pharm 2

A client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? 1. Insomnia 2. Weight gain 3. Seizure activity 4. Orthostatic hypotension

3. Seizure activity

Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications? A) levodopa B) carbidopa C) selegiline D) diphenhydramine

C) selegiline

A client receives a prescription for an oral opioid analgesic for post-operative pain. Which adverse effect should the practical nurse (PN) monitor for with the client? 1 Constipation. 2 Photosensitivity. 3 Decreased heart rate. 4 Frequent urination.

Constipation. Opioid analgesics slow peristalsis, which leads to constipation (A), a common side effect of opiates. (B, C, and D) are not associated with opioid analgesics.

In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants

b. Benzodiazepines

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "When was your last bowel movement?" "Have you had any changes in your mood or anxiety level?"

"Have you had any changes in your mood or anxiety level?" In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

A client has been taking diazepam (Valium) for three months. The nurse determines that the outcome of medication therapy has been successful when the client makes which statement? "I feel like I am able to cope with routine stress at my job." "I like this medication. I know that I needed it to treat my anxiety, which is now better, but I think it just makes me feel good, so I am planning to stay on it for quite a while." "I thought this medication would make me think clearly, but I don't feel any change in my feelings." "I will need to take this medication for the rest of my life."

"I feel like I am able to cope with routine stress at my job." Objective: Use the nursing process to care for clients receiving drug therapy for anxiety and insomnia. Rationale: To answer this question correctly, the statement by the client needs to clearly show that she has experienced the expected benefit of the medication therapy. Diazepam is a benzodiazepine used in the treatment of anxiety, seizure disorders, alcohol withdrawal syndrome, and muscle relaxation.

A tricyclic antidepressant is administered to a client daily. The nurse plans to monitor for the common side effects of the medication and includes which of the following in the plan of care? 1. Offer hard candy or gum periodically. 2. Offer a nutritious snack between meals. 3. Monitor the blood pressure every 2 hours. 4. Review the white blood cell (WBC) count results daily.

1. Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray will the nurse remove? 1. Yogurt 2. Crackers 3. Tossed salad 4. Oatmeal cookies

1. Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, or figs.

A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse monitors for which gastrointestinal (GI) side effect of this medication? 1. Diarrhea 2. Dry mouth 3. Increased appetite 4. Hyperactive bowel sounds

2. Dry mouth Rationale: Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication. *Eliminate options 1 and 4 because they are comparable or alike. Recall that the medication is an anticholinergic, which causes dry mouth*

A client with diabetes reports increasing pain and numbness in his legs. "It feels like pins and needles all the time, especially at night." Which drug would the nurse expect to be prescribed for the client? 1. Motrin 2. Gabapentin (Neurontin) 3. Naloxene (Narcan) 4. Methadone

2. Gabapentin (Neurontin)

A health care provider initiates carbidopa/levodopa (Sinemet) therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. The nurse tells the client that: 1. Taking an antiemetic is the best measure to prevent the nausea. 2. Taking the medication with food will help to prevent the nausea. 3. This is an expected side effect of the medication and will decrease over time. 4. The nausea and vomiting will decrease when the dose of levodopa is stabilized.

2. Taking the medication with food will help to prevent the nausea. Rationale: If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food will prevent the nausea. Additionally, the client should be instructed not to take the medication with a high-protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. *eliminate options 3 and 4 because they are comparable or alike*

A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? 1. Reports not going to work for this past week 2. Complains of not being able to "do anything" anymore 3. Arrives at the clinic neat and appropriate in appearance 4. Reports sleeping 12 hours per night and 3 to 4 hours during the day

3. Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be: 1. Withheld until the next scheduled dose 2. Withheld and the health care provider is notified immediately 3. Taken as long as it is not immediately before the next dose 4. Withheld until the next scheduled dose, which should then be doubled

3. Taken as long as it is not immediately before the next dose Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the health care provider.

