Exam 5

A 15-year-old male client receiving phenytoin for treatment of epilepsy is being discharged from the hospital. What statement by Richard's mother leads you to believe she has understood your teaching related to his care and drug administration?

"I will make sure he has routine visits to the dentist."

A client has been prescribed multiple eye medications. Which of the following instructions would be important for the nurse to explain to the client?

"Place one of the medications into the eye and then wait 5-15 minutes before administering the next medication."

What health education should the nurse provide to a client prior to the instillation of atropine eyedrops?

"These drops might sting a little bit, and they will make you temporarily sensitive to light."

A client asks the nurse if the eye drops (a beta-adrenergic blocking drug used to treat his open-angle glaucoma) just prescribed will cause any effect on his asthma. What would be an appropriate response from the nurse?

"They might. Let's talk to the care provider and pharmacist about asthma and these eye drops."

An African American male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the physician's office with signs of tardive dyskinesia, and his physician modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?

"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in African Americans."

After the nurse administers a cholinergic medication to the client, the nurse would provide which interventions because of the drug's actions on the body? Select all that apply.

* Auscultate lung sounds and report bronchoconstriction. * Instruct client to report diarrhea. * Compare muscle strength to baseline for improvement.

Which would be included when describing the parasympathetic nervous system structure and function?

* Ganglia are located close to or within the effector tissue. * Muscarinic and nicotinic receptors are found in the parasympathetic nervous system.

A client with AD is prescribed rivastigmine by the primary health care provider. The nurse would anticipate administering this drug by which route? Select all that apply.

- Orally - Transdermally

Phenylephrine (e.g., Neo-Synephrine, others) is a synthetic drug that acts on alpha-adrenergic receptors to produce vasoconstriction. Which of the following are actions of this drug? Choose all that apply.

-Decreases cardiac output and renal perfusion -Increases peripheral vascular resistance and blood pressure

Epinephrine is contraindicated in patients with which diseases or disorders? -Asthma -Narrow-angle (or closed-angle) glaucoma -Hypotension -Bronchoconstriction

-Narrow-angle (or closed-angle) glaucoma

A female client wears soft contact lenses. She uses eye drops containing benzalkonium. The nurse teaches the client that the medication should be instilled under what condition?

15 minutes or longer before inserting soft contacts

The first symptom of Parkinson's is often:

A resting tremor that begins in one hand, involving the fingers and thumb of one hand.

A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.) A) Agitation B) Agglutination C) Insomnia D) Intermittent tachycardia E) Dry mouth

A) Agitation C) Insomnia E) Dry mouth

A nursing student is reviewing a 72-year-old man's chart. In the diagnostic section of the chart, the student notices that the man's intraocular pressure is 23 mm Hg. What should the student suspect regarding this pressure? A. Glaucoma B. Blepharitis C. Diminished vision D. Macular degeneration

ANSWER: A → When the patient's intraocular pressure is 22 mm Hg or above, the nurse should suspect that he or she has some form of glaucoma. The patient may have diminished vision, but there is no sign of this in the chart.

A client is diagnosed with depression and prescribed sertraline (Zoloft) on an outpatient basis. The client should warn the client about what possible adverse effects ? Select all that apply.

Agitation Insomnia Dry mouth

Which receptor does phenylephrine stimulate?

Alpha1

14. You are caring for a patient in the ICU whose condition is deteriorating. You receive orders for dopamine, which is an intravenous vasoactive drug. What would be your priority assessment and interventions specific to the administration of vasoactive medications? A) Frequent vitals, monitoring the central line site, and providing accurate drug titration B) Reviewing medications, performing a focused cardiovascular assessment, and providing patient education C) Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema D) Routine vitals, monitoring the peripheral IV site, and providing early discharge instructions

Ans: A Page and Header: 321, General Management Strategies in Shock Feedback: When vasoactive medications are administered, vital signs must be monitored frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive medications should be administered through a central venous line because infiltration and extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An intravenous pump should be used to ensure that the medications are delivered safely and accurately. Individual medication dosages are usually titrated by the nurse, who adjusts drip rates based on the prescribed dose and the patient's response. Option B is incorrect; reviewing medications, performing a focused cardiovascular assessment, and providing patient education are important nursing tasks, but they are not specific to the administration of intravenous vasoactive drugs. Option C is incorrect; reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema are not the priorities for administration of intravenous vasoactive drugs. Option D is incorrect; the vitals are taken on a frequent basis when monitoring administration of intravenous vasoactive drugs, vasoactive medications should be administered through a central venous line, and early discharge instructions would be inappropriate in this time of crisis.

