316b Test 1

The nurse is teaching a client about tricyclic antidepressants. Which potential sideeffects would the nurse include? Select all that apply. One, some, or all responses may becorrect. A. Dry mouth B. Drowsiness C. Constipation D. Severe hypertension E. Orthostatic hypotension

A, B, C, E Dry mouth is a common anticholinergic side effect of tricyclic antidepressants.Drowsiness can be a common side effect but usually decreases with continuedtreatment. Constipation is a common side effect that usually can be managed with stoolsofteners and a high-fiber diet. Orthostatic hypotension is a common side effect oftricyclic antidepressants; the client should be instructed to rise slowly from a sitting to astanding position. Hypertension of any type is not a side effect of tricyclicantidepressants.

Which statement accurately describes nortriptyline? Select all that apply. One, some,or all responses may be correct. A. Overdosage is often lethal. B. Constipation and urinary retention may occur. C. It is a selective serotonin reuptake inhibitor (SSRI). D. Weight gain is a common side effect. E. It increases effectiveness of monoamine oxidase inhibitors (MAOIs).

A, B, D Nortriptyline is notoriously lethal; between 70% and 80% of people who die fromoverdose do so before reaching the hospital. Nortriptyline can cause constipation andurinary retention because it causes blockage of cholinergic receptors, and it tends toincrease appetite and cause weight gain. Nortriptyline is not an SSRI; it is a tricyclicantidepressant and affects the balance of neurotransmitters in the brain. The interactionbetween nortriptyline and MAOIs is severe and possibly fatal.

The health care provider prescribes a cholinergic medication to treat a client'surinary problem. Which effect would the nurse anticipate? A. Urinary frequency decreases. B. Urinary retention is prevented. C. Pain is controlled. D. Urinary urgency decreases.

B Cholinergics intensify and prolong the action of acetylcholine, which increases tone inthe genitourinary tract, preventing urinary retention. Cholinergic antagonists areprescribed for frequency and urgency associated with a spastic bladder; thereforecholinergics would worsen rather than decrease these problems. Cholinergic do not haveanalgesic effects.

A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m.dose. Which action should the nurse perform to alleviate this side effect? A. Change the time of the dose. B. Hold the 9 p.m. dose. C. Administer the dose with a snack. D. Offer an antiemetic with the dose.

C Administering oral doses of albuterol with food helps minimize gastrointestinaldiscomfort such as nausea.

Nortriptyline is prescribed for a depressed client. Which time period identifies whenthe nurse would expect a therapeutic response? A. 1 to 3 days B. 12 to 24 hours C. 30 minutes to 2 hours D. 2 to 3 weeks

D As with other tricyclics, optimal therapeutic effects take 2 to 3 weeks to occur. One to 3days, 12 to 24 hours, and 30 minutes to 2 hours are all too soon to expect a response tonortriptyline.

A client begins treatment with pyridostigmine bromide therapy for myastheniagravis. Which action would the nurse perform in administration of the medication? A. Administer the medication after meals. B. Administer the medication on an empty stomach. C. Evaluate the client's psychological responses between medication doses. D. Evaluate the client's muscle strength every hour after the medication is given.

D The onset of action of pyridostigmine is 30 to 45 minutes after administration, and theeffects last up to 6 hours; the client's response will influence dosage levels.Pyridostigmine usually is administered before meals to promote mastication.Pyridostigmine should be administered with food to prevent gastric irritation. There areno psychological side effects associated with pyridostigmine.

Which medication class includes amitriptyline? A. Tricyclics B. Monoamine oxidase inhibitors (MAOIs) C. Selective serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

A Amitriptyline is one of several tricyclic antidepressants used to treat anxiety disorders.It is not an MAOI, SSRI, or SNRI.

The nurse is providing discharge education to a client with moderate persistentasthma. The nurse should instruct the client to administer which medication first? A. Bronchodilator B. Glucocorticoid C. Anticholinergic D. Mast cell stabilizer

A Bronchodilators, such as albuterol, are beta-agonist drugs that relieve bronchospasm byrelaxing the smooth muscle of the airway. These medications should be inhaled first toopen the airways, which will allow the other medications to move more deeply into thelungs and increase their effectiveness.

The nurse is teaching a nursing student about tricyclic antidepressant medications.Which statement made by the student indicates the need for further teaching? Select allthat apply. One, some, or all responses may be correct. A. Nortriptyline is contraindicated in older adult clients. B. Desipramine is preferred for use in older adult clients. C. Imipramine is used as an adjunct in the treatment of childhood enuresis. D. Tricyclic antidepressant medications are prescribed for clients with seizuredisorders. E. Tricyclic antidepressant medications are contraindicated in clients with a historyof seizures.

A, D Nortriptyline is a preferred tricyclic antidepressant that can be administered safely inolder adult clients. Antiepileptic medications are prescribed to clients with seizures.Desipramine and nortriptyline are preferred tricyclic antidepressants for use in olderadult clients. Childhood enuresis necessitates the administration of imipramine. Clientswith epilepsy should not be prescribed tricyclic antidepressants to avoid the risk ofmedical complications.

