NCLEX style questions pharmacology exam 2

21. The caregiver of a client diagnosed with AD asks the nurse about the prescribed therapy with rivastigmine and about how the drug works. The nurse would integrate knowledge of which action in the response to the caregiver? A) Increases the level of acetylcholine in the CNS B) Decreases the level of neurotoxins in the brain C) Increases the level of cholinesterase in the blood D) Increases the level of adenosine triphosphate in the blood

A Feedback: Administration of cholinesterase inhibitors results in an increase in the level of acetylcholine in the CNS. Administration of cholinesterase inhibitors does not decrease the neurotoxins in the brain or increase the level of adenosine triphosphate in the blood. Cholinesterase inhibitors inhibit and do not increase the level of cholinesterase in the blood.

20. A client has been prescribed an amphetamine. The nurse would assess the client for which of the following? A) Decreased appetite B) Low blood pressure C) Drowsiness D) Depression

A Feedback: Amphetamines have the ability to suppress appetite, so the client will show a decrease in appetite. The drug action results in high blood pressure, not low blood pressure. The client also experiences wakefulness, not drowsiness. Amphetamines produce a euphoric state, not depression.

19. An older adult client is prescribed diazepam for seizure control. Which of the following would be most important for the nurse to monitor? A) Respiratory rate and depth B) Blood glucose levels C) Swallowing ability D) Speech quality

A Feedback: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill patients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. There is no need to monitor the client's blood glucose levels, swallowing ability, or speech quality unless these were issues before this drug therapy was initiated.

21. A nurse emphasizes the need to avoid caffeine and caffeinated beverages with a client undergoing treatment for insomnia based on the nurse's understanding that caffeine will most likely have which effect? A) Wakefulness B) Depression C) Delirium D) Restlessness

A Feedback: Clients with insomnia should not drink beverages containing caffeine because it can cause wakefulness. Caffeine does not cause depression, delirium, or restlessness.

31. A client is receiving lithium therapy at a health care facility. The client informs the nurse that he is taking antacids for heartburn. The nurse would be alert for which of the following due to the interaction of the two drugs? A) Decreased effectiveness of lithium B) Increased risk of lithium toxicity C) Increased risk for bipolar disorder D) Increased psychotic symptoms

A Feedback: Combining lithium with antacids may result in decreased effectiveness of lithium. This combination will not increase the risk for lithium toxicity, bipolar disorder, or psychotic symptoms.

15. A nurse is caring for a client who is receiving cyclobenzaprine. The nurse would expect to assess which of the following as indicating the therapeutic effect of the drug? A) Reduction of muscle spasm B) Prevention of convulsion C) Relief from anxiety D) Relief from nervous disorder

A Feedback: Cyclobenzaprine affects muscle tone, thereby causing reduction of muscle spasm. Administration of cyclobenzaprine does not result in prevention of convulsion, relief from anxiety, or relief from nervous disorder.

21. A client with anxiety is prescribed anxiolytic therapy. Before administering the drug, the nurse assesses the client for symptoms of anxiety. Which of the following would the nurse expect to find? A) Increased blood pressure B) Decreased muscle tension C) Increased glucose level D) Decreased pulse rate

A Feedback: Increased blood pressure is a manifestation of anxiety. Additional manifestations include increased pulse rate and increased muscle tension. Increased glucose levels are not associated with anxiety.

14. A client is receiving alendronate for osteoporosis. The client has informed the nurse that she has also been taking aspirin. Which of the following interactions should the nurse monitor for in this client? A) Increased risk of GI bleeding B) Decreased effects of bisphosphonate C) Increased level of sedation D) Increased risk of rash

A Feedback: Interaction of aspirin with a bisphosphonate drug causes increased risk of GI bleeding, which requires monitoring. Interaction of a uric acid inhibitor with barbiturates and benzodiazepines causes an increased level of sedation. Interaction of a uric acid inhibitor with ampicillin causes increased risk of rash. Interaction of calcium supplements or antacids with bisphosphonates decreases the effects of bisphosphonates.

20. A nurse is assigned to care for a client who is to receive a cholinergic blocking drug. The nurse obtains the history from the client. Which of the following would alert the nurse to the need for cautious administration? A) The client has a decreased liver function. B) The client has a history of hallucinations or psychosis. C) The client has a cardiovascular disease. D) The client has a pulmonary disease.

A Feedback: It is important for the nurse to know if the client has decreased liver or kidney function so that the cholinergic blocking drug can be administered cautiously in the client. Other conditions in clients that require cautious use include tachycardia, cardiac arrhythmias, hypertension, hypotension, tendency toward urinary retention, and obstructive disease of the urinary system or gastrointestinal tract. The cholinergic blocking drugs are given with caution to older adults. The nurse should use dopamine receptor agonist drugs with caution in clients with a history of hallucinations or psychosis or cardiovascular disease. The nurse should use dopaminergic drugs with caution in clients with pulmonary diseases.

25. A client who is prescribed a hypnotic asks the nurse, "About how long will I be taking this medication?" Which time frame would the nurse most likely include in the response? A) 2 weeks B) 4 weeks C) 6 weeks D) 8 weeks

A Feedback: Sedatives and hypnotics are best given for no more than 2 weeks and preferably for a shorter time. Sedatives and hypnotics can become less effective after they are taken for a prolonged period.

18. After administering rivastigmine to a client with AD, the nurse would continue to assess the client for which of the following adverse effects? A) Anorexia and nausea B) Cardiovascular dysfunction C) Diabetes mellitus D) Hypertension

A Feedback: The adverse effects associated with the administration of cholinesterase inhibitors include anorexia and nausea. Cardiovascular dysfunction, diabetes mellitus, and hypertension are not adverse effects associated with the administration of cholinesterase inhibitors.

26. While assessing a client, the nurse observes hives and flushing. The client reports itching and a tightness in the throat. The nurse would identify which of the following nursing diagnoses? A) Risk for Allergy Response B) Ineffective Tissue Perfusion C) Decreased Cardiac Output D) Risk for Injury

A Feedback: The client is exhibiting signs and symptoms of an allergic reaction. Therefore, Risk for Allergy Response would be appropriate. Ineffective Tissue Perfusion and Decreased Cardiac Output would be appropriate if a client is experiencing hypotension and shock. Risk for Injury would be appropriate if the client was experiencing dizziness, weakness, confusion, or disorientation related to the drug therapy.

25. A client is receiving nadolol as part of the treatment plan for hypertension. The client reports dizziness on standing. The nurse checks the client's blood pressure lying, sitting, and standing and notes a significant drop in the readings. When developing this client's plan of care, which nursing diagnosis would the nurse most likely identify? A) Risk for Injury B) Ineffective Tissue Perfusion C) Impaired Comfort D) Decreased Cardiac Output

A Feedback: The client is experiencing orthostatic hypotension, placing the client at risk for falls and injury. Ineffective Tissue Perfusion would be appropriate if the client was experiencing more rapid changes in blood pressure and or changes in pulse and heart rate. Impaired Comfort would apply if the client was complaining of other adverse reactions such as dry mouth or constipation. There is no information provided that would suggest decreased cardiac output.

13. The nurse is providing care to a client receiving clozapine (Clozaril). The nurse would be alert for an increased risk of bone marrow suppression if the client is also receiving which of the following? Select all that apply. A) Immunological agents B) Anticholinergics C) Opioids D) Anticoagulants

A Feedback: The concomitant use of clozapine and immunological drugs can increase the severity of bone marrow suppression. The use of anticholinergics in combination with antipsychotics can increase the risk of tardive dyskinesia and psychotic symptoms. Opioids and anticoagulants are not associated with interactions involving antipsychotic drugs.

22. A nurse is caring for a client with suicidal tendencies. Which of the following would be most important for the nurse to do after administering the drug orally? A) Inspect the oral cavity to ensure that the drug is swallowed. B) Monitor body temperature for changes. C) Monitor blood pressure for unusual changes. D) Inspect pulse rate for unusual changes.

A Feedback: The immediate nursing intervention is to inspect the oral cavity to ensure that the client swallowed the drug. Assessment for changes in body temperature, blood pressure, and pulse rate should be completed once the nurse ensures that the client has swallowed the drug.

