composite Exam 2

A patient is in the operating room and is about to receive anesthesia. The anesthetist plans to use a barbiturate for anesthesia induction. Which type of barbiturate will be chosen? 1. Ultra-short acting 2. Short acting 3. Intermediate acting 4. Long acting

1. Ultra-short acting Rationale: Ultra-short acting barbiturates are used for anesthesia induction, as well as for anesthesia for short surgical procedures. The other types are used for various levels of sedation or control of convulsive conditions.

A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern? 1. Pulse 2. Blood pressure 3. Temperature 4. Respirations

4. Respirations Rationale: This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations.

Should you dilute Diazipam?

Must be in a dedicated line cause it can crystalize

Should you take amphetamines at night

NO!!!!!

Patient shows up with a new prescription for Phenytoin, and ask: "do I need to discontinue my Metformin for my diabetes?" A proper nursing responce would be:

No, you can continue to take your metformin, but take your blood glucose levels regullarly.

While taking with a patient about taking chlorpromazine, which of the following instructions should the health care professional include?

wear sunscreen when exposed to light Reasoning: can cause photosensitivity or increased susceptibility to sunburn when exposed to sunlight. Limit exposure and wear protective clothing when outdoors

long acting barbituate toxicity

hemodialysis

A health care professional is caring for a patient who has been taking alprazolam for an extended period of time to treat anxiety. The health care professional should recognize that stopping alprazolam therapy suddenly can resulting which of the following?

withdrawal symptoms Reasoning: alprazolam (benzo) users can develop dependence with long-term use

How long should you wait etween taking an amphetamine and a B-blocker

1-2 hr

A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects? 1. Restrict dietary intake of fat. 2. Restrict dietary intake of fiber. 3. Increase intake of dairy products. 4. Avoid intake of carbonated beverages.

1. Restrict dietary intake of fat. Rationale: Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.

The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the: 1. administration of minimal doses of multiple anesthetic drugs. 2. administration of inhaled anesthetics. 3. IV administration of anesthetics. 4. administration of anesthetics to cause muscle relaxation.

1. administration of minimal doses of multiple anesthetic drugs. Rationale: The use of a combination of drugs allows less of each drug to be used and a more balanced, controlled state of anesthesia to be achieved.

The beneficial role of the newer dopamine agonists, such as pramipexole and ropinirole, is that they: 1. appear to delay the start of levodopa therapy. 2. allow for levodopa therapy to begin earlier. 3. improve the patient's tolerance of Parkinsonian symptoms. 4. replace dopamine in the brain.

1. appear to delay the start of levodopa therapy. Rationale: The longer that levodopa therapy can be delayed, then the longer the benefit of the therapy will be experienced once it is eventually started.

A patient who has been receiving daily doses of epoetin alfa (Epogen) has a hemoglobin level of 12.2 g/dL after 1 week of therapy. The drug therapy with epoetin alfa should: 1. be stopped immediately. 2. be reduced to every-other-day dosing. 3. continue as long as the patient is receiving chemotherapy. 4. be changed to weekly doses of darbepoetin alfa (Aranesp).

1. be stopped immediately. Rationale: If epoetin therapy is not stopped when the hemoglobin levels reach 12 g/dL, or if the hemoglobin level rises too quickly, hypertension and seizures may occur.

Phenytoin therapeutic level

10-20 ug/ml

Therapeutic levels of phendoarortal

10-30 mcg/dL

The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct? 1. "The nicotine patch will give you quick relief from cravings." 2. "Chewing the gum rapidly will release an immediate dose of nicotine." 3. "It seems that patients have better treatment compliance with the gum than the patch." 4. "The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette."

2. "Chewing the gum rapidly will release an immediate dose of nicotine." Rationale: The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum, because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however.

A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be: 1. 1000 mg. 2. 2000 mg. 3. 3000 mg. 4. 4000 mg.

2. 2000 mg Rationale: Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons.

A patient is taking ibuprofen 800 mg three times a day as treatment for osteoarthritis. While taking his health history, the nurse finds out that he likes to go to bars on the weekends and have a few beers with friends. What concern would there be with the interaction of the alcohol and ibuprofen? 1. Increased bleeding tendencies 2. Increased chance for gastrointestinal bleeding 3. Increased nephrotoxic effects 4. Reduced antiinflammatory effects of the nonsteroidal antiinflammatory drug (NSAID)

2. Increased chance for gastrointestinal bleeding Rationale: NSAIDs taken with alcohol may result in increased gastrointestinal bl

Which potential problem is of most concern for the patient receiving immunosuppressant drugs? 1. Orthostatic hypotension 2. Increased susceptibility to infections 3. Neurotoxicity 4. Peripheral edema

2. Increased susceptibility to infections Rationale: Neurotoxicity and edema may be a problem with some immunosuppressants (not orthostatic hypotension), but a heightened susceptibility to opportunistic infections is a major risk factor in immunosuppressed patients.

