PHARM EXAM 5 PrepU
What action by the nurse will be most effective at preventing skin breakdown in a patient immobilized by a neuromuscular junction (NMJ) blocking agent?
Regularly turn and reposition.
A patient newly diagnosed with depression has been prescribed fluoxetine, a selective serotonin reuptake inhibitor (SSRI). Why would the physician order an SSRI for a newly diagnosed patient?
SSRIs usually produce fewer and milder adverse effects than other antidepressants.
A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?
Safety precautions
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?
Salami
After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?
Selective serotonin reuptake inhibitors
A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?
Serotonin
Opioid analgesics are used primarily for the treatment of what issues? (Select all that apply.)
Severe acute pain Moderate chronic pain Opioid dependence
A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?
Reduction of muscle spasm
Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
decrease salivation, spasticity, and tremors.
Common side effects of anticholinergics include:
dry mouth, urinary retention, constipation, and increased pulse rate.
A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?
onset of suicidal ideation.
The three major features of Parkinson's include:
rigidity, bradykinesia, and tremors.
A black box warning alerts health care providers to risks in young adults 18 to 24 years of age when taking antidepressant medications. Which symptoms of concern should be included?
statements or resignation and futility and a desire to die
A client is prescribed phenytoin and reports gastrointestinal (GI) upset. The nurse should tell the client to:
take the medication with meals.
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which?
use another form of birth control, such as condoms.
When describing the actions of various drugs, a nursing instructor defines the drug as a substance that counteracts the action of something else. The instructor is describing which action?
antagonist
The most effective drug to treat major symptoms associated with Parkinson's is:
Levodopa
Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder?
Lithium
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
Liver toxicity
A client who has claustrophobia is scheduled for an magnetic resonance imaging (MRI) for the investigation of an abdominal mass. The nurse should anticipate what pre-medication order?
Lorazepam 2 mg PO
A nurse should recognize the situations when naloxone (Narcan) should be used cautiously. What represents one of those situations?
A client who is pregnant A client with cardiovascular disease A client with an opioid dependency
A client is admitted to the emergency department for an opioid overdose. What would the nurse expect to administer to this client?
Naloxone
A client received fentanyl during a surgical procedure. The nurse will have what drug available to treat any possible respiratory depression associated with the use of fentanyl?
Naloxone
What drug would the floor nurse be sure to have on the unit that is used to reverse the effects of opioids?
Naloxone hydrochloride (Narcan) tartrate
The nurse is teaching a client newly-diagnosed with Parkinson disease about the appropriate use of levodopa-carbidopa. What should the nurse teach the client?
Take the drug three times each day, at the times that are specified.
Which instruction would the nurse include for a client who is prescribed extended release oxycodone?
Take the tablet as a whole tablet at one time.
A client with Parkinson's disease began treatment with dopaminergic two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect?
The client is able to walk more briskly and stably than two weeks ago
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.
A nurse is caring for a client who has been diagnosed with Parkinson's disease. The client does not understand how the medication, carbidopa-levodopa, is going to help the condition. What is the correct response by the nurse?
"Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms."
A patient receiving succinylcholine experiences malignant hyperthermia. What drug is used to treat this condition?
Dantrolene
A patient who experiences panic attacks in social situations has been prescribed an antianxiety medication. What should the nurse check before administering the drug?
Blood pressure
A nurse is teaching a client about musculoskeletal medication that has been prescribed. The client needs further teaching about the medication when making which statements?
"I take my medicine with three to four beers each evening."
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client?
"It's safest if you avoid drinking alcohol while you're taking this drug."
The client is scheduled for surgery. The nurse administers diazepam (Valium) preoperatively for what purpose?
Decreased anxiety
A client with myoclonic seizures has been prescribed clonazepam as an adjunctive treatment by the neurologist. What teaching should the nurse prioritize when explaining this new drug regimen to the client?
"Make sure you don't stop taking this abruptly because that might bring on a seizure."
A 57-year-old client is given morphine for myocardial ischemic pain. The nurse needs to monitor the client frequently for which adverse effect?
