PHARM 32-45 PAGES

2. Which drug may be used early in the treatment of Parkinson's disease but eventually loses effec-tiveness and must be replaced by another drug? a. Amantadine b. Levodopa c. Selegiline d. Tolcapone

a. Amantadine

8. In which patient population would the nurse expect to see the use of analeptics in the treatment of respi-ratory depression? a. Neonates b. Children c. Adults d. Older adults

a. Neonates

2. 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 life-threatening emergency known as a. status epilepticus. b. tonic-clonic convulsion. c. epilepsy. d. secondary epilepsy.

a. status epilepticus.

9. Which drug is considered first-line treatment for partial and tonic-clonic seizures? a. Carbamazepine b. Diazepam c. Oxcarbazepine d. Ethosuximide

b. Diazepam

1. A patient with Parkinson's disease has difficulty performing voluntary movements. What is the correct term for this symptom? a. Akinesia b. Dyskinesia c. Chorea d. Dystonia

b. Dyskinesia

3. The nurse is giving an intravenous dose of phenytoin. Which guidelines will the nurse follow for administration? (Select all that apply.) a. Inject phenytoin into a smaller vein. b. Inject phenytoin slowly. c. The injection of phenytoin is followed by an injection of sterile saline. d. Do not infuse phenytoin continuously. e. Mix the phenytoin with D5W (5% dextrose and water) for the infusion.

b. Inject phenytoin slowly. c. The injection of phenytoin is followed by an injection of sterile saline. d. Do not infuse phenytoin continuously.

2. A patient who has been taking a benzodiazepine for 5 weeks has been instructed to stop the medication. Which instruction will the nurse provide to the patient on how to discontinue the medication? a. Stop taking the drug immediately. b. Plan a gradual reduction in dosage. c. Overlap this medication with another drug. d. Take the medication every other day for a number of weeks.

b. Plan a gradual reduction in dosage.

4. The nurse is administering phenobarbital and will monitor the patient for which possible adverse effect? a. Constipation b. Gingival hyperplasia c. Drowsiness d. Dysrhythmias

c. Drowsiness

5. A patient with back muscle spasms is being treated with a skeletal muscle relaxant. To ensure that these drugs are most effective, the nurse will make sure what other treatment is ordered? a. Benzodiazepines b. Moist heat c. Physical therapy d. Aspirin

c. Physical therapy

8. Primary side effects of the SSRIs include which symptoms? a. Rash and alopecia b. Gastritis and diarrhea c. Weight gain and sexual dysfunction d. Photosensitivity and discoloration of the skin

c. Weight gain and sexual dysfunction

22. ________ Affective disorders

d. Emotional disorders characterized by changes in mood

3. Which drug may be used as monotherapy or in conjunction with levodopa to treat Parkinson's disease? a. Bromocriptine b. Benztropine c. Carbidopa d. Selegiline

d. Selegiline

9. Which statement describes the rationale for com-bining carbidopa with levodopa in the treatment of Parkinson's disease? a. The combination eliminates the side effects of both medications. b. The combination decreases the liver's first-pass effect on dopamine. c. The combination decreases the level of acetyl-choline at the synapses. d. The combination allows lower levels of dopamine to be used with the same effect on the alleviation of symptoms.

d. The combination allows lower levels of dopamine to be used with the same effect on alleviation of symptoms.

14. ________ Psychosis

o. A type of serious mental illness that can take several different forms and is associated with being truly out of touch with reality

11. A brief episode of abnormal electrical activity in the nerve cells of the brain

11. Seizure

15. Mrs. A., who is 81 years of age, weighs significantly more than her 47-year-old daughter, yet she is given a lower dosage of a benzodiazepine for insomnia of a similar degree. Explain the rationale for the lower dose

15. Benzodiazepines can create a significant fall hazard in older adults, and the lowest effective dose must be used in this patient population.

2. Status epilepticus is considered a life-threatening medical ______________.

2. Emergency

9. Generic name of a first-line antiepileptic drug that can cause gingival hyperplasia with long-term use

9. Phenytoin

12. Mark the medication cup with the amount of medi-cation the nurse will administer for Question 11.

MARK

11. Indicate on the syringe the amount of medication the nurse will draw up for each dose of the medication in Question 10

PIC

9. A child will be taking amphetamine/dextroamphet-amine for ADHD. He weighs 88 lb, and the initial dose ordered is 2.5 mg/kg daily. How many milligrams will the nurse administer with each dose? ______________

. 100 mg (See Overview of Dosage Calculations, Section IV.)

