Pharmacology Exam 3 PrepU and ATI Questions

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen? "It's best to avoid taking a dose of baclofen unless your spasticity becomes impossible to manage." "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." "Even though baclofen is a drug that's available over the counter, it still has the potential to cause serious adverse effects if taken incorrectly." "You'll likely have to stop taking your other medications for a week to ten days before starting to take baclofen."

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." Explanation: Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.

A patient has been prescribed methocarbamol for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which statement by the patient indicates that the patient has an understanding of at least one of the significant side effects of methocarbamol? "My urine could be discolored while I take this drug." "I should have lots of energy while taking this drug." "I will probably have diarrhea while taking this drug." "This drug will help my tension headaches."

"My urine could be discolored while I take this drug." Explanation: One significant side effect of methocarbamol is that it causes urine to be discolored. Central-acting muscle relaxants such as methocarbamol usually cause fatigue and loss of energy along with constipation, not diarrhea. Methocarbamol is not designed to treat tension headaches.

A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response? "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." "You're not permitted to drink alcohol while you're taking baclofen."

"The combination of baclofen and alcohol could depress your nervous system to a dangerous level." Explanation: The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.

A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response" "This drug causes your urine to change color, so it's not likely blood that you're seeing." "It's likely that your chlorzoxazone is reacting with one of your other medications." "There's a risk of that with this particular medication, so you should come be assessed promptly." "Please check in again if it doesn't clear up within the next 24 hours."

"This drug causes your urine to change color, so it's not likely blood that you're seeing." Explanation: Chlorzoxazone causes discoloration of the urine that can mimic hematuria. This is not due to a drug-drug interaction. Telling the client to monitor this for the next day without giving any explanation will not alleviate the client's concern.

Which patient would likely have the highest risk for hepatotoxicity from dantrolene? A 32-year-old male who is taking an antipsychotic drug A 45-year-old female who is taking an antihypertensive agent A 57-year-old female who is on hormone replacement therapy A 70-year-old male who is taking a cardiac glycoside

A 57-year-old female who is on hormone replacement therapy Explanation: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased; this combination should be avoided. There is no indication that patients taking a cardiac glycoside, an antipsychotic, or an antihypertensive drug in combination with dantrolene puts the patient at increased risk for hepatotoxicity.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone. Which explanation by the nurse is correct? After surgery, a client may feel nauseated as a side effect of the anesthesia. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. This is a precaution in case the client begins to choke when resuming a general diet. Suction equipment should be placed in all client rooms as a standard of care postoperatively.

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. Explanation: It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.

A client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action? Offer an ice pack and reassess the client's respiratory status in 30 minutes Inform the client that morphine would cause excessive respiratory depression and offer non-pharmacologic interventions Administer the morphine as prescribed and monitor the client's respiratory status closely Contact the care provider to seek direction

Administer the morphine as prescribed and monitor the client's respiratory status closely Explanation: A respiratory rate of 14 breaths per minute is lower than expected, but is not low enough to warrant withholding a client's medication. The nurse should give the medication and monitor the client closely. There is no clear need to contact the provider.

A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates? Assess the client's vital signs hourly. Delay the ordered dose if respirations are below 15 bpm. Assess the respiratory rate before giving a dose of opiates. Give a dosage only if you think it is necessary.

Assess the respiratory rate before giving a dose of opiates. Explanation: Check the rate, depth, and rhythm of respirations before each dose. If the rate is fewer than 12 per minute, delay or omit the dose and report to the health care provider. Vital signs do not need to be assessed hourly. Give the medication as scheduled.

The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? Assessing the client for migraine pain Assessing the client for narcotic withdrawal syndrome Assessing the client for respiratory depression Assessing the client's lying, sitting and standing blood pressure

Assessing the client for migraine pain Explanation: Sumatriptan is indicated for the treatment of acute migraine and cluster headaches. As such, the nurse should assess the client for indications of this health problem, more so than respiratory status or blood pressure. Narcotic withdrawal syndrome is unrelated.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Baclofen Allopurinol Alendronate Hydroxychloroquine

Baclofen Explanation: Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.

A client with impaired liver function secondary to hepatitis C requires a centrally acting skeletal muscle relaxant for temporary pain relief. What medication would put the least metabolic burden on the client's liver? Baclofen Methocarbamol Diazepam Orphenadrine

Baclofen Explanation: Baclofen is not metabolized. The other answer choices are centrally acting skeletal muscle relaxants that are all metabolized by the liver to differing degrees.

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? Baclofen Carisoprodol Chlorzoxazone Cyclobenzaprine

Baclofen Explanation: Baclofen is used for the treatment of muscle spasticity associated with spinal cord injuries. Carisoprodol is used for the relief of discomfort of acute musculoskeletal conditions. Chlorzoxazone is used for the relief of discomfort of acute musculoskeletal conditions. Cyclobenzaprine is used for the relief of discomfort of acute musculoskeletal conditions.

Which skeletal muscle relaxant is also available in intrathecal form? Cyclobenzaprine (Flexeril) Tizanidine (Zanaflex) Baclofen (Lioresal) Carisoprodol (Soma)

Baclofen (Lioresal) Explanation: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity.

A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug? Binding to phospholipids to diminish anxiety Interrupting the calcium intake in the neuron Binding to serotonin to produce vasoconstriction Reducing inflammation in the temporal arteries

Binding to serotonin to produce vasoconstriction Explanation: Sumatriptan binds to the serotonin receptors in the intracranial blood vessels, resulting in vasoconstriction. Sumatriptan does not bind to phospholipids to diminish anxiety. Sumatriptan does not interrupt the calcium intake in the neuron. Sumatriptan does not reduce inflammation in the temporal arteries.

The extra pyramidal tract is made up of cells from which areas? Skeletal muscle Peripheral nerves Cerebral cortex Cranial nerves

Cerebral cortex Explanation: The extra pyramidal tract is composed of cells from the cerebral cortex, as well as those from several subcortical areas, including the basal ganglia and the cerebellum.

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Diarrhea Bleeding Sleep deprivation Constipation

Constipation Explanation: Morphine and other opiates delay stomach emptying and slow peristalsis. They can be used to treat severe diarrhea or for surgical interventions involving the intestines. However, this slowed peristalsis can also cause constipation (a very common side effect), abdominal pain, and distention. Sleep deprivation, bleeding and diarrhea are not normal side effects.

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? "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time." "We'll need to closely monitor your blood sugar levels for the next week." "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug." "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."

Correct response: "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.

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? The medication can be very irritating to mucous membranes. The crushed medication can permanently stain teeth. Crushing the medication may precipitate an overdose. Crushing the medication interferes with its absorption.

Crushing the medication may precipitate an overdose. Explanation: Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.

The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? Cyclobenzaprine produces an anticholinergic response Cyclobenzaprine acts in the peripheral nervous system Cyclobenzaprine has an effect at the neuromuscular junction Cyclobenzaprine is structurally similar to amitriptyline

Cyclobenzaprine produces an anticholinergic response Explanation: Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

During surgery to repair a ruptured Achilles tendon, the client develops severe muscle contractions and a dramatic rise in body temperature. Which medication will be administered? Dantrolene sodium Baclofen Carisoprodol Cyclobenzaprine

Dantrolene sodium Explanation: The signs indicated in the scenario suggest malignant hyperthermia. Of the choices offered, dantrolene is the only agent used to treat the condition.

A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication? Reduction in the appearance of new lesions in magnetic resonance imaging (MRI) studies Decreased muscle spasms Increased muscle strength Decreased severity and duration of exacerbations

Decreased muscle spasms Explanation: Baclofen, a GABA agonist, is used in the treatment of spasms. It can be administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions in MRI studies. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication? Reduction in the appearance of new lesions in magnetic resonance imaging (MRI) studies Decreased muscle spasms Increased muscle strength Decreased severity and duration of exacerbations

Decreased muscle spasms Explanation: Baclofen, a GABA agonist, is used in the treatment of spasms. It can be administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions in MRI studies. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug? Insomnia Anxiety Constipation Drowsiness

Drowsiness Explanation: The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration. Depression is not an adverse reaction of carisoprodol administration. Insomnia and anxiety are adverse reactions associated with bisphosphonate drugs.

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? Falls prevention measures Seizure precautions Continuous pulse oximetry Deep breathing and coughing exercises

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.

A nurse is assessing a client's pain level. Which would be the most appropriate method? Ask the client to describe their pain in their own words. Have the client rate it on a scale of 0 to 10. Palpate the area where the client says the client has pain. Review the client's vital signs for changes.

Have the client rate it on a scale of 0 to 10. Explanation: The most appropriate method for assessing pain is to have the client rate his pain by using some type of scale. This provides objective evidence of the severity of the pain and provides a basis for comparison later on.

The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching? Hypotension Dark black urine Excessive salivation Eczema

Hypotension Explanation: Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

Which medications are opioids for which naloxone may be given to counter the effects? Meperidine Acetaminophen Ibuprofen Naproxen

Meperidine Explanation: 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.

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? Methadone Oxycodone Oxymorphone Tramadol

Methadone Explanation: Methadone is used for detoxification and temporary maintenance treatment of narcotic addiction. Oxycodone is used for the relief of moderate to severe pain in adults. Oxymorphone is used for the relief of moderate to severe pain in adults, preoperative medication, and obstetrical analgesia. Tramadol is used for the relief of moderate to moderately severe pain, and its use should be limited in clients with a history of addiction.

An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family? Administer the medication with meals. Monitor the client before ambulating. Instruct on how to assess client's pain level. Give the medication at the same time each day.

Monitor the client before ambulating. Explanation: Safety is the top priority concern, because skeletal muscle relaxants can cause drowsiness. Administering the medication with meals can reduce GI distress but is not the top priority safety concern. Checking the client's pain level is important but not the top priority safety concern. Giving the medication at the same time each day may help the caregivers remember it, but is not the top priority safety concern.

The nurse notes a respiratory rate of 6 breaths/min in a client in the postanesthesia recovery unit. Which drug would the nurse anticipate being given immediately? Acetaminophen and diphenhydramine Epinephrine Butorphanol Naloxone

Naloxone Explanation: Naloxone has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-Q injection and last 1 to 2 hours. Butorphanol would worsen respiratory depression. Acetaminophen and diphenhydramine are used to treat headache. Epinephrine may be prescribed for an allergic reaction but not for respiratory depression.

A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first? Prepare the patient for the injection. Wash her hands. Notify the physician. Document the polymyxin on the chart.

Notify the physician. Explanation: If the botulinum toxins are used with other drugs that interfere with neuromuscular transmission—neuromuscular junction (NMJ) blockers, lincosamides, quinidine, magnesium sulfate, anticholinesterases, succinylcholine, or polymyxin—or with aminoglycosides, there is a risk of additive effects. If any of these must be given in combination, extreme caution should be used.

A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication? Vital signs Pain scale Glasgow coma scale Subjective assessment

Pain scale Explanation: The method the nurse should prioritize in this situation is using the pain scale. Following the administration of the acetaminophen-aspirin-caffeine combination, the client should exhibit diminished pain. The nurse assesses for pain using the pain scale. A subjective assessment would involve more than just the pain scale. Assesing vital signs would be an objective assessment and not necessarily confirm therapeutic effects The Glasgow coma scale would not be indicated for migraine headache.

A client is receiving a narcotic agonist- antagonist parenterally immediately after surgery but will be switched to the oral form when tolerating fluid and food. Which agent would most likely be preferred? Buprenorphine Butorphanol Nalbuphine Pentazocine

Pentazocine Explanation: Pentazocine is available in parenteral and oral forms, making it the preferred choice for clients who will be switched from parenteral to oral forms after surgery.

