Exam 2 Pharm

A client with a long leg cast for a fractures bone is to be discharged. In which time frame would the nurse advise the client to take the prescribed as needed oxycodone?

When the discomfort begins

A patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic?

12 mcg/mL Therapeutic serum drug levels for phenytoin are between 10 and 20 mcg/mL.

Which meds would the nurse identify as being used as preanesthetic agents?

Barbiturates and Bensodiazepines

The nurse teaches the client about foods to avoid while taking selegiline for depression. Which foods identified by the client indicate to the nurse that instructions have been understood?

Beer and licorice

The client with a seizure disorder receives IV phenytoin. The nurse will monitor closely for which condition?

Cardiac dysrhythmias

An intravenous dose of midazolam (Versed) has been prescribed for a patient before a colonoscopy. What does the nurse teach the patient is the most common adverse effect of this medication?

Amnesia Versed is known to cause amnesia and anxiolysis (reduced anxiety) as well as sedation and is most commonly used preoperatively for certain procedures.

The nurse finds that a child has inattention, hyperactivity, and impulsivity upon assessment. The nurse anticipates which medication to be most beneficial for the child?

Atomexetine

A primary health care provider prescribes atenolol 20mg by mouth four times a day. Which information is important for the nurse to include in the discharge teaching plan for this client?

Avoid abruptly discontinuing the medication

A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given?

Depresses the CNS

A patient is admitted to the hospital with a diagnosis of benzodiazepine overdose. The nurse anticipates the health care provider will prescribe which antidote for benzodiazepine overdose?

Flumazenil (Romazicon)

When administering intravenous (IV) phenytoin (Dilantin), which action would the nurse perform?

Flush the line with normal saline before and after administration to prevent precipitation. Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. Flushing with normal saline before and after minimizes precipitation. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred.

The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What is the common adverse effect the nurse is educating for with this teaching?

Gingival hyperplasia A well-known adverse effect of long-term oral phenytoin therapy is overgrowth of gum tissue or gingival hyperplasia. This can be minimized by frequent oral hygiene.

The nurse would identify which med as the most common cause of extrapyramidal side effects?

Haloperidol

Which action describes a therapeutic effect of atenolol?

Heart rate decreases

While completing preoperative patient teaching, which information would the nurse include for a surgery with a general anesthetic?

It produces muscle relaxation and loss of consciousness. General anesthesia produces muscle relaxation (both visceral and skeletal) as well as loss of consciousness.

The nurse teaches the client about the effects of carbamazepine that would be reported to the pcp. What effects would the nurse include?

Nausea and unusual bleeding or bruising

What assessment is highest priority when monitoring a patient on an opioid analgesic?

Respiratory rate The most serious adverse effect of opioid analgesics is respiratory depression and is the assessment priority.

Which administration guidelines would the nurse follow when administering midazolam to an older client?

The increments should be smaller, and the rate of injection should be slower

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). The nurse suspects that the patient has which type of seizure?

Absence Ethosuximide is used to treat uncomplicated absence seizures.

A client's phenytion level is 16mcg/L. Which action will the nurse take?

Administer the next dose of the med as prescribed. Therapeutic range is 10-20mcg/L

A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance?

Alcohol

A child with ADHD is prescribed methylphenidate. The mother asks about its action and side effects. Which response by the nurse is most appropriate?

It is a stimulant that has a calming effect on children with ADHD

A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants?

CNS stimulants increase release of and block reuptake of neurotransmitters. CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

A patient with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine when I have no pain?" The nurse's response is based on knowledge that codeine also has what effect?

Cough suppressant Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.

Which adverse effect of morphine indicates the need for naloxone administration?

respiratory depression

The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. What is the appropriate action of the nurse?

Withhold the medication and notify the health care provider. Respiratory depression is an adverse effect of opioid analgesia. Therefore, because the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. Which instruction will the nurse include when teaching the client about this medication?

