Pharmacology Exam 3

A nurse is teaching a client who has OCD and a new prescription for paroxetine. Which of the following instructions should the nurse include? A. "It can take several weeks before you feel like the medication is helping". B. "Take the medication just before bedtime to promote sleep." C. "You should take the medication when needed for obsessive urges." D. "Monitor for weight gain while taking this medication."

A. "It can take several weeks before you feel like the medication is helping." (Paroxetine can take 1 to 4 weeks before the client reaches full therapeutic benefit)

A patient with muscle spasm is prescribed baclofen. He should be educated about the side effects of baclofen which are: (Single Choice) * A. Drowsiness B. Jaundice C. high blood pressure D. Diarrhea

A. Drowsiness

Proton Pump Inhibitors include: (Select all that apply) A. Esomeprazole B. Tetracycline C. Omeprazole D. Pantoprazole

A. Esomeprazole C. Omeprazole D. Pantoprazole

A nurse is providing teaching for a client who has schizophrenia and is taking risperidone. Which of the following instructions should a nurse include in a teaching? A. "Add extra snacks to your diet to prevent weight loss." B. "Notify the provider if you have trouble sleeping." C. "You may begin to have mild seizures while taking this medication." D. "This medication is likely to increase your libido."

B. "Notify the provider if you have trouble sleeping." (The client should report difficulty sleeping, agitation or irritability to the provider so this can be managed)

Which of the following about Cimentide (Tagament) is true? A. Can only be administered orally. B. Absorption is slow if taken with meals. C. May cause diarrhea. D. Crosses the blood barrier without difficulty.

B. Absorption is slow if taken with meals.

A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of he following should the nurse suggest to the client to minimize anticholinergic effects? A. Take the medication in the morning to prevent insomnia. B. Chew sugarless gum to moisten the mouth. C. Use cooling measures to decrease fever. D. Take an antacid to relieve nausea.

B. Chew sugarless gum to moisten the mouth. (Chewing sugarless gum can help the client cope with dry mouth which is a potential anticholingeric effect of fluphenazine)

A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indications of toxicity to this medication? A. Severe hypertension. B. Coarse tremors. C. Constipation. D. Muscle spasms.

B. Coarse tremors. (Hypotension, diarrhea, and muscle weakness all indicate toxicity as well)

A nurse is taking care of a client who is taking phenytoin. The nurse should recognize which of the following is an indication that the medication is effective? (Single Choice) * A. Increase in the activity of electrical activity in the brain as detected by EEG B. Decrease in the frequency of seizures C. Decrease in Urinary output D. Weight gain

B. Decrease in the frequency of seizures

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the the following actions is the nurse's priority? A. Administer flumazenil. B. Identify clients level of orientation. C. Increase IV fluids. D. Prepare the clients for gastric lavage.

B. Identify clients level of orientation. (The first action to take when using the nursing process is to assess the client. Identifying the clients level of orientation is the priority)

A nurse is administering medication to a client. Which medication is most effective when administered with little to no water? A. Famotidine (Pepcid) B. Sucralfate (Carafate) C. Syrup of Ipecac (Ipecac) D. Calcium Carbonate. (Mylanta)

B. Sucralfate (Sucralfate (Carafate) is given as a protective barrier in the stomach to protect against excessive acid erosion. Sucralfate coats the stomach and is not absorbed systemically, making administration of additional fluid unnecessary. The purpose of a full glass of water for most oral medications is to promote absorption of medications systemically, thus this medication does not benefit from water or any other fluid. This medication does not need to be diluted)

Female clients who are prescribed sumatriptan for migrane headache, should be educated on: (Single Choice) * A. Pulmonary vasoconstriction B. Teratogenesis C. Angina D. Vertigo

B. Teratogenesis

A nurse is providing medication teaching for a client who has a new prescription for gabapentin for neuropathy. Which of the following statements should the nurse include in the teaching? (Single Choice) * A. Take this medication with an antacid, to reduce bloating. B. You should change positions slowly while taking this medication. C. The medication will help with your alcohol addiction. D. Do not take with phenytoin.

B. You should change positions slowly while taking this medication.

this drug acts topically to disrupt cell wall of H. pylori and cause lysis and death, also may inhibit urease activity and prevent H. pylori from adhering to gastric surface, can impart harmless black coloration to tongue and stool, patient teaching required, long term therapy causes possible risk of neurologic injury

Bismuth compounds

A nurse is teaching a client who takes phenytoin and has a new prescription for sucralfate tablets. Which of the following instructions should the nurse include? A. Take an antacid with the sucralfate. B. Take sucralfate with a glass of milk. C. Allow a 2-hr interval between these medications. D. Chew the sucralfate thoroughly before swallowing.

C. Allow a 2-hr interval between these medications. (Sucralfate can interfere with the absorption of phenytoin, so client should allow a 2-hr interval between sucralfate and phenytoin)

A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply) A. Expect therapeutic effects in 24 to 48 hrs. B. Discontinue the medication after a week of improved mood. C. Change positions slowly to minimize dizziness. D. Decrease dietary fiber intake to control diarrhea. E. Chew sugarless gum to prevent dry mouth

C. Change positions slowly to minimize dizziness E. Chew sugarless gum to prevent dry mouth

A nurse is caring for a client with a new prescription for Clozapine (Clozaril). Which of the following is an expected response to this medication? A. ​Development of orthostatic hypotension. ​B. Control of seizure activity. ​C. Decreased auditory hallucinations. ​D. Increased energy level and involvement in activities.

C. Decreased auditory hallucinations. (Clozapine is prescribed for the treatment of psychotic findings which include auditory hallucinations)

A nurse has just administered a dose of Diazepam (Valium) to a client. Which of the following actions should the nurse take before she leaves the clients room? A. Turn off the overhead lights. B. Reduce the ringer volume on the clients cell phone. C. Put up the side rails on the clients bed. D. Turn off the clients television.

C. Put up the side rails on the clients bed. (​Diazepam is a benzodiazepine that causes sedation and has antianxiety and muscle relaxation properties. For the client's safety, the nurse should raise the side rails, place the bed in the lowest position, and make sure the client's call light access device is within reach)

This drug surpasses the growth of H. pylori by inhibiting protein synthesis, in absence of resistance treatment is highly effective, most common side effects are nausea/diarrhea/distortion of taste

Clarithromycin (Biaxin)

A nurse is providing discharge teaching for a patient taking phenytoin (Dilantin). Which of the following comments by the client should alert the nurse that further teaching is needed? A. "I will notify my doctor before taking any other medications." B. "I have made an appointment to see my dentist next week." C. "I know that I cannot substitute a generic brand of this medication." D. "I'll be glad when I am free of seizures so I can stop taking this medicine."