A male client is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The health care provider advises the nurse to pay attention to the clinical management of the client's pain to allow proper agonist coverage during the change in drug dosage. Why is the client likely to suffer unnecessary pain and discomfort if proper management is not ensured? Tolerance to the drug Physical dependence on the drug Addiction to the drug Adverse effects of the drug

Physical dependence on the drug Explanation: If morphine use lasts longer than 3 months, then physical dependence will occur. Dependence is characterized by a withdrawal or abstinence syndrome when morphine is discontinued; it represents an exaggerated rebound from its acute effects. Physical dependence is not the same as tolerance or addiction. Tolerance means that the body has become accustomed to the effects of a substance and that the client must use more of it to achieve the desired effect, while addiction involves compulsive use of the drug for a secondary gain, not for pain control.

What are nonpharmacological methods that can be used for tension headaches? Select all that apply. -Rest -Exercise -Diet of fruits and vegetables -Deep breathing exercises -Stress reduction strategies

Rest Deep breathing exercises Stress reduction strategies Explanation: Nonpharmacological methods that can be used for tension headaches include rest, relaxation techniques such as deep breathing, or stress-reduction strategies. Exercise and diet do not impact tension headaches.

A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen? Risk for Injury related to CNS depression Risk for Impaired Swallowing related to adverse neuromuscular effects Risk for Sexual Dysfunction related to endocrine changes Risk for Ineffective Airway Clearance related to increased secretions and decreased lung function

Risk for Injury related to CNS depression Explanation: The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.

Which assessment finding would support a client's report of migraine headaches? Severe unilateral pulsating pain Sharp steady eye pain Dull band of pain around the head Onset occurring during sleep

Severe unilateral pulsating pain Explanation: Migraine headaches are associated with severe unilateral pulsating pain on one side of the head. Sharp steady eye pain with an onset usually during sleep is associated with cluster headaches. A dull band of pain around the head suggests a tension headache.

A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client's history should prompt the nurse to discourage the client from taking the drug? The client has not adhered to previous treatment regimens. The client has a chronic venous ulcer on the lower leg. The client has a diagnosis of liver cirrhosis. The client is a smoker.

The client has a diagnosis of liver cirrhosis. Explanation: Clients diagnosed with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address? During pain assessment, the client may report less pain. The client may begin to demonstrate symptoms of withdrawal. Double the standard dosage of the medication may be needed. Multiple doses may be needed to be therapeutic.

The client may begin to demonstrate symptoms of withdrawal. Explanation: The client may begin to demonstrate symptoms of withdrawal when he or she has a history of opioid abuse and is administered an opioid antagonist. The other answers are incorrect. In fact, clients will likely have increased pain due to antagonistic effects of the drug. The standard dosage and a single dose will be administered even with a history of opioid abuse.

Spinal reflexes are the simplest nerve pathways that monitor movement and posture. True False

True Explanation: The spinal reflexes are the simplest nerve pathways that monitor movement and posture.

A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method? Using a pain rating scale Asking a client to describe his or her pain Percussing or palpating the area where pain is identified Assessing the client's vital signs

Using a pain rating scale Explanation: A pain rating scale is the most reliable method because it provides measurable evidence of pain severity. A client's description of pain is useful, but does not provide objective or quantifiable data over time. Although percussing or palpating provides information, it would increase the client's pain and be inappropriate. Vital sign changes occur for numerous reasons and are not the best indicator of pain in clients who can speak.

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction? Eat a high-protein diet. Decrease the dosage if any adverse effect is experienced. Wear appropriate clothing and sunscreen whenever he is in direct sunlight. Have a complete blood cell count done weekly.

Wear appropriate clothing and sunscreen whenever he is in direct sunlight. Explanation: The nurse will need to caution the patient about the adverse effect of photosensitivity, especially considering his work. He should be advised to wear protective clothing and sunglasses and to use sunscreen whenever he is outside on the job site. A complete blood cell count should be done before therapy begins but would not be needed again unless indicated. A nurse must check with the prescriber before advising a patient to decrease a drug dosage. A diet high in protein is not necessary with this drug.

When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing? acute somatic pain chronic visceral pain visceral pain neuropathic pain

acute somatic pain Explanation: Sprains and other traumatic injuries are examples of acute somatic pain. Somatic pain results from stimulation of nociceptors in the skin, bone, muscle, and soft tissue. Visceral pain, which is diffuse and not well localized, results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues either from acute or chronic injuries. Neuropathic pain is caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the central nervous system.

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor: prothrombin time and partial thromboplastin time. urine specific gravity. alanine aminotransferase and total bilirubin levels. follicle-stimulating hormone levels.

alanine aminotransferase and total bilirubin levels. Explanation: The nurse will monitor alanine aminotransferase and total bilirubin levels, because a serious adverse effect of dantrolene is drug-induced hepatitis. The nurse will also educate the patient and family concerning signs and symptoms of hepatitis. Prothrombin time and partial thromboplastin time would be monitored for someone taking an anticoagulant, not for someone taking dantrolene. Urine specific gravity is part of a urinalysis and would be used to assess urinary function, which is not affected by dantrolene use. Follicle-stimulating hormone level is important to the female reproductive system and would not be assessed in a male.

A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to: avoid drinking alcohol for the duration of treatment. avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued. increase intake of foods that are high in potassium. increase fluid intake and self-monitor for decreased urine output.

avoid drinking alcohol for the duration of treatment. Explanation: The CNS depressant effects of baclofen can be dangerously exacerbated by alcohol, which should be avoided. Grapefruit is not contraindicated and there is no reason to increase potassium or fluid intake while taking baclofen.

The nurse is planning care for a client who has been prescribed dantrolene therapy. The nurse knows that the plan should incorporate monitoring for what serious adverse effect? anemia hepatitis hypotension hypoglycemia

hepatitis Explanation: Dantrolene may cause potentially fatal hepatitis, with jaundice and other symptoms that usually occur within 1 month of starting drug therapy. Liver function tests should be monitored periodically in all clients receiving dantrolene. None of the other options are associated with dantrolene therapy.

A 60-year-old client tearfully explains to the nurse how her husband downplays her frequent migraines and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning this client's care? ineffective health maintenance related to migraine headaches ineffective role performance related to migraine headaches situational low self-esteem related to migraine headaches spiritual distress related to migraine headaches

ineffective role performance related to migraine headaches Explanation: Many nursing diagnoses likely apply to this client's situation, but there is evidence that she grieves her inability to perform a caregiving role for her grandchildren. There is no evidence that the client's health maintenance is inadequate or that she has low self-esteem. Spiritual distress is also not in evidence.

Which client would the nurse identify as being opioid naive? one who does not routinely take opioids person who routinely takes opioids individual who is physically dependent on opioids one who is psychologically dependent on opioids

one who does not routinely take opioids Explanation: Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.

A nurse is conducting a presentation for a community group about herbal remedies used for pain relief. Which remedy would the nurse include in the presentation? passionflower ginger garlic ginseng

passionflower Explanation: Passionflower has been used in medicine to treat pain, anxiety, and insomnia. Ginger, garlic, and ginseng are not used for pain relief.

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as a common adverse reaction? Drowsiness Dyspnea Hypertension Tachycardia

Drowsiness Explanation: Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.

The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for? Muscle spasms Insomnia Drowsiness Urinary incontinence

Drowsiness Explanation: A common adverse effect with cyclobenzaprine is drowsiness. The client will not experience muscle spasms, insomnia, or urinary incontinence as a result of this medication therapy.

What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals? gold salts cox 2 inhibitors propionic Acids fenamates

gold salts Explanation: Gold salts can be quite toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation.

The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response? "ADHD usually starts in childhood and resolves by adolescence." "ADHD usually starts in childhood and resolves by adulthood." "ADHD usually starts in childhood and resolves before adolescence." "ADHD usually starts in childhood and may persist through adulthood."

"ADHD usually starts in childhood and may persist through adulthood." Explanation: ADHD usually starts in childhood and may persist through adulthood.

A female client reports a mild headache and is prescribed acetaminophen 325 mg, two tablets by mouth every 4 to 6 hours. The client states that she usually takes ibuprofen for her headaches and asks why the health care provider ordered acetaminophen. Which explanation would the nurse give? "Acetaminophen is more effective than ibuprofen for headaches." "Acetaminophen is less expensive and more efficient for pain relief." "Acetaminophen is often the initial drug of choice for relieving mild to moderate pain." "Acetaminophen will reduce the inflammation causing your headache."

"Acetaminophen is often the initial drug of choice for relieving mild to moderate pain." Explanation: Acetaminophen is often the initial drug of choice for relieving mild to moderate pain and fever, because it does not cause gastric irritation or bleeding. It may be taken on an empty stomach.

A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed? "Do you have a history of depression?" "Have you ever been diagnosed with narcolepsy?" "Do you have a problem with sleepwalking?" "Do you have trouble falling asleep?"

"Have you ever been diagnosed with narcolepsy?" Explanation: Modafinil is used to treat narcolepsy and to improve wakefulness in other sleep disorders. It is not used to treat insomnia, somnambulism, or depression.

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse? "It is used to treat severe arthritis." "It is an aspirin substitute for pain and fever." "It is used to treat chronic pain." "It is an anti-inflammatory medication."

"It is an aspirin substitute for pain and fever." Explanation: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.

A client has told the nurse that she has been invited to a work colleague's house where she and some of her peers will be able to receive Botox injections. What is the nurse's best response? "It's safest to have these injections performed under medical supervision." "Have you ever received a Botox injection before?" "What effect are you hoping to achieve with the injections? "These injections have serious side effects so it's best to avoid them."

"It's safest to have these injections performed under medical supervision." Explanation: Botox injections are not deemed unsafe and clients are not normally counselled to avoid them absolutely. However, it is recommended that they be administered under appropriate medical supervision because they are prescription medications and are not risk-free. This caution is more important than asking the client's intentions or previous history of Botox injections.

A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client? "Older adults metabolize the drug more quickly, but due to renal dysfunction, the medication must be reduced." "Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." "Older adults metabolize the drug at the same speed as younger adults; I will check the dosage with your health care provider." "Older adults do not need as much of the medication for the desired effect as a younger adult does."

"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." Explanation: In older adults, most non-benzodiazepines are metabolized more slowly, and half-lives are longer than in younger adults. Exceptions are lorazepam and oxazepam, whose half-lives and dosages are the same for older adults as for younger ones. The recommended initial dose of zaleplon or zolpidem is 5 mg, one half of the initial dose recommended for younger adults. Dosages of eszopiclone should also be reduced for older adults, beginning with 1 mg initially, not to exceed 2 mg at bedtime.

A client with a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug? "Take your medication as soon as you first sense a migraine coming." "Take your sumatriptan at bedtime to minimize the effects of sedation." "You'll likely be prescribed doses three times a day, so take it with meals to remind yourself." "Make sure that you don't drink any grapefruit juice while you're taking sumatriptan."

"Take your medication as soon as you first sense a migraine coming." Explanation: Sumatriptan is taken at the first sign of a migraine. It is not normally taken on a regular basis, so taking it with meals or at bedtime is unnecessary. Grapefruit juice is not contraindicated.

The parents of a child receiving a central nervous system stimulant for treatment of attention deficit disorder asks the nurse why they are stopping the drug for a time. Which statement by the nurse would be most appropriate? "He probably doesn't need the medication anymore since he is getting older." "We need to check and see if he still has symptoms that require drug therapy." "The drug should be used for a specified period of time and then switched to another." "He is prone to developing severe adverse effects if he stays on it any longer."

"We need to check and see if he still has symptoms that require drug therapy." Explanation: Periodically, the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which would indicate the need for continued treatment.

What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide? "When did you have your last drink of alcohol?" "What is motivating you to stop drinking alcohol?" "How has your alcohol use affected your quality of life?" "How much alcohol have you ingested in the last 8 hours?"

"When did you have your last drink of alcohol?" Explanation: Chlordiazepoxide is used primarily when clients are in acute alcohol withdrawal. Assessment should be focused on when the client last consumed alcohol to help in the planning of care. While the other questions are not inappropriate, they are not directly related to caring for a client experiencing alcohol withdrawal.

