Pharmacology Psychiatric & Neurological Medications

The client is receiving meperidine hydrochloride for pain. Which signs/symptoms are side and adverse effects of this medication? Select all that apply. 1.Diarrhea 2.Tremors 3.Drowsiness 4.Hypotension 5.Urinary frequency 6.Increased respiratory rate

2.Tremors 3.Drowsiness 4.Hypotension Rationale: Meperidine hydrochloride is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A client with fibromyalgia has not achieved pain relief with opioid pain medication. The client has a history of diabetes mellitus and atherosclerosis. The nurse anticipates that which single medications may be selected by the primary health care provider to be given in conjunction with the opioid pain medication? Select all that apply. 1.Duloxetine 2.Pregabalin 3.Alprazolam 4.Imipramine 5.Amitriptyline

1.Duloxetine 2.Pregabalin 3.Alprazolam Rationale: The nurse anticipates that duloxetine, pregabalin, or alprazolam will be given in conjunction with the opioid pain medication. Serotonin-norepinephrine reuptake inhibitors (duloxetine) are used for chronic pain disorders, as are certain anticonvulsants (pregabalin) and benzodiazepines (alprazolam). Each of these is used as an adjunct to the opioid medication. Tricyclic antidepressants are also used as adjuncts for chronic pain. However, in this case, the tricyclic antidepressants (imipramine and amitriptyline) are contraindicated because the client has atherosclerosis.

The nurse is providing instructions to a client who is taking codeine sulfate for severe back pain. Which action does the nurse instruct the client to do? 1.Increase fluid intake. 2.Maintain a low-fiber diet. 3.Avoid all exercise to prevent lightheadedness. 4.Avoid the use of stool softeners to prevent diarrhea.

1.Increase fluid intake. Rationale: Codeine sulfate can cause constipation. The client is instructed to increase fluid intake to prevent constipation. Options 2, 3, and 4 are incorrect because they do not address the side effects associated with the use of this medication. Although lightheadedness can occur with the use of this medication, all exercise is not avoided. It is important that the client ambulate frequently.

A tricyclic antidepressant is administered to a client daily. The nurse plans to alleviate the common side effects of the medication and includes which in the plan of care? 1.Offer hard candy or gum periodically. 2.Offer a nutritious snack between meals. 3.Monitor the blood pressure every 2 hours. 4.Review the white blood cell (WBC) count results daily.

1.Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC count daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

A client receiving long-term therapy with lithium carbonate has a toxic serum lithium level of 1.5 and 2 mEq/L. Which organ functions are the major long-term risk factors? Select all that apply. 1.Renal function 2.Cardiac function 3.Thyroid function 4.Endocrine function 5.Respiratory function 6.Musculoskeletal function

1.Renal function 3.Thyroid function Rationale: The organ functions that are major long-term risk factors for lithium toxicity are renal and thyroid function. Primary long-term risks of lithium therapy can cause hypothyroidism and impairment of the kidney's ability to concentrate urine. A client receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Before lithium is administered, a medical evaluation is performed to assess the client's ability to tolerate the drug. Besides thyroid and renal disease, lithium therapy is generally contraindicated in clients with cardiovascular disease, brain damage, or myasthenia gravis. Whenever possible, lithium is not given to women who are pregnant because it may harm the fetus.

A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up, and the level is 3.0 mEq/L (3.0 mmol/L). The nurse knows that this is which level? 1.Toxic 2.Normal 3.Slightly above normal 4.Excessively below normal

1.Toxic Rationale: The therapeutic serum level of lithium is 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L). A level of 3 mEq/L indicates toxicity.

The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine. The nurse determines that the client understands the use of the medication if the client knows to perform which activity? 1.Use sunscreen when outside. 2.Drive as long as it is not at night. 3.Discontinue the medication if fever or sore throat occurs. 4.Keep tissues handy because of excess salivation that may occur.

1.Use sunscreen when outside. Rationale: Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving or doing other activities that require mental alertness until the effect on the client is known. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. The medication may cause dry mouth (not excessive salivation), and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because it could cause return of seizures or status epilepticus. Fever and sore throat should be reported to the primary health care provider (PHCP).

A hospitalized client is started on phenelzine sulfate for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray should the nurse remove? 1.Yogurt 2.Crackers 3.Tossed salad 4.Oatmeal cookies

1.Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client needs to avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine. Which information should be important for the nurse to gather regarding the adverse effects related to the medication? 1.Cardiovascular symptoms 2.Gastrointestinal dysfunctions 3.Problems with mouth dryness 4.Problems with excessive sweating

2.Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include CNS and GI system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

A primary health care provider initiates carbidopa/levodopa therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. What should the nurse tell the client regarding how to avoid side effects when taking this combination medication? 1.Taking an antiemetic is the best measure to prevent the nausea. 2.Taking the medication with food will help prevent the nausea. 3.This is an expected side effect of the medication and will decrease over time. 4.The nausea and vomiting will decrease when the dose of levodopa is stabilized.

2.Taking the medication with food will help prevent the nausea. Rationale: If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food may decrease the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. Options 1, 3, and 4 are incorrect.

A client with a history of simple partial seizures is taking clorazepate, and asks the nurse if there is a risk of addiction. The nurse's response is based on which fact? 1.Clorazepate is not habit forming, either physically or psychologically. 2.Clorazepate leads to physical tolerance but only after 10 or more years of therapy. 3.Clorazepate leads to physical and psychological dependence with prolonged high-dose therapy. 4.Clorazepate can result in psychological dependence only because of the nature of the medication.

3.Clorazepate leads to physical and psychological dependence with prolonged high-dose therapy. Rationale: Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic. One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted. Options 1, 2, and 4 are incorrect.

A client who is taking lithium carbonate is scheduled for surgery. The nurse would reinforce what information in the preoperative teaching about this medication? 1.The medication will be discontinued a week before the surgery and resumed 1 week postoperatively. 2.The medication is to be taken until the day of surgery and resumed by injection immediately postoperatively. 3.The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. 4.The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period.

3.The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is prescribed after the surgery. The other options regarding when to discontinue lithium carbonate before surgery are incorrect.

A hospitalized client is taking clozapine for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client should the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1.Platelet count 2.Cholesterol level 3.White blood cell count 4.Blood urea nitrogen level

3.White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

The client with trigeminal neuralgia is being treated with carbamazepine. Which laboratory result indicates that the client is experiencing an adverse effect of the medication? 1.Sodium level, 140 mEq/L (140 mmol/L) 2.Uric acid level, 5.0 mg/dL (0.3 mmol/L) 3.White blood cell count, 3000 mm3 (3 × 109/L) 4.Blood urea nitrogen (BUN) level, 15 mg/dL (5.4 mmol/L)

3.White blood cell count, 3000 mm3 (3 × 109/L) Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbance, thrombophlebitis, dysrhythmia, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

The nurse is caring for a client receiving morphine sulfate intravenously for pain. Because morphine sulfate has been prescribed for this client, which nursing action should be included in the plan of care? 1.Encourage fluid intake. 2.Monitor the client's temperature. 3.Maintain the client in a supine position. 4.Encourage the client to cough and deep breathe.

4.Encourage the client to cough and deep breathe. Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. The remaining options are not specifically associated with this medication.

A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication? 1.It is a serotonin reuptake blocker. 2.It inhibits the breakdown of released acetylcholine. 3.It blocks the uptake of norepinephrine and serotonin. 4.It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.

4.It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride is a potent serotonin reuptake blocker.

The nurse has administered a dose of diazepam to a client. The nurse should take which most important action before leaving the client's room? 1.Place commode at bedside. 2.Draw the shades or blinds closed. 3.Turn down the volume on the television. 4.Per agency policy, put up the side rails on the bed.