A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? 1. Platelet count 2. Cholesterol level 3. White blood cell count 4. Blood urea nitrogen level

3. White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever. Options 1, 2, and 4 are unrelated to this medication.

A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to: 1. Avoid soy sauce, wine, and aged cheese. 2. Have the lithium level checked every week. 3. Take medication only as prescribed because it can become addicting. 4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.

4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting, and, although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated with monoamine oxidase inhibitors.

A client with a psychotic disorder is being treated with haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication? 1. Nausea 2. Hypotension 3. Blurred vision 4. Excessive salivation

4. Excessive salivation Rationale: Toxic effects include extrapyramidal symptoms (EPS) noted as marked drowsiness and lethargy, excessive salivation, and a fixed stare. Akathisia, acute dystonias, and tardive dyskinesia are also signs of toxicity. Hypotension, nausea, and blurred vision are occasional side effects.

A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is: 1. Prescribing the client a tyramine-free diet 2. Checking the client for anticholinergic effects 3. Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication 4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is: 1. Prescribing the client a tyramine-free diet 2. Checking the client for anticholinergic effects 3. Monitoring blood levels frequently because there is a narrow range between therapeutic and toxic blood levels of this medication 4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered

4. Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication? 1. It is a serotonin reuptake blocker. 2. It inhibits the breakdown of released acetylcholine. 3. It blocks the uptake of norepinephrine and serotonin. 4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain.

4. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

A nurse has administered a dose of diazepam (Valium) to a client. The nurse would take which important action before leaving the client's room? 1. Giving the client a bedpan 2. Drawing the shades or blinds closed 3. Turning down the volume on the television 4. Per agency policy, putting up the side rails on the bed

4. Per agency policy, putting up the side rails on the bed Rationale: Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Options 1, 2, and 3 may be helpful measures that provide a comfortable, restful environment, but option 4 is the one that provides for the client's safety needs.

An 80-year old client is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. The nurse will implement safety measures because this client is at an increased risk for which adverse effects with the administration of this drug? 1. Dementia and confusion. 2. Insomnia and forgetfulness related to sleep deprivation. 3. Stroke and decreased motor function. 4. Sedation and falls.

4. Sedation and falls.

A client in the mental health unit is administered haloperidol (Haldol). The nurse would check which of the following to determine medication effectiveness? 1. The client's vital signs 2. The client's nutritional intake 3. The physical safety of other unit clients 4. The client's orientation and delusional status

4. The client's orientation and delusional status Rationale: Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation and delusional status. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Aged cheese and sherry B. Grapefruit and other citrus juices C. Coffee, colas, and tea D. Potato and corn chips

A Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? a. Bupropion [Wellbutrin] b. Imipramine [Tofranil] c. Isocarboxazid [Marplan] d. Trazodone [Oleptro]

A Bupropion does not cause weight gain, sexual dysfunction, or sedation, so it may be a useful adjunct to or substitute for an SSRI when those side effects become intolerable. Imipramine causes sedation. Isocarboxazid is an MAOI and is not used unless other drugs are ineffective. Trazodone causes sedation.

When teaching a patient about carbidopa-levodopa (Sinemet), the nurse responds based on knowledge that A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. B) carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. C) giving both drugs together minimizes side effects. D) carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.

The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's response is based on knowledge that A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. B) carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease. C) both drugs have the same pharmacodynamic and side effect profiles. D) carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.

A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa.

he nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." C. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." D. "This medication often causes drowsiness. You should take it at bedtime." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety

A,B,E Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) A. Lithium B. Risperidone C. Divalproex sodium [Depakote] D. Carbamazepine E. Venlafaxine [Effexor]

A,C,D Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

he nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What is the nurse assessing for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

A. Dystonia Rationale Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

While completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that what potential complication could occur if he or she abruptly stopped taking the antiepileptic drug? A. Rebound seizure activity B. Acute withdrawal syndrome C. Hypotension D. Confusion and delirium

A. Rebound seizure activity

A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa? A. Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease. B. Use of benzodiazepines increases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease. C. Use of benzodiazepines decreases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease. D. Use of benzodiazepines increase the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.

