ATI Pharmacology Made Easy 4.0 ~ The Neurological System (Part 2)

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

B. Seasonal affective disorder D. Nicotine addiction E. Depression Rationale: A. Bupropion, an atypical antidepressant, can cause nausea, vomiting, and constipation. It does not prevent or treat motion sickness. B. Bupropion, an atypical antidepressant, helps prevent and treat seasonal affective disorder, a type of depression associated with the reduction of natural light during winter months. C. Bupropion, an atypical antidepressant, can cause insomnia and agitation. It does not prevent or treat insomnia. D. Bupropion, an atypical antidepressant, is an appropriate adjunct for clients who are trying to quit smoking. E. Bupropion, an atypical antidepressant, can help treat depression.

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

C. Avoid taking NSAIDs. Rationale: A. Reduced serum sodium decreases lithium excretion, which can lead to toxicity. B. Dehydration increases the risk for lithium toxicity. C. NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs. D. Taking lithium with food can reduce gastric irritation, but it does not reduce the risk for lithium toxicity.

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

B. "If you have persistent headaches, let the provider know." Rationale: A. The nurse should instruct the client to measure their weight weekly and report a consistent decline to the provider. Fluoxetine can cause abdominal pain, abnormal taste, dry mouth, nausea, and anorexia, which can affect appetite. B. The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction. C. Fluoxetine can cause hyponatremia. The nurse should instruct the client to maintain consistent sodium intake and to monitor for indications of a low blood sodium level. D. The nurse should inform the client that the medication can take up to 4 weeks to become effective, and the client should communicate a lack of effectiveness after that time.

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

B. Hypertensive crisis Rationale: A. Phenelzine, a monoamine oxidase inhibitor (MAOI), is not likely to cause respiratory depression; however, it can cause fatigue and weakness. B. Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in clients who are taking phenelzine. Manifestations include hypertension, headache, and nausea. C. Neuroleptic malignant syndrome is a serious adverse effect of some antipsychotic drugs, such as haloperidol, but not of monoamine oxidase inhibitors (MAOIs), such as phenelzine. Manifestations include high fever, rigidity, vital-sign instability, and loss of consciousness. D. Signs of serotonin syndrome can begin 2 to 72 hr after initiating therapy with a selective serotonin reuptake inhibitor (SSRI). Manifestations include mental confusion, difficulty concentrating, and agitation.

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

A. Renal function impairment Rationale: A. Alprazolam dosage should be decreased for clients who have renal or hepatic impairment. B. Glaucoma is a contraindication for receiving alprazolam, but cataracts do not affect this client's recommended dosage. Clients over 65 years of age might require a decreased dosage. C. Weight gain is an adverse drug reaction of alprazolam. Pediatric clients might require a decreased dosage. D. Smoking can decrease the levels and effects of alprazolam. The client might need an increased dosage if smoking while taking alprazolam.

A nurse is caring for a client who has a new prescription for alprazolam. For which of the following adverse effects should the nurse monitor. (Select all that apply.) A. Tolerance B. Anxiety C. Sedation D. Respiratory depression E. Constipation

A. Tolerance B. Anxiety C. Sedation D. Respiratory depression Rationale: A. Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Clients should use these drugs only as needed and for short periods of time. B. Paradoxical reactions, such as anxiety and insomnia, can develop when taking alprazolam, especially in older adults. Clients should report these findings C. CNS depression, manifested as sedation and drowsiness, is an adverse effect of benzodiazepines, such as alprazolam. Clients should take a benzodiazepine 30 min prior to bedtime. D. Benzodiazepines, such as alprazolam, can cause CNS depression when taken with other CNS depressants, especially for older adult clients. It is important to monitor for respiratory depression and recommend the lowest effective dose. Clients should avoid alcohol and other CNS depressants while taking a benzodiazepine. E. Benzodiazepines, such as alprazolam, are unlikely to cause constipation. However, they can cause nausea, vomiting, and diarrhea.

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

A. Tremors B. Confusion D. Nausea E. Muscle weakness Rationale: A. A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. B. Confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range. C. Lithium toxicity is unlikely to cause bronchospasm because it does not usually affect the respiratory system. D. Nausea, vomiting, and diarrhea are early indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Clients should report any of these adverse effects. E. Muscle weakness is an early indication of lithium toxicity that develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels periodically.

