Pharm 332 Exam 2

A nurse is teaching a class on Alzheimer's disease to a group of nurses. One of the nurses asks how a cholinesterase inhibitor drug works in the Alzheimer's patient. The nurse's best response would be: A. "It prevents the breakdown of acetylcholine by acetylcholinesterase, reducing symptoms, such as memory loss." B. "It promotes excretion of neurotoxins." C. "It reverses central nervous system cell degeneration." D. "It helps grow new nerve cells to replace damaged ones in the brain."

A. "It prevents the breakdown of acetylcholine by acetylcholinesterase, reducing symptoms such as memory loss."

The nurse is completing a discharge plan for a 24-year-old woman who has been prescribed an antiepileptic drug. What is the priority for teaching the patient about this drug? A. "Let's talk about what kind of contraception you plan to use while you are taking this medication." B. "I know it's depressing to have to take a drug for the rest of your life, but you absolutely may not ever stop taking it." C. If you stop taking the medication all of a sudden, the withdrawal syndrome is less likely to occur." D. "You may stop taking this drug when you have had no seizures for 1 full year."

A. "Let's talk about what kind of contraception you plan to use while you are taking this medication."

A patient is prescribed zolpidem (Ambien) for insomnia. Which instructions should the nurse give to the patient? 1. "Take zolpidem immediately before going to sleep" 2. "Take zolpidem only when able to get a full night's sleep (7-8 hours)." 3. Avoid driving within 8 hours of taking this drug." 4. "It is recommended to take this drug more than 30 days."

A. 1, 2, 3

A patient taking oxycodone with acetaminophen (Percocet, an opioid) for pain after fracturing an ankle. What instructions should the nurse give to the patient? 1. Take stool softener to prevent and treat constipation 2. Increase fluid intakes 3. Increase physical activity as tolerated 4. Take the drug on a regular schedule (ATC) rather than PRN

A. 1, 2, 3, 4

A patient with the end-stage cancer is taking an oral opioid drug for chronic and moderate-severe pain. Which side effects/adverse effects could the patient experience? 1. Respiratory Depression 2. Addiction 3. Dependence 4. Tolerance

A. 1, 2, 3, 4

A client has been advised to take ibuprofen (Motrin). Which topic should the nurse teach the client about Motrin? 1. Tell client to avoid taking aspirin with Motrin. 2. Advise client to take with food to reduce GI upset. 3. Monitor for bleeding gums, nosebleeds, black and tarry stools. 4. Encourage client to take herbs, such as gingko and garlic, with Motrin. 5. Advise female client to take NSAIDs 2 days before menstruation to decrease discomfort.

A. 1,2,3

A client is taking aspirin for arthritis. Which adverse reaction should the nurse teach the client to report to the health care provider? A. Black stool B. Frequent urination C. Sinusitis D. Palpitations

A. Black stool

How do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve patient's pain? A. By blocking cyclooxygenase (COX) receptor and inhibiting the COX enzymes needed for synthesis of prostaglandins production. B. By binding to opioid receptors in the central nervous system and altering the perception of pain. C. By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission. D. By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts.

A. By blocking cycloooxygenase (COX) receptor and inhibiting the COX enzymes needed for synthesis of prostaglandin production.

A client is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout attack? A. Colchicine B. Allopurinol (Zyloprim) C. Probenecid (Benemid) D. Lasix (furosemide), a diuretic

A. Colchicine

A patient has been on carbamazepine (Tegretol) therapy for 3 weeks and comes to the clinic for a follow-up appointment. The patient complains of fatigue, headache, and vertigo. After laboratory tests are completed, which laboratory value would cause the most concern? A. Hemoglobin 8 g/dL B. Leukocytes 8,000 mm3 C. Platelets: 280,000 mm3 D. Potassium level; 4.5 mEq/L

A. Hemoglobin 8 g/dL

A patient has been recently diagnosed with Parkinson's disease. A nurse is providing patient education for the patient and the spouse. The nurse is correct to state that the goal with the current drug regimen is to: A. Improve the patient's ability to carry out activities of daily living. B. Stimulate the growth of new neurons. C. Cure the disease. D. Prevent hypertensive crisis.