4.Per agency policy, put up the side rails on the bed. Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

The nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? 1.The magnesium sulfate is effective. 2.The infusion rate needs to be increased. 3.The client is experiencing cerebral edema. 4.The client is experiencing magnesium toxicity.

4.The client is experiencing magnesium toxicity. Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate, maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these symptoms and asks the nurse what to do. The nurse's response is based on which understanding of these symptoms? 1.The client is experiencing a severe adverse reaction to the medication. 2.Symptoms usually occur when the client takes the medication with food. 3.Symptoms are probably the result of an interaction with another medication. 4.These are expected effects during initial therapy and decrease or disappear with long-term use.

4.These are expected effects during initial therapy and decrease or disappear with long-term use. Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe adverse reaction is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset.

The nurse is caring for a client on the mental health unit who has been declared incompetent through a formal legal proceeding. A guardian has been appointed. The nurse knows that guardians are typically selected from among family members. From the list of family members, what is the order of selection of a guardian for this client? List in descending order of importance from the first to the last choice. All options must be used. 1. Adult nieces and nephews 2. Parents 3. Spouse 4. Adult children or grandchildren 5. Adult siblings

1. Spouse 2. Adult children or grandchildren 3. Parents 4. Adult siblings 5. Adult nieces and nephews Rationale: Guardians are typically selected from among family members. The order of selection is usually (1) spouse, (2) adult children or grandchildren, (3) parents, (4) adult siblings, and (5) adult nieces and nephews. If found incompetent, the client may be appointed a legal guardian or representative who is legally responsible for giving or refusing consent for the client, while always considering the patient's wishes. In the event a family member is either unavailable or unwilling to serve as guardian, the court may also appoint a court-trained and approved social worker, representing the county, state, or member of the community.

client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse should expect to note which signs and symptoms on data collection? Select all that apply. 1.Ataxia 2.Nausea 3.Tinnitus 4.Restlessness 5.Hyperactive reflexes 6.Respiratory rate of 9 breaths per minute

1.Ataxia 2.Nausea 4.Restlessness 6.Respiratory rate of 9 breaths per minute Rationale: The therapeutic serum range of phenytoin should be 10 to 20 mcg/mL. Central nervous system (CNS) depression, restlessness, ataxia, and nausea are all signs of phenytoin toxicity. Phenytoin toxicity depresses the CNS; thus, hyperactive reflexes should not be present. Tinnitus is not associated with phenytoin toxicity; rather it is associated with acetylsalicylic acid (aspirin toxicity).

A client with myasthenia gravis is being discharged on pyridostigmine bromide. The nurse reinforces medication instructions with the client and makes which statement to the client? 1."Take the medication on an empty stomach." 2."Take the medication before activities such as eating." 3."The use of tonic water with quinine and the use of antacids improve the effect of the medication." 4."It is not important when you take the medication, as long as you take the exact amount prescribed."

2."Take the medication before activities such as eating." Rationale: Pyridostigmine bromide is an anticholinesterase that is used to improve muscle strength in the client with myasthenia gravis. Taking the medication before activities such as eating helps lessen fatigue and dysphagia and improves muscle strength. The medication should be taken with food. Clients should avoid quinine, antacids, magnesium, and morphine sulfate and its derivatives because these medications can reverse the action of the pyridostigmine bromide and increase weakness. The medication should be taken regularly and on time to prevent fluctuating blood levels, which can cause weakness.

The nurse reviews the phenytoin level of a client who is taking phenytoin. The nurse notes that the plasma drug level is 9 mcg/mL. Which should the nurse anticipate to be prescribed for the client? 1.A decrease in the present dosage 2.An increase in the present dosage 3.Maintenance of the prescribed present dosage 4.The addition of a second anticonvulsant medication

2.An increase in the present dosage Rationale: The dosing objective is to produce phenytoin levels between 10 and 20 mcg/mL. Levels below 10 mcg/mL are too low to control seizures. At levels greater than 20 mcg/mL, signs of toxicity begin to appear.

The nurse should instruct the client taking atomoxetine to avoid foods containing which substance? 1.Calcium 2.Caffeine 3.Potassium 4.Saturated fat

2.Caffeine Rationale: The action of atomoxetine is central nervous system (CNS) stimulation. Thus, the client should avoid other CNS stimulants, such as caffeine. The substances in options 1, 3, and 4 are not contraindicated for consumption in the client taking atomoxetine and do not need to be avoided.

A client is receiving phenytoin. Which findings would indicate that the client is experiencing side/adverse effects related to this medication? Select all that apply. 1.Ataxia 2.Constipation 3.Bleeding gums 4.Decreased white blood cells 5.Decreased platelet count

2.Constipation 3.Bleeding gums 4.Decreased white blood cells 5.Decreased platelet count Rationale: Phenytoin causes blood dyscrasias, such as decreased platelet counts and decreased white blood cell counts; it contributes to constipation as well. Gingival hyperplasia can occur, causing gums to bleed easily. Ataxia is a side effect of benzodiazepines.

A client has a history of seizures. The primary health care provider has prescribed amitriptyline three times daily. The nurse seeks clarification of the prescription, knowing that the client is at risk for injury because of which adverse effect of the amitriptyline? 1.Decreased mental acuity 2.Decreased seizure threshold 3.Decreased platelet aggregation 4.Depressed immunological system

2.Decreased seizure threshold Rationale: Amitriptyline, a tricyclic antidepressant, lowers the seizure threshold, increasing the risk of seizures. This may not be the medication of choice for a client who is already at risk for seizure activity. The other adverse effects are unrelated to the use of this medication.

A client who recently began medication therapy with levodopa for Parkinson's disease complains of nausea. The nurse reminds the client to do which action to manage this problem? 1.Lie down and rest after taking the dose. 2.Eat a snack before taking the medication. 3.Take the medication with three glasses of water. 4.Take an antiemetic at the same time as the levodopa.

2.Eat a snack before taking the medication. Rationale: Levodopa is a dopaminergic medication used to treat Parkinson's disease. The nurse should remind the client that a snack should be eaten before taking the medication to prevent the nausea. The interventions in options 1, 3, and 4 will not manage the client's problem.

The nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which should the nurse include in the plan of care while the client is taking this medication? 1.Restrict fluid intake. 2.Monitor bowel activity. 3.Monitor for hypertension. 4.Monitor peripheral pulses.

2.Monitor bowel activity. Rationale: While the client is taking codeine sulfate, an opioid analgesic, the nurse should monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

The nurse is caring for a hospitalized child with a history of seizures who is receiving oral phenytoin sodium. Which should be included in the plan of care for this child? 1.Monitoring intake and output 2.Providing oral hygiene, especially care of the gums 3.Administering medications 1 hour before food intake 4.Checking the heart rate before administering the phenytoin

2.Providing oral hygiene, especially care of the gums Rationale: Phenytoin sodium causes gum bleeding and hypertrophy; therefore, oral hygiene is important. Soft toothbrushes and gum massage should be instituted to reduce the risk of complications and prevent further trauma. Options 1 and 4 are incorrect because the intake and output, as well as heart rate, are not affected by this medication. Option 3 is incorrect because directions for administration of this medication include administering with food to minimize gastrointestinal upset.

Fluoxetine is prescribed, and the nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about the administration of this medication? 1."I should take the medication with my evening meal." 2."I should take the medication at noon with an antacid." 3."I should take the medication in the morning when I first arise." 4."I should take the medication right before bedtime with a snack."

3."I should take the medication in the morning when I first arise." Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It is administered in the early morning without consideration to meals. Options 1, 2, and 4 are incorrect.