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? 1. Give the drug by rapid IV push. 2. Infuse slowly, not exceeding 50 mg/min. 3. Mix the medication with dextrose solution. 4. Give via continuous infusion.

2. Infuse slowly, not exceeding 50 mg/min. Rationale: Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion).

8. Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? 1. High white blood cell count 2. Low serum albumin levels 3. Low platelet levels 4. High hemoglobin levels

2. Low serum albumin levels Rationale: Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.

When patients are taking selective serotonin reuptake inhibitors (SSRIs) for the first time for depression, which of the following is most important to monitor for during the first few weeks of therapy? 1. Hypertensive crisis 2. Suicidal thoughts 3. Convulsions 4. Orthostatic hypotension

2. Suicidal thoughts Rationale: Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy.

A patient in a long-term care facility has a new order for carbamazepine for seizure management. The nurse monitors for autoinduction, which will result in: 1. toxic levels of carbamazepine. 2. lower than expected drug levels. 3. gingival hyperplasia. 4. cessation of seizure activity.

2. lower than expected drug levels. Rationale: Carbamazepine is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.

When providing education to the patient on the use of a benzodiazepine medication, the nurse should include the following information should include that: 1. these medications have little effect on the normal sleep cycle. 2. using this medication may cause drowsiness the next day. 3. it is safe to drive while taking this medication. 4. these drugs are safe to use with alcohol.

2. using this medication may cause drowsiness the next day. Rationale: Benzodiazepines interfere with REM sleep and may cause a "hangover" effect or next-day drowsiness. They should not be used with alcohol, and persons taking these drugs should not drive.

The "off-on phenomenon" that some patients with Parkinson's disease (PD) experience is best explained as the: 1. need to take a drug holiday to improve response to medications. 2. variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. 3. alternating schedule of medications needed to control PD. 4. fluctuation of emotions that often occurs with PD.

2. variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. Rationale: Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled.

Clonazepam Therapeutic levels

20ng/m - 80 ng/m

Which dose of apomorphine (Apokyn) is written correctly? 1. 0.2 mcg 2. 0.2 mg 3. 0.2 mL 4. 0.2 grams

3. 0.2 mL Rationale: Apomorphine (Apokyn) dosages are titrated to avoid hypotensive effects, and the drug should be prescribed in terms of milliliters and not milligrams to avoid potentially life-threatening overdose. The subcutaneous dose is 0.2 to 0.6 mL adjusted for "off" episodes.

A patient's chemotherapy has ended at 1800 on a Tuesday afternoon. When is it appropriate to start therapy with filgrastim? 1. 1800 on Tuesday 2. 0600 on Wednesday 3. 1800 on Wednesday 4. 1 week later, 1800 the next Tuesday

3. 1800 on Wednesday Rationale: Filgrastim and sargramostim have significant drug interactions when given with myelosuppressive (bone marrow depressant) antineoplastic drugs. Remember that these two drugs are administered to enhance the production of bone marrow cells; therefore, when myelosuppressive antineoplastics are given with them, the drugs directly antagonize each other. Typically filgrastim and sargramostim are not given within 24 hours of administration of myelosuppressive antineoplastics.

A patient in the intensive care unit will be receiving a neuromuscular blocking drug. Which piece of equipment is essential to have nearby when the nurse initiates this therapy? 1. Defibrillator 2. Sphygmomanometer 3. Mechanical ventilator 4. Oxygen source

3. Mechanical ventilator Rationale: Neuromuscular drugs paralyze the respiratory muscles; it is essential to have sufficient ventilator support nearby in case the medication causes the patient to lose the ability to breathe. Oxygen alone is not sufficient.

. During surgery, the anesthetist notes that the patient's heart rate is gradually increasing and becoming more irregular, the patient's blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately? 1. Pupillary reactions 2. Respiratory effort 3. Temperature 4. Urinary output

3. Temperature Rationale: These are indications of malignant hyperthermia, which can progress rapidly.

15. A hospitalized patient has an order for ketorolac, and the nurse notes that the order is only for 5 days. What is the reason for this? 1. The patient's pain should subside by that time. 2. There are concerns about addiction to the drug. 3. The drug can cause severe renal and gastrointestinal effects. 4. The drug loses its effectiveness over time.

3. The drug can cause severe renal and gastrointestinal effects. Rationale: The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract.

A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? 1. Strattera is highly addictive. 2. Psychotherapy is rarely helpful in cases of ADHD. 3. The patient should be monitored for possible suicidal thoughts and behavior. 4. Strattera is used to treat narcolepsy as well as ADHD.

3. The patient should be monitored for possible suicidal thoughts and behavior Rationale: Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

A patient is to receive a neuromuscular blocking drug while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be: 1. sedated. 2. resisting the ventilator. 3. awake but unable to move. 4. pain free.

