon the findings, what is the priority nursing diagnosis? Risk for impaired skin integrity related to adverse reactions to hydantoin Risk for impaired oral mucous membranes related to hydantoin therapy Risk for injury related to untoward effect of hydantoin Risk for infection related to immunosuppression from hydantoin

Risk for injury related to untoward effect of hydantoin The client is exhibiting symptoms of hydantoin toxicity, including ataxia, nystagmus, dizziness, and acute onset of confusion, which are untoward effects of the drug when the drug level is in toxic range and needs to be reported immediately. The dosage of hydantoin should also be held until further orders are received from the primary care provider. The symptoms can lead to the risk for injury and constitute the highest priority nursing diagnosis. The rash is located on one arm, and usually a drug reaction results in a generalized rash, so impaired skin integrity needs further investigation as to what may be the etiology for the rash, but not as high of a priority as the drug toxicity reaction. Risk for an infection related to immunosuppression is a risk, but there are no symptoms suggesting an onset of an infection or history of an exposure to an infection. The risk for impaired oral mucous membranes is not as high of a priority since there are no symptoms of gingival hyperplasia noted. The client does need to be seen by the dentist at least every 6 months.

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time? Several weeks after stopping the paroxetine Concurrently with the paroxetine as it is being tapered Forty-eight hours after being weaned from the paroxetine Immediately upon stopping the paroxetine.

Several weeks after stopping the paroxetine Paroxetine, a SSRI, and phenelzine, an MAOI, should not be given together because of the risk for serotonin syndrome. At least 2 weeks and up to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

The nurse is administering a client's chemotherapeutic drug through a peripheral IV site, and the nurse observes that extravasation has occurred. What is the nurse's best action? Stop the infusion and inform the health care provider immediately. Stop the infusion, document the event, and monitor the IV site closely. Administer a bolus of 0.9% NaCl or 0.45% NaCl to dilute the drug. Establish another IV site so that the antidote can be administered.

Stop the infusion and inform the health care provider immediately. Extravasation should prompt the nurse to stop the infusion and collaborate promptly with the care provider. A bolus would cause more harm than benefit by distributing the drug in compromised tissue. Monitoring is not a sufficient response, and another IV site may or may not be needed.

A client with a spinal cord injury is experiencing increasing muscle spasticity and the care team is considering the use of dantrolene. The nurse should identify what possible contraindication to the safe and effective use of this medication? The client's injury took place less than three months ago The client is receiving a selective serotonin reuptake inhibitor for depression The client has hepatitis C The client has a sacral pressure ulcer

The client has hepatitis C Dantrolene is associated with possible hepatocellular injury and a concurrent diagnosis of hepatitis C would require great caution, or may contraindicate the use of dantrolene. Pressure ulcers, use of SSRIs and recent injury do not contraindicate its use.

A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider? The client has gained 1.5 lbs. over the past 48 hours The client tells the nurse, "I'm struggling to come to grips with the fact that I'm never going to recover." The client's most recent laboratory results show an upward trend in AST and ALT levels The client is reluctant to participate in physical therapy this morning, when she is normally highly motivated

The client's most recent laboratory results show an upward trend in AST and ALT levels An increase in liver enzyme levels could indicate the onset of hepatocellular damage, which is a high risk in female clients of this age. The provider must be made aware of this immediately. The client's lack of motivation and apparent despair should be addressed by the nurse, but may be able to be addressed independently by the nurse. As well, these issues are less time-dependent than a decrease in liver function. A weight gain of 1.5 lbs. over 48 hours is not outside the range of usual fluctuations in fluid balance.

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect? The drug is ineffective throughout all phases of the cell cycle. The drug has intermittent effectiveness throughout the cell cycle. The drug will be effective through all phases of the cell cycle. The drug will be effective through specific areas of the cell cycle.

The drug will be effective through all phases of the cell cycle. Drugs that are effective through all phases of the cell cycle and not limited to a specific phase are classified as cell cycle-nonspecific.

