PHARM: NEURO SYSTEM PT.2

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?

- Cholinergic crisis — manifestations if cholinergic crisis includes nausea, vomiting, diaphoresis, and bradycardia. Chlorpromazine unlikely to cause - Serotonin syndrome — include agitation, confusion, and anxiety. Unlikely to cause - Steven-Johnson's syndrome — includes fever, rash, and blisters. Unlikely to cause - Acute dystonia✔️

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?

- Consume a low-sodium diet — reduced serous sodium decreases lithium excretion, leading to toxicity - Reduce fluid intake — dehydration increases the risk - Avoid taking NSAIDs✔️ — NSAIDs increase renal reabsorption of lithium and sodium - Take the drug with food — taking lithium with food can reduce gastric irritation, but it does not reduce the risk for lithium toxicity

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?

- Ischemic stroke — atypical antidepressant like bupropion is unlikely to cause ischemic stroke, but can cause headache and agitation - Drowsiness — more likely to cause insomnia than drowsiness - Respiratory depression — does not affect respiratory system, however can cause nausea and vomiting - Seizure activity✔️ — can cause seizure activity when clients take high doses or have a seizure disorder, CNS tumor, or history of head trauma

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? (SATA)

- Tremors✔️ — a fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity - Confusion✔️ — confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range - Bronchospasms — does not usually affect the respiratory system - Nausea✔️ — 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✔️ — this 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 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?

- Venlafaxine — SNRI more likely to cause hypertension - Bupropion — adverse effects of bupropion, an atypical antidepressant includes nausea, vomiting, headache, and insomnia - Imipramine✔️ — also known as Amitriptyline is a TCA that can result in orthostatic HTN - Valproic Acid — conventional antipsychotic typically causes EPS including akathisia, Parkinsonism, acute dystonia, and tardive dyskinesia

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

- Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops✔️ — helps keep the drug from entering the systemic circulation - Do not touch the tip of the dropper✔️ — tip should remain sterile. - Wash hands after instilling the drops — wash hands before. Not necessary after unless they have spilled any on their hands - Rub eyes gently after instilling the drops — avoid rubbing or touching eyes because doing so can cause damage - Remove contact lenses prior to instilling the drops✔️ — yes because it can cause further irritation if left in place

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

- Take the drug with grapefruit juice to increase absorption — this increases buspirone drug levels - Use the drug as needed for anxiety — to avoid a reoccurrence or exacerbation of symptoms, clients should take buspirone on a regular basis and not PRN - Allow 2-4 weeks for full therapeutic effects✔️ — can take up to 2-4 weeks for client to feel the drugs full therapeutic effects - Take the drug on an empty stomach — can cause nausea, so taking with food helps minimize this effect

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

- "It is not a big deal if I forget my pills for a couple of days" — abruptly stopping medication can cause seizures, insomnia, nervousness, or irritability - "I should limit alcohol intake to one drink daily while taking this medication" — taking alcohol with diazepam can cause CNS depression. - "I will avoid salt because this medication can increase my BP" — diazepam can cause hypotension when administered IV - "If I become pregnant, it is important to let me health care provider know"✔️ — diazepam can increase risk of congenital malformations and is contraindicated for clients who are pregnant

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?

- Alprazolam — Venlafaxine an SNRI that is unlikely to interact with alprazolam a benzodiazepine. Cimetidine is a drug that interacts with alprazolam to increase alprazolam levels - Phenytoin — SNRI unlikely to interact with phenytoin an anticonvulsant. Amiodarone is a drug that interacts with phenytoin to increase phenytoin levels - Phenelzine✔️ — Clients should not take SNRI 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 - Pilocarpine — a direct-acting cholinergic is unlikely to interact with SNRI. Ipratropium is an anticholinergic drug that interacts with pilocarpine to reduce ipratropium levels

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?