A 54-year-old woman has had problems with insomnia "off and on for a few years" and has tried over-the-counter medications, herbal remedies, and prescrip-tion drugs. She likes to drink a glass of wine each night before going to bed. Today she is visiting the clinic for a checkup and asks for a prescription for secobarbital because that was the last drug she tried several years ago. The physician prescribes zaleplon instead. She says she can't understand why the doctor won't refill her prescription for secobarbital. 1. Why did the physician change her prescription? 2. What are the consequences of long-term use of barbiturates? 3. What interactions should she be cautioned about while she is taking zaleplon? 4. What other patient teaching is important for this patient?

1. Barbiturates are considered controlled substances because of the potential for misuse and the severe effects that result if they are not used appropriately. Other hypnotic drugs are now used because they have fewer side effects and are safer than the older barbi-turates. Barbiturates are no longer recommended for insomnia. 2. Barbiturates are habit forming, they have a low ther-apeutic index, and severe withdrawal effects may occur when the medication is stopped. Other drugs are now recommended for treatment of insomnia. 3. Other CNS depressants, especially alcohol, should be avoided. There may also be an additive effect when the herbal products kava or valerian is used. 4. Zaleplon is indicated for the short-term treatment of insomnia; it is not approved for long-term use. It has a very short half-life, so the patient should be taught that if sleep difficulties include early awakenings, a dose can be taken as long as it is at least 4 hours before the patient must arise. In addition, the patient should explore other nonpharmacologic options for the treatment of insomnia and try to find the cause of the sleep problems. See Box 12-1 for information on nonpharmacologic measures to promote sleep.

1. A type of epilepsy with a distinct cause

1. Secondary

Nancy, a 44-year-old accountant, has had an increasing number of headaches in the past year. Whenshe has these headaches, she often is nauseated and vomits. She has been to her physician, who has ordered several diagnostic tests. As a result, Nancy has been diagnosed with migraine headaches and will be given a prescription for a serotonin receptor agonist. 1. How do serotonin receptor agonists work in the treatment of migraine headaches? 2. What dosage form(s) would be helpful for Nancy's situation? 3. If the physician decides to write a prescription for sumatriptan (Imitrex), Nancy's history should be assessed for which conditions? 4. What foods may be associated with the development of migraine headaches? 5. What else should be included in the treatment regimen for Nancy's migraine headaches?

1. Serotonin receptor agonists work by stimulating 5-HT1 receptors in the brain; this stimulation results in constriction of dilated blood vessels in the brain and decreased release of inflammatory neuropeptides. 2. Orally administered medications may not be tolerated because of the nausea and vomiting that often accompany the headaches. Alternative formulations such as subcutaneous self-injections, sublingual forms, and nasal sprays are advantageous. They also typically have a more rapid onset of action, producing relief in some patients in 10 to 15 minutes compared with 1 to 2 hours with tablets. 3. Use of sumatriptan is contraindicated in patients with drug allergy and the presence of serious cardiovas-cular disease because of the vasoconstrictive potential of these medications. 4. Foods containing tyramine should be avoided because tyramine is known to precipitate severe headaches. Tyramine-containing foods include beer, wine, aged cheese, food additives, preservatives, artificial sweeteners, chocolate, and caffeine. 5. Keeping a journal of the occurrence of headaches, precipitating factors, and response to drug therapy is also encouraged so that the patient's progress and response to drug therapy can be followed.

Alexander, a 54-year-old man, has been diagnosed with Parkinson's disease and is about to start drug therapy. His symptoms are mild, yet he has some akinesia that interferes with his ability to type at work. The physician explains that Alexander may have to take a variety of drugs as the disease progresses. 1. What is the underlying pathologic defect in Parkinson's disease? 2. What is the aim of drug therapy for Parkinson's disease? 3. The first drugs prescribed for Alexander are aman-tadine along with levodopa-carbidopa. What is the purpose of taking the amantadine at this time? 4. The physician tells Alexander that the amantadine may be helpful in the early stages but will need to be changed at a later date. Why is this true? 5. How does the carbidopa affect the "on-off phenom-enon" that may occur with the use of levodopa?

