test 3 practice questions from pp
The nurse assesses a client starting a benzodiazepine prescription for which of the following?
suicide ideation
Adrenergic agonist drugs are also known by what name?
sympathomimetic
Side effects of antipsychotic medications including stiff, jerky movements of your face and body that you can't control, present as which disorder?
tardive dyskinesia
The patient has been started on a treatment regimen that includes the beta blocker atenolol (Tenormin) and complains of feeling weak. Which is the best response from the nurse?
this is a normal side effect-lets alternate periods of activity with periods of rest.
The nurse is teaching a patient who will begin a TCA, amitripyline to treat depression. Which statement by the patient indicates a need for further teaching?
I will take the medication in the morning before breakfast
A patient who is taking aspirin for arthritis pain asks the nurse why it also causes GI upset. The nurse understands that this is because aspirin
Inhibits both COX-1 and COX-2
When assessing a patient taking hydration therapy for seizure disorder, which indicates an adverse reaction to this therapy?
Thrombocytopenia
A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed?
Thyroid hormone assay Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.
List drugs that are classified as alpha adrenergic antagonists?
doxazosin, phentolamine, & tamsulosin.
Your patient has just begun taking a benzodiazepine to treat anxiety. You should monitor the client for which potentially injurious side effect of this class of medication?
drowsiness
You are teaching a patient who will begin taking the cholinergic agonist, bethanechol (Urecholine). Which statement by the patient indicates adequate teaching?
this medication will increase or improve my urine output.
Your patient with CHF has been started on a beta-blocker medication. What interventions are appropriate for this patient?
monitor HR, BP, daily weights, and for complaints of fatigue.
Your patient has been receiving the antiseizure medication phenytoin. What patient labs are considered a priority for the nurse to review?
monitor phenytoin level, BUN, creatinine, LFTs, and platelet count.
A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of toxicity?
memory impairment, tremors, and blurred vision.
The nurse is preparing to administer an antidepressant, paroxentine HCl (Paxil) to a 70 year old patient. The nurse understands that this patient may require
A decreased dose
A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide?
Alcohol increases the chance of phenytoin toxicity. Rationale: The nurse should include in the home instructions that alcohol alters the blood level of phenytoin.
It is especially important not to consume alcohol or CNS depressants while taking this class of drug
Anti anxiety drugs
A drug used to treat Parkinson's that inhibits the release of acetylcholine is known as what classification
Anticholingeric
This class of drug is known to cause constipation
Anticholingeric meds
This class of drug is known for the side effect of HA, nervousness, suicide ideation
Antidepressants
.A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect?
Constipation Rationale: Mydriatic eye drops can cause systemic anticholinergic effects, such as constipation and dry mouth.
What is the highest priority nursing diagnosis for a patient taking phenytoin? A. Anxiety B. Risk for falls C. Risk for constipation D. Deficient fluid volume
B. Risk for falls
This classification of antiseizure medication is restricted to short-term use ( 2 weeks or less) because of side effects and risk for drug tolerance?
Barbiturate drugs.
.A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse?
Bologna sandwich Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content.
Before administering a daily dose of phenytoin, it is most important for the nurse to do what?
Check the phenytoin level
The nurse is assisting with a client who was just in a motor vehicle accident (MVA). The client complains of feeling jittery, with heart palpitations, and dizziness. Why is the client feeling this way?
His sympathetic nervous system has been triggered
A patient arrives in the emergency department with dehydration. The patient reports taking antipsychotic medications to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6 F, A hr of 98 bpm, and a bp of 90/58mmHg. The nurse will anticipate administering what medication?
Dantrolene ( dantrium)
.A nurse is caring for a client who has a prescription for olanzapine. The nurse should monitor the client for which of the following manifestations as an expected response to this medication?
Decreased auditory hallucinations Rationale: Olanzapine is prescribed for the treatment of the manifestations of schizophrenia, one of which is auditory hallucinations.
A nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching?
Diazepam can cause drowsiness. Rationale: Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.
A patient is experiencing status epilecticus. The nurse anticipate immediate administration of which drug first?
Diazepam or lorazepam
A patient is taking aspirin to help prevent MI and is experiencing moderate GI upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug?
Enteric coated aspirin
A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client?
Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication.