18. A client is to receive midodrine. Which of the following would the nurse include in the plan of care to ensure that the client doesn't develop supine hypertension? A) Administer midodrine during the day. B) Ensure that the client is lying in a supine position. C) Instruct the client to regularly shift positions. D) Assist the client when moving out of bed.

A Feedback: The nurse can minimize the risk of supine hypertension by administering the drug during the daytime. The nurse should ensure that the client is in an upright, not supine, position. Instructing the client to regularly shift positions or assisting the client when moving out of bed will not significantly reduce the risk of supine hypertension.

22. A nurse is monitoring the vital signs of a client who has received epinephrine. The nurse would report which of the following assessment findings? A) Systolic blood pressure below 100 mm Hg B) Temperatures reading of 97.6°F C) Pulse rate of 60 beats\min D) A diastolic blood pressure of 75 mm Hg

A Feedback: The nurse must immediately report a fall in systolic blood pressure below 100 mm Hg. Epinephrine should raise the blood pressure, so a continued low systolic pressure indicates the medication has not been effective. A diastolic blood pressure of 75 mm Hg, a pulse rate of 60 beats\min, and a temperature reading of 97.6°F are normal and need not be reported immediately.

17. A nurse is caring for a client who has been prescribed propranolol for angina. After administering the drug, which of the following would the nurse do? A) Ask about relief of symptoms and record responses on the chart. B) Determine signs of infection in the client. C) Monitor for sudden decrease in urine output. D) Monitor for sudden increase in intraocular pressure.

A Feedback: The nurse should ask about the relief of symptoms and record the responses on the client's chart. Determining the signs of infection in the client is part of the nurse's preadministration assessment, not the ongoing assessment. The nurse need not monitor the client for a sudden decrease in urine output and a sudden increase in intraocular pressure for a client receiving propranolol therapy for angina.

17. A nurse is caring for a 70-year-old client who is receiving anticholinergic drug therapy for Parkinson's disease. The nurse would be alert for the development of which of the following in this client? A) Confusion and disorientation B) Choreiform movements C) Suicidal tendencies D) Psychotic episodes

A Feedback: The nurse should assess for confusion and disorientation when caring for this elderly client receiving anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.

22. A nurse is caring for a client with a musculoskeletal disorder who is experiencing a significant impairment in the ability to ambulate due to pain. As a result, the client spends a majority of time in bed. Which of the following would the nurse most likely include in the client's plan of care? A) Changing the client's position every 2 hours B) Changing the bed linens every hour C) Encouraging the client to walk with assistance D) Encouraging the client to exercise with assistance

A Feedback: The nurse should change the client's position every 2 hours and inspect pressure sites for skin breakdown. The nurse need not change linens every hour. Once the client's condition improves, then encouraging ambulation with assistance and exercises would be appropriate.

21. A nurse is caring for a client who requires antiparkinson drug therapy. The nurse confirms that which of the following conditions is absent because it would contraindicate the use of the COMT inhibitor? A) Pregnancy B) Achalasia C) Peptic ulcers D) Glaucoma

A Feedback: The nurse should confirm that the client is not pregnant or lactating and that the client does not have a hypersensitivity to the drug to ensure that the use of COMT inhibitors is not contraindicated. Achalasia, peptic ulcers, and glaucoma are not conditions that are contraindications to the use of COMT inhibitors. The use of cholinergic blocking drugs is contraindicated in clients with achalasia, peptic ulcers, and glaucoma.

20. A client is prescribed dopamine. Which of the following would the nurse include in the client's plan of care? A) Administering dopamine only via IV route B) Maintaining a fixed rate of administration C) Monitoring blood pressure every half hour D) Diluting dopamine with sodium bicarbonate

A Feedback: The nurse should ensure that dopamine is administered intravenously. The rate of administration of the drug should be adjusted according to the client's blood pressure, and it should not be fixed at any particular rate. The nurse should monitor blood pressure every 2 minutes, not every half hour, from the beginning of therapy until the desired blood pressure is achieved.

19. A nurse would cautiously administer sedatives and hypnotics to which of the following clients? A) Clients who are lactating B) Clients with heart trouble C) Clients with hypertension D) Clients with gastrointestinal upset

A Feedback: The nurse should exercise caution when administering sedatives and hypnotics to lactating clients. Sedatives and hypnotics are not contraindicated in clients with heart trouble, hypertension, or gastrointestinal problems, nor do they require cautious use.

19. A nurse is caring for a client with depression. The client has been prescribed amitriptyline. Which of the following would the nurse integrate into the teaching for the client about how the drug works? A) Decreased reuptake of norepinephrine B) Increased serotonin in the nervous system C) Increased endogenous norepinephrine D) Increased endogenous epinephrine

A Feedback: The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the patient's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.

16. A nurse is caring for a client with schizophrenia. The physician has prescribed olanzapine in a disintegrating tablet form for the client. Which of the following points should the nurse include in the teaching plan for the client? A) Remove the tablet with dry hands. B) Take the tablet with a full glass of water. C) Add extra salt to food. D) Avoid tea or coffee.

A Feedback: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in his or her mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee.

16. A nurse is caring for a client who has been prescribed amantadine for the treatment of the influenza A virus. After administration of the drug, the client complains of dry mouth. Which of the following instructions should the nurse offer the client to help relieve dry mouth? A) Instruct the client to take ice chips frequently. B) Encourage the client to take small, frequent meals. C) Instruct the client to avoid protein-rich foods. D) Stop the use of the antiparkinsonism drug by the client.

A Feedback: The nurse should instruct the client to suck on ice chips or hard candy (if allowed). The nurse should also instruct the client to take frequent sips of water throughout the day and between meals. The nurse encourages the client to have small, frequent meals when the client experiences a GI disturbance and not when the client complains of dry mouth. The nurse also need not instruct the client to avoid protein-rich foods because this will not reduce the client's discomfort due to dry mouth. The nurse should stop the use of the antiparkinsonism drug when the client complains of severe nausea or vomiting and not when the client is experiencing dry mouth. If dry mouth is so severe that there is difficulty in swallowing or speaking, or if loss of appetite and weight loss occur, the dosage of the antiparkinsonism drug may be reduced but not stopped completely.

21. After administering dobutamine to a client, the nurse would assess the client closely for which adverse reaction? A) Cardiac arrhythmias B) Urinary retention C) Elevated temperature D) Sleeplessness

A Feedback: The nurse should monitor for cardiac arrhythmias (bradycardia and tachycardia) because they are common adverse reactions observed in clients receiving dobutamine HCL. Dobutamine HCL does not cause urinary retention, elevated temperature, or sleeplessness.

16. A client who is receiving a b blocker tells the nurse that he also takes ibuprofen for arthritis pain. The nurse would be alert for which of the following? A) Decreased effect of the b blocker B) Increased risk of bradycardia C) Increased risk of paradoxical hypertensive effect D) Increase risk of hypotension

A Feedback: The nurse should monitor for the decreased effect of the b blocker in the client who is receiving a b blocker along with NSAIDs. The nurse need not monitor for increased risk of bradycardia and paradoxical hypertensive effect or decreased risk of hypotension. There is an increase in the risk of paradoxical hypertensive effect when a b-adrenergic blocking drug is administered with clonidine. There is an increase in the risk of bradycardia when a b-adrenergic blocking drug is administered with antidepressants. There is an increased risk of hypotension when a b-adrenergic blocking drug is administered with loop diuretics.

17. A nurse is caring for a client with urinary retention who is receiving a cholinergic drug as part of the treatment plan. After administering the drug, the nurse would notify the primary health care provider if the assessment reveals which of the following? A) Failure to void after drug administration B) Frequent vomiting after drug administration C) Increase in abdominal pain after drug administration D) Occurrence of blood in urine after drug administration

A Feedback: The nurse should notify the primary health care provider if the client fails to void after drug administration. Frequent vomiting, increase in abdominal pain, and occurrence of blood in urine are not usually observed when urinary retention is treated with cholinergic therapy.

18. A nurse at a health care center has been asked to prepare a teaching plan for a client on oxazolidinedione therapy. Which of the following points should the nurse include? A) Avoiding exposure to ultraviolet light B) Taking the drug 2 hours after a meal C) Taking the drug with milk D) Avoiding carbonated drinks during therapy

A Feedback: The nurse should suggest avoiding exposure to ultraviolet light in the teaching plan of the client on oxazolidinedione therapy because of the risk for photosensitivity. The nurse need not include taking the drug 2 hours after a meal, taking the drug with milk, or avoiding carbonated drinks.