1. The primary cause of Parkinson's disease is an imbalance in the two neurotransmitters dopamine and acetylcholine (ACh) in the basal ganglia of the brain. This imbalance is caused by a failure of the nerve terminals in the substantia nigra to produce dopamine, which acts in the basal ganglia to control body movements. A correct balance between dopamine and ACh is needed for the proper regulation of posture,muscle tone, and voluntary movement. The deficiency of dopamine can also lead to excessive ACh activity because of the lack of dopamine's normal balancing effect. Symptoms of Parkinson's disease do not appear until approximately 80% of the dopamine store in the substantia nigra of the basal ganglia has been depleted. 2. Drug therapy is aimed at increasing the levels of dopamine at the remaining functioning nerve termi-nals. It is also aimed at blocking the effects of ACh and slowing the progression of the disease. 3. Amantadine causes the release of dopamine from nerve endings that are still intact. The result is higher levels of dopamine in the central nervous system. 4. It is most effective in the early stages of Parkinson's disease, but as the disease progresses and the number of functioning nerves diminishes, amantadine's effect is also reduced. Amantadine is usually effective for only 6 to 12 months. 5. Patients with Parkinson's disease often experience rapid swings in response to levodopa; this fluctuating response is known as the "on-off phenomenon." This phenomenon is seen in patients who take levodopa for a long time. Such patients may experience periods when they have good control ("on" time) and periods when they have bad control or breakthrough Parkinson's disease ("off" time). Carbidopa is a peripheral decarboxylase inhibitor that does not cross the blood-brain barrier. As a result, carbidopa is able to prevent levodopa from breaking down in the periphery and allows more levodopa to reach and cross the blood-brain barrier. Levodopa-carbidopa combinations, such as Sinemet CR, may help decrease the "off" time.

Four-year-old Mattie has started preschool. Today the teacher calls Mattie's mother to tell her that she noticed that Mattie seems to have a problem with "daydream-ing." She explains that Mattie seemed inattentive dur-ing group work and was staring out into space several times during the day. She is also worried because she saw Mattie's eyes move back and forth rapidly during these episodes. These "spells" lasted a minute or two, and then Mattie seemed fine. Mattie's mother has brought her to the pediatric office to have her checked. The health care provider suspects that Mattie is experiencing a type of seizure disorder and has ordered some diagnostic testing. 1. What type of seizure is Mattie experiencing? 2. Mattie's mother is given a prescription for a liquid antiepileptic drug for Mattie. What is important to teach the mother regarding administration of this type of medication? 3. What will the nurse teach Mattie's mother to monitor for during Mattie's drug therapy with this medication? 4. After a year, Mattie's mother is pleased that the seizures have "disappeared" and wants to take Mattie off the medication. What is the best response by the nurse?

1. The signs and symptoms that Mattie is experiencing are typical of absence seizures. These are most often seen in children. 2. She needs to be sure to measure the dose carefully with an exact graduated device or oral syringe, rather than using a household teaspoon, and to give the medication at the same time daily. She needs to report excessive sedation, confusion, lethargy, or decreased movement. See the Patient Teaching Tips in your textbook for more information. 3. Encourage her to keep a journal to record Mattie's signs and symptoms before, during, and after any seizure activity to measure the therapeutic effectiveness of the medication. 4. A therapeutic response to antiepileptic drugs does not mean that the patient has been cured of the seizures but only that seizure activity is decreased or absent. Further evaluation will be needed before a decision is made to stop the medication. Treatment may need to last for years or may be lifelong.

10. A patient is unable to take oral medications and has received a loading dose of phenytoin intravenously. The orders call for him to receive phenytoin 5 mg/kg/ day in three divided doses. The medication comes in a vial with 50 mg/mL. The patient weighs 90 kg. a. How many milligrams will the patient receive each day? For each dose? ______________ b. How many milliliters of medication will be drawn up for each dose? ______________

10. a. 450 mg/day; 150 mg per dose b. 3 mL per dose

10. A child will be receiving PO midazolam as preop-erative sedation. The child weighs 33 lb. The dose ordered is 0.5 mg/kg, and the medication is available as a syrup, with a concentration of 2 mg/mL. a. What will be the dosage for this child? _______________ b. How much is the PO dose for this child in milli-liters? ______________

10. a. 7.5 mg b. 3.75 mL (See Overview of Dosage Calculations, Section IV.)

