NCLEX Pharm: Musculoskeletal and Neurologic
What is ginseng used for?
promote mental alertness and enhance the immune system.
A client with Parkinson disease is prescribed carbidopa-levodopa. Which of the following instructions should the nurse include with the client's discharge teaching?
1) Change positions slowly and sit on the side of the bed 2) This medication takes several weeks to reach maximum benefit. 3) Your saliva may turn reddish brown while on this medication, but this is not harmful.
What is the therapeutic index level for phenytoin?
10-20
What are the adverse effects associated with methotrexate?
Adverse effects associated with methotrexate include bone marrow suppression, hepatotoxicity (ie, drug-induced liver injury), and gastrointestinal irritation (eg, nausea, vomiting, diarrhea). Bone marrow suppression is a leads to anemia, leukopenia, and thrombocytopenia. Thrombocytopenia manifests as petechiae and other forms of bleeding.
The nurse is reviewing new prescriptions for assigned clients. Which prescription would require further clarification from the health care provider?
Alteplase for an ischemic stroke in a client with a BP of 192/112 - Thrombolytic agents (eg, alteplase, tenecteplase, reteplase) place clients at risk for bleeding. Therefore, they are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension.
What are the s/s of phenytoin drug-induced toxicity?
Common symptoms of phenytoin drug-induced toxicity involve the central nervous system and include ataxia, nystagmus, slurred speech, and decreased alertness.
A client diagnosed with trigeminal neuralgia is given a prescription of carbamazepine by the health care provider. Which intervention does the nurse add to this client's care plan?
Encourage patient to report fever or sore throat - A client diagnosed with trigeminal neuralgia is given a prescription of carbamazepine by the health care provider. Which intervention does the nurse add to this client's care plan?
The home health nurse reviews the serum laboratory test results for a client with seizures. The phenytoin level is 27 mcg/mL. The client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify the health care provider?
I am feeling unsteady when I walk
The home health nurse prepares to give benztropine to a 70-year-old client with Parkinson disease. Which client statement is most concerning and would warrant health care provider notification?
I am going to repeat testing for glaucoma - Anticholinergic medications (eg, benztropine, trihexyphenidyl) are used to treat Parkinson disease tremor. However, they can precipitate acute glaucoma and urinary retention and are therefore contraindicated in susceptible clients (eg, those with glaucoma or benign prostatic hyperplasia).
The nurse assesses a client who is receiving methotrexate for rheumatoid arthritis. Which statement by the client is most concerning?
I have small purple dots all over my skin -
A client is receiving scheduled doses of carbidopa-levodopa. The nurse evaluates the medication as having the intended effect if which finding is noted?
Improvement in spontaneous activity
What are adverse effects of cabidopa-levodopa and why should it not be stopped suddenly?
It is started in low doses to prevent orthostatic hypotension and neuropsychiatric adverse effects. Carbidopa-levodopa once started should never be stopped suddenly as doing so can lead to akinetic crisis (complete loss of movement).
The nurse is caring for a client who is taking riluzole for amyotrophic lateral sclerosis (ALS). The client asks, "There's no cure for ALS, so why should I keep taking this expensive drug?" What is the nurse's best response?
It may be able to slow the progression of ALS by 3-6 months (it is a glutamine agonist)
A client with a brain tumor is admitted for surgery. The health care provider prescribes levetiracetam. The client asks why. What is the nurse's response?
It prevents seizure development
What medications are used to promote memory in Alzheimer's?
Medications for the treatment of Alzheimer disease, such as donepezil and rivastigmine, are used to improve cognition and memory.
What is midazolam and what are its side effects?
Midazolam (versed) is a benzodiazepine used for conscious sedation. Side effects: Side effects can include airway occlusion, apnea, hypotension (especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest.
A client with gout who was started on allopurinol a week ago calls the health care provider's (HCP's) office with several concerns. The nurse should recognize which report by the client as being significant and requiring immediate follow-up?