A client has begun taking phenelzine. At the initiation of therapy, the nurse teaches the client that which items are allowed in the diet? 1.Avocados, figs, and raisins 2.Red wines such as Chianti or sherry 3.Carrots, sweet potatoes, and squash 4.Lunchmeats such as bologna or salami

3.Carrots, sweet potatoes, and squash Rationale: Carrots, sweet potatoes, and squash are allowed in the client's diet. Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid foods high in tyramine because they could trigger a potentially fatal hypertensive crisis. Foods to avoid include aged cheeses; smoked or processed meats; red wines; and avocados, raisins, or figs. Vegetables are generally acceptable, with the exception of broad bean pods.

The nurse is reinforcing instructions to an adolescent who is taking phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? 1."The medication may cause oily skin." 2."Drinking alcohol may affect the medication." 3."If my gums become sore, I need to stop the medication." 4."Birth control pills may not be effective when I take this medication."

3."If my gums become sore, I need to stop the medication." Rationale: The adolescent should not stop taking antiepileptic medications suddenly or without discussing it with a primary health care provider or nurse. Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a primary health care provider for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid the use of alcohol. Birth control pills may be less effective when the client is taking antiseizure medication.

A client with a closed head injury is receiving phenytoin, an anticonvulsant medication. Which would indicate that the client is experiencing side effects related to this medication? Select all that apply. 1.Ataxia 2.Sedation 3.Constipation 4.Bleeding gums 5.Hyperglycemia 6.Decreased platelet count

3.Constipation 4.Bleeding gums 5.Hyperglycemia 6.Decreased platelet count Rationale: Phenytoin causes blood dyscrasias, such as decreased platelet counts and decreased white blood cells counts; it contributes to constipation as well. Gingival hyperplasia can occur, causing gums to bleed easily, and blood glucose levels can be elevated when taking phenytoin. Sedation is a side effect of barbiturates, not phenytoin. Ataxia is a side effect of benzodiazepines.

A 16-year-old child is brought to the emergency department by his mother with a complaint that the child just experienced a tonic-clonic seizure. On arrival in the emergency department no apparent seizures were occurring. The mother states that her son is taking medication for the seizure disorder. The nurse plans care, knowing that which medications are used for long-term control of tonic-clonic seizures? Select all that apply. 1.Diazepam 2.Alprazolam 3.Gabapentin 4.Ethosuximide 5.Carbamazepine 6.Methylphenidate

3.Gabapentin 4.Ethosuximide 5.Carbamazepine Rationale: Medications that are prescribed for long-term control of tonic-clonic seizures are gabapentin, ethosuximide, and carbamazepine. Diazepam is a medication that is prescribed to halt tonic-clonic episodes, and methylphenidate is a medication used to treat attention deficit hyperactivity disorder. Both of these medications are not suitable for long-term control of a seizure condition. Alprazolam is a medication used to treat anxiety.

The parent of a client taking atomoxetine asks how the medication works to control attention deficit hyperactivity disorder (ADHD). The nurse's correct explanation is based on which fact? 1.The medication increases serotonin at the synaptic cleft. 2.The medication increases the levels of dopamine in the striatum. 3.The medication inhibits norepinephrine (NE) transport and reuptake. 4.The medication decreases the amount of acetylcholine at the motor end plate.

3.The medication inhibits norepinephrine (NE) transport and reuptake. Rationale: Atomoxetine is a selective inhibitor of NE reuptake and hence causes NE to accumulate at synapses. Options 1, 2, and 4 are not actions of atomoxetine. Antidepressants work by selective serotonin reuptake inhibition. Increasing dopamine and decreasing acetylcholine are important in the treatment of Parkinson's disease

The nurse is caring for a client who is taking phenytoin for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which information should the nurse provide to the client? 1.Pregnancy should be avoided while taking phenytoin. 2.The client may stop taking the phenytoin if it is causing severe gastrointestinal effects. 3.The potential for decreased effectiveness of the birth control pills exists while taking phenytoin. 4.The increased risk of thrombophlebitis exists while taking phenytoin and birth control pills together.

3.The potential for decreased effectiveness of the birth control pills exists while taking phenytoin. Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, are 4 are not accurate.

The nurse is assisting in the care of a client with Parkinson's disease who is receiving carbidopa/levodopa. The nurse plans to monitor the client for which adverse effect, which could appear with elevated serum levels of this medication? 1.Pruritus 2.Hypertension 3.Tachycardia 4.Impaired voluntary movements

4.Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high carbidopa/levodopa doses. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as "on-off phenomenon") are frequent side effects of the medication. The signs and symptoms listed in the other options are incorrect.

A client receiving morphine by the epidural route complains of itching. The nurse should anticipate which prescription to relieve the itching? 1.A dose of prednisone 2.A dose of methdilazine 3.Clemastine twice a day 4.Low dose infusion of naloxone

4.Low dose infusion of naloxone

A registered nurse (RN) asks a licensed practical nurse (LPN) to obtain a vial of mannitol for administration to a client. The LPN notes that the vial contains a few small crystals. Based on this observation, which would the LPN expect the RN to do? 1.Discard the vial. 2.Shake the vial to dissolve the crystals. 3.Send the vial back to the pharmacy for replacement. 4.Place the vial in warm water until the crystals dissolve.

4.Place the vial in warm water until the crystals dissolve. Rationale: Crystals form in mannitol if the solution is cooled, but quickly dissolve if the container is placed in warm water, then cooled to body temperature before administration. Options 1 and 3 are unnecessary, and option 2 will not dissolve the crystals.

A licensed practical nurse (LPN) is assisting in the care of a pregnant teenaged client with preeclampsia receiving magnesium sulfate. The LPN plans to notify the registered nurse immediately if which sign of magnesium toxicity is noted? 1.Proteinuria 2.Hyperactive deep tendon reflexes 3.Serum magnesium level of 5 mEq/L 4.Respiratory rate of 10 breaths per minute

4.Respiratory rate of 10 breaths per minute Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, sudden drop in fetal heart rate, and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.

The nurse is caring for a client who has been prescribed gabapentin and is monitoring for adverse effects of the medication. Which finding indicates a potential adverse effect? 1.Tremors 2.Dysarthria 3.Weight gain 4.Slurred speech

4.Slurred speech Rationale: Gabapentin is classified as an anticonvulsant and antineuralgic and works by reducing seizure activity and neuropathic pain. Adverse effects include overdosage, which manifests as slurred speech, drowsiness, lethargy, and diarrhea. Tremors, dysarthria (difficulty speaking), and weight gain are side effects of this medication.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex-partial seizures. The nurse interprets that which value is consistent with an adverse effect to this medication? 1.Sodium 136 mEq/L 2.Platelet count 350,000 mm3 3.Blood urea nitrogen 19 mg/dL 4.White blood cell count 3200 mm3

4.White blood cell count 3200 mm3 Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. A low white blood cell count would indicate an adverse effect. The values noted in options 1, 2, and 3 are normal values.

The nurse is caring for a mental health client who has been prescribed a benzodiazepine called chlorazapate. Which are the principal indications for this medication? Select all that apply. 1.Anxiety 2.Insomnia 3.Seizure disorders 4.Alcohol withdrawal 5.Postpartum depression 6.Obsessive-compulsive disorder (OCD)

1.Anxiety 2.Insomnia 3.Seizure disorders 4.Alcohol withdrawal Rationale: Benzodiazepines have three principal indications: (1) anxiety, (2) insomnia, and (3) seizure disorders. In addition, they are used as preoperative medications and to treat muscle spasm and withdrawal from alcohol. Although all benzodiazepines share the same pharmacological properties, and therefore might be equally effective for all applications, not every benzodiazepine is actually employed for all potential uses. Benzodiazepines are not prescribed to treat postpartum depression or OCD.