You may experience dizziness when moving from sitting to standing

A client with myasthenia gravis has been receiving neostigmine and asks about its action. Which information would the nurse consider when formulating a response?

blocks the action of cholinesterase

For which therapeutic effect will the nurse monitor the clients who is prescriber alprazolam?

decreased anxiety

A health care provider prescribes morphine for a client being treated for myocardial infarction. Which physiological response will occur if the client experiences the intended therapeutic effect of morphine?

decreased workload of the heart

tardive dysknesia

gross involuntary movements of extremities, tongue, and facial muscles that develop after prolonged therapy.

How would a patient receiving narcotic analgesics for chronic pain can minimize the GI side effects?

increasing fluid and fiber in the diet Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation.

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. Which mode of med admin is preferred for this client?

intravenous

parkinsonian syndrome

motor retardation, rigidity, and tremors; the reaction resembles parkinsonian syndrome but usually responds to decreasing the dose, the administration of an antidyskinetic medication, or discontinuation of haloperidol

A client who receives morphine by PCA pump has a respiratory rate of 6 breaths/minute. Which intervention is needed?

naloxone administration

A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to the family that the medication is used to achieve which purpose?

to make the client more receptive to psychotherapy

Which statement by the patient indicates the need for additional teaching on phenothiazine (Thorazine) drug therapy?

"It is okay to take this drug with a small glass of wine to help relax me." Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

A patient prescribed massage therapy for musculoskeletal pain asks the nurse, "How is rubbing my muscles going to make the pain go away?" What is the nurse's best response?

"Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain." The gate theory of pain control identifies large sensory nerve fibers that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore, the patient is not having the sensation of pain even if the stimulus is still present.

Which statement is accurate for the nurse to use when teaching a patient the difference between a sedative and hypnotic effect of a drug?

"Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses." Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.

A patient verbalizes concern to the nurse regarding postoperative nausea and vomiting from the anesthesia. Which is the nurse's best response?

"Nausea and vomiting occur less frequently than in the past because of the use of a balanced approach to anesthesia." Explain to the patient the advances in anesthesia may help alleviate fear. Adverse effects such as nausea and vomiting are less common because drugs from several different classes rather than a single drug are used to produce anesthesia. This approach is referred to as balanced anesthesia.

The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond?

"Ropinirole is a dopamine agonist that has fewer adverse effects than carbidopa-levodopa." Ropinirole stimulates specific dopamine receptors in the brain. It is more specific for the receptors associated with parkinsonian symptoms, the D2 subfamily of dopamine receptors. This in turn may have more specific antiparkinson effects, with fewer adverse effects associated with generalized dopaminergic stimulation.

A patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) asks the nurse, "Why have I suddenly developed a relapse of my symptoms." Which explanation by the nurse is appropriate?

"This is called the "on-off phenomenon." Discuss this with your health care provider and a possible change in the medication regimen to help manage this effect." Patients who have been taking levodopa for a period of time may experience periods of symptom return. Changing to Sinemet controlled release or adding another medication can help reduce the on-off phenomenon.

A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug used in the emergency department for someone who is coding." Which is the nurse's best response?

"Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site." Epinephrine causes localized vasoconstriction, not only allowing for a bloodless field to suture but also delaying absorption of the lidocaine and thus enhancing its numbing effect.

The nurse is providing care for a neonate diagnosed with apnea of prematurity. The prescription by the health care provider is for caffeine citrate intravenously 5 mg/kg once daily. The infant's weight is 5.4 lb. What is the correct dosage to administer to the patient? __

12.3mg

At which time would the nurse plan to administer morphine 2mg PO every 2 hours as needed to a client who has burns on 55% of the body surface and requires dressing changes?

60 minutes before dressing change

A client reports haven taken two hydrocodone/acetaminophen tabs every 4 hrs for several weeks before surgery. If each tab contains 500 mg of acetaminophen, how many mg if acetaminophen had the client been ingesting per day?