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. The patient has chronic heart failure resulting in significant peripheral edema. The patient had a total knee arthroplasty several months earlier.

The patient has chronic heart failure resulting in significant peripheral edema. Imatinib may be associated with edema. Patients should be weighed regularly and assessed for signs of fluid retention that could be severe. The risk of edema increases with higher doses of imatinib and age greater than 65 years. Previous strokes, orthopedic surgery, or well-controlled diabetes may not contraindicate the use of imatinib.

Cancer is considered the second leading cause of death in the United States. False True

True

Centrally acting skeletal muscle relaxants lyse or destroy the spasm. False True

True The centrally acting skeletal muscle relaxants work in the CNS to interfere with the reflexes that are causing the muscle spasm. Because these drugs lyse or destroy spasm, they are often referred to as spasmolytics.

Which drug would be classified as a mitotic inhibitor? Methotrexate Fluorouracil Vincristine Chlorambucil

Vincristine Vincristine is classified as a mitotic inhibitor. Fluorouracil and methotrexate are classified as antimetabolites. Chlorambucil is classified as an alkylating agent.

A client is taking levodopa. What should the nurse caution the client to avoid? St. John's wort Aged cheese Vitamin B6 Analgesics

Vitamin B6 Vitamin B6 interacts with levodopa decreasing its effectiveness. St. John's wort is not known to interact with levodopa, but does interact with rasagiline. Aged cheese contains tyramine and should be avoided if the client is taking rasagiline, but there is no caution associated with levodopa. Analgesics are not known to interact with levodopa.

An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which measure best protects the nurse from harm related to the chemotherapy? Administer medication intramuscularly whenever possible. Wear gloves when handling the client's soiled linens. Care for only one client receiving chemotherapy in any given shift. Perform thorough hand hygiene using an alcohol handrub.

Wear gloves when handling the client's soiled linens. Because of the drugs' toxicity, nurses who administer IV cytotoxic chemotherapy should be specially trained to administer the medications safely and use protective equipment when handling the medication or handling the client's soiled linens or excreta. Alcohol handrub will not negate the harmful effects of contacting a chemotherapeutic agent. The medication is not administered intramuscularly.

After teaching a client who is prescribed isocarboxazid, the nurse determines that additional teaching is needed when the client states a need to avoid what food? sausage. red wine. whole milk. Parmesan cheese

Whole milk Whole milk is not high in tyramine and thus does not need to be avoided during treatment with an MAOI. Red wine, sausage, and aged cheeses are high in tyramine and should be avoided.

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor: alanine aminotransferase and total bilirubin levels. urine specific gravity. prothrombin time and partial thromboplastin time. follicle-stimulating hormone levels.

alanine aminotransferase and total bilirubin levels. The nurse will monitor alanine aminotransferase and total bilirubin levels, because a serious adverse effect of dantrolene is drug-induced hepatitis. The nurse will also educate the patient and family concerning signs and symptoms of hepatitis. Prothrombin time and partial thromboplastin time would be monitored for someone taking an anticoagulant, not for someone taking dantrolene. Urine specific gravity is part of a urinalysis and would be used to assess urinary function, which is not affected by dantrolene use. Follicle-stimulating hormone level is important to the female reproductive system and would not be assessed in a male.

Which agents would be considered cancer non-cell cycle specific agents? mitotic inhibitors protein tyrosine kinase inhibitors antimetabolites alkylating agents

alkylating agents Alkylating agents affect cells in all phases of the cell cycle and are considered non-cell cycle specific. Antimetabolites are considered to be S phase specific agents. Mitotic inhibitors are cell cycle-specific agents working in the M phase of the cell cycle. Protein tyrosine kinase inhibitors target specific enzymes needed for protein building by specific tumor cells. They do not affect healthy human cells.