A client is receiving anticonvulsant therapy with phenytoin. The nurse plans to monitor the results of which laboratory tests closely? Select all that apply. 1.Urinalysis 2.Serum sodium 3.Serum calcium 4.Alkaline phosphatase 5.Complete blood cell count

1.Urinalysis 3.Serum calcium 4.Alkaline phosphatase 5.Complete blood cell count Rationale: The nurse would monitor the client's complete blood cell counts because hematological side effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other values that warrant monitoring include serum calcium levels and the results of urinalysis, and hepatic and thyroid function tests. Serum sodium is not affected by phenytoin.

The nurse is caring for a client who is receiving lithium carbonate for the treatment of bipolar disorder and monitors the client for signs/symptoms of lithium toxicity. Which sign/symptom should alert the nurse to the potential for toxicity? 1.Vomiting 2.Headaches 3.Constipation 4.Increased urination

1.Vomiting Rationale: One of the most common early sign/symptom of lithium toxicity is the presence of gastrointestinal (GI) disturbances, such as nausea, vomiting, and diarrhea. The other signs/symptoms are unrelated to lithium toxicity.

A client taking carbamazepine asks the nurse what to do if he misses one dose. Which response should the nurse give? 1."Withhold the medication until the next scheduled dose." 2."Take the medication as long as it is not immediately before the next dose." 3."Withhold the medication and notify the primary health care provider immediately." 4."Withhold the medication until the next scheduled dose, which should then be doubled."

2."Take the medication as long as it is not immediately before the next dose." Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the primary health care provider.

A client with schizophrenia has been started on medication therapy with loxapine. The nurse determines that the client is experiencing the intended effects of the medication if which client behavior is observed? 1.Presence of fixed stare 2.Absence of delusional statements 3.Decreased appetite and food intake 4.Taking sips of water for dry mouth

2.Absence of delusional statements Rationale: The nurse knows that the client is experiencing the intended effects of Loxapine if there is an absence of delusional statements. Loxapine is an antipsychotic medication used to treat psychotic symptoms in clients. Hallucinations, delusions, and altered thought processes are characteristic of this disorder and would decrease with effective treatment. Presence of fixed stare and taking sips of water for dry mouth are side effects of therapy. Decreased appetite is unrelated to the question.

The nurse is caring for a client who has been prescribed citalopram and checks the client for which signs/symptoms of serotonin syndrome? Select all that apply. 1.Lethargy 2.Diarrhea 3.Bradycardia 4.Abdominal pain 5.Increased blood pressure

2.Diarrhea 4.Abdominal pain 5.Increased blood pressure Rationale: Serotonin syndrome signs/symptoms include diarrhea, abdominal pain, elevated blood pressure, hyperactivity (not lethargy), tachycardia (not bradycardia), fever, altered mental status, irrationality, seizures, myoclonus, bloating, and apnea.

A client with Parkinson's disease has been prescribed benztropine. The nurse monitors for which gastrointestinal (GI) side effect of this medication? 1.Diarrhea 2.Dry mouth 3.Increased appetite 4.Hyperactive bowel sounds

2.Dry mouth Rationale: Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication.

An older mental health client diagnosed with chronic neuropathic pain is starting therapy with a tricyclic antidepressant called imipramine hydrochloride. The client is complaining of constipation. The nurse knows that which signs/symptoms are other adverse effects of this medication? Select all that apply. 1.Nausea 2.Dry mouth 3.Drowsiness 4.Muscle spasms 5.Acute confusion 6.Urinary retention

2.Dry mouth 3.Drowsiness 5.Acute confusion 6.Urinary retention Rationale: Adverse effects of tricyclic antidepressants besides constipation include urinary retention (which can lead to infection), dry mouth, drowsiness, and acute confusion. Clients must be instructed to notify their primary health care provider to report these changes, but they do not stop these drugs abruptly.

The nurse reviews the laboratory results of a client with trigeminal neuralgia who is being treated with carbamazepine 400 mg orally daily. The client's white blood cell (WBC) count is 3000 cells/mm3, blood urea nitrogen (BUN) is 15 mg/dL, sodium is 140 mEq/L, and uric acid is 5 ng/dL. Which laboratory result should the nurse report to the primary health care provider? 1.The BUN is elevated, indicating nephrotoxicity. 2.The WBC is low, indicating a blood dyscrasia. 3.The sodium level is low, indicating an electrolyte imbalance. 4.The uric acid level is elevated, indicating the risk for renal calculi.

2.The WBC is low, indicating a blood dyscrasia. Rationale: Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 3, and 4 are incorrect because the laboratory values identified in the question for these specific tests are within normal range.

The nurse is caring for a child receiving carbamazepine who has a carbamazepine level drawn. Which result indicates a therapeutic level? 1.1 mcg/mL 2.3 mcg/mL 3.6 mcg/mL 4.15 mcg/mL

3.6 mcg/mL Rationale: When carbamazepine is administered, blood levels need to be drawn periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum level for this medication is 4 to 12 mcg/mL.

The client with myasthenia gravis is receiving pyridostigmine. The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? 1.Vitamin K 2.Acetylcysteine 3.Atropine sulfate 4.Protamine sulfate

3.Atropine sulfate Rationale: The antidote for cholinergic crisis is atropine sulfate. Acetylcysteine is the antidote for acetaminophen. Vitamin K is the antidote for warfarin and protamine sulfate is the antidote for heparin.

A client has a prescription for valproic acid orally once daily. How should the nurse plan to administer the medication? 1.Administer the medication with an antacid. 2.Administer the medication with a carbonated beverage. 3.Ensure that the medication is administered at the same time each day. 4.Ensure that the medication is administered 2 hours before breakfast only when the client's stomach is empty.

3.Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels.

A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, which is the most important nursing intervention? 1.Prescribing the client a tyramine-free diet 2.Checking the client for anticholinergic effects 3.Getting baseline postural blood pressures before administering the medication and each time the medication is administered 4.Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication

3.Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: The most important nursing intervention is getting baseline postural blood pressures before administering the medication and each time the medication is administered. Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

A hospitalized client is having the dosage of clonazepam adjusted. The nurse should plan to implement which action? 1.Weighing the client daily 2.Observing for ecchymosis 3.Instituting seizure precautions 4.Monitoring blood glucose levels

3.Instituting seizure precautions Rationale: Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are not associated with the use of this medication.

A client is placed on hydrate sedative-hypnotic for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication? 1.Monitoring neurological signs every 2 hours 2.Monitoring the blood pressure every 4 hours 3.Instructing the client to call for ambulation assistance 4.Lowering the bed and clearing a path to the bathroom at bedtime

3.Instructing the client to call for ambulation assistance Rationale: A sedative-hypnotic causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation.

The nurse is assisting in preparing a plan of care for a client with renal colic receiving meperidine hydrochloride for pain. The nurse includes in the plan of care to monitor for which side effect of this medication? 1.Bradycardia 2.Hypertension 3.Urinary retention 4.Increased respirations

3.Urinary retention Rationale: Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

The nurse is reinforcing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which statement indicates the client understands the instructions? 1."I will never be able to drive a car." 2."My anticonvulsant medication will clear up my skin." 3."If I forget my morning medication, I can take two pills at bedtime." 4."I should not stop taking my medications even if my seizures go away."

4."I should not stop taking my medications even if my seizures go away." Rationale: The anticonvulsant medication should not be stopped even if there are no seizures. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore, a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the primary health care provider should be notified.

A client with narcolepsy has been prescribed a central nervous system (CNS) stimulant. The client complains to the nurse that he cannot sleep well anymore at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which time schedule? 1.After dinner each day 2.Just before going to bed 3.Two hours before bedtime 4.At least 6 hours before bedtime

4.At least 6 hours before bedtime Rationale: A central nervous system (CNS) stimulant acts by releasing norepinephrine from nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep. Taking the medication at the time frames indicated in options 1, 2, and 3 will prevent the client from sleeping because of the stimulant properties of the medication.