3. awake but unable to move. Rationale: Neuromuscular blocking drugs make the patient unable to move, but they do not cause sedation or relieve pain.

Addiction to substances is considered: 1. psychologic in nature. 2. physical in nature. 3. both psychologic and physical in nature. 4. too difficult of a condition to determine a cause.

3. both psychologic and physical in nature. Rationale: Addiction has both psychologic and physical components.

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient: 1. is unaware of his own disease history. 2. has been taking his wife's medication by mistake. 3. may be taking this drug for neuropathic pain. 4. is reluctant to admit to having a seizure disorder.

3. may be taking this drug for neuropathic pain. Rationale: Gabapentin is commonly used to treat neuropathic pain.

Monoclonal antibodies can specifically target cancer cells, yet they don't bother healthy cells. The result is that they: 1. are not as effective as other chemotherapy drugs. 2. have few adverse effects. 3. may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. 4. are only used in cases of last resort when other chemotherapy drugs have failed.

3. may cause flulike effects but do not cause the typical adverse effects associated with chemotherapy. Rationale: Because these drugs only target cancer cells, they do not have the adverse effects that are typically associated with chemotherapy. However, they do cause acute symptoms that are similar to classic allergy or flulike symptoms. As a result, these symptoms are managed during therapy.

FDA-approved uses for atypical antipsychotic drugs, such as risperidone (Risperdal), in elderly patients include: 1. Parkinson's disease. 2. Alzheimer's disease. 3. schizophrenia. 4. vascular dementia.

3. schizophrenia. Rationale: Atypical antipsychotic drugs in elderly patients are currently FDA approved for the treatment of schizophrenia and mania. In practice, however, they are also commonly used to control behavioral symptoms of agitation in elderly patients with dementia, including dementia related to Alzheimer's disease. In April of 2005, the FDA issued a special public health advisory that reminded prescribers that atypical antipsychotics are not officially indicated for dementia-related behavioral symptoms. The agency also recommends that patients so treated have their treatment plans reevaluated by their prescribers.

Toxic level of phenobarotol

>40mcg/dL

A patient has overdosed on a benzodiazepine. She took half of a 30-day supply of tablets. She is somewhat sedated and opens her eyes to shaking and calling of her name. Which treatment will be used first? 1. Flumazenil 2. Syrup of ipecac 3. Hemodialysis 4. Gastric lavage

4. Gastric lavage Rationale: Syrup of ipecac is contraindicated in patients who have ingested medications that cause sedation because of the danger of aspiration of stomach contents. Hemodialysis is not useful in this type of overdose, and flumazenil is normally used only in cases of excessive overdose or sedation. Gastric lavage is the best and most effective means of gastric decontamination.

An 82-year-old woman is taking a nonsteroidal antiinflammatory drug (NSAID) as treatment for arthritis. She has had no health problems throughout her life except for the arthritis. What is the most important assessment to monitor for this patient while on this therapy? 1. No monitoring necessary 2. Liver function studies 3. Assessment of hearing 4. Renal function studies

4. Renal function studies Rationale: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction.

A patient is being treated with a selective serotonin reuptake inhibitor (SSRI) antidepressant because of a new diagnosis of depression. His wife has expressed hope that the medication will help him "snap out of it quickly." Which of these statements is true? 1. The SSRI will work faster than the older tricyclic antidepressants. 2. The SSRI will have an immediate beneficial effect on his depression symptoms. 3. The SSRI will not work well for severe cases of depression. 4. The SSRI may take several weeks to have a beneficial effect.

4. The SSRI may take several weeks to have a beneficial effect. Rationale: It may take several weeks to see the therapeutic effects of SSRIs.

A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming "unbearable." The nurse is reluctant to give him the ordered oxycodone for pain because the nurse does not want the patient to get addicted to the pain medication. The nurse's actions reflect: 1. appropriate concern for the patient's best welfare. 2. appropriate caution for a patient who is already on a long-term opioid. 3. an uncaring attitude toward the patient. 4. a failure to manage the patient's pain properly.

4. a failure to manage the patient's pain properly. Rationale: Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief.

Barbiturates have a low therapeutic index. This means: 1. low doses are not therapeutic. 2. the toxic range is narrow. 3. they are habit forming. 4. the effective, safe dosage range is narrow.

4. the effective, safe dosage range is narrow. Rationale: Drugs with a low therapeutic index have only a narrow dosage range within which the drug is effective; above that range, they are rapidly toxic. Barbiturates are habit forming, but this is not related to the therapeutic index.

A patient's medication administration record has an order to give 325 mg of aspirin daily. The purpose of this medication is: 1. pain management. 2. fever reduction. 3. treatment of osteoarthritis. 4. thromboprevention.

4. thromboprevention. Rationale: "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher.