10. The medication order reads: "Give doxapram 0.5 mg/kg IV STAT." The patient weighs 165 lb. How much medication will the patient receive? ______________

10. 37.5 mg (See Overview of Dosage Calculations, Section IV.)

10. A patient is to receive lithium carbonate, 1800 mg/ day in two divided doses. The medication is available in 300-mg capsules. How many milligrams of lith-ium will the patient receive for each dose? How many capsules per dose? _______________

10. 900 mg; 3 capsules (See Overview of Dosage Calculations, Section II.)

10. A potential adverse effect of valproic acid

10. Hepatotoxicity

11. A patient is to receive diazepam 10 mg twice a day via a PEG tube. The medication comes in a liquid, with a concentration of 5 mg/5 mL. How many milliliters will the nurse administer with each dose? ______________

10mL

11. Mr. H. is about to have levodopa added to his car-bidopa treatment regimen. a. Why must dopamine be administered in the form of levodopa? b. What problems are avoided when carbidopa is given with levodopa? c. How does the carbidopa work when given with levodopa? d. What foods should Mr. H limit in the amount consumed?

11. a. Dopamine must be given in this form because exogenously administered dopamine cannot pass through the blood-brain barrier; levodopa can. b. The addition of carbidopa avoids the high peripheral levels of dopamine and unwanted side effects induced by the very large dosages of levodopa necessary when the drug is given alone. c. Carbidopa does not cross the blood-brain barrier and thus prevents levodopa breakdown in the periphery. This, in turn, allows levodopa to reach and cross the blood-brain barrier. In the brain, the levodopa is then broken down to dopamine, which can be used directly. d. Meat, fish and cheese should not be taken con-currently with levodopa.

11. Stacey, age 35 years, reports that she falls asleep unexpectedly at work, in class, and even while singing in her city's choir. a. Which condition might Stacey have? b. What might be the drug of choice for Stacey? c. Describe the therapeutic effects of such drugs. d. Draw up a patient teaching plan for Stacey. Offer guidelines for substances she might be wise to avoid.

11. a. Stacey probably has narcolepsy. b. Methylphenidate (an amphetamine) or modafinil (a nonamphetamine) may be ordered. c. These drugs boost mental alertness, increase motor activity, and diminish the patient's sense of fatigue by stimulating the cerebral cortex and possibly the reticular activating system. d. Stacey should avoid other central nervous system stimulants, in particular, caffeine-containing products (e.g., coffee, tea, colas, and chocolate). She should check with her physician before taking any over-the-counter drug or herbal product, and she should not consume any substance that con-tains alcohol. In addition, she should keep a journal to document her response to the medication.

12. What is meant by autoinduction in a drug? Identify at least one antiepileptic drug that undergoes autoinduction.

12. Carbamazepine undergoes autoinduction, the pro-cess by which the metabolism of a drug increases over time, which leads to lower-than-expected drug concentrations.

12. Intravenously administered antiepileptic drugs are given______________toavoid serious adverse effects.

12. Slowly

12. Mrs. R., a 35-year-old new mother, has experienced slowing movements, cogwheel rigidity, and pill-rolling tremor. She has been diagnosed with Parkinson's disease, a somewhat rare occurrence in someone her age. In addition to the usual history questions, what must the nurse ask in anticipation of dopaminergic therapy in Mrs. R.'s specific situation?

12. The nurse must ask whether Mrs. R. is lactating; if so, use of amantadine is contraindicated. In addition, pregnancy may be a contraindication to many antiparkinson drugs.

12. Five-year-old Jeffrey is taking atomoxetine (Strattera) for ADHD. What specific precautions must be taken with children who are taking ADHD drugs? Why?

12. Weight loss caused by anorexia is associated with these drugs, so it is important to monitor for weight gain or loss in children who are taking drugs for attention-deficit/hyperactivity disorder. Height and weight should be measured and recorded before therapy is initiated, and growth rate should be plotted during therapy. Nutritional status should be assessed, with attention to daily dietary intake and the amount eaten before drug therapy and after therapy is initiated.