23. A client who was receiving a benzodiazepine for treatment of anxiety tells the nurse that he has decided to discontinue the treatment. Which of the following would the nurse include in the teaching plan for this client? A) "Be sure to gradually decrease the dosage over time." B) "It's fine to just stop taking the medication." C) "You need to first increase the dose and then stop." D) "It's important that you continue the medication even if you want to stop."

A Feedback: The nurse should suggest the client gradually decrease the dosage schedule to avoid withdrawal symptoms. It is not advisable for the nurse to suggest just stopping the medication, increasing the dosage, or continuing with the medication as prescribed.

21. A nurse is caring for a client with an arrhythmia. Which of the following would be most important for the nurse to do for a client with a life-threatening arrhythmia who is receiving an adrenergic blocking drug intravenously? A) Perform continuous cardiac monitoring. B) Obtain pulse rate readings every 6 to 8 hours. C) Assess respiratory rate every hour. D) Obtain body temperature readings every 15 minutes.

A Feedback: The patient with a life-threatening arrhythmia may receive an adrenergic blocking drug, such as propranolol, by the intravenous (IV) route. When these drugs are administered IV, cardiac monitoring is necessary. Patients not in a monitored unit are usually transferred to one as soon as possible. When these drugs are administered for a life-threatening arrhythmia, it is important to monitor the patient continually with cardiac, blood pressure, and respiratory rate monitoring frequently.

14. A nurse is caring for a client who has been given a centrally acting antiadrenergic drug. The nurse knows that under which of the following conditions is the use of a centrally acting antiadrenergic drug contraindicated? A) Active hepatic disease B) Active peptic ulcer C) Ulcerative colitis D) Mental depression

A Feedback: The use of a centrally acting antiadrenergic drug is contraindicated in clients with active hepatic disease. The use of a centrally acting antiadrenergic drug is not contraindicated in clients with active peptic ulcer, ulcerative colitis, or mental depression. In clients with active peptic ulcer, ulcerative colitis, or mental depression, the use of peripherally acting antiadrenergic drug is contraindicated.

14. A client is prescribed memantine for the treatment of dementia of Alzheimer's disease. The nurse should assess the client for which of the following as a possible adverse reaction? A) Confusion B) Dyspepsia C) Muscle cramps D) Vomiting

A Feedback: When administering memantine to a client, a nurse should monitor the client for adverse reactions such as dizziness, headache, or confusion. Dyspepsia is an adverse reaction of rivastigmine; muscle cramps are an adverse reaction of donepezil; vomiting is an adverse reaction of rivastigmine and galantamine.

19. A client uses levodopa for treatment of Parkinson's disease. The client is now prescribed an adrenergic blocking agent. The nurse would assess the client for which of the following? A) Decreased effect of levodopa B) Increased effect of adrenergic blocker C) Increased risk of levodopa toxicity D) Decreased risk of psychotic behavior

A Feedback: When levodopa and adrenergic blockers are administered together, the effect of the levodopa is decreased. Therefore, the client's Parkinson's disease may not be controlled as effectively as before. The effect of the adrenergic blocker is not increased, nor is the risk for levodopa toxicity. The client is not experiencing psychotic behavior.

20. A client is receiving allopurinol. Which of the following would be most important for the nurse to include in the client's plan of care? A) Liberal fluid intake B) Moderate exercise C) Use of a brace or corset D) Avoidance of direct sunlight

A Feedback: When using uric acid inhibitors, such as allopurinol, the nurse should encourage liberal fluid intake and measure the client's intake and output. The client does not need to exercise or use braces or corsets; clients with osteoporosis may require a brace or corset when out of bed. The client need not avoid sunlight as uric acid inhibitors do not cause photosensitivity.

22. After teaching a group of nursing students about sedatives and hypnotics, the instructor determines that additional teaching is needed when the students identify the absorption of which drug as being affected by a high-fat meal? A) Zolpidem B) Eszopiclone C) Ramelteon D) Zaleplon

A Feedback: Zolpidem should not be taken with food. A high-fat meal or snack can interfere with the absorption of the following drugs: eszopiclone, ramelteon, and zaleplon.

2. When describing drugs that block or inhibit the sympathetic nervous system, the nurse includes which of the following? Select all that apply. A) Antiadrenergic drugs B) Adrenergic blocking drugs C) Adrenergic stimulating drugs D) Adrenergic drugs E) Sympatholytics

A, B, E Feedback: Drugs that block or inhibit the sympathetic nervous system are known as antiadrenergic drugs, adrenergic blocking drugs, and sympatholytics.

5. When describing the adrenergic nervous system, which of the following would the instructor describe as two types of receptors that are found in this system? Select all that apply. A) Alpha receptors B) Beta receptors C) Delta receptors D) Gamma receptors E) Omega receptors

A, B Feedback: Alpha and beta receptors are the two types of adrenergic nervous system receptors.

2. After teaching a group of nursing students about antipsychotic drugs, the instructor determines that the teaching was successful when the students identify aripiprazole (Abilify) as exerting its effect on which of the following in the brain? Select all that apply. A) Serotonin B) Dopamine C) Norepinephrine D) Muscarinic E) Nicotinic

A, B Feedback: Atypical antipsychotic drugs like aripiprazole (Abilify) are thought to act on serotonin and dopamine receptors in the brain. The conventional, or first-generation, antipsychotics (FGAs) work to diminish the positive symptoms by blocking dopamine transmission.

8. A nurse should advise clients taking which medications to avoid the use of ginkgo? Select all that apply. A) Selective serotonin reuptake inhibitors B) Monoamine oxidase inhibitors C) NSAIDs D) Nonsalicylates E) Anticholinergics

A, B Feedback: Ginkgo is contraindicated in clients taking SSRI or MAOI antidepressants, because of the risk of a toxic reaction. Cholinesterase inhibitors interact with anticholinergics. Ginkgo does not interact with NSAIDs or nonsalicylates.

28. A group of nursing students are reviewing information about drug therapy for rheumatoid arthritis. The students demonstrate understanding of the information when they identify which of the following as an example of a DMARD? Select all that apply. A) Infliximab B) Etanercept C) Ibandronate D) Zoledronic acid E) Carisoprodol

A, B Feedback: Infliximab and etanercept are examples of DMARDs. Ibandronate and zoledronic acid are examples of bone resorption inhibitors (bisphosphonates). Carisoprodol is a skeletal muscle relaxant.

12. When administering antipsychotic drugs, the nurse would need to keep in mind that which of the following atypical antipsychotics are most commonly associated with weight gain? Select all that apply. A) Olanzapine (Zyprexa) B) Risperidone (Risperdal) C) Ziprasidone (Geodon) D) Quetiapine (Seroquel) E) Clozapine (Clozaril)

A, B Feedback: Olanzapine (Zyprexa) and risperidone (Risperdal) are atypical antipsychotics that are most commonly associated with weight gain. None of the other drugs are associated with weight gain.

13. A client receiving clomipramine is given a prescription for zolpidem for sleep. The primary health care provider was unaware the client was taking clomipramine. Which of the following reactions might the nurse observe in this client? Select all that apply. A) Respiratory depression B) CNS depression C) Hypertensive crisis D) Easy bruising E) Hyperglycemia

A, B Feedback: The concomitant administration of tricyclic antidepressants like clomipramine with hypnotics like zolpidem can result in the increased risk of respiratory depression and CNS depression.

4. When reviewing the client's medical record, the nurse understands that which of the following if found would contraindicate administering phenytoin (Dilantin) to a client? Select all that apply. A) Pregnancy B) Sinus bradycardia C) Hepatic disease D) Diabetes E) Atrial fibrillation

A, B Feedback: The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block and in clients who are pregnant or lactating.

21. The nurse identifies a nursing diagnosis of Diarrhea for a client being started on cholinergic drug therapy. Which of the following would the nurse most likely include in the client's plan of care? Select all that apply. A) Ensure that the client has readily available access to the bathroom. B) Evaluate the number, frequency, and consistency of the stools. C) Contact the primary health care provider for an order to switch to another cholinergic drug. D) Limit the client's fluid intake to 1000 mL per day. E) Maintain the client on strict bed rest.