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.) -Therapeutic response is achieved and discomfort is reduced. -An adequate breathing pattern is maintained. -Client reports decreased bowel movements. -Client maintains adequate nutritional status. -Client reports decreased urinary output.

-Therapeutic response is achieved and discomfort is reduced. -An adequate breathing pattern is maintained. -Client maintains adequate nutritional status. Explanation: The plan of care is considered effective when therapeutic response is achieved and discomfort is reduced; an adequate breathing pattern is maintained; the number of bowel movements is maintained; and adequate nutritional status is maintained. Urinary output should mirror increased fluid intake (increased fluid in, increased fluid out).

The nurse is providing education to a client who will be receiving intravenous (IV) morphine. The nurse should teach the client that maximum relief of pain will occur in what time frame? Immediately 3 to 5 minutes 10 to 20 minutes 30 to 45 minutes

10 to 20 minutes Explanation: After IV injection of morphine, maximal analgesia and respiratory depression usually occur within 10 to 20 minutes.

The nursing student is reviewing information learned in anatomy and physiology class about the nervous system. The student recalls that the nervous system has how many divisions? 1 2 3 4

2 Explanation: The nervous system has two main divisions: the central nervous system and the peripheral nervous system.

A nursing student correctly identifies a normal dose of aspirin for the adult client as which? 81 mg orally q 4 hours 325 to 650 mg orally q 4 hours 650 to 1000 mg orally q 4 hours 1000 mg orally every morning

325 to 650 mg orally q 4 hours Explanation: The correct dose for an adult client receiving aspirin orally is 325 to 650 mg every 4 hours. The other options would not be recommended and would be medication errors if given.

The nurse is caring for a client treated with flumazenil for benzodiazepine toxicity. After administering flumazenil what should the nurse carefully assess for? Agitation, confusion, and seizures Cerebral hemorrhage and dystonia Hypertension and renal insufficiency Hypotension, arrhythmias, and cardiac arrest

Agitation, confusion, and seizures Explanation: Administration of flumazenil blocks the action of benzodiazepines. If the client has been taking these medications for an extended period of time, the blockage of the drug's effects could precipitate an acute benzodiazepine withdrawal syndrome with symptoms including agitation, confusion, and seizures. Anexate does not cause cerebral hemorrhage and dystonia, hypertension, renal insufficiency, hypotension, arrhythmias, and cardiac arrest.

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery? Take as little pain medication as possible to prevent addiction. Ask for pain medication before the pain gets severe. Request your pain medication whenever it is available to you. Wait as long as possible for pain medication; it will work more effectively.

Ask for pain medication before the pain gets severe. Explanation: The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.

A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate? -Assess the client's allergy status. -Assess the client for recent exacerbations of rheumatoid arthritis. -Assess the client's use of salicylates. -Assess the client's use of acetaminophen.

Assess the client's use of salicylates. Explanation: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with acetaminophen toxicity or an exacerbation of rheumatoid arthritis itself. This constellation of symptoms is not suggestive of an allergic reaction.

A client presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the client has been taking medication throughout the evening. What would the nurse suspect? Hypnotic overdose Sedative overdose Anti-anxiety overdose Benzodiazepine overdose

Benzodiazepine overdose Explanation: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity.

What is a priority nursing assessment of a client prescribed oral sumatriptan? Blood pressure Urinary output Head to toe assessment Glasgow coma scale

Blood pressure Explanation: After administration of sumatriptan, the nurse should assess for adverse effects. These include increased blood pressure as well as chest pain, shock, dizziness and vertigo. Urine output and head to toe assessment are not warranted. The Glasgow comas scale is used to determine best neurological function and not migraine pain.

The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize? Blood pressure Oxygen saturation Assessment for bleeding Anaphylaxis

Blood pressure Explanation: Hypotension is a possible effect when barbiturates are given IV and is more common than hypoxia. Bleeding is not associated with intravenous barbiturate use. Anaphylaxis would be a serious but rare occurrence.

Which drug used to treat anxiety would be appropriate for a client who is a school teacher and is concerned about feeling sedated at work? Alprazolam Buspirone Diazepam Lorazepam

Buspirone Explanation: Buspirone does not cause as much sedation and functional impairment as lorazepam, alprazolam, and diazepam. However, it can cause dizziness, nausea, headache, nervousness, lightheadedness, or excitement.

Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety? Diphenhydramine Zaleplon Buspirone Meprobamate

Buspirone Explanation: Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Diphenhydramine is an antihistamine that can be sedating. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and CNS-relaxing effects.

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? Eletriptan Ergotamine Sumatriptan Celecoxib

Celecoxib Explanation: Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.

A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order? Chlorzoxazone Metaxalone Dantrolene Methocarbamol

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.

A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication? Tizanidine Dantrolene Diazepam Cyclobenzaprine

Dantrolene Explanation: Dantrolene is a peripherally acting spasmolytic, while tizanidine, diazepam, and cyclobenzaprine are all centrally acting.

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer? Botulinum toxin type B Dantrolene Baclofen Methocarbamol

Dantrolene Explanation: Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client? Increased diffusion and perfusion Decreased cardiac workload Increased level of consciousness Decreased blood pH

Decreased cardiac workload Explanation: Antianxiety and sedative-hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of consciousness.

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms? Carisoprodol (Soma) Diazepam (Valium) Chlorzoxazone (Paraflex) Tizanidine (Zanaflex)

Diazepam (Valium) Explanation: Diazepam (Valium), a drug widely used as an anxiety agent, also has been shown to be an effective centrally acting skeletal muscle relaxant. It may be advantageous in situations in which anxiety may be precipitating the muscle spasm.

The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client? Do not walk or drive after taking the drug. Discontinue the use of alcohol. Learn to self-administer the drug. Take a laxative when needed.

Discontinue the use of alcohol. Explanation: In a client experiencing spasticity, the nurse should advise the client to stop drinking alcohol. Alcohol consumption may increase the adverse effect of sedation, causing sleepiness, dizziness, and blurred vision. The client should not drive or walk after taking the drug; the client should learn to self-administer the drug; and constipation is a concern. However, the most important safety concern is to avoid alcohol.

Then nurse is caring for a client who has a diagnosis of schizophrenia. The nurse understands that the client's condition is thought to be most likely related to an increased level of activity of what neurotransmitter? Dopamine Norepinephrine Acetylcholine Adenosine

Dopamine Explanation: Scientists have attributed schizophrenia to increased dopamine activity in the brain. The serotonergic and glutamatergic systems are also thought to play a role. Norepinephrine, acetylcholine, and adenosine are not currently thought to have major involvement in the pathophysiology of schizophrenia.

An older adult client diagnosed with generalized anxiety disorder is prescribed a benzodiazepine. The nurse caring for the client knows to include what intervention in the client's care plan? Seizure precautions Falls risk assessment Frequent dysrhythmias monitoring Education regarding sexual dysfunction

Falls risk assessment Explanation: Adverse effects of benzodiazepines (e.g., drowsiness, dizziness) may contribute to falls and other injuries unless clients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Morphine Fentanyl Codeine Hydromorphone

Fentanyl Explanation: Fentanyl is available as a transdermal patch.

What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult? Give the medication as prescribed. Administer half the dose. Call the health care provider for a smaller dose. Give the dose by mouth.

Give the medication as prescribed. Explanation: The client should be administered the full dose of medication, which is within dosing recommendations. A client with adequate hepatic and renal function should not receive a lower dose of meperidine without specific instruction from the prescribing care provider. There is no apparent reason to change the route of administration, and such action cannot be implemented without the instruction of the prescribing care provider.

Monitoring of patients taking lithium includes periodically obtaining a serum lithium level; at what level may toxic reactions occur? Greater than 1.5 mEq/mL Greater than 0.5 mEq/mL Greater than 1 mEq/mL Greater than 1.25 mEq/mL

Greater than 1.5 mEq/mL Explanation: Toxic reaction may occur when serum lithium levels are greater than 1.5 mEq/mL

The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching? Metabolic acidosis Hypercarbia Renal calculi Hepatitis

Hepatitis Explanation: The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene.

A client is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is the most common in acute or chronic overdose of acetaminophen? Nephrotoxicity Hepatotoxicity Pulmonary insufficiency Pancreatitis

Hepatotoxicity Explanation: Acetaminophen is normally metabolized in the liver to metabolites that are excreted by the kidneys, and these metabolites may accumulate in clients especially those diagnosed with renal failure. In acute or chronic overdose of acetaminophen, the client can develop hepatotoxicity. None of the other options are associated with an adverse effect of an acetaminophen overdose since none are associated with the liver.

A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement? Take an over-the-counter (OTC) laxative daily. Increase fiber intake. Take diphenoxylate hydrochloride. Take metronidazole.

Increase fiber intake. Explanation: Constipation is a common adverse effect of dextroamphetamine. A client who is experiencing constipation should be instructed to increase fiber in the diet. The client should not take a laxative before attempting to manage the problem with dietary modifications. The client should not be instructed to take diphenoxylate hydrochloride because it is an antidiarrheal agent. The client should not be given metronidazole since it is an anti-infective agent.

A patient with muscle ache would like to use an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy? It causes increased metabolism of the antihypertensive drug. It causes increased absorption of the antihypertensive drug. It causes decreased effectiveness of the antihypertensive drug. It causes decreased metabolism of NSAIDs.

It causes decreased effectiveness of the antihypertensive drug. Explanation: The nurse should inform the patient that taking an NSAID while on antihypertensive drug therapy decreases the effectiveness of antihypertensive drugs. Interactions of NSAIDs and antihypertensive drugs do not include increased metabolism of antihypertensive drugs, increased absorption of antihypertensive drug, or decreased metabolism of NSAID.

The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means? It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. It is a drug that has a special caution because use of this drug is more likely to have adverse effects. It is a drug that no longer has a patent and can be sold by its generic name. It is a drug that reduces the likelihood of drug abuse and dependence.

It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. Explanation: A drug with no ceiling effect is one in which there is no upper limit to the dosage that can be given to clients who have developed tolerance to previous dosages. This characteristic is especially valuable in clients with severe cancer-related pain because drug dosage can be increased and titrated to relieve pain when pain increases or tolerance develops. None of the other statements explain the terminology.

An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene? Cerebrovascular accident Malignant hyperthermia Myocardial ischemia Uncontrolled hypertension

Malignant hyperthermia Explanation: IV dantrolene is the drug of choice, when accompanied by supportive measures, for acute treatment of malignant hyperthermia. The drug is not used in the treatment of emergent CVA, myocardial ischemia, or hypertension.

Serotonin abnormalities are thought to be involved in the following disorders: Epilepsy and strokes. Attention deficit disorder. Mental depression and sleep disorders. Severe anxiety and hyperactivity.

Mental depression and sleep disorders. Explanation: Normal levels of serotonin in the brain produce mood elevation or euphoria, increasing mental alertness and capacity for work, decrease fatigue and drowsiness, and prolong wakefulness. Abnormalities alter these functions.

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? Aspirin Ibuprofen Celecoxib Morphine

Morphine Explanation: Morphine is a narcotic analgesic. Aspirin, ibuprofen, and celecoxib are nonnarcotic analgesics. Aspirin is classified as a salicylate and ibuprofen as a nonsteroidal anti-inflammatory drug (NSAID). Celecoxib is a newer NSAID that acts by inhibiting the cyclo-oxygenase-2 (COX-2) enzyme.

The nurse is monitoring for adverse effects in a client who has been prescribed chlorpromazine. What interventions should the nurse incorporate into the plan of care? Select all that apply. -Monitor white blood cell (WBC) count. -Take and record daily weight. -Monitor urinary output. -Assess for hallucinations. -Monitor for facial edema.