The nurse is teaching a client with asthma about albuterol. How should the nursebest describe the action of this medication? A. "The medication is given to reduce secretions that block airways." B. "The medication will help to relax smooth muscles in the airways." C. "The medication will stimulate the respiratory center in the brain." D. "The medication will help to prevent pneumonia."

B Albuterol is a bronchodilator and rescue drug of choice to treat asthma. It is a short-acting beta-adrenergic agonist that is used to prevent and treat wheezing, difficultybreathing, and chest tightness. Albuterol works by relaxing and opening the airways tomake breathing easier. The medication comes as a tablet, syrup, inhaler and nebulizer.Albuterol does not reduce secretions, stimulate the respiratory center in the brain orprevent pneumonia.

The nurse has administered fentanyl, atropine, cefazolin and benzocaine to a clientfor an endoscopic procedure. The nurse is monitoring the client and notes that the heart rate has increased from the pre-procedure baseline. The nurse knows that which of thefollowing medications is most likely responsible for the client's increased heart rate? A. Fentanyl B. Atropine C. Cefazolin D. Benzocaine

B Procedural sedation is used in endoscopic procedures as an effective way to provide anappropriate degree of pain and anxiety control; memory loss; and decreased awareness.The most commonly used medication regimen for gastrointestinal endoscopic procedureis still the combination of benzodiazepines, opioids, anticholinergics and topicalanesthetics. Atropine is an anticholinergic drug that is used to dry secretions during theprocedure. However, it can also increase the heart rate and dilate the pupils and is themost likely cause for the increased heart rate. Fentanyl is an opioid analgesic and short-term central nervous system (CNS) depressant and tends to slow breathing and lowerheart rate and blood pressure. Benzocaine is a topical anesthetic and cefazolin is anantibiotic; neither should affect the heart rate.

The nurse administers albuterol to a child with asthma. Which common side effectwould the nurse monitor for in the child? A. Flushing B. Dyspnea C. Tachycardia D. Hypotension

C Albuterol produces sympathetic nervous system side effects such as tachycardia andhypertension. Pallor, not flushing, is a common side effect. Dyspnea is not a commonside effect; this medication is given to decrease respiratory difficulty. Hypertension, nothypotension, is a common side effect.

The nurse is reviewing the medical record of a client who received a new prescriptionfor benztropine. For which condition in the client's record should the nurse clarify theprescription with the health care provider? A. Cataracts B. Schizophrenia C. Glaucoma D. Parkinson's disease

C Benztropine is an anticholinergic medication used to treat extrapyramidal disorderscaused by antipsychotic medications or Parkinson's disease. Use of benztropine or otheranticholinergics is contraindicated for individuals diagnosed with glaucoma, ileus andprostatic hypertrophy. Adverse effects include tachycardia, urinary retention andincreased intraocular pressure.

The nurse is preparing to discharge a client who presented to the emergency room foran acute asthma attack. The nurse notes that upon discharge the health care providerhas prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse willteach the client to take the medication on which schedule? A. One hour before or 2 hours after eating B. At bedtime C. At the specific time prescribed D. Daily until symptoms are gone

C For theophylline to be effective, therapeutic serum levels must be maintained by takingthe medication at the prescribed time. If the medication is not taken at the prescribedtime, the level may drop below the therapeutic range. The medication will not beeffective if it drops below the therapeutic range. Theophylline should be given after ameal and with a full glass of water to decrease gastric irritability. Giving it 2 hours aftera meal (on an empty stomach) can result in gastric discomfort. It should not be taken at

Which instruction would the nurse give to clients prescribed psychotropicmedications who are experiencing anticholinergic-like side effects? A. 'Restrict fluid intake.' B. 'Eat a diet high in carbohydrates.' C. 'Suck on sugar-free hard candies.' D. 'Avoid products that contain aspirin.'

C Hard candy may produce salivation, which helps alleviate the anticholinergic-like sideeffect of dry mouth that is experienced with some psychotropics. Dry mouth increasesthe risk for cavities; candy with sugar adds to this risk. Fluids should be encouraged, notdiscouraged; fluids may alleviate dry mouth. Eating a diet high in carbohydrates andavoiding aspirin are unnecessary.

Upon admission to the emergency center, an adult client with acute statusasthmaticus is prescribed this series of medications. In which order should the nurseadminister the prescribed medications? (Arrange from first to last.) A. Prednisone (Deltasone) orally. B. Gentamicin (Garamycin) IM. C. Albuterol (Proventil) puffs. D. Salmeterol (Serevent Diskus).

C. Albuterol (Proventil) puffs. D Salmeterol (Serevent Diskus). A. Prednisone (Deltasone) orally. B. Gentamicin (Garamycin) IM. Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, abeta2 adrenergic agonist and short acting bronchodilator, should be administered byinhalation first to provide rapid and deep topical penetration to relieve bronchospasms,dilate the bronchioles, and increase oxygenation. In stepwise management of persistentasthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid,provides prolonged anti-inflammatory effects and should be given after the client'srespiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM,which can be painful, and may require repositioning the client, so should be last in thesequence.