Decreased respiratory rate
A patient recovering from a procedure that involved succinylcholine reports muscle soreness and asks the nurse for an explanation. What will the nurse tell the patient?
"The drug triggers receptors to cause prolonged muscle contraction."
A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what?
Decreased tremors
The nurse is caring for a client experiencing postoperative pain. The client is prescribed 2.5 mg of morphine IV every 2 hours. Morphine is supplied in 10 mg/mL vials. How many mL should the nurse administer?
0.25 mL
A client is prescribed a tricyclic antidepressant. The nurse would anticipate administering this drug by which route?
Oral
Which client statement reflects an understanding of typical length of antipsychotic medication therapy?
"I may always have to take this medication."
The healthcare provider has prescribed alprazolam (Xanax) for a client. After the nurse has taught the client about this medication. The nurse confirms that the client understands the drug's action when the client makes which statement?
"I may be a little drowsy at first when I start taking this medication."
The nurse provides client teaching about use of levodopa for treatment of Parkinson disease. What statement by the client would indicate a good understanding of levodopa?
"I should take this drug with food to avoid an upset stomach."
A patient expresses that being diagnosed with narcolepsy has been devastating for him. Which statement by the patient should the nurse focus on initially during the assessment?
"I sometimes wonder if it is worth living a life that has so many restrictions."
A 30-year-old female client is diagnosed with seizure disorder, and the provider is considering the use of carbamazepine. What assessment question best addresses the safety and effectiveness of the medication regimen?
"Is there any chance that you could be pregnant?"
A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client?
"It may take another two to three weeks before the medication is completely effective."
A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?
Pyridoxine (vitamin B6)
A family member asks if a relative, who is taking prochlorperazine for schizophrenia, can go on a beach vacation. What is one point of education that the nurse would make sure the client and family understand?
"Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn."
A client is prescribed amitriptyline for migraine prophylaxis. What statement should be included in the care plan regarding the medication administration?
"The medication should be taken at bedtime."
A client has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse?
"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective."
A female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:
"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."
A male client presents in the emergency department and states that he is experiencing pain in his shoulder and chest muscles. The health care provider orders a cardiac diagnostic assessment. The client asks the nurse why the health care provider feels that he has cardiac problems if his shoulder hurts. What is the nurse's best response?
"You may have referred pain. Pain of cardiac origin may radiate to the neck, shoulders, chest muscles, and down the arms, often on the left side."
A client is at the clinic for a follow-up appointment related to treatment for depression. The client had began taking fluoxetine 2 weeks ago. The client states, "This medication must not be working, because I don't feel better at all." What would be the nurse's best response?
"You may have to take this drug for a few more days before you feel its effects."
The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?
1.8 mEq/L
When a client is started on an antidepressant, it is important for the nurse to explain to the client that it may take time to see a change in mood. How long can it take for the client to see the beneficial effects of an antidepressant?
4 weeks
A 13-year-old patient is scheduled to receive pancuronium (Pavulon). Which healthcare provider should administer the medication?
A CRNA trained to use NMJ blockers
A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?
A client has dysphagia
The client is to have a spinal anesthesia for surgery. While educating the client, which statement by the nurse is correct regarding the insertion of the needle?
A small gauge needle will be inserted into the subarachnoid space and medication will be administered into the cerebrospinal fluid.
Which assessment finding indicates that a neuromuscular junction (NMJ) blocking agent is effective?
Absent reflexes
The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?
Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans
Patient should be cautioned to avoid which when taking skeletal muscle relaxants?
Alcohol
When the nurse is engaging in teaching with clients taking anti-psychotic medications and their families, what would be important to include to decrease adverse effects of the medication?
Alcohol should be avoided.
A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?
Antiepilepsy drugs are teratogenic.
A group of nursing students are reviewing information about antianxiety drugs. The students demonstrate understanding of the information when they identify which as another name for this group of drugs?
Anxiolytics
The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?
Asking the client to sit on the side of the bed for 1 minute before getting up
A 21-year-old client refuses to take his oral antipsychotic medication. What would be the appropriate action for the nurse do?