A. Improve the patient's ability to carry out activities of daily living.

An elderly woman with Alzheimer's Disease is admitted to the hospital. Her daughter tells the nurse that her mother has been taking a cholinesterase inhibitor. But she does not remember the name of the medication. It could be the following drugs EXCEPT: A. Memantine (Namenda) B. Donepeizil (Aricept) C. Galantamine (Razadyne) D. Rivastigmine (Exelon)

A. Memantine (Namenda)

Which of the following side effects is associated with oral steroids? A. Reduced muscle mass B. Hypotension C. Hypoglycemia D. Dehydration

A. Reduced muscle mass

Which of the following seizure has NO loss of consciousness? A. Simple partial seizures B. Tonic-Clonic seizures (Grand Mal) C. Absence seizures (Petit Mal) D. Myoclonic seizures

A. Simple partial seizures

A nurse is obtaining a health history from the family of a patient who has a history of seizures and is being treated with phenytoin (Dilantin). The patient was brought to the emergency department and was unresponsive o voice or touch. The family states that the patient has been drinking alcohol all afternoon. What further assessment by the nurse is indicated? A. The nurse should assess for other signs of central nervous system depression. B. The nurse should suspect that a grand mal seizure has occurred. C. The nurse should assess for gingival hyperplasia. D. The nurse should administer IV Lorazepam (Ativan) stat.

A. The nurse should assess for other signs of central nervous system depression.

Which teaching does the nurse realize would have the highest priority for the client with gout who is taking colchicine? A. Increase vitamin C B. Avoid alcohol and caffeine C. Increase foods high in purine D. Take colchicine 2 hours before meals

B. Avoid alcohol and caffeine

A nurse is providing patient education for a 71-year-old patient. The patient has taken levodopa (dopar) for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. The nurse should tell the patient: A. "Stop the drug. If you have not noticed any effects within 2 weeks, the prescriber may need to change your drug regimen." B. "It may take several months for a response to occur. Continue the medication as prescribed." C. "Double the dose to see whether an effect occurs. Finding the correct dose takes many adjustments." D. "Another agent will need to be added to the reigmen to manage your symptoms."

B. "It may take several months for a response to occur. Continue the medication as prescribed."

The client has been prescribed a first generation antihistamine medication. The nurse anticipates that the client will need a teaching plan regarding management of: A. Bradycardia B. Drowsiness and dry mouth C. Diaphoresis D. Insomnia

B. Drowsiness and dry mouth

A patient with a history of seizures has been taking both lamotrigine (Lamictal) and valproic acid (Dekapote). Upon assessment, the nurse notes that the patient has widespread rash of the skin and mucous membranes. The nurse should suspect: A. A hematological reaction B. Stevens-Johnson syndrome C. Chickenpox D. Vasculitis

B. Steven-Johnson syndrome

A patient with the absence seizure was brought to the clinic. The nurse anticipates that the prescriber will order which medication? A. Lorazepam (Ativan) B. Phenytoin (Dilantin) C. Valproic acid (Depakote) D. Carbamazepine (Tegretol)

B. Valproic acid (Depakote)

A patient with Parkinson's Disease says, "I always take my other medications with bacon and eggs each morning. Can I take the levodopa (Dopar) at this time, too?" The nurse's best response would be: A. "You can take the levodopa at breakfast if it helps you remember to take it." B. "You should take all of your medications together to enhance efficacy." C. "You should take the levodopa at least 1 hour before you eat your breakfast." D. "You should never take this medication with food, because that would increase its side effects."

C. "You should take the levodopa at least 1 hour before you eat your breakfast."

A patient with Parkinson's disease who has been responding well to drug treatment suddenly develops a relapse of symptoms. Which explanation by the nurse is most appropriate? A. "You have apparently developed resistance to your current medication and will have to change to another drug." B. "This is an atypical response. Unfortunately, there are no other options for drug therapy to treat your disease." C. "This is called the 'on-off' phenomenon. Avoiding high-protein meals and adding another drug may help." D. "You should keep taking your medication at the current dose. These effects will go away with time."