- Anterograde amnesia — benzodiazepines can impair the memory of events that occur after taking the drug. Stopping the drug does not cause this effect - Respiratory depression — benzodiazepines can cause depression and drowsiness. - Paradoxical reaction — a paradoxical reaction to a benzodiazepine includes excitement and agitation. This does not occur with sudden cessation of drug therapy - Withdrawal symptoms✔️ — physical dependence can develop with extended use of alprazolam. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks

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

- Asthma✔️ — timolol is a beta-and Renee Vic antagonist that can cause bronchospasm and difficulty breathing. Clients who have any disorder that compromises the respiratory function should not use drug - Seizure disorder — appropriate for seizure disorders, however those who have heart failure or bradycardia should not use drug - Diabetes mellitus — appropriate for diabetes mellitus although caution is essential when patients who have peripheral vascular disease or hyperthyroidism use the drug - Rheumatoid arthritis — appropriate for RA, although Raynaud's disease is a contraindication for using the drug

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? (SATA)

- Motion sickness — bupropion an atypical antidepressant can cause nausea, vomiting, and constipation. Does not prevent or treat motion sickness - Seasonal affective disorder✔️ — helps prevent SAD, a type of depression with the reduction of natural light during winter months - Insomnia — can cause insomnia and agitation. Does not prevent or treat insomnia - Nicotine addiction✔️ — is an appropriate adjunct for clients who are trying to quit smoking - Depression✔️ — correct indication

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?

- Respiratory depression — MAOIs not likely to cause respiratory depression, but can cause fatigue and weakness - Hypertensive crisis✔️ — Tyramine-enriched foods like aged cheese, and processed meat can trigger severe HTN in clients who are taking phenelzine. Manifestations include HTN, headache, and nausea - Neuroleptic malignant syndrome — serious adverse effect of some antipsychotic drugs such as haloperidol, but not of MAOIs like phenelzine. Manifestations include high fever, rigidity, vital-sign instability, and loss of consciousness - Serotonin syndrome — can begin 2-72 hours after initiating therapy with SSRI. Manifestations include mental confusion, difficulty concentrating, and agitation

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?

- Anxiety✔️ — client can experience paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. - Ringing in the ears — blurred vision is a possible adverse drug reaction - Increased appetite — nausea and vomiting are possibly adverse drug reactions - Muscle spasms — not an expected adverse drug reaction. Diazepam can be prescribed to treat muscle spasms

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?

- Renal function impairment✔️ — should be decreased for patients who have renal of hepatic impairment - Cataracts — glaucoma is contraindication. Clients over age 65 years of age might require decreased dosage - Recent weight loss — weight gain is an adverse drug reaction. Pediatric clients might require decreased dosage - Smoking — can decrease the levels and effects of alprazolam. Client may need an increased dosage of smoking while taking alprazolam

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?

- "Take a missed dose as soon as you remember"✔️ — should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, they should take it as soon as they remember as long as it is not close to time for the next scheduled dose - "Take the drug as needed at the first sign of anxious feelings" — should be taken on daily basis not as needed. Onset of action is 1-2 weeks so it is important to maintain consistent blood levels - "Take the drug in the morning with a glass of grapefruit juice" — grapefruit juice increases serum levels and effects of buspirone. - "Drink a cup of chamomile tea at night with the drug" — chamomile can increase CNS depression and should be avoided when taking this drug

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?

- BUN level — unlikely to cause kidney impairment, however an adverse effect is urinary retention. Therefore nurse should monitor urine output - Blood pressure✔️ — clients taking chlorpromazine are at risk for hypotension during and immediately after IV admin. Client should remain supine for 30 minutes while nurse monitors BP. Nurse should instruct patient to change positions slowly as safety precaution to prevent client injury. This med can also cause orthostatic hypotension. - Urine specific gravity — unlikely to cause, check for urine output to evaluate urinary retention - Pedal pulse strength — unlikely to cause alterations to peripheral circulation, but can cause tachycardia. Nurse should monitor clients HR

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

- Stop taking the drug immediately with the first sign of sore throat — clients who take chlorpromazine, a conventional antipsychotic should taper drug to prevent withdrawal symptoms. Drug is appropriate for sore throat clients, but those who have a respiratory impairment because of infection require cautious use - Wear sunscreen when exposed to sunlight✔️ — can cause photosensitivity or increased susceptibility to sunburn, when exposed to light. Clients should limit exposure and wear sunscreen and protective clothing while outdoors - Take the drug with food to reduce gastrointestinal distress — treats nausea and vomiting. Not necessary to take with food - Take the drug in the morning to prevent nocturia — cause sedation and urinary hesitancy, not urinary frequency. Clients should take it in the evening