4. You are caring for a patient in liver failure who is exhibiting signs and symptoms of hypovolemic shock. You anticipate that the physician will order the administration of a crystalloid for the management of this patient. Which crystalloid fluid is most commonly used to treat hypovolemic shock? A) Lactated Ringer's B) Albumin C) Dextran D) 3% NaCl

Ans: A Page and Header: 323, Hypovolemic Shock Feedback: Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringer's and 0.9% sodium chloride are isotonic crystalloid fluids commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but Dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock. 3% NaCl is a hypertonic solution and is not isotonic.

13. You are precepting a new graduate nurse in the ICU. The two of you are caring for a patient who is receiving large volumes of crystalloid fluid as a result of shock. What would you teach the new nurse to monitor the patient for symptoms of? A) Hypothermia B) Bradycardia C) Coffee ground emesis D) Pain

Ans: A Page and Header: 324, Hypovolemic Shock Feedback: Temperature should be monitored closely to ensure that rapid fluid resuscitation does not precipitate hypothermia. Intravenous fluids may need to be warmed during the administration of large volumes. Option B is incorrect; the nurse should monitor the patient for cardiovascular overload and pulmonary edema when large volumes of intravenous solution are administered. Option C is incorrect; coffee ground emesis is an indication of a gastrointestinal bleed, not shock. Option D is incorrect; pain is related to cardiogenic shock.

19. You are the nurse in the emergency department who is caring for a patient recently admitted with a myocardial infarction. The patient's heart is pumping an inadequate supply of oxygen to the tissue. What would you assess for? A) Dysrhythmias B) Increase in blood pressure C) Decrease in heart rate D) Decrease in oxygen demands

Ans: A Page and Header: 325, Cardiogenic Shock Feedback: Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Symptoms of cardiogenic shock include angina pain and dysrhythmias. Cardiogenic shock does not exhibit increased blood pressure, decreased heart rate, or a decrease in oxygen demands.

A patient is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite aggressive interventions, the patient's mean arterial pressure (MAP) has fallen to 55 mm Hg. The nurse should gauge the onset of acute kidney injury by referring to what laboratory findings? Select all that apply. A) Blood urea nitrogen (BUN) level B) Urine specific gravity C) Alkaline phosphatase level D) Creatinine level E) Serum albumin level

Ans: A, B, D Feedback: Acute kidney injury (AKI) is characterized by an increase in BUN and serum creatinine levels, fluid and electrolyte shifts, acid-base imbalances, and a loss of the renal-hormonal regulation of BP. Urine specific gravity is also affected. Alkaline phosphatase and albumin levels are related to hepatic function.

25. You are caring for a patient with shock. What cardiac signs or symptoms would indicate acute organ dysfunction? (Mark all that apply.) A) Drop in systolic blood pressure greater than 40 mm Hg from baseline blood pressure B) Hypotension that responds to fluid resuscitation C) Vasopressor support is not needed D) Serum lactate greater than 4 mmol/L E) Mean arterial pressure (MAP) less than 65 mm Hg

Ans: A, D, E Page and Header: 330, Circulatory Shock Feedback: Signs of acute organ dysfunction in the cardiovascular system include systolic blood pressure less than 90 mm Hg or mean arterial pressure (MAP) less than 65 mm Hg, or drop in systolic blood pressure greater than 40 mm Hg from baseline blood pressure. Is hypotension responsive to fluid resuscitation, or is vasopressor support needed? Is the serum lactate greater than 4 mmol/L? Options B and C are incorrect.

An 11-year-old boy has been brought to the ED by his teacher, who reports that the boy may be having a "really bad allergic reaction to peanuts" after trading lunches with a peer. The triage nurse's rapid assessment reveals the presence of respiratory and cardiac arrest. What interventions should the nurse prioritize? A) Establishing central venous access and beginning fluid resuscitation B) Establishing a patent airway and beginning cardiopulmonary resuscitation C) Establishing peripheral IV access and administering IV epinephrine D) Performing a comprehensive assessment and initiating rapid fluid replacement

Ans: B Feedback: If cardiac arrest and respiratory arrest are imminent or have occurred, CPR is performed. As well, a patent airway is an immediate priority. Epinephrine is not withheld pending IV access and fluid resuscitation is not a priority.