C. "This is called the 'on-off' phenomenon. Avoiding high-protein meals and adding another drug may help.

The nurse notes the following changes in a 72-year-old nursing home patient taking nortriptyline (Pamelor) for chronic pain. 1. Hand tremor. 2. Unable to urinate. 3. Unsteady gait due to sedation. 4. No bowel movement for 1 week. A. 1,2,3 B. 2,3,4 C. 1,2,3,4 D. 1,3,4

C. 1,2,3,4

Which statement is true about anticonvulsants for pain control? 1. They are used to treat chronic pain, such as fibromyalgia and diabetic neuropathy. 2. They can potentially increase blood pressure in a patient who just discontinued MAOI within 3 days. 3. The adverse effects include CNS sedation and bone marrow suppression. 4. The grapefruit juice prolongs anticonvulsants' both expected and adverse effects. A. 1, 2, 3 B. 2, 3, 4 C. 1, 2, 3, 4 D. 1, 3, 4

C. 1,2,3,4

A nurse is reviewing medications with a client newly diagnosed with rheumatoid arthritis. The nurse should instruct the client that which of the following medications will relieve arthritis pain and inflammation but will NOT stop the disease from progressing? 1. Infliximab (Remicade) 2. Abacept (Orencia) 3. Indomethacin (Indocin) 4. Methotrexate (Rheumatrex)

C. Indomethacin (Indocin)

A nurse is providing patient education to patients who experience seizures and their families. To evaluate their understanding, the nurse asks the group several questions about medications. Which statement from the group best demonstrates an understanding of antiepileptic medication therapy? A. All seizure medications can be monitored by drug levels present in the urine. B. The monitoring period is 10 days for most patients. C. Maintenance of a seizure frequency chart is essential. D. Patients can safely drive during the monitoring period

C. Maintenance of a seizure frequency chart is essential.

Which class of drugs is the first line drug used to treat insomnia? A. Antihistamines B. Bennzodiazepines C. Non-Benzodiazapines (Benzodiazepine receptor agonists) D. Sedating antidepressants

C. Non-Benzodiazzapines

A patient has been taking valproic acid (Depakote) for seizures. During the health history, the patient tells the nurse, "I don't have as good of an appetite as I used to. Sometimes my stomach hurts since I am on this medication." The priority nursing action would be to: A. Obtain plasma potassium level B. Administer 10mg morphine IM stat C. Obtain liver function tests D. Obtain serum creatinine levels

C. Obtain liver function tests

A patient with advanced Parkinson's disease who takes levodopa (Dopar) has been taking Pramipexole (Mirapex) for several weeks. Which of the following findings should most concern the nurse? A. Increased urine output B. Increased blood pressure C. Orthostatic Hypotension D. Dry cough

C. Orthostatic Hypotension

The differences between COX-1 and COX-2 inhibitors is that ibuprofen is more likely than celecoxib to cause which adverse effect? A. Fever B. Constipation C. Peptic Ulcer D. Metallic Taste

C. Peptic Ulcers

A patient on levodopa (Dopar) for Parkinson's disease comes to the emergency department complaining of a severe headache. The vital signs are: temperature 98.8 degrees F, pulse 92/minute, blood pressure 202/107 mm Hg, and respirations 18/minute. A nurse should be most concerned if which of the following drugs is on the patient's current list? A. Carbidopa B. Citalopram (Celexa) C. Phenelzine (Nardil) D. Amitriptyline

C. Phenelzine (Nardil)

A patient with a history of Alzheimer's disease has been taking tacrine (Cognex) for 18 months. Based on the side effects of the medication, the nurse should monitor which laboratory finding? A. Blood urea nitrogen B. 24-hour creaatinine clearance studies C. Serum alanine transaminase (ALT) D. Complete blood count with differential

C. Serum alanine transaminase (ALT)

The spouse of a patient with advanced Alzheimer's disease confides to the nurse that the patient's wandering, pacing, and agitation seem to get worse in the evening. The nurse correctly explains the phenomenon to the spouse as: A. Evening psychosis B. Drug toxicity C. Sundowner's syndrome D. New onset of psychosis

C. Sundowner's Syndrome

An Alzheimer's patient has been taking a cholinesterase inhibitor for a week. What anticipated side effects (signs and symptoms) related to the medication would the nurse anticipate in the patient? A. Numbness and tingling in the extremities B. Hypertension C. Urinary incontinent, excessive sweating, and diarrhea D. Tinnitus and hearing loss

C. Urinary incontinent, excessive sweating, and diarrhea

Which statement is true about gold, a disease-modifying antirheumatic drug (DMARD)? A. Gold is used to reduce inflammation by inhibiting the migration of erythrocytes. B. Gold is used in the early stages of arthritis and the first line therapy. C. When the patient is on gold therapy, his/her blood should be monitored for agranulocytosis or aplastic anemia. D. When the patient is taking both gold and another highly protein bound drug, Warfarin (blood thinner), gold will not increase the risk of bleeding.