This drug is known for causing blurred vision ( with halos) and tremors with toxicity
Lithium
The nurse is performing an admission assessment on an adolescent who reports taking extra strength acetaminophen (Tylenol) regularly to treat daily HAs. The nurse will notify the patients provider and discuss an order for
Liver enzyme tests
.A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching?
Obtain a daily weight. Rationale: Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance.
A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an antipsychotic medication. The provider and nursing staff suspect the client is not adhering to his medication therapy. Which of the following interventions should the staff use to encourage the client's adherence?
Provide for once-daily dosing. Use sustained-release forms. Engage the client in conversation following medication administration.
A patient has been taking the atypical antipsychotic medication, risperidone for 2 weeks. The patient reports drowsiness and HA. What will the nurse do?
Reassure the patient that these are common side effects of the medication
A patient has been taking a SSRI, sertraline 20 mg per day for 2 weeks and reports HAs, nervousness, and poor appetite. Which action will the nurse take?
Reassure the patient that these side effects will decrease over time
A nurse is teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor for and report which of the following adverse effects of this medication?
Skin rash Rationale: Phenytoin is an antiepileptic medication used to treat partial seizures and generalized tonic-clonic seizures. Phenytoin can cause a rash that can progress to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). If a rash develops, the client should notify the provider immediately and stop the use of phenytoin.
A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements?
Sodium Rationale: Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.
You are caring for a patient who has asthma and you administer albuterol, a selective adrenergic agonist to treat bronchospasm. You will anticipate hearing what lung sounds with bronchospasm?
wheezes to the upper lobes.
While taking a dopamine agonist your patient complains of dizziness, insomnia
These are common side effects
A nurse is assessing a client who has been taking the antidepressant sertraline for 3 weeks. The nurse should identify which of the following findings as an indication that the medication is effective
a report of mood elevation
A nurse is teaching a client who has a new prescription for alprazolam to treat insomnia. Which of the following instructions should the nurse included?
"Avoid activities that require alertness such as driving." Rationale: The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation and dizziness.
A patient with major depression has been prescribed fluoxetine. What nursing diagnosis would be most appropriate? A.Social Isolation B.Mobility, Impaired Physical C.Urinary Elimination, Impaired D.Sensory Perception, Disturbed
ANS: A The most appropriate nursing diagnosis for the patient taking fluoxetine is social isolation. Impaired physical mobility, impaired urinary elimination, and disturbed sensory perception are not associated with fluoxetine.
A nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide?
. "Sleepiness should subside within a week." Rationale: The nurse should inform the client that fluphenazine, like other first-generation antipsychotics, may cause sedation with early treatment, but should subside within a week or so.
.A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication?
. Insomnia Rationale: The nurse should monitor the client for paradoxical effects such as insomnia and excitation. If these occur, the medication should be withdrawn.
A home health nurse is assessing an older adult client who reports falling a couple of times over the past week. Which of the following findings should the nurse suspect is contributing to the client's falls?
. The client takes alprazolam. Rationale: Alprazolam is a CNS depressant that can cause dizziness and orthostatic hypotension, which can cause the client to lose his balance and fall.
Which se of carbidopa/ levodopa does the nurse monitor for
Urinary retention
A patient is about to begin taking the atypical antipsychotic medication clonazpine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication?
You are more likely to experience dry mouth, constipation, and urinary retention
A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? • A.Dantrolene B.Tetrabenazine C.Propranolol D.Lorazepam
ANS: A Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).
When providing dietary teaching for a patient taking monoamine oxidase inhibitors, the nurse should teach the patient to avoid which food? • A.Yogurt B.Avocado C.Grapefruit D.Potato chips
ANS: A When taking monoamine oxidase inhibitors (MAOIs), patients should avoid cheese, red wine, beer, liver, bananas, yogurt, and sausage.
Your patient is beginning to have a new increase in their symptoms associated with Parkinson's disease. As the nurse you understand that this impacts medical management in what way?
You notify the PCP about how the client's disease has progressed and that it may be time to add a second-line treatment.
A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. Which of the following instructions should the nurse provide?
Administer the medications 5 min apart. Rationale: The nurse should instruct the client that, if more than one ophthalmic medication is to be administered, they should be given 5 min apart.