6000mg

A client is prescribed MAOI for depression. The nurse includes teaching on foods and meds known to cause serious adverse effects when used in combination with MAOIs. Which adverse effect would the nurse include in the teaching plan?

A serious increase in blood pressure

While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity?

Acetylcysteine (Mucomyst) Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 additional doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).

A client is prescribed a MOAI. Which foods would the nurse teach the client to avoid?

Aged cheese, ripe avocados, delicatessen meats

A client receiving high doses of haloperidol tells the nurse, "I just can't sit still, and I feel jittery." Which side effect would the nurse suspect the client is experiencing?

Akathisia

While taking a patient's history before surgery for a cardiac problem, the patient tells the nurse, "I am addicted to cocaine." The nurse notifies the anesthesiologist of this finding because use of cocaine can cause which effect when a patient is under anesthesia?

Anesthetic-induced complications A patient with a history of substance abuse is at higher risk of anesthetic-related complications and will require closer monitoring by the anesthesia team.

When a client exhibits severe bradycardia, which type of med will the nurse be prepared to administer?

Anticholinergic

A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance?

Atomoxetine (Strattera) Atomoxetine (Strattera) is not a controlled substance because it lacks drug addictive (psychological dependence) properties, unlike amphetamines and phenidates.

A healthcare provider prescribes tolterodine for a client with an overactive bladder. Which action is important to include in client teaching?

Avoid activities requiring alertness until the response to medication is known

A patient with a diagnosis of depression is being discharged with a prescription for an monoamine oxidase inhibitors (MAOI). Which instruction would the nurse include for this medication?

Avoid eating aged cheese. Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs

When doing an admission drug history, the nurse notes that the patient has a prescription for lithium. The nurse suspects that this patient has been diagnosed with which condition?

Bipolar disorder Lithium is a mood-stabilizing drug for the treatment of manic episodes associated with bipolar disorders.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?

Block the reuptake of neurotransmitters at nerve endings The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin. The monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme that stops the actions of neurotransmitters such as dopamine, serotonin, and norepinephrine. Amphetamines stimulate areas of the brain associated with mental alertness.

A client who is receiving atenolol for hypertension frequently reports feeling dizzy. Which effect of atenolol is responsible for this response?

Blocking the adrenergic response

A patient is prescribed selegiline (Eldepryl), an MAO-B inhibitor, as adjunctive therapy in treatment of Parkinson's disease. What potential adverse effects would the nurse include in education for this patient? (Select all that apply.)

Blood pressure changes, headache, Insomnia, Depression MAO-B inhibitors have many potential adverse effects, including dizziness, insomnia, hallucinations, ataxia, agitation, depression, paresthesia, somnolence, headache, dyskinesia, nausea, diarrhea, hypotension or hypertension, chest pain, weight loss, dermatologic reactions, rhinitis, and pharyngitis.

A patient prescribed lorazepam (Ativan) for the treatment of anxiety states, "I feel drowsy all the time, and it's interfering with every aspect of my life." The nurse knows that a better drug therapy option for this patient is which anxiolytic medication?

Buspirone (BuSpar) Buspirone (BuSpar) has the advantage of having fewer adverse effects such as sedation and lack of dependency potential. All of the other options are sedatives as well as anxiolytics.

When teaching a patient about carbidopa-levodopa (Sinemet), what information would the nurse include about this medication?

Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa inhibits the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal adverse effects caused by dopamine in the periphery, resulting in fewer unwanted adverse effects.

A nurse is education a patient on use of caffeine. If a patient has what condition, would alert the nurse to be concerned with use of this prescribed drug?

Cardiac dysrhythmias Caffeine is a CNS stimulant. It should be used with caution in patients with a history of peptic ulcers, cardiac dysrhythmia, or recent myocardial infarction.

The nurse is providing care for a patient with a diagnosis of Parkinson's disease who has pre-existing liver failure. What class of medications, if prescribed, would the nurse question?