To ensure drops stay in the eye and avoid systemic absorption of the medication, the nurse should instruct the client to do which of the following after instilling eyedrops?

Apply finger pressure over the lacrimal sac for 1 to 2 minutes after instillation.

8. You are transferring a patient who is in the progressive stage of shock into ICU from your medical-surgical unit. You are aware that the shock affects many organ systems and that nursing management of the patient will focus on what? A) Reviewing the cause of shock and trying to limit the progression B) Assessing and understanding shock and the significant changes in assessment data to guide the plan of care C) Giving the prescribed treatment but shifting focus to providing family time as the patient is unlikely to survive D) Giving progressive care to the patient and family using critical pathways for shock therapy

Ans: B Page and Header: 319, Stages of Shock Feedback: Nursing care of patients in the progressive stage of shock requires expertise in assessing and understanding shock and the significance of changes in assessment data. Early interventions are essential to the survival of patients in shock; thus, suspecting that a patient may be in shock and reporting subtle changes in assessment are imperative. Option A is incorrect; reviewing the cause of shock and trying to limit the progression is important, but it must be followed by a plan of care. Option C is incorrect; it is important during the progressive of shock to give the prescribed treatment, but the patient still has a chance of survival; providing family time in important, but patient survival is still the priority. Option D is incorrect; giving progressive care to the patient and family is not defined, and using critical pathways for shock therapy sounds good, but there is no information in the stem of the question that indicates we are using a critical pathway. This answer is designed to distract the test-taker.

23. Why are antiarrhythmic medications required in the treatment of shock? A) To prevent serious cardiac dysrhythmias B) All patient with shock have serious cardiac dysrhythmias C) They are not required D) To stabilize cardiac afterload

Ans: B Page and Header: 326, Cardiogenic Shock Feedback: Multiple factors, such as hypoxemia, electrolyte imbalances, and acid-base imbalances, contribute to serious cardiac dysrhythmias in all patients with shock. Antiarrhythmic medications are required to stabilize the heart rate. Option A is incorrect; antiarrhythmic medications treat dysrhythmias, they don't prevent them. Option C is incorrect; they are required. Option D is incorrect; antiarrhythmic drugs do not stabilize cardiac afterload.

The ICU nurse is caring for a patient in neurogenic shock following an overdose of antianxiety medication. When assessing this patient, the nurse should recognize what characteristic of neurogenic shock? A) Hypertension B) Cool, moist skin C) Bradycardia D) Signs of sympathetic stimulation

Ans: C Feedback: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

What action do sympathomimetic drugs have in the body? A) Decreased heart rate B) Decreased blood pressure C) Increased respirations D) Increased intraocular pressure

Ans: C Feedback: Sympathomimetic drugs increase respirations. Heart rate and blood pressure are also increased and intraocular pressure is decreased.

12. When caring for a patient at risk for shock, what assessment finding would the nurse consider a potential sign of shock? A) Elevated systolic blood pressure B) Elevated mean arterial pressure C) Shallow, rapid respirations D) Bradycardia

Ans: C Page and Header: 317, Stages of Shock Feedback: A symptom of shock is shallow, rapid respirations. Options A and B are incorrect; systolic blood pressure drops in shock, and MAP is less than 65 mm Hg. Option D is incorrect; bradycardia occurs in neurogenic shock; other states of shock have tachycardia as a symptom.

17. You are working in the ICU and have just been notified that you are receiving a patient from the Obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery. You know that the best choice for fluid replacement for this patient is what? A) 5% Albumin because it is inexpensive and is always readily available B) Dextran because it increases intravascular volume and counteracts coagulopathy C) Whatever fluid that is most readily available in the ICU, due to the nature of the emergency D) Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failure

Ans: C Page and Header: 320, General Management Strategies in Shock Feedback: The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids like dextran and albumin should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Option A is incorrect; albumin is very expensive and is a blood product so it is not always readily available for use. Option B is incorrect; dextran does increase intravascular volume, but it increases the risk for coagulopathy. Option D is incorrect; Lactated Ringer's is a good solution choice because it increases volume and buffers acidosis but should not be used in patients with liver failure because the liver is unable to covert lactate to bicarbonate.