CNS depression is a common drug interaction between psychotherapeutic drugs and what socially imbibed substance?
alcohol
Your admit has a new diagnosis of epilepsy. Which nursing interventions are your highest priority?
seizure precautions: safe environment, place IV lock, set-up suction.
A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching?
"I'll take this medicine first thing in the morning." Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia.
A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching?
"Vomiting is an indication of toxicity." Rationale: Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.
A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states, • A."I feel like I need to throw up." B."I need to urinate." C."My mouth feels dry." D."I have a headache."
ANS: C Atropine is useful primarily (1) as a preoperative medication to decrease salivary secretions and (2) as an agent to increase heart rate when bradycardia is present.
A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). Which foods present a risk for interactions?
high tyramine containing foods
A patient who has been diagnosed with social anxiety disorder will begin taking a SNRI, venlafaxine (Effexor). The nurse who performs a medication and dietary history will be concerned about ingestion of which substance or drug?
St Johns wort
A nurse is caring for an adolescent client who is receiving carbamazepine for partial seizure disorder. Which of the following statements by the client's parent is the nurse's priority?
"He has so many new bruises on his body." Rationale: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority concern is frequent bruising because this is a manifestation of carbamazepine toxicity. Carbamazepine toxicity can cause bone marrow depression, including leukopenia, anemia, and thrombocytopenia. The parent should monitor the client for bruising, bleeding, and sore throat and have periodic blood work drawn to monitor for myelosuppression.
A nurse is providing teaching to a client who has schizophrenia and is receiving chlorpromazine. Which of the following client statements indicates an understanding of the teaching?
"I will contact my provider if I have difficulty urinating." Rationale: Chlorpromazine is a first-generation, or typical, antipsychotic medication. The client should be instructed to monitor for increased anticholinergic adverse effects, such as dry mouth and urinary retention. Difficulty urinating could be a sign of urinary retention and should be reported to the provider for further evaluation.
A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching?
"I'll be glad when I can stop taking this medicine." Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.
Before administering an monoamine oxidase inhibitor, it is most important for the nurse to assess the patient's • A.sexual history. B.socioeconomic status. C.dietary intake. D.hydration status.
ANS: C Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.
Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium? • A.Urinalysis B.Serum glucose C.Serum electrolytes D.Complete blood count
ANS: C Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.
A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? • A.Asthma B.Hypertension C.Diabetes mellitus D.Chronic allergies
ANS: A Before administering bethanechol chloride (Urecholine), the nurse should obtain a history of health problems such as peptic ulcer, urinary obstruction, or asthma. Cholinergic agonists can aggravate symptoms of these conditions.
A nurse is administering epinephrine to a patient during a cardiac arrest. The primary desired action of this medication is to A.stimulate a heart rate. B.decrease cerebral blood flow. C.initiate respirations. D.increase blood flow to the kidneys.
ANS: A Epinephrine is a potent inotropic (strengthens myocardial contraction) drug that increases cardiac output, promotes vasoconstriction and systolic blood pressure elevation, increases heart rate, and produces bronchodilation. High doses can result in cardiac dysrhythmias necessitating electrocardiogram (ECG) monitoring. Epinephrine can also cause renal vasoconstriction, thereby decreasing renal perfusion and urinary output.
A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because: A.taking alcohol with Ativan can be fatal. B.taking alcohol with Ativan may increase sedative effects. C.all patients using alcohol should be referred for assistance. D.Ativan and alcohol antagonize one another.
ANS: B Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.
A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? ● A.Diabetes mellitus B.Glaucoma C.Allergy to penicillin D.Gastric ulcer
ANS: B Because anticholinergic drugs can increase intraocular pressure, they should not be administered to patients diagnosed with glaucoma.
When teaching a patient who has been prescribed metoprolol about side/adverse effects, which is the highest priority teaching point? A.Report any complaints of stuffy nose. B.Instruct the patient how to take a pulse. C.Check for bladder distention. D.Warn of possible impotence and decreased libido.
ANS: B It is most important for the patient to learn how to monitor the heart rate because of the side effect of bradycardia with metoprolol.
A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? A.Nausea B.Tachycardia C.Rales D.Hypotension
ANS: B It is most important to monitor the heart rate for tachycardia after atropine is given. Atropine may be given without regard to meals. Rales would not be expected because atropine dries secretions rather than increase them. Hypertension is a more likely response than orthostatic hypotension.