Attempt to reason with the client. If he still refuses, contact the provider for further instructions.
A client is experiencing a seizure and the provider prescribes phenobarbital 6 mg IV STAT. What is the nurse's best action?
Question the provider about the order.
The nurse is caring for a client who is scheduled to receive a local anesthetic. The nurse understands that vital signs should be monitored at what point?
Before, during, and after the procedure
A client with a foreign body embedded in her hand requires local anesthesia for removal. What drug would be most appropriate?
Benzocaine
A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do?
Reduce the dose
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?
Diazepam
Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?
Diazepam (Valium)
A 28-year-old client has been experiencing muscle spasms in the neck from a four-wheeler accident. The client is receiving 10 mg of cyclobenzaprine PO tid. The nurse's teaching plan should include which instruction?
Do not drive or operate heavy machinery for the first week.
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
Do not drive or operate machinery until individual drug effects are known.
The nurse is reviewing the results of a hospital client's serum phenytoin level, which has just become available. The results indicate that the client's phenytoin level is 17.5 mcg/mL. What is the nurse's best action?
Document the fact that the nurse checked the client's phenytoin levels
A nurse administrates an opioid medication to a client. For what side effect should the nurse assess?
Drowsiness
The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for?
Drowsiness
The nurse administers an anxiolytic to the client. The nurse recognizes the family needs further teaching on the effects of the medication when the family initiates what action?
Encourages the client to walk to the bathroom independently
A clint's past experience with pain has little impact on the patient's perception of pain.
False
A patient who was on benzodiazepine antianxiety drug therapy intends to discontinue the treatment. What should the nurse suggest regarding continuation of the medication?
Gradually decrease dosage schedule.
A student asks the physiology instructor what causes loss of muscle function, or paralysis. What would the instructor respond?
If ACh cannot react with the cholinergic muscle receptor to allow new stimulation muscle contraction, muscle paralysis, or loss of muscle function, occurs
The nurse is reviewing the medication chart of an 82-year-old man who has recently moved to a long-term care facility. The record reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this resident's drug regimen?
Increased risk for falls
The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include?
Informing the client and family that seizure control is not gained immediately
What best reflects the action of barbiturates when used to control seizures?
Inhibition of impulse conduction
Prior to the administration of a topical local anesthetic, what is the nurse's priority assessment?
Intact skin
A male client's physician orders levodopa for the treatment of the client's Parkinson's disease. The client asks the nurse whether the levodopa will cure his condition. Which is a correct statement about the effects of levodopa?
It does not alter the underlying disease process, but it may improve a client's quality of life.
When a client's family asks the nurse to explain anxiety disorders, the nurse's response should be based on what statement concerning anxiety disorders?
It is a common disorder in which the client perceives a situation as threatening to his or her well-being.
A nurse assessing a postoperative patient who received a neuromuscular blocking (NMJ) agent during the procedure notes extreme muscle rigidity, pyrexia, and acidosis. What family history predisposed the patient to this event?
Malignant hyperthermia
The nurse is caring for a client immediately prior to the administration of anesthesia. The nurse knows that what equipment must be available when the anesthesiologist administers vecuronium?
Mechanical ventilation
A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure?
Midazolam
After a client receives succinylcholine, the nurse would assess the client for what initially?
Muscle pain
The nurse is collecting a nursing history from a preoperative client who is to receive local anesthesia. While taking the admission history, the client reports an allergy to lidocaine. What is the nurse's priority action?
Notify the anesthesiologist.
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?
Observe respirations frequently.
A client needs to be administered topical anesthesia. The nurse would administer the anesthetic at which location?
On the surface of the skin
While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan?
Orthostatic hypotension
Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?
Oxygen
A priority assessment prior to a 70-year-old client being given succinylcholine as adjunct to general anesthesia for surgery is:
Renal and hepatic function
The nurse is preparing to admit a client who has received conscious sedation. What is the most important area to assess when the client returns from the procedure using this type of anesthesia?
Respirations
A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the nurse teach family members to make while caring for this client at home?