A, B Feedback: When a cholinergic drug is administered, the client may experience diarrhea. This reaction will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse needs to ensure that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist in the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse should document fluid intake and output and track the number, consistency, and frequency of stools if diarrhea is present. Since diarrhea occurs with any cholinergic drug, switching to another would be of no help. The client needs to replace fluids lost with diarrhea, so limiting fluid intake would be inappropriate. Ambulating to assist with the passage of flatus would be appropriate, while strict bed rest would not be necessary.

10. A client is prescribed ropinirole (Requip). The nurse would anticipate an increase in dopamine agonist effects if which of the following medications are initiated? Select all that apply. A) Ranitidine (Zantac) B) Verapamil (Calan) C) Estradiol (Estrace) D) Perphenazine (Trilafon) E) Lisinopril (Prinivil)

A, B, C Feedback: A client taking ropinirole (Requip) will have increased dopamine agonist effects if ranitidine, verapamil, or estrogens such as estradiol are initiated.

9. Which of the following are reasons a nurse may need to contact the client's physician to administer an antipsychotic drug intramuscularly instead of orally? Select all that apply. A) Client is combative. B) Client refuses the medication. C) Client won't allow the nurse to inspect the oral cavity. D) Client has difficulty swallowing. E) Client is elderly.

A, B, C Feedback: A nurse may need to contact the client's physician to administer an antipsychotic drug intramuscularly instead of orally because the client is combative, refuses the medication, or refuses to allow the nurse to inspect the oral cavity. Clients who have difficulty swallowing may be given an oral liquid in lieu of an IM injection.

27. A nurse would anticipate that a client receiving a sedative or hypnotic would experience an increased sedative effect if the client was also receiving which of the following? Select all that apply. A) Antihistamines B) Phenothiazines C) Opioid analgesics D) NSAIDs E) Anticoagulants

A, B, C Feedback: An increased sedative effect occurs when sedatives or hypnotics are given with antihistamines, phenothiazines, and opioid analgesics.

28. After teaching a group of students about antidepressant therapy, the instructor determines that the teaching was successful when the students identify which of the following as a class of antidepressants? Select all that apply. A) Selective serotonin reuptake inhibitors B) Tricyclics C) Monoamine oxidase inhibitors D) Benzodiazepines E) Barbiturates

A, B, C Feedback: Antidepressants include selective serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors. Benzodiazepines and barbiturates are sedative and hypnotics.

10. A client is hospitalized and is prescribed diazepam. Before administering the drug, which of the following information should the nurse obtain? Select all that apply. A) Complete medical history B) Mental status exam C) Anxiety level D) Pain assessment E) Medication history

A, B, C Feedback: Before starting anxiolytic therapy in a hospitalized client, the nurse obtains a complete medical history, including mental status and anxiety level.

10. A nurse is caring for a client with benign prostatic hypertrophy (BPH). Which of the following would the nurse expect to be prescribed as treatment? Select all that apply. A) Doxazosin (Cardura) B) Alfuzosin (Uroxatral) C) Tamsulosin (Flomax) D) Prazosin (Minipress) E) Mecamylamine (Inversine)

A, B, C Feedback: Doxazosin, alfuzosin, and tamsulosin are peripherally acting adrenergic blocking drugs used in the treatment of BPH.

24. A nurse is reviewing the medical record of a client who is exhibiting Parkinson-like adverse reactions due to drug therapy. Which drugs might the nurse note in the client's record? Select all that apply. A) Antidepressants B) Conventional antipsychotics C) Lithium D) Opioids E) NSAIDs

A, B, C Feedback: Drugs such as antidepressants, antiemetics, first-generation antipsychotics, lithium, and stimulants can cause symptoms similar to Parkinson's disease. Opioids and NSAIDs are not associated with Parkinson-like symptoms.

10. In addition to obtaining the client's vital signs, which of the following questions would be most appropriate to consider before administering a prescribed medication to a client for sedation? Select all that apply. A) Is the drug being used in preparation for a surgical procedure? B) Is the timing of the drug administration correct? C) Has a consent form for the procedure been signed? D) Is the client experiencing discomfort related to pain? E) Are there disturbances in the environment that may keep the client awake?

A, B, C Feedback: In addition to obtaining the client's vital signs, the nurse should ask the following questions in preparation for a client to receive a prescribed sedative: Is the drug being used in preparation for a surgical procedure? Is the drug's administration correctly timed? Has a consent form for the procedure been signed before the medication is given?

15. An older adult client is experiencing anxiety. Which anxiolytic drug would the nurse identify as being relatively safe to administer to this client at a normal dose? Select all that apply. A) Buspirone B) Lorazepam C) Oxazepam D) Alprazolam E) Diazepam

A, B, C Feedback: Lorazepam, oxazepam, and buspirone are relatively safer for older adult clients when given at normal doses.

23. A client is receiving antipsychotic therapy. As part of the client's plan of care, the nurse assesses the client for possible adverse reactions. Which of the following would lead the nurse to suspect that the client is experiencing extrapyramidal effects? Select all that apply. A) Mask-like facial appearance B) Increased motor activity C) Facial grimacing D) Delusions E) Flat affect

A, B, C Feedback: Manifestations of extrapyramidal syndrome include Parkinson-like symptoms—fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, and unsteady gait; akathisia—extreme restlessness and increased motor activity; and dystonia—facial grimacing and twisting of the neck into unnatural positions. Delusions and flat affect are manifestations associated with schizophrenia.

26. A client comes to the clinic for a follow-up visit. The client is prescribed lamotrigine for seizure control. The nurse suspects that the client may be experiencing Stevens-Johnson syndrome based on which of the following? A) Complaints of muscle pain B) Lesions on the mucous membranes C) Blisters on the face and neck D) Recurrence of seizure activity E) Dizziness

A, B, C Feedback: Stevens-Johnson syndrome (SJS) is manifested by fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities. Recurrence of seizure activity and dizziness are not associated with this condition.

27. After teaching the family of a client with Parkinson's disease about possible adverse reactions, the nurse determines that the teaching was successful when the family states they will withhold the drug if the client experiences which of the following? Select all that apply. A) Facial grimacing B) Exaggerated chewing motions C) Protruding tongue D) Constipation E) Lack of appetite

A, B, C Feedback: The nurse should teach the client and family how to describe movements and to be alert for those such as facial grimacing, protruding tongue, exaggerated chewing motions and head movements, and jerking movements of the arms and legs. If these occur, the client should not take the next drug dose and should notify the primary health care provider immediately.

2. A client is prescribed donepezil. The nurse would assess the client for which of the following as a possible adverse reaction? Select all that apply. A) Anorexia B) Dizziness C) Headache D) Constipation E) Bradycardia

A, B, C Feedback: The nurse would assess the client for generalized adverse reactions to cholinesterase inhibitors like donepezil, which would include anorexia, nausea, vomiting, diarrhea, dizziness, and headache.

7. After conducting an in-service presentation about CNS stimulants, the presenter determines that the teaching was successful when the group identifies which of the following as a contraindication to their use? Select all that apply. A) Epilepsy B) COPD C) Glaucoma D) Diabetes E) GERD

A, B, C Feedback: The use of CNS stimulants is contraindicated in clients with known hypersensitivity, epilepsy, COPD, or glaucoma.

6. After administering an anxiolytic, the nurse assesses the client for adverse reactions. Which of the following would the nurse identify as a common early reaction to this group of drugs? Select all that apply. A) Headache B) Sedation C) Lightheadedness D) Dizziness E) Hypertension

A, B, C, D Feedback: Common early reactions caused by anxiolytics include mild drowsiness, sedation, lightheadedness, dizziness, and headache.

25. The nurse is providing care to an older adult who is receiving antipsychotic therapy. The primary health care provider prescribes an oral liquid concentrate. When administering the drug, the nurse would mix the drug with which of the following? Select all that apply. A) Fruit juice B) Milk C) Pudding D) Soup E) Green leafy vegetables

A, B, C, D Feedback: Oral liquid concentrates are available for patients who can more easily swallow a liquid. To aid in administration to debilitated or elderly patients, oral drugs can be mixed in liquids such as fruit juices, tomato juice, milk, or carbonated beverages. Semisolid foods, such as soups or puddings, may also be used. Green leafy vegetables would be an inappropriate choice based on the usual texture of the food and the inability to mix the drug solution with the food.

