Exam 3 - Review Questions (Pharm)

Following administration of phenylephrine, the nurse would assess for which of the following adverse drug effects? 1. Insomnia, nervousness, and hypertension 2. Nausea, vomiting, and hypotension 3. Dry mouth, drowsiness, and dyspnea 4. Increased bronchial secretions, hypotension, and bradycardia

1 Rationale: Adrenergic agonists such as phenylephrine (Neo-Synephrine) stimulate the sympathetic nervous system and produce symptoms including insomnia, nervousness, and hypertension.

A patient is treated for psychosis with fluphenazine. What drug will the nurse anticipate may be given to prevent the development of acute dystonia? 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan)

1 Rationale: Benztropine (Cogentin), an anti- cholinergic, may be given to suppress the tremor and rigidity that may be caused by fluphenazine or other phenothiazine antipsychotic drugs.

A client has purchased capsaicin OTC cream to use for muscle aches and pains. What education is most important to give this client? 1. Apply with a gloved hand only to the site of pain. 2. Apply the medication liberally above and below the site of pain. 3. Apply to areas of redness and irritation only. 4. Apply liberally with a bare hand to the affected limb.

1 Rationale: Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment.

To avoid the first-dose phenomenon, the nurse knows the the initial dose of prazosin should be: 1. Very low and given at bedtime 2. Doubled and given before breakfast 3. The usual dose and given before breakfast 4. The usual dose and given immediately after breakfast

1 Rationale: Drugs that cause a "first-dose phenomenon" should have very low initial doses administered at bedtime. The decline in blood pressure due to prazosin is often marked when beginning pharmacotherapy and when increasing the dose. This "first- dose phenomenon" can lead to syncope due to reduced blood flow to the brain.

The nurse should immediately report the development of which of the following symptoms in a patient taking antipsychotic medication? 1. Fever, tachycardia, confusion, incontinence 2. Pacing, squirming, or difficulty with gait such as bradykinesia 3. Severe spasms of the muscles of the tongue, face, neck, or back 4. Sexual dysfunction of gynecomastia

1 Rationale: Fever, tachycardia, confusion, and incontinence are symptoms of the development of NMS and should be immediately reported.

A client who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? a. Whether the client has been taking the medication consistently or only when the pain is severe b. Whether the client has been consuming alcohol during this time. c. Whether the client has increased the dosage without consulting the health care provider d. Whether the client's log of symptoms indicates that the client is telling the truth.

1 Rationale: Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug effects.

The patient or family of the patient taking neostigmine should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred? 1. Excessive sweating, salivation, and drooling 2. Extreme constipation 3. Hypertension and tachycardia 4. Excessively dry eyes and reddened sclera

1 Rationale: Overdosage of parasympathomimetics (cholinesterase-inhibitors) such as neostigmine (Prostigmin) may produce excessive sweating, drooling, dyspnea, or excessive fatigue. These symptoms should be promptly reported.

A client has received succinylcholine (Anectine) along with the general anesthetic in surgery. Which of the following abnormal finding in the recovery period should be reported immediately to the provider? 1. Temperature 38.9C (102F) 2. Heart rate 56 3. Blood pressure 92/58 4. Respiratory rate 15

1 Rationale: The combination of succinylcholine (Anectine, Quelicin) and general anesthetics is known to trigger malignant hyperthermia in some patients. A temperature of 38.9°C (102°F) may signal the development of malignant hyperthermia and should be immediately reported.

A patient who is taking an adrenergic-bocker for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to: 1. Move slowly from the recumbent to upright position 2. Drink a full glass of water before rising to increase vascular circulatory volume 3. Avoid sleeping in a prone position 4. Stop taking the medication

1 Rationale: The nurse should suspect that the patient is describing orthostatic hypotension induced by the medication. Most patients find it helpful to move slowly from a recumbent position to avoid dizziness and syncope.

The client received lidocaine viscous before a gastroscopy was performed. Which of the following would be a priority for the nurse to assess during the post procedure period? 1. Return gag reflex 2. Ability to urinate 3. Leg pain 4. Ability to stand

1 Rationale: The patient's throat was anesthetized during gastroscopy with lidocaine viscous. The patient should be assessed for the return of the gag reflex before being allowed to drink or eat to prevent aspiration.