Which action would the nurse perform when beginning pyridostigmine bromide therapy for a client with myasthenia gravis? A. Administer the medication after meals. B. Administer the medication on an empty stomach. C. Evaluate the client's psychological responses between medication doses. D. Evaluate the client's muscle strength every hour after the medication is given.

D The onset of action of pyridostigmine is 30 to 45 minutes after administration, and theeffects last up to 6 hours; the client's response will influence dosage levels.Pyridostigmine usually is administered before meals to promote mastication.Pyridostigmine should be administered with food to prevent gastric irritation. There areno psychological side effects associated with pyridostigmine.

Which adverse effect of imipramine requires further assessment and possibleimmediate medical intervention? A. Dry mouth B. Weight gain C. Blurred vision D. Urinary hesitancy

D Urinary hesitancy and retention are adverse effects of imipramine that may requireimmediate medical intervention. Dry mouth, weight gain related to increased appetite,and blurred vision may occur as side effects of imipramine; they usually decrease overtime or can be managed through nursing interventions.

The nurse is teaching a client diagnosed with asthma about the medication albuterol.Which statement by the nurse demonstrates appropriate teaching? A. "Call your doctor's office if you need to use the drug more often." B. "Use this medication at bedtime to promote rest." C. "Use this medication after other asthma inhalers." D. "Discontinue the inhaler if you feel dizzy."

A Albuterol is a bronchodilator used for the relief of bronchospasm. It is considered arescue medication for a client during an asthmatic attack. If the client notices the needto use the inhaler more frequently, the health care provider (HCP) should be notified.The client may need to seek emergency medical care, as the medication is no longereffective. In addition, clients should not exceed the recommended dosage, as adverseeffects may occur. Be sure the client understands how to correctly use this medication.The client may experience side effects of dizziness, headache, nausea, vomiting, rapidheart rate, anxiety, sweating, flushing and insomnia. Using albuterol at bedtime maylead to insomnia. Albuterol should be used before all other inhalers, as it dilates thebronchi or bronchioles and allows more of the other medication to reach the lowerrespiratory tract. It would not be appropriate to suddenly discontinue taking abronchodilator.

The nurse administers albuterol to a 4-year-old child. Which intervention wouldassist the nurse in evaluating the effectiveness of this medication? A. Auscultate breath sounds. B. Collect a sputum sample. C. Conduct a neurological examination. D. Palpate chest excursion.

A Albuterol is an adrenergic medication that stimulates beta-receptors, leading torelaxation of the smooth muscles of the airway. The lungs should be auscultated to evaluate the effectiveness of this medication. Albuterol does not affect the consistency ofpulmonary secretions. Albuterol will not cause central nervous system stimulation.Albuterol does not affect intercostal contractility; chest excursion is not the appropriateassessment.

The nurse is educating a client with end stage chronic obstructive pulmonary disease(COPD) about medication management. Which statement by the client indicates anunderstanding of the teaching? A. "I will use the albuterol in the nebulizer before my other inhalers each morning." B. "I can use my tiotropium inhaler if I get short of breath." C. "I will only use the fluticasone inhaler on the days I am really out of breath." D "The side effects of these medications will be less severe because I'm not takingthem by mouth."

A Medication regimens used to treat COPD are based on disease severity. Forgrade III or IV (severe and very severe) COPD, medication therapy includes treatmentwith one or more bronchodilators and inhaled corticosteroids. Clients with COPDexperience significant breathlessness and reduced FEV1 upon waking. Use of nebulizedalbuterol prior to administration of long-acting medications relaxes the airway andallows other medications to get deeper into the lungs. Tiotropium is a long-actinganticholinergic (muscarinic) and is not meant for rescue purposes. Fluticasone preventsinflammation and therefore, must be used every day. Clients with COPD will experienceside effects of the medications due to the long duration of use.

The nurse is providing education to the client prescribed montelukast for thetreatment of asthma. What medication should the nurse instruct the client to avoid? A. Ibuprofen B. Prednisone C. Amoxicillin D. Formoterol

A Montelukast should not be taken with NSAIDs. It increases the risk ofbleeding as well as has the potential to make asthma symptoms worse. Prednisone,amoxicillin, and formoterol are all safe to administer to the client on montelukast

While receiving an adrenergic beta 2 agonist medication for asthma, the clientcomplains of palpitations, chest pain, and a throbbing headache. Which nursing actionis the most appropriate? A. Withhold the medication and notify the health care provider. B. Tell the client that these are expected side effects from the medicine. C. Give instructions to breathe slowly and deeply for several minutes. D. Explain that the effects are temporary and will subside as medication tolerancedevelops.