Mild red rashes have developed over the torso - Allopurinol-induced rashes can develop into severe and sometimes fatal hypersensitivity reactions, such as Stevens-Johnson syndrome.
What is carbidopa-levodopa used for and what are its side effects?
Most helpful for treating bradykinesia in Parkinson disease and can also improve tremor and rigidity to some extent. - DOES NOT enhance memory
What is benztropine?
Muscarinic/anticholinergic - Anticholinergic medications (eg, benztropine, trihexyphenidyl) are commonly used to treat tremor in these clients. - Benztropine (Cogentin) is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide.
The clinic nurse prepares to administer a newly prescribed dose of sumatriptan to a client with a migraine headache. Which item in the client's history would cause the nurse to question the prescription?
Past medical history of uncontrolled HTN - Sumatriptan relieves migraines by constricting dilated cranial blood vessels. - It is contraindicated in: coronary artery disease and uncontrolled hypertension because the vasoconstrictive effects can cause hypertensive urgency, angina, decreased cardiac perfusion, and acute myocardial infarction.
The nurse reviews the laboratory results of several clients. Which finding should the nurse report to the health care provider immediately?
Patient who is receiving tube feedings and has a phenytoin level of 8 - Tube feedings decrease phenytoin (Dilantin) absorption, which reduces serum drug concentrations (therapeutic index 10-20 mcg/mL [40-79 mcmol/L]) and may precipitate seizures. - The nurse should pause tube feedings for 1-2 hours before and after phenytoin administration to ensure adequate absorption.
What is phentolamine the antidote for?
Phentolamine (Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation.
A client has just been prescribed allopurinol for chronic gout. Which instruction is most important for the nurse to emphasize to the client?
Take the medication with a full glass of water and increase fluids during the day - Increased fluids help to prevent renal stones and promote diuresis and uric acid excretion.
What medications are known for having steven johnson syndrome as a side effect?
Similar instructions should be given to clients taking anticonvulsants (eg, carbamazepine, phenytoin, lamotrigine) and sulfa antibiotics.
A client with seizure activity is receiving a continuous tube feeding via a small-bore enteral tube. The nurse prepares to administer phenytoin oral suspension via the enteral route. What is the nurse's priority action before administering this medication?
Stop the feeding for 1-2 hours - The nurse's priority action is to stop the feeding for 1 to 2 hours before and after administering phenytoin as products containing calcium (eg, antacids, calcium supplements) and/or nutritional enteral tube feedings can decrease the absorption and the serum level of this drug.
What type of IV solution is used with SIADH?
Syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in water retention and dilutional hyponatremia. Clients with SIADH often require hypertonic (3%) saline for sodium repletion to increase serum sodium levels with a minimal infused volume of water.
The health care provider (HCP) has told a client to take over-the-counter (OTC) supplemental calcium carbonate 1000 mg/day for treatment of osteoporosis. Which instruction should the clinic nurse give the client?
Take calcium in divided doses with food - Multiple daily doses are recommended as calcium absorption is impaired when taken in excess of 500 mg per dose. - Constipation is a frequent side effect of calcium supplementation.
What is alteplase and what is its mechanism of action?
Thrombolytic agents (eg, alteplase, tenecteplase, reteplase) are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism). They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.
The nurse reviews the analgesia prescriptions for assigned clients. The nurse should question the health care provider about which prescription?
Transdermal fentanyl patch for a client who is 1 day postop above the knee amputation and reports intermittent, throbbing stump pain - A transdermal fentanyl patch is indicated to treat moderate to severe chronic pain. - It is not recommended for treating acute postoperative, temporary, or intermittent pain as it does not provide immediate analgesia when applied.
What is dexamethasone used for in brain tumors?
Used to treat cerebral edema associated with a brain injury/tumor by decreasing inflammation.
What is evening primrose used for?
eczema or skin irritations
What medication causes metallic taste in the mouth?
metronidazole