A client on the nursing unit has a prescription for a central nervous (CNS) stimulant orally daily. The nurse collaborates with the dietitian to limit the amount of which item on the client's dietary trays? 1.Fat 2.Protein 3.Starch 4.Caffeine

4.Caffeine Rationale: Caffeine is a stimulant and should be limited in the client taking a central nervous system (CNS) stimulant. The client should also be taught to limit caffeine intake as well.

A client with vascular headaches is taking ergotamine. Which client complaint should the nurse monitor? 1.Constipation 2.Hypotension 3.Dependent edema 4.Cool, numb fingers and toes

4.Cool, numb fingers and toes Rationale: Ergotamine produces vasoconstriction, which suppresses vascular headaches when given at a therapeutic dose range. The nurse monitors for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting. Options 1, 2, and 3 are not associated with this medication.

The nurse is monitoring a client taking an antipsychotic medication for signs/symptoms of neuroleptic malignant syndrome (NMS). The nurse should expect to note which sign/symptom if NMS occurred? 1.Dysphagia 2.Bradycardia 3.Hypotension 4.Hyperpyrexia

4.Hyperpyrexia Rationale: Hyperpyrexia up to 107° F may be present in neuroleptic malignant syndrome. Signs/symptoms develop suddenly and may include respiratory distress and muscle rigidity. As the condition progresses, there is evidence of tachycardia, hypertension, increasing respiratory distress, confusion, and delirium. The presence and severity of signs/symptoms are compounded when two or more antipsychotics are taken concomitantly.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse effects of the medication. Which sign/symptom indicates the client is experiencing an adverse effect? 1.Pruritus 2.Tachycardia 3.Hypertension 4.Impaired voluntary movements

4.Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication should the nurse prepare in anticipation of the prescription to treat this adverse effect related to the use of chlorpromazine? 1.Bromocriptine 2.Phytonadione 3.Enalapril maleate 4.Protamine sulfate

1.Bromocriptine Rationale: Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension.

Carbamazepine is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history knowing that this medication is contraindicated if which disorder is present? 1.Headaches 2.Liver disease 3.Hypothyroidism 4.Diabetes mellitus

2.Liver disease Rationale: Carbamazepine is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options.

The nurse has reinforced instructions to a client with Parkinson's disease who is taking carbidopa/levodopa. Which statement by a client indicates the need for further teaching? 1."I will eat lots of foods high in vitamin B6." 2."I will get up slowly to prevent dizziness." 3."I may need to take this medication for the rest of my life." 4."I will take the medication just before meals to avoid nausea."

1."I will eat lots of foods high in vitamin B6." Rationale: Foods high in vitamin B6 can counteract the effects of carbidopa/levodopa, so their intake should be limited. Options 2, 3, and 4 are accurate statements regarding this medication.

A client is receiving lithium carbonate. The client's lithium carbonate level is 1.5 mEq/L, which indicates an early sign of toxicity. Which are some early signs/symptoms of toxicity? Select all that apply. 1.Slurred speech 2.Muscle weakness 3.Lethargy 0.7 mEq/L 4.Diarrhea 1.0 mEq/L 5.Weight gain 1.1 mEq/L 6.Blurred vision 1.7 mEq/L

1.Slurred speech 2.Muscle weakness 3.Lethargy 0.7 mEq/L 4.Diarrhea 1.0 mEq/L Rationale: Lethargy, diarrhea, slurred speech, muscle weakness, nausea, vomiting, thirst, polyuria, and fine hand tremor are all early signs/symptoms of toxicity. The therapeutic serum level of lithium carbonate ranges from 0.6 to 1.2 mEq/L. Serum lithium carbonate levels above the therapeutic level will produce signs of toxicity. When early signs/symptoms of toxicity occur, lithium carbonate needs to be withheld, blood lithium levels measured, and dosage reevaluated. Weight gain is an expected side effect. Blurred vision is a severe sign/symptom of lithium carbonate toxicity.

The nurse is reinforcing instructions to a client taking phenytoin for seizure control. Which statement should the nurse make to the client regarding the administration of this medication? 1."If you miss a dose of medication, wait until the next dose and take both doses." 2."If you develop a sore throat, it is necessary to notify the primary health care provider." 3."If you have difficulty swallowing the capsules, open them and mix the contents with applesauce." 4."You need to cancel your next dentist visit and plan dentist appointments yearly rather than twice a year."

2."If you develop a sore throat, it is necessary to notify the primary health care provider." Rationale: Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, and swelling and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not miss medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity.

When teaching a client who is being started on imipramine hydrochloride, when should the nurse tell the client that the medication would have the desired effects? 1.Desired effects start during the first week of administration. 2.Desired effects do not occur for 2 to 3 weeks of administration. 3.Desired effects start immediately following initial administration. 4.Desired effects do not occur until after 2 months of administration.

2.Desired effects do not occur for 2 to 3 weeks of administration. Rationale: The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. Therefore, the other times are incorrect.

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? Select all that apply. 1.Diarrhea 2.Tremors 3.Drowsiness 4.Hypotension 5.Urinary frequency 6.Increased respiratory rate

2.Tremors 3.Drowsiness 4.Hypotension Rationale: Meperidine is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

A client is taking trihexyphenidyl for the treatment of Parkinson's disease. The nurse should monitor for which side effect of this medication? 1.Diarrhea 2.Urinary retention 3.Urinary incontinence 4.Excessive perspiration

2.Urinary retention Rationale: Trihexyphenidyl is an anticholinergic medication. Because of this, it can cause urinary hesitancy and retention, constipation, dry mouth, and decreased sweating as side effects.

A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? 1.Reports not going to work for the past week 2.Complains of not being able to "do anything" anymore 3.Arrives at the clinic neat and appropriate in appearance 4.Reports sleeping 12 hours per night and 3 to 4 hours during the day

3.Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints, as well as demonstrate an improvement in their appearance.

A client taking buspirone hydrochloride for 1 month is scheduled for a follow-up appointment. The nurse gathers data from the client and interprets that the medication is effective if the client reports an absence of which sign/symptom? 1.Delusions 2.Paranoid thoughts 3.Palpitations and anxiety 4.Alcohol withdrawal signs/symptoms

3.Palpitations and anxiety Rationale: The nurse interprets that the medication is effective if the client reports an absence of palpitations and anxiety. Buspirone hydrochloride is indicated most often for the treatment of anxiety and aggression. It is not recommended for the treatment of thought disorders such as delusions, schizophrenia including paranoid thoughts, or drug or alcohol withdrawal signs/symptoms.

A client arrives at the health care clinic and tells the nurse that they have been doubling their daily dosage of bupropion hydrochloride to help them get better faster. The nurse understands that the client is now at risk for which problem? 1.Insomnia 2.Weight gain 3.Seizure activity 4.Orthostatic hypotension

3.Seizure activity Rationale: Bupropion is an atypical antidepressant and does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

A client is receiving a daily dose of oral fluphenazine. The nurse should reinforce instructions to the client to practice which intervention to minimize common side effects of this medication? 1.Monitor pulse daily. 2.Eat snacks at midmorning and bedtime. 3.Use hard, sour candy or sugarless gum. 4.Have blood pressure checked once a week.

3.Use hard, sour candy or sugarless gum. Rationale: To minimize common side effects of this medication, the nurse would reinforce to the client to use hard, sour candy or sugarless gum. Fluphenazine is classified as an antidepressant and a selective serotonin reuptake inhibitor. Dry mouth is a common side effect. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of oral fluphenazine. Fluphenazine does not affect the pulse. Weight gain is a common side effect, and frequent snacks will worsen the problem.

The nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates a need for further teaching? 1."I rest each afternoon after my walk." 2."I cough and deep breathe many times during the day." 3."If I get abdominal cramps and diarrhea, I should call my doctor." 4."I can change the time of my medication on the mornings that I feel strong."