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

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Aspirin (ASA) for mild headache Diphenhydramine [Benadryl] for cold symptoms

Aspirin Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administering a cough suppressant B. Inserting a Foley catheter C. Administering an antidiarrheal D. Monitoring liver function tests

B Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.) A. The second-generation antipsychotics generally are more effective than the first-generation agents. B. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. C. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. D. The lipid levels of patients receiving second-generation antipsychotics should be monitored. E. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

B, D, E The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

A patient has been started on a tricyclic antidepressant and wants to know when he will start feeling better. What is the nurse's best response? A. 1 to 3 days B. 1 to 3 weeks C. 1 month D. Several months

B. Initial responses to tricyclic antidepressants develop in 1 to 3 weeks. Maximal responses develop over 1 to 2 months.

A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse should anticipate administering a medication in which category? A. Cholinergic B. Anticholinergic C. Antidepressants D. Dopamine agonists

B. Anticholinergic

What is another approved and indicated use for bupropion (Zyban), a second-generation antidepressant? A. Orthostatic hypotension B. Smoking cessation C. Anorexia in patients undergoing chemotherapy D. Nocturnal enuresis in children

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

The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? A. Diarrhea B. Urinary retention C. Risk for infection D. Insomnia

B. Urinary retention

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? A. On-off phenomenon B. Wearing-off phenomenon C. Chorea D. Dystonia

B. Wearing-off phenomenon Rationale: The wearing-off phenomenon occurs when antiparkinson 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.

The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease?

Beta-amyloid and neuritic plaques Neurofibrillary tangles and tau Neuronal degeneration and decreased acetylcholine

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: a. changing the medication to another drug class. b. discontinuing the medication immediately. c. hospitalizing the patient for closer monitoring. d. requiring more frequent clinic visits for this patient.

C Patients with depression often think of suicide, and during treatment with antidepressants, these thoughts often increase for a time. Patients whose risk of suicide is especially high should be hospitalized. All antidepressants carry this risk, so changing medication is not recommended. Discontinuing the medication is not recommended. More frequent clinic visits are recommended for patients with a low to moderate risk of suicide.

A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? a. Grief and sadness b. Hypomania c. Major depression d. Situational depression

C This patient has symptoms of major depression, which include depressed mood, loss of pleasure in usual activities, insomnia, weight loss, and feelings of fatigue. For a diagnosis of major depression, these symptoms must be present most of the day, nearly every day, for at least 2 weeks. Grief and sadness and situational depression are common responses to the death of a loved one, but this patient's symptoms go beyond this normal response. This patient does not show signs of hypomania.

The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? A) "You have obviously developed resistance to your current medication and will have to be switched to another drug." B) "This is an atypical response. Unfortunately, there are no other options of drug therapy to give you." C) "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect." D) "You just need to keep taking your medication and these effects will go away."

C) "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."

What is the goal of pharmacologic therapy in treating Parkinson's disease? A) Increase the amount of acetylcholine at the presynaptic neurons. B) Decrease the amount of dopamine available in the substantia nigra. C) Balance cholinergic and dopaminergic activity in the brain. D) Block dopamine receptors in both presynaptic and postsynaptic neurons.

C) Balance cholinergic and dopaminergic activity in the brain.

A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A) Drowsiness B) Tics and tremors C) Increased pain D) Nausea and vomiting

C) Increased pain

The nurse includes information about which of the following in an inservice about the therapeutic effects of agonist-antagonists? A. These drugs relieve pain better than opioids. B. These drugs have greater potential for abuse than opioids. C. These drugs produce less respiratory depression than opioids. D. These drugs have minimal side effects when compared with opioids.