13. A 19-year-old college freshman is brought into the emergency department with a suspected barbiturate overdose. What symptoms would you expect to see? How is overdose treated?

13. An overdose of barbiturates produces central nervous system (CNS) depression ranging from sleep to profound coma and death. Respiratory depression progresses to Cheyne-Stokes respirations, hypoven-tilation, and cyanosis. Patients often have cold, clammy skin or are hypothermic, and later they can exhibit fever, areflexia, tachycardia, and hypoten-sion. The priority of care would be to maintain the ABCs (airway, breathing, and circulation), especially respirations because respiratory depres-sion is likely. There is no antidote for barbiturate overdose.

13. Jeremy, an 8-year-old boy, has resisted his oral doses of topiramate, which has made compliance with the drug regimen difficult. His mother calls and says that she has found a way to get him to take it: she crushes the tablet and sprinkles it on flavored gelatin. She is delighted. How will the nurse respond?

13. Jeremy's mother needs to be told that topiramate must be taken whole, not crushed, broken in half, or chewed. It does have a very bitter taste and seems to be better tolerated when taken with food. She can still give it with gelatin as long as the dosage form remains whole.

13. Jane, age 45 years, is taking benztropine in addition to a dopaminergic drug for Parkinson's disease. Her 76-year-old neighbor comments that he cannot take benztropine because it is too risky for him. Jane calls and asks why this is not a concern in her case. What do you say?

13. Older patients, especially men with benign prostatic hyperplasia, are at risk for urinary retention. Jane's neighbor may or may not have that condition, but his age is a major factor. Jane's age is not a concern at this time. This drug may also cause palpitations.

13. What nutritional counseling is needed for patients taking orlistat (Xenical)?

13. With orlistat, patients need to watch dietary fat intake. Restricting the intake of fat to less than 30% of total caloric intake may help decrease the occur-rence of gastrointestinal side effects. Supplementa-tion with fat-soluble vitamins may be indicated.

14. Rosie, a 24-year-old paralegal, has been taking antiepileptic drugs for several years, with her seizures well controlled with the drug therapy. She is in the clinic for an annual checkup and tells the nurse, "I want to stop all my medicines because we want to have a baby. I've always read that these drugs are unsafe for the unborn baby. What do I need to do?" What is the nurse's best response?

14. Although it is true that pregnancy is a common contraindication to antiepileptic drugs, the prescriber will consider the risks to the mother and infant of untreated maternal epilepsy and the increased risks for seizure activity. The newer-generation antiepi-leptic drugs appear to be safer in pregnancy than the traditional drugs; many women take these drugs throughout their pregnancies. However, women with epilepsy need to be monitored closely by both an obstetrician and a neurologist during pregnancy. Birth defects in infants of mothers with epilepsy are higher than normal regardless of whether the mother was receiving drug therapy.

14. Explain the difference between the concepts of the "on-off phenomenon" and the "wearing-off phenomenon."

14. The "on-off phenomenon" occurs because of rapid swings in the patient's response to levodopa. The result is worsening of the disease when too little dopamine is present, or dyskinesias when too much is present. In contrast, the "wearing-off phenomenon" occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses.

14. Jackie is taking benzodiazepines to treat her insom-nia. Today she visits your clinic and states that she is going to Europe for 2 months and wants a prescrip-tion that will allow her to take enough medication along for her entire stay. The physician declines. Jackie is a little insulted and asks you why the phy-sician refused her request. "Does my doctor think I'm an addict or something?" What do you explain to her? What other options are possible for her?

14. These drugs can be taken for insomnia only if their use is limited to the short term (less than 2 to 4 weeks). With long-term use, rebound insomnia and severe withdrawal can develop. If Jackie needs to take something to help her sleep while she is on her trip, the nonbenzodiazepine hypnotics may be an option, and of course, you could provide patient teaching on nonpharmacologic methods to aid sleep.

14. Sadie experiences migraine headaches about four times a year and has a new prescription for a serotonin receptor agonist. She tells you that she hopes that the medication will prevent her "awful headaches." What is the best response to Sadie's comments?

