Neuro Pharm Exam 1

1503) An 18-month-old toddler is being treated with intravenous diazepam every 4 hours for generalized tetanus. Which response to the medication would the nurse anticipate? Control of hypertonicity and prevention of seizures Control of laryngospasms and neck and jaw rigidity Prevention of excess oxygen and caloric expenditure Prevention of restlessness and resistance to assisted ventilation

Control of hypertonicity and prevention of seizures

309) Which medication would the nurse instruct a client to avoid while taking alprazolam? Select all that apply. One, some, or all responses may be . Opioids Alcohol Barbiturates Antidepressants First-generation antipsychotics

Opioids Alcohol Barbiturates Rationale: Respiratory depression can occur if a client combines benzodiazepines with opioids, alcohol, or barbiturates. Antidepressants and first-generation antipsychotics are safe to take with benzodiazepines.

3. The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client's medical record, which prescription should the nurse question? AContinuous infusion of dextrose 5% in 0.9% saline BNPH insulin 40 units before meals CLabetalol 100 mg orally twice per day DKetorolac 15 mg IV push as needed for pain

AContinuous infusion of dextrose 5% in 0.9% saline

219) Which instruction about phenytoin will the nurse provide during discharge teaching to a client with epilepsy who is prescribed phenytoin for seizure control? "Antiseizure medications will probably be continued for life." "Phenytoin prevents any further occurrence of seizures." "This medication needs to be taken during periods of emotional stress." "Your antiseizure medication usually can be stopped after a year's absence of seizures."

"Antiseizure medications will probably be continued for life." Rationale: Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite medication therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the medication irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from ion of the pathophysiological condition.

715) A client with a seizure disorder will begin taking phenytoin. Which instructions will the nurse give to the client? 'Take the medication on an empty stomach.' 'Provide meticulous oral hygiene.' 'Taper off the medication if seizures are controlled for 3 months.' 'Stop taking the medication if you become pregnant.'

'Provide meticulous oral hygiene.' Rationale: Phenytoin can cause gingival overgrowth that increases the risk for periodontal disease. The medication should be taken with food or milk to decrease gastrointestinal side effects. The health care provider should oversee any dosage adjustment or discontinuation. Although it can affect the developing fetus, current evidence suggests that the effect of seizure activity on the developing fetus may cause even greater problems.

1031) A client with a seizure disorder is receiving phenytoin and phenobarbital. Which client statement indicates that the instructions regarding the medications are understood? 'I will not have any seizures with these medications.' 'These medicines must be continued to prevent falls and injury.' 'Stopping the medications can cause continuous seizures and I may die.' 'By my staying on the medicines I will prevent postseizure confusion.'

'Stopping the medications can cause continuous seizures and I may die.'

514) The nurse teaches the parents of a child prescribed long-term phenytoin therapy about care. Which statement indicates the teaching has been effective? 'We give the medication between meals.' 'We'll call the clinic if her urine turns pink.' 'She's eating high-calorie foods, and we encourage fluids, too.' 'We'll have her massage her gums and floss her teeth frequently.'

'We'll have her massage her gums and floss her teeth frequently.' Rationale: A common side effect of phenytoin is gingival hyperplasia. Meticulous oral hygiene may reduce the risk of this side effect. Phenytoin is strongly alkaline and should be administered with meals to help prevent gastric irritation. Pink urine may be observed during medication excretion; it is expected and does not require treatment. Avoidance of overeating and overhydration may result in better seizure control.

6 The nurse is educating a client with seizure disorder about newly prescribed phenytoin. Which statement should the nurse include in the teaching? ABlood work will be required if you have a seizure while taking this medication BYou will need to have routine visits with a dentist when taking this medication CIt is normal to have a change in your gait when you first start this medication DAvoid grapefruit juice when taking this medication

ABlood work will be required if you have a seizure while taking this medication Rationale: Phenytoin is the first-line medication for the treatment of seizures. Clients should be instructed that they will need routine lab work to ensure that they are at a therapeutic level with the medication, even if they have been seizure-free. This medication can cause gingival hyperplasia, which will require routine dental visits. The client does not need to avoid grapefruit juice with this medication. Difficulty with hand and gait coordination could indicate toxicity and should be reported to the healthcare provider.

5 The nurse is caring for a client who was prescribed alprazolam. When educating the client about the new medication, which intended effect should the nurse include? AReduce anxiety and provide a calming effect BIncrease coordination and the ability to concentrate CAlleviate signs and symptoms of spasticity DReduce symptoms of depression

AReduce anxiety and provide a calming effect

1038) A client's phenytoin level is 16 mcg/L. Which action will the nurse take? Hold the medication and notify the health care provider. Administer the next dose of the medication as prescribed. Hold the next dose and then resume administration as prescribed. Call the health care provider to obtain a prescription with an increased dose.

