pharm quiz (1) cont
A patient with chronic back pain is admitted to a local health care facility for respiratory depression and is prescribed an opioid antagonist. What assessment should a nurse perform before administering an opioid antagonist to the patient?
Review patient's allergy history and treatment modalities.
The nurse is caring for a 59 year-old female client who was diagnosed with multiple sclerosis two years ago. In recent weeks, the client has developed increasing muscle spasticity and the care team is considering the use of dantrolene. What assessment question should the nurse prioritize? Chapter 25: Muscle Relaxants - Page 434
"Are you on hormone replacement therapy?" Explanation: The combination of dantrolene and estrogen creates an unacceptable risk for hepatotoxicity. For this reason, concurrent use of dantrolene and and hormone therapy would be unsafe. The age at which the client began menopause and any history of fibromyalgia or hysterectomy would be much less relevant to the safety and effectiveness of dantrolene.
Mrs. Laird is a 56-year-old postsurgical patient who has an unremarkable social and medical history. Her surgeon has ordered fentanyl patient-controlled analgesia (PCA) but Mrs. Laird admits to you that she is very reluctant to use it for fear of becoming addicted. How should you best respond to Mrs. Laird's concerns? Chapter 12: Pain Management - Page 225-226
"I will make a note for your health care provider to see if you can receive non-narcotic medications for your pain."
The nurse's home care teaching for a client who takes baclofen will include which instructions? (Select all that apply.) Chapter 25: Muscle Relaxants - Page 430-431
"Rise carefully from a seated to a standing position." "This medication may cause you to have to urinate more frequently." "This medicine may give you a headache or make sleeping difficult."
A female patient who had a normal vaginal delivery had an epidural with lidocaine and prilocaine. She asks if it is safe to breastfeed after receiving these medications via epidural. Choose the BEST answer.
"Yes, you can breastfeed immediately after delivery." Chapter 27: General and Local Anesthetic Agents - Page 473
A client with myasthenia gravis has been prescribed dantrolene for the treatment of muscle spasticity. What education should the nurse provide to the client?
"You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic." Dantrolene often causes urinary frequency and urgency. It is not linked with anorexia and is administered orally each day. Dantrolene is not associated with a high risk for dependence.
A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide? Chapter 25: Muscle Relaxants - Page 436
"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time? Chapter 25: Muscle Relaxants - Page 431
10 AM Baclofen peaks in 2 hours after administration, so maximum effectiveness would be noted at this time, which in this case would be 10 AM.
A patient receives intrathecal baclofen at 10 AM. The nurse would expect to see the maximum effect of this drug at approximately what time? Chapter 25: Muscle Relaxants - Page 430
3 PM Intrathecal baclofen peaks in 4 to 6 hours; in this situation, peak or maximum drug effects would occur around 3 PM.
What client is using his or her pyramidal tract to the largest extent? Chapter 25: Muscle Relaxants - Page 428
A client who is filling out the dietary preferences card for the next day The pyramidal tract is part of the CNS that controls precise intentional movement such as writing. The other clients' gross movements. would entail less involvement from the pyramidal tract.
Which nursing diagnosis most likely would be the priority for a client who is receiving a centrally acting skeletal muscle relaxant as treatment for acute knee strain? Chapter 25: Muscle Relaxants - Page 429
Acute pain
A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient? Chapter 24: Antiparkinsonism Agents - Page 418
Administer the next drug dose with meals.
A nurse is preparing a teaching plan for a client who is receiving baclofen therapy. Which would the nurse include as possible adverse effects? (Select all that apply.) Chapter 25: Muscle Relaxants - Page 431
Adverse effects associated with baclofen therapy include drowsiness, urinary frequency, constipation, hypotension, fatigue, weakness, and dry mouth.
A nurse understands that which skeletal muscle relaxants should not be administered to a client with skeletal muscle spasms caused by systemic lupus erythematosus? Chapter 25: Muscle Relaxants - Page 431
Baclofen A nurse should not administer the skeletal muscle relaxant baclofen (Lioresal) to a client with skeletal muscle spasms caused by systemic lupus erythematosus, as baclofen is contraindicated in skeletal muscle spasms caused by rheumatoid disorders. Cyclobenzaprine is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, and hyperthyroidism. In addition, cyclobenzaprine is contraindicated within 14 days of the administration of a monoamine oxidase inhibitor (MAOI). Carisoprodol is used with caution in clients with severe liver or kidney disease and during pregnancy (category unknown) and lactation. Cyclobenzaprine is used cautiously in clients with cardiovascular disease and during pregnancy and lactation (pregnancy category B). Methocarbamol is used for muscle pain relief and stiffness.