4."I can change the time of my medication on the mornings that I feel strong." Rationale: The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. Options 1, 2, and 3 include the necessary information that the client needs to understand to maintain health with this neurological degenerative disease.

The client with myasthenia gravis becomes increasingly weak. The primary health care provider (PHCP) prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which change in condition indicates that the client is in cholinergic crisis? 1.No change in the condition 2.Complaints of muscle spasms 3.An improvement of the weakness 4.A temporary worsening of the condition

4.A temporary worsening of the condition Rationale: An edrophonium injection makes the client experiencing cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Options 1 and 2 would not occur in either crisis.

A client being seen in the clinic is taking phenytoin. The client's phenytoin blood level is within therapeutic range, and the client's seizures are controlled. Which data collected by the nurse would require primary health care provider notification and possible discontinuation of the medication? 1.Diplopia 2.Bleeding gums 3.Mental impairment 4.Diffuse body rash

4.Diffuse body rash Rationale: Stevens-Johnson syndrome is a rash indicating an allergy, and if this occurs the primary health care provider needs to be notified for consideration of medication discontinuation. Options 1, 2, and 3 are also side effects of the medication but may be reversed with medication dose alteration rather that medication discontinuation.

A client admitted to the hospital gives the nurse a bottle of clomipramine. The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication? 1.Complaints of hunger 2.Complaints of insomnia 3.A pulse rate less than 60 beats per minute 4.Frequent hand washing with hot, soapy water

4.Frequent hand washing with hot, soapy water Rationale: Frequent hand washing is a common obsessive-compulsive behavior. Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Weight gain is a common side effect of this medication. Tachycardia and sedation are also side effects. Insomnia may occur but is seldom a side effect.

The client with myasthenia gravis is suspected of having cholinergic crisis. Which sign/symptom indicates this crisis is taking place? 1.Ataxia 2.Mouth sores 3.Hypothermia 4.Hypertension

4.Hypertension Rationale: Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions.

Mannitol is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which indicates the therapeutic action of this medication? 1.Prevents the filtration of sodium and water through the kidneys 2.Prevents the filtration of sodium and potassium through the kidneys 3.Decreases water loss by promoting the reabsorption of sodium and water in the loop of Henle 4.Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes

4.Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale: Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma.

A client in the mental health unit is administered haloperidol. What should the nurse check to determine its effectiveness? 1.The client's vital signs 2.The client's nutritional intake 3.The physical safety of other unit clients 4.The client's orientation and delusional status

4.The client's orientation and delusional status Rationale: To determine medication effectiveness, the nurse would check the client's orientation and delusional status. Haloperidol is used to treat clients exhibiting psychotic features. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

Meperidine hydrochloride is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication? 1.Diarrhea 2.Bradycardia 3.Hypertension 4.Urinary retention

4.Urinary retention Rationale: Meperidine hydrochloride is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

The nurse is collecting data from a client, and the client's spouse reports that the client is taking donepezil hydrochloride. Which disorder should the nurse suspect that this client may have based on the use of this medication? 1.Dementia 2.Schizophrenia 3.Seizure disorder 4.Obsessive-compulsive disorder

1.Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer's type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. This medication is not used to treat the disorders in options 2, 3, and 4.

The nurse is caring for a client with myasthenia gravis who has received edrophonium intravenously to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. The nurse's response is based on the understanding that the duration is usually how many minutes? 1.5 2.15 3.30 4.60

3.30 Rationale: Edrophonium may be given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication and lasts for about 30 minutes.

A client receiving therapy with carbidopa/levodopa is upset and tells the nurse that his urine has turned a darker color since he began to take the medication. The client wants to discontinue its use. In formulating a response to the client's concerns, how does the nurse interpret this development? 1.A sign of dehydration 2.Indicative of developing liver failure 3.A harmless side effect of the medication 4.A result of taking the medication with milk

3.A harmless side effect of the medication Rationale: With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. Options 1, 2, and 4 are incorrect interpretations.

A client with epilepsy is taking the prescribed dose of phenytoin to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/mL. Which symptom would be expected as a result of this laboratory result? 1.Nystagmus 2.Tachycardia 3.Slurred speech 4.No symptoms, because this is a normal therapeutic level

3.Slurred speech Rationale: The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur.

A client is taking a monoamine oxidase (MAO) inhibitor. The nurse plans care, knowing which information? 1.This classification of medications increases the amount of MAO in the liver. 2.Hypotensive crisis may be precipitated by foods that contain tyramine and tryptophan. 3.Symptomatology of MAO toxicity includes headache, hypertension, and nausea and vomiting. 4.Increased salivation, bradycardia, constipation, and mild insomnia are expected side effects.

3.Symptomatology of MAO toxicity includes headache, hypertension, and nausea and vomiting. Rationale: Headache, hypertension, tachycardia, and nausea and vomiting are precursors to hypertensive crisis. Hypertensive crisis is caused by the ingestion of foods that contain tyramine and tryptophan while a client is taking monoamine oxidase inhibitors. These medications act by decreasing the amount of monoamine oxidase in the liver, which is necessary for the breakdown and utilization of tyramine and tryptophan. Hypertensive crisis may lead to circulatory collapse, intracranial hemorrhage, and death. The identified side effects do not relate to the classification of medications.

A client with a history of seizures is taking phenytoin for seizure control. The client arrives at the health care clinic, and a serum phenytoin drug level is drawn. The laboratory calls the nurse and reports a result of 10 mcg/mL. Which interpretation should the nurse make of this value? 1.The laboratory value represents a toxic level. 2.The laboratory value represents an inadequate drug level. 3.The laboratory value is at the low end of therapeutic range. 4.The laboratory value is at the high end of therapeutic range.

3.The laboratory value is at the low end of therapeutic range. Rationale: The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/L. A laboratory result of 10 mcg/mL is at the low end of therapeutic range.

The nurse is caring for a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1.Pregnancy must be avoided while taking phenytoin. 2.The client may stop the medication if it is causing severe gastrointestinal effects. 3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4.There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. Rationale: Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus

A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. How should the nurse respond to the client's concerns? 1."Clumsiness and unsteadiness usually occur if the client takes the medication with food." 2."Clumsiness and unsteadiness are probably the result of an interaction with another medication." 3."Clumsiness and unsteadiness indicate that the client is experiencing a severe untoward reaction to the medication." 4."Clumsiness and unsteadiness are worse during initial therapy and decrease or disappear with long-term use."

4."Clumsiness and unsteadiness are worse during initial therapy and decrease or disappear with long-term use." Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset.

Fluoxetine hydrochloride is prescribed for a client being treated for depression, and the nurse reinforces instructions to the client regarding the medication. Which statement by the client would indicate that the client understands this medication therapy? 1."If my mouth becomes dry, I need to stop the medication." 2."If I don't feel better in 1 week, I need to stop the medication." 3."I will need a stronger dose if I don't feel results in a few days." 4."It takes approximately 2 to 4 weeks before improvement is noted."

4."It takes approximately 2 to 4 weeks before improvement is noted." Rationale: The time frame in which the therapeutic effects of fluoxetine hydrochloride are seen is usually 2 to 4 weeks after initiation of therapy. It is important to advise clients to comply with the prescribed regimen so that therapeutic levels are maintained. Dry mouth is a side effect of the medication, and the client would be instructed to relieve the dry mouth by chewing sugarless gum or sipping tepid water.

A client with Parkinson's disease has begun therapy with carbidopa/levodopa. The nurse determines that the client understands the action of the medication if the client verbalizes that results may not be apparent for which length of time? 1.24 hours 2.1 week 3.2 to 3 days 4.2 to 3 weeks

4.2 to 3 weeks Rationale: Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy. Options 1, 2, and 3 are incorrect because of the short time frames.