14. These drugs work to reduce the severity of the headaches but do not prevent headaches.

15. George, a 14-year-old student, has been taking a medication for ADHD for 6 months. At today's follow-up visit, the physician suggests that George take a "drug holiday" on the weekends and during the school's spring break. Explain the reasoning behind drug holidays.

15. Specialists sometimes recommend periodic "drug holidays" (e.g., 1 day per week without medication) to diminish the addictive tendencies of the stimulant drugs. School-aged children often do not take these drugs on weekends and school vacations.

16. You have been asked to take a patient history for William, who will be given a benzodiazepine. a. What conditions or disorders will you ask about? b. What drug intake will you be most concerned about? c. What if William were an infant? A great-grandfather? Would this additional information matter? Why or why not?

16. a. Ask about allergies, CNS disorders, sleep disor-ders, diabetes, addictive disorders, personality disorders, thyroid conditions, and renal and liver function. b. Alcohol and CNS depressants but also all pre-scribed or over-the-counter medications and herbal products used c. The patient's age matters because these drugs have increased effects in older persons and small children.

17. Mr. P. is recovering from an automobile accident and has received a prescription for cyclobenzaprine for painful muscle spasms. a. What patient teaching will he need about this medication? b. What other measures should be included in addition to this drug therapy?

17. a. Patient teaching should include information about potential side effects and potential drug interac-tions. In addition, safety measures to prevent injury stemming from decreased sensorium must be emphasized. b. These medications are most effective when used in conjunction with rest and physical therapy.

10. The medication order reads: "Give benztropine 2.5 mg PO every morning." The medication is available in 1-mg tablets. How many tablets will the nurse administer? _______________

2.5 tablet

3. An involuntary spasmodic contraction of voluntary muscles throughout the body

3. Convulsion

4. This class of drugs is one of the first-line drugs used to treat status epilepticus.

4. Benzodiazepines

5. Another term for 6 Across

5. Idiopathic

6. A barbiturate used primarily to control tonic-clonic and partial seizures

6. Phenobarbital

6. A type of epilepsy with an unknown cause

6. Primary

7. The metabolic process that occurs when the metab-olism of a drug increases over time, which leads to lower-than-expected drug concentrations.

7. Autoinduction

8. Recurrent episodes of convulsive seizures

8. Epilepsy

9. A patient will be receiving benztropine (Cogentin) 1.5 mg PO daily. The medication comes in 0.5-mg tablets. How many tablets will the nurse administer per dose? ______________

9. 3 tablets (See Overview of Dosage Calculations, Section II.)

9. A patient will be receiving the barbiturate pheno-barbital as part of treatment for seizures. The nurse assesses the patient's current list of medications. Which medications are known to cause interactions with barbiturates? (Select all that apply.) a. Benzodiazepines b. Proton pump inhibitors c. Oral contraceptives d. Anticoagulants e. Monoamine oxidase inhibitors (MAOIs)

a. Benzodiazepines c. Oral contraceptives d. Anticoagulants e. Monoamine oxidase inhibitors (MAOIs)

3. A patient has asked for a cup of coffee. The nurse keeps in mind that patients with a history of which condition need to avoid caffeine? a. Cardiac dysrhythmias b. Asthma c. Diabetes mellitus d. Gallbladder disease

a. Cardiac dysrhythmias

6. Which are expected side effects of the anticholiner-gic drugs used to treat Parkinson's disease? (Select all that apply.) a. Dry mouth and decreased salivation b. Urinary retention c. Decreased GI motility and constipation d. Pupillary constriction e. Smooth muscle relaxation

a. Dry mouth and decreased salivation b. Urinary retention c. Decreased GI motility and constipation e. Smooth muscle relaxation