35. The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a characteristic of neurogenic shock? A) Hypertension B) Cool, moist skin C) Bradycardia D) Signs of sympathetic stimulation

Ans: C Page and Header: 331, Circulatory Shock Feedback: In neurogenic shock, the sympathetic system is not able to respond to body stressors. Therefore, the clinical characteristics of neurogenic shock are signs of parasympathetic stimulation. It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

3. You are admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. You know that an early sign that accompanies initial shock is what? A) Increased urine output B) Decreased heart rate C) Hyperactive bowel sounds D) Cool, clammy skin

Ans: D Page and Header: 315, Stages of Shock Feedback: In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patient's skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases

In glaucoma, intraocular pressure increases in which part of the eye

Anterior chamber

A nurse is caring for a hospital client who has just been prescribed phenytoin (Dilantin) for a seizure disorder. What assessment should the nurse prioritize when assessing for adverse effects? Assessment of level of consciousness Assessment for chest pain or shortness of breath Assessment of urinary output and urine appearance Assessment of respiratory rate and oxygen saturation

Assessment of respiratory rate and oxygen saturation

A nurse is preparing a 65-year-old woman for an ophthalmic examination. The nurse notes she has glaucoma. Which of the following drugs should the nurse question before administering?

Atropine

A client with Parkinson's disease is being treated with carbidopa-levodopa and benztropine. The client has a comorbid diagnosis of depression and takes amitriptyline 125 mg PO daily. What assessment should the nurse prioritize?

Auscultation of bowel sounds and monitoring bowel movements

A patient is being treated for bipolar disorder with lithium carbonate (Eskalith). He also suffers from congestive heart failure and hypertension. The patient has an increased fluid volume and has recently had difficulty breathing. What laboratory value will most affect the action of the patient's lithium carbonate? A. Increased potassium level B. Increased sodium level C. Increased white blood cell count D. Increased hematocrit

B. Increased sodium level

Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? A. Mydriasis B. Miosis C. Decrease in drainage of aqueous humor D. Pupillary dilatation

B. Miosis

The nurse is educating a patient who was administered atropine sulfate solution for an eye exam. The nurse includes which information in the education? A. The patient will have to wait 72 hours to wear contacts. B. Use of sunglasses is encouraged to decrease sunlight sensitivity. C. The patient may have small pupils for 12 hours after administration. D. A common side effect is dry eyes.

B. Use of sunglasses is encouraged to decrease sunlight sensitivity.

During an opthalmic procedure, the patient receives opthalmic acetycholine. The nurse is aware that which effect is the purpose of administering this drug? A. to produce mydriasis for opth exam B. to produce immediate miosis during opth surgery C. to cause cycloplegia to allow for measurement of intraoccular pressure D. to provide topical anesthesia during opth surgery

B. to produce immediate miosis during opth surgery

Which of the components of the eyeball is without blood vessels? A. Retina B. All of these C. Cornea D. Choroid

C. Cornea

The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? A. Avoid overuse of the eyes. B. Decrease the amount of salt in the diet. C. Eye medications will need to be administered for the client's entire life. D. Decrease fluid intake to control to control the intraocular pressure.

C. Eye medications will need to be administered for the client's entire life.

The nurse on the med-surg floor is reviewing discharge instructions with a patient who has a history of glaucoma. Which classification of drugs on the patient's discharge instructions is used to treat the patient's glaucoma?

Cholinergics

A nurse is teaching a patient with glaucoma how to administer eyedrops to achieve maximum absorption. Where should the nurse teach the patient to instill the eyedrops?

Conjunctival sac

A patient with dementia of Alzheimer's disease is administered donepezil HCL. Which of the following are the actions associated with cholinesterase inhibitors?

Increase in the level of acetylcholine in CNS

The opthamologist has given a patient a dose of ocular atropine gtts before an eye exam. Which statement by the nurse accurately explains to the patient the reason for these drops? A. These drops will cause the surface of your eye to become numb so the doctor can do an exam B. These drops are used to to check for any possible foreign bodies or corneal defects that may be in your eye C. These drops will reduce tear production for the eye exam D. These drops will cause your pupil to dilate, which makes the eye exam easier

D. These drops will cause your pupil to dilate, which makes the eye exam easier

In order to improve client outcomes, early recognition of the signs and symptoms of shock by the nurse is important. A nurse is caring for a client that has recently suffered an acute myocardial infarction. Which of the following are signs and symptoms of shock for which the nurse should monitor the client? Select all that apply: Bradycardia Tachypnea Hypoxia Decreased urinary output Increased blood pressure

Decreased urinary output Hypoxia Tachypnea

The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism?

Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus

In clients with acute psychosis, the treatment goal during the first week of treatment includes: Assessing the client for medical conditions, including obesity and hypertension. Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. Decreasing the client's medications and documenting patterns of sleeping and eating. Ensuring the client's compliance with oral drug therapy.

Decreasing the client's symptoms and normalizing the patterns of sleeping and eating.

Use of beta-adrenergic blocking drugs (e.g., propranolol) may have what effect?

Decreasing the effectiveness of epinephrine in cases of anaphylaxis

The nuring instructor is teaching students about Alzheimer's disease. The instructor informs the students that patients with this illness experience problems with memory and thinking. The reason that this happens is:

Degeneration of cholinergic pathways

The eyeball can exhibit refractory errors, which impair vision by interfering with the eye's ability to focus light rays on the retina. How are ophthalmic drugs used in these instances?

Diagnostically

What are the three mechanisms of action for Adrenergic drugs?

Direct receptor stimulation Indirect receptor stimulation Mixed-acting receptor stimulation

The nurse is assessing a client in the emergency department who has taken an overdose of phenylephrine. What symptoms should the nurse be alert for in this client? (Select all that apply.) Dizziness Headache Polyuria Pulmonary edema Seizures

Dizziness Headache Seizures

The nurse is administering haloperidol to a patient with psychosis. The nurse understands that the mechanism of action of this drug is to block the response of receptors in the brain. Which of the following receptors does it block? Dopamine (specifically D2), alpha, serotonin, and histamine receptors Dopamine (specifically D1), alpha, serotonin, cholinergic, and histamine receptors Dopamine (specifically D1), cholinergic, and histamine receptors Dopamine (specifically D2), serotonin, and histamine receptors

Dopamine (specifically D2), alpha, serotonin, and histamine receptors

An 80-year-old patient in the emergency department is receiving dopamine for treatment of shock. Which of the following adverse effects could the patient experience?

Dysrhythmia

Which would the nurse expect to be given to a patient experiencing acute bronchospasm?

Epinephrine

A patient is prescribed ophthalmic corticosteroids. What eye disorder may result from long-term use of ophthalmic corticosteroids?

Glaucoma

After teaching a group of students about anticholinergic agents, the instructor determines the need for additional teaching when the students identify which of the following as a contraindication for use? a) Toxic megacolon b) Hypertension c) Myasthenia gravis d) Prostatic hypertrophy

HTN

A nurse monitoring a client receiving dopamine should be aware of which adverse reactions that may result? (Select all that apply.)

Headache Cardiac arrhythmias Nausea Explanation: Adrenergic drugs like dopamine can cause the following adverse reactions: cardiac arrhythmias, headache, nausea, vomiting, and hypertension.

In which organ are the majority of beta-adrenergic receptors found? (Choose one) Kidney Liver Brain Heart

Heart

The autonomic nervous system controls which body functions? (Select all that apply.)

Heart rate Blood pressure Glandular secretions GI activity

As part of the nursing process in caring for a patient using adrenergic drugs, a registered nurse would include which of the following in her assessment data? Choose all that apply. History of asthma Allergies History of angina or hypertension ABGs

History of asthma Allergies History of angina or hypertension ABGs

Glaucoma is an optical disorder characterized by increased intraocular pressure (IOP). What causes increased IOP?

Impaired drainage of aqueous humor

The adrenergic receptors are categorized as alpha or beta. Which action results from stimulation of alpha2 receptors?

Inhibited release of norepinephrine

In the field, emergency personnel are quick to treat the signs and symptoms of shock because it can quickly lead to organ failure and death. What causes the generalized metabolic acidosis? Insufficient perfusion Cardiomyopathy GI bleed Insufficient glucose metabolism

Insufficient perfusion Inadequate blood flow to tissues results in anaerobic metabolism, which leads to generalized metabolic acidosis.