D. "I'll be glad when I am free of seizures so I can stop taking this medicine." (Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider)

A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A. "Take this medication on an empty stomach". B. "Expect optimal therapeutic effects within 24hr." C. "Take this medication when needed for anxiety." D. "This medication has a low risk for dependency."

D. "This medication has a low risk for dependency."

A client has Alzheimer disease and was prescribed Donepezil (Aricept). Client was educated on the side effects of the drug which includes: (Single Choice) * A. Nausea and diarrhea B. Bradycardia C. Fainting D. All of the above

D. All of the above

Monitoring of patients who are taking carbamazepine includes: (Single Choice) • A. Routine troponin levels for cardiac damage B. Annual eye examinations to assess for cataract develooment C. Monthly pregnancy tests for all women of childbearing age D. Complete blood counts every 3 to 4 months for hematological abnormalities (fever, bruising, petechiae)

D. Complete blood counts every 3 to 4 months for hematological abnormalities (fever, bruising, petechiae)

What is the most frequent CNS side effect of Cimetidine in older people? A. Tremors. B. Hallucinations. C. Dizziness. D. Confusion.

D. Confusion.

A nurse is caring for a client who received prochlorperazine 4 hr ago. The client reports spasms of the face. The nurse should expect a prescription for which of the following medications? A. Fomepizole B. Naloxone C. Phytonadione D. Diphenhydramine

D. Diphenydramine (An adverse effect of prochlorperazine is acute dystonia, which is evidenced by spasms of the muscles in the face, neck, and tongue. Diphenhydramine is used to suppress extrapyramidal effects of prochlorperazine)

A client with a gastric ulcer is taking sucralfate. What times should the medication be scheduled? A. With meals and at bedtime. B. One hour after meals and at bedtime. C. Every 6 hours around the clock. D. One hour before meals and at bedtime.

D. One hour before meals and at bedtime.

What is the best position when inserting a rectal suppository ? A. Lithotomy B. Supine C. Prone D. Sims

D. Sims

Loperamide is used to increase the volume of discharge in ileostomies? True or False?

False

this drug class is most effective for suppressing secretion of gastric acid, they are used for gastric/duodenal ulcers and GERD, they are well tolerated, and can increase the risk of serious adverse events (fractures, pneumonia, acid rebound, possible intestinal infection w/ c. diff)

PPIs

Ativan (Lorazepam) can be used as a antiemetic and sedative? True or False?

True

The most common effect of Amoxicillin is diarrhea? True or False?

True

A nurse is caring for a client who has a prescription for alprazolam. For which of the following adverse effects should the nurse monitor? (Select all that apply.) a. Tolerance b. Anxiety c. Sedation d. Respiratory depression e. Constipation

a. Tolerance b. Anxiety c. Sedation d. Respiratory depression

Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: (Single Choice) * a. Zolpidem should be taken just before going to bed. b. Zolpidem may cause dry mouth and constipation. c. Patients may need to double the dose for effectiveness d. They should stop drinking alcohol at least 30 minutes before taking zolpidem.

a. Zolpidem should be taken just before going to bed.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include? a. "Weigh yourself twice a month." b. "If you have persistent headaches, let the provider know." c. "Reduce your daily sodium intake." d. "If your symptoms don't improve in 10 days, you will need a higher dosage."

b. "If you have persistent headaches, let the provider know." The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction.

When prescribing zolpidem, instructions to the patient should include (Single Choice) * a. Do not take with Antihypertensive medications b. Do not take with lorazepam c. Take with alcohol d. Do not take with milk

b. Do not take with lorazepam

this condition is caused by infection, malindigestion, inflammation, functional disorders of the bowel. complications include dehydration and electrolyte depletion. it is managed with dgx and tx of underlying disease, replacement of lost water and salts, relief of cramping, reducing passage of unformed stools, and use of drugs

diarrhea

this motion sickness drug is of the antihistamine class, it is considered an anticholinergic as it blocks acetylcholine and histamine receptors. side effects include sedation, dry mouth, blurred vision, urinary retention, and constipation

diphenhydrinate, meclisine, cyclizine

this drug is formulates with atropine to discourage abuse, it is an opioid only used for diarrhea, high doses can elicit typical morphine-like subjective responses

diphenoxylate (Lomotil)

these drugs are of the cannabinoid class, they're related to marijuana, they're used for CINV, MOA with emesis is unclear, potential for abuse and psychomimetic effects are the side effects

dronabinol (Marinol) and nabilone (Cesamet)

this drug is nearly identical to omeprazole, it is used for erosive esophagitis, GERD, duodenal ulcers associated w/ h. pylori, prophylaxis of NSAID induced ulcers. adverse effects include headache, nausea, diarrhea, flatulence, abdominal pain, dry mouth, pneumonia, hypomagnesemia, osteoporosis, and fractures

esomeprazole (Nexium, Nexium IV)

these drugs are of the butyrophenones class, they block dopamine 2 receptors in CTZ, used for postoperative n/v, chemotherapy emesis, radiation therapy, and toxins, side effects are similar to phenothiazines, may cause prolonged QT interval and fatal dysrhythmias so ECG s/b performed b/f administration

haloperidol (Haldol) and droperidol (Inapsine)

this drug blocks dopamine receptors in CTZ, used for postoperative n/v, anticancer drug, opioids, toxins, and radiation therapy

metoclopramide (Reglan)

this drug is very effective against sensitive strains of H. pylori, over 40% of strains are now resistant, most common side effects are nausea and headache, avoid alcohol as it causes disulfiram-like reaction, avoid use in pregnancy

metronidazole (Flagyl)

these drugs are of the dopamine antagonists class . they block dopamine 2 receptors in CTZ. surgery, cancer, chemo, and toxins. use in children's. side effects include extrapyramidal reactions, anticholinergic effects, hypotension and sedation, acute dystonia evidenced by face/neck/tongue muscle spasms treated with diphenhydramine

phenothiazines/prochlorperazine

patients over 60 yoa, history of ulcers, and high dose NSAID therapy can be given what prophylactic drugs for treatment?