8. Carbidopa-levodopa is prescribed for a patient with Parkinson's disease. The nurse will inform the patient of which possible adverse effects? (Select all that apply.) a. Palpitations b. Insomnia c. Hypotension d. Urinary frequency e. Depression

a. Palpitations c. Hypotension e. Depression

1. When reviewing actions of drugs, the nurse recog-nizes that a hypnotic is a drug that performs which action? a. Produces sleep b. Stops seizures c. Prevents nausea and vomiting d. Relieves pain

a. Produces sleep

7. Phenytoin is prescribed for a patient. The nurse checks the patient's current list of medications and notes that interactions may occur with which drugs or drug classes? (Select all that apply.) a. Proton pump inhibitors b. Warfarin c. Sulfonamide antibiotics d. Corticosteroids e. Oral contraceptives

a. Proton pump inhibitors b. Warfarin c. Sulfonamide antibiotics

2. During therapy for depression with a selective serotonin reuptake inhibitor (SSRI), it is most important for the nurse to instruct the family to monitor for which adverse effect? a. Suicidal thoughts b. Visual disturbances c. Tardive dyskinesia d. Bleeding tendencies

a. Suicidal thoughts

21. ________ Anxiety

a. The unpleasant state of mind in which real or imagined dangers are anticipated or exaggerated

4. When administering certain antipsychotic drugs, the nurse monitors for which extrapyramidal effects? (Select all that apply.) a. Tremors b. Elation and a sense of well-being c. Painful muscle spasms d. Motor restlessness e. Bradycardia

a. Tremors c. Painful muscle spasms d. Motor restlessness

3. A patient will be undergoing a brief surgical proce-dure to obtain a biopsy from a superficial mass on his arm. The nurse expects that which type of barbiturate will be used at this time? a. Ultrashort b. Short c. Intermediate d. Long

a. Ultrashort

8. In which time frame should the nurse expect the greatest risk for hypotension after administration of muscle relaxants? a. 10 minutes after administration b. 60 minutes after administration c. 2 hours after administration d. 4 hours after administration?\

b. 60 minutes after administration

15. ________ Mania

b. A state characterized by an expansive emotional state (including symptoms of extreme excitement and elation) and hyperactivity

1. The nurse is administering the antipsychotic drug clozapine (Clozaril) and should monitor the patient for what long-term problems associated with this drug? (Select all that apply.) a. Mood swings b. Agranulocytosis c. Weight gain d. Photosensitivity e. Increased appetite

b. Agranulocytosis c. Weight gain e. Increased appetite

7. Which drug represents the only drug that acts directly on skeletal muscle? a. Diazepam b. Dantrolene c. Baclofen d. Methocarbamol

b. Dantrolene

2. The nurse is administering a stimulant drug and expects which responses from stimulation of the central nervous system (CNS)? (Select all that apply.) a. Increased fatigue b. Decreased drowsiness c. Increased respiration d. Bradycardia e. Euphoria

b. Decreased drowsiness c. Increased respiration e. Euphoria

5. A patient has been admitted to the emergency department with status epilepticus. The nurse knows that which of these drugs is considered the drug of choice for this condition? a. Phenobarbital b. Diazepam c. Valproic acid d. Phenytoin

b. Diazepam

7. A patient will be taking sumatriptan (Imitrex) as part of treatment for migraine headaches. Before beginning therapy, the nurse reviews the patient's current list of medications. Which medications may have an interaction with sumatriptan? (Select all that apply.) a. Opioids b. Ergot alkaloids c. Selective serotonin reuptake inhibitors (SSRIs) d. Monoamine oxidase inhibitors (MAOIs) e. Nonsteroidal antiinflammatory drugs (NSAIDs)

b. Ergot alkaloids c. Selective serotonin reuptake inhibitors (SSRIs) d. Monoamine oxidase inhibitors (MAOIs)

6. The nurse is providing care for a patient who has accidentally taken an overdose of benzodiazepines. Which drug would be used to treat this patient? a. Methamphetamine b. Flumazenil c. Epinephrine d. Naloxone

b. Flumazenil

6. A patient with migraine headaches is being treated with a serotonin antagonist. Which condition would cause the nurse to question the use of this class of medication to treat the patient's migraines? (Select all that apply.) a. Asthma b. Hypertension c. Glaucoma d. Diabetes mellitus

b. Hypertension

8. The nurse is providing discharge instruction to the patient who will be taking phenytoin. With an understanding of the side effects of phenytoin, which instruction is most important? a. Drink plenty of fluids throughout the day. b. Perform mouth care at least twice a day. c. Limit intake of spinach. d. Use sunscreen liberally.

b. Perform mouth care at least twice a day.