A These medications cause increased heart contraction (positive inotropic effect) andincreased heart rate (positive chronotropic effect). If toxic levels are reached and sideeffects occur, the medication should be withheld until the health care provider isnotified. Telling the client that these are expected side effects from the medicine is falsereassurance and a false statement; they should not cause chest pain. Controlledbreathing may be helpful in allaying a client's anxiety; however, the medication may beproducing adverse effects and should be withheld.

To which nursing home resident could a nurse safely administer tricyclicantidepressants without questioning the health care provider's order?A. A client with mild hypertension B. A client with narrow-angle glaucoma C. A client with coronary artery disease (CAD) D. A client with benign prostatic hypertrophy (BPH)

A Tricyclics can be safely administered to the hypertensive client. The expectedanticholinergic effects of tricyclic antidepressants include difficulty in urination, whichis why TCAs are contraindicated with BPH. TCAs are also contraindicated in narrow-angle glaucoma (they can cause elevated pressure in the eyes) and for certain heartabnormalities.

A client is prescribed albuterol to relieve severe asthma. Which adverse effects willthe nurse instruct the client to anticipate? Select all that apply. One, some, or allresponses may be correct. A. Tremors B. Lethargy C. Palpitations D. Bronchoconstriction E. Decreased pulse rate

A, C Albuterol's sympathomimetic effect causes central nervous system (CNS) stimulation,precipitating tremors, tachycardia, and palpitations. Lethargy is an adverse effect ofmedications that cause CNS depression, not CNS stimulation. Albuterol causesbronchodilation, not bronchoconstriction. Albuterol will cause tachycardia, notbradycardia.

A client with chronic obstructive pulmonary disease (COPD) is receivingaminophylline 25 mg/hour intravenously (IV). Which finding would be associated withside effects of this medication? A. Flushing and headache B. Restlessness and palpitations C. Decreased urine volume D. Pruritus

B Aminophylline is a bronchodilator often used to treat symptom of asthma, bronchitis,and emphysema. Side effects include restlessness, palpitations, chest pain ordiscomfort, increased urine volume, vertigo, and vomiting. The other choices are notside effects of this drug

The anticholinesterase medication pyridostigmine is prescribed for the client with myasthenia gravis. When providing medication teaching, the nurse explains that the client should expect a decrease in which function? A. Bowel function B. Heart rate C. Skeletal muscle contraction D. Urinary frequency

B Anticholinesterase medications inactivate cholinesterase, the enzyme that mediatesbreakdown of acetylcholine. As a result of increased cholinergic activity, the heart ratewill typically decrease. As a result of the increased cholinergic activity, the client cananticipate increased (not decreased) bowel movements and increased (not decreased)urinary frequency. Skeletal muscle contractions are increased (not decreased); this is the reason the medication is administered for myasthenia gravis.

Which intervention would the nurse implement for a client admitted for anexacerbation of asthma? A. Determine the client's emotional state. B. Give prescribed medications to promote bronchiolar dilation. C. Provide education about the effect of a family history. D. Encourage the client to use an incentive spirometer routinely.

B Asthma involves spasms of the bronchi and bronchioles as well as increased productionof mucus; this decreases the size of the lumina, interfering with inhalation andexhalation. Bronchiolar dilation will reduce airway resistance and improve the client'sbreathing. Although identifying and addressing a client's emotional state is important,maintaining airway and breathing are the priority. In addition, emotional stress is onlyone of many precipitating factors, such as allergens, temperature changes, odors, andchemicals. Although recent studies indicate a genetic correlation along with otherfactors that may predispose a person to the development of asthma, exploring this issue is not the priority. The use of an incentive spirometer is not helpful because of mucosaledema, bronchoconstriction, and secretions, all of which cause airway obstruction.

Which ophthalmic solution is contraindicated for clients with glaucoma? A. Timolol B. Atropine C. Pilocarpine D. Epinephrine

B Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucomabecause it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker,decreases aqueous humor production; beta blockers are the preferred initialmedications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constrictsthe pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent,enhances aqueous humor outflow, thereby reducing intraocular pressure.

A client with myasthenia gravis begins taking pyridostigmine. Two days later, theclient develops loose stools and increased salivation. Which conclusion would the nursemake about these new developments? A. The client is experiencing a myasthenic crisis. B. The medication is causing cholinergic side effects. C. The medication is triggering a paradoxical reaction. D. The client is exhibiting toxic effects of the medication.

B Because this medication inhibits the destruction of acetylcholine, parasympatheticactivity may increase, resulting in cholinergic side effects such as diarrhea and increasedsalivation. The signs do not indicate a myasthenic crisis. Myasthenic crisis ischaracterized by difficulty breathing or speaking, morning headaches, feeling tiredduring the daytime, waking up frequently at night, not sleeping well, a weak cough withincreased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary and notparadoxical; they continue as long as the medication is continued. The dosage may beadjusted or an anticholinergic may be given to limit side effects. Toxicity or cholinergiccrisis is manifested by increased muscle weakness, including muscles of respiration.