ppis (omeprazole) and misoprostol (can cause diarrhea)

this drug class acts to increase tone and motility of GI tract, used for GERD, CINV, diabetic gastroparesis, it includes metoclopramide and cisapride,

pro kinetic agents

this drug has many of the properties of cimetidine but it is more potent, has fewer adverse effects, fewer drug interactions. adverse effects— significant ones are uncommon, does not bind to androgen receptors, elevated gastric pH which may increase r/o pneumonia. It is used for the ST tx of gastric/duodenal ulcers, prophylaxis of recurrent duodenal ulcers, Zollinger-ellison syndrome and hypersecretory states, and GERD

ranitidine (Zantac)

this motion sickness drug is a muscarinic antagonist with side effect of dry mouth, blurred vision, and drowsiness

scopolamine

granisetron, dolasetron, palonosetron, ondansetron (Zofran) are of which drug class

serotonin receptor antagonists

this drug is used for treating acidoses and elevating urinary pH to promote excretion of acidic drugs after overdose, it is inappropriate for treating PUD as it has a brief duration with high sodium content and can cause alkalosis. eructation and flatulence can occur, it can exacerbate HTN and HF, and can cause systemic alkalosis in pxs with renal impairment

sodium bicarbonate

this drug is very similar to metronidazole, has the same adverse effects and interactions — nausea, headache, avoid alcohol and pregnancy

tinidazole (Tindamax)

A nurse is assessing a client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider? A. Shuffling gait. B. Neck spasms. C. Drowsiness. D. Sexual dysfunction.

B. Neck spasms. (Neck spasms are an indication of acute dystonia (involuntary muscle movements)

A client is taking Pancrelipase. What is the optimal intended benefit ? A. Weight loss. B. Absence of abdominal pain. C. Relief of heartburn. D. Reduction of steatorrhea.

D. Reduction of steatorrhea.

this drug is rapid acting, has a high ANC, and effects have a long duration. acid rebound may occur, principle adverse effects— constipation (combine with magnesium hydroxide), eructation (belching) and flatulence, and low palatability

calcium carbonate

Antiemetic medications include: (Select all that apply) A. Ondansetron B. Docusate Sodium C. Cannabinoids D. Loperamide

A. Ondansetron C. Cannabinoids

A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs? a. Venlafaxine b. Bupropion c. Imipramine d. Valproic acid

c. Imipramine Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients who take this drug should change positions slowly from sitting or lying to standing.

these glucocorticoid drugs have an unknown MOS as antiemetic . they are commonly used to suppress CINV, however this is not an application approved by the FDA, it is effective alone and in combination with antiemetics

dexamethasone and methylprednisone

this drug class attracts water into the large intestines to produce bulk and stimulate peristalsis. it includes polyethylene glycol (causes abdominal bloating when used via peg tube), lactulose (causes vomiting, used as laxative, w/ cirrhosis pxs to decrease ammonia levels), magnesium citrate, magnesium hydroxide (saline laxative, most prominent effect is diarrhea)

osmotic

this drug is similar to omeprazole and the PPIs, it is used to treat GERD and hypersecretory states. adverse effects depend on route and duration. oral— diarrhea, headache, dizziness. IV— diarrhea, headache, nausea, dyspepsia, injection site reactions (thrombophlebitis and abcess). LT use— hypomagnesemia, osteoporosis fractures

pantoprazole (Protonix)

A nurse is instructing a pediatric client and his family about how methylphenidate (Ritalin) will help manage ADHD. The nurse should explain that this medication will help with which of the following ? A. Increase focus. B. Promote rest. C. Improve appetite. D. Prevent panic.

A. Increase focus. (​Methylphenidate acts on the cerebral cortex to create a stimulating effect that helps increase focus on metal activities and tasks)

A nurse is instructing a pediatric client and his family about how methylphenidate (Ritalin) will help manage attention- deficit hyperactivity disorder (ADHD). The nurse should explain that this medication therapy will help which of the follow? A. Increased focus. B. Promote rest. C. Improve appetite. D. Prevent panic.

A. Increased focus. (Methylphenidate acts on the cerebral cortex to create a stimulating effect that helps increase focus on metal activities and tasks.)

A nurse is caring for a client who has depression and a new prescription for venlafaxine. For which of the following adverse effects should the nurse monitor the client? (Select all that apply) A. Mydriasis (Dilation of pupil) B. Dizziness C. Decreased libido D. Alopecia E. Hypotension

A. Mydriasis (Dilation of pupil) B. Dizziness C. Decreased libido

A client tells a nurse she took a dose of Dimenhydranite (Dramamine) before coming to the health care clinic. The nurse determines that the medication is effective when the client reports relief of which of the following symptoms? A. Nausea. B. Dry mouth. C. Headache. D. Diarrhea.

A. Nausea. (​Dimenhydrinate helps prevent and treat motion sickness. It also treats vertigo and reduces nausea and vomiting from radiation sickness)

A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication? A. Orthostatic Hypotension. B. Hearing loss. C. Gastrointestinal bleeding. D. Weight loss.

A. Orthostatic Hypotension. (Adverse effect of MAOIs)

What health treatment would the nurse use to promote gastric health for an adult client? (Select all that apply) A. Stop smoking or use of tobacco of any form B. Avoid taking large amounts of NSAIDS C. Do not drink excessive amounts of alcohol D. Consume high fat foods

A. Stop smoking or use of tobacco of any form. B. Avoid taking large amounts of NSAIDS. C. Do not drink excessive amounts of alcohol.

A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have which of the following lac tests completed periodically? (Select all that apply) A. Thrombocyte count. B. Glucose. C. Amylase. D. Liver function tests. E. Potassium.

A. Thrombocyte count. C. Amylase. D. Liver function test. (Treatment with valporic acid can result in thrombocytoprnia, pancreatitis and hepatotoxicity.

A nurse is caring for a client who reports taking Bisacodyl (Ducolax) to promote a daily bowel movement. Which of the following should be the nurses priority response ? A. "What do your bowel movements look like?" B. "How long have you been taking the Ducolax?" C. "Have you taken the Ducolax with a glass of milk?" D. "How often do you have a bowel movement?"

B. "How long have you been taking the Ducolax?" (​Bisocodyl is a stimulant laxative indicated for short-term use due to a risk of dependency. It is important for the nurse to determine the history, specifically the length of time the client has relied on this medication for bowel elimination.)

A nurse is talking with a client who has PUD and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take the medication in which of the following ways? A. With an Antacid B. 1hr before meals C. With food or milk. D. Immediately after meals.