The nurse is providing education for a 12 year old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report what symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

1 Rationale: Valproic acid may cause life- threatening pancreatitis, and any severe or increasing abdominal pain should be reported immediately.

A patient is started an atenolol. Which is the most important action to be included in the plan of care for this patient related to this medication? 1. Monitor apical pulse and blood pressure 2. Elevate head of the bed during meals 3. Take the medication after meals 4. Consume food high in potassium

1 Rationale: With beta-adrenergic blockers such as propranolol, the most important action is to monitor the patient for adverse effects associated with the cardiovascular system such as changes in pulse and blood pressure.

Nursing implications of the administration of haloperidol (Haldol) to a patient exhibiting psychotic behavior include which of the following? (Select all that apply) 1. Take 1 hour before or 2 hours after antacids 2. The incidence of extrapyramidal symptoms is high 3. It is therapeutic if ordered on an as-needed basis 4. Haldol is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush sustained release form for easier swallowing

1, 2, 4 Rationale: Aluminum- and magnesium- based antacids decrease absorption of haloperidol (Haldol). Haldol also has a high incidence of EPS. It is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression.

Anticholinergics may be ordered for which of the following conditions? (Select all that apply) 1. Peptic ulcer disease 2. Bradycardia 3. Decreased sexual function 4. Irritable bowel syndrome 5. Urine retention

1, 2, 4 Rationale: Anticholinergics are used in the treatment of peptic ulcer disease, irritable bowel syndrome, and bradycardia because they suppress the effects of Ach and stimulate the sympathetic nervous system.

What medications may be used to treat partial seizures? (select all that apply) 1. Phenytoin (Dilantin) 2. Valproic Acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Euthosuximide (Zarontin)

1, 2, 4 Rationale: The phenytoin-like drugs including phenytoin (Dilantin), valproic acid (Depakene), and carbamazepine (Tegretol) are used to treat partial seizures.

Cyclobenzaprine (Amrix, Flexeril) is prescribed for a patient with muscle spasms of the lower back. Appropriate nursing interventions would include which of the following? (Select all that apply) 1. Assessing the heart rate for tachycardia 2. Assessing the home environment for patient safety concerns 3. Encouraging frequent ambulation 4. Providing oral suction for excessive oral secretions 5. Providing assistance with activities of daily living such as reading

1, 2, 5 Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring patient safety must be a priority. The patient may need assistance with reading or other activities requiring visual acuity if blurred vision occurs.

The patient returns to the post anesthesia recovery unit for observation and recovery following surgery with a general anesthetic. Which of the following assessment findings may the nurse expect to find during this recovery period? (Select all that apply) 1. Bradycardia 2. Severe headache 3. Hypertension 4. Respiratory depression 5. Urinary frequency

1, 4 Rationale: Bradycardia and respiratory depression are common findings with general anesthetics in the immediate postoperative period due to the CNS depressant effects of the drugs.

Prior to discharge, the nurse plans for patient teaching related to side effects of phenothiazines to the patient, family, or caregiver. Which of the following should be included? 1. The patient may experience withdrawal and slowed activity 2. Severe muscle spasms may occur early in therapy 3. Tardive dyskinesia is likely early in therapy 4. Medications should be taken as prescribed to prevent adverse effects

2 Rationale: Acute dystonias, or severe muscle spasms, particularly of the back, neck, face, or tongue, may occur within hours or days of the first dose of a phenothiazine drug and should be reported immediately.

The patient taking benztropine should be provided education on methods to manage which common adverse effects? 1. Heartburn 2. Constipation 3. Hypothermia 4. Increased gastric motility

2 Rationale: Anticholinergic medications such as benztropine (Cogentin) slow intestinal motility; therefore, constipation is a potential side effect. Patients should be taught methods to manage constipation such as increasing fluids and fiber in the diet.

A 20-year-old man is admitted to the psychiatric unit for treatment of acute schizophrenia and is started on risperidone (Risperdal). Which patient effects should the nurse assess for to determine whether the drug is having therapeutic effects? 1. Restful sleep, elevated mood, and coping abilities 2. Decreased delusional thinking and lessened auditory/visual hallucinations 3. Orthostatic hypotension, reflex tachycardia, and sedation 4. Relief of anxiety and improved sleep and dietary habits

2 Rationale: Antipsychotic drugs such as risperidone (Risperdal) treat the positive and negative effects of the underlying mental disorder. A decrease in delusional thinking, lessened hallucinations, and over- all improvement in mental thought processes should be noted.