A provider should question prescribing an anorexiant to a patient who is: A. A teacher who spends each day at work till 4 pm and takes Excedrin for migraines B. a Bus driver who uses pepermint to stimulate his senses C. A nurse who only works weekends

A teacher who spends each day at work till 4 pm and takes Excedrin for migraines Do not give anorexiants to pateints who have caffiene within their systems, Excedrin contains Caffiene

Which of the following information should a health care professional include when talking to a patient abotu taking baclofen? A) Avoid drinking until the drug's effects are evident B) Stop taking the drug immediately if headache occurs C) Take the drug as needed for spasticity D) Take the drug with antacids to reduce gastric effects

A) Avoid driving until the drug's effects are evident Rationale: Baclofen, a centrally acting muscle relaxant, causes CNS depression. Patients taking the drug should avoid alcohol and other CNS depressants and should not drive a vehicle until they know how the drug will affect them

Because of the potential for adverse effects, which of the following should a health care professional recommend for patients who begin taking carbamazepine? A) Begin taking the drug at a low dosage B) Discontinue the drug immediately if diarrhea occurs C) Have serum glucose levels checked regularly D) Take the drug on an empty stomach

A) Begin taking the drug at a low dosage Rationale: Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, an iminostilbene that treats seizure disorders. Dosages should be low to minimize or prevent these adverse effects.

A health care professional should include which of the following instructions when talking with a patient about taking levodopa/carbidopa to treat Parkinson's disease? A) Change positions slowly to prevent orthostatic hypotension B) Eat a protein snack to increase absorption C) Take the drug at bedtime to avoid daytime drowsiness D) Expect eye twitching to develop with long term therapy

A) Change positions slowly to prevent orthostatic hypotension Rationale: Levodopa/carbidopa can cause orthostatic hypotension

A health care professional is talking to a patient about beginning sumatriptan therapy to treat migraine headaches. The health care professional should advise the patient to watch for which of the following adverse effects? A) Chest pain B) Polyuria C) Joint pain D) Insomnia

A) Chest pain Rationale: Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Patients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for patients who have a history of coronary artery disease.

A health care professional is talking to a patient about the adverse efects of interferon beta-1a. To help minimize these effects, she should tell the patient to A) Premedicate with acetaminophen (Tylenol) B) Take the drug with food C) Increase his fluid intake D) Take the drug in the morning

A) Premedicate with acetaminophen (Tylenol) Rationale: Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen or a NSAID can help minimize these symptoms

a patient is taking Anorexiant stimulants, what are some of the AE that the provider will monitor for? SATA A. Malnutrition B. Tachycardia C. Fatty stool D. Nausea E. Headaches F. Anxiety

A, B, E, F Malnutrition Tachycardia Headaches Anxiety

A health care professional is caring for a patient who is about to begin taking lithium carbonate (Lithobid) to treat bipolar disorder. The health care professional should caution the patient to watch for which of the following indications of litium toxicity? A. tremors B. confusion C. Bronchospasm D. nausea E. muscle weakness

A. advances toxicity resulting in seizures B. confusion, slurred speach, and ataxia are indications of lithium toxicity due to the drug's narrow therapeutic range D. n/v/d are early indications of toxicity. pts should report any of these adverse effects E. muscle weakness is an early indication of toxicity due to the drug's narrow therapeutic range *HCP should monitor lithium levels periodically

A health care professional is caring for a patient who is about to begin amitriptyline therapy to treat major depression. The health care professional should include which of the following instructions when talking with the patient about taking the drug? A. change position slowly B. do not quit taking abruptly C. Wear sunscreen and protective clothing D. take at bedtime to prevent daytime drowsiness E. Increase fiber and fluid intake

A. change position slowly -orthostatic hypotension B. do not quit taking abruptly -relapse and withdrawal s/s can occur. Reduce dose over a 2 week period D. take at bedtime to prevent daytime drowsiness -can cause drowsiness: avoid activities requiring mental alertness E. Increase fiber and fluid intake -Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Patients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

Which of the following instructions should a health care professional include when advising a patient about instilling pilocarpine (Isopto Carpine) for managing open-angle glaucoma? A. apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops do not touch the tip of the dropper B. do not touch the tip of the dropper C. wash hands after instilling the drops D. Rub eyes gently after instilling the drops E. Remove contact lenses prior to instilling the drops

A. keeps the drug from entering the systemic circultion B. remain sterility E. leaving contacts in can cuase further irritation if left in place

A health care professional should monitor and older adult patient who is taking alprazolam (Xanax) for which of the following adverse effects? A. tolerance B. anxiety C. sedation D. respiratory depression E. constipation

A. tolerance tolerance and dependence develop with benzos. Use only as needed for short periods of time B. anxiety paradoxical rxn can develop, especially in elderly patients-report findings C. sedation CNS depression D. respiratory depression benzos cause CNS depression. Monitor for respiratory depression and use lowest effective dose

Malignant hyperthermia is a genetically linked condition. 1. True 2. False

True Rationale: Malignant hyperthermia is an uncommon, but potentially fatal, genetically linked adverse metabolic reaction to general anesthesia.

how do you know if the anti-parkinson med?