B. 1hr before meals (Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness)

A nurse is caring for a client who has muscle spasm and a prescription for baclofen. The client asks the nurse how baclofen will reduce the spasm. Which of the following explanation should the nurse provide (Single Choice) * A. Baclofen activates the GABA receptor in the brain and spinal cord B. Baclofen blocks the GABA receptor in the brain and spinal cord C. Baclofen activates the muscarinic receptor D. Baclofen blocks the alpha receptor

B. Baclofen blocks the GABA receptor in the brain and spinal cord

When talking with a patient about taking Cimetidine (Tagamet), the nurse should include which of the following instructions? A. Take the medication with an antacid to minimize stomach upset. B. Do not take this medication if you start taking blood-thinning medications. C. Take this medication on an empty stomach for better absorption. D. Do not stop taking this mediation after a few days or weeks.

B. Do not take this medication if you start taking blood-thinning medications. (Cimetidine can interfere with the absorption of warfarin (Coumadin) and several other medications, including phenytoin (Dilantin) and propranolol (Inderal).)

A nurse who is teaching a client who is about to start taking decussate (Colace) should make sure that the client understands that this medication should result in which of the following ? A. Fewer bowel movements. B. Regular bowel movements C. Relief from nausea. D. Less diarrhea.

B. Regular bowel movements. (The intended outcome of docusate therapy is to produce stool that is softer in consistency and easier for the client to pass. That should improve the regularity of the client's bowel movements)

A nurse is teaching a client who has a new prescription for omeprazole. Which of the following information should the nurse include in the teaching? A. Take this medication at bedtime. B. This medicine decreases the production of gastric acid. C. Take this medication 2 hr after eating. D. This medication can cause hyperkalemia.

B. This medicine decreases the production go gastric acid. ( Omeprazole rescues gastric acid secretion by inhibiting the enzyme that produces gastric acid)

A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching? A. "You should have a high-carbohydrate snack between meals and at bedtime." B. "You are likely to develop hand tremors if you take this medication for a long period of time." C. "You may experience temporary numbness of your mouth after each dose." D. "You should have your white blood cell count monitored every week."

D. "You should have your white blood cell count monitored every week." (Due to the risk of agranulocytosis weekly monitoring of the clients WBC count is recommended while taking clozapine)

A client who has a gastric ulcer is about to start taking Sucralfate (Carafate). The nurse determines that teaching was effective when the client states that he will take this medication? A. Every 4 hours around the. clock. B. After each meal. C. With meals and first thing in the morning. D. 1 hour before meals and at bedtime.

D. 1 hour before meals and at bedtime. (Sucralfate creates a protective coating over the ulcer. To achieve this, the client should take it on an empty stomach - 1 hr before each meal and at bedtime)

A client has been taking omeprazole (Prilosec) for the past four weeks. The nurse determines that the medication is effective when the client reports relief from which of the following? A. Nausea. B. Diarrhea. C. Headache. D. Acid indigestion.

D. Acid indigestion. (​Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis)

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches. B. Restrict intake of foods rich in sodium. C. Decrease fluid intake to less than 1,500 mL daily. D. Limit aerobic activity in hot weather.

D. Limit aerobic activity in hot weather. (The client needs to avoid activities that caused sodium/water depletion, which can increase the risk for toxicity)

A nurse is caring for a client who has a new prescription for phenytoin (Dilantin). For which of the following findings should the nurse instruct the client to. notify the provider? A. Headache. B. Insomnia. C. Skin rash. D. Gastric discomfort.

D. Skin rash. (Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. It slows the entrance of sodium and calcium back into the neuron and extends the time it takes for the nerve to return to its active state. Phenytoin can cause a rash that may progress to more serious conditions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin.)

Hannah is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? (Single Choice) * A. valproate is safe during all trimesters of pregnancy. B. She can get pregnant while taking valproate, but she should take adequate folic acid. C. Valproate is not safe at anytime during pregnancy D. Valproate is a known teratogen, but may be taken after the first trimester if necessary

D. Valproate is a known teratogen, but may be taken after the first trimester if necessary

A nurse is planning to administer ondansetron to a client. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply.) A. Headache B. Diarrhea C. Shortened PR interval D. Hyperglycemia E. Prolonged QT interval

A. Headache B. Diarrhea E. Prolonged QT interval

Medications used to treat H-Pylori (spiral) include: (Select all that apply) A. Tetracycline B. Metronidazole C. Amoxicillin D. Cyclosporin

A. Tetracycline B. Metronidazole C. Amoxicillin

two up to three of these antibiotics are prescribed to reduce the risk of resistance developing.

amoxicillin, clarithromycin, bismuth compounds, tetracycline, metronidazole, tinidazole

this drug family is given to suppress n/v, emetic response is a complex reflex that occurs after activation of vomiting center in the medulla oblongata, several types of receptors are involved in emetic response (serotonin, glucocorticoids, substance P, neurokinin 1, dopamine, acetylcholine, histamine, many antiemetics interact with one or more of the receptors).

antiemetics

A nurse is providing teaching to a parent of a child receiving methylphenidate (Ritalin) attention deficit disorder (ADD). Which of the client's statements indicates a need for further teaching? (Single Choice) A. I should give my child caffeinated soft drink. B. I should inform prescriber of any palpitations. C. I should take the morning dose after breakfast. D. I should inform the prescriber if any edema develops

A. I should give my child caffeinated soft drink.

A nurse is providing teaching to a client receiving levodopa/carbidopa for Parkinson disease. Which of the client's statements indicates an understanding of the teaching? (Single Choice) * A. I will not take this medication with a high-protein meal. B. I will see effect of this drug immediately. C. Dizziness is not a side effect of this drug. D. Taking the drug with food will not help with nausea.

A. I will not take this medication with a high-protein meal.

A nurse is preparing to administer a dose of Lactulose (Cephulac) to a client who has cirrhosis when the client states, "I don't need this medication. I am not constipated." The nurse should also explain that lactulose is used to decrease serum levels of which of the following ? A. Glucose. B. Ammonia. C. Potassium. D. Bicarbonate.

B. Ammonia. (Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma)

A nurse is caring for a client who has been taking sertraline for the past two days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? A. Bruising B. Fever C. Tinnitus (Ear ringing) D. Rash

B. Fever (Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.

A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should expect a prescription for which of the following medications? A. Lubiprostone B. Metoclopramide C. Bisacodyl D. Loperamide

B. Metaclopramide (Metoclopramide is a dopamine antagonist that is used to treat nausea and also increases gastric motility. It can relieve bloating and nausea of diabetic gastroparesis)

A provider prescribes Fluoxetine (Prozac) for a client who reports frequent periods of extreme sadness. The nurse teaching the client knows that he understands how to take this medication when he makes which of the following statements? ​A. "I'll take this medicine at bedtime." ​B. "I should not take this medicine with grapefruit juice." ​C. "I'll take this medicine with food." ​D. "I'll take this medicine first thing in the morning."