Respiratory depression
A client will undergo an endoscopy with conscious sedation using midazolam. The nurse who is participating in this procedure should monitor the client closely for which sign of adverse reaction?
Respiratory depression
An opioid antagonist will reverse which opioid effects? (Select all that apply.)
Respiratory depression Constipation Analgesia Hypotension Bradycardia
The post-anesthetic recovery unit nurse is caring for a client whose balanced anesthesia included midazolam. The nurse should prioritize assessments for what health problems?
Respiratory depression and CNS suppression
A client is scheduled for dental surgery and will be given nitrous oxide. What assessment should the nurse prioritize before administering the medication?
Respiratory status
A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses?
Risk for Falls
A 40-year-old client with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize for the nursing care plan for this client?
Risk for Injury related to CNS depressant effects
A client taking carbidopa-levodopa for the treatment of Parkinson's disease reports blurred vision and the nurse observes that the client has worsening ataxia. Which nursing diagnosis should the nurse prioritize?
Risk for injury
Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?
Risk for injury
A client diagnosed with Parkinson's disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death?
St. John's wort
When assessing a client's medication history, the use of which herb would alert the nurse to the potential for adverse reactions when taken with antidepressants?
St. John's wort
A client prescribed phenytoin for a seizure disorder has recently run out of medication and has not obtained a refill. What is the client at risk for developing?
Status epilepticus
The nurse is teaching a client who has been started on antiseizure medications. The nurse should inform the client that abrupt withdrawal from the medications can cause which problem?
Status epilepticus
A 6-year-old child has been brought to the emergency department in apparent status asthmaticus. The care team recognizes the need to intubate the client, who is inconsolably agitated. The nurse should anticipate a STAT prescription for what medication?
Succinylcholine
Which neuromuscular blocking agent would a nurse expect to have the shortest duration of action?
Succinylcholine
The nurse is caring for a teenage client who has recently been prescribed a selective serotonin reuptake inhibitor. What assessment should the nurse prioritize?
Suicidal ideation
For which assessment finding will the nurse intervene first when providing postoperative care to a patient who returned to the nursing unit 2 hours after receiving succinylcholine?
Temperature 40 degrees C (104 degrees F)
A female client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence?
The drug may need to be lowered in dosage or discontinued.
The operating room nurse is taking a male patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104°F temperature in the operating room and nearly died 15 years ago. The nurse knows that the anesthetist is planning to use a volatile liquid as part of the anesthetic. What relevance is this information regarding the patient?
The patient may be at risk for developing malignant hyperthermia.
The client has been taking a sleep medication for the last 6 months. The client informs the primary care provider that she sleeps great now and wants to discontinue the drug. The provider informs the client that this is not a good idea. What is the best rationale for the providers advice?
The provider believes that stopping the drug abruptly may cause serious consequences for the client.
The nursing students are learning about synergistic effects of combined medications. Which is a desired effect of combining epinephrine with a local anesthetic? Select all that apply.
There is a lower risk of systemic toxicity. The local anesthetic stays in the desired tissues longer.
What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?
They may cause dangerous interactions with some foods and drugs.
Respiratory distress is a contraindication for the use of barbiturates.
True
Which client should the nurse expect to receive a lower-than-usual dose of benzodiazepines?
a client with alcoholic liver disease
A 64-year-old-client has been prescribed lorazepam because of increasing periods of anxiety. The nurse should be careful to assess for which?
a history of current or past alcohol use.
A client has a progressive neuromuscular disorder that causes muscle weakness. A deficiency of what neurotransmitter would be most likely to cause this client's symptoms?
acetylcholine
A client has been taking levodopa (L-dopa) for the treatment of Parkinson's disease. What additional medication may decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects of levodopa?
carbidopa
Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply.
central nervous (CNS) respiratory
A 34-year-old executive for an insurance company has been taking lorazepam for the last 6 months for anxiety. The client abruptly stopped the medication. The client then calls the health care provider and reports feeling irritable, and increased heart rate, and restlessness. What would explain the client's current symptoms?
withdrawal from stopping the medication