Catechol-O-methyltransferase (COMT) inhibitors COMT inhibitors are contraindicated in patients with liver failure or liver disease. Potential liver failure is also a known adverse effect.

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed?

Charcoal (Activated charcoal) There is no antidote for barbiturates. The use of activated charcoal binds to the drug in the stomach and gastrointestinal tract, preventing absorption.

A client is receiving PCA after surgery. Which benefit would this type of therapy provide?

Client is able to self-administer pain-relieving medications as necessary Decreases client dependency increases client sense of autonomy

Which laboratory test would be monitored closely to assess for a potential life-threatening adverse effect to clozapine (Clozaril)?

Complete blood count Patients taking clozapine must be monitored for the life-threatening adverse effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings are the nurse most likely to find? (Select all that apply.)

Constipation Inability to void Morphine sulfate causes a decrease in GI motility (delayed gastric emptying and slowed peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention (inability to void).

While reviewing the lab reports on a client with bipolar disorder the nurse finds the client's lithium levels are 1.3mEq/L. Which nursing intervention would be most appropriate in this client?

Continuing to administer the medication. Normal range is below 1.5

A client takes oxycodone every 3 hours for pain after surgery. Which actions would the nurse take before administering each dose of oxycodone?

Count clients respirations Ask clients to rate level of pain Assess the client's level of consciousness

A client has a tonic-clonic seizure. The nurse anticipates that the health care provider will prescribe the intravenous admin of which medication?

Diazepam

The nurse is caring for a postoperative craniotomy patient. Which prescribed drug does the nurse have available to treat possible acute seizures?

Diazepam (Valium) Drug therapy for acute seizure activity is typically diazepam (Valium), which is considered by many to be the drug of choice. Other drugs used for acute therapy include lorazepam, fosphenytoin, phenytoin, and phenobarbital.

The nurse is teaching a client about tricyclic antidepressants. Which potential side effects would the nurse include?

Dry mouth, drowsiness, constipation, orthostatic hypotension

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?

Every 72 hours The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.

Which medication acts as an antidote to benzodiazepine?

Flumazenil

A patient with narcolepsy is prescribed methylphenidate (Ritalin). Which adverse effects would the nurse include when teaching about this drug? (Select all that apply.)

Headache, Insomnia, Weight loss The adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth, and worsening of or new onset of psychiatric disorders (including mania, psychoses, or aggression).

A patient receiving valproic acid (Depakote) would be monitored for which adverse effects? (Select all that apply.)

Hepatotoxicity, Tremors, Weight gain Common adverse effects of valproic acid (Depakote) include drowsiness; nausea, vomiting, and other gastrointestinal disturbances; tremor; weight gain; and transient hair loss. The most serious adverse effects are hepatotoxicity and pancreatitis. It is not known to cause hypoglycemia.

The health care provider prescribes atenolol for a client with angina. Which potential side effect will the nurse mention when instructing the client about this medication?

Hypotension

Which client statement indicates that teaching about acetaminophen is effective?

I have to be careful about which over the counter cold preparations I take

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority?

Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.

A patient is prescribed an opioid analgesic for chronic pain. Which information would the nurse discuss with the patient to minimize the GI adverse effects?

Increase fluid intake and fiber in the diet. Opioid analgesics decrease GI intestinal motility (peristalsis), leading to constipation. Increasing fluid and fiber in the diet or use of stool softener or mild laxative can prevent constipation.

Which information would the nurse include in the teaching plan for the client who is prescribed sumatriptan for migraine headaches?

Is contraindicated in people with coronary artery disease

The client wants to know why midazolam will be administered preoperatively. Which reason would the nurse provide?

It induces sedation

Which instructions would the nurse include in teaching a patient to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)?

Limit dietary intake of fat. Orlistat is an anorexiant that works by blocking the absorption of fat from the GI tract. Restricting dietary intake of fat reduces the GI adverse effects associated with increased fat content in stool (flatulence, oily spotting, and fecal incontinence).