Pilocarpine (Pilocar) is used in the treatment of glaucoma. What is this drug's mechanism of action? It slows the production of aqueous fluid. It clears the debris from the Canal of Schlemm. It decreases the edema in the cornea. It pulls the iris away from the drainage channels so that the aqueous fluid can escape.

It pulls the iris away from the drainage channels so that the aqueous fluid can escape. Explanation: Miotics such as carbachol (Miostat) and pilocarpine (Pilocar) constrict the pupil. These medications pull the iris away from the drainage channels so that the aqueous fluid can escape. A drug that slows the production of aqueous fluid is Diamox. Option B is incorrect as no drug can do this.

The nurse is caring for a client with eye disease and is aware that drug therapy of eye disorders is unique because of what factors? (Select all that apply.)

Location, structire and function of the eye and blood-eye barrier pg. 1076

A patient experiences an acute convulsive seizure in the emergency department. Which of the following antiseizure drugs can be administered intravenously first to terminate this type of seizure? Lorazepam Gabapentin Ethosuximide Phenytoin

Lorazepam

The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response?

Monitor for increased signs of confusion or forgetfulness.

After reviewing the autonomic nervous system and cholinergic neurons, the students demonstrate a need for additional study when they identify which of the following as a location for cholinergic neurons?

Most postganglionic sympathetic nervous system nerves

The nurse should monitor a client closely for which of the following symptoms after an abrupt reduction in levodopa dose as neuroleptic malignant-like syndrome may occur? Select all that apply: Fever Urinary incontinence Muscular rigidity Mental status changes Hypotension

Muscular rigidity Fever Mental status changes

A patient who suffers from Parkinson's disease is being treated with levodopa (L-dopa). Which disorder will result in the discontinuation of levodopa (L-dopa) based on a disease-related contraindication? Narrow-angle glaucoma Normal-tension glaucoma Human immune deficiency virus Human papillomavirus

Narrow-angle glaucoma

The nurse would monitor a patient receiving a dopaminergic agent for which adverse effects. (Select all that apply.) Nervousness Dysphagia Flushing Hypertension Urinary frequency

Nervousness Dysphagia Flushing

A female client has both heart and eye disease. The nurse will administer the eye medications in what way to prevent exacerbation of her cardiac symptoms?

Occlude the nasolacrimal duct in the inner canthus of the eye

Which anticonvulsant elicits its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain? Phenytoin (Dilantin) Zonisamide (Zonegran) Valproic acid (Depakote) Ethosuximide (Zarontin)

Phenytoin (Dilantin)

A nurse administering a cholinergic-blocking medication to a client should monitor the client for which of the following visual adverse reactions? Select all that apply: a) Dipolpia b) Mydriasis c) Cycloplegia d) Photophobia e) Miosis

Photophobia • Mydriasis • Cycloplegia

A male client took zolpidem daily for 1 week with good response, then stopped the medication. Two days later, he returns to the office stating that his insomnia is worse than it ever was. The nurse is responsible for the development of a teaching plan for the client, including adverse reactions. After 1 week of regular use, which adverse reaction may occur with zolpidem?

Rebound insomnia

Which of the following is an effect of systemic administration of phenylephrine?

Reflex bradycardia

The nurse is caring for a client who has taken hydantoins for several years. The nurse noted that the client has an unsteady gait, dizziness, nystagmus, acute confusion, a non-raised red rash on one arm, and has not been to the dentist for 2 years. Based upon the findings, what is the priority nursing diagnosis?

Risk for injury related to untoward effect of hydantoin

A client with glaucoma has been given a prescription for a mydriatic drug. What is a priority action of the nurse?

Tell the physician

The patient with open-angle glaucoma exhibits which of the following?

The angle that permits drainage of aqueous humor appears normal but does not function properly.

A client who is experiencing withdrawal from alcohol has developed psychosis and is being treated with haloperidol. Which assessment findings should prompt the care team to assess the client for neuroleptic malignant syndrome?

The client develops muscle rigidity and a sudden, high fever.

When reviewing the medical record of a client receiving levodopa, what client factors should alert the nurse to the need for closer monitoring after administering the drug? The client is obese and has usually led a sedentary lifestyle The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma The client has taken calcium and vitamin D supplements for many years to prevent osteoporosis The client had cataract surgery last year and has hypertension

The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma

When caring for a client with chronic glaucoma, the nurse sets the goal of drug therapy to slow disease progression by reducing IOP. What are the first-line drugs used to treat glaucoma?

