Pharm exam 2
A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease?
"A levodopa/carbidopa combination is used to improve motor function."
A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching?
"Adaptation results in an increased sensitivity to side effects over time."
A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests?
"After the first year of treatment, I will need once yearly blood work."
A nurse is teaching nursing students about inhalation anesthesia and asks, "What is balanced anesthesia?" Which response by a student is correct?
"An anesthesia that combines other drugs with inhalation anesthesia to produce the desired effects."
A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?
"Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA."
A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?
"Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia."
An anesthesiologist completes preoperative teaching for a patient the night before surgery. The patient asks the nurse to clarify the reason methohexital [Brevital] will be given as an adjunct to the anesthetic. Which statement by the patient indicates understanding?
"Brevital is used to produce rapid unconsciousness before administration of the inhaled anesthetic."
A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
"Combination products cause fewer dyskinesias and decreased psychosis."
A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday?
"Don't take the medication on Friday and Saturday."
The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct?
"Drugs to treat Alzheimer's disease may slow the progression of memory loss."
A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?
"Dry mouth and constipation are uncommon with this medication."
The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse
"During manic episodes, many patients don't see the benefit of prophylactic medications."
A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?
"Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug."
A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?
"Febrile seizures are a type of generalized tonic-clonic seizure."
A patient complains of chronic insomnia and reports being tired of being tired all the time. The patient is reluctant to try pharmacologic remedies and asks the nurse what to do. What will the nurse suggest?
"Get out of bed for a while if you can't fall asleep."
A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?
"I can continue to use ibuprofen as needed for muscle pain."
A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
"I may need to try a lower dose of Sinemet to reduce my tics."
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?
"I should brush and floss my teeth regularly."
A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching?
"I should report any nausea, drowsiness, and headache to my provider."
A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?
"I will apply a thin layer of the medication to a small area of skin."
A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?
"I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness."
A nurse provides teaching for a 25-year-old patient who will receive mitoxantrone [Novantrone] for worsening relapsing-remitting multiple sclerosis. Which statement by the patient indicates a need for further teaching?
"I will need an infusion of this medication once weekly."
A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?
"I've broken out in a rash on my chest and back."
A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching?
"If medication is begun early, permanent remission can be achieved."
A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching?
"If my child has a seizure, I should stop giving the medication immediately."
A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug?
"If the ANC is less than 3000, the drug will be discontinued permanently."
The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson's disease. What will the nurse include in teaching?
"If you need to stop this drug, your provider will order a gradual withdrawal."
A nursing student caring for a patient with cancer tells the nurse that the patient seems to be exaggerating when reporting the degree of pain. Which statement by the nurse is an appropriate response to this concern?
"It is important to give pain medication as ordered for the degree of pain the patient reports."
A patient has taken levodopa [Dopar] for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?
"It may take several months for a response to occur."
A patient with bone cancer has recently undergone chemotherapy and radiation therapy to reduce the size of the tumor. The patient is taking a large dose of an opioid analgesic, along with acetaminophen and an antidepressant. The nursing student caring for this patient is concerned that the patient is showing drug-seeking behaviors, because the individual requested an increased dose of the opioid. The student discusses this concern with the nurse. Which statement by the student indicates a need for further teaching?
"It would probably help this patient more to give a larger antidepressant dose."
A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?
"Local anesthetics affect motor and sensory nerves."
A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching?
"Memantine modulates the effects of glutamate to alter calcium influx into neurons."
A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?
"Olanzapine causes more metabolic side effects than thioridazine."
A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?
"Phenobarbital doses for seizures are nonsedating."
A nurse is teaching a group of nursing students about the differences between pure opioid agonists and agonist-antagonist opioids. Which statement by a student indicates understanding of the teaching?
"Pure agonists act as agonists at both mu receptors and kappa receptors."
A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What will the nurse tell this patient?
"Studies to date do not clearly indicate effectiveness of acupuncture for alleviating cancer pain."
A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?
"TCAs have many side effects, but none of them are serious."
A patient has begun taking dimethyl fumarate [Tecfidera] to treat relapsing MS and calls the clinic to report flushing of the skin with itching and burning sensations. What will the nurse recommend to this patient?
"Take a non-enteric-coated aspirin 30 minutes before each dose."
A patient will receive intravenous midazolam [Versed] combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching?
"The patient will not remember the procedure."
A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?
"There is increased pain relief with the combination than when either product is used alone."
A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching?
"These drugs are developed based on scientific knowledge of CNS transmitters and receptors."
A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?
"This drug significantly slows the progression of the disease."
A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?
"Vasoconstrictors should not be used as adjunct agents with this drug."
The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine [Exelon] transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?
"We only need to change the patch every 2 weeks."
A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?
"When this drug is metabolized, the resulting compound has longer-lasting effects."
A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?
"While some drugs show promise, there are no studies that have proven a neuroprotective effect."
A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug?
"You may experience blurred vision, dry mouth, or constipation."
A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement?
"You will need to take an oral antipsychotic drug for 3 weeks."
Which patient should receive dantrolene [Dantrium] with caution?
A 55-year-old woman with multiple sclerosis
A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine [Zanaflex] to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug?
A history of hepatitis
A patient is being treated with interferon beta-1a [Avonex] for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend?
Acetaminophen or ibuprofen
A patient who has migraine headaches is prescribed sumatriptan [Imitrex] 5 mg unit-dose nasal spray. The patient has administered two sprays at 1400, 1600, and 1800 and calls to report little relief from headache pain. What will the nurse instruct the patient to do?
Administer 2 sprays at 2000 and call the provider if no relief.
An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?
Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.
A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do?
Administer the dose and tell the patient that the side effects are temporary.
A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient?
Administration of levothyroxine
A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?
Advancing age and family history are known risk factors.
A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?
An increased dose of phenytoin
A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?
Ask her to complete the Edinburgh Postnatal Depression Scale.
A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?
Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.
A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?
Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?
Avoid prolonged exposure to the sun.
A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy?
Baclofen [Lioresal]
A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity?
Baclofen [Lioresal]
A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication?
Bethanechol
An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults?
Blood-brain barrier
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?
Bupropion [Wellbutrin]
Supplemental oxygen has been shown to help reduce symptoms for which type of headache?
Cluster
An 8-year-old child with advanced cancer has an order for oxycodone [OxyContin] PO, PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain. What will the nurse do?
Contact the provider to discuss using patient-controlled analgesia (PCA).
A patient who stopped taking teriflunomide [Aubagio] 1 year prior tells the nurse that she has just found out she is pregnant. Which action by the nurse is correct?
Contact the provider to obtain an order for serum drug levels.
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?
Contact the provider to report symptoms of a complex partial seizure.
A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?
Contact the provider to report these findings.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?
Contact the provider to request an order for serum drug levels.
A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient's history is of concern when taking this drug?
Coronary artery disease
A patient who has developed opioid tolerance will experience which effect?
Decreased analgesic effect
A patient in the postanesthesia recovery unit received ketamine [Ketalar] for right open reduction internal fixation surgery. What drug would be beneficial as a premedication to help minimize adverse reactions?
Diazepam [Valium]
A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient?
Discuss gradual withdrawal of the medication with the provider.
A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?
Discuss these symptoms with a dentist.
A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient?
Duloxetine [Cymbalta]
A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern?
Elevated temperature
A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?
Fentanyl [Duragesic] transdermal patch
A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action?
Giving an anticholinergic medication
A patient who has cancer reports pain as "burning" and "shooting" alternating with feelings of numbness and coldness. The nurse will contact the provider to discuss the use of which medication?
Imipramine [Tofranil]
A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?
Increasing salt and water intake
A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen?
Increasing the dose of valproic acid to 300 mg PO twice daily
A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?
Increasing the lamotrigine dose to 500 mg twice daily
A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do?
Instruct the parents not to activate the device when their child is sleeping.
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?
Interrupting treatment with amantadine for several weeks
A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?
Lithium [Lithobid]
A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?
Lower the head of the bed to a 10- to 15-degree head-down position
A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?
Maintaining adequate oxygenation to the brain
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?
Major depression
A patient with cerebral palsy who has been receiving baclofen [Lioresal] via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspect to be the cause of these seizures?
Missed doses of baclofen
A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76; RR, 16; and BP, 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer?
Morphine and ondansetron [Zofran]
A patient who has migraine headaches has been using sumatriptan [Imitrex] with good results, but reports frequent migraine recurrence 24 hours later. Which medication will the nurse expect the provider to order for this patient?
Naratriptan [Amerge]
A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?
Nervousness and tachycardia
A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?
Notify the prescriber, and request an order to reduce the dose of phenobarbital.
. A patient who has recently begun taking interferon beta reports feeling depressed. Which action by the nurse is correct?
Notify the provider of these symptoms.
A patient is about to begin therapy with fingolimod [Gilenya] to treat multiple sclerosis. The nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?
Obtain an order for a VZV antibody test.
A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be used initially to treat pain in this patient?
Opioid analgesics
A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?
Prepare to administer naloxone and possibly ventilatory support.
A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention?
Preparing to support respirations
A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes?
Prolonged QT interval
A surgical nurse is caring for a patient who is receiving isoflurane [Forane]. Which is true about this inhalation anesthetic?
Propofol is used for induction to minimize cough prior to administering isoflurane.
A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?
Question the use of the epinephrine for this procedure.
A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?
Rash
A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?
Reassure the patient that these effects occur early in treatment and will resolve over time.
A young woman with migraine headaches who has recently begun taking sumatriptan [Imitrex] calls the nurse to report a sensation of chest and arm heaviness. The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do?
Reassure the patient that this is a transient, reversible side effect of sumatriptan.
A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient?
Reducing the dose of memantine
A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct?
Request an order for meperidine [Demerol].
A patient with schizophrenia has been taking an antipsychotic drug forcfrv several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do?
Request an order to give diphenhydramine.
A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following?
Respiratory support
A patient has been diagnosed with multiple sclerosis (MS) for 10 years and has a history of 3 periods of neurologic dysfunction lasting several weeks separated by long periods of full recovery. In the past 6 months, the patient has had a prolonged period of neurologic dysfunction without remission. The nurse understands that the patient may have which MS subtype?
Secondary progressive MS
A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects?
Seizures and hallucinations
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
She should consider a different form of birth control while taking phenytoin.
A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?
Slowed heart rate and lightheadedness
A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?
Some symptoms take months to improve.
A patient has received an initial dose of glatiramer acetate [Copaxone] for relapsing-remitting multiple sclerosis. The nurse notes that the patient appears flushed and anxious and has urticaria. The patient reports palpitations, chest pain, and a feeling of laryngeal constriction. What will the nurse do?
Stay with the patient until this self-limiting episode passes.
A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?
Suspect a possible paradoxical reaction to the clorazepate.
A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do?
Take oral diphenhydramine [Benadryl].
A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?
Taking a lower dose with a low-protein snack
A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient's tongue. The nurse recognizes which adverse effect in this patient?
Tardive dyskinesia
A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?
Teach the patient about drug side effects and how to manage them.
An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?
Tell the spouse that this is an expected progression of the disease.
A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptom free. The nurse will tell the patient that this indicates what?
Temporary improvement
A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication?
That sertraline is safer than other antidepressants for nursing mothers
An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?
The dose can be increased, because the patient has been taking the drug for longer than 3 months.
A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?
The patient should discuss increasing the dose with the provider.
A patient who is taking a fixed-dose combination drug with an opioid and acetaminophen for cancer pain reports increased muscular pain. The patient asks the nurse if the pain medication dose can be increased. What will the nurse tell this patient?
The provider will prescribe separate dosing of the opioid and acetaminophen.
A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?
The provider will withdraw the drug over a 6- to 12-week period.
A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient?
To list all foods eaten that day
A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?
Tonic-clonic
A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider?
Topiramate [Topamax]
A hospitalized patient with Parkinson's disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?
Trimethobenzamide [Tigan]
A nurse caring for a patient after a cesarean section learns that the patient received isoflurane [Forane] during the surgery. What will the nurse monitor most closely in this patient?
Uterine tone
A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?
Zaleplon [Sonata]
A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:
a fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic.
A patient newly diagnosed with cancer is admitted to the hospital, and the provider orders oxycodone [OxyContin] every 4 to 6 hours PRN pain. The patient requests pain medication whenever he reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but he tells the nurse the medication is not working well. The nurse will contact the provider to discuss:
a fixed dosing schedule for the oxycodone.
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:
administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about
any history of alcohol abuse or compulsive behaviors.
A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for:
bradycardia.
A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent:
bradycardia.
A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of
changes in the brain as a result of prolonged drug exposure.
A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:
changing the medication to a continued-release preparation.
A patient is taking hydrocodone and ibuprofen for cancer pain and is admitted to the hospital for chemotherapy. The nurse anticipates that the prescriber will ____ ibuprofen.
discontinue the
An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to:
divide the daily dose into two equal doses 12 hours apart.
A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
does not cross the blood-brain barrier
A patient arrives in the emergency department complaining of numbness in the extremities. The nurse notes that the patient's hands and feet are cool and pale. When conducting a health history, the nurse learns that the patient has a history of migraine headaches. The nurse recognizes this patient's symptoms as:
ergotism.
A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the patient
has taken ergotamine in the past 24 hours.
A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic, the patient has a pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of:
heart block.
A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:
help control symptoms during manic episodes.
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
hospitalizing the patient for closer monitoring.
A woman with moderate migraine headaches asks a nurse why the provider has ordered metoclopramide [Reglan] as an adjunct to aspirin therapy, because she does not usually experience nausea and vomiting with her migraines. The nurse will tell her that the metoclopramide is used to:
improve absorption of the aspirin.
A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be:
improved sleep hygiene.
A patient with cancer who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:
infection or metastasis.
A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for
irritability, tremor, and respiratory distress.
A patient who has occasional migraine headaches tells a nurse that the abortive medication works well, but she would like to do more to prevent the occurrence of these headaches. The nurse will suggest that the patient:
keep a headache diary to help determine possible triggers.
A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient
may need increased amounts of the drug over time.
A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will:
monitor the patient's heart rate.
A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:
potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression.
A patient receives a neuromuscular blocking agent as an adjunct to inhalation anesthesia. When caring for this patient, it is important for the nurse to remember that neuromuscular blocking agents:
prevent contraction of the diaphragm.
A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier:
prevents some potentially toxic substances from crossing into the central nervous system.
A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:
prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.
A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to
re-evaluate the diagnosis
A child is diagnosed with absence seizures, and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of:
recording the number of seizures the child has each day.
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss
reducing the dose of bromocriptine
A patient who has had cancer for 1 year uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of pain (which she rates as 8 or 9 on a scale of 1 to 10) each day, and each episode lasts 15 to 30 minutes. The nurse will contact the provider to:
request a strong, short-acting opioid PRN.
A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from the hospital will:
request an order to change to trazodone [Desyrel] for sleep.
A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for:
respiratory depression.
A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:
sit or lie down when feeling lightheaded.
A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is
sleep attacks
A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to
stop taking the MAOI 2 weeks before starting the SSRI.
A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:
the patient has a cross-dependence to the benzodiazepine.
A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to:
try a second-generation antipsychotic (SGA).
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:
using nondrug therapies to augment the medication.
A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of:
worsening hypoxia.
A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for:
yawning and sweating.