Assess their gait

when talking with a patient about taking temazepam which of the followinginstructions should the health care profesional include?

Avoid alcohol and other depressants -Temazepam can cause CNS depression. Combined use with alcohol or other depressants can cause severe respiratory depression. Take the drug 30 min before bedtime -patients should take temazepam 30 min before bedtime to improve sleep and to prevent daytime drowsiness Taper the drug slowly to prevent withdrawal symptoms -abrupt discontinuation of temazepam can cause withdrawal symptoms. Patients should taper the drug slowly to prevent or minimize withdrawal.

A health care professional is talking to a patient who is taking lithium carbonate. Which of the following instructions should be included to reduce the risk of lithium toxicity?

Avoid taking NSAIDS Reasoning: NSAIDS increase renal absorption of lithium and Na.

A health care professional is caring for a patient who is about to begin taking pramipexole to treat Parkinson's disease. The health care professional should recognize that which of the following laboratory tests require monitoring? A) C-reactive protein B) Creatine phosphokinase (CPK) C) Thyroid function D) CBC

B) Creatine phosphokinase Rationale: CPK is an enzyme found in the heart, brain, and skeletal muscles. Patients taking pramipexole can develop muscle weakness with a lack of energy, creating a situation that can be more problematic for patients than their original muscle dysfunction. Monitoring CPK can alert health care professionals to the possibility of skeletal muscle damage from the drug.

An anesthetist is about to administer lidocaine as part of the protocol for spinal anesthesia for a patient who is undergoing a surgical procedure. The health care professional should be aware that the patient could develop which of the following potentially serious effects? A) Tachycardia B) Hypotension C) Hyperthermia D) Hemoptysis

B) Hypotension Rationale: When systemially absorbed in sufficient amounts, lidocaine, a local anesthetic, can cause hypotension, particularly when used as spinal anesthesia.

A health care professional is reviewing the medical record of a patient who has newly diagnosed seizure disorder. The patient is to begin taking both valproic acid and and phenytoinThe heal care professional should recognize that which of the following can occur as aresult of a drug interaction between valproic acid and phenytoin? A) Hyperammonemia B) Phenytoin toxicity C) Hypertension D) Peptic ulcer disease

B) Phenytoin toxicity Rationale: Valproic acid can cause an increase in phenytoin blood levels, causing phenytoin toxicity. The primary care provider should monitor serum phenytoin levels and reduce the dosage if levels begin to

A health care professional is caring for a patient who is receiving thiopental. For which of the following should the health care professional monitor? A) Cardiac excitability B) Respiratory depression C) Hypothermia D) Hypotension

B) Respiratory depression Rationale: Thiopental, a short acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for patients receiving the drug.

A health care professional is caring for a patient who is about to begin taking dantrolene for skeletal muscle spasms. The health care professional should recognize that which of the following laboratory tests requires monitoring? A) serum potassium B) liver function C) serum sodium D) thyroid function

B) liver function Rationale: Liver toxicity is a serious adverse effect of dantrolene. The health care professional should monitor liver function prior to treatment and at regular intervals, and advise patients to report jaundice or abdominal pain.

A health care professional is caring for a patient who is taking zolpidem. The patient has a history of benzodiazpeine abuse and reports insomnia. The health care professional should caution the patient that the drug can cause A) hearing loss B) memory impairment C) joint pain D) constipation

B) memory impairment Rationale: non-benzodiazepine can cause antergrade amnesia, or memory impairment, particularly an inability to recall activities patients carry out just before or during sleep

A health care professional is caring for a patient who is about to begin taking dantrolene for skeletal muscle spasms. The health care professional should tell the patient to report which of the following adverse effects? A) slow pulse rate B) cough C) diarrhea D) hearing loss

C) Diarrhea Rationale: Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea is an adverse effect of dantrolene, as are nausea and vomiting. Patients should report these effects so the health care professional can monitor fluid balance and intervene accordingly.

A health care professional is talking to a patient and her family about how methylphenidate will help manage ADHD. Which of the following effects should they expect? A) Reduced pain B) Improved mood C) Increased focus D) Decreased anxiety

C) Increased focus Rationale: Stimulants, such as methylphenidate, regulate levels of dopamine and norepinephrine in the brain to produce calmness, reduce hyperactivity, and increase focus for patients who have ADHD.

A health care professional is talking with a patient who is to begin taking valproic acid to treat a seizure disorder. He should advise the patient to monitor for which of the following adverse effects? A) Hirsutism B) Depression C) Jaundice D) Gum irritation

C) Jaundice Rationale: Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. Patients taking the drug should report these symptoms, and health care professionals should monitor liver function studies prior to treatment and periodically during therapy.