A client with Parkinson's disease is beginning treatment with carbidopa/levodopa. Which statement made by the client indicates the need for further teaching? 1."I will need to change positions slowly." 2."I should take my medication after a full meal." 3."Hard candy may help if I experience dry mouth." 4."I should notify my primary health care provider if I have difficulty sleeping."

2."I should take my medication after a full meal." Rationale: Carbidopa/levodopa should be taken on an empty stomach with a full glass of water to enhance absorption. Because the medication can cause orthostatic hypotension, clients should be taught to change positions slowly. To ease the side effect of dry mouth, sugarless chewing gum, hard candy, and frequent mouth rinses are indicated. The side effect of sleep difficulty should be reported. In addition, the client is taught to avoid high-protein meals because it affects the effectiveness of the medication.

A client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse would expect to note which signs and symptoms on data collection of the client? Select all that apply. 1.Ataxia 2.Nausea 3.Tinnitus 4.Diplopia 5.Nystagmus 6.Hyperactive reflexes

1.Ataxia 2.Nausea 4.Diplopia 5.Nystagmus Rationale: The therapeutic serum range of phenytoin should be 10 to 20 mcg/mL. A level of 30 mcg/mL indicates toxicity. Central nervous system (CNS) depression, lethargy, ataxia, and nausea are all signs of phenytoin toxicity. Nystagmus and diplopia also occur. Phenytoin toxicity depresses the CNS, thus hyperactive reflexes would not be present. Tinnitus is not associated with phenytoin toxicity; rather, it is associated with acetylsalicylic acid toxicity.

The nurse employed in a primary health care provider's office is collecting data on a client who is taking ergotamine tartrate. The nurse evaluates the effectiveness of therapy by asking which question? 1."Do you still have a backache?" 2."Are the headaches relieved?" 3."Are you having any diarrhea?" 4."Has the coughing decreased?"

2."Are the headaches relieved?" Rationale: Ergotamine tartrate is used to treat migraine or cluster headaches. Options 1, 3, and 4 are unrelated to the use of this medication

The nurse is reinforcing instructions to the family of a client with Alzheimer's disease regarding tacrine. Which statement by the family would indicate an understanding of the side/adverse effects related to this medication? 1."Fever is a sign of an adverse effect of the medication." 2."Increased urination may be an indication of an adverse effect." 3."I need to call the primary health care provider if constipation occurs." 4."If difficulty voiding occurs, I need to call the primary health care provider immediately because the medication will need to be discontinued."

2."Increased urination may be an indication of an adverse effect." Rationale: Tacrine is a cholinergic agent. Frequent side effects of this medication include nausea, vomiting, diarrhea, dizziness, and headache. Overdose (adverse effects) will cause cholinergic crisis, including increased salivation, lacrimation, urination, defecation, bradycardia, hypotension, and increased muscle weakness. Fever is not an adverse effect, although if a fever occurs and persists this may be an indication of an unassociated infection and the primary health care provider should be notified. Constipation is not associated with this medication, and if constipation occurs, measures can be taken to relieve it. Difficulty voiding is not associated with the use of this medication. Although this symptom may warrant primary health care provider notification, it does not indicate the need to discontinue the medication.

The client is taking phenytoin for seizure control, and a blood sample for a serum drug level is drawn. Which laboratory finding indicates a therapeutic serum drug result? 1.5 mcg/mL (19.84 mcmol/L) 2.15 mcg/mL (59.52 mcmol/L) 3.25 mcg/mL (99.2 mcmol/L) 4.30 mcg/mL (119.0 mcmol/L)

2.15 mcg/mL (59.52 mcmol/L) Rationale: The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL (39.68 to 79.36 mcmol/L). Therefore, options 1, 3, and 4 are incorrect.

A client has been given a prescription for chloral hydrate for short-term use. The nurse includes which nursing intervention in caring for this client? 1.Monitor the vital signs every 4 hours. 2.Leave the lights on in the client's room. 3.Perform a neurological assessment every 4 hours. 4.Instruct the client to call for help to get out of bed.

4.Instruct the client to call for help to get out of bed. Rationale: Chloral hydrate is a sedative-hypnotic. This medication promotes sleep, and the client is at risk for falls due to sedative effects. The nurse should instruct the client to ask for assistance getting out of bed. It is not necessary to leave the room lights on; this would interfere with sleep. Awakening the client for vital sign measurement and neurological assessment is unnecessary and interferes with sleep as well.

The nurse is providing instructions to a client beginning medication therapy with divalproex sodium for the treatment of absence seizures. The nurse instructs the client that which is the most frequent side effect of this medication? 1.Tinnitus 2.Irritability 3.Blurry vision 4.Nausea and vomiting

4.Nausea and vomiting Rationale: Divalproex sodium is an anticonvulsant. The most frequent side effects of medication therapy are gastrointestinal (GI) disturbances such as nausea, vomiting, and indigestion. The items in the other options are not side effects.

The nurse is caring for a client who has been prescribed carbidopa/levodopa. The nurse should monitor the client for which side effects? Select all that apply. 1.Insomnia 2.Dry mouth 3.Constipation 4.Urinary retention 5.Orthostatic hypotension

4.Urinary retention 5.Orthostatic hypotension Rationale: Monitor clients taking carbidopa/levodopa for orthostatic hypotension and urinary retention. Amantadine and pergolide may cause insomnia. Anticholinergics cause dry mouth and constipation.

Disulfiram is prescribed for a client and the nurse is collecting data on the client and is reinforcing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1.A history of hyperthyroidism 2.A history of diabetes insipidus 3.When the last full meal was consumed 4.When the last alcoholic drink was consumed

4.When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

A client taking buspirone for 1 month returns to the clinic for a follow-up visit. Which should indicate medication effectiveness? 1.No rapid heartbeats or anxiety 2.No paranoid thought processes 3.No thought broadcasting or delusions 4.No reports of alcohol withdrawal symptoms

1.No rapid heartbeats or anxiety Rationale: Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

A client is admitted to the hospital because of complaints of vomiting and abdominal pain. During data collection, the client tells the nurse that he is taking entacapone. Based on this finding, the nurse elicits information from the client regarding the presence of which condition? 1.Hypertension 2.Hyperlipidemia 3.Parkinson's disease 4.Peripheral vascular disease

3.Parkinson's disease Rationale: Entacapone is an antiparkinsonian agent used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. It is not used to treat cardiovascular disorders.

Ibuprofen is prescribed for a client. Which instruction should the nurse give the client about taking this medication? 1.Take with 8 oz of milk. 2.Take in the morning after arising. 3.Take 60 minutes before breakfast. 4.Take at bedtime on an empty stomach.

1.Take with 8 oz of milk. Rationale: Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

A client's medication sheet contains a prescription for sertraline hydrochloride. To ensure safe administration of the medication, which action should the nurse take? 1.Administer on an empty stomach. 2.Administer at the same time each evening. 3.Administer evenly spaced around the clock. 4.Administer on an as-needed basis when the client complains of depression.

2.Administer at the same time each evening. Rationale: The nurse would administer the medication at the same time each evening. Sertraline is classified as an antidepressant and a selective serotonin reuptake inhibitor. It is generally administered once every 24 hours. It may be administered in the morning or evening, but evening may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. It is not prescribed for use on an as-needed basis.

The nurse is reinforcing instructions to the spouse of a client who is taking tacrine for the management of moderate dementia associated with Alzheimer's disease. The nurse should tell the spouse which information? 1."Do not administer food with the medication." 2."If a dose is missed, double up on the next dose." 3."If a change in the color of the stools occurs, notify the primary health care provider." 4."If flulike symptoms occur, it is necessary to notify the primary health care provider immediately."