D. "I'll take this medicine first thing in the morning." (​The usual recommendation is to take fluoxetine as a single dose in the morning)

A nurse is providing teaching who has a new prescription for Levetiracetam. The nurse should inform the patient that the drug has interactions with: (Single Choice) * A. Combined oral contraceptives B. Alcohol C. Warfarin D. Few, if any drugs.

D. Few, if any drugs

this drug is relatively low acid-neutralizing capacity, is slow acting, effects have long duration, it is rarely used alone and widely used in combination with magnesium hydroxide, caution use as it has significant amounts of sodium, adverse reaction of constipation and drug interactions include tetracyclines, warfarin, and digoxin

aluminum hydroxide

H. pylori is highly sensitive to this drug, rate of resistance low (3%), it kills bacteria by disrupting cell Wass, antibacterial activity is highest at a neutral pH and thus c/b enhanced by reducing gastric acidity w/ an anti secretory agent (like omeprazole), the most common side effect is diarrhea

amoxicillin

these medications react with gastric acid to produce neutral salts or salts of low acidity to reduce destruction of gut wall by neutralizing acid and may also enhance mucosal protection by stimulating production of prostaglandins, sodium bicarbonate antacids don't alter systemic pH, use these medications with caution in patients with renal impairment, adverse effects — sodium loading, constipation with aluminum hydroxide, diarrhea with magnesium hydroxide. drug interactions include cimetidine, ranitidine, and sucralfate. families include aluminum compounds, magnesium compounds, calcium compounds, and sodium compounds

antacid families

A nurse is preparing to administer an IV injection of phenytoin (Dilantin) to a client. Which of the following nursing actions is appropriate? a. Administer the drug rapidly. b. ​Administer a saline solution after injection. c. Hold the injection if seizure activity is present. d. Dilute the medication with dextrose 5% in water.

b. ​Administer a saline solution after injection. The nurse should immediately flush the injection site with a saline solution after the injection of phenytoin (Dilantin). This intervention helps reduce and prevent venous irritation..

Rabi is being prescribed phenytoin (dilantin) for seizures. Monitoring includes (Single Choice) * A. Renal toxicity, leading to renal fallure B. Hepatotoxicity, leading to liver failure. C. Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis D. Cardiac effects, including supraventricular tachycardia

c. Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis

​A nurse is caring for a client who has been prescribed timolol (Timoptic). Which of the following is the appropriate procedure for administration of this medication? a. ​Place the eyedropper gently against the sclera. b. Instill the medication directly onto the client's cornea. c. ​Drop prescribed amount of medication into the conjunctival sac. d. ​Protect the distal portion of the eye dropper using clean technique.

c. ​Drop prescribed amount of medication into the conjunctival sac.

this drug is an H2RA that potentiates theophylline (dose may need to be reduced), absorption is slow if taken with meals, crosses BBB with difficulty, may cause CNS side effects, it is used to treat gastric and duodenal ulcers/GERD/zollinger-ellison/aspiration pneumonitis/heartburn, acid indigestion and sour stomach. adverse effects include — antiandrogenic effects, CNS effects, pneumonia, if given IVB hypotension and dysrhythmias. Drug interactions include— warfarin, phenytoin, theophylline, lidocaine, antacids reduce absorption of this medication so they s/b taken 1 hour apart

cimetidine (Tagamet)

A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. Which of the following client statements indicates an understanding of the teaching? a. "It is not a big deal if I forget my pills for a couple of days." b. "I should limit alcohol intake to one drink daily while taking this medication." c. "I will avoid salt because this medication can increase my blood pressure." d. "If I become pregnant, it is important to let my health care provider know."

d. "If I become pregnant, it is important to let my health care provider know." Diazepam can increase the risk of congenital malformations and is contraindicated for clients who are pregnant.

A nurse is caring for a client who reports occasionally self-medicating with an over-the-counter calcium carbonate antacid. To avoid the adverse effects of calcium carbonate, the nurse should recommend that the client take this medication with a. orange juice b. milk. c. a carbonated beverage. d. water.

d. water. Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance effectiveness.

this drug has actions similar to ranitidine. It is used for the ST tx of gastric/duodenal ulcers, prophylaxis of recurrent duodenal ulcers, Zollinger-ellison syndrome and hypersecretory states, GERD, and c/b used OTC for tx of heartburn, acid indigestion, and sour stomach. there are no antiandrogenic effects b/c it doesn't bind to androgen receptors, but there's a possible increased r/f pneumonia caused by the elevation of pH

famotidine (Pepcid)

NSAID induced ulcers are treated with what?

histamine blockers and ppis (omeprazole) and discontinuation of NSAIDs if possible

this condition results in dehydration, ketonuria, hypokalemia, and loss of 5% or more of body weight, first line therapy is a two drug combination of doxylamine and vitamin B6, others include prochlorperazine, metoclopramide, and ondansetron. methylprednisolone may be tried as a last resort but only after 10w gestation

hyperemesis gravidarum

this condition is caused by a variety of bacteria and protozoa, infections are usually self-limited, many cases require no treatment, antibiotics should only be used when indicated (salmonella, shigella, campylobacter, or clostridium infection, e coli). treated with ciprofloxacin and norfloxacin

infectious diarrhea

this drug is very similar to omeprazole, adverse effects include diarrhea, abdominal pain, nausea, pneumonia, hypomagnesemia, osteoporosis, fractures

lansoprazole (Prevacis, Prevacis IV, Prevacid 24 HR)

this drug is a structural analog of meperidine used to treat diarrhea and to reduce the volume of discharge from ileostomies, there is little or no potential for abuse

loperamide

this drug is of the benzodiazepine class and is used in combination regimens to suppress CIV, it has 3 primary benefits — sedation, suppression of anticipatory emesis, production of anterograde amnesia

lorazepam (Ativan)

this drug is rapid acting, high acid-neutralizing capacity and produces long lasting effects, it is an antacid of choice, its most prominent adverse effect is diarrhea, it's usually taken in combination with aluminum hydroxide (which promotes constipation), it is avoided in patients with undiagnosed abdominal pain, it is frequently used as a laxative, use with caution in pxs with renal failure

magnesium hydroxide (Milk of Magnesia)