A health care professional administers fentanyl to a patient to reduce pain. Which of the following drugs should she have available to reverse the effects of fentanyl? A) Neostigmine (Bloxiverz) B) Succinycholine (Anectine) C) Naloxone D) Dantrolene (Dantrium)

C) Naloxone Rationale: Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an opioid agonist, can cause severe respiratory depression. Health care professionals administering fentanyl should also have resuscitation equipment available.

For which of the following should a health care professional monitor a patient who is taking donzepezil for Alzheimer's disease? A) Confusion B) Dry mouth C) Nausea D) Double vision

C) Nausea Rationale: The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking the drug with food can help minimize adverse effects.

which client diagnosed with parkinson's disease should the nurse question administering the anticholinergic medications benztropine? A) patient with congestive heart failure B) Patient with myocardial infarction C) Patient with glaucoma D) Patient with hip replacement

C) Pateint with glaucoma Rational: Anticholinergic meds increase intraocular pressure.

A health care professional is caring for a patient who is about to begin taking amphetamine sulfate The health care professional should monitor the patient who which of the following adverse effects? A) Hypotension B) Tinnitus C) Tachycardia D) Bronchospasm

C) Tachycardia Rationale: Amphetamine sulfate is an amphetamine stimulant. It can cause tachycardia and dysrhythmias. Patients should notify the health care professional if they develop palpitations or chest pain.

When talking to a patient about buspirone, the health care professional should include which of the following instructions? A. Take the drug with grapefruit juice to increase absorption B. Use the drug only as needed for anxiety C. allow 2-4wks before expecting to feel better D. Take the drug on an empty stomach

C. allow 2 to 4 weeks to notice effects Reasoning: It can take up to 4 weeks for patient's to feel the drug's full therapeutic effects

Pregnancy catagory of Amphetamines

Catagory D casues risk for preterm labor miscarriage

A new nurse sees that a Dr. is ordering Phenytoin to a pateint with diabetes. What would the nurse do?

Check the glucose more frequently

when giving an amphetamine to an older adult, what AE's would the provider need to monitory for?

Confusion and agitation

Which of the following findings should alert a health care professional that a patient is developing a potentially serious adverse reaction to interferon beta-1B? A) Tinnitus B) Twitching eyelids C) Blue-green discoloration D) Fatigue

D) Fatigue Rationale: Because of the potential for bone marrow suppression and decreased platelet count, patients should report unexplained bruising, bleeding, or fatigue.

A health care professional is talking to a patient who is newly diagnosed with Parkinson's disease about how levodopa/carbidopa will help her control her symptoms. With which of the following mechanisms is the drug effective in treating this disorder? A) Increases available acetylcholine in the brain B) Inhibits norepinephrine metabolism in the brain C) Inhibits serotonin metabolism in the brain D) Increases available dopamine in the brain

D) Increases available dopamine in the brain Rationale: Levodopa/carbidopa, a dopaminergic agent, can act by increasing dopamine in the extra-pyramidal center of the brain, reducing involuntary motion.

A patient is taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the patient but should be aware that a drug interaction between selegiline and meperidine (Demerol) can result in which of the following? A) Frequent urination B) Jaundice C) Cellulitis D) Muscle rigidity

D) Muscle rigidity Rationale: A drug interaction between selegiline and opioids, especially meperidine, can result in a serious reaction resulting in rigidity, stupor, agitation, hypertension and fever.

While talking with a patient and his family about taking memantine or Alzheimer's disease, the health care professional should include which of the following instructions? A) Increase fluids to improve renal excretion B) Report memory loss or confusion C) Watch for signs of liver impairment, such as jaundice and abdominal pain D) Notify the health care professional before taking OTC antacids

D) Notify the health care professional before taking OTC antacids Rationale: Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity

Anesthetists often administer midazolam (Versed) during induction of anesthesia because of which of the followign pharmacological actions? A) produces analgesia B) induces muscle paralysis C) dries secretions D) causes amnesia

D) causes amnesia Rationale: Midazolam, a benzodiazepine, is appropriate during induction because of its anti anxiety and amnesic properties

A health care professional is collecting data from a patient who is taking bupropion hydrochloride to treat depression. The health care professional notes that the patient has a recent history of a head injury. She should recognize that the drug is inappropriate for the patient because of the increase risk for which of the following? A. ischemic stroke B. Drowsiness C. Respiratory depression D. Seizure activity

D. Seizure activity Reasoning: Bupropion, an atypical anti-depressant, can cause seizure activity when patients take high doses or have a seizure d/o, a CNS tumor, or a hx of head trauma

A patient taking Carbidopa/ levadopa, presents with decreased muscle tone, dizziness, and shows signs of dehydration. What would the nurse do?

Decrease their dose of the medicaiton

a health care professional is talking to a patient who is about to begin taking valproic acid for a newly diagnosed seizure disorder. he should tell the patient to watch for which of the following adverse side effects?