9. A client is prescribed a CNS stimulant as treatment for attention deficit hyperactivity disorder. Which of the following assessments would be most important for the nurse to obtain before administering the drug? Select all that apply. A) Blood pressure B) Weight C) Respiratory rate D) Behavior pattern E) Review of recent lab work

A, B, C, D Feedback: The nurse's preadministration assessment of a client receiving a CNS stimulant for attention deficit hyperactivity disorder should include blood pressure, respiratory rate, weight, and behavior pattern. A review of recent lab work would not be necessary.

10. Which of the following would be most important for the nurse to assess before administering a CNS stimulant to a client being treated for obesity? Select all that apply. A) Blood pressure B) Pulse C) Weight D) Respiratory rate E) Review of recent lab work

A, B, C, D Feedback: The nurse's preadministration assessment of a client receiving a CNS stimulant for the treatment of obesity should include blood pressure, pulse, respiratory rate, and weight. A review of recent lab work would not be necessary.

13. Which of the following are examples of supportive care the nurse can provide to a client receiving a sedative or hypnotic drug to promote the effects of the drug? Select all that apply. A) Darkening the client's room B) Discouraging caffeine intake C) Providing a quiet atmosphere D) Administering back rubs E) Waking the client to check consciousness

A, B, C, D Feedback: To promote the effects of the sedative or hypnotic drug, the nurse can provide supportive care, such as giving back rubs, using night lights or making the room dark, providing a quiet atmosphere, and discouraging caffeine use.

8. A nurse withholds a cholinergic blocking drug prescribed for an older adult client based on which assessment finding? Select all that apply. A) Excitement B) Mental confusion C) Urinary retention D) Drowsiness E) Agitation

A, B, C, D, E Feedback: A nurse should withhold a cholinergic blocking drug from an older adult client who is excited, agitated, mentally confused, drowsy, or experiencing urinary retention or other adverse effects.

8. A client is prescribed a CNS stimulant as treatment for respiratory depression. Before administering the drug, which of the following would be most important for the nurse to assess? Select all that apply. A) Blood pressure B) Pulse C) Respiratory rate D) Respiratory pattern E) Review of recent lab work

A, B, C, D, E Feedback: Before administering a CNS stimulant, the nurse should assess the following: blood pressure; pulse; respiratory rate, depth, and pattern; and review of recent lab work. In addition, the nurse should identify the drug or drugs that may have contributed to the client's respiratory depression.

12. Ma huang is an herbal product that has been used to relieve cold symptoms and for weight loss. The nurse would instruct a client receiving which of the following to avoid products containing ma huang? Select all that apply. A) Digoxin (Lanoxin) B) Phenelzine (Nardil) C) Guanethidine (Ismelin) D) Oxytocin (Pitocin) E) Halothane (Avestan)

A, B, C, D, E Feedback: Clients taking digoxin, phenelzine, guanethidine, oxytocin, halothane, or St. John's wort should not take ma huang.

8. Before administering a prescribed antipsychotic drug to a client, the nurse observes the client for any behavior patterns that appear to be deviations from normal. Which of the following would the nurse identify as a deviation? Select all that apply. A) Poor eye contact B) Monotone speech pattern C) Inappropriate laughter D) Failure to answer questions completely E) Inappropriate crying

A, B, C, D, E Feedback: Examples of deviation from normal include poor eye contact, failure to answer questions completely, inappropriate answers to questions, a monotone speech pattern, and inappropriate laughter, sadness, or crying.

1. A nurse understands that sedatives and hypnotics are used to treat insomnia, which may be caused by which of the following? Select all that apply. A) Hospitalization B) Chronic pain C) Stress D) Anxiety E) Jet lag

A, B, C, D, E Feedback: Insomnia may be caused by lifestyle changes, such as a new job, moving to a new town, or returning to school; jet lag; chronic pain; headaches; stress; anxiety; or hospitalization.

15. The nurse instructs the client and family about possible visual and mental adverse reactions that can occur. Which of the following would the nurse include in the teaching to reduce the client's risk for injury? Select all that apply. A) Removing throw rugs B) Moving furniture against the wall C) Making sure floors are dry D) Avoiding having the floors waxed E) Removing electrical cords from walkways

A, B, C, D, E Feedback: Objects or situations that may cause falls, such as throw rugs, electrical cords, footstools, furniture, and wet or newly waxed floors, are removed or avoided whenever possible.

15. A client is prescribed paroxetine. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? Select all that apply. A) Sexual dysfunction B) Insomnia C) Somnolence D) Diarrhea E) Constipation

A, B, C, D, E Feedback: The following are possible adverse reactions that may occur with paroxetine: headache, tremors, somnolence, nervousness, dizziness, insomnia, nausea, diarrhea, constipation, dry mouth, sweating, weakness, and sexual dysfunction.

12. A nurse is assessing a client's seizure activity. Which of the following would the nurse include? Select all that apply. A) Description of seizures B) Seizure frequency C) Average length of seizures D) Description of aura E) Description of the degree of impairment

A, B, C, D, E Feedback: The nurse's general assessment of seizure activity should include the following: description of seizures, seizure frequency, average length of seizures, description of aura, description of the degree of impairment, and description of what appears to bring on the seizure.

11. After administering a CNS stimulant to a client being treated for respiratory depression, the nurse would continue to assess which of the following? Select all that apply. A) Blood pressure B) Pulse C) Respiratory rate D) Respiratory pattern E) Level of consciousness

A, B, C, D, E Feedback: The nurse's ongoing assessment of a client receiving a CNS stimulant for respiratory depression should include blood pressure; pulse; respiratory rate, depth, and pattern; and level of consciousness.

8. Before administering an antidepressant to a client, which of the following would the nurse assess? Select all that apply. A) Vital signs B) Presence of suicidal ideation C) Complete medical history D) Weight E) Mental status

A, B, C, D, E Feedback: The nurse's preadministration assessment for a client receiving an antidepressant should include vital signs, presence of suicidal ideation, complete medical history, weight, and mental status.

9. A nurse monitoring a client taking trimethadione should notify the primary health care provider if assessment reveals which of the following? Select all that apply. A) Visual disturbances B) Fever C) Easy bruising D) Dry mouth E) Sore throat

A, B, C, E Feedback: A nurse monitoring a client taking trimethadione should notify the primary health care provider if visual disturbances, excessive drowsiness or dizziness, sore throat, fever, skin rash, pregnancy, malaise, easy bruising, epistaxis, or bleeding is observed.

1. A nurse would assess a client treated with an antipsychotic medication for which of the following behaviors if the antipsychotic medication was stopped? Select all that apply. A) Hallucinations B) Anhedonia C) Delusions D) Dystonia E) Flattened affect

A, B, C, E Feedback: Antipsychotic medications help control symptoms associated with psychotic disorders such as hallucinations, delusions, disorganized speech, behavior disturbances, social withdrawal, flattened affect, and anhedonia. Dystonia would be noted as an adverse reaction with antipsychotic drugs.

11. A client is prescribed benztropine. The nurse would administer the drug cautiously and monitor the client closely if the client also had a diagnosis of which of the following? Select all that apply. A) Hyperthyroidism B) Hepatic disease C) Renal disease D) Epilepsy E) Hypertension

A, B, C, E Feedback: Cholinergic blocking drugs, like benztropine (Cogentin), are used cautiously in clients with hypertension, GI infection, benign prostatic hypertrophy, urinary retention, hyperthyroidism, and hepatic or renal disease.

32. The nurse is reviewing the medical records of several clients who are receiving lithium. Which of the following would the nurse identify as being at increased risk for the development of lithium toxicity? Select all that apply. A) Clients receiving furosemide (Lasix) B) Clients experiencing diarrhea C) Clients with renal insufficiency D) Clients with liver cirrhosis E) Clients experiencing vomiting

A, B, C, E Feedback: Clients with dehydration, diarrhea, vomiting, renal or cardiovascular disease, or sodium depletion and those receiving diuretics (i.e., furosemide) are at an increased risk for developing lithium toxicity.

7. A nurse suspects that a client who is receiving lorazepam may be experiencing benzodiazepine withdrawal based on assessment of which of the following? Select all that apply. A) Anxiety B) Tremor C) Photophobia D) Insomnia E) Metallic taste

A, B, C, E Feedback: Symptoms of benzodiazepine withdrawal include increased anxiety, concentration difficulties, tremor, and sensory disturbances, such as paresthesias, photophobia, hypersomnia, and metallic taste.