Monitor white blood cell (WBC) count. Take and record daily weight. Monitor urinary output. Explanation: The nurse assesses the fluid and electrolyte status for a possible fluid volume deficit, making it necessary to measure the client's weight daily and assess for signs of dehydration. In addition, the nurse assesses for increased anticholinergic effects, such as diminished fluid status and urinary retention. The nurse assesses for aspiration related to depressed cough reflex. It is important to monitor renal and hepatic function along with the complete blood count. A depression in white blood cell count requires discontinuation of the medication. Excessive fluid volume is not associated with this medication. The medication is prescribed to eliminate hallucinations.

The nurse is providing education to a client who has been prescribed clozapine. The nurse should emphasize the importance of what monitoring routine during teaching? Weekly liver enzymes Daily international normalized ratio (INR) Monthly creatinine levels Regular complete blood counts

Regular complete blood counts Explanation: Clozapine is associated with life-threatening decrease in white blood cells (agranulocytosis). It is essential to monitor the complete blood count due to this risk. Weekly liver enzymes, monthly creatinine levels (kidney function), and INR monitoring (blood clotting function) are not recommended with clozapine therapy.

A nurse is caring for a patient with chronic pain who has been prescribed epidural analgesia. The nurse should monitor the patient for which condition after insertion of the epidural catheter and throughout the therapy? Abdominal pain Respiratory depression Fever Nervousness

Respiratory depression Explanation: The nurse should closely monitor the patient for respiratory depression after insertion of the epidural catheter and throughout the therapy. Patients using epidural analgesics for chronic pain are monitored for respiratory problems with an apnea monitor. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. The nurse need not monitor the patient for abdominal pain, fever, and nervousness because they do not occur as a result of the administration of epidural analgesia.

A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition? Acute acetaminophen poisoning Salicylate intoxication Ibuprofen overdose Caffeine abuse

Salicylate intoxication Explanation: Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.

When a client is prescribed ergotamine tartrate, what information should be included in the teaching plan regarding the administration of the medication? Tablet is placed under the tongue to dissolve. Ingest 8 ounces of water with the medication. Chewing the tablet can aid in the medication working faster. Take this medication with meals.

Tablet is placed under the tongue to dissolve. Explanation: Administration of ergotamine is sublingual, and the tablets should be dissolved under the tongue. It is important that tablets not be crushed, chewed or swallowed whole. The client should not drink, eat, or smoke while the medication is being dissolved.

A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority? The client will demonstrate independent health maintenance. The client will interact therapeutically with peers. The client will participate in activities of daily living (ADL). The client will remain safe.

The client will remain safe. Explanation: Safety is a priority over other goals. Goals such as participation in ADLs, health maintenance, and participation in relationships are valid, but safety is a priority.

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? The client's spasticity is due to rheumatoid arthritis The client takes opioid analgesics on a regular basis The client's adherence to drug therapy has been irregular The client has type 1 diabetes and takes insulin regularly

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's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication? The importance of regularly scheduled liver function testing The need to maintain a diet that is high in iron and folic acid The importance of ensuring safety related to possible sedation The importance of maintaining a sterile central venous catheter

The importance of ensuring safety related to possible sedation Explanation: Baclofen carries a risk of CNS depression and a consequent threat to safety. The use of baclofen does not necessitate regular liver function testing or dietary changes. Baclofen is administered orally or intrathecally, not intravenously.

A male patient is being discharged home from the hospital after having pneumonia. At home, the patient will be taking the same drugs he was taking before he was hospitalized. These drugs include an anti-anxiety medication and a medication for insomnia. During the home care nurse's initial visit, what should the nurse review with the patient? The risk of injuries if reaction times are slowed by drugs The risk of injuries if the mental processes are slowed by drugs The risk of injuries if let insomnia go untreated by drugs The risks of injuries if mental and physical responses are slowed by drugs

The risks of injuries if mental and physical responses are slowed by drugs Explanation: The home care nurse should provide thorough patient teaching, including drug name, prescribed dosage, measures for avoidance of adverse effects, and warning signs that may indicate possible problems. Instruct patients about the need for periodic monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance. Offer support and encouragement to help the patient cope with the diagnosis and the drug regimen.

Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine? The patient's insistence on receiving the drug The patient's gender The route of administration The patient's disease process

The route of administration Explanation: Patient response to morphine depends on the route of administration and the dosage.

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following? To treat osteoarthritis To inhibit platelet aggregation To decrease pain To decrease temperature

To inhibit platelet aggregation Explanation: Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage. If the client is having elevated temperatures daily, the cause would need to be investigated.

Respiratory distress is a contraindication for the use of barbiturates. True False

True Explanation: Other contraindications to barbiturates are latent or manifest porphyria, which may be exacerbated; marked hepatic impairment or nephritis, which may alter the metabolism and excretion of these drugs; and respiratory distress or severe respiratory dysfunction, which could be exacerbated by the CNS depression caused by these drugs.

Centrally acting skeletal muscle relaxants lyse or destroy the spasm. True False

True Explanation: The centrally acting skeletal muscle relaxants work in the CNS to interfere with the reflexes that are causing the muscle spasm. Because these drugs lyse or destroy spasm, they are often referred to as spasmolytics.

A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with: allergy to sulfonamides. diabetic retinopathy. cataract. acute gout.

allergy to sulfonamides. Explanation: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.

When describing the actions of various drugs, a nursing instructor defines the drug as a substance that counteracts the action of something else. The instructor is describing which action? antagonist agonist analgesic anti-inflammatory

antagonist Explanation: An antagonist is defined as a substance that counteracts the action of something else. An agonist is a chemical that binds to a receptor and activates the receptor to produce a biologic response. An analgesic is given to relieve or reduce pain, and an anti-inflammatory is given to reduce the inflammation that can cause pain.

While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is: codeine. aspirin. ibuprofen. acetaminophen.

codeine. Explanation: Codeine is a narcotic drug used for its analgesic and antitussive effects. Aspirin, ibuprofen, and acetaminophen do not have antitussive effects.

The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching? dependence suicide personality changes persistent insomnia

dependence Explanation: Benzodiazepines carry a significant risk for dependence. They do not cause suicidality, personality changes, or insomnia.

What is the prototype for the classification of drugs referred to as benzodiazepines? alprazolam lorazepam diazepam clonazepam

diazepam Explanation: Diazepam is the prototype benzodiazepine. High-potency benzodiazepines such as alprazolam, lorazepam, and clonazepam may be more commonly prescribed due to their greater therapeutic effects and rapid onset of action.

A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling? dopamine serotonin epinephrine norepinephrine

dopamine Explanation: Stimulants enhance dopamine transmission to areas of the brain that interpret well-being. To maintain pleasurable feelings, people continue the use of stimulants, which leads to their abuse and the potential for addiction. Low serotonin levels are believed to cause depression and anxiety. Epinephrine is a hormone that increases cardiac output. Low levels of norepinephrine are believed to lead to ADHD and depression.

A client is receiving botulinum toxin type A as treatment for frown lines. The nurse would instruct the client about: abnormal hair growth. acne. photosensitivity. drooping eyelids.

drooping eyelids. Explanation: The use of botulinum toxin type A is associated with droopy eyelids (in severe cases), headache, respiratory infections, flulike syndrome, pain, redness, and muscle weakness, which are usually temporary. Abnormal hair growth, acne, and photosensitivity may be associated with dantrolene.

A client has been prescribed naproxen for the treatment of migraines. The nurse who will administer the medication is aware that the black box warning that accompanies this drug will consequently prioritize what assessment? heart rate and rhythm signs and symptoms of liver failure character and quantity of urine output characteristics of deep tendon reflexes

heart rate and rhythm Explanation: The FDA has issued a black box warning stating that naproxen sodium may put clients at increased risk for cardiovascular events and GI bleeding. Renal failure, liver failure, and reduced deep tendon reflexes are not the focus of this black box warning.

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which? height and weight. Vision. body temperature. blood pressure.

height and weight. Explanation: The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric client. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.

A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is: constipation. dry mouth. fatigue. hypotension.

hypotension. Explanation: Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate? balsalazide ibuprofen ketorolac auranofin

ibuprofen Explanation: NSAIDs such as ibuprofen are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Balsalazide is used to treat ulcerative colitis. Ketorolac is used to treat acute pain in the short term. Auranofin is a gold salt that is not a first-line treatment.

The nurse suspects that a client receiving olanzapine is developing type 2 diabetes. Which finding would help support the nurse's suspicion? Select all that apply. -increased thirst -weight gain -increased urination -fever -sore throat

increased urination increased thirst weight gain Explanation: The nurse would suspect development of type 2 diabetes based on assessment of increased thirst and urination and weight gain. Fever and sore throat would suggest an infection, possibly due to agranulocytosis from clozapine therapy.

A client has been diagnosed with severe rheumatoid arthritis, and hylan G-F 20 has been ordered. How is this drug given? injected into joint orally IM sub Q

injected into joint Explanation: Hyaluronidase derivatives, such as hylan G-F 20 and sodium hyaluronate, have elastic and viscous properties. These drugs are injected directly into the joints of clients with severe rheumatoid arthritis of the knee. They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis. They are given weekly for 3 to 5 weeks.

A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which? gastrointestinal distress. acute renal failure. cognitive deficits. liver damage.

liver damage. Explanation: A client taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.

Acetaminophen overdose has the potential to cause fatal: kidney damage. pancreas damage. lung damage. liver damage.

liver damage. Explanation: Potentially fatal hepatotoxicity is the main concern with acetaminophen overdose. It is most likely to occur with doses or 20 g or more.

A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is: dizziness. drowsiness. nausea. headache.

nausea. Explanation: Adverse nervous system reactions associated with sedatives and hypnotics are dizziness, drowsiness, and headache. A common GI reaction is nausea.

The nurse is providing education to a client who has been prescribed eszopiclone. What information should the nurse include? the importance of taking the drug with food the importance of taking the drug immediately before going to bed the need to supplement the medication with a benzodiazepine the need to have monthly blood work drawn during treatment

the importance of taking the drug immediately before going to bed Explanation: People should take eszopiclone immediately prior to going to bed because of its rapid onset of action. It does not need to be taken with food and should not be combined with benzodiazepines. Regular blood work is not indicated.

A client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify? willow bark kava kava feverfew black cohosh

willow bark Explanation: Willow bark has analgesic, antipyretic, and anti-inflammatory properties and was the plant from which the chemical structure of aspirin (salicylic acid) was derived. Kava kava is used for anxiety and stress. Feverfew is used for the treatment of migraines and headache. Black cohosh is used for menopausal symptoms and hot flashes.

The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate? "Adverse effects include hypertension and nervousness." "The medication is usually taken just before bedtime." "The drug may cause weight gain." "There is no risk of dependence."

"Adverse effects include hypertension and nervousness." Explanation: Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.

A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed? "Allopurinol promotes formation of uric acid. It is used in combination with another drug to prevent reoccurrences of the symptoms of gout." "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." "Allopurinol is used to cure hyperuricemia, which commonly occurs with gout." "Allopurinol is not a first-line drug but can be used to cure gout."

"Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." Explanation: Allopurinol is used to prevent or treat (but not cure) hyperuricemia, which occurs with gout and with antineoplastic drug therapy. Allopurinol prevents formation of uric acid. The drug promotes resorption of urate deposits and prevents their further development. Allopurinol is among the first-line drugs used in the treatment of gout but does not cure the condition.

A client is being discharged following an allergic reaction after ingesting aspirin. When providing client education about the allergy, the nurse would provide the client with what information? "Always take NSAIDs with food." "Do not take any NSAIDs." "Take only the buffered form of aspirin." "Take only nonaspirin NSAIDs."

"Do not take any NSAIDs." Explanation: In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.

The nurse is caring for a client who has been prescribed oxazepam. What statement by the client would suggest an increased risk of CNS depression to the nurse? "I take an over-the-counter antihistamine each day for my allergies." "If I get constipated, I sometimes take a stool softener for a couple of days." "I'm also taking baby Aspirin each day for my heart." "I'm almost finished my course of antibiotics for this sinus infection."