Which factor in the patient's history would cause the nurse to question a medication order for atropine? 1. A 32-year-old man with a history of drug abuse 2. A 65-year-old man with BPH 3. An 8-year-old boy with chronic tonsillitis 4. A 22-year-old woman on the second day of her menstrual cycle

2 Rationale: Atropine causes urinary retention to worsen in patients with BPH.

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). What information should the nurse provide to the parents? 1. After school sports activities will ned to be stopped because they will increase the risk of seizures 2. Monitor height and weight to assess that growth is progressing normally 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet 4. Avoid dehydration with activities and increase fluid intake

2 Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child's height and weight to assess whether nutritional intake is sufficient for normal growth and development.

The client is scheduled to receive rimabotulinumtoxinB (Myobloc) for treatment of muscle spasticity. Which of the following will the nurse teach the client to report immediately? 1. Fever, aches, or chills 2. Difficulty swallowing, ptosis, blurred vision 3. Continuous spasms and pain on the affected side 4. Moderate levels of muscle weakness on the affected side

2 Rationale: Dysphagia, ptosis, and blurred vision are all symptoms of possible botulinum toxin B toxicity and must be reported immediately.

The nurse discusses the disease process of multiple sclerosis with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included? 1. Drink extra fluids while this drug is given. 2. Local injection site irritation is a common affect. 3. Take the drug with plenty of water and remain in an upright position for at least 30 minutes. 4. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.

2 Rationale: Glatiramer (Copaxone) is given by injection and often causes injection site irritation.

A patient has been taking phenytoin (Dilantin) for control of generalized seizures, tonic-clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased 2. The dosage will be decreased 3. The dosage will remain the unchanged; these are symptoms unrelated to the phenytoin 4. The dosage will remain unchanged but and additional antiseizure medication may be added.

2 Rationale: Nystagmus, confusion, and ataxia may occur with phenytoin, particularly with higher dos- ages. The dosage is likely to be decreased.

Planning teaching needs for a patient who is to be discharged postoperatively with a prescription for oxycodone with acetaminophen (Percocet) should include which of the following? 1. Refer the patient to a drug treatment center if addiction occurs 2. Encourage increased fluids and fiber in diet 3. Monitor for GI bleeding 4. Teach the patient to self assess blood pressure

2 Rationale: Opioids such as hydrocodone with acetaminophen (Percocet) slow peristalsis which can lead to constipation. Increasing fluids and fiber in the diet may help prevent this adverse effect.

The client asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of parkinsonism. What is the best response by the nurse? 1. "A cure can be expected within 6 months." 2. "Symptoms can be reduced and the ability to perform ADLs can be improved." 3. "Disease progression will be stopped." 4. "EPS will be prevented."

2 Rationale: Pharmacotherapy does not cure or stop the disease process but does improve the patient's ability to perform ADLs such as eating, bathing, and walking.

The nurse teaches the patient relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. What is the main rationale for the use of these techniques as adjuncts to analgesic medication? 1. They are less costly techniques 2. They may allow lower doses of drugs with fewer adverse effects 3. They can be used at home 4. They do not require self-injection

2 Rationale: When used concurrently with medication, nonpharmacologic techniques may allow for lower doses and possibly fewer drug-related adverse effects. Relaxation techniques and guided imagery may also be used in the acute care setting.

A female client is prescribed dantrolene sodium (Dantrium) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the client and will include which of the following teaching points? (Select all the apply) 1. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day. 2. Inform the health care provider if she is taking estrogen products. 3. Sip water, ice, or hard candy to relieve dry mouth. 4. Return periodically for required laboratory work. 5. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels.

2, 3, 4 Rationale: Dantrolene (Dantrium) may cause hepatotoxicity with the greatest risk occurring for women over age 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness.

The nurse knows that which of the following are major disadvantages for the use of donepezil (Aricept) to treat the symptoms of early Alzheimer's disease? (Select all that apply) 1. It must be administered four times per day 2. It may cause significant weight loss 3. It may cause potentially fatal cardiac dysrhythmias 4. It may cause serious hepatic damage 5. It results in only modest cognitive improvement and results do not last.