this drug blocks receptors for dopamine and serotonin in the CTZ, increases upper GI motility and suppresses emesis. when taken PO it is therapeutic for diabetic gastroparesis and suppresses GERD. when used IV it promotes gastric emptying, used for suppression of postoperative n/v and CINV, facilitates radiologic examination of GI tract. adverse effects based on dosage and duration— high dose therapy causes sedation and diarrhea, long term high dose therapy can cause irreversible tar dive dyskinesia (TD) . it is contraindicated in patients with GI obstruction, perforation, and hemorrhage

metoclopramide

this drug's only approved GI indication is prevention of gastric ulcers caused by LT NSAID therapy, common adverse effects include dose related diarrhea and abdominal pain, it is contraindicated in pregnancy (X) so significant actions need to be taken to ensure that pregnancy doesn't occur after therapy starts and patient is not pregnant at therapy initiation

misoprostol (Cytotec)

this drug has actions similar to ranitidine and famotidine and is used for duodenal/gastric ulcers, GERD, heartburn, acid indigestion, and sour stomach

nizatidine (Acid)

this drug is the first PPI available. it acts to inhibit gastric secretions by reducing dyspepsia has a short half-life, used for ST therapy, used as ulcer prophylaxis for patients in ICUm and only if they have an additional rF (like multiple trauma, spinal cord injury, or mechanical ventilation>48hrs). adverse effects are usually inconsequential w/ ST use— headache, GI effects, pneumonia, fractures, hypomagnesemia, rebound acid hyper secretion, c. diff infection, gastric cancer

omeprazole (Prilosec)

this drug is the first to be approved for (CINV), it is also used to prevent n/v associated with radiotherapy and anesthesia, blocks type 3 serotonin receptors on afferent vagal nerve, more effective when used with dexamethasone, adverse effects include headache, diarrhea, dizziness, prolonged QT intervals risk for tornadoes de pointes

ondansetron (Zofran)

this drug class is of the nonspecific antidiarrheal family and is the most effective antidiarrheal agent. it includes diphenoxylate, difenoxin, loperamide, paregoric, and opium tincture. they act to activate opioid receptors in the GI tract— reduce intestinal motility, slow intestinal transit, allow more fluid to be absorbs, decrease secretion of fluid into small intestine and increase absorption of fluid and salt. the most commonly used are iphenoxylate (Lomotil) and loperamide (Imodium)

opioids

this drug should be administered without foods or fluids, it creates a protective barrier for up to 6 hours, it is used for acute ulcers and maintenance therapy, adverse effect of constipation in 2% of patients, drug interactions include phenytoin and antacids interfere with effects of this drug

sucralfate (Carafate)

this drug inhibits bacterial protein synthesis, it is highly active against H. pylori, resistance is rare (<1%), not for use in pregnant patients and young children because it can stain developing teeth

tetracycline

A nurse is teaching a client about probiotic supplements. Which of the following information should the nurse include? (Select all that apply.) A. "Probiotics are micro-organisms that are normally found in the GI tract." B. "Probiotics are used to treat CDIFF." C. "Probiotics are used to treat benign prostatic hyperplasia." D. "You can experience bloating while taking probiotic supplements." E. "If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement."

A. "Probiotics are micro-organisms that are normally found in the GI tract." B. "Probiotics are used to treat CDIFF." D. "You can experience bloating while taking probiotic supplements."

A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine for PTSD. Which of the following statements should the nurse include in the teaching? A. "You may have decreased desire for intimacy while taking this medication." B. "You should take this medication at bedtime to help promote sleep." C. You will have fewer urinary adverse effects if you urinate just before taking this medication." D. You'll need to wear sunglasses when outdoors due to the light sensitivity caused by this medication.

A. "You may have decreased desire for intimacy while taking this medication" (Decreased libido is a potential adverse effect of fluoxetine and other SSRIs)

A nurse is caring for four clients who have peptic ulcer disease. The nurse should identify misoprostol is contraindicated for which of the following clients? A. A client who is pregnant. B. A client who has osteoarthritis. C. A client who has a kidney stone. D. A client who has a UTI.

A. A client who is pregnant. (Misoprostol can induce labor and is contraindicated in pregnancy)

The mechanism of action for H2 Blockers is? (Select all that apply) A. Alleviate symptoms of heartburn. B. Causes diarrhea and abdominal pain. C. Prevents stress ulcers. D. Suppress secretion of gastric acid.

A. Alleviate symptoms of heartburn. C. Prevents stress ulcers. D. Suppress secretion of gastric acid.

A nurse is caring for a client who takes paroxetine to treat PTSD and reports that he grinds his teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply) A. Concurrent administration of buspirone. B. Administration of a different SSRI. C. Use a mouth guard. D. Changing to a different class of antidepressent meds. E. Increasing the dose of paroxetine.

A. Concurrent administration of buspirone. C. Use a mouth guard. D. Changing to a different class of antidepressent medication.

A nurse is caring for a client who is in renal failure with an elevated serum phosphorus level & is to be started on aluminum hydroxide (Amphojel). The client asks the nurse about potential side effects. The nurse should explain to the client that a common side effect of aluminum based antacids is what? A. Constipation. B. Metallic taste. C. Headache. D Diarrhea.

A. Constipation (Aluminum-based antacids have few side effects, and the most common one is constipation)

A client is about to start taking aluminum hydroxide (Amphojel) to treat heartburn. The nurse should explain to the client that this medication can cause which of the following? A. Constipation. B. Flatulence. C. Hypertension. D. Headache.

A. Constipation. (This type of antacid can cause constipation, so the nurse should tell the client to increase fluid and fiber intake and to exercise more to help prevent this effect)

Which of the following should a nurse teach about Sucralfate: (Select all that apply) A. Creates a protective barrier against acid and pepsin. B. An adverse effect is constipation. C. Should be taken on an empty stomach. D. An adverse effect is diarrhea.

A. Creates a protective barrier against acid and pepsin. B. An adverse effect is constipation. C. Should be taken on an empty stomach.

A nurse is speaking with a client about to receive a one time dose of Diazepam (Valium). Which of the following information should the nurse be sure to give to the client ? A. Diazepam can cause drowsiness. B. A single dose of Diazepam is unlikely to cause side effects. C. It is important to avoid foods that contain tyramine. D. Grapefruit juice inactivates this medication.

A. Diazepam can cause drowsiness. (Valium has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam)

A nurse is following up on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply) A. Disorganized speech. B. Bizzarre behavior. C. Impaired social interactions. D. Hallucinations. E. Decreased motivation.