8. The nurse understands the need for cautious administration of the prescribed entacapone to a client with which of the following? Select all that apply. A) Hypotension B) Renal dysfunction C) Hepatic dysfunction D) Diabetes E) Hypertension

A, B, C, E Feedback: The nurse should cautiously administer entacapone (Comtan) to clients with hypotension, hypertension, and decreased hepatic or renal function.

6. A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when which of the following medications are initiated? Select all that apply. A) Cimetidine (Tagamet) B) Amitriptyline (Elavil) C) Metformin (Glucophage) D) Aspirin E) Lisinopril (Prinivil)

A, B, D Feedback: A nurse administering valproic acid to a client should monitor the client for increased effects of valproic acid when antibiotics, antifungals, salicylates (such as aspirin), tricyclic antidepressants such as amitriptyline, and cimetidine are initiated.

19. A nurse caring for a client with obesity would expect the primary health care provider to prescribe which of the following CNS stimulants? Select all that apply. A) Benzphetamine B) Phentermine C) Modafinil D) Sibutramine E) Dextroamphetamine

A, B, D Feedback: A nurse caring for a client with obesity may administer benzphetamine, phentermine, and sibutramine.

14. An older adult client is receiving a CNS stimulant. When assessing this client, the nurse integrates knowledge about an older adult client's increased sensitivity to the drug, closely monitoring the client for which of the following? Select all that apply. A) Anxiety B) Insomnia C) Bradycardia D) Confusion E) Hypotension

A, B, D Feedback: A nurse caring for an older adult client receiving CNS stimulants should monitor the client closely for anxiety, nervousness, insomnia, and mental confusion because older clients are more sensitive to the adverse reactions of this group of drugs.

7. A client is prescribed phenelzine. Which of the following would the nurse instruct the client to avoid? Select all that apply. A) Blue cheese B) Pepperoni C) Apples D) Chocolate E) Celery

A, B, D Feedback: A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid foods containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) because the combination can result in a life-threatening hypertensive crisis.

2. A group of students are reviewing antiparkinson drugs. They demonstrate understanding when they identify which of the following as classified as dopaminergic drugs? Select all that apply. A) Amantadine (Symmetrel) B) Bromocriptine (Parlodel) C) Biperiden (Akineton) D) Carbidopa (Lodosyn) E) Benztropine (Cogentin)

A, B, D Feedback: Amantadine (Symmetrel), bromocriptine (Parlodel), and carbidopa (Lodosyn) are classified as dopaminergic drugs. Biperiden and benztropine are cholinergic blocking drugs used to treat Parkinson's disease.

11. A client is prescribed lorazepam. The nurse understands that this drug can be given by which route? Select all that apply. A) Intramuscular B) Oral C) Transdermal D) Intravenous E) Rectal

A, B, D Feedback: Lorazepam can be administered to a client via the oral, IM, and IV routes.

8. Before administering a sedative or hypnotic to a client, the nurse would assess which of the following? Select all that apply. A) Blood pressure B) Pulse C) Oxygen saturation level D) Respiratory rate E) Temperature

A, B, D Feedback: The nurse's preadministration assessment for a client receiving a sedative or hypnotic should include blood pressure, pulse, and respiratory rate.

7. A nurse may be asked to administer adrenergic drugs to clients with which of the following conditions? Select all that apply. A) Hypovolemic shock B) Respiratory distress C) Severe hypertension D) Allergic reactions E) Cardiac arrest

A, B, D, E Feedback: A nurse may be asked to administer adrenergic drugs to clients with hypovolemic shock, respiratory distress, severe hypotension, allergic reactions, and cardiac arrest. These drugs would not be used to treat severe hypertension.

5. A nurse is providing care to a client taking a CNS stimulant. The nurse assesses the client closely for which of the following as a possible adverse reaction? Select all that apply. A) Disorientation B) Dyspnea C) Bradycardia D) Urinary retention E) Headache

A, B, D, E Feedback: A nurse should monitor a client taking a CNS stimulant for the following adverse reactions: headache, dizziness, apprehension, disorientation, hyperactivity, nausea, vomiting, cough, dyspnea, urinary retention, tachycardia, and palpitations.

18. A nurse is preparing a teaching plan for a client who is prescribed an anxiolytic. As part of the plan, the nurse addresses medications that should be avoided to reduce the risk of increased CNS depression and sedation. Which of the following would the nurse include? Select all that apply. A) Alcohol B) Analgesics C) Digoxin D) Tricyclic antidepressants E) Antipsychotics

A, B, D, E Feedback: Alcohol, analgesics, tricyclic antidepressants, and antipsychotics should be used with caution with anxiolytics due to increased CNS depression and increased risk of sedation.

13. When conducting client teaching with a client and his family about the prescribed cholinergic therapy for myasthenia gravis, which of the following would be most important to include? Select all that apply. A) How to adjust dosage B) Indications of drug underdosage C) The need to monitor blood glucose levels D) How to keep a record of response to therapy E) The need to wear medical identification

A, B, D, E Feedback: Client and family teaching should include signs and symptoms associated with under- and overdosage, instructions on how to adjust the dosage up or down, how to keep a record of the response to therapy, and the importance of wearing medical identification. There is no need for the client and family to monitor blood glucose levels.

1. When describing the different cholinergic blockers, which of the following would a nursing instructor include as affecting only the muscarinic receptors? Select all that apply. A) Darifenacin (Enablex) B) Oxybutynin (Ditropan) C) Benztropine (Cogentin) D) Biperiden (Akineton) E) Tolterodine (Detrol)

A, B, E Feedback: Antispasmodic cholinergic blocking drugs, like darifenacin (Enablex), oxybutynin (Ditropan), and tolterodine (Detrol), only affect muscarinic receptors in the parasympathetic nervous system and have no effect on nicotinic receptors.

9. In addition to obtaining the client's vital signs, which of the following questions should the nurse use to assess the client's status when the client is receiving temazepam for a sleep disturbance? Select all that apply. A) "Is the client uncomfortable?" B) "Is it too early for the client to receive the drug?" C) "Has a consent form been signed for the procedure?" D) "Does the client receive insulin to treat hyperglycemia?" E) "Are there disturbances in the environment that may keep the client awake?"

A, B, E Feedback: In addition to obtaining the client's vital signs, the nurse should ask the following questions to assess the client's status when the client is receiving temazepam for a sleep disturbance: Is the client uncomfortable? Is it too early for the client to receive the drug? Are there disturbances in the environment that may keep the client awake? There is no need for a consent form to be signed. Asking about insulin use has no impact on the use of the drug.

6. A nurse administering carbidopa\levodopa (Sinemet) to a client should monitor the client for decreased effects of carbidopa\levodopa when which of the following medications are initiated? Select all that apply. A) Phenytoin (Dilantin) B) Amitriptyline (Elavil) C) Zonisamide (Zonegran) D) Ibuprofen (Motrin) E) Meperidine (Demerol)

A, C Feedback: A nurse administering carbidopa\levodopa (Sinemet) to a client should monitor the client for decreased effects of carbidopa\levodopa (Sinemet) when anticonvulsants, like phenytoin and zonisamide, are initiated.

5. After teaching a client receiving leflunomide, the nurse determines that the teaching was successful when the client identifies which of the following as a possible adverse reaction? Select all that apply. A) Alopecia B) Hypotension C) Diarrhea D) Nystagmus E) Hematuria

A, C Feedback: Adverse reactions to leflunomide include hypertension, alopecia, rash, nausea, and diarrhea.

2. The nurse is preparing to administer a cholinergic drug. The nurse understands that the drug would be appropriate for which condition? Select all that apply. A) Urinary retention B) Overactive bladder C) Myasthenia gravis D) Parkinson's disease E) Graves' disease

A, C Feedback: Cholinergic drugs can be used to treat urinary retention, myasthenia gravis, and glaucoma.

28. After teaching a group of nursing students about confusion and how it differs from dementia, the instructor determines that the teaching was successful when the students identify which of the following about delirium? Select all that apply. A) The onset occurred suddenly. B) Memory is significantly impaired. C) Sensory impairment occurs. D) Environmental changes are needed for safety.