Drowsiness -Patients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these effects can indicate the need for a reduction in dose. Headache -Valproic acid can cause headache, along with other central nervous system adverse effects, such as sleep disturbances Rash -Skin rash is a side effect of valproic acid and other antiepileptic drugs.

Rationale: The longer that levodopa therapy can be delayed, then the longer the benefit of the therapy will be experienced once it is eventually started. True False

False Rationale: A major adverse effect of the nonselective MAOIs is that they interact with tyramine-containing foods (cheese, red wine, beer, and yogurt) because of their inhibitory activity against MAO-A. This has been called the cheese effect, and one hazardous result can be severe hypertension. Selegiline, an amphetamine derivative, is a selective MAO-B inhibitor, and is much less likely to elicit the classic cheese effect at dosages of 10 mg or less daily.

Use of disulfiram (Antabuse) is the best first step to overcoming alcoholism because it prevents the person from drinking. 1. True 2. False

False Rationale: Disulfiram is not a cure for alcoholism, and it is usually reserved as a treatment of last resort for alcoholic patients for whom other treatments have failed. Its use can result in potentially dangerous adverse effects.

Ginkgo iloa is an excellent and harmless heral product that can e used to enhance memory. Few problems occur with its use. True False

False Rationale: Ginkgo biloba is used as a memory enhancer, but potential drug interactions may occur with aspirin and anticoagulants such as warfarin.

Ramelteon (Rozerem) has a high risk of causing dependency. True False

False Rationale: Ramelteon (Rozerem) is not classified as a controlled substance because of its lack of observed dependency risk.

t. John's wort, an herbal product, is often called "herbal Prozac" because it is an excellent adjunct therapy when used with a monoamine oxidase inhibitor (MAOI) or selective serotonin reuptake inhibitor (SSRI). 1. True 2. False

False Rationale: St. John's wort interacts with both drugs, resulting in potentially dangerous adverse effects.

Accidental or intentional overdose of acetaminophen is rarely a problem because the drug is an over-the-counter product. 1. True 2. False

False Rationale: The ingestion of large amounts of acetaminophen can cause hepatic necrosis, a serious complication.

Epoetin alfa therapy is effective in patients who have iron-deficiency anemia. 1. True 2. False

False Rationale: This medication is ineffective if the body does not have adequate iron stores because the bone marrow would be unable to produce red blood cells (RBCs) without adequate iron stores.

Designer drugs are not as dangerous as opioids. 1. True 2. False

False Rationale: Toxic levels of "designer drugs" can result in convulsions, coma, cerebral hemorrhage, and ultimately death.

Transdermal fentanyl patches are the preferred forms of opioids for opioid-naive patients. 1. True 2. False

False Rationale: Transdermal fentanyl patches should never be used in opioid-naive patients because the drug is extremely potent.

All COX-2 inhibitors are high-risk drugs and have been pulled from the market. 1. True 2. False

False Rationale: Two COX-2 inhibitors have been pulled from the market recently due to increased risk for adverse cardiovascular events. Valdecoxib has been associated with other problems. Celecoxib (Celebrex) is still on the market, but there is some evidence that it may have similar risks. Though the Food and Drug Administration (FDA) has not pulled it from the market, its use is being closely monitored.

A client is prescribed an Anorexiant and is told to take this medication before meals. True False

False Take anorexiants with or after meals.

Antidote for Benzodiazepine

Flumazenil

A health care professional is obtaining a patient drug history when he finds that the patient is taking lithium carbonate (Lithobid) for bipolar disorder. Which of the following findings in the patients drug history should alert the health care professional to monitor him for lithium toxicity?

Furosemide (Lasix) for hypertension Reasoning: Lasix is a high-ceiling diuretic, increases Na loss and can cause lithium re-absorption. HCP should eval for lithium toxicity

A patient on diazepam presents with jaundice, hyperglycemia, changes in urine color, and confusion. What would be diagnosed for this patient?

Hepatoxicity

When reviewing the adverse effects of drug therapy with a patient, a health care professional should explain orthostatic hypotension is a common adverse reaction of which of the following drugs?

Imipramine (Tofranil) Reasoning: imipramine (tricyclic antidepressant, can result in orthostatic (postural) hypotension. Patients taking this drug should change positions slowly from sitting or lying to standing

what are the AE of Anti-migraine/ serotonin agonists

Nausea Vomiting Diarrhea Visual changes decreased appetite Cardiac arrest Orthostatic HTN

A health care professional is caring for a patient who is about to begin using betaxolol eye drops to treat open-angle glaucoma. The health care professional should advise the patient to expect which of the following reactions?

Ocular Stinging Betaxolol, a beta-adrenergic blocker, can cause short-term, mild stinging and burning of the eye. Patients should expect transient eye discomfort, but should not rub their eyes. Continuous irritation should be reported

A health care professional is caring for a patient who is taking venlafaxine to treat major depression. The health care professional should recognize that which of the following drugs can cause serotonin syndrome when patient take it concurrently with venlafaxine?