The health care provider prescribes dantrolene (Dantrium) to a patient immediately after surgery. The nurse is aware this medication is used to treat what condition?

Malignant hyperthermia Dantrolene is a direct acting skeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a possible complication of generalized anesthesia.

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of anticonvulsant pharmacologic therapy?

Maximally reducing seizure activity while minimizing the adverse effects of medication therapy. Anticonvulsant medications are used to prevent the convulsive seizures typically associated with epilepsy. These medications have many adverse effects. The goal of antiepileptic drug therapy is to control or prevent seizures while maintaining quality of life with minimal adverse effects.

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication?

Methadone (Dolophine) Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.

Which meds would the nurse identify as commonly used as an adjunct during conscious sedation for minor surgeries?

Midazolam

A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse's response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype?

Morphine An equianalgesic table is a conversion chart for commonly used opioids. It identifies oral and parenteral dosages that provide comparable analgesia. The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine. It is important to use when changing to a new opioid or different route. Morphine is the drug prototype for all opioid drugs.

The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates the patient is having an adverse effect from this drug?

Muscle cramps of the head and neck Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed. The other adverse effects also occur but are not extrapyramidal effects.

A client in the emergency department presents with signs and symptoms of an opioid overdose. Which medication would the nurse anticipate administering?

Naloxone

Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic and reverse the adverse effects?

Naloxone (Narcan) Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

Immediate postoperative assessment of a patient reveals a body temperature of 102° F. What is the appropriate nursing intervention?

Notify the health care provider. A fever immediately after surgery must be evaluated for potential malignant hyperthermia. Thus, the health care provider must be notified. Infection of a surgical wound takes several days to develop.

The nurse plans pharmacologic management for a patient with pain. The nurse would administer the pain medication based on what dosage schedule?

Pain relief is best obtained by administering analgesics around the clock. When pain is present for more than 12 hours a day, analgesic dosages are best administered around the clock rather than on an as-needed basis, but dosages should always be within the dosage guidelines for each drug used. The around-the-clock (or "scheduled") dosing maintains steady-state levels of the medication and prevents drug troughs and escalation of pain.

An intubated, mechanically ventilated patient in the intensive care unit (ICU) is becoming increasingly restless and anxious. The nurse expects to administer which intravenous (IV) anesthetic drug?

Propofol (Diprivan) Propofol is an IV sedative-hypnotic drug used for induction and maintenance of anesthesia as well as for sedation in patients who are intubated and mechanically ventilated in the ICU. It has a rapid onset and short duration of action, allowing for easy titration and maintenance of the patient's level of consciousness.

The nurse is completing discharge teaching for a patient prescribed an antiepileptic drug. The nurse instructs the patient of which potential complication if the medication is stopped abruptly?

Rebound seizure activity Abrupt withdrawal of antiepileptic drugs can cause rebound seizure activity.

A client is to begin lithium carbonate therapy. Which baseline lab work will the nurse ensure is completed before medication admin?

Renal studies

The nurse administers carbidopa-levodopa to client with Parkinson's disease. Which activity describes the mechanism of action of this med?

Replacement of a neurotransmitter in the brain

Which nursing diagnosis is appropriate for a patient who has just been administered a sedative-hypnotic drug?

Risk for injury and falls Sedative-hypnotic drugs cause central nervous system depression, putting the patient at risk for injury and falls.

What atypical antipsychotic medication would the nurse anticipate the health care provider prescribing for treatment of refractory schizophrenia?

Risperidone (Risperdal) Risperidone is effective for schizophrenia, including negative symptoms. The other medications listed are antidepressants.

A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified?

Schedule II CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system (CNS) and therefore allows a decreased dose of other medications?

Selegiline (Eldepryl) Selegiline is a selective monoamine oxidase (MAO) B inhibitor that has been shown to cause an increase in the levels of dopaminergic stimulation in the CNS and thus allows the dose of levodopa to be decreased.