A, C Feedback: Delirium occurs suddenly, affects the senses, and is reversible when the cause is found. In contrast, dementia occurs slowly, affects memory and judgment, and is not reversible, often requiring a change in the environment to maintain safety.

3. A nurse would administer phentolamine cautiously to a client with which condition? Select all that apply. A) Recent MI B) Type 1 diabetes C) Renal failure D) Hepatic failure E) Peripheral artery disease

A, C Feedback: Phentolamine is an a-adrenergic blocker that should be used cautiously in clients who are pregnant or lactating, had a recent MI, or have renal failure or Reynaud's disease.

13. A nurse should monitor a client closely for increased CNS depressant effects when an anticonvulsant is used concomitantly with which of the following? Select all that apply. A) Analgesics B) Oral contraceptives C) Alcohol D) Antibiotics E) Antidiabetic medications

A, C Feedback: The concomitant use of anticonvulsants and analgesics or alcohol can result in increased CNS depressant effects.

7. A nurse suggests melatonin to a client traveling overseas on a 2-week business trip to help with jet lag. The nurse would alert the client to the possibility of which adverse reaction? Select all that apply. A) Depression B) Hypotension C) Headache D) Dry mouth E) Constipation

A, C Feedback: The nurse should advise the client that headache, depression, and allergic reaction are possible adverse reactions that can occur with the use of melatonin.

5. The nurse should monitor clients taking which of the following medications closely for decreased efficacy if a cholinergic blocking drug is initiated? Select all that apply. A) Fluconazole (Diflucan) B) Meperidine (Demerol) C) Haloperidol (Haldol) D) Amitriptyline (Elavil) E) Digoxin (Lanoxin)

A, C Feedback: The nurse should monitor clients taking fluconazole (Diflucan) and haloperidol (Haldol) closely for decreased efficacy if a cholinergic blocking drug is initiated.

3. After teaching a group of nursing students about the action of antidepressants, the instructor determines that the teaching was successful when the students identify which of the following classes as exerting their effects by inhibiting reuptake of norepinephrine and serotonin? Select all that apply. A) Amitriptyline B) Bupropion C) Clomipramine D) Duloxetine E) Venlafaxine

A, C Feedback: Tricyclic antidepressants like amitriptyline and clomipramine exert their effects by inhibiting reuptake of norepinephrine and serotonin. Bupropion, duloxetine, and venlafaxine are believed to affect serotonin, norepinephrine, and dopamine receptors.

6. When teaching a client who is to receive antipsychotic therapy, the nurse would include which of the following as a common skin reaction that might occur when initiating therapy? Select all that apply. A) Urticaria B) Stevens-Johnson syndrome C) Photosensitivity D) Hyperpigmentation E) Toxic epidermal necrolysis

A, C Feedback: Urticaria and photosensitivity are common skin reactions a nurse should warn a client about when the client is initiated on antipsychotic therapy.

7. A nurse would closely monitor which client for an increase in possible adverse reactions after administering propranolol? Select all that apply. A) Clients with asthma B) Clients with hyperlipidemia C) Clients with diabetes D) Clients with peptic ulcer disease E) Clients with migraine headaches

A, C, D Feedback: A nurse should carefully observe clients with asthma (bronchospasm can result with the use of nonselective b blockers) and diabetes (b blockers can mask the symptoms of hypoglycemia) during the use of propranolol (Inderal), a nonselective b blocker. The drug also should be used cautiously in clients with peptic ulcer disease.

9. A nurse is monitoring a client who is receiving dopamine. The nurse should be alert for which of the following adverse reactions? Select all that apply. A) Headache B) Hypotension C) Cardiac arrhythmias D) Nausea E) Diarrhea

A, C, D Feedback: Adrenergic drugs like dopamine can cause the following adverse reactions: cardiac arrhythmias, headache, nausea, vomiting, and hypertension.

11. A nurse is conducting discharge teaching with a client being discharged on clonidine (Catapres). The nurse would instruct the client about which of the following as a possible adverse reaction? Select all that apply. A) Dry mouth B) Bradycardia C) Sedation D) Anorexia E) Tachypnea

A, C, D Feedback: Adverse reactions associated with the use of centrally acting antiadrenergic drugs like clonidine (Catapres) include dry mouth, drowsiness, sedation, anorexia, rash, malaise, and weakness.

5. A nurse is preparing to administer an anxiolytic drug. The nurse integrates knowledge of this group of drugs, understanding that the drugs can be used in the management of which of the following conditions? Select all that apply. A) Alcohol withdrawal B) Diabetic neuropathy C) Seizures D) Panic attacks E) Hypertension

A, C, D Feedback: Anxiolytic drugs can be used in the management of anxiety disorder, panic attacks, convulsions, seizures, and alcohol withdrawal and for preanesthetic sedation and muscle relaxation.

13. A nurse instructs a client to avoid other CNS stimulants while taking dexmethylphenidate. Which of the following would the nurse include in the instructions? Select all that apply. A) Tea B) Fruit juice C) Coffee D) Cola drinks E) Milk

A, C, D Feedback: CNS stimulants include tea, coffee, and cola drinks. Fruit juices and milk are caffeine free.

9. The nurse should screen clients carefully for medical conditions involving which of the following prior to the administration of colchicine? Select all that apply. A) Gastrointestinal disorders B) Pulmonary disorders C) Cardiac disorders D) Blood disorders E) Central nervous system disorders

A, C, D Feedback: Colchicine is contraindicated in clients with serious GI, renal, hepatic, or cardiac disorders and those with blood dyscrasias.

3. When reviewing the medical record of a client who is prescribed galantamine, which of the following, if found, would the nurse identify as a contraindication for the drug requiring the nurse to contact the primary health care provider? Select all that apply. A) Hepatic disease B) Renal disease C) Pregnancy D) Lactation E) Hyperthyroidism

A, C, D Feedback: Galantamine is contraindicated in clients who are pregnant, are lactating, or have hepatic disease.

10. The nurse is reviewing the medical records of several clients. The nurse integrates knowledge of the drug isoproterenol, understanding that this drug would be contraindicated in a client with which condition? Select all that apply. A) Digitalis toxicity B) Type 2 diabetes C) Ventricular arrhythmias D) Angina pectoris E) Narrow-angle glaucoma

A, C, D Feedback: Isoproterenol (Isuprel) is contraindicated in clients with tachyarrhythmias, tachycardia, or heart block caused by digitalis toxicity, ventricular arrhythmias, and angina pectoris.

10. After teaching a client and family about prescribed phenytoin therapy, the nurse determines that the teaching was successful when they identify that which of the following should be reported to the primary health care provider as possibly indicating toxicity? Select all that apply. A) Ataxia B) Nystagmus C) Slurred speech D) Lethargy E) Diplopia

A, C, D Feedback: Signs suggesting phenytoin toxicity that need to be reported include slurred speech, ataxia, lethargy, dizziness, nausea, and vomiting.

4. A group of nursing students are reviewing information about central nervous system stimulants. The students demonstrate understanding of the information when they identify which of the following as an indication for use? Select all that apply. A) Sleep apnea B) Hypertension C) Attention deficit hyperactivity disorder (ADHD) D) Drug-induced respiratory depression E) Hyperglycemia

A, C, D Feedback: The CNS stimulants are used in the treatment of the following: ADHD, drug-induced respiratory depression, narcolepsy, sleep apnea, exogenous obesity, and fatigue.

4. A nurse would monitor a client closely for increased CNS depressant effects when a skeletal muscle relaxant is used concomitantly with which of the following? Select all that apply. A) Antihistamine B) Oral contraceptives C) Alcohol D) Opiates E) Antidiabetic medications

A, C, D Feedback: The concomitant use of skeletal muscle relaxants and antihistamines, alcohol, opiates, or sedatives can result in increased CNS depressant effects.

13. In which of the following situations would a nurse caring for a hospitalized client hold the dose of propranolol (Inderal)? Select all that apply. A) Pulse less than 60 bpm B) Blood glucose less than 100 mg\dL C) Irregular pulse D) Systolic pressure less than 90 mm Hg E) Diastolic pressure greater than 90 mm Hg

A, C, D Feedback: The nurse should hold the dose of propranolol (Inderal) for clients experiencing any of the following: pulse less than 60 bpm, any irregularity in the client's heart rate or rhythm, or systolic pressure less than 90 mm Hg.

dL. C) The client appears lethargic. D) Blood pressure drops significantly. E) The client is having trouble sleeping.