Administer the next dose of the medication as prescribed. Rationale: Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mcg/L (40-80 mcmol/L); the nurse would administer the medication as prescribed. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the medication. Calling the health care provider to obtain a prescription with an increased dose is inappropriate because the blood level is within the therapeutic range.

419) Which medication would the nurse anticipate developing a teaching plan for when a client reports becoming panicked and having an irrational fear of talking in public? Buspirone Alprazolam Diazepam Lorazepam

Alprazolam Rationale: Alprazolam (a benzodiazepine) is a short-acting anxiolytic medication used to treat those clients with panic disorders and the irrational fear of talking openly in public (agoraphobia). Buspirone, an anxiolytic medication that is different both chemically and pharmacologically from the benzodiazepines, is always administered on a scheduled basis (not on an as-needed basis) for the treatment of anxiety. Diazepam is an anxiolytic medication commonly prescribed for the treatment of anxiety but has generally been replaced by short-acting benzodiazepines. Lorazepam is an intermediate-acting anxiolytic medication used in the treatment of acutely agitated clients.

102) Which manifestation is an adverse effect of intravenous lorazepam? Select all that apply. One, some, or all responses may be correct. Amnesia Drowsiness Sleep driving Blurred vision Respiratory depression

Amnesia Drowsiness Sleep driving Blurred vision Respiratory depression

8 The nurse is preparing to administer diltiazem to a client with heart disease. Which action should the nurse take first? AAssess the client's lung sounds and monitor for wheezing BAssess the client's blood pressure and apical pulse CAssess the client's urine output and potassium level DAuscultate the abdomen for bowel sounds

BAssess the client's blood pressure and apical pulse

6. The nursing is preparing to administer phenytoin IV push to a client. The client has dextrose 5% in water infusing continuously. Which action is appropriate? APinch the line above the infusion port during the administration BHold the medication and collaborate with the provider prior to administration CStop the infusion and flush the port with normal saline prior to administration DAsk the pharmacy to mix the medication into an IV piggyback (IVPB) infusion

CStop the infusion and flush the port with normal saline prior to administration Rationale: If giving phenytoin as an infusion, it cannot be administered with D5W because it will precipitate. The D5W should be disconnected, the port flushed with normal saline solution (NSS), medication administered, and the port flushed again with NSS before the D5W is reconnected. The provider does not need to be contacted as this is best practice and aligns with hospital protocol. Administering the medication via IVPB does not reduce the risk for precipitation.

20 The nurse is educating a client about newly prescribed alprazolam. Which information should the nurse include in the teaching? ATardive dyskinesia is common early in treatment. BAdministration of paroxetine may be needed to prevent adverse effects. CThe use of grapefruit juice should be avoided. DHyperactivity is seen with long-term use.

CThe use of grapefruit juice should be avoided. Rationale: Grapefruit or grapefruit juice is a known food-drug interaction and may increase drug levels of alprazolam to potentially toxic concentrations. Paroxetine when given with alprazolam will increase the incidence of adverse side effects. Alprazolam is used to treat tardive dyskinesia and is not an adverse side effect of this medication. In general, side effects of benzodiazepines with long-term use include drowsiness, lethargy, and weight gain but not hyperactivity.

711) The client with a seizure disorder receives intravenous (IV) phenytoin. The nurse will monitor closely for which condition? Cardiac dysrhythmias Hypoglycemia Polycythemia Paradoxical excitation

Cardiac dysrhythmias Rationale: IV phenytoin was once used to treat dysrhythmias until better medications were developed. It depresses both atrial and ventricular conduction, and so it can cause significant dysrhythmias. It can also cause hyperglycemia (not hypoglycemia) and pancytopenia (not polycythemia). Paradoxical excitation is not a known issue; it has a depressant effect resulting in drowsiness.

134) A client is prescribed alprazolam. Which action must the nurse include in the client assessment during the initiation of therapy? Measure the client's urine output. Examine the client's pupils daily. Check the client's blood pressure. Assess the abdomen for distention.

Check the client's blood pressure. check for orthostatic htn

22) The health care provider prescribes alprazolam 5 mg by mouth three times a day for a client with anxiety. Which intervention will the nurse take before administering this prescription? Assess the apical pulse. Check the blood pressure. Encourage the ventilation of feelings. Clarify the prescription with the health care provider.