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

Phenytoin urine colors

Pink-brown

Initial teaching for Caridopa/ levadopa will be for:

Risk of falling, and do not take on an empty stomach Rational: administration of this drug causes the client to develop orthostatic hypertension. Taking it with a meal will allow for better absorbtion

Soon after beginning fluxetine , a patient is admitted to the emergency department with agitation and confusion. The health care professional should suspect which of the following?

Serotonin Syndrome Reasoning: can begin 2-72 hr after begining fluoxetine, and SSRI. Manifestations: confusion, difficulty concentration, and agitation

A health care professional is caring for a young adult patient who is taking fluuxetine to treat depression. The health care professional should tell the patient and the patients family to report which of the following?

Suicidal Thoughts Reasoning: fluuxetine (SSRI) have increased risk for suicide, eps in early tx. pts who are severly depressed can have, with drug therapy, the energy for self harm. Monitor for worsening depression

Risks for kids on Amphetamines?

Suicidal thoughts depression

A healthcare professional is caring for a patient who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic test should the health care professional recommend periodically for the patient?

Thyroid function test Reasoning: hypothyroidism is an adverse effect of lithium carbonate. pts should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin and annually thereafter

Bupropion is used for both treatment of depression and management of nicotine withdrawal. 1. True 2. False

True Rationale: Bupropion is an antidepressant that is used to relieve depression. The form known as Zyban is used as part of the management of nicotine withdrawal.

Decaffeinated coffee may still contain caffeine. True False

True Rationale: Even decaffeinated coffee may contain 2 to 4 mg of caffeine per 5-ounce cup.

Colony-stimulating factors (CSFs) allow for higher doses of chemotherapy. 1. True 2. False

True Rationale: In addition to reducing the duration of low neutrophil counts, CSFs enhance the body's mature immune cells. As a result, these CSF properties allow patients to receive higher dosages of chemotherapy, which results in the destruction of greater numbers of cancer cells.

A nurse is oserving a new nurse administer 12 ug/mL of Dilantin to a patient suffering from seizures, with normal saline, and then Flush with D5. Is the a therapeutic medicine administraiton?

Yes

A patient is admitted to the emergency department with spasms of his face and back. He has recently begun taking chlorpromazine to treat schizophrenia. Which of the following adverse reactions should the health care professional suspect? - Cholinergic crisis - serotonin syndrome - Stevens-Johnson syndrome - Acute dystonia

acute dystonia Reasoning: manifestations include muscle spasms of the back, neck, face, and tongue. Tx includes IMMEDIATE administration of an anticholinergic drug, such as diphenhydramine.

A health care professional should question the use of timolol for a patient who has which of the following disorders?

asthma Reasoning: Timolol, a beta-adrenergic antagonist, can cause bronchospasm and dyspnea. Pts who have compromised respiratory function should not use this drug.

When reviewing the indications for various antidepressants, a health care professional should understand that bupropion hydrochloride (Wellbutrin) is an appropriate choice for patients who have which of the following? A. motion sickness B. seasonal affective d/o C. depression D. seasonal effective disorder E. nicotine addiction

b. atypical antidepressant, helps prevent and treat seasonal affective disorder, a type of depresssion associated with the reduction of natural light during winter months d. appropriate for patients trying to quit smoking e. antidepressants help tx depression

During and immediately following IV administration of chlorpromazine to a patient who has schizoaffective disorder, the health care professional should monitor which of the following?

blood pressure Reasoning: pts recieving are at risk for hypotension during and immediatley after IV administration. Remain supine for 30 minutes post IV adm. HCP should monitor BP It's ESSENTIAL to infuse slowly and not to mix it with other drugs

A health care professional should expect which of the following adverse effects for a patient who is taking betaxolol eye drops to treat glaucoma?

bradycardia Reasoning: blockade of cardiac beta1 receptors Nsg Interventions: check pulse regularly and report any sustained decreases

A health care professional is caring for a patient who is about to begin taking echothiophate to treat glaucoma. The health care professional should monitor the patient for the development of which of the following adverse effects?

cataracts Reasoning: echothiophate , a cholinesterase inhibitor, can cause cataracts or opacity of the lens of the eye. Patients should report any changes in vision, such as cloudiness or halos around lights

A HCP should question the use of alprazolam (Xanax) for a patient who

drinks two 8-oz glasses of wine each evening Reasoning: prevent severe dehydration and respiratory depression. avoid alcohol and CNS depressants when taking benzos

A health care professional should advise a patient who is taking phenelzine to avoid tyamine-enriched foods because of an increased risk for which of the following adverse reactions?

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

When caring for a patient who is taking risperidone for schizophrenia, the health care professional should monitor for which of the following adverse effects of the drug?

polyuria Reasoning: atypical antipsychotic, can cause new-onset diabetes mellitus. It's essential to monitor pts taking the drug, for signs of hyperglycemia, and check their glucose levels regularly