pharm exam 2

Hallucinations Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome.

A nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past 2 weeks. Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome?

presence of a migraine headache

A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should instruct the client that sumatriptan is indicated for which of the following conditions?

Allow 2 to 4 Weeks for therapeutic effects It can take up to 4 weeks for a client to feel the drug's full therapeutic effects.

A nurse is providing teaching to a client who has a prescription for buspirone. Which of the following instructions should the nurse include?

sodium Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.

Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?

•Alzheimer's disease is a neurologic disorder in which patients have decreased levels of acetylcholine. Acetylcholine is a neurotransmitter that helps with memory and cognition. •Rationale: Donepezil (Aricept) is an indirect-acing cholinergic drug (cholinesterase inhibitor) used to treat Alzheimer's disease. Donepezil increases concentrations of acetylcholine in the brain by inhibiting cholinesterase. This increase in acetylcholine levels helps to enhance and maintain memory and learning capabilities.

Jane isn't certain what acetylcholine is and asks how this is affected by her grandmother's medication, donepezil (Aricept)

seasonal affective disorder nicotine depression

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? (Select all that apply.)

anxiety The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the provider, who might consider a different medication.

A nurse is assessing a client who has been taking alprazolam for several days. Which of the following findings should the nurse identify as an adverse drug reaction caused by alprazolam

creatinine clearance Pramipexole, a direct-acting dopamine receptor agonist, should be used with caution for clients who have renal disease. Therefore, the nurse should monitor the client's renal function.

A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests requires monitoring?

Tolerance anxiety sedation respiratory depression Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Clients should use these drugs only as needed and for short periods of time. Paradoxical reactions, such as anxiety and insomnia, can develop when taking alprazolam, especially in older adults. Clients should report these findings. CNS depression, manifested as sedation and drowsiness, is an adverse effect of benzodiazepines, such as alprazolam. Clients should take a benzodiazepine 30 min prior to bedtime. Benzodiazepines, such as alprazolam, can cause CNS depression when taken with other CNS depressants, especially for older adult clients. It is important to monitor for respiratory depression and recommend the lowest effective dose. Clients should avoid alcohol and other CNS depressants while taking a benzodiazepine. they can cause nausea, vomiting, and diarrhea.

A nurse is caring for a client who has a prescription for alprazolam. For which of the following adverse effects should the nurse monitor? (Select all that apply.)

withdrawal symptoms Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.

A nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects?

Muscle rigidity A drug interaction between selegiline and opioids, especially meperidine, can result in rigidity, stupor, agitation, hypertension, and fever.

A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the client but should be aware that a drug interaction between selegiline and meperidine can result in which of the following?

blood pressure Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV administration. The client should remain supine for 30 min while the nurse monitors their blood pressure. The nurse should instruct the client to change positions slowly as a safety precaution to prevent client injury. This medication can also cause orthostatic hypotension. an adverse effect is urinary retention. Therefore, the nurse should monitor the client's urine output. it can cause tachycardia. Therefore, the nurse should monitor the client's heart rate.

A nurse is caring for a client who has schizoaffective disorder and who has been prescribed chlorpromazine IV. Which of the following client findings should the nurse monitor after administering the medication?

Tremors, Confusion, Nausea, Muscle Weakness. A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. Confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Nausea, vomiting, and diarrhea are early indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Clients should report any of these adverse effects. Muscle weakness is an early indication of lithium toxicity that develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels periodically.

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply.)

respiratory depression Methohexital, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for clients receiving the drug.

A nurse is caring for a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects?

nausea The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking donepezil with food can help minimize adverse effects.

A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor?

Fatigue The nurse should identify that potential serious adverse effects of interferon beta-1b include unexplained bruising, bleeding, and fatigue. Clients should report these adverse effects to their provider immediately because they can indicate bone marrow suppression and decreased platelet count.

A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that which of the following findings indicates a potential serious adverse effect of this drug?

Thyroid function tests ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter.

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically?

Phenelzine (Nardil) Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever.

A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine?

acute dystonia Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine.

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and who was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse suspect?

seizure activity can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

A nurse is caring for a client who was admitted to the emergency department with a head injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. For which of the following adverse effects is the client at increased risk?

Cirrhosis Memantine should be used cautiously in clients who have severe hepatic impairment. The nurse should contact the provider about the client's history of cirrhosis to see if laboratory testing is required before starting the drug or if the dosage needs to be adjusted.

A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the drug and notify the provider?

Bradycardia Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1 receptors. Clients should check their pulse rate regularly and report any sustained decreases.

A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops. Which of the following adverse effects should the nurse include in the teaching?

hypertensive crisis Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in clients who are taking phenelzine. Manifestations include hypertension, headache, and nausea.

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions?

Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops Do not touch the tip of the dropper Remove contact lenses prior to instilling the drop Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the drug from entering the systemic circulation. The tip of the dropper should remain sterile. It is important that clients avoid touching the dropper's tip or touching it to the eye area. Clients should remove contact lenses before instilling eye drops because they can cause further irritation if left in place.

A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle glaucoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Imipramine Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients who take this drug should change positions slowly from sitting or lying to standing.

A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs?

"If I become pregnant, it is important to let my health care provider know." Diazepam can increase the risk of congenital malformations and is contraindicated for clients who are pregnant.

A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. Which of the following client statements indicates an understanding of the teaching?