Clarify the prescription with the health care provider. Rationale: The prescribed dosage is excessive, and it must be questioned before its administration. Checking the apical pulse and/or blood pressure is not indicated. Encouraging the client to ventilate feelings does not affect the need to question the prescription. Therapeutic dosages of alprazolam range from 0.75 mg to 4 mg daily; the maximal daily dose for acute anxiety is 8 mg.

8 A nurse is providing care to a client who takes phenytoin for seizure prevention. The latest laboratory report shows a phenytoin level of 32 mcg/mL. Which action does the nurse take next? AExamine the oral cavity BPercuss the abdomen CCheck the skin turgor DAssess the pupillary respons

DAssess the pupillary respons Rationale: A phenytoin level of 32 mcg/mL is not an expected response to therapy. The therapeutic range of phenytoin is 10 to 20 mcg/mL. Signs of phenytoin toxicity include nystagmus, ataxia, and confusion. The pupillary response will assess for symmetrical movements of the eye. Examining the oral cavity, percussing the abdomen, and checking for skin turgor do not evaluate symptoms of phenytoin toxicity.

The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin, which concept should the nurse emphasize? AOmit the medication if the child is seizure-free BServe a diet that is high in iron CA rash is normal with this medication DMaintain good oral hygiene and dental care

DMaintain good oral hygiene and dental care

805) For which therapeutic effect will the nurse monitor the client who is prescribed alprazolam? Pain relief Decreased anxiety Reduction in dysrhythmias Reduced blood pressure

Decreased anxiety Rationale: Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client.

798) A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given? Decreases anxiety associated with seizures Promotes rest after the seizure episode Depresses the central nervous system (CNS) Provides amnesia for the convulsive episode

Depresses the central nervous system (CNS) Rationale: Lorazepam is used to treat status epilepticus because it depresses the CNS. It also functions as an anxiolytic and sedative and can cause anterograde amnesia; however, these are not the reasons it is prescribed for status epilepticus.

118) A primary health care provider prescribes 0.25 mg of alprazolam by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. Which side effect of this medication will the nurse monitor for in this client? Drowsiness Bradycardia Agranulocytosis Tardive dyskinesia

Drowsiness

157) Which medication would the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? Lithium Flumazenil Methadone Chlorpromazine

Flumazenil Rationale: Flumazenil is the medication of choice in the management of overdose when a benzodiazepine is the only agent ingested by a client not at risk for seizure activity. Flumazenil competitively inhibits activity at benzodiazepine recognition sites on gamma-aminobutyric acid-benzodiazepine receptor complexes. Lithium is used in the treatment of mood disorders. Methadone is used for narcotic addiction withdrawal. Chlorpromazine is contraindicated in the presence of central nervous system depressants.

1544) Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be . Alcohol Grapefruit juice Cheddar cheese Summer sausage Dark green vegetables

Grapefruit juice

124) The nurse provides care for a client with a long history of alcohol abuse. Which medication would the nurse anticipate will be prescribed for the client to prevent symptoms of withdrawal? Lorazepam Phenobarbital Chlorpromazine Disulfiram

Lorazepam etoh withdrawal

371) Which medications would the nurse identify as commonly used as an adjunct during conscious sedation for minor surgeries? Diazepam Midazolam Lorazepam Clonazepam

Midazolam so you don't wake up mid surgery

466) Which primary reason identifies why oxazepam is given during detoxification? Prevents injury when seizures occur Enables the client to sleep better during periods of agitation Encourages the client to accept treatment for alcoholism Minimizes withdrawal symptoms the client may experience

Minimizes withdrawal symptoms the client may experience

1496) Which instruction would the nurse provide to parents of a school-age child who has been on long-term phenytoin therapy to prevent side effects? Provide good oral hygiene. Administer the medication between meals. Watch for a reddish-brown discoloration of urine. Supplement the diet with high-calorie foods.

Provide good oral hygiene.

1046) Which concern will the nurse keep in mind when a client has been taking a benzodiazepine? Rebound insomnia may occur if the medication is discontinued abruptly. Lifelong treatment is often required. Higher doses are needed to accommodate physiological changes during pregnancy. These medications have both analgesic and antidepressant properties.

Rebound insomnia may occur if the medication is discontinued abruptly. Rationale: Benzodiazepine often leads to tolerance and withdrawal; therefore it can cause rebound insomnia when discontinued abruptly. Benzodiazepine is not indicated for lifelong treatment; addiction is a concern. Benzodiazepine should be discontinued if the client becomes pregnant. Benzodiazepines not have analgesic, antidepressant, or antipsychotic properties.