C. When the patient is on gold therapy, his/her blood should be monitored for agranulocytosis or aplastic anemia.

Which statement(s) is(are) true about the analgesic drugs in general? 1. Acetaminophen (tylenol) can cause permanent liver damage. 2. Opioids can cause the visual impairment (miosis) in the older patients. 3. Salicylate poisoning can be caused by all the NSAIDs. 4. Opioids act in the central nerve system, while NSAIDs act at the injured site. A. 1,2,3 B. 2,3,4 C. 1,3,4 D. 1,2,4

D. 1,2,4

A nurse who is assessing a nursing student's knowledge of antiepileptic medication asks, "How is ethosuximide (Zarontin) different from phenytoin (Dilantin)?" Which response by the nursing student best demonstrates understanding of the differences between the medications? A. "Ethosuximide cannot be used in children" B. "Ethosuximide has more significant adverse events and drug interactions. C. "Ethosuximide efficacy is readily monitored by serum levels." D. "Ethosuximide is effective against absence seizures."

D. "Ethosuximide is effective against absence seizures."

Which statement is true about the Dopaminergic (Levodopa) and dopamine agonist? A. "Dopamine agonists are more effective than levodopa (Dopar)." B. "The effect of dopamine agonists will be reduced by dietary proteins." C. "Dopamine agonists are more likely to cause permanent and disabling dyskinesias compared to Levodopa." D. Postural or orthostatic hypotension is common in patients taking levodopa and pramipexole.

D. "Postural or orthostatic hypotension is common in patients taking levodopa and pramipexole.

The nurse is teaching a client about taking aspirin. Which are important points for the nurse to include? 1. Advising client to avoid alcohol while taking aspirin. 2. Instructing client to take aspirin before meals on an empty stomach. 3. Instructing client to inform dentist of aspirin dosage before any dental work. 4. Instructing client to inform surgeon of aspirin dosage before any surgery. 5. Suggesting that aspirin may be given to children for flu symptoms. A. 2,3,4,5 B. 1,2,3,4 C. all of the above D. 1,3,4

D. 1,3,4

A client enters the emergency department in generalized convulsive status epilepticus. The nurse anticipates the administration of: A. Phenobarbital (Luminal) B. Phenytoin (Dilantin) C. Valproic acid (Depakene) D. Diazepam (Valium)

D. Diazepam (Valium)

Which of the following dietary restrictions is indicated with carbamazepine (Tegretol)? A. Limit foods high in Vitamin K B. Restrict acid-ash foods C. Maintain a high-fiber diet. D. Do not drink grapefruit juice.

D. Do not drink grapefruit juice.

The client has been started on Zyflo. The nurse's highest priority intervention while the client is receiving this medication is to monitor: A. Calcium level B. Serum glucose C. Potassium level D. Liver enzymes

D. Liver enzymes

A nurse checks on a patient with Parkinson's disease who recently began taking levodopa (Dopar). The patient tells the nurse that every time she gets out of bed, she gets dizzy and light-headed. The nurse should instruct the patient to: A. Maintain bed rest for at least 2 weeks. B. Sleep on her left side to improve her circulation. C. Take extra pill to reduce blood pressure. D. Push the call light to get help before she gets out of bed.

D. Push the call light before she gets out of bed.

A 26-year-old patient sustained a head injury at the age of 19 years. The patient has been on Antiepileptic drugs and has been seizure free since 8 months after the accident. He now wants to discontinue the medications. The nurse's response would be based on which of the following rationales about Antiepileptic medications? A. The patient can immediately stop the medications now and keep an accurate seizure chart to determine whether medications need to be reinstituted. B. The patient should wait a full 10 years after the last seizure; then, it is probably safe to stop the medication all at once. C. Antiepileptic drugs are needed for life. D. The dosage may be gradually reduced based on an accurate seizure record and consistent drug serum levels.

D. The dosage may be gradually reduced based on an accurate seizure record and consistent drug serum levels.

A patient taking warfarin (Coumadin) has mild to moderate pain after exercising. Which over-the-counter pain reliever should he take? A. aspirin B. ibuprofen (Advil) C. acetaminophen (Tylenol) D. naproxen (Aleve)

c. Acetaminophen