"I take an over-the-counter antihistamine each day for my allergies." Explanation: Antihistamines, combined with benzodiazepines, create a heightened risk for CNS depression. Aspirin, antibiotics and stool softeners would be unlikely to have this effect.

A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond? "This drug hasn't been definitively proven to be unsafe, so it's still available." "A final decision from the FDA on whether Celebrex is safe will be released in 2018." "As long as you take your heart medications, you'll be fine." "That was a scare that was entirely created by the media."

"This drug hasn't been definitively proven to be unsafe, so it's still available." Explanation: Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?

5 Explanation: The client's weight must be converted to kilograms: 88 lbs ÷ 2.2 = 40 kg. To calculate the daily dose, multiply the child's weight by the prescribed dose: 0.125 mg X 40 kg = 5 mg

A client with muscle spasticity following a back injury has been prescribed tizanidine (Zanaflex) 8 mg t.i.d. for use on an outpatient basis. When filling this prescription for a two-week supply, how many 4-mg tablets will the pharmacy provide the client with?

84 Explanation: The client's doses each consist of 2 tablets (8 mg ÷ 4 mg) and the client takes these three times daily, for a total of 6 tablets per day. Over 14 days, the client will need 84 tablets (6 X 14).

Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen? A male 30 years of age who drinks four beers per day A male 40 years of age with arthritis A female 50 years of age with hypoprothrombinemia A female 62 years of age with a vitamin K deficiency

A male 30 years of age who drinks four beers per day Explanation: Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl? A woman 85 years of age A man 25 years of age A man 50 years of age A woman 35 years of age

A woman 85 years of age Explanation: The transdermal route of medication administration is dependent upon the amount of subcutaneous tissue present for medication distribution. Subcutaneous tissue is reduced as a result of the aging process. Therefore, the client 85 years of age would be least likely to be prescribed a transdermal medication. The clients 25, 35 and 50 years of age would have adequate subcutaneous tissue for medication distribution.

A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? Aspirin Diflunisal (Dolobid) Acetaminophen Ibuprofen

Acetaminophen Explanation: Acetaminophen is the analgesic of choice during pregnancy.

The nurse knows, that as a COX-1 inhibitor, indomethacin inhibits prostaglandins associated with which tissues? Kidneys and female reproductive system All tissues and cell types Heart, brain, and kidneys Liver, kidneys, and GI tract

All tissues and cell types Explanation: COX-1 is present in all tissues and cell types, especially platelets, endothelial cells, the GI tract, and the kidneys. Prostaglandins produced by COX-1 are important in numerous homeostatic functions and are associated with protective effects on the stomach and kidneys.

What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.) -Anti-inflammatory -Analgesic -Antipruritic -Antipyretic -Antibacterial

Anti-inflammatory Analgesic Antipyretic Explanation: Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects.

What might occur if a client inadvertently receives a benzodiazepine intra-arterially? CNS depression Blurred vision Urinary retention Arteriospasm

Arteriospasm Explanation: Intra-arterial administration of benzodiazepines would result in arteriospasm and gangrene. CNS depression, blurred vision, and urinary retention are adverse effects associated with benzodiazepines in general.

A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug? Somnambulism Difficulty falling asleep at night Early morning waking Frequent nighttime awakenings

Difficulty falling asleep at night Explanation: Ramelteon is use for the long-term treatment of insomnia characterized by difficulty with sleep onset. Ramelteon is not effective in managing any of the other suggested sleep-related issues.

A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action? Ensure all members of the care team are aware of the risk for hepatotoxicity Review the client's most recent blood urea nitrogen and creatinine levels, if available Educate the client about the risks of taking dantrolene during pregnancy Review each of the other components of the client's current drug regimen

Ensure all members of the care team are aware of the risk for hepatotoxicity Explanation: In women, a combination of dantrolene and estrogen seems to affect the liver, thus posing a greater risk of hepatotoxicity. Renal function is a not a priority, nor are the other client's other medications at this time. Education about the risks of pregnancy is relevant, but more so if the client were trying to become pregnant rather than prevent pregnancy.

A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects? Neuroleptic malignant syndrome Agranulocytosis Extrapyramidal symptoms Gastrointestinal problems

Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug.

A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate? Renal function Hepatic function Respiratory function Cardiac function

Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about? Decreased sedative effect Increased sedative effect If the client's insurance will cover the two drugs Cost of the drugs

Increased sedative effect Explanation: An increased sedative effect may occur when a sedative is given with cimetidine for gastric upset. The other options do not play a role in providing the best care for the client.

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? Decreases stress Eases pain Induces sleep Improves circulation

Induces sleep Explanation: Flurazepam induces sleep. Adrenergic drugs help to relieve stress. Analgesics are used to ease pain. Circulation can be improved by exercising.

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? Recent gastrointestinal upset Infection at the intended site of administration Reports of urinary frequency Difficulty swallowing

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.

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? Decreased risk of hepatic injury Less central nervous system depression Rapid onset and short duration Sublingual administration

Less central nervous system depression Explanation: Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the client needs to be alert such as when driving or working. Buspirone does not have a reduced risk of hepatic injury relative to other anxiolytics, nor does it have a faster onset and shorter duration. It is administered orally, not sublingually.

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse? Pain intensity and blood glucose level Level of consciousness and respiratory rate Respiratory rate and electrolytes Urine output and pain intensity

Level of consciousness and respiratory rate Explanation: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

The nurse is developing a care plan for a child diagnosed with night terrors who is prescribed diazepam. The nurse should include monitoring for development of what disorder in the plan? Insomnia Dependence Mood disorders Hepatotoxicity

Mood disorders Explanation: Children may be more sensitive to its effects of this drug, namely mood and/or mental changes. Hepatotoxicity, insomnia, and dependence are not among the most common adverse effects.

An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client? Salicylates Nonsalicylates Morphine Barbiturates

Nonsalicylates Explanation: Nonsalicylate analgesics, such as acetaminophen (Tylenol, Atasol), have the same analgesic and antipyretic properties as aspirin, but fewer side effects and are a good choice for mild to moderate pain in children. Salicylates or aspirin is not recommended for children because it is believed to contribute to the development of Reye syndrome in children. Morphine and barbiturates are used for severe pain and would not be appropriate in this situation.

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? Oral Subcutaneous Intramuscular Intravenous

Oral Explanation: Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is not given via the subcutaneous, intramuscular, or intravenous routes.

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route? Oral Subcutaneous Transdermal patch Sublingual

Oral Explanation: Zolmitriptan is administered by either the oral route or intranasally. It is not currently available by either a transdermal patch or subcutaneous injection.

After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype? Amobarbital Secobarbital Pentobarbital Phenobarbital

Phenobarbital Explanation: Phenobarbital is considered the prototype barbiturate.

A client with dysmenorrhea has been prescribed naproxen 1250 mg PO b.i.d. What is the nurse's best action? Question the prescriber about the dose Question the prescriber about the route Question the prescriber about the frequency Assess the client's baseline renal and hepatic status

Question the prescriber about the dose Explanation: For adults, naproxen is given 250-500 mg PO b.i.d. As a result, the nurse should question the prescriber about the dose before proceeding.

A client has developed a fever. What aspect of the client's health history would contraindicate the safe and effective use of acetaminophen? The client has hepatitis C and abuses alcohol The client had an allergic reaction to penicillin during a previous admission The client's most recent hospital admission was because seizures which were treated with benzodiazepines The client was prescribed diclofenac for back pain and did not experience pain relief

The client has hepatitis C and abuses alcohol Explanation: Liver disease and alcoholism contraindicate the use of acetaminophen. An allergy to penicillin would not pose a problem. Similarly, a history of seizures, benzodiazepine use and diclofenac would not rule out the use of acetaminophen.

A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider? The client's most recent laboratory results show an upward trend in AST and ALT levels The client is reluctant to participate in physical therapy this morning, when she is normally highly motivated The client tells the nurse, "I'm struggling to come to grips with the fact that I'm never going to recover." The client has gained 1.5 lbs. over the past 48 hours

The client's most recent laboratory results show an upward trend in AST and ALT levels Explanation: An increase in liver enzyme levels could indicate the onset of hepatocellular damage, which is a high risk in female clients of this age. The provider must be made aware of this immediately. The client's lack of motivation and apparent despair should be addressed by the nurse, but may be able to be addressed independently by the nurse. As well, these issues are less time-dependent than a decrease in liver function. A weight gain of 1.5 lbs. over 48 hours is not outside the range of usual fluctuations in fluid balance.

Which test should be scheduled every week for a patient taking clozapine? Serum lithium WBC count Blood glucose pH level

WBC count Explanation: Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months? Liver enzymes Hemoglobin White blood cells PT/PTT

White blood cells Explanation: Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs or who exhibit recurrent suicidal behavior. The reason for the second-line status of clozapine is its association with agranulocytosis, a life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of therapy. A BLACK BOX WARNING alerts health practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained, then WBC counts can be monitored every 2 weeks.

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function? Improvement will occur within 30 minutes from the time of administration. Slow improvement can be noted throughout the shift. Within one to five minutes, an effect may be seen. Response is highly individualized based upon client weight.

Within one to five minutes, an effect may be seen. Explanation: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

The nurse knows the medication methylphenidate is used to treat attention deficit hyperactivity disorder(ADHD). What type of medication is methylphenidate? a selective serotonin reuptake inhibitor (SSRI) a central CNS stimulant a respiratory stimulant an anorectic agent

a central CNS stimulant Explanation: Methylphenidate, a drug used in the treatment of ADHD, is a central CNS stimulant. It is not as SSRI, respiratory stimulant or anorectic agent.

A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that: a dose adjustment should be made if these symptoms persist. the drug should be stopped immediately if these effects persist. the drug should be administered intravenously if these effects persist. no changes should be made at this time; the adverse effects will resolve with continued use.

a dose adjustment should be made if these symptoms persist. Explanation: If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: a return to normal respiratory rate, rhythm, and depth. management of alcohol withdrawal symptoms. a reduction in the client's rating of their pain. alertness and improve memory function.

a return to normal respiratory rate, rhythm, and depth. Explanation: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

A group of nursing students are reviewing information about nonopioid analgesics. The students demonstrate understanding of the information when they identify which drug as a nonsalicylate analgesic? acetaminophen aspirin diflunisal magnesium salicylate

acetaminophen Explanation: Acetaminophen is classified as a nonsalicylate analgesic. Aspirin, diflunisal, and magnesium salicylate are salicylates.

How should a nurse best explain the presence of the inflammation process? as an attempt by the body to remove the damaging agent and repair the damaged tissue as a normal response to infection or trauma, which results in necrotic tissue formation as the initial stage of infection, requiring antibiotic medication for resolution as a typical response to bacterial infection

as an attempt by the body to remove the damaging agent and repair the damaged tissue Explanation: Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. The remaining options are either incorrect or incomplete descriptions of the inflammation process.

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what? urine specific gravity. skin integrity. bowel patterns. core body temperature.

bowel patterns. Explanation: Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

A client is receiving a barbiturate intravenously. The nurse would monitor the client for: hypertension. bradycardia. tachypnea. bleeding.

bradycardia. Explanation: When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm. Bleeding is not associated with barbiturate therapy.

The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment? ACE inhibitors selective serotonin reuptake inhibitors (SSRIs) central nervous system (CNS) stimulants monoamine oxidase inhibitors (MAOIs)

central nervous system (CNS) stimulants Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent hyperactivity, short attention span, and difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used; they do not affect CNS stimulation.

A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an electrocardiogram (ECG). electromyelogram (EMG). electroencephalogram (EEG). electrophysiologic study (EPS).

electrocardiogram (ECG). Explanation: In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.

