PrepU Exam 2

The nurse is providing education to a client who has been prescribed clozapine. The nurse should emphasize the importance of what monitoring routine during teaching?

Regular complete blood counts

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Salami

A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?

Reduction of muscle spasm

A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?

dry mouth

A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?

onset of suicidal ideation.

A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n):

increased risk for toxic effects of haloperidol therapy.

A 49-year-old woman has been diagnosed with myalgia. The health care provider has recommended aspirin. The client is concerned that the aspirin will upset her stomach. The nurse will encourage the client to take this medication by:

swallowing the tablet with milk or food.

A patient with muscle ache would like to use an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?

It causes decreased effectiveness of the antihypertensive drug.

A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?

"Acetaminophen has no effect on inflammation."

The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent?

Clozapine

When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action?

Platelet aggregation is inhibited.

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

SSRIs prevent serotonin from being reabsorbed.

A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication?

Decreased muscle spasms

While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan?

Orthostatic hypotension

When does a client with spinal cord injury-associated spasticity require treatment for this condition?

Safety, mobility, and activities of daily living are impaired.

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?

Serotonin

A client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience?

Tardive dyskinesia

A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome?

Acetylsalicylic acid

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide?

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."

Which is the antidote for acetaminophen poisoning?

acetylcysteine

An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

"This is the result of neurologic factors over which you have no direct control."

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy?

"I may always have to take this medication."

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse?

"It is an aspirin substitute for pain and fever."

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective."

A client is prescribed transdermal selegiline. What health education should the nurse provide?

"Place the patch on dry skin on your torso that has no cuts or openings."

A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?

5

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?

Avoid alcohol or other CNS depressants.

A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?

Blocks interleukin-1

The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed?

Chlorpromazine

The nurse is providing education to a client who has been prescribed clozapine. During teaching, the nurse should inform the client of the need for regular monitoring of what laboratory test during the initial months of therapy and periodically thereafter?

Complete blood count (CBC)

The nurse is preparing to administer chlorpromazine intramuscularly to a client. What action should the nurse implement during administration?

Encourage the client lie down for 30 to 60 minutes after the injection.

A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?

Extrapyramidal

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness

A client with schizophrenia has been taking haloperidol for several years. The care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention?

Gradually taper the dose of haloperidol.

The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?

Hypotension

A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?

Increased blood glucose

The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means?

Increasing levels of both serotonin and norepinephrine

The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects?

Inspection for muscle spasticity and range of motion assessment

An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?

Malignant hyperthermia

A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions?

Monitor the client closely for bleeding and review coagulation indices when available.

A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first?

Notify the physician.

The nursing instructor is discussing COX-2 inhibitors with her nursing students. Where would the instructor tell her students that COX-2 inhibitors work?

Only at sites of trauma and injury

The nurse is assessing a 13-year-old client who has symptoms of depression and recognizes that what class of antidepressant medication would not be a drug of choice for an adolescent?

TCAs

A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication?

The importance of ensuring safety related to possible sedation

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs.

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?

To inhibit platelet aggregation

What is chrysotherapy?

Treatment with gold salts

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months?

White blood cells

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?

blood pressure

A client has been diagnosed with severe rheumatoid arthritis, and hylan G-F 20 has been ordered. How is this drug given?

injected into joint

What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.)

- Anti-inflammatory - Analgesic - Antipyretic

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."

A client has called the ambulatory clinic reporting headache, a "droopy eyelid" and malaise after receiving Botox injections at a friend's home the previous evening. The client is distressed, stating, "I had no idea that the injections could cause any problems." What is the nurse's best response?

"Come to the clinic so you can be assessed. You're likely having adverse reactions to the Botox injections."

A client has told the nurse that she has been invited to a work colleague's house where she and some of her peers will be able to receive Botox injections. What is the nurse's best response?

"It's safest to have these injections performed under medical supervision."

A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client?

"The drug has no effect on inflammation."

A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment?

"This will likely make you drowsy, so don't take it before doing anything that would require alertness."

A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?

"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients."

A male client is taking aspirin 81 mg by mouth each day for prevention of recurrent myocardial infarction. He makes a dentist appointment for a tooth extraction. He calls the health care provider's office and asks the nurse if he is at risk for bleeding. Which response is correct?

"Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders."

A nurse should review a client's medical conditions prior to administering a dantrolene as its use is contraindicated in clients with which issues? (Select all that apply.)