Which conclusion would the nurse make about the development of loose stools and increased salivation two days after a client with myasthenia gravis begins taking pyridostigmine? A. The client is experiencing a myasthenic crisis. B. The medication is causing cholinergic side effects. C. The medication is triggering a paradoxical reaction. D. The client is exhibiting toxic effects of the medication.

B Because this medication inhibits the destruction of acetylcholine, parasympatheticactivity may increase, resulting in cholinergic side effects such as diarrhea and increasedsalivation. The signs do not indicate a myasthenic crisis. Myasthenic crisis ischaracterized by difficulty breathing or speaking, morning headaches, feeling tiredduring the daytime, waking up frequently at night, not sleeping well, a weak cough withincreased secretions (mucus or saliva), an inability to clear secretions, a weak tongue,trouble swallowing or chewing, and weight loss. Side effects are not temporary and notparadoxical; they continue as long as the medication is continued. The dosage may beadjusted or an anticholinergic may be given to limit side effects. Toxicity or cholinergiccrisis is manifested by increased muscle weakness, including muscles of respiration.

An 11-year-old client reports having bedwetting issues (enuresis). Which medicationwould the nurse anticipate when developing a teaching plan ? A. Alprazolam B. Imipramine C. Lithium salts D. Clomipramine

B Certain conditions of pediatric clients necessitate the usage of tricyclic antidepressantmedications as an adjuvant. Childhood enuresis is one such condition that necessitatesthe administration of imipramine. Alprazolam is the medication of choice for treatinganxiety disorders. Lithium salt is prescribed to treat bipolar disorders. Clomipramine isa tricyclic antidepressant medication prescribed for treating obsessive-compulsivedisorder.

Cholinergic agonists are prescribed for which type of urinary condition? A. Kidney stones B. Urine retention C. Spastic bladder D. Urinary tract infections

B Cholinergics intensify and prolong the action of acetylcholine, which increases the tonein the genitourinary tract, preventing urinary retention. Cholinergics will not preventrenal calculi. Anticholinergics, not cholinergic agonists, are prescribed for the frequencyand urgency associated with a spastic bladder. Preventing urinary tract infections is asecondary gain because cholinergics help prevent urinary retention that can lead to aurinary tract infection, but this is not the purpose for administering these medications.

A 65-year-old client is receiving amitriptyline. Which recommendation will the nursemake to the client concerning this medication? A. 'Obtain a complete cholesterol and lipid profile.' B. 'Have an eye examination to check for glaucoma.' C. 'Check your temperature daily for nighttime increases.' D. 'Watch for excessive sweating and possible weight loss.'

B In addition to baseline laboratory tests, an older adult should have an eye examinationwith glaucoma testing when taking amitriptyline. It causes dilation of the pupil(mydriasis), which interferes with drainage of aqueous humor through the canal ofSchlemm. Interfering with the outflow of aqueous humor will increase intraocularpressure and may cause a progressive loss of vision in clients with glaucoma.Amitriptyline does not affect cholesterol production or temperature regulation. It doesnot cause excessive sweating or weight loss, but it can increase appetite especially forsweets, resulting in weight gain.

A depressed client has been prescribed a tricyclic antidepressant. Which time periodindicates how long it usually takes before the client notices a significant change in thedepression? A. 4 to 6 days B. 2 to 4 weeks C. 5 to 6 weeks D. 12 to 16 hours

B It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level.Time spans of 4 to 6 days and 12 to 16 hours are both too short for a therapeutic blood level of the medication to be achieved. Improvement in depression should bedemonstrated sooner than 5 to 6 weeks.

A health care provider prescribes metaproterenol for a client. For which therapeuticeffect would the nurse monitor the client? A. Induced sedation B. Relaxed bronchial spasm C. Decreased blood pressure D. Productive cough

B Metaproterenol stimulates beta receptors of the sympathetic nervous system, causingbronchodilation and an increased rate and strength of cardiac contractions. Barbituratesand hypnotics produce sedation. Antihypertensives and diuretics help decrease bloodpressure. Expectorants mobilize respiratory secretions, promoting a productive cough.

The health care provider prescribes neostigmine for a client with myasthenia gravis.Which client statement indicates understanding regarding medication managementplans? A. 'I must keep the medication in a container in the refrigerator.' B. 'I should take the medication at the exact time that is listed on the prescription.' C. 'I will plan to take the medication between meals.' D. 'I expect that the onset of the medication's action will occur several hours after Itake it.'

B Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia andpossible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept atroom temperature. Neostigmine should be taken with milk to prevent gastrointestinalirritation; usually it is taken about 30 minutes before meals. The onset of the action ofneostigmine occurs 45 to 75 minutes after administration; the duration of its action is2.5 to 4 hours.