C. Compared with pure opioid agonists, the agonist-antagonists have a low potential for abuse, produce less respiratory depression, and generally have less powerful analgesic effects

A nurse is caring for a client who has been taking an SSRI antidepressant for the past two days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? A. Bruising B. Fever C. Abdominal pain D. Urinary retention

C. Abdominal pain

The nurse is providing care for a patient who has been diagnosed with Parkinson's disease. The patient is also in early stage liver failure. What class of medications, if prescribed, would the nurse question? A. Dopamine modulator B. Anticholinergics C. COMT inhibitors D. Ergot derivative

C. COMT inhibitors Rationale: COMT inhibitors are contraindicated in patients with liver failure or liver disease. Potential liver failure is also a known side effect.

Which of the following is an antidote for benzodiazepine overdose or toxicity? A. Buspirone (BuSpar) B. Hydroxyzine (Vistaril) C. Flumazenil (Romazicon) D. Naloxone (Narcan)

C. Flumazenil (Romazicon)

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication? A. Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months. B. Reducing seizure occurrence to one per week. C. Maximally reducing seizure activity while minimizing side effects of medication therapy. D. Maximizing drug dosages to control seizure activity.

C. Maximally reducing seizure activity while minimizing side effects of medication therapy.

A patient has been given a prescription for levodopa-carbidopa for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact? A. Levodopa alone cannot cross the blood-brain barrier. B. There is really no difference between the two drugs. C. The combination drug is more efficient in increasing the dopamine level in the brain. D. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.

C. The combination drug is more efficient in increasing the dopamine level in the brain.

A provider has ordered once-daily phenytoin (Dilantin) for an 8-year-old child who has a seizure disorder, and the parents say that is is "impossible" to have the child take pills by mouth. What intervention would the nurse recommend? A. The parents should learn to administer shots, and phenytoin could be given IM. B. The parents should open the medication and put it in food without the child's knowledge. C. The parents should ask the healthcare provider for a suspension form of the medication. D. The parents should request a chewable form of phenytoin and put it into the child's food.

C. The parents should ask the healthcare provider for a suspension form of the medication.

A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about: a. adding a second medication to complement this drug. b. changing the medication to one in a different drug class. c. increasing the dose of this medication. d. using nondrug therapies to augment the medication.

D Patients with severe depression benefit more from a combination of drug therapy and psychotherapy than from either component alone, so this patient should ask the provider about nondrug therapies. Once a drug has been selected for treatment, it must be used for 4 to 8 weeks before its efficacy can be assessed. Until a drug has been used at least 1 month without success, it should not be considered a failure. Adding a second medication, changing to a different medication, and increasing the dose of this medication should all be reserved until the current drug is deemed to have failed after at least 4 weeks.

The patient is receiving IV antiepileptic therapy. Which parenteral antiepileptic drug is effective against generalized seizures? A) Phenytoin (Dilantin) B) Fosphenytoin (Cerebyx) C) Phenobarbital (Luminal) D) Valproic acid (Depakene)

D Valproic acid is indicated in all its forms for generalized seizures, including tonic-clonic, absence, and myoclonic seizures. Phenytoin, fosphenytoin, and phenobarbital are parenteral antiepileptic medications, effective in the treatment of partial seizures and, secondarily, generalized tonic-clonic seizures.

A patient takes oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A) Take an antacid with each dose. B) Eat foods high in lactobacilli. C) Take the medication on an empty stomach. D) Increase fluid and fiber in the diet.

D) Increase fluid and fiber in the diet.

The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brownish-orange urine. The nurse's response is based on the knowledge that A) the patient may be developing renal failure. B) the patient may be developing hepatic failure. C) brownish-orange urine signifies a lack of fluid intake. D) this is a normal occurrence related to entacapone (Comtan).

D) this is a normal occurrence related to entacapone (Comtan).

When a patient is taking an anticholinergic such as benztropine as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan? A. Minimize the amount of fluid taken while on this drug. B. Discontinue the medication immediately if adverse effects occur. C. Take the medication on an empty stomach to enhance absorption. D. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

D. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

A patient has a new order for a catechol-O-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that an advantage of this drug class is that it A. has a shorter duration of action. B. causes less gastrointestinal distress. C. has a slower onset than traditional Parkinson disease agents. D. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

D. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) a. Mood stabilizers are used to prevent recurrent manic-depressive episodes. b. Antipsychotics are used to treat depressive episodes. c. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. d. Lithium and valproate are the preferred mood stabilizers for BPD. e. A lithium level of 2.0 mEq/L is considered therapeutic.