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

C. Allow 2 to 4 weeks for full therapeutic effects. Rationale: A. Clients who take buspirone should not drink grapefruit juice, because it increases buspirone drug levels. B. To avoid a recurrence or exacerbation of symptoms, clients should take buspirone on a regular basis and not PRN. C. It can take up to 4 weeks for a client to feel the drug's full therapeutic effects. D. Buspirone can cause nausea, so taking it with food can help minimize this effect.

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

D. Bradycardia Rationale: A. Pilocarpine, a direct-acting cholinergic drug, causes miosis, or constricted pupils, and blurred vision. Betaxolol is unlikely to constrict the pupils. B. Latanoprost can cause a brownish discoloration of the iris. Betaxolol is unlikely to cause this effect. C. Betaxolol can cause hypotension. Oral betaxolol treats hypertension. D. Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1 receptors. Clients should check their pulse rate regularly and report any sustained decreases.

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

A. "Take a missed dose as soon as you remember." Rationale: A. Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose. B. Buspirone should be taken on a regular basis, not as needed. The onset of action is 1 to 2 weeks, so it is important to maintain consistent blood levels. C. Grapefruit juice can increase serum levels and the effects of buspirone. The client should avoid drinking grapefruit juice while taking this drug. D. Chamomile can increase CNS depression and should be avoided while taking this drug.

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

A. Anxiety Rationale: A. The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the provider, who might consider a different medication. B. The nurse should recognize that blurred vision is a possible adverse drug reaction of alprazolam. C. The nurse should recognize that nausea and vomiting are possible adverse drug reactions of alprazolam. D. Muscle spasms are not an expected adverse drug reaction for alprazolam. Diazepam, another benzodiazepine, can be prescribed to treat muscle spasms.

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

A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops. B. Do not touch the tip of the dropper. E. Remove contact lenses prior to instilling the drops. Rationale: A. Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the drug from entering the systemic circulation. B. The tip of the dropper should remain sterile. It is important that clients avoid touching the dropper's tip or touching it to the eye area. C. Clients should wash their hands before instilling eye drops. It is not necessary after instillation unless they have spilled any of the drops on their hands. D. Clients should avoid rubbing or touching their eyes because doing so can cause eye damage. E. Clients should remove contact lenses before instilling eye drops because they can cause further irritation if left in place.

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

A. Asthma Rationale: A. Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients who have asthma or any disorder that compromises respiratory function should not use the drug. B. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have a seizure disorder. However, those who have heart failure or bradycardia should not use the drug. C. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have diabetes mellitus, although caution is essential when patients who have peripheral vascular disease or hyperthyroidism use the drug. D. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have rheumatoid arthritis, although Raynaud's disease is a contraindication for using the drug.

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

A. Change positions slowly from sitting or lying to standing. B. Do not stop taking the drug abruptly. D. Take the drug at bedtime to prevent daytime drowsiness. E. Increase fiber and fluid intake. Rationale: A. Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension. Clients should move slowly from sitting or lying to standing. B. Relapse and withdrawal symptoms can occur with abrupt discontinuation of amitriptyline. When discontinuing the drug, it is important to reduce the dosage over a 2-week period to prevent or minimize withdrawal symptoms. C. This medication may be crushed if the client has difficulty swallowing the tablet(s) D. Amitriptyline, a tricyclic antidepressant, can cause drowsiness. Clients should take the drug at bedtime and avoid activities that require alertness until they know how the drug will affect them. E. Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Clients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

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

A. Furosemide for hypertension Rationale: A. Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity. B. Acetaminophen does not increase lithium levels. However, NSAIDs such as ibuprofen can cause lithium reabsorption and toxicity. C. There is no known interaction between lithium and quinolone antibiotics, such as ciprofloxacin. However, the risk of toxicity increases with tetracyclines. D. There is no known interaction between lithium and montelukast. Theophylline preparations, however, can decrease lithium levels.

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

A. Hallucinations Rationale: A. Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome. B. Fever is an expected finding of serotonin syndrome. The client can also become agitated. C. Fluoxetine can cause sexual dysfunction, not hypersexuality. The client can develop hyperactive deep tendon reflexes. D. Diarrhea is an expected finding of serotonin syndrome. Constipation can be an adverse drug reaction of fluoxetine.

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

B. Blood pressure Rationale: A. Chlorpromazine is unlikely to cause kidney impairment; however, an adverse effect is urinary retention. Therefore, the nurse should monitor the client's urine output. B. Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV administration. The client should remain supine for 30 min while the nurse monitors their blood pressure. The nurse should instruct the client to change positions slowly as a safety precaution to prevent client injury. This medication can also cause orthostatic hypotension. C. Chlorpromazine is unlikely to alter urine specific gravity; however, it can cause urinary retention. It is important to monitor the client's urine output. D. Chlorpromazine is unlikely to alter the client's peripheral circulation; however, it can cause tachycardia. Therefore, the nurse should monitor the client's heart rate.