A. Disorganized speech. B. Bizzarre behavior. D. Hallucinations. (A client who takes chlorpromazine should have the greatest improvement in positive manifestation ie. disorganized speech, bizarre behavior and hallucinations.

Prolonged use of Glucocortcoids can cause? (Select all that apply) A. Osteoporosis. B. Electrolyte depletion. C. Increased susceptibility to infection. D. Cushing syndrome

A. Osteoporosis. C. Increased susceptibility to infection. D. Cushing syndrome

A nurse is reviewing lab findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A. Perform immediate gastric lavage. B. Prepare the client for hemodialysis. C. Administer an additional oral dose of lithium. D. Request a stat repeat of the laboratory test.

A. Perform immediate gastric lavage. (Maintenance levels fall between 0.6 to 1.2 mEq/L. Early toxicity levels are 1.5 to 2.0 mEq/L & require dosage change. Advanced toxicity levels fall between 2.0 to 2.5 mEq/L & require gastric lavage. Severe toxicity levels are > 2.5 mEq/L & require hemodialysis.

A nurse is reviewing a client during a yearly health assessment. The client reports occasionally taking several over the counter medications, including H2 blockers, as needed. When evaluating the effectiveness of H2 - blocker therapy, the nurse should asses for which of the following? A. Relief of heartburn. B. Cessation of diarrhea. C. Passage of flatus. D. Absence of constipation.

A. Relief of heartburn. (Histamine H2-receptor antagonists, also known as H2-blockers, are used to treat duodenal ulcers and prevent their return. In OTC strengths, these medicines are used to relieve or prevent heartburn, acid indigestion, and sour stomach)

A nurse is caring for a 2 year old client receiving Phenytoin (Dilantin) in suspension form. Which of the following actions should the nurse take before administering each dose? A. Shake the container vigorously. B. Be sure the child has not eaten within the hour. C. Perform mouth care. D. Check the child's blood pressure.

A. Shake the container vigorously. (A suspension form of medication refers to one in which the particles of medication are mixed with, but not dissolved in, a fluid. It is important for the nurse to shake the container that contains the suspension, because the child can be under-medicated if the medication is not evenly distributed)

A client has started to take lithium carbonate (Eskalith) to treat bipolar disorder. The nurse should make sure the client understands that he maintains consistency in his intake of which of the following dietary elements? A. Sodium B. Potassium C. Vitamin K D. Vitamin C

A. Sodium (Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity)

A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client to avoid which of the following laxatives? A. Sodium phosphate B. Psyllium C. Bisacodyl D. Polyethylene glycol

A. Sodium Phosphate (Absorption of sodium from sodium phosphate causes fluid retention which can exacerbate heart failure)

A nurse is reviewing the history and physical for a client who has schizophrenia. Reported findings include jerky choreiform movements, lip smacking, & neck & back tonic contractions. These findings are chronic despite discontinuation of Chlorpromazine (Thorazine). The nurse should suspect that the client has developed which of the following adverse effects ? A. Tardive Dyskinesia. B. Pseudoparkinsonism. C. Dystonia. D. Akathisia.

A. Tardive Dyskinesia

A nurse is preparing a teaching plan for a client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? A. "This medication can be safely taken during pregnancy." B. "Eliminate grapefruit juice from the diet." C. "You will need to have a CBC and carbamazepine levels drawn periodically." D. "Notify your provider if you develop a rash." E. "Avoid driving for the first few days after starting this medication."

B. "Eliminate grapefruit juice from the diet." C. "You will need to have a CBC and carbamazepine levels drawn periodically." D. "Notify your provider if you develop a rash." E. "Avoid driving for the first few days after starting this medication."

A nurse is teaching a client who will begin taking aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. "If constipation develops switch to a calcium-based antacid." B. "Take this medication two hours before or after other medication." C. "This medication increases risk for pneumonia." D. " Have your magnesium level monitored while taking this medication."

B. "Take this medication two hours before or after other medications." (Cimetidine alters absorption of many medications. The client should ensure no other medications are taken within 1 to 2 hours of cimetidine)

A nurse is preparing to administer a bisacodyl (Ducolax) 10 mg suppository. Which of the following are correct administration guidelines for the nurse to implement? (Select all that apply) A. Don sterile gloves. B. Lubricate index finger. C. Use a rectal applicator for insertion. D. Position client supine with knees bent. E. Insert suppository just beyond internal sphincter.

B. Lubricate index finger. E. Insert suppository just beyond internal sphincter.

A nurse is teaching the caregiver of a school age child about transdermal methylphenidate. Which of the following instructions should the nurse include? A. Apply one patch 2x per day. B. Leave the patch on for 9 hrs. C. Apply the patch to the child's waist. D. Use opened tray within 6 months.

B.Leave the patch on for 9hrs. ( Transdermal methylphenidate is administered for 9 hr/day, applied to the Childs hip, and has to be used within 2 months)

A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A. "I should take the medication on an empty stomach." B. "I will follow a low sodium diet while taking this medication". C. "I need to discontinue the medication slowly". D. "I should not crush this medication before swallowing".

C. "I need to discontinue the medication slowly." (When discontinuing this drug, the client should taper the medication slowly according to a prescribed tapered doing schedule to reduce the risk of withdrawal syndrome)

A nurse is teaching a client about cimetidine. Which of the following are adverse effects of cimetidine? (Select all that apply.) A. Increased libido B. Insomnia C. Enlargement of breast tissue (Gynecomastia) D. Confusion E. Decreased sperm count (Impotence)

C. Gynecomastia D Confusion E. Impotence

A provider prescribes fluoxetine (Prozac) for a client who reports frequent periods of extreme sadness. The nurse teaching the client knows he understands how to take this medication when he makes which of the following statements? A. "I'll take this medication at bedtime." B. "I should not take this medicine with grapefruit juice." C. "I'll take this medicine with food." D. "I'll take this medicine first thing in the morning."

D. "I'll take this medicine first thing in the morning." (​The usual recommendation is to take fluoxetine as a single dose in the morning)

A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. Which of the following instructions should the nurse include? a. "Take a missed dose as soon as you remember." b. "Take the drug as needed at the first sign of anxious feelings." c. "Take the drug in the morning with a glass of grapefruit juice." d. "Drink a cup of chamomile tea at night with the drug."

a. "Take a missed dose as soon as you remember." Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose.

A nurse is assessing a client who has been taking alprazolam for several days. Which of the following findings should the nurse identify as an adverse drug reaction caused by alprazolam? a. Anxiety b. Ringing in the ears c. Increased appetite d. Muscle spasms

a. Anxiety The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the provider, who might consider a different medication.