A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may: have undiagnosed diabetes. have the flu. have a urinary tract infection. be making up the symptoms simply to get attention.

have undiagnosed diabetes. Explanation: Schizophrenic clients have a higher than normal incidence of diabetes. The flu usually has a fever along with respiratory symptoms. A urinary tract infection may cause burning and frequent urination, but thirst is not normally a symptom. Also, UTIs are not more common in schizophrenics. A client could be making up symptoms, but the nurse should first consider other options that could be causing the symptoms.

The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal? uncharacteristic memory lapses unstable blood sugars in recent days current mood is described as "depressed" severe insomnia for the past several nights

severe insomnia for the past several nights Explanation: Common signs and symptoms of benzodiazepine, like lorazepam, withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Memory lapses, unstable blood sugars, and depression are not typical.

The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? maintenance of adequate nutrition potential therapeutic effects of medication the need for weekly blood coagulation testing the importance of adherence to prescribed treatment

the importance of adherence to prescribed treatment Explanation: The success or failure of treatment is largely dependent on the client's adherence to treatment. For most clients, this supersedes the immediate significance of nutrition or teaching about therapeutic effects. There is no need for weekly coagulation tests.

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide? "You'll find that your muscles will get progressively stronger over the next several weeks." "Make sure to see your health care provider promptly if you develop yellowish skin or eyes." "Take an over-the-counter laxative so that you don't get constipated." "You'll have to come to the hospital daily to be administered this drug."

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes." Explanation: Dantrolene carries a significant risk of hepatitis; signs and symptoms must be reported promptly. It typically causes diarrhea, not constipation, and muscle weakness, not increases in strength. Dantrolene may be administered on an outpatient basis.

The client is to take almotriptan 6.25 mg orally for a migraine. Almotriptan is sent to the unit from the pharmacy in 12.5-mg tablets. The nurse will administer how many tablet(s)?

0.5 Explanation: 6.25/12.5 = 0.5 or 1/2 tablet

A client has been prescribed morphine 4 - 6 mg IV q4h PRN. The client reports pain rated at 8/10 and the nurse verifies on the MAR that the client has most often required 6-mg doses. The nurse chooses to administer 6 mg. The drug is available in ampules containing 10mg/mL. How many mL should the nurse withdraw and administer?

0.6 Explanation: 6 mg ÷ 10 mg/mL = 0.6 mL

Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery? 3 to 4 weeks 1 to 2 weeks 6 to 8 weeks 2 to 3 weeks

1 to 2 weeks Explanation: Aspirin should generally be avoided for 1 to 2 weeks before and after surgery, because it increases the risk of bleeding. Most other NSAIDs should be discontinued approximately 3 days before surgery; nabumetone and piroxicam have long half-lives and must be discontinued approximately 1 week before surgery. NSAIDs, administered intraoperatively, have been shown to reduce postoperative pain and use of opioids after abdominal surgery.

The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? Cyclobenzaprine produces an anticholinergic response Cyclobenzaprine acts in the peripheral nervous system Cyclobenzaprine has an effect at the neuromuscular junction Cyclobenzaprine is structurally similar to amitriptyline

Cyclobenzaprine produces an anticholinergic response Explanation: Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

The client is taking NSAIDs for pain. The nurse explains to the client that NSAIDs act by which actions? Inhibiting impulses to the brain Inhibiting the synthesis of prostaglandins Blocking the neuronal terminal Decreasing nerve stimulation

Inhibiting the synthesis of prostaglandins Explanation: NSAIDs inhibit prostaglandin synthesis by blocking the action of cyclooxygenase. This helps to block pain and inflammation.

A client has been administered an opioid. For what effect should the nurse regularly assess? Oliguria Level of consciousness (LOC) Edema Tachycardia

Level of consciousness (LOC) Explanation: Opioids will produce decreased LOC. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.

Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication? Antibiotic Antihypertensive Monoamine oxidase (MAO) inhibitor NSAID

Monoamine oxidase (MAO) inhibitor Explanation: The client should not receive morphine within 14 days of receiving an MOA inhibitor.

A client is receiving acetaminophen for fever. The client also has inflammation in the knees and elbows with pain. Why will acetaminophen assist in reducing fever but not in decreasing the inflammatory process? Prostaglandin inhibition is limited to the central nervous system. Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only. Acetaminophen has an antiplatelet effect to decrease edema. Prostaglandins decrease the gastric acid secretion.

Prostaglandin inhibition is limited to the central nervous system. Explanation: The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform? Provide assistance with movement Provide supportive care Provide respiratory assistance Provide a safe environment

Provide respiratory assistance Explanation: The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment are suggested for patients at risk for injury due to drowsiness or impaired memory.

The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client? The client diagnosed with peptic ulcers The client diagnosed with diabetes The client diagnosed with psoriasis The postpartum woman who had a vaginal birth

The client diagnosed with peptic ulcers Explanation: The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely and the nurse would not question the order. NSAIDs are often ordered for pain control for clients following vaginal birth and this order need not to be questioned.

What are adverse effects a nurse should assess for when administering ergotamine to a client? Select all that apply. -Decreased pulse and blood pressure -Increased pain and headache -Urinary output -Increased muscle strength -Diarrhea and GI upset

Urinary output Decreased pulse and blood pressure Explanation: Following administration of ergotamine, the nurse assesses for cardiovascular adverse effects. Measurement of pulse and blood pressure is essential. The nurse also assesses for vertigo, muscle pain, numbness, paresthesia, and weakness, as well as for signs and symptoms of a hypersensitivity reaction to ergotamine. The nurse also assesses the patient's urinary elimination due to the adverse effect of retroperitoneal fibrosis. Pain, headache, diarrhea, GI upset and increased muscle strength are not associated with ergotamine.

A client is prescribed midazolam in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing? oral secretions anxiety hypotension muscle tone

anxiety Explanation: Midazolam provides preoperative sedation, which assists in minimizing anxiety. It does not reduce secretions, increase blood pressure, or reduce muscle tone.

A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client? phenytoin loratadine eszopiclone norepinephrine

eszopiclone Explanation: Eszopiclone (Lunesta) is a newer medication commonly prescribed to treat insomnia. Phenytoin (Dilantin) is an anticonvulsive that depresses the brain's sensory areas located in the motor cortex. Loratadine (Claritin) is an antihistamine that causes the least amount of drowsiness in this class of drugs. Norepinephrine (levarterenol, Levophed) is a potent sympathetic neurotransmitter. Its primary action is to increase blood pressure as a result of vasoconstriction of peripheral blood vessels.

The nurse administers ibuprofen to adult clients experiencing a variety of health disorders. Following administration, the nurse should assess for therapeutic effects related to what symptoms? Select all that apply. fever pruritus inflammation moderate pain hyperuricemia

inflammation moderate pain fever Explanation: Ibuprofen is used to relieve mild to moderate pain or inflammation related to rheumatoid arthritis or osteoarthritis. In addition, it is effective in reducing fever. During initial attacks of acute gout, ibuprofen may be administered, but it does not directly reduce uric acid levels. Pruritus (itching) management is not a primary indication for ibuprofen use.

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of: congestive heart failure. cerebral hemorrhage. hepatocellular disease. diabetic ketoacidosis.

hepatocellular disease. Explanation: Caution should be used with dantrolene in all patients older than 35 years because of increased risk of potentially fatal hepatocellular disease.

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? "Are you on hormone replacement therapy?" "Have you had a hysterectomy?" "Have you ever been treated for fibromyalgia?" "At what age did you begin menopause?"

"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 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.

A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching? "Be sure not to stop the drug abruptly." "Take the drug with meals if necessary." "Increase the amount of fiber in your diet." "Try other measures to help you relax, too."

"Be sure not to stop the drug abruptly." Explanation: Although taking the drug with meals, increasing fiber intake (to prevent constipation), and using additional measures to promote relaxation would be helpful instructions, it would be most important for the nurse to warn the client not to stop the drug abruptly. There is a risk for withdrawal if anxiolytics, both benzodiazepines and barbiturates, are stopped abruptly.

A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response? "Benzodiazepines do not cause physiologic dependence, and withdrawal symptoms will not occur if the drug is stopped abruptly." "Benzodiazepines may cause physiologic dependence, but withdrawal symptoms will not occur if the drug is stopped abruptly." "Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug's dosages are tapered." "Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."

"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." Explanation: Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the Controlled Substances Act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.

A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response? "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." "You're not permitted to drink alcohol while you're taking baclofen."

"The combination of baclofen and alcohol could depress your nervous system to a dangerous level." Explanation: The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.

A client is prescribed amitriptyline for migraine prophylaxis. What statement should be included in the care plan regarding the medication administration? "The medication should be taken at bedtime." "Take the medication with a full glass of water." "Food is helpful to decrease gastrointestinal irritation." "It should be taken when a migraine aura is felt."

"The medication should be taken at bedtime." Explanation: Amitriptyline is a tricyclic antidepressant, and the client should be instructed to take the medication at bedtime. Tricyclic antidepressants have a sedative effect. The medication can be taken with or without food. Amitriptyline is used for prevention of migraines regardless of the presence of an aura.

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response? "An anxiolytic, such as alprazolam, is usually prescribed for long-term anxiety disorders." "This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." "Anxiolytics are prescribed to treat anxiety and can be purchased without a prescription after discharge." "Anxiolytic drugs are different from antianxiety drugs, because they work without a tranquilizing effect."

"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." Explanation: Drugs used to treat anxiety are called antianxiety, or anxiolytic, drugs. Long-term use of benzodiazepines, such as Xanax, can result in physical or psychological dependence. Due to the risk of dependence, benzodiazepines are used for short-term anxiety relief. Due to the risk of dependence, anxiolytics are classified as schedule IV controlled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.

The nurse is teaching the client, who has been newly prescribed etanercept, how to administer the medication. What statement is accurate? "Be sure to drink a whole glass of water when swallowing the pill." "Do not take this medication for at least 1 hour after taking an antacid." "You can rotate subcutaneous injection sites to avoid tissue damage." "Inject this medication deeply into the muscle to promote absorption."

"You can rotate subcutaneous injection sites to avoid tissue damage." Explanation: Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.

A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome? Acetaminophen Acetylsalicylic acid Ibuprofen Ascorbic acid

Acetylsalicylic acid Explanation: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye's syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.

A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache? Administer subcutaneous sumatriptan succinate (Imitrex). Administer naproxen. Administer ergotamine subcutaneously. Administer diclofenac.

Administer subcutaneous sumatriptan succinate (Imitrex). Explanation: Sumatriptan succinate (Imitrex) should be administered. Ergotamine is administered sublingually. Diclofenac and naproxen are NSAIDs.

The nurse is preparing to administer oral chlorpromazine to a client. What action should the nurse include in administration? Have the client hold the drug under the tongue for at least 30 seconds. Administer the day's last dose 1 to 2 hours before bedtime. Administer the drug on alternating days. Instruct the client to avoid dairy products for 1 hour before and 2 hours after administration.

Administer the day's last dose 1 to 2 hours before bedtime. Explanation: For oral administration of chlorpromazine, the nurse should give the last dose of the day 1 to 2 hours before bedtime, as peak sedation occurs in about 2 hours. The drug is not given on alternating days, and there is no need to avoid dairy products. It is unnecessary for the client to hold the drug under the tongue.

A client is experiencing acute anxiety and the nurse has received an order for diazepam 4 mg PO STAT. What is the nurse's best action? Administer the medication as prescribed Contact the prescriber to confirm the dose Contact the prescriber to confirm the route Ensure flurazepam is available

Administer the medication as prescribed Explanation: This order is within expected parameters for dose and route, so there is no obvious need to contact the prescriber. Flumazenil, not flurazepam, is the antidote for benzodiazepine overdose.

A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate? Assess the client's allergy status. Assess the client for recent exacerbations of rheumatoid arthritis. Assess the client's use of salicylates. Assess the client's use of acetaminophen.

Assess the client's use of salicylates. Explanation: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with acetaminophen toxicity or an exacerbation of rheumatoid arthritis itself. This constellation of symptoms is not suggestive of an allergic reaction.