After surgery an adolescent has a patient controlled analgesia pump that is set to allow morphine delivery every 6 minutes. Which statement indicates to the nurse that the family understand instructions about the PCA pump?

She needs to push the PCA button whenever she needs pain medication

What is another approved and indicated use for the antidepressant bupropion (Zyban)?

Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients to quit smoking.

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement?

St. John's wort Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.

A health care provider in the emergency department identifies that a client is in cardiogenic shock. Which type of med is indicated for management of this condition?

Sympathomimetic

Which postoperative nursing action will help the patient avoid serious complications from general anesthesia?

Teach to turn, cough, and deep breathe. Frequent turning, coughing, and deep breathing can help prevent postoperative atelectasis, a sequela of generalized anesthesia and mechanical ventilation.

In monitoring a patient for adverse effects related to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS)?

The chemoreceptor trigger zone Morphine sulfate can irritate the gastrointestinal (GI) tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.

A pain scale of 1 to 10 is used by the nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client's response to pain medication?

The medication is not adequately effective

A mechanically ventilated patient receiving a neuromuscular-blocking drug has tearing in the eyes and increased heart rate and blood pressure. How does the nurse interpret this clinical finding?

The patient's level of sedation is inadequate. Tearing in the eyes and increased heart rate and blood pressure are symptoms of increased anxiety or pain. A patient receiving a neuromuscular blocking drug cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation.

A patient diagnosed with depression is being discharged with a prescription for tricyclic antidepressants (TCA) after no improvement of symptoms on a selective serotonin reuptake inhibitors (SSRI). Which instruction would the nurse include specific to TCAs?

There is a risk of toxicity when this medication is taken with alcohol. There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

The nurse is caring for a patient with Parkinson's disease who has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide to the patient?

This is a normal adverse effect of entacapone (Comtan) and is not harmful. Patients should be instructed that entacapone (Comtan) can turn urine a brownish-orange color, and this is not a harmful adverse effect.

What is the goal of pharmacologic therapy in treating Parkinson's disease?

To balance cholinergic and dopaminergic activity in the brain Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. By increasing dopamine, the neurotransmitter activity becomes more balanced and symptoms become controlled.

The nurse would monitor an older adult patient prescribed a benzodiazepine for treatment of insomnia for which potential adverse effect?

Unsteady gait Benzodiazepine doses for children and older adults should be small with gradual increases to avoid ataxia (unsteady gait) and excessive sedation. Thus, these patients should be closely monitored for these adverse effects.

A patient with Parkinson's disease discusses with the nurse experiencing insomnia recently. The patient asks the nurse, "Can I take my old prescription of benzodiazepine that is prescribed to treat my insomnia?" What does the nurse know about the use of benzodiazepines in patients taking levodopa (Larodopa)?

Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease. Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson's disease.

Ergot alkaloids exert their therapeutic effect by which action?

Vasoconstriction Ergot alkaloids narrow or constrict blood vessels in the brain. They are useful in the treatment of migraine headache caused by vasodilation of vessels in the brain. Ergot alkaloids were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy.

The nurse teaches the parents of a child prescribed long-term phenytoin therapy about care. Which statement indicates the teaching has been effective?

We'll have her massage her gums and floss her teeth frequently

A patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use?

Wearing-off phenomenon The wearing-off phenomenon occurs when antiParkinson disease medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The symptoms return and continue on a constant basis despite treatment and medications.

A client has been receiving oxycodone for moderate pain associated with multiple injuries sustained in a mvc. Which assessment finding, in addition to the client's slurred speech, leads the nurse to suspect opioid intoxication?

constricted pupils

akathisia

side effect of halaperidol restlessness and agitation

torticollis

stiff neck

The nurse is educating a client who is taking clozapine to treat schizophrenia. Which adverse effect of clozapine would the nurse emphasize as being important to report to the health care provider?

temperature rise