Topical beta blockers

The physiology instructor explains to the nursing students that Beta2 stimulation leads to which of the following?

Vasodilation of blood vessels

A client is in shock and is receiving dopamine. The nurse knows that the proper way dopamine should be given is by what method?

Via an electric infusion pump, by itself, and titrated to desired systolic blood pressure

A client has a neurologic disorder characterized by a deficiency of acetylcholine. In what location is acetylcholine normally synthesized? In the synaptic cleft between nerves and effector cells In the adrenal medulla Within cholinergic nerves themselves Within the grey matter of the spinal cord

Within cholinergic nerves themselves Explanation: Cholinergic nerves use choline, obtained in the diet, to produce ACh. It is not produced in the synaptic cleft, the adrenal medulla or in the spinal cord.

A signal has reached the terminus of a client's nerve and is in the space where the nerve is closest to the effector cell in a muscle. At what location is this signal? a. Synapse b. Soma c. Neuron d. Schwann cell

a. Synapse

A patient is using his incentive spirometer during the postoperative period. The skeletal muscles during the use of the incentive spirometer are stimulated by which neurotransmitter?

acetylcholine

The nurse is caring for a client who is under psychological and physiological stress. During sympathetic stimulation, the nurse should identify which neurotransmitter as being released by the preganglionic nerves of the sympathetic nervous system?

acetylcholine

An older adult client diagnosed with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention to ensure adequate function of which organ system?

assess renal function

The nurse assessed a client at 0800 and obtained a blood pressure of 111/70 mmHg. Two hours later, the client's blood pressure is 130/81 mmHg. The nurse should attribute this change to what action within the autonomic nervous system? a. Stimulation of nicotinic receptors b. Stimulation of beta-receptors c. Antagonism of alpha-receptors d. Decreasing levels of acetylcholinesterase

b. Stimulation of beta-receptors

Epinephrine is the drug of choice for treatment of anaphylactic shock. Epinephrine acts by stimulating

beta receptors

A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?

blood cell count

A female patient who takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?

blood cell count

A nurse is caring for a 59-year-old client with Parkinson's disease. What would indicate to the nurse that the client is experiencing an adverse reaction related to the drug carbidopa-levodopa?

blurred vision

While administering phenytoin, the nurse should observe the client for symptoms of which adverse reaction?

bradycardia

Nicotinic receptors would be found in which location? a. Bladder b. Gastrointestinal tract c. Adrenal medulla d. Sweat glands

c Nicotinic --> CNS, medulla, autonomic ganglia, and the neuromuscular junction. Muscarinic --> a sweat glands, bladder and GI tract.

Mr. Seeman, 65 years old, is admitted to the hospital for cardiogenic shock. He is placed on dopamine to improve his blood pressure. He also has a history of peripheral vascular disease, hyperlipidemia, and diabetes mellitus type 2. What adverse effect(s) would require health care provider notification?

changes in temperature or color of skin

Deactivation of norepinephrine (NE) occurs by breakdown of NE by which enzyme?

comt

The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client? a) Antianxiety b) Opioid c) Antiemetic d) Cholinergic blocking

d) Cholinergic blocking

A nurse is reviewing the structure and function of the neurologic system in preparation for a work placement on a neurologic unit? What statement most accurately describes an aspect of the autonomic nervous system? a. Nicotinic receptors are primarily associated with the parasympathetic nervous system b. Cholinergic receptors are exclusively located in the sympathetic nervous system c. Alpha- and beta-receptors are the two basic types of muscarinic receptors d. The autonomic nervous spans the central and peripheral nervous systems

d. The autonomic nervous spans the central and peripheral nervous systems

In which type of shock does the patient experience a mismatch of blood flow to the cells?

distributive

A client's thought disorder has been treated with haloperidol (Haldol). For what adverse effect should the nurse most closely monitor the client?

eps effects

A child has been presented for care because he has episodes where he pauses what he is doing for a few seconds, is unresponsive, and then continues on with his activity. The nurse should anticipate the administration of what medication?

ethosuximide

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: excessive sedation. infection. falls. uncontrolled bleeding.

falls

Anticholinergics do not block the effects of acetylcholine in the central nervous system. True or False.

false

What is a common risk for epileptic seizures during late infancy to early childhood?