A client with myasthenia gravis has been receiving neostigmine and asks about itsaction. Which information would the nurse consider when formulating a response? A. Stimulates the cerebral cortex B. Blocks the action of cholinesterase C. Replaces deficient neurotransmitters D. Accelerates transmission along neural sheaths

B Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thusprolonging neurotransmission. Neostigmine's action is at the myoneural junction, notthe cerebral cortex. Neostigmine prevents neurotransmitter breakdown, but it is not aneurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

The nurse is preparing to administer an albuterol nebulizer treatment to a patientwith asthma. Which assessment finding should be brought to the health care provider'sattention prior to administering the medication? A. Temperature of 101°F (38.3°C) B. Heart rate of 116 bpm C. Respiratory rate of 28 D. Lower extremity edema

B One of the more common adverse effects of beta-adrenergic medications, such asalbuterol, is an increase in heart rate. Normal resting heart rate for children 10-years-old and older is the same as adults: 60 to 100 bpm. The nurse should report the heartrate to the health care provider prior to administering the medication.

Pyridostigmine bromide is prescribed for a client with myasthenia gravis. The nurseevaluates that the medication regimen is understood when the client makes whichstatement? A. 'I will take the medication on an empty stomach.' B. 'I need to set an alarm so I take the medication on time.' C. 'It will be important to check my heart rate before taking the medication.' D. 'I should monitor for an increase in blood pressure after taking the medication.'

B Pyridostigmine is a vital medication that must be taken on time; a missed or late dosecan result in severe respiratory and neuromuscular consequences or even death.Pyridostigmine should be taken with a small amount of food to prevent gastricirritation. It is unnecessary to take the pulse rate before taking pyridostigmine.Pyridostigmine may cause hypotension, not hypertension, which is a sign of cholinergiccrisis.

The nurse is evaluating the effectiveness of therapy for a client who receivedalbuterol via nebulizer during an acute episode of shortness of breath due to asthma.Which finding is the best indicator that the therapy was effective? A. Accessory muscle use has decreased. B. Oxygen saturation is greater than 90%. C. Respiratory rate is 16 breaths/minute. D. No wheezes are audible.

B The goal for treatment of an asthma attack is to relieve bronchospasms and keep theoxygen saturation greater than 90%. Albuterol is a short-acting inhaled beta2-adrenergic agonist and the treatment of choice for an acute asthma attack. Pulseoximetry is an objective data point that the nurse should use to determine oxygenationstatus of the client. The other client data may occur when the client is too fatigued tocontinue with the increased work of breathing required in an asthma attack and,therefore, should not be used to evaluate effectiveness of treatment.

The nurse is discharging a client with a new prescription for tiotropium to helpmanage the symptoms of chronic obstructive pulmonary disease. What informationshould the nurse include in the discharge teaching? A. It may be a few days before you feel the full effects of tiotropium. B. This medication cannot be used to relieve sudden breathing problems. C. Be sure to swallow the capsules with a full glass of water. D. A common side effect is nausea and loose stools.

B Tiotropium is a long-acting anticholinergic bronchodilator. The medication comes as acapsule to use with a specially designed inhaler - clients should never swallow thecapsules. For new prescriptions, it's important to tell the client that they may startbreathing better with the full dose but it may take a few weeks to feel the full effects. It cannot be used as a fast-acting inhaler. Due to its anticholinergic properties, it maycause constipation (not loose stools).

A client presents to the clinic for a follow-up appointment after startingpyridostigmine for management of myasthenia gravis. Which new client problems areadverse effects of pyridostigmine? Select all that apply. One, some, or all responses maybe correct. A. Respiratory depression B. Increased urinary frequency C. Diplopia D. Muscle twitching E. Diarrhea

B, D, E Pyridostigmine is an acetylcholinesterase inhibitor. By inhibiting the enzyme thatbreaks down acetylcholine, it increases cholinergic activity. The increased cholinergicactivity is responsible for the most common adverse effects of pyridostigmine such asdiarrhea and increased urinary frequency. Another adverse effect is muscle twitchingthat occurs as pyridostigmine affects the muscle weakness that is characteristic ofmyasthenia gravis. Respiratory depression is a clinical manifestation of myastheniagravis that can occur due to respiratory muscle weakness. Weakness of eye musclesresults in ptosis or diplopia in about half of clients with myasthenia gravis.

The nurse is reinforcing the correct use of a metered-dose inhaler (MDI) for a clientnewly-diagnosed with asthma. The client asks, "how will I know the canister is empty?"What is the best response by the nurse? A. "Contact your pharmacy to find out when to obtain a refill." B. "Drop the canister in water to observe if it floats." C. "Count the number of doses as the inhaler is used." D. "Shake the canister and listen for any fluid movement."

C Floating an MDI in water, or shaking it to listen for fluid movement to determine howmuch medication is left, is not recommended. MDIs that count down the number ofremaining doses are available, however, these mechanisms are not always accurate.Therefore, it is best to calculate how long the inhaler will last by dividing the number ofdoses in the container by the number of doses the client takes per day. For example, aclient who needs to take two puffs of albuterol, four times a day, will take a total of eightpuffs per day. The MDI contains a total of 200 puffs. Divide 200/8 = 25 days. Theinhaler in this example will last 25 days. To ensure that the client does not run out ofmedication, the client should obtain a refill at least 7 to 10 days before it runs out. Thepharmacy would not be able to determine if the canister is empty.