What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy? Chapter 24: Antiparkinsonism Agents - Page 421
Blurred vision Explanation: Blurred vision is considered a peripheral anticholinergic effect. Delirium, agitation, and memory loss are considered central effects affecting the CNS.
After reviewing information about skeletal muscle relaxants, a group of students demonstrate understanding of the material when they identify which drug as a direct-acting muscle relaxant? Chapter 25: Muscle Relaxants - Page 432
Botulinum toxin type A Botulinum toxin type A is classified as a direct-acting skeletal muscle relaxant. Diazepam, methocarbamol, and orphenadrine are centrally acting skeletal muscle relaxants.
A client receives hydromorphone 2 mg intravenously for report of postoperative pain. Fifteen minutes later, the nurse notes respirations are 6 breaths/minute and the client is nonresponsive. The nurse administers prescribed naloxone. The next time the client reports pain, the best nursing action is: Chapter 12: Pain Management - Page 242
Consult with the healthcare provider to reduce the dose. The nurse consults with the health care provider about reducing the dose of an opioid temporarily, because doing so may prevent deep sedation. The nurse assesses the client and administers the prescribed dose of an opioid. The nurse does not withhold or change the prescribed dose of the medication unless client safety is immediately compromised. The nurse will ensure naloxone (Narcan)is available when an opioid is again administered to the client.
A client is to have an intravenous line inserted, and the nurse prepares to apply a dermal patch to provide local anesthesia to the area. The nurse would apply the patch at which time before initiating intravenous access? Chapter 27: General and Local Anesthetic Agents - Page 473
Correct response: 30 minutes Explanation: The dermal patch is applied 20 to 30 minutes before the procedure.
A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication?
Dantrolene
A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order? Chapter 25: Muscle Relaxants - Page 433
Dantrolene Explanation: Dantrolene is indicated for the control of spasticity resulting from upper motor neuron disorders such as amyotrophic lateral sclerosis. Chlorzoxazone, metaxalone, and methocarbamol are used to treat acute musculoskeletal conditions.
Patients receiving chlorzoxazone should be cautioned that what will occur with administration? Chapter 25: Muscle Relaxants - Page 431
Discoloration of urine Explanation: Chlorzoxazone may discolor urine, becoming orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent fears of blood in the urine. Tizanidine has been associated with liver toxicity and hypotension in some patients.
Which adverse effects would a nurse most likely assess in a client who is receiving a centrally acting skeletal muscle relaxant? (Select all that apply.)
Drowsiness Insomnia Dry mouth Constipation Adverse effects include drowsiness, urinary frequency, constipation, hypotension, insomnia, and dry mouth.
The nurse is providing care for a client with Parkinson's disease. Which of the client's medications will most directly affect catecholamine-O-methyl transferase (COMT) function?
Entacapone
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan? Chapter 25: Muscle Relaxants - Page 430-431
Falls prevention measures Explanation: The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.
Baclofen should be tapered slowly to prevent:
If using baclofen, taper the drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Use baclofen cautiously in patients whose spasticity contributes to mobility, posture, or balance to prevent loss of function.
A client comes to the health care provider's office. The client is to receive botulinum toxin. What, if assessed, would suggest to the nurse that the drug administration should be postponed? Chapter 25: Muscle Relaxants - Page 434
Infection at the intended site of administration Explanation: Botulinum toxin is administered as an injection and should not be given if there is active infection at the site of the intended injection.
Which would a nurse include when describing the action of dantrolene?
Interference with calcium release from the muscles Explanation: Dantrolene interferes with the release of calcium from the muscle tubules, preventing the fibers from contracting. Botulinum toxins A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine. Centrally acting skeletal muscle relaxants interfere with the reflexes that are causing the muscle spasm. Tizanidine is thought to increase inhibition of presynaptic motor neurons in the CNS.
Which medications are opioids for which naloxone may be given to counter the effects?
Meperidine is an opioid medication for which naloxone is an opioid antagonist, and for which naloxone counters the effects. Acetaminophen is not an opioid medication and naloxone would have no effect on a client receiving this medication. Ibuprofen and naproxen are nonsteroidal anti-inflammatory drugs, and naloxone would have no effect on a client receiving these medications.