fever

A client has had a stroke and computed tomography reveals infarcts in multiple brain regions. An infarct in which region is most likely to affect the function of the client's autonomic nervous system?

hypothalamus

The patient in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to which of the following?

inability to swallow

A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer?

lorazepam

The physician prescribes medication for a client's eye disorder. The physician's concern is that the client requires high concentrations of the drug. The nurse knows that the physician will order the medication in what type of formulation?

ointment

The nurse is reviewing the medication history with a new client. During the assessment the nurse notes this patient should be screened for glaucoma. Which of the following is a basic guideline to screen for glaucoma?

older than 40 years of age

Which anticonvulsant elicits its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain?

phenytoin

For a client with a known heart block (conduction disorder), what medication is contraindicated?

phenytoin (dilantin)

While providing patient education for a patient newly diagnosed with Parkinson's disease and their family, the nurse would explain that Parkinson's disease is characterized by

postural instability

The nurse is educating the client who has been started on Dilantin and its side effects. Which symptom would indicate a life-threatening condition and should be reported to the healthcare provider immediately?

rash with itching

A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication?

recent mi

A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses?

risk for falls

Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing lorazepam withdrawal?

severe insomnia for the past several nights

Your 69-year-old patient is started on IV dopamine for management of hypotension following open-heart surgery. As you care for the patient, you monitor him for adverse effects of the drug, including

tachycardia

The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply. temperature blood pressure cardiac function respiratory function level of consciousness

temperature blood pressure level of consciousness

The nurse is aware that epinephrine may be administered in what ways? (Select all that apply.)

topical iv inhalation

A patient is taking rivastigmine for Alzheimer disease. The nurse will evaluate the patient regularly for

weight loss

A patient is taking rivastigmine for Alzheimer disease. The nurse will evaluate the patient regularly for:

weight loss

The nurse is caring for a client who has been prescribed lithium and will perform which nursing interventions related to this medication? Select all that apply.

• Administer lithium with food. • Monitor client for drowsiness. • Increase fluid intake to approximately 3000 mL/day

The ophthalmic preparation pilocarpine (Isopto Carpine) should be used cautiously in clients with which of the following? Select all that apply:

• Asthma • Hypertension • Peptic ulcer disease

The nurse is preparing to administer timolol maleate to a client who has just been diagnosed with chronic open-angle glaucoma. The nurse will contact the physician before administering the medication if the client reports a history of which conditions? (Select all that apply.)

• Asthma • Heart failure • Left ventricular dysfunction

A nurse is preparing to teach a patient about timolol, which has been prescribed to treat newly diagnosed glaucoma. When reviewing the patient's current medication list, the nurse notes some medications that can increase the effect of timolol. Which of the following medications should not be used with timolol? Select all that apply.

• Calcium-channel blockers • Antihypertensives • Monoamine oxidase (MAO) inhibitors

A nurse monitoring a client taking carbidopa/levodopa (Sinemet) may notice which common adverse reactions? (Select all that apply.)

• Choreiform movements • Dry mouth • Anorexia

The nurse should be cautious and closely monitor clients receiving phenytoin (Dilantin) with which medical conditions? (Select all that apply.)

• Hypotension • Hepatic impairment

Which of the following adverse effects of ophthalmic medications should a nurse educate her client on? Select all that apply.

• Irritation • Blurred vision • Redness

A client comes to the emergency department. The client is experiencing continuous seizure activity without any interruptions. The nurse would anticipate that the primary health care provider would most likely prescribe which anticonvulsant? Select all that apply.

• Lorazepam • Phenytoin • Fosphenytoin

In which clients should the nurse review medical conditions prior to administering a carbidopa/levodopa (Sinemet), as its use is contraindicated in these clients? (Select all that apply.)

• Narrow angle glaucoma • Renal disease • Hepatic disease • Use of MAOI antidepressants

The nurse is preparing a client for an eye examination and administers atropine sulfate (ophthalmic). The nurse instructs the client that this medication has what effects on the eye? (Select all that apply.)

• Produces pupillary dilation • Produces mydriasis

A nurse is writing a care plan for a client who is being treated for glaucoma. Which of the following nursing diagnoses would be appropriate for this client? Select all that apply.

• Risk for Injury Related to Blurred Vision • Risk for Body Image Disturbance related to eye discoloration • Risk for Acute Pain related to increased intraocular pressure