An 80-year-old client with depression requires the prescription of antidepressantmedication. Which tricyclic antidepressant medication causes fewer complications inolder clients? A. Doxepin B. Amoxapine C. Nortriptyline D. Trimipramine

C Nortriptyline and desipramine are preferred for use in older adults because theseantidepressant medications have less anticholinergic activity. Doxepin, amoxapine, andtrimipramine have more cholinergic activity than nortriptyline and are not the preferredmedications for older adult clients.

The nurse is teaching a client diagnosed with depression about a new prescription ofnortriptyline. What information would be essential for the nurse to emphasize aboutthis medication? A. Episodes of diarrhea can be expected B. The medication must be stored in the refrigerator C. The use of alcohol should be avoided D. Symptom relief occurs in a few days

C Nortriptyline is a tricyclic antidepressant used to manage chronic neurogenic pain anddepression. Adverse reactions include central nervous system (CNS) side effects such assuicidal thoughts, drowsiness, fatigue, lethargy, and confusion. Clients who areprescribed this medication should be educated to avoid the use of alcohol consumptionor other CNS depressant drugs as this can worsen the adverse reactions of themedication and cause injury.

A client with a history of asthma is admitted for a minor surgical procedure.Preoperatively, the peak flow is measured at 480 liters/minute. Postoperatively, theclient reports chest tightness and the peak flow is now 200 liters/minute. What shouldthe nurse do first? A. Notify both the surgeon and primary care provider B. Repeat the peak flow reading in 30 minutes C. Administer the PRN dose of albuterol D. Apply oxygen at two liters per nasal cannula

C Peak flow monitoring during exacerbations of asthma is recommended for clients withmoderate-to-severe persistent asthma to determine the severity of the exacerbation andto guide the treatment. A peak flow reading of less than 50% of the client's baselinereading is a medical alert condition and a short-acting beta agonist must be taken immediately. Notifying the health care provider is important, but that is not what wouldbe done first. First, the client needs assistance. Oxygen administration will not beeffective if the airway constriction is not relieved with the albuterol. Leaving the clientand returning in 30 minutes will do nothing to help a client in acute distress.

The nurse is providing teaching to the client prescribed albuterol for themanagement of asthma. The nurse is including reportable side effects in the teachingplan. Which of the following side effects is the priority? A. Nervousness B. Headache C. Palpitations D. Muscle aches

C Side effects of albuterol include nervousness, shakiness, headache, throatirritation, and muscle aches. Muscle tremor is the most frequent adverse effect. Themain risks with adrenergic bronchodilators, particularly in older adults, are excessivecardiac and central nervous system (CNS) stimulation. Symptoms of cardiac stimulationinclude angina, tachycardia, and palpitations. Symptoms of central nervous system(CNS) stimulation consist of agitation, anxiety, insomnia, seizures, and tremors. Otherreported effects may include serious dysrhythmias and cardiac arrest.

The nurse is teaching a pediatric client and family about prescribed albuterol sulfateextended-release tablets. Which statement should be included? A. If you cannot swallow the tablet, it is ok to chew it B. This medication can cause restlessness C. "This medication can cause restlessness." D. Rinse your mouth after taking this medication E. Oral albuterol can cause an increase in urination

C The adverse reactions to albuterol are the same whether administered orallyor via inhalation. The most frequent adverse reactions to albuterol are nervousness,tremors, headache, tachycardia, and palpitations. Less frequent adverse reactions aremuscle cramps, insomnia, nausea, weakness, dizziness, drowsiness, flushing,restlessness, irritability, chest discomfort, and difficulty in urination. Extended-releasemedications should not be chewed or crushed. Doing so can release all of the drug atonce, increasing the risk of side effects. Inhaled corticosteroids require the mouth to berinsed. This medication is not inhaled and is not a corticosteroid.

The nurse is caring for a client who was recently prescribed atropine as a treatmentfor symptomatic bradycardia. Which condition should the nurse question as acontraindication when taking this medication? A. Urinary incontinence B. Right-sided heart failure C. Glaucoma D. Increased intracranial pressure

C The nurse should question the use of atropine with a client who has glaucoma. Atropineis contraindicated in clients with angle-closure glaucoma because it can cause pupillarydilation with an increase in aqueous humor. This can lead to an increase in opticpressure causing blurred vision and ocular pain.

During a procedure, the client's heart rate drops to 38 beats/min. Which medicationis indicated to treat bradycardia? A. Digoxin B. Lidocaine C. Amiodarone D. Atropine sulfate

D Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increasedheart rate. Digoxin slows the heart rate; hence, it would not be indicated in thissituation. Lidocaine decreases myocardial sensitivity and will not increase the heartrate. Amiodarone is an antidysrhythmic medication used for ventricular tachycardia; itwill not stimulate the heart rate.

The nurse is caring for a client who has been prescribed atropine preoperatively. Thenurse understands the intended purpose for administering this preoperatively is toinduce which effect? A. Reduce heart rate B. Elevate blood pressure C. Enhance sedation D. Decrease secretions

D Atropine is a common anesthesia adjunct. It decreases the amount of secretions which,in turn, decreases the risk of aspiration during the operative procedure.