Which action would be a priority for a client receiving apomorphine? Chapter 24: Antiparkinsonism Agents - Page 416
Monitoring cardiac status Explanation: Apomorphine is associated with a risk for hypotension and a prolonged QT interval. Therefore, the priority would be to monitor the client's cardiac status closely. The drug is given by subcutaneous injection, not oral administration. Checking for skin lesions would be appropriate for a client receiving levodopa due to its association with melanoma. Palpating the bladder would be appropriate for any dopaminergic agent because of the risk for urinary retention. However, this would not be the priority.
A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic?
Morphine
A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route?
Oral Explanation: Trihexyphenidyl is available only in an oral form.
The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic? Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 452-452
Respiratory rate Explanation: The first sign of narcotic overdose is often respiratory depression. Therefore, monitoring the client's vital signs, particularly respirations, is extremely important when administering narcotics.
The nursing instructor is teaching students about anesthesia and instructs that general surgical anesthesia is divided into four different stages. In which stage would the nurse expect to see delirium? Chapter 27: General and Local Anesthetic Agents - Page 466
Stage 2 Explanation: Stage 1 is analgesia, stage 2 is delirium, stage 3 is surgical anesthesia, and stage 4 is respiratory paralysis.
A client with a spinal cord injury is experiencing increasing muscle spasticity and the care team is considering the use of dantrolene. The nurse should identify what possible contraindication to the safe and effective use of this medication? Chapter 25: Muscle Relaxants - Page 435
The client has hepatitis C Explanation: Dantrolene is associated with possible hepatocellular injury and a concurrent diagnosis of hepatitis C would require great caution, or may contraindicate the use of dantrolene. Pressure ulcers, use of SSRIs and recent injury do not contraindicate its use.
A client is taking levodopa. What should the nurse caution the client to avoid Chapter 24: Antiparkinsonism Agents - Page 414
Vitamin B6 Explanation: Vitamin B6 interacts with levodopa decreasing its effectiveness. St. John's wort is not known to interact with levodopa, but does interact with rasagiline. Aged cheese contains tyramine and should be avoided if the client is taking rasagiline, but there is no caution associated with levodopa. Analgesics are not known to interact with levodopa.
When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 449
a return to normal respiratory rate, rhythm, and depth.
Which assessment findings should cause the nurse to suspect that the client is experiencing withdrawal from butorphanol? Select all that apply. Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 172
anxiety tremors Explanation: The signs of withdrawal from butorphanol include tremors and anxiety.
A client is diagnosed with trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder? Chapter 23: Anti-seizure Agents - Page 405
carbamazepine Explanation: Carbamazepine is prescribed to treat trigeminal neuralgia. Neither phenytoin, fosphenytoin, nor ethosuximide is administered for trigeminal neuralgia.
While most muscle relaxants drugs are central nervous system (CNS) depressants, which medication acts only on the muscle? Chapter 25: Muscle Relaxants - Page 432
dantrolen Explanation: Dantrolene is the only skeletal muscle relaxant that acts peripherally on the muscle itself; it inhibits the release of calcium in skeletal muscle cells, thereby decreasing the strength of muscle contraction. Reference:
The therapeutic goals for use of anticholinergic drugs in the treatment for parkinsonism is to decrease what symptomology? Select all that apply. Chapter 24: Antiparkinsonism Agents - Page 420
fine tremors salivation muscle spasticity Explanation: Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. The therapy would cause dry mouth and urinary retention.
What is the primary medication prescribed to relieve pain associated with shingles? Chapter 23: Anti-seizure Agents - Page 405
gabapentin Explanation: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?
involuntary movements.
The nurse admits a child who was diagnosed with tetanus after stepping on old barbed wire fencing. What medication should the nurse expect to administer? Chapter 25: Muscle Relaxants - Page 430
methocarbamol Explanation: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Amrix is not used for the treatment of tetanus.
A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing? Chapter 12: Pain Management - Page 226
neuropathic pain Explanation: Neuropathic pain can affect cancer patients due to nerve damage from chemotherapy or radiation therapy. Somatic pain is caused by damage or disorders that affect bones, joints, muscles, skin, or other structures. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is pain felt in the body in a location that is different from the actual source of the pain.