A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle glaucoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) a. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops. b. Do not touch the tip of the dropper. c. Wash hands after instilling the drops. d. Rub eyes gently after instilling the drops. e. Remove contact lenses prior to instilling the drops.

a. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops. b. Do not touch the tip of the dropper. e. Remove contact lenses prior to instilling the drops.

A nurse should identify that timolol is contraindicated for a client who has which of the following disorders? a. Asthma b. Seizure disorder c. Diabetes mellitus d. Rheumatoid arthritis

a. Asthma Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients who have asthma or any disorder that compromises respiratory function should not use the drug.

A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. Which of the following instructions should the nurse include? (Select all that apply.) a. Change positions slowly from sitting or lying to standing. b. Do not stop taking the drug abruptly. c. Avoid crushing the tablet. d. Take the drug at bedtime to prevent daytime drowsiness. e. Increase fiber and fluid intake.

a. Change positions slowly from sitting or lying to standing. b. Do not stop taking the drug abruptly. d. Take the drug at bedtime to prevent daytime drowsiness. e. Increase fiber and fluid intake.

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity? a. Furosemide for hypertension b. Acetaminophen for headaches c. Ciprofloxacin for a urinary tract infection d. Montelukast for asthma

a. Furosemide for hypertension Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity.

A nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past 2 weeks. Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome? a. Hallucinations b. Decreased temperature c. Hypersexual behavior d. Constipation

a. Hallucinations Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome.

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason for the prescription modification? a. Renal function impairment b. Cataracts c. Recent weight loss d. Smoking

a. Renal function impairment Alprazolam dosage should be decreased for clients who have renal or hepatic impairment.

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply.) a. Tremors b. Confusion c. Bronchospasm d. Nausea e. Muscle weakness

a. Tremors b. Confusion d. Nausea e. Muscle weakness

A nurse is caring for a client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication? a. ​Sedation b. ​Bradycardia c. Hearing loss d. ​Abdominal pain

a. ​Sedation

A nurse is caring for a client who has schizoaffective disorder and who has been prescribed chlorpromazine IV. Which of the following client findings should the nurse monitor after administering the medication? a. BUN level b. Blood pressure c. Urine specific gravity d. Pedal pulse strength

b. Blood pressure Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV administration. The client should remain supine for 30 min while the nurse monitors their blood pressure. The nurse should instruct the client to change positions slowly as a safety precaution to prevent client injury. This medication can also cause orthostatic hypotension.

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions? a. Respiratory depression b. Hypertensive crisis c. Neuroleptic malignant syndrome d. Serotonin syndrome

b. Hypertensive crisis Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in clients who are taking phenelzine. Manifestations include hypertension, headache, and nausea.

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? (Select all that apply.) a. Motion sickness b. Seasonal affective disorder c. Insomnia d. Nicotine addiction e.Depression

b. Seasonal affective disorder d. Nicotine addiction e.Depression

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instructions should the nurse include? a. Stop taking the drug immediately with the first sign of a sore throat. b. Wear sunscreen when exposed to sunlight. c. Take the drug with food to reduce gastrointestinal distress. d. Take the drug in the morning to prevent nocturia.

b. Wear sunscreen when exposed to sunlight. Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors.

A nurse is providing teaching to a client who has a prescription for buspirone. Which of the following instructions should the nurse include? a. Take the drug with grapefruit juice to increase absorption. b. Use the drug as needed for anxiety. c. Allow 2 to 4 weeks for full therapeutic effects. d. Take the drug on an empty stomach.

c. Allow 2 to 4 weeks for full therapeutic effects. It can take up to 4 weeks for a client to feel the drug's full therapeutic effects.

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include? a. Consume a low-sodium diet. b. Reduce fluid intake. c. Avoid taking NSAIDs. d. Take the drug with food.

c. Avoid takingNSAIDs NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs. .

A nurse at an ophthalmology clinic is caring for a client who has open-angle glaucoma. The client is started on a treatment regimen of timolol (Timoptic) and pilocarpine (Pilocar) eye drops. The nurse should understand that these medications will be administered a. when the client is experiencing eye pain b. until the client's intraocular pressure returns to normal. c. on a regular schedule for the rest of the client's life. d. for approximately 10 days, followed by a gradual tapering off.

c. on a regular schedule for the rest of the client's life. Medications prescribed for glaucoma are intended to enhance aqueous outflow, or decrease its production, or both. The client must continue the eye drops on an uninterrupted basis for life.

​A nurse who has just admitted a client to an inpatient medical unit notices that the client brought a container of ginkgo biloba with him. When the nurse asks him about it, he says he takes it every day to "help his brain." Which of the following is an appropriate nursing response? a. "We don't allow anyone to bring their own medications to the hospital with them." b. ​"How do you know that this herb is actually helping your brain?" c. ​"For now, let's just make sure your doctor is okay with you taking it while you're in the hospital." d. ​"Are you aware of the dangers of taking herbal preparations?"

c. ​"For now, let's just make sure your doctor is okay with you taking it while you're in the hospital." ​Herbal preparations like ginkgo biloba can interact with other medications and can cause various adverse effects. However, it can also have therapeutic effects. Offering to check with the provider is reasonable, as it will help ensure the client's safety while also recognizing his rights.

A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine? a. Alprazolam b. Phenytoin c. ​Phenelzine d. Pilocarpine

c. ​Phenelzine Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever.

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically? a. Chest x-ray b. Tonometry c. ​Thyroid function tests d. Endoscopic retrograde cholangiopancreatography (ERCP)

c. ​Thyroid function tests ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter.

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and who was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse suspect? a. Cholinergic crisis b. Serotonin syndrome c. Stevens-Johnson syndrome d. Acute dystonia

d. Acute dystonia Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine

A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops. Which of the following adverse effects should the nurse include in the teaching? a. Constricted pupils b. Discoloration of the iris c. Hypertension d. Bradycardia

d. Bradycardia Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1 receptors. Clients should check their pulse rate regularly and report any sustained decreases.

A nurse is caring for a client who was admitted to the emergency department with a head injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. For which of the following adverse effects is the client at increased risk? a. Ischemic stroke b. Drowsiness c. Respiratory depression d. Seizure activity

d. Seizure activity Bupropion, an atypical antidepressant, can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

A nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects? a. Anterograde amnesia b. Respiratory depression c. Paradoxical reaction d. Withdrawal symptoms

d. Withdrawal symptoms Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.