A client develops extrapyramidal effects after taking a neuroleptic medication, and thenurse notes extrapyramidal effects. Which medication can limit these side effects? A. Zolpidem B. Hydroxyzine C. Dantrolene D. Benztropine mesylate

D Benztropine mesylate, an anticholinergic, helps balance neurotransmitter activity in thecentral nervous system (CNS) and helps control extrapyramidal tract symptoms.Zolpidem is a sedative-hypnotic medication used for short-term insomnia. Hydroxyzineis a sedative that depresses activity in the subcortical areas in the CNS; it is used toreduce anxiety. Dantrolene, a muscle relaxant, has a direct effect on skeletal muscle byacting on the excitation-contraction coupling of muscle fibers and not at the level of theCNS, unlike most other muscle relaxation medications.

A client with myasthenia gravis is receiving pyridostigmine bromide to controlsymptoms. Recently, the client has begun experiencing increased difficulty inswallowing. Which nursing action is effective in preventing aspiration of food? A. Place a tracheostomy set in the client's room. B. Assess respiratory status after meals. C. Request for the diet to be changed from soft to clear liquids. D. Coordinate mealtimes with the peak effect of the medication.

D Dysphagia should be minimized during peak effect of pyridostigmine bromide, therebydecreasing the probability of aspiration. A tracheostomy set is a treatment for, ratherthan equipment to prevent, aspiration. Although it is vital that the client's respiratoryfunction be monitored, assessing the client's respiratory status will not preventaspiration. There are insufficient data to determine whether changing the diet from softfoods to clear liquids is appropriate; also, liquids are aspirated more easily thansemisolids.

A client receiving fluphenazine decanoate develops dystonia/extrapyramidal sideeffect early in therapy. Which medication would the nurse anticipate administering toreverse this side effect? A. Nafarelin B. Fluoxetine C. Trandolapril D. Benztropine

D Dystonia is an extrapyramidal side effect (EPS) of fluphenazine decanoate. Theanticholinergic benztropine is used to reverse the signs and symptoms (e.g., oculogyriccrisis, torticollis, retrocollis) of dystonia. Nafarelin is a gonadotropin that stimulates therelease of luteinizing hormone and follicle-stimulating hormone. Fluoxetine is aselective serotonin reuptake inhibitor antidepressant. Trandolapril is an angiotensin-converting enzyme inhibitor antihypertensive.

Which nursing action is appropriate when administering imipramine? A. Telling the client steroids will not be prescribed B. Warning the client not to eat cheese C. Monitoring the client for increased tolerance D. Having the client checked for increased intraocular pressure

D Glaucoma is one of the side effects of imipramine, and the client should be taught aboutthe symptoms. The prescribing of steroids and avoiding cheese are true of monoamineoxidase inhibitors (MAOIs); imipramine is not an MAOI. Tolerance is not an issue withtricyclic antidepressants such as imipramine.

Pyridostigmine is prescribed for a client with myasthenia gravis. Why would thenurse instruct the client to take pyridostigmine about 1 hour before meals?A. This timing limits first pass metabolism. B. Taking it on an empty stomach increases absorption. C. Taking it before meals decreases gastric irritation. D. Taking it before meals improves the ability to chew.

D Peak action of the medication will occur during meals to promote chewing andswallowing and prevent aspiration. It should be given with a small amount of food toprevent gastric irritation. First pass metabolism is a process of metabolism, which is notaffected by medication timing. Absorption is not affected significantly by the presence offood in the stomach. Gastric irritation is reduced best by the administration ofmedications with food, not on an empty stomach.

A client with Parkinson's disease is prescribed benztropine (Cogentin). For which ofthe following should the nurse call the health care provider immediately? A. The client is complaining of dizziness when standing up. B. The client is exhibiting bradykinesia and slurred speech. C. The client's heart rate increased from 80 to 95 beats per minute. D. The client has a history of primary angle-closure glaucoma.

D The nurse must be able to recognize adverse drug effects and contraindications ofmedications commonly prescribed for the client with Parkinson's disease. Commonclinical manifestations of Parkinson's disease include bradykinesia (slow movement),dysarthria (slurred speech) and orthostatic hypotension, caused by the loss of theneurotransmitter dopamine. The goal of pharmacotherapy is to restore the functional balance of dopamine and acetylcholine. This is achieved by giving dopaminergic drugsand cholinergic blockers.Benztropine is an anticholinergic medication used in the treatment of Parkinson'sdisease that blocks excess cholinergic stimulation in the brain and reduces musculartremors and rigidity. Tachycardia is a potential adverse drug event, but a heart rateincrease of 15 bpm is within acceptable limits. Due to their blocking actions of theparasympathetic nervous system, anticholinergics are contraindicated with glaucoma,where they can cause an increase in intraocular pressure (IOP), which can lead to visionloss and blindness.