Which are examples of benzodiazepine antianxiety drugs? (Select all that apply.) -Alprazolam (Xanax) -Buspirone (BuSpar) -Hydroxyzine (Atarax) -Chlordiazepoxide (Librium) -Lorazepam (Ativan)

Chlordiazepoxide (Librium) Lorazepam (Ativan) Alprazolam (Xanax) Explanation: Alprazolam, chlordiazepoxide, and lorazepam are examples of benzodiazepine antianxiety drugs.

Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication? Dexmethylphenidate will increase Scott's ability to understand information better. Dexmethylphenidate will stabilize Scott's mood so that he can concentrate. Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Dexmethylphenidate will improve Scott's memory.

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Explanation: Dexmethylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. This activity results in improved attention spans, decreased distractibility, and increased ability to follow directions or complete tasks, and decreased impulsivity and aggression in patients with ADHD. Although dexmethylphenidate does not produce a physical dependence, it may induce tolerance or psychic dependence.

The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis? Disorganized and often bizarre thinking Slowed reaction time and poor coordination Short manic episodes followed by long depressive episodes Short- and long-term memory deficits

Disorganized and often bizarre thinking Explanation: Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.

Which medication order should a nurse question? Meperidine IM 50 mg q 3 to 4 hours for a 23-year-old woman in labor with severe pain Fentanyl PO 1 mg q 4 hours for a 6-year-old in severe pain after surgery Hydrocodone PO 10 mg q 4 to 6 hours for a 54-year-old man who has moderate back pain Morphine IM 30 mg q 4 hours for severe pain in a 36-year-old man who has been in a motor vehicle accident

Fentanyl PO 1 mg q 4 hours for a 6-year-old in severe pain after surgery Explanation: Fentanyl is not administered by the oral route. The other medication orders are acceptable for the patients identified in each of the answers.

The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout? Follow a low purine diet For an acute gouty flare up take double the dose and then another dose in 1 hour Alcohol can be used in moderation only Severe diarrhea is an expected response

Follow a low purine diet Explanation: The nurse should encourage the client to follow a low-purine diet which would exclude items such as any alcohol products, organ and game meat, sardines, anchovies, scallops, asparagus, spinach, and peas. Alcohol should not be used at all even in moderation to avoid future attacks of gout. For acute gouty flare-ups, take one dose and the second dose 1 hour later. The dose should not be doubled. Although severe diarrhea may occur, it is not an expected or therapeutic response and should be immediately reported to the health care provider.

A nurse is preparing to teach a client about the adverse effects of the prescribed NSAID therapy. Which system would the nurse include as being involved? Gastrointestinal Respiratory Hepatobiliary Nervous

Gastrointestinal Explanation: The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver or hepatobiliary system while taking NSAIDs.

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Hydroxychloroquine Humira Gold salts Azathioprine

Gold salts Explanation: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.

A nurse is preparing to administer an anxiolytic to a client. What would be most appropriate for the nurse to do before administering the drug? Raise the side rails. Institute a bowel program. Dim the lights. Have the client void.

Have the client void. Explanation: It would be appropriate to have the client void before administering the medication to reduce the client's risk for injury if the client attempts to get out of bed after the drug is given. Raising the side rails, instituting a bowel program, and dimming the lights would be appropriate after giving the drug.

A nurse should recognize which as common early reactions caused by anxiolytics? (Select all that apply.) -Headache -Sedation -Light-headedness -Dizziness -Hypertension

Headache Sedation Light-headedness Dizziness Explanation: Common early reactions caused by anxiolytics include mild drowsiness, sedation, light-headedness, dizziness, and headache.

The etiology of anxiety involves which physiologic process? Stimulation of the parasympathetic nervous system Stimulating effects of somatotropin Increased activation of the autonomic nervous system Adrenocortical suppression

Increased activation of the autonomic nervous system Explanation: Clinical manifestations of anxiety include overactivity of the autonomic nervous system, such as dyspnea, palpitations, tachycardia, sweating, dry mouth, dizziness, nausea, and diarrhea. Somatotropin is not directly involved, and the adrenal cortex is not suppressed during times of anxiety. The parasympathetic nervous system is not stimulated during times of anxiety.

A patient admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. Why should the nurse suggest the patient stop consuming alcohol while therapy is ongoing? Increased risk for digitalis toxicity Increased risk for respiratory depression Increased risk for sedation Increased risk for central nervous system depression

Increased risk for central nervous system depression Explanation: The nurse should suggest that the patient stop consuming alcohol while therapy is going on because such consumption increases the risk for CNS depression. Increased risk for digitalis toxicity is identified when the patient is taking digoxin for management of cardiac problems. Increased risk for sedation and respiratory depression is identified when tricyclic antidepressants or antipsychotics are being used simultaneously.

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action? Inform the prescriber and monitor for GI and CNS effects Inform the prescriber and perform a focused respiratory assessment Contact the prescriber and request a supplementary dose of lithium Facilitate a transfer to the intensive care unit

Inform the prescriber and monitor for GI and CNS effects Explanation: Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic, but would be unlikely to warrant admission to intensive care. The nurse should report the finding and assess for common adverse effects of toxicity, which include GI and CNS effects more often than respiratory effects.

What conditions are salicylates are effective in managing? (Select all that apply.) -Pain -Fever -Inflammation -GI upset -Infection

Pain Fever Inflammation Explanation: Salicylates are effective in the management of pain, fever, and for inflammation. They are contraindicated in gastrointestinal disorders and are not indicated for infection.

The nurse is doing a physical assessment on admission of a client diagnosed with elevated blood pressure due to anxiety. What are the most important physical assessments for a nurse to perform? Select all that apply. -Blood pressure -Bowel sounds -Respiratory rate -Skin temperature and color -Hair texture

Respiratory rate Skin temperature and color Blood pressure Explanation: During the intake exam, a focused physical assessment for anxiety should include checking blood pressure, pulse, respiratory rate, and weight. Physiologic manifestations of anxiety can include increased blood pressure and pulse rate, increased rate and depth of respiration, and increased muscle tension. An anxious client may have cool and pale skin. Bowel sounds and hair texture would not be as important as assessing blood pressure, respiratory rate, and skin temperature for the client who is anxious.

An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client? Reye syndrome Excess antiplatelet action Asthma Salicylate poisoning

Reye syndrome Explanation: Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the heart attack.

The aspirin is being prescribed because it reduces your risk of a second heart attack. Explanation: Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how? avoid driving until he is aware of the adverse effects. change his profession, because the drug has long-term effects after cessation of therapy. avoid driving at night, because lorazepam affects the wake-sleep cycle and can lead to drowsiness. drive only 2 hours after consuming the drug and stop when it's time for the subsequent dose.

avoid driving until he is aware of the adverse effects. Explanation: Drowsiness, sedation, and ataxia may occur when the drug is started, but these effects should disappear once the client becomes accustomed to the drug. The nurse must advise the client to avoid driving or performing any other tasks that require mental alertness and concentration until the effects of the drug are known. Lorazepam does not have prolonged effects after cessation of therapy, so the nurse would not advise the client to change his profession. The client should avoid driving until the drug effects are known, instead of avoiding driving only at night or for 2 hours after drug consumption.

The clinician has recommended that an adolescent take an arranged interruption from the prescribed methylphenidate therapy. What assessments should the nurse focus on to provide data to support the need for this intervention? Select all that apply. -mood -height -appetite -cognition -sleep patterns

height appetite Explanation: Methylphenidate often causes loss of appetite and cause physical growth impairment. Thus, the health care provider may stop the medication usually during the months when the child is not in school to help minimize weight loss and growth suppression. Assessment of mood, cognition, or sleep pattern will not provide the necessary information.

A client who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by: increasing the effects of the neurotransmitter GABA. inhibiting the action of monoamine oxidase. affecting the regulation of serotonin and norepinephrine in the brain. increasing the amount of serotonin available in the synapses.

increasing the effects of the neurotransmitter GABA. Explanation: Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs increase the availability of serotonin in the synapses.

A nurse has just administered an IM injection of meperidine (Demerol) to an elderly client. The priority nursing action for the nurse would be which? close the draperies. make sure the side rails are up. check the temperature of the room. make sure the client is positioned comfortably.

make sure the side rails are up. Explanation: The priority nursing action will be to make sure that the side rails are up. Meperidine can cause dizziness and sedation, which increase the risk of the client falling. The side rails should be up to remind the client that she should not get out of bed without help. Closing the draperies, checking the temperature of the room, and making sure the client is comfortable creates an environment that will enhance the efficacy of the medication therapy but are not the priority actions.

A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction? idiopathic thrombocytopenic purpura (ITP) respiratory depression esophageal bleeding urinary retention

respiratory depression Explanation: Chlordiazepoxide may have profound central nervous system (CNS) effects, including respiratory depression, and the nurse must assess accordingly. Urinary retention, ITP, and esophageal bleeding have not been noted.

A nurse is assessing a client who has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy? "I'm careful not to eat grapefruit or drink grapefruit juice." "I asked my doctor to check for blood in my stool regularly." "I do not like to swallow whole tablets, so I crush them." "I drink as little water as possible when I take my medication so I don't dilute their effect."

"I asked my doctor to check for blood in my stool regularly." Explanation: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; by asking the health care provider to check the stool for bleeding, the client demonstrates awareness of this. Crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. Grapefruit juice does not interfere with NSAID metabolism.

A client uses sumatriptan for treating her migraine headaches. Which statement by the client indicates to the nurse that she understands how to take this drug? "I can repeat a dose in 15 minutes for a total of four doses." "I should repeat the dose in 30 minutes for a total of three doses." "I can take another dose 2 hours after the first one." "I can take another dose in about 4 hours, if needed."

"I can take another dose 2 hours after the first one." Explanation: With sumatriptan, the client should take the first dose at the first sign of a headache and then repeat the dose, if needed, in approximately 2 hours.

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy? "I may always have to take this medication." "I will need medication if my hallucinations get worse." "If I take good care of myself, I'll be off medications soon." "Medications are less effective once my symptoms subside."

"I may always have to take this medication." Explanation: People with schizophrenia usually need to take antipsychotics for years because there is a high rate of relapse (acute psychotic episodes) when drug therapy is discontinued, most often by clients who become unwilling or unable to continue taking their medication. Symptoms tend to increase when medications are stopped. While ineffective self-care is a factor, it is not the only trigger for an acute psychotic episode.

A nurse has entered a client's room at the beginning of a shift to quickly assess the client's airway, breathing, circulation, and consciousness. The nurse observes that the client is wincing, stating, " Oh, I am in so much pain right now." What initial question should the nurse ask this client? "When did this pain begin?" "Would you like me to get you something?" "In the past, what has helped your pain?" "Where exactly are you hurting?"

"Where exactly are you hurting?" Explanation: To begin the pain assessment, first determine the location of the pain. Location gives possible clues to the source of the pain and can help identify whether the pain is acute or of a more chronic nature. Questions about preferred treatments and the timing of the pain are appropriate and important, but it is normally necessary to first ascertain the location of the client's pain.

The nurse is caring for a patient who is suffering from postoperative pain. The physician orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer in each dose? 0.25 mL 0.5 mL 1 mL 2.5 mL

0.25 mL Explanation: Since 1 mL contains 10 mg of morphine, the nurse will administer 0.25 mL to deliver 2.5 mg of morphine (2.5 mg ÷ 10 mg/mL = 0.25 mL)

What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client who recently began taking ziprasidone

An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

What effects are exerted by aspirin? (Select all that apply.) Analgesic Antipyretic Anti-inflammatory Anti-infective Antiviral

Analgesic Antipyretic Anti-inflammatory Explanation: Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.

A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client's needs? Buspirone Zaleplon Meprobamate Diphenhydramine

Buspirone Explanation: Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and central nervous system relaxing effects. Diphenhydramine is an antihistamine that can be sedating.