3."If a change in the color of the stools occurs, notify the primary health care provider." Rationale: Tacrine may be administered between meals on an empty stomach, and if gastrointestinal upset occurs, it may be administered with meals. Flulike symptoms without fever and gastrointestinal symptoms are frequent side effects of the medication. The client or spouse should never be instructed to double the dose of any medication if it was missed, and the client and caregiver are instructed to notify the primary health care provider if nausea, vomiting, diarrhea, rash, jaundice, or changes in the color of the stool occur. This may be indicative of hepatitis.

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which indicates toxicity associated with the medication? 1.Sodium of 140 mEq/L 2.Prothrombin time of 12 seconds 3.A direct bilirubin level of 2 mg/dL 4.Platelet count of 400,000 cells/mm3

3.A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen causes liver damage. Option 3 is an indicator of liver function and is the only option that indicates an abnormal laboratory value applicable to liver dysfunction. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

A client began taking amantadine approximately 2 weeks ago. A decrease in which should the nurse expect to see if the medication is having a therapeutic effect? 1.Anxiety 2.Hallucinations 3.Rigidity and akinesia 4.White blood cell count

3.Rigidity and akinesia Rationale: Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication.

Amantadine hydrochloride 100 mg orally twice daily has been prescribed for a client with Parkinson's disease, and the nurse teaches the client about the medication. Which statement by the client indicates a need for further teaching? 1."I should see improvement in my condition in about 7 days." 2."I can empty the capsules into food or fluid to make swallowing easier." 3."I can get this medication in syrup form if I have difficulty swallowing." 4."I'll take this medication early in the morning and just before I go to bed."

4."I'll take this medication early in the morning and just before I go to bed." Rationale: Amantadine hydrochloride is an antiparkinson medication administered twice a day, but the last dose should not be administered near bedtime because it may cause insomnia in some clients. Options 1, 2, and 3 are correct statements for this medication.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? 1.Auranofin 2.Pentostatin 3.Fludarabine 4.Acetylcysteine

4.Acetylcysteine Rationale: The antidote for acetaminophen is acetylcysteine. The normal therapeutic serum level of acetaminophen is 10 to 20 mcg/mL (100 to 200 mcmol/L). A toxic level is higher than 50 mcg/mL (500 mcmol/L), and levels higher than 100 mcg/mL (1000 mcmol/L) could indicate hepatotoxicity. Auranofin is a gold preparation that may be used to treat rheumatoid arthritis. Pentostatin and fludarabine are antineoplastic agents.

A client who is on lithium carbonate will be discharged at the end of the week. In reinforcing a discharge teaching plan, the nurse should include which instructions? 1.Avoid soy sauce, wine, and aged cheese. 2.Have the lithium level checked every week. 3.Take medication only as prescribed because it can become addicting. 4.Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.

4.Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale: The client needs to check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is the medication of choice to treat manic-depressive illness. Lithium is not addicting, and although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet or one including soy sauce, wine, and aged cheese, is associated with monoamine oxidase inhibitors.

The nurse is assisting in preparing a plan of care for a client with a diagnosis of cancer who is receiving morphine sulfate in an extended format by mouth. The nurse should include which priority nursing action in the plan of care for this client? 1.Monitor the urine output. 2.Encourage increased fluids. 3.Monitor the client's temperature. 4.Encourage the client to cough and deep breathe.

4.Encourage the client to cough and deep breathe. Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent complications related to the use of this medication. Although options 1, 2, and 3 may be components of the plan of care for this client, option 4 identifies the priority nursing action.

A client has been started on medication therapy with alprazolam. When the nurse teaches the client that the medication should not be discontinued abruptly, the client asks why. The nurse should incorporate which information in formulating a reply? 1.The client is likely to suffer irreversible kidney damage. 2.The client is likely to become resistant to medication effects. 3.It will make the medication much less effective if it must be restarted. 4.Rebound central nervous system (CNS) excitation could occur, including seizure activity.

4.Rebound central nervous system (CNS) excitation could occur, including seizure activity. Rationale: The information the nurse would include in formulating a reply to the client is that rebound central nervous system (CNS) excitation could occur, including seizure activity. Alprazolam is a benzodiazepine anxiolytic. The abrupt withdrawal of alprazolam could result in seizure activity from CNS excitation. All clients receiving this medication need to be warned of this danger. The other options are incorrect and unrelated to this medication.

Morphine sulfate is being administered to a client with cancer. The nurse is monitoring the client for signs of overdose related to this medication therapy. Which finding noted in the client should require the need to notify the registered nurse? 1.Temperature of 98.6° F 2.Blood pressure 110/70 mm Hg 3.Apical rate of 72 beats per minute 4.Respirations of 10 breaths per minute

4.Respirations of 10 breaths per minute Rationale: Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be determined. The registered nurse is notified immediately if the respiratory rate is below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value. The registered nurse would then contact the primary health care provider.

Entacapone is prescribed for a client with a diagnosis of Parkinson's disease. The nurse reinforces medication instructions to the client and instructs on which frequent side effect? 1.Pruritus 2.Joint pains 3.Muscle weakness 4.Urine discoloration to dark yellow or orange

4.Urine discoloration to dark yellow or orange Rationale: Entacapone is an antiparkinsonian agent that is used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. A frequent side effect is a urine discoloration to dark yellow or orange. Joint pains, muscle weakness and pruritus are not associated with the use of this medication.

A hospitalized client is prescribed phenelzine sulfate for the treatment of depression. The nurse reinforces instructions to the client and tells the client to avoid consuming which foods while taking this medication? Select all that apply. 1.Figs 2.Yogurt 3.Crackers 4.Aged cheese 5.Tossed salad 6.Oatmeal cookies

1.Figs 2.Yogurt 4.Aged cheese Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor. The client should avoid consuming foods that are high in tyramine. Eating these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

Phenytoin, 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? 1."I will use a soft toothbrush to brush my teeth." 2."It's all right to break the capsules to make it easier for me to swallow them." 3."If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4."If my throat becomes sore, it's a normal effect of the medication and it's nothing to be concerned about."

1."I will use a soft toothbrush to brush my teeth." Rationale: Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity.

The nurse is reinforcing medication discharge instructions for a client who has just begun taking isocarboxazid for depression and knows that the client needs further teaching after stating that which foods are safe to eat? Select all that apply. 1.Avocado 2.Apple 3.Bologna 4.Tomato 5.Broccoli

1.Avocado 3.Bologna Rationale: The client who is taking isocarboxazid needs further teaching after stating that avocado and bologna are safe to eat. Foods that are restricted for clients who take monoamine oxidase inhibitors (MAOIs) are foods that contain tyramine and include avocados; figs; fermented, smoked, and organ meats; dried and cured fish and most cheeses; foods with yeast; imported beers and Chianti wines; and some soups that contain protein extract. Apples, tomatoes, and broccoli do not contain tyramine and are safe to eat.

The nurse is caring for a client who has been admitted for alcohol abuse and knows that which medications may be prescribed in the treatment of this disorder? Select all that apply. 1.Diazepam 2.Bupropion 3.Disulfiram 4.Chlordiazepoxide 5.Methadone hydrochloride

1.Diazepam 3.Disulfiram 4.Chlordiazepoxide Rationale: Medications used in the treatment of alcohol abuse include diazepam, disulfiram, chlordiazepoxide, carbamazepine, acamprosate calcium, phenobarbital, quetiapine fumarate, and naltrexone. Bupropion is used in the treatment of nicotine addiction, and methadone hydrochloride is used in the treatment of opiate addiction.

A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse explains to the client that which side effect is associated with this type of medication? 1.Postural hypotension 2.Cardiac dysrhythmias 3.Psychosomatic symptoms 4.Respiratory insufficiency

1.Postural hypotension Rationale: Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication. The other side effects are unrelated to the use of this medication.