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? (SATA)

- Change positions slowly from sitting or lying to standing✔️ — amitriptyline is a TCA and can cause orthostatic hypotension - Do not stop taking the drug abruptly✔️ — relapse and withdrawal symptoms can occur with abrupt discontinuation. When discontinuing drug, reduce dosage over 2-week period to prevent or minimize withdrawal symptoms - Avoid crushing the tablet — can be crushed if client has difficulty swallowing tablets - Take the drug at bedtime to prevent daytime drowsiness✔️ — TCA can cause drowsiness. Clients should take at bedtime and a voice activities that require alertness until they know how the drug will affect them - Increase fiber and fluid intake✔️ — TCA that causes anticholinergic effects such as dry mouth, constipation, and urinary retention. Increase fiber and fluid intake during drug therapy and urinate before taking drug

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?

- Furosemide for hypertension✔️ — high delinking loop diuretic that increases sodium loss and can cause lithium reabsorption. - Acetaminophen for headaches — does not increase lithium levels. However, NSAIDs such as ibuprofen can cause lithium reabsorption and toxicity - Ciprofloxacin for a urinary tract infection — no known interaction between lithium and quinolone antibiotics, such as ciprofloxacin. However, risk of toxicity increases with tetracyclines - Montelukast for asthma — no known interaction between lithium and montelukast. Theophylline preparations, however can decrease lithium levels

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?

- Hallucinations✔️ — expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome - Decreased temperature — fever would be an expected finding, and can also become agitated - Hypersexual behavior — can cause sexual dysfunction, not hypersexuality. Client can develop hyperactive DTRs - Constipation — diarrhea would be an expected finding. Constipation can be an adverse drug reaction of fluoxetine

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

- Tolerance✔️ — tolerance and dependence can develop with benzodiazepines. Clients should use these drugs only as needed and for short periods of time - Anxiety✔️ — paradoxical reactions such as anxiety and insomnia can develop, especially in older adults - Sedation✔️ — CNS depression manifested as sedation and drowsiness, is an AE of benzodiazepines. Client should take 30 minutes prior to bedtime - Respiratory depression✔️ — can cause CNS depression when taken with other CNS depressants, especially for older adults. Important to monitor respiratory depression and recommend lowest effective dose. Clients should avoid alcohol and other CNS depressants while taking this medication - Constipation — unlikely to cause however can cause nausea, vomiting, and diarrhea

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

- "Weigh yourself twice a month" — nurse should instruct client to weigh themselves weekly and report consistent decline to provider. Fluoxetine can cause abdominal pain, abnormal taste, dry mouth, nausea, anorexia, which can affect appetite - "If you have persistent headaches, let the provider know"✔️ — client should report persistent headaches, anxiety, or insomnia to provider as adverse drug reactions - "Reduce your daily sodium intake" — fluoxetine can cause hyponatremia. Nurse should instruct client to maintain consistent sodium intake an monitor for indications of a low blood sodium level - "If your symptoms don't improve in 10 days, you will need a higher dose" — medication can take up to 4 weeks to become effective, and the clients should communicate a lack of effectiveness after that time

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?

- Chest x-ray — identify problems with heart and lungs. Lithium can cause dysrhythmias, but unlikely to cause dysfunction of the heart or lungs detectable on chest x-rays - Tonometry — method of testing for glaucoma. Lithium carbonate is unlikely to cause glaucoma. - 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. - Endoscopic retrograde cholangiopancreatography (ERCP) — helps identify disorders of the liver, gallbladder, bile ducts, and pancreas. Lithium carbonate is unlikely to cause abnormalities of these structures.

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?

- Constricted pupils — pilocarpine, a direct-acting cholinergic drug causes miosis, or constricted pupils, and blurred vision. Betaxolol is unlikely to constrict the pupils - Discoloration of the iris — latanoprost can cause brownish discoloration of the iris. Betaxolol unlikely to cause - Hypertension — betaxolol can cause hypotension. Oral betaxolol treats hypertension - Bradycardia✔️ — betaxolol and timolol can cause bradycardia because of the blockage of cardiac beta 1 receptors. Clients should check their pulse rate regularly and report any sustained decreases