The client is 65-years-old and has a diagnosis of cancer. Morphine has been ordered for pain management. Before the administration of morphine, the initial action of the nurse would be to check which? Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 449
respiratory rate, depth, and rhythm. The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the client's respiratory rate, depth, and rhythm. Morphine should not be administered to any client with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse.
How will the addition of nitrous oxide or IV anesthetics affect the minimum alveolar concentration (MAC) of isoflurane? Chapter 27: General and Local Anesthetic Agents - Page 469
Correct response: The MAC will decrease. Explanation: With the addition of other medications such as opioids, intravenous anesthetics, or nitrous oxide, the MAC values decrease.
Simple reflex arcs comprise the:
spindle gamma loop system. Explanation: Simple reflex arcs involve sensory receptors in the periphery and spinal motor nerves. Such reflex arcs make up what is known as the spindle gamma loop system. The pyramidal tract is part of the CNS that controls precise intentional movement. The extrapyramidal tract, also a part of the CNS, controls unconscious muscle activity. The basal ganglia is the portion of the brain that is associated with unconscious muscle movements.
The nurse in a long term care facility cares for several clients with Parkinson's disease or parkinsonism. Which client should the nurse refer to his or her provider for the possible use of adjunctive agents? Chapter 24: Antiparkinsonism Agents - Page 422
Correct response: A client who has been taking carbidopa-levodopa for three years but with decreasing therapeutic effects Explanation: Adjunctive drugs are usually used in combination with levodopa-carbidopa when the client has begun to experience decreasing benefits from that drug. It would be much less common for a client to receive these drugs to treat drug-induced parkinsonism or pending a diagnosis of Parkinson's disease. Nausea would not normally be a sufficient indication for their use.
Dantrolene is being considered for the treatment of a client's spasticity. Which aspect of the client's current health status is most likely to contraindicate the use of this medication? Chapter 25: Muscle Relaxants - Page 432-433
Correct response: The client's spasticity is due to rheumatoid arthritis Explanation: Dantrolene is not used for the treatment of muscle spasms associated with musculoskeletal injury or rheumatic disorders. Diabetes, opioids and issues with adherence would not necessarily contraindicate the use of dantrolene, though these factors must be addressed.
A client is postoperative and has not taken her pain medication. The nurse is performing an assessment at the beginning of her shift and determines that sensitization has occurred. The first nursing intervention is to Chapter 12: Pain Management - Page 230
Administer the prescribed intravenous opioid. Explanation: Sensitization occurs when the client waits too long to report pain and the pain is so intense that it is difficult to relieve. The first action of the nurse is to relieve the client's pain through administration of the prescribed intravenous opioid. Then the nurse can provide other alternative measures for pain relief. Once the pain is relieved, the nurse can educate the client about notifying the nurse when pain occurs. Naloxone is administered for opioid-induced respiratory depression. It is not needed in this client's situation
A client whose Parkinson's disease is being treated with tolcapone should concurrently take what drug? Chapter 24: Antiparkinsonism Agents - Page 423
Correct response: levodopa/carbidopa Explanation: It is necessary to administer tolcapone in conjunction with levodopa/carbidopa and to monitor the client's response to the medication. Ipratropium, atropine, and benztropine are not indicated.
A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which? Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents - Page 449
Correct response: pneumonia. Explanation: Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia. The drug does not cause myocardial infarction or renal impairment. A common cold is not known to cause hypersensitivity to the morphine.
The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?
Crushing the medication may precipitate an overdose.
A client sustained a musculoskeletal injury to his left leg that has resulted in occasional spasticity. What should the nurse expect the health care provider to prescribe? Chapter 25: Muscle Relaxants - Page 430
Cyclobenzaprine Explanation: Cyclobenzaprine is used for the treatment of discomfort of acute musculoskeletal conditions. Baclofen is used to treat muscle spasticity associated with neuromuscular diseases. Dantrolene is used to treat upper motor neuron-associated muscle spasticity. Botulinum toxin type B is used to reduce the severity of abnormal head position and neck pain associated with cervical dystonia
A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing? Chapter 12: Pain Management - Page 227
visceral Explanation: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating. Neuropathic pain is pain that is processed abnormally by the nervous system. Deeper somatic pain such as that caused by trauma produces localized sensations that are sharp, throbbing, and intense. Chronic pain has a duration longer than 6 months.