20 A newly admitted client reports taking phenytoin for several months. Which assessment should the nurse include in the admission report? Select all that apply. Report of unsteady gait, rash and diplopia Report of any seizure activity Serum phenytoin levels Report of anorexia, numbness and tingling of the extremities

Report of unsteady gait, rash and diplopia Report of any seizure activity Serum phenytoin levels Report of anorexia, numbness and tingling of the extremities

265) Which finding would the nurse report to the health care provider when caring for a client prescribed temazepam at bedtime? Anxiety Drowsiness Sleep driving Morning headache

Sleep driving Rationale: Benzodiazepines are frequently used at bedtime for treating insomnia. However, some clients taking the medications may experience the side effect of performing tasks without remembering the events. When these side effects occur at night, dangerous sleep-related behaviors, such as sleep driving or preparing and consuming meals, can occur. If a client reports these side effects, the nurse will need to report the finding to the health care provider immediately to ensure the client's safety. Anxiety, drowsiness, and morning headaches are common findings during treatment with benzodiazepines and do not need to be reported to the health care provider.

307) A client has completed therapy and requests to discontinue treatment with benzodiazepines. Which information would the nurse provide to prevent injury? Taper dose over several months. Switch to using an antidepressant. Refrain from renewing prescription. Monitor for signs of increased anxiety.

Taper dose over several months. Rationale: Abruptly discontinuing the use of benzodiazepines can cause withdrawal symptoms including intense anxiety and worsening of panic disorders. Therefore, the dose will need to be tapered over several months. Switching to an antidepressant does not alleviate withdrawal symptoms when discontinuing benzodiazepines. Refraining from renewing the prescription would lead to abrupt discontinuation of the medication and would be discouraged. Monitoring for signs of increased anxiety would not actively prevent injury.

54) A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. Which action by the patient makes the nurse confident that the medication information discussed has been understood? The client removes the pepperoni from a pizza. The client asks for an extra bottle of flavored water to drink with dinner. The client requests a prescription for oral contraceptives before being discharged. The client states that chewable antacids may be taken to relieve heartburn.

The client requests a prescription for oral contraceptives before being discharged. Rationale: Benzodiazepines increase the risk of congenital anomalies and so should not be taken by pregnant women. Refraining from eating pepperoni is appropriate for people taking monoamine oxidase inhibitors because tyramine needs to be strictly avoided. Appropriate hydration is critical for those taking lithium. Antacids can affect both absorption and metabolism of benzodiazepines and should be avoided.

120) A client has been robbed, beaten, and sexually assaulted. The primary health care provider prescribes 0.25 mg of alprazolam for agitation. Which event would alert the nurse to administer this medication? The client's crying increases. The client requests something to calm her. The nurse determines a need to reduce her anxiety. The primary health care provider is getting ready to perform a vaginal examination.

The client requests something to calm her. pt autonomy

372) 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. The medication should be given as a rapid intravenous push. It is important to monitor for spikes in blood pressure elevation during administration. During the procedure, the medication should be given as needed for pain management.

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

179) Which rationale explains why the nurse would question a benzodiazepine prescription for an individual experiencing acute grief? The depression is magnified, and the risk of suicide increases. Brain activity is suppressed, and the risk of depression increases. Lethargy results, and it prevents a return to interpersonal activity. The period of denial is extended, and the grieving process is suppressed.

The period of denial is extended, and the grieving process is suppressed.

88) Which statement about benzodiazepines requires clarification? They are indicated for ethanol withdrawal. These medications increase the activity of gamma-aminobutyric acid. Benzodiazepines are the first-line medications used in chronic anxiety disorders. These medications depress activity in the brainstem.

These medications increase the activity of gamma-aminobutyric acid. Rationale: Benzodiazepines act by decreasing the activity of gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Apart from their indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the first-line medications of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and the limbic system.

159) In addition to hydration, parenteral lorazepam is prescribed for a client during alcohol withdrawal delirium. Which primary purpose accurately explains why this medication is given during detoxification? To prevent injury when seizures occur To enable the client to sleep better during periods of agitation To reduce the anxiety tremor state and prevent more serious withdrawal symptoms To calm the client and promote acceptance of the treatment plan

To reduce the anxiety tremor state and prevent more serious withdrawal symptoms

806) Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Which medication interaction complicates seizure therapy? Warfarin inhibits the metabolism of phenytoin. Warfarin decreases phenytoin absorption. Phenytoin competes with warfarin for receptor occupation. Warfarin promotes excretion of phenytoin.

Warfarin inhibits the metabolism of phenytoin. Rationale: Warfarin inhibits metabolism of phenytoin, which can result in phenytoin toxicity. Warfarin does not decrease phenytoin absorption. Phenytoin and warfarin act on different receptors. Excretion of phenytoin is not increased.