Mood stabilizers prevent recurrent manic depressive episodes antidepressants should be used w. mood stabilizer for bipolar pt's Lithium and valproate are preferred for BPD The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? To reduce the risk of suicide with overdose To avoid weight gain and other gastrointestinal (GI) effects To help prevent sexual dysfunction To prevent the risk of serotonin syndrome

To reduce the risk of suicide with overdose The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The practical nurse (PN) is assessing a client who takes olanzapine (Zyprexa), an antipsychotic. Which side effect should the PN most likely note in this client? 1 Insomnia and irritability. 2 Hand tremors and tearing. 3 Nausea and frontal headache. 4 Weight gain and constipation.

Weight gain and constipation. Olanzapine (Zyprexa), an atypical antipsychotic, causes orthostatic hypotension, weight gain, and anticholinergic effects, such as constipation (D). Common anticholinergic side effects include dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, decreased sweating, increased sensitivity to sunlight, and constipation (D). (A, B, and C) are not expected side effects of this medication.

The nurse is administering an antiepileptic drug and will follow which guidelines? (Select all that apply.) a Monitor the patient for drowsiness. b Medications may be stopped if seizure activity disappears. c Give the medication at the same time every day. d Give the medication on an empty stomach. e Notify the prescriber if the patient is unable to take the medication.

a Monitor the patient for drowsiness. c Give the medication at the same time every day. e Notify the prescriber if the patient is unable to take the medication.

A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-cterm-39ontaining foods. c. Monitor results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration.

a. Notify the patient that this drug causes discoloration of the urine.

A patient is experiencing a seizure that has lasted for several minutes and he has not regained consciousness. The nurse recognizes that this is a lifethreatening emergency known as: a. status epilepticus. b. tonic-clonic convulsion. c. epilepsy. d. secondary epilepsy

a. status epilepticus.

A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. the entacapone can reduce on-off effects. b. the levodopa may be stopped in a few days. c. there is less GI upset with entacapone. d. it does not cause the cheese effect.

a. the entacapone can reduce on-off effects.

Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? (Select all that apply.) Alcoholism Bulimia Schizophrenia Hypertension Glucocorticoid-induced psychosis

alcohol - bulimia - schizophrenia - glucocorticoid Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).

Your patient is taking valproic acid (Depakote). Which of the following is a false statement? a. Valproic acid requires hepatic monitoring b. Valproic acid has the lowest seizure relapse rate when discontinued c. Valproic acid is also used in migraine therapy d. Valproic acid is also used in bipolar disorder therapy

b. Valproic acid has the lowest seizure relapse rate when discontinued

A patient who is experiencing neuropathic pain tells the nurse that the physician is going to start him on a new medication that is generally used to treat seizures. The nurse anticipates that which drug will be ordered? a. phenobarbital (Luminal) b. phenytoin (Dilantin) c. gabapentin (Neurontin) d. tiagabine (Gabitril)

c. gabapentin (Neurontin)

3. During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a. "The drug will be stopped when tremors and weakness are relieved." b. "If a dose is missed, take two doses to avoid significant decreases in blood levels." c. "Be sure to notify your physician if your urine turns brownish-orange in color." d. "Take care to change positions slowly to prevent falling due to a drop in blood pressure."

d. "Take care to change positions slowly to prevent falling due to a drop in blood pressure."

A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? A. Decreased appetite B. Gradual development of cogwheel rigidity C. Occurrence of adverse effects, such as confusion, anxiety, irritability, and headache D. Improved mental status, as well as improved ability to perform activities of daily living

d. Improved mental status, as well as improved ability to perform activities of daily living

A patient has been taking antiepileptic drugs for a year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time? a. Loss of appetite b. Jaundice c. Weight loss d. Suicidal thoughts or behavior

d. Suicidal thoughts or behavior