A, C, D Feedback: The nurse should hold the hypnotic drug if the respiratory rate is below 10 breaths

12. The nurse should withhold the hypnotic drug if assessment reveals which of the following? Select all that apply. A) Respiratory rate is below 10 breaths-min. B) Blood glucose is above 200 mg-dL. C) The client appears lethargic. D) Blood pressure drops significantly. E) The client is having trouble sleeping.

A, C, D Feedback: The nurse should hold the hypnotic drug if the respiratory rate is below 10 breaths-min, the client appears lethargic, or the blood pressure drops significantly. Difficulty sleeping is the indication for administering the drug. Blood glucose is unrelated to the use of hypnotics.

28. A client asks the nurse about using valerian to help him sleep. Which response by the nurse would be most appropriate? Select all that apply. A) "The herb is generally considered safe." B) "You need to take it about 4 hours before bedtime." C) "It might take 2 to 4 weeks before you notice the full benefit." D) "You can combine it with other calming herbs." E) "If you stop using it, you won't have any withdrawal symptoms."

A, C, D Feedback: Valerian is classified as "generally recognized as safe" (GRAS) for use in the United States. When used as an aid to sleep, valerian is taken approximately 1 hour before bedtime. It can be used in combination with other calming herbs, such as lemon balm or chamomile. It may take 2 to 4 weeks before the full therapeutic effect (i.e., improvement of mood and sleep patterns) occurs. Individuals have been known to experience withdrawal symptoms when they stop taking valerian abruptly.

28. A client asks the nurse about using valerian to help him sleep. Which response by the nurse would be most appropriate? Select all that apply. A) "The herb is generally considered safe." B) "You need to take it about 4 hours before bedtime." C) "It might take 2 to 4 weeks before you notice the full benefit." D) "You can combine it with other calming herbs." E) "If you stop using it, you won't have any withdrawal symptoms."

A, C, D Feedback: Valerian is classified as "generally recognized as safe" (GRAS) for use in the United States. When used as an aid to sleep, valerian is taken approximately 1 hour before bedtime. It can be used in combination with other calming herbs, such as lemon balm or chamomile. It may take 2 to 4 weeks before the full therapeutic effect (i.e., improvement of mood and sleep patterns) occurs. Individuals have been known to experience withdrawal symptoms when they stop taking valerian abruptly.. A nurse understands that sedatives and hypnotics are used to treat insomnia, which may be caused by which of the following? Select all that apply. A) Hospitalization B) Chronic pain C) Stress D) Anxiety E) Jet lag Ans: A, B, C, D, E Feedback: Insomnia may be caused by lifestyle changes, such as a new job, moving to a new town, or returning to school; jet lag; chronic pain; headaches; stress; anxiety; or hospitalization.

18. Which of the following would a nurse expect to be prescribed when providing care to a client with narcolepsy? Select all that apply. A) Methylphenidate B) Phentermine C) Modafinil D) Armodafinil E) Dextroamphetamine

A, C, D, E Feedback: A nurse caring for a client with narcolepsy may administer methylphenidate, modafinil, armodafinil, and dextroamphetamine.

6. A nurse would cautiously administer sedatives and hypnotics to clients with which of the following? Select all that apply. A) Hepatic impairment B) Hypertension C) Renal impairment D) Mental health problems E) Habitual alcohol use

A, C, D, E Feedback: A nurse should use caution when administering sedatives and hypnotics to clients with hepatic or renal impairment, habitual alcohol use, and mental health problems and in clients who are lactating.

13. Before administering dobutamine to a client, the nurse should assess which of the following? Select all that apply. A) Blood pressure B) Blood glucose C) Respiratory rate D) Pulse E) Level of consciousness

A, C, D, E Feedback: Prior to administering dobutamine to a client, the nurse should assess the client's blood pressure, respiratory rate, pulse, and level of consciousness.

10. A client is prescribed probenecid and several other medications. When reviewing the client's medication record, the nurse determines that the client is at risk for possible toxicity if which of the following is also prescribed? Select all that apply. A) Phenobarbital (Luminal) B) Valproic acid (Depakote) C) Diazepam (Valium) D) Diclofenac (Voltaren) E) Acyclovir (Zovirax)

A, C, D, E Feedback: Probenecid (Benemid) increases the serum levels of the following medications, placing the client at risk for toxicity: penicillins, cephalosporins, acyclovir, rifampin, sulfonamides, barbiturates (phenobarbital), benzodiazepines (diazepam), and NSAIDs (diclofenac).

3. A client with which of the following would require the nurse to use caution when administering a skeletal muscle relaxant? Select all that apply. A) Cerebrovascular accident B) Diabetes C) Epilepsy D) Pregnancy E) Parkinsonism

A, C, D, E Feedback: Skeletal muscle relaxants are used with caution in clients with a history of cerebrovascular accident, cerebral palsy, parkinsonism, or epilepsy and during pregnancy and lactation.

1. When describing the autonomic nervous system to a group of nursing students, the instructor determines that the teaching was successful when the students identify which body function as being controlled by this system? Select all that apply. A) Heart rate B) Muscle movement C) Blood pressure D) Glandular secretions E) GI activity

A, C, D, E Feedback: The autonomic nervous system controls blood pressure, heart rate, GI activity, and glandular secretions.

8. A nurse monitors a client closely for methotrexate toxicity when the client is also prescribed which of the following? Select all that apply. A) Aspirin (Ecotrin) B) Cephalexin (Keflex) C) Sulfamethoxazole\trimethoprim (Septra) D) Ibuprofen (Motrin) E) Diclofenac (Voltaren)

A, C, D, E Feedback: The nurse should closely monitor the client for methotrexate toxicity when methotrexates is given with aspirin (Ecotrin), sulfa antibiotics (Septra) and NSAIDs (ibuprofen and diclofenac).

11. After administering a hypnotic drug to a client, the nurse would assess which of the following? Select all that apply. A) Blood pressure B) Blood glucose level C) Drug efficacy D) Level of consciousness E) Respiratory rate

A, C, D, E Feedback: The nurse's ongoing assessment for the administration of a hypnotic drug should include assessment of the client's vital signs, level of consciousness, and drug efficacy.

13. Before administering a prescribed anxiolytic to a client, which of the following would the nurse include in the physical assessment of the client? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Respiratory rate E) Weight

A, C, D, E Feedback: The nurse's preadministration physical assessment for the administration of an anxiolytic should include blood pressure, pulse, respiratory rate, and weight.

6. A client taking which of the following medications will see a decrease in effectiveness if rivastigmine (Exelon) is initiated? Select all that apply. A) Benztropine (Cogentin) B) Quetiapine (Seroquel) C) Glycopyrrolate (Robinul) D) Theophylline (Theo-Dur) E) Tiotropium (Spiriva)

A, C, E Feedback: A client taking anticholinergic medications, like benztropine, glycopyrrolate, and tiotropium, will see a decrease in effectiveness if rivastigmine (Exelon) is initiated.

12. A nurse is preparing to administer rivastigmine oral solution. The nurse decides to mix it in a small amount of which of the following? Select all that apply. A) Water B) Coffee C) Soda D) Tea E) Fruit juice

A, C, E Feedback: A nurse administering rivastigmine (Exelon) oral solution can give the solution directly to the client or mix it in a small amount of water, cold fruit juice, or soda.

9. After administering tolcapone (Tasmar) to a client, the nurse would be alert for which of the following as a possible adverse reaction? Select all that apply. A) Orthostatic hypotension B) Renal failure C) Dyskinesia D) Dry mouth E) Anorexia

A, C, E Feedback: Adverse reactions associated with tolcapone (Tasmar) include orthostatic hypotension, dyskinesia, sleep disorders, dystonia, excessive dreaming, somnolence, dizziness, nausea, anorexia, muscle cramps, and liver failure.

14. A nurse identifies a nursing diagnosis of Constipation related to the effects of the prescribed cholinergic blocking drug. Which of the following would the nurse expect to include in the client's plan of care? Select all that apply. A) Encouraging the intake of a diet high in fiber B) Decreasing the dosage of the cholinergic blocking medication C) Increasing client's fluid intake to at least 