The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam states: A."I must stop drinking coffee and colas." B."I can stop this drug after 3 weeks if I feel better." C."I must stop drinking alcoholic beverages." D."I should not become pregnant while taking this drug."
ANS: B Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.
A patient on risperidone may be at increased risk for injury due to: A.increased potential for aspiration due to sedation. B.increased risk for falls due to orthostatic hypotension. C.increased risk for infection due to neutropenia. D.increased risk for suicide due to changes in thought processes.
ANS: B Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).
A young woman is being treated for psychosis with fluphenazine. Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? A.A decrease in pulse and respiratory rate B.Facial grimacing and tongue spasms C.An increase in hallucinations D.A decrease in the patient's level of orientation
ANS: B Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.
Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? • A."It might take 6 weeks or more for the drug to take effect." B."I will get up slowly from a seated position." C."When I start to feel better, I will cut the dose of my medication in half." D."I will avoid exposure to direct sunlight."
ANS: C The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.
The nurse is teaching the patient about the side effects of propranolol. These include • A.pupillary constriction. B.blood vessel dilation. C.bronchospasm. D.tachycardia.
ANS: C The side effects commonly associated with beta blockers are bradycardia, hypotension, headache, dizziness, cold extremities, hypoglycemia, and bronchospasm.
A patient has received atropine earlier today. It is most important for the nurse to assess the patient for which effect? A. Anxiety B. Constipation C. Urinary retention D. Impaired oral mucous membrane
ANS: C Urinary retention is the highest priority because it is more serious to systemic homeostasis than anxiety, constipation, or a dry mouth.
Atropine is most useful in the treatment of which cardiovascular condition? A.Ventricular fibrillation B.First-degree heart block C.Premature atrial contraction D.Sinus bradycardia
ANS: D Atropine is used to treat sinus bradycardia.
Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include: A.bradycardia. B.hypothermia. C.muscle weakness. D.rhabdomyolysis.
ANS: D NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.
A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient?
Therapeutic effects may not be evident for another week
Which side effects indicate an adverse reaction to the antidepressant serotonin norepinephrine re-uptake inhibitors?
a pounding HA ( elevated BP) and tachycardia (feeling of heart racing or palpitations).
Sertraline and fluoxetine are two drugs in which category and classification of meds?
antidepressants- serotonin re-uptake inhibitors.
This class of drugs is known for causing neuroleptic malignant syndrome?
Antipsychotic drugs
Which classification of psychotherapeutic drug is used to treat schizophrenia and other psychotic disorders in patients not responding to or intolerant of the usual antipsychotics?
Atypical antipsychotics.
Which of the following should the nurse include with a new prescription for alprazolam to treat insomnia
Avoid activities that require alertness
A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include?
Avoid activities that require alertness such as driving. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known.
Teaching for a client who has a seizure and he prescription for phenytoin
Avoid flossing
The nurse knows that urinary retention is a side effect of which psychotherapeutic drug class?
antipsychotics-haloperidol
The nurse educates the client who has had anaphylaxis on the following drug side effects: heart dysrhythmias, heart palpitations, fast heartbeat, and nausea. These are noticed with the use of which drug?
epinephrine
The nurse should assess a patient taking anticholinergic meds for which diagnosis
glaucoma
A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?
Counsel the patient to discuss a prescription NSAID with the provider
The E.D. nurse assesses the patient as presenting with the inability to concentrate or sit down, irritation, and sweating as potentially having which disorder related to the use of serotonin effecting medications?
serotonin syndrome
A charge nurse is teaching a group of nurses about the antagonist action of medications. The nurse should include in the teaching that which of the following antagonist medications is used for benzodiazepines?
Flumazenil Rationale: The nurse should teach that flumazenil is an antagonist that reverses the effects of benzodiazepines by recognition site on the GABA/benzodiazepine receptor complex.
A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?
Tardive dyskinesia Rationale: These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. For many clients, the manifestations are irreversible.
A nurse is assessing a client who has been taking sertraline for 2 weeks. The nurse should identify which of the following findings as an indication that the medication is effective?
The client reports increase in mood. Rationale: Sertraline is a selective serotonin reuptake inhibitor used to treat major depressive disorders. Therapeutic effects include increase in mood, and an increased interest in activities.