2, 3, 4, 5 Rationale: Donepezil (Aricept) may cause serious liver damage and potentially fatal dysrhythmias including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cognitive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term.

Which of the following client statements indicates that the levodopa/carbidopa (Sinemet) is effective? 1. "I'm sleeping a lot more, especially during the day." 2. "My appetite has improved." 3. "I'm able to shower by myself." 4. "My skin doesn't itch anymore."

3 Rationale: Becoming more independent in ADLs shows an improvement in physical abilities.

An early sign(s) of levodopa toxicity is (are) which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking muscle twitching 4. Nausea, vomiting, and diarrhea

3 Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity.

A client has been prescribed clonazepam (Klonopin) for muscle spasms and stiffness secondary to an automobile accident. While the client is taking this drug, what is the nurse's primary concern? 1. Monitoring hepatic laboratory work 2. Encouraging fluid intake to prevent dehydration 3. Assessing for drowsiness and implementing safety measures. 4. Providing social services referral for client concerns about the cost of the drug.

3 Rationale: Clonazepam (Klonopin) is a benzodiazepine; because it works on the CNS, it may cause significant drowsiness and dizziness. Safety measures should be implemented to prevent falls and injury.

A patient admitted with hepatitis B is prescribed hydrocodone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take? 1. Administer the drug as ordered 2. Administer 1 tablet only 3. Recheck the order with the health care provider 4. Hold the drug until the health care provider arrives

3 Rationale: Hydrocodone with acetaminophen (Vicodin) contains acetaminophen which can be hepatotoxic. This patient has hepatitis B, a chronic liver infection with inflammation, which may affect the metabolism of the drug.

The patient who is scheduled to have a minor in-office surgical procedure will receive nitrous oxide and expresses concern to the nurse that the procedure will hurt. Which of the following would be the nurse's best response? 1. "You may feel pain during the procedure but you won't remember any of it." 2. "You will be unconscious the entire time and won't feel any pain." 3. "You will not feel any pain during the procedure because the drug blocks the pain signals." 4. "You will feel pain but you won't perceive it the same way; that's why it's called "laughing gas."

3 Rationale: Nitrous oxide suppresses the pain mechanisms within the CNS thereby causing analgesia.

What is the most appropriate method to ensure adequate pain relief in the immediate postoperative period from an opioid drug? 1. Give the drug only when the family members report that the patient is complaining of pain 2. Give the drug every time the patient complains of acute pain 3. Give the drug as consistently as possible for the first 24 to 48 hours 4. Give the drug only when the nurse observes signs and symptoms of pain

3 Rationale: Opioid pain relievers should be given as consistently as possible and before the onset of acute pain in the immediate postoperative period unless the patient's condition does not allow the consistent dosing (e.g., vital signs do not support regular doses).

The nurse is preparing a plan of care for a patient with myasthenia gravis. Which of the following outcome statements would be appropriate for a patient receiving a cholinergic agonist such as pyridostigmine for this condition? The patient will exhibit: 1. An increase in pule rate, BP, and RR 2.Enhanced urinary elimination 3.A decrease in muscle weakness, ptosis, and diplopia 4.Prolonged muscle contractions and proprioception

3 Rationale: Pyridostigmine is used primarily for myasthenia gravis, a neurologic disorder characterized by muscle weakness and ptosis. A decrease in these symptoms is an expected therapeutic outcome for this drug.

Levodopa is prescribed for a client with Parkinson's disease. At discharge, which of the following teaching points should the nurse include? 1. Monitor blood pressure every 2 hours for the first 2 weeks. 2. Report development of diarrhea. 3. Take the pill on an empty stomach or 2 hours after a meal containing protein. 4. If tremors seem to worsen, take a double dose for two doses and call the provider

3 Rationale: Taking dopamine replacement drugs such as levodopa with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein.

Older adult patients taking bethanechol need to be assessed more frequently because of which of the following adverse effects? 1. Tachycardia 2. Hypertension 3. Dizziness 4. Urinary retention

3 Rationale: The nurse should monitor older adult patients for episodes of dizziness caused by CNS stimulation from the parasympathomimetic system.