A mother is concerned about recent behaviors by her young-adult son, and asks the nurse about what behaviors characterize schizophrenia. The nurse knows that the characteristics of schizophrenia include what actions? (Select all that apply.) -Disordered thinking -Abnormal behavior -Impaired socialization -Repetitive actions -Sexual promiscuity

Disordered thinking Abnormal behavior Impaired socialization Explanation: Schizophrenia is characterized by disordered thinking, abnormal behavior, and impaired socialization. Sexual promiscuity and repetitive actions are not common characteristics of schizophrenia.

An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac, which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs? GI discomfort GI distress GI bleed GI upset

GI bleed Explanation: Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.

What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)? Blocks hypothalamus activity Act directly on thermoregulatory cells Inhibit phagocytosis Inhibit prostaglandin synthesis

Inhibit prostaglandin synthesis Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.

When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action? Inflammation is relieved. Core body temperature is reduced. Pain is relieved. Platelet aggregation is inhibited.

Platelet aggregation is inhibited. Explanation: At low doses, acetylsalicylic acid blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet. None of the remaining options accurately describes the physiologic action results of this medication since neither inflammation, core body temperature, nor pain is affected by the synthesis of thromboxane A2.

A client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue? Kidney failure Potential for abuse Stroke with excessive doses Unstable blood glucose levels

Potential for abuse Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars

Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential? Lower blood pressure Manage hypertension Raise blood pressure Manage hypotension

Raise blood pressure Explanation: Both categories of migraine abortive drugs (e.g., ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and have the potential to raise blood pressure.

If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern? The infant may experience withdrawal symptoms during the postnatal period. The mother will have withdrawal symptoms during labor. There is no cause for concern. The baby will have birth defects.

The infant may experience withdrawal symptoms during the postnatal period. Explanation: Women taking barbiturates and benzodiazepines should be warned of the potential risk to the fetus so that contraception methods may be instituted. A child born to a mother taking a benzodiazepine may experience withdrawal during the postnatal period.

A benzodiazepine is prescribed for a pregnant woman with insomnia. When describing the effects on the newborn, which would the nurse include? The newborn can develop withdrawal symptoms. The newborn can develop physical deformation. The newborn can develop drug toxicity. The newborn can develop mental disabilities.

The newborn can develop withdrawal symptoms. Explanation: Administration of a benzodiazepine to a pregnant client can cause the client's newborn child to develop withdrawal symptoms. Administration of a benzodiazepine to a pregnant client does not cause physical deformation, drug toxicity, or mental disabilities in the newborn child.

A nurse has administered a prescribed dose of acetaminophen to a hospital client with a fever. This medication will reduce the client's temperature by what means? blocking the increase of interleukin-1 reacting with free-floating tumor necrosis (TNF) factor that is released by active leukocytes acting directly on the hypothalamus to cause vasodilation and sweating being taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal enzymes

acting directly on the hypothalamus to cause vasodilation and sweating Explanation: Acetaminophen acts on the hypothalamus to cause vasodilation and sweating to reduce fever. The mechanism of action as an analgesic is not understood. Anakinra blocks the increased interleukin-1, which is responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating TNF released by active leukocytes in autoimmune inflammatory disease to prevent the damage caused by TNF. Gold compounds are taken up by macrophages, which, in turn, inhibits phagocytosis and releases lysosomal enzymes, which causes damage associated with inflammation.

A nurse is reviewing the medical record of a client who is prescribed NSAID therapy. Which medication would be contraindicated with NSAID therapy? aspirin acetaminophen hydrochlorothiazide lisinopril

aspirin Explanation: A hypersensitivity to aspirin is a contraindication for all NSAIDs. The alternative to aspirin for fever and pain when aspirin is contraindicated is usually acetaminophen. Hydrochlorothiazide and lisinopril are antihypertensives.

A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon. The nurse will be sure to ask if the patient is taking: secobarbital. oxycodone. cimetidine. meperidine.

cimetidine. Explanation: The nurse will assess for cimetidine use. Cimetidine greatly increases the level of circulating zaleplon and could cause toxic effects in the patient. Secobarbital is a barbiturate, and oxycodone and meperidine are narcotics that would not be used with lorazepam because the combinations may depress respiratory drive, create severe hypotension or bradycardia, and substantially alter level of consciousness.

One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication? allergic reaction to the benzodiazepine paradoxical excitement taking too much of the medication (nonadherence) not taking the medication as ordered (noncompliance)

paradoxical excitement Explanation: When beginning drug therapy with a sedative or benzodiazepine to treat anxiety, the older client may experience an effect that is the opposite of intended. This effect is known as paradoxical excitement, whereby the client is wide awake and hyperactive rather than calm and relaxed.

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? anemia. peptic ulcer disease or gastritis. interstitial nephritis. constipation.

peptic ulcer disease or gastritis. Explanation: During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.

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? renal impairment. myocardial infarction. hypersensitivity to the drug. pneumonia.

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.

An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology? "This is the result of neurologic factors over which you have no direct control." "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy." "This is something that runs in certain families, and it's not your fault that this has happened." "This usually stems from suppressed emotions, so counseling usually helps greatly."

"This is the result of neurologic factors over which you have no direct control." Explanation: Narcolepsy is a neurologic sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. Learning that improvement of sleeping habits is important, but it will not address embarrassment.

A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment? "This will likely make you drowsy, so don't take it before doing anything that would require alertness." "Don't use this for more than five consecutive days to prevent damage to your liver." "If you experience sedation, seek care promptly since it could be a sign of a serious drug reaction." "Make sure to avoid grapefruit juice and fresh grapefruit until treatment is complete."

"This will likely make you drowsy, so don't take it before doing anything that would require alertness." Explanation: Cyclobenzaprine causes drowsiness because of CNS depression. There is no absolute prohibition against using the drug for more than five days; it is metabolized in the liver but is not noted to be highly hepatotoxic. Sedation is an anticipated adverse effect, not a sign of a serious drug reaction.

Which agent would be least appropriate to administer to a client with joint inflammation and pain? Ibuprofen Naproxen Acetaminophen Diclofenac

Acetaminophen Explanation: Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.

A male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain? Acetaminophen Aspirin Naproxen sodium Ibuprofen

Acetaminophen Explanation: Acetaminophen is not an anti-inflammatory medication. It is an analgesic and an antipyretic. Aspirin, naproxen sodium, and ibuprofen decrease pain and inflammation.

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client? Benzodiazepine toxicity Antihypertensive toxicity Sedative toxicity Analgesic toxicity

Benzodiazepine toxicity Explanation: Common manifestations include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures.

A student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation? -Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. -Cancer rarely produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs eliminate sensitization of peripheral pain receptors by inhibiting prostaglandin formation. -Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs potentiate sensitization of peripheral pain receptors by increasing prostaglandin formation. -Cancer rarely produces severe pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.

Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. Explanation: Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment (chemotherapy, surgery, or radiation). As with acute pain, acetaminophen, aspirin, or other NSAIDs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation. NSAIDs are especially effective for pain associated with bone metastases.

The nurse expects to monitor a client's white blood count weekly when the client is prescribed: Aripiprazole Olanzapine Clozapine Quetiapine

Clozapine Explanation: Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.

The nurse should not administer sedatives or hypnotic drugs to which client? Client with a history of asthma Comatose client Woman of childbearing age Client with an egg allergy

Comatose client Explanation: The nurse should not administer these drugs to comatose clients, those with severe respiratory problems, those with a history of habitual drug and alcohol use, or pregnant or lactating women. The nurse could safely administer sedatives or hypnotics to a client with a history of asthma as long as the client is not having an acute attack. A woman of childbearing age can receive sedatives or hypnotics after it is confirmed she is not currently pregnant. An egg allergy is not a contraindication to sedative or hypnotic administration.

The nurse is providing education to a client who has been prescribed clozapine. During teaching, the nurse should inform the client of the need for regular monitoring of what laboratory test during the initial months of therapy and periodically thereafter? partial thromboplastin time (PTT) Complete blood count (CBC) Prothrombin time (PT) blood urea nitrogen (BUN)

Complete blood count (CBC) Explanation: It is essential to monitor white blood cell counts via CBC in clients taking clozapine due to the risk of fatal agranulocytosis. Coagulation tests and measurement of BUN are not indicated.

A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen? Metabolism may be accelerated and drug elimination half-lives shortened, causing an increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives shortened, with resultant accumulation and increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Metabolism may be accelerated and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.

A client presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is the client's issue? Anakinra toxicity Ibuprofen toxicity Salicylism Acetaminophen toxicity

Salicylism Explanation: Salicylism can occur with high levels of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur.

A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior? Stevens-Johnson syndrome Neuroleptic malignant syndrome Tardive dyskinesia Extrapyramidal syndrome

Tardive dyskinesia Explanation: Tardive dyskinesia is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw, and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome (EPS), neuroleptic malignant syndrome (NMS), and Stevens-Johnson syndrome do not cause rhythmic, involuntary, facial movements.

The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated? The 16-year-old with an upper respiratory infection The 23-year-old with diabetes insipidus The 32-year-old with osteoarthritis The 45-year-old with bone marrow depression

The 45-year-old with bone marrow depression Explanation: Contraindications to antipsychotic drugs include bone marrow depression, liver damage, coronary artery disease, coma, and severe hypotension or hypertension. The use of clozapine is not contraindicated in clients with upper respiratory infection, diabetes insipidus or osteoarthritis.

Three days after discontinuing diazepam with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status? Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. The client may have decreased liver function. The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. The adverse effects of benzodiazepines can persist for several days after stopping the drug.

The adverse effects of benzodiazepines can persist for several days after stopping the drug. Explanation: Both therapeutic effects and adverse effects of diazepam are more likely to occur after 2 or 3 days of therapy than initially. Such effects accumulate with chronic usage and persist for several days after the drug is discontinued. Hypersensitivity and decreased liver function are unlikely. Benzodiazepines do not cause permanent changes in cognition.

A nurse knows that when elderly clients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction? adverse reaction paradoxical reaction allergic reaction idiosyncratic reaction

paradoxical reaction Explanation: The older adult is at increased risk for oversedation, dizziness, confusion, or ataxia when taking a sedative or hypnotic. When they show marked excitement, confusion, or both this is called a paradoxical reaction. In such cases, the nurse should observe the client at frequent intervals and for the duration to prevent injury, as well as inform the physician.

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for: ataxia and confusion. respiratory disturbances and partial airway obstruction. seizures. leukopenia and diplopia.

respiratory disturbances and partial airway obstruction. Explanation: A priority assessment would be for respiratory disturbances and partial airway obstruction. These adverse effects usually occur when a high dose of the drug is given prior to a procedure. Ataxia and confusion are also adverse effects of lorazepam, but are seen mostly in older adults. Leukopenia and diplopia are not adverse effects specific to intravenous administration but are general hematologic and ophthalmic adverse effects that can occur in anyone of any age with any method of lorazepam administration. Seizures can be an adverse effect of the drug with any type of administration. However, lorazepam is usually administered for seizures.

A 49-year-old woman has been diagnosed with myalgia. The health care provider has recommended aspirin. The client is concerned that the aspirin will upset her stomach. The nurse will encourage the client to take this medication by: crushing the tablet before swallowing. swallowing the tablet whole. swallowing the tablet with milk or food. avoiding drinking milk for 3 hours after swallowing the tablet.

swallowing the tablet with milk or food. Explanation: Taking aspirin with milk or food minimizes the stomach upset because it buffers the stomach wall from direct contact with the medication, decreasing gastric distress. Chewable tablets can be chewed before swallowing or crushed and then advised to be taken with food or mixed in a drink. Swallowed whole, extended-release tablets are enteric coated to delay release of the aspirin, which again buffers the stomach wall from the medication, decreasing gastric distress. Nonchewable tablets should be swallowed whole and should never be advised to be crushed or chewed.