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

B. Wear sunscreen when exposed to sunlight. Rationale: A. Clients who take chlorpromazine, a conventional antipsychotic, should taper the drug slowly to prevent withdrawal symptoms. The drug is appropriate for clients who have a sore throat, but those who have respiratory impairment because of infection require cautious use. B. Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors. C. Chlorpromazine, a conventional antipsychotic, treats nausea and vomiting. It is not necessary to take it with food. D. Chlorpromazine, a conventional antipsychotic, can cause sedation and urinary hesitancy, not urinary frequency. Clients should take it in the evening.

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

C. Imipramine Rationale: A. Venlafaxine, a serotonin/norepinephrine reuptake inhibitor, is more likely to cause hypertension than orthostatic hypotension. B. Adverse effects of bupropion, an atypical antidepressant, include nausea, vomiting, headache, and insomnia. This drug is unlikely to cause orthostatic hypotension. C. Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients who take this drug should change positions slowly from sitting or lying to standing. D. Valproic acid, a conventional antipsychotic, typically causes extrapyramidal effects, including akathisia, Parkinsonism, acute dystonia, and tardive dyskinesia. This drug is unlikely to cause orthostatic hypotension.

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

C. Phenelzine Rationale: A. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with alprazolam, a benzodiazepine. Cimetidine is a drug that interacts with alprazolam to increase alprazolam levels. B. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with phenytoin, an anticonvulsant. Amiodarone is a drug that interacts with phenytoin to increase phenytoin levels. C. Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever. D. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with pilocarpine, a direct-acting cholinergic. Ipratropium is an anticholinergic drug that interacts with pilocarpine to reduce ipratropium levels.

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

C. Thyroid function tests Rationale: A. Chest x-rays help identify problems with the heart and lungs. Lithium can cause dysrhythmias, but it is unlikely to cause a dysfunction of the heart or lungs that will be detectable on chest x-rays. B. Tonometry is a method of testing for glaucoma. Lithium carbonate is unlikely to cause glaucoma. C. ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter. D. An ERCP helps identify disorders of the liver, gallbladder, bile ducts, and pancreas. Lithium carbonate is unlikely to cause abnormalities of these structures.

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

D. "If I become pregnant, it is important to let my health care provider know." Rationale: A. The nurse should instruct the client that abruptly stopping this medication can cause seizures, insomnia, nervousness, or irritability. B. Taking alcohol with diazepam can cause CNS depression. The nurse should instruct the client to avoid alcohol intake. C. Diazepam can cause hypotension when administered IV. The nurse should instruct the client to use caution when changing positions. D. Diazepam can increase the risk of congenital malformations and is contraindicated for clients who are pregnant.

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse expect? A. Cholinergic crisis B. Serotonin syndrome C. Stevens-Johnson syndrome D. V

D. Acute dystonia Rationale: A. Manifestations of a cholinergic crisis include nausea, vomiting, diaphoresis, and bradycardia. Chlorpromazine is unlikely to cause a cholinergic crisis. B. Indications of serotonin syndrome include agitation, confusion, and anxiety. Chlorpromazine is unlikely to cause serotonin syndrome. C. Indications of Stevens-Johnson syndrome include fever, rash, and blisters. Chlorpromazine is unlikely to cause Stevens-Johnson syndrome. D. Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine.

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

D. Seizure activity Rationale: A. Bupropion, an atypical antidepressant, is unlikely to cause an ischemic stroke. However, it can cause headache and agitation. B. Bupropion, an atypical antidepressant, is more likely to cause insomnia than drowsiness. C. Bupropion, an atypical antidepressant, is unlikely to cause respiratory depression because it does not affect the respiratory system. However, it can cause nausea and vomiting. D. Bupropion, an atypical antidepressant, can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

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

D. Withdrawal symptoms Rationale: A. Alprazolam, a benzodiazepine, can impair the memory of events that occur after taking the drug. Stopping drug therapy does not cause this effect. B. Alprazolam, a benzodiazepine, can cause respiratory depression and drowsiness. Stopping drug therapy does not cause this effect. C. A paradoxical reaction to alprazolam, a benzodiazepine, includes excitement and agitation. This does not occur with sudden cessation of drug therapy. D. Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.