5. When a child is taking drugs for attention-deficit/ hyperactivity disorder (ADHD), what will the nurse instruct the caregivers to closely monitor in the child? a. Blood glucose levels b. Physical growth, especially weight c. Grades at school d. Respiratory rates

b. Physical growth, especially weight

1. The nurse is reviewing a patient's medication administration record.Which best describes a common use for doxapram? a. To control increased respiration caused by other drugs b. To treat drug-induced respiratory depression c. To treat postoperative respiratory excitation d. To stimulate respiration in a patient with a head injury

b. To treat drug-induced respiratory depression

7. The nurse is providing teaching on COMT inhibitors to a patient with a new prescription. The nurse will be sure to educate the patient on the possibility of which adverse effect? a. Insomnia b. Urine discoloration c. Leg edema d. Visual changes

b. Urine discoloration

3. The wife of a patient who has started taking antide-pressant therapy asks, "How long will it take for him to feel better?" What is the nurse's best response? a. "Well, depression rarely responds to medication therapy." b. "He should be feeling better in a few days." c. "It may take 4 to 6 weeks before you see an improvement." d. "You may not see any effects for several months."

c. "It may take 4 to 6 weeks before you see an improvement."

4. A patient who is newly diagnosed with Parkinson's disease and beginning medication therapy with entacapone, a COMT inhibitor, asks the nurse, "How soon will improvement occur?" What is the nurse's best response? a. "That varies from patient to patient." b. "You should discuss that with your physician." c. "You should notice a difference in a few days." d. "It may take several weeks before you notice any degree of improvement."

c. "You should notice a difference in a few days."

19. ________ Benzodiazepines

c. A group of psychotropic drugs prescribed to alleviate anxiety

6. 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 b. Phenytoin c. Gabapentin d. Tiagabine

c. Gabapentin

6. A patient has been taking antipsychotic medication for years, and his wife has noticed that he has had some new physical symptoms. She describes him as having odd facial movements, sticking out his ton-gue, and having movements of his arms that he cannot seem to control. The nurse suspects that the patient is exhibiting signs of which condition? a. Hypomania b. Serotonin syndrome c. Tardive dyskinesia d. Neuroleptic malignant syndrome

c. Tardive dyskinesia

7. Which outcome represents the most serious adverse effect of lithium? a. Renal failure b. Hyponatremia c. Respiratory depression d. Cardiac dysrhythmia

d. Cardiac dysrhythmia

5. A patient asks the nurse why a second drug is given with his drugs for Parkinson's disease. The nurse notes that this drug, an anticholinergic, is given to control or minimize which symptom? a. Constipation b. Muscle rigidity c. Bradykinesia d. Dry mouth

d. Dry mouth

5. The nurse instructs a patient who is undergoing therapy with monoamine oxidase inhibitors (MAOIs) to avoid tyramine-containing foods. What medical emergency may occur if the patient eats these foods while taking MAOIs? a. Gastric hemorrhage b. Toxic shock c. Cardiac arrest d. Hypertensive crisis

d. Hypertensive crisis

4. The physician has ordered orlistat. The nurse recognizes that this drug is used to treat which condition? a. Anorexia b. Malnutrition c. Narcolepsy d. Obesity

d. Obesity

4. While monitoring a patient who took an overdose of barbiturates, the nurse keeps in mind that a potential cause of death would be which of these? a. Tachycardia b. Hypertension c. Dyspnea d. Respiratory arrest

d. Respiratory arrest

1. A patient has been taking antiepileptic drugs for 1 year. The nurse is reviewing the patient's 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

12. ________ Tyramine

f. Patients taking MAOIs need to be taught to avoid foods that contain this substance.

13. ________ Tricyclics

g. An older class of antidepressant drugs

23. ________ Depression

h. An abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, and worthlessness out of proportion to reality

16. ________ Diazepam (Valium)

i. A long-acting benzodiazepine

17. ________ Amitriptyline (Elavil)

j. The most widely used tricyclic antidepressant

18. ________ Risperidone (Risperdal)

k. An atypical antipsychotic drug used to treat schizophrenia

11. ________ Buspirone (BuSpar)

l. A nonbenzodiazepine drug used to treat anxiety

20. ________ Lithium (Eskalith)

n. Medication used to treat mania