- Lactation - Hepatic disease

A client is being discharged following an allergic reaction after ingesting aspirin. When providing client education about the allergy, the nurse would provide the client with what information?

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?

A lower dose of the antidepressant

Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen?

A male 30 years of age who drinks four beers per day

A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?

Antipsychotics do not improve memory loss and may further impair cognitive functioning.

The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication?

Aspirin

When acetylsalicylic acid (aspirin) is administered, what action prevents the synthesis of thromboxane A2?

Aspirin's acetyl portion dissociates, binding to COX-1 to decrease aggregation.

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?

Baclofen

A nurse understands that which skeletal muscle relaxants should not be administered to a client with skeletal muscle spasms caused by systemic lupus erythematosus?

Baclofen

A student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation?

Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.

A high-school-age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?

Cardiac monitoring

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?

Diazepam (Valium)

The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client?

Discontinue the use of alcohol.

The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit?

Disorganized and often bizarre thinking

What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?

Do not drive or operate machinery until individual drug effects are known.

A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?

Drowsiness

The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for?

Drowsiness

Which is the drug of choice in children who need to be treated with tetanus?

Methocarbamol (Robaxin)

Which diffuse connective tissue disease is the result of an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema?

Rheumatoid arthritis (RA)

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives.

The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital?

The patient will take medications as prescribed.

A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?

Venlafaxine

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction?

Wear appropriate clothing and sunscreen whenever he is in direct sunlight.

The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition?

When close supervision is available for monitoring drug effects

The nurse knows the medication methylphenidate is used to treat attention deficit hyperactivity disorder(ADHD). What type of medication is methylphenidate?

a central CNS stimulant

A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:

allergy to sulfonamides

A nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug?

celecoxib

The nurse knows that acetaminophen should not be used in older adults with which condition?

cirrhosis.

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?

dantrolene

A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an

electrocardiogram (ECG).

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?

gold salts

A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may:

have undiagnosed diabetes.

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse's priority assessment would be

height and weight

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which?

height and weight.

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of:

hepatocellular disease.

A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?

history of seizure disorder

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?

oral

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which?

peptic ulcer disease or gastritis.

A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?

presence of suicidal ideation

A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

Dangerous drug interactions

A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to leave work for clinic appointments. How should the nurse respond to that request to best assure client safety?

"The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse."

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response"

"This drug causes your urine to change color, so it's not likely blood that you're seeing."

The nurse interviews the family of a client hospitalized with severe depression and suicidal ideations. What assessment data is important in planning this family's plan of care? (Select all that apply.)

- Recent suicide attempts - GI obstruction - Affect

The clinician has recommended that an adolescent take a "drug holiday" from the prescribed methylphenidate. What assessments should the nurse focus on to provide data to support the need for this intervention? Select all that apply.

- height - appetite

What conditions are salicylates are effective in managing? (Select all that apply.)

- inflammation - pain - fever

How long does a patient need to wait after stopping a phenelzine before starting paroxetine?

14 days

The nurse expects to monitor a client's white blood count weekly when the client is prescribed:

Clozapine

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?

Drowsiness

Moderate CNS depression is characterized by:

Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.

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

Falls prevention measures

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?

Hepatic dysfunction

A client is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is the most common in acute or chronic overdose of acetaminophen?

Hepatotoxicity

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?

It may take up to two more weeks before the client feels better

A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen?

Risk for Injury related to CNS depression

While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as:

an attempt by the body to remove the damaging agent and repair the damaged tissue.

How should a nurse best explain the presence of the inflammation process?

as an attempt by the body to remove the damaging agent and repair the damaged tissue

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet.

A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

better mobility

The nurse is caring for a client who has been prescribed lithium. Which nursing interventions are related to this medication? (Select all that apply.)

- Increase fluid intake to approximately 3000 mL/day. - Monitor client for drowsiness. - Administer lithium with food.

A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug?

Acetaminophen

A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area?

Adverse effects of NSAIDs

The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching?

Hepatitis

A patient is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is most common in acute or chronic overdose of acetaminophen?

Hepatotoxicity

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension

An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?

Measurement of height and body weight

A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.

Which drug shares the abuse potential of amphetamines and is a Drug Enforcement Administration (DEA) schedule II controlled substance?

Methylphenidate, a centrally acting CNS stimulant

A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?

ibuprofen

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine

Antipsychotic drugs are contraindicated in clients with:

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.