When providing education to a client recuperating from a muscle injury, what factor regarding muscle recovery should the nurse stress? Select all that apply. resting the muscle application of heat benefit of physical therapy need for nutritional supplements benefit of massage

application of heat benefit of massage resting the muscle benefit of physical therapy Rest of the muscle, heat, massage, and physical therapy are key components to recovery from any muscular injury or pain. While good nutrition is a general need, it is not necessarily derived from supplements.

A client is receiving botulinum toxin type A as treatment for frown lines. The nurse would instruct the client about: drooping eyelids. abnormal hair growth. photosensitivity. acne.

drooping eyelids. The use of botulinum toxin type A is associated with droopy eyelids (in severe cases), headache, respiratory infections, flulike syndrome, pain, redness, and muscle weakness, which are usually temporary. Abnormal hair growth, acne, and photosensitivity may be associated with dantrolene.

Which adverse effect(s) would a nurse most likely assess in a client who is receiving the centrally acting skeletal muscle relaxant baclofen? Select all that apply. insomnia headache urinary retention drowsiness constipation hypotension

drowsiness insomnia headache constipation urinary retention hypotension

What is the primary medication prescribed to relieve pain associated with shingles? naproxen sodium morphine sulfate meperidine gabapentin

gabapentin Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.

A client has developed symptoms of rigidity and bradykinesia. Which medication has been linked to the development of such symptomology? furosemide valproic acid psyllium hydrophilic mucilloid haloperidol

haloperidol Drugs that deplete dopamine stores or block dopamine receptors, including the older antipsychotic drugs (phenothiazines and haloperidol), reserpine, and metoclopramide, can produce movement disorders such as secondary parkinsonism. Neither furosemide, psyllium, nor valproic acid depletes dopamine stores.

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of: congestive heart failure. cerebral hemorrhage. diabetic ketoacidosis. hepatocellular disease.

hepatocellular disease. Caution should be used with dantrolene in all patients older than 35 years because of increased risk of potentially fatal hepatocellular disease.

A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is: fatigue. dry mouth. constipation. hypotension.

hypotension Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for: constipation. cardiotoxicity. neurotoxicity. asthma.

neurotoxicity Neurotoxicity is a major problem associated with paclitaxel therapy, and close monitoring is needed. Neurotoxicity generally begins 2 to 3 days after the infusion. Cardiotoxicity is observed in less than 1% of patients. The drug is not known to cause constipation or asthma.

When preparing to administer ondansetron for a patient's nausea and vomiting, the nurse understands that this agent blocks: serotonin. dopamine. GABA. norepinephrine.

serotonin Ondansetron blocks serotonin receptors in the chemoreceptor trigger zone.

The nurse is providing education to an adult client who has been prescribed lamotrigine for a seizure disorder. The nurse should inform the client that the medication must be stopped if what unexpected reaction develops? anorexia insomnia skin rash fever

skin rash The FDA has issued a black box warning related to the potential development of serious dermatologic reactions. It should be discontinued at the first sign of skin rash in an adult. Insomnia, anorexia, and fever aren't known adverse effects, so the nurse wouldn't mention them in the teaching.

A client taking long-term phenytoin informs the nurse they have not refilled the prescription. The nurse identifies that the client is at highest risk for what health problem? transient ischemic attack (TIA) delirium tremens status epilepticus hypertensive crisis

status epilepticus In a client taking medications such as phenytoin for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping antiepileptic drugs. Abruptly stopping phenytoin will not cause hypertension, delirium tremens, or TIAs.

A client receiving joint replacement surgery experiences a temperature spike during the procedure. For which reason would the nurse anticipate preparing dantrolene for this client? to control muscle spasticity in the operative limb to stop the development of muscle spasms from nerves to lower the client's body temperature to prevent malignant hyperthermia

to prevent malignant hyperthermia Dantrolene directly affects peripheral muscle contraction and is used in the treatment and prevention of malignant hyperthermia. It does not affect the body temperature. It is not being used to control muscle spasticity in the operative limb. Dantrolene is a direct-acting muscle relaxant. Centrally acting muscle relaxants stop the development of muscle spasms that generate from the nerves.