The nurse administers morphine 4 mg IV to a patient for treatment of severe pain. Which of the following assessments require immediate nursing interventions? (Select all that apply) 1. The patient's blood pressure is 110/70 mmHg 2. The patient is drowsy 3. The patient's pain is unrelieved in 15 minutes 4. The patients respiratory rate is 10 breaths per minute 5. The patient becomes unresponsive

3, 4, 5 Rationale: Opioids may cause respira- tory depression, particularly with the first dose given. The patient's respiratory rate should remain above 12 breaths per minute. Although the patient may also be- come drowsy, he or she should not become unresponsive after administration of morphine sulfate. Because of the rapid onset of drugs when given IV, the provider should be notified if the patient's pain is unrelieved in 15 minutes.

The patient states that he has not taken his antipsychotic drug for the past two weeks because it was causing sexual dysfunction. What is the nurse's primary concern at this time? 1. Hypertensive crisis may occur with abrupt withdrawal of the drug 2. Significant muscle twitching may occur, increasing fall risk 3. Extrapyramidal symptoms such as secondary parkinsonism are likely to occur 4. Symptoms of psychosis are likely to return.

4 Rationale: Antipsychotic medications treat the symptoms associated with mental illness but do not cure the underlying disorder. Without the medication, symptoms of the disorder are likely to return.

Propranolol has been ordered for a patient with hypertension. Because of adverse effects related to this dug, the nurse would carefully monitor for which adverse effect? 1. Bronchodilation 2. Tachycardia 3. Edema 4. Bradycardia

4 Rationale: Because beta-adrenergic blockers such as propranolol (Inderal) slow electrical conduction through the cardiac conduction system, they may cause bradycardia.

The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for seizure disorder. Because of this client's age, the nurse would establish what nursing diagnosis related to the drug's common adverse effects? 1. Risk for deficient fluid volume 2. Risk for impaired verbal communication 3. Risk for consipation 4. Risk for falls

4 Rationale: CNS depression including dizziness and drowsiness is a common adverse effect of gabapentin (Gralise, Horizant, Neurontin). Because of this patient's age, these effects may increase the risk of falls.

Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report what symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

4 Rationale: Carbamazepine (Tegretol) is associated with Stevens-Johnson syndrome and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing.

The health care provider prescribes epinephrine for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows that the primary purpose of this medication for this patient is to: 1. Stop the systemic release of histamine produced by the mast cells 2. Counteract the formation of antibodies in response to an invading antigen 3. Increase the number of WBCs produced to fight the primary invader 4. Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis

4 Rationale: Epinephrine is used during anaphylaxis to prevent hypotension and bronchoconstriction.

A patient is admitted to the post anesthesia recovery unity (PACU) after receiving ketamine (Ketalar) after his minor orthopedic surgery. What is the most appropriate nursing action in the recovery period for this client? 1. Frequently orient the client to time, place, and person 2. Keep the client in a bright environment so there is less drowsiness 3. Frequently assess the client for sensory deprivation 4. Place the client in a quiet area of the unit with low lights and away from excessive noise

4 Rationale: Neuroleptanalgesia drugs such as ketamine do not result in full loss of consciousness but cause disconnection from events that are occurring. Confusion, anxiety, fear, or panic may occur in the immediate postprocedure period if sensory stimulation is misinterpreted. Sensory stimulation should be kept to a minimum during this period for this reason.

A young client requires suturing of a laceration to right forearm and the provider will use lidocaine (Xylocaine) with epinephrine as the local anesthetic prior to the procedure. Why is the epinephrine included in the lidocaine for this client? 1. It will increase vasodilation at the site of the laceration 2. It will prevent hypotension 3. It will ensure that infection risk is minimized post suturing. 4. It will prolong anesthetic action at the site

4 Rationale: Solutions of lidocaine containing epinephrine are used for local anesthesia because the epinephrine will prolong the anesthetic action at the site. Because this is a young patient, that may be particularly advantageous.

The emergency department nurse is caring for a patient with a migraine. Which drug would the nurse anticipate administering to abort the patient's migraine attack? 1. Morhpine 2. Propranolol (Inderal) 3. Ibuprofen (Motrin) 4. Sumatriptan (Imitrex)

4 Rationale: Triptans such as sumatriptan (Imitrex) are used to abort a migraine attack.