"if you have persistent headaches let the provider know The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include?

"Take a missed dose as soon as you remember." Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose

A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. Which of the following instructions should the nurse include?

wear sunscreen when exposed to sunlight Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors. treats nausea and vomiting. It is not necessary to take it with food. can cause sedation and urinary hesitancy, not urinary frequency. Clients should take it in the evening. The drug is appropriate for clients who have a sore throat, but those who have respiratory impairment because of infection require cautious use.

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instructions should the nurse include?

Avoid Taking NSAIDs. NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs.

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include

Change positions slowly from sitting or lying to standing Do not stop taking the drug abruptly Take the drug at bedtime to prevent daytime drowsiness Increase fiber and fluid intake can cause orthostatic hypotension. Clients should move slowly from sitting or lying to standing. When discontinuing the drug, it is important to reduce the dosage over a 2-week period to prevent or minimize withdrawal symptoms. This medication may be crushed if the client has difficulty swallowing the tablet(s). Clients should take the drug at bedtime and avoid activities that require alertness until they know how the drug will affect them. causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Clients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. Which of the following instructions should the nurse include? (Select all that apply.)

furosemide for hypertension Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity.

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity?

renal function impairment Alprazolam dosage should be decreased for clients who have renal or hepatic impairment Clients over 65 years of age might require a decreased dosage. Weight gain is an adverse drug reaction of alprazolam. Pediatric clients might require a decreased dosage. Smoking can decrease the levels and effects of alprazolam. The client might need an increased dosage if smoking while taking alprazolam.

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason for the prescription modification?

Premedicate with acetaminophen Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen can help minimize these symptoms.

A nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug?

Avoid taking over the counter antacids Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity.

A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include?

Increases available dopamine in the brain Levodopa/carbidopa, a dopaminergic agent, can increase dopamine in the extrapyramidal center of the brain, reducing involuntary motion, or tremors, associated with Parkinson's disease.

A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how levodopa/carbidopa can help control symptoms. The nurse should identify that the drug has which of the following pharmacologic effects?

chest pain Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Clients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for clients who have a history of coronary artery disease

A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects?

change position slowly to prevent orthostatic hypotension Levodopa/carbidopa can cause orthostatic hypotension.

A nurse is teaching a client who is taking levodopa/carbidopa to treat Parkinson's disease. Which of the following instructions should the nurse include?

administer the drug in your thigh or upper arm Interferon beta-1a is administered via the subcutaneous route. Therefore, the nurse should instruct the client how to perform subcutaneous injections for self-administration.

A nurse is teaching a client who received a prescription for interferon beta-1a for the treatment of multiple sclerosis. Which of the following information should the nurse include?

Avoid the use of NSAIDs for pain Combining NSAIDs with donepezil can cause gastrointestinal bleeding. Therefore, the nurse should instruct the client's family to avoid the use of NSAIDs.

A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include?

Asthma Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients who have asthma or any disorder that compromises respiratory function should not use the drug.

A nurse should identify that timolol is contraindicated for a client who has which of the following disorders?

Serotonin syndrome have to treat the symptoms

A patient is admitted to the emergency department. The patient's heart rate is 112 beats/min. He is sweating and has muscle tremors and is agitated. The patient says, "I was depressed and took more of the pills the doctor gave me so I would feel better." What does the nurse suspect is happening with this patient? What treatment does the nurse expect to implement?

Although their therapeutic efficacy is often limited, patient response varies (15%- 30%; see benefits). Failure to respond to maximally titrated dosage of donepezil doesn't rule out trying another drug in this same class. If this doesn't work, then memantine (Namenda) can be tried, but it is not a cholinesterase inhibitor. Rationale: The cholinesterase inhibitors may enhance a patient's mental status enough to cause a noticeable, if temporary, improvement in the quality of life for patients as well as caregivers and family members.

Jane knows Alzheimer's disease is progressive and asks how well this donepezil works and if there's anything else that can save her grandmother's memory.

•The primary adverse effect of cholinergic drugs is the consequence of overstimulation of the PNS. The effects on the cardiovascular system are complex and may include syncope, hypotension with reflex tachycardia, hypertension, or bradycardia. Early symptoms to watch for include abdominal cramps, salivation, flushing of the skin, nausea, and vomiting. •The most severe consequence is a cholinergic crisis. Symptoms include circulatory collapse, hypotension, bloody diarrhea, shock, and cardiac arrest. Early signs include abdominal cramps, salivation, flushing of the skin, nausea, and vomiting. Transient syncope, transient complete heart block, dyspnea, and orthostatic hypotension may also occur. These can be reversed promptly by the administration of atropine. Severe cardiovascular reactions or bronchoconstriction may be alleviated by epinephrine. One way of remembering the effects of cholinergic poisoning is to use the acronym SLUDGE, which stands for salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis.

Jane wants to know if the cholinergic drugs have significant side effects and asks you what she should watch for.

A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation.

Several months later, the patient returns to the health care provider's office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn't plan on taking the medication again. When talking with the patient, which knowledge should guide the nurse's response?

decreased IOP

When administering eyedrops for glaucoma, the nurse understands the desired drug effect causes

suicidal thoughts

When patients are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks of therapy?

The SSRI may take several weeks to have a beneficial effect.

When providing teaching for a patient who is prescribed a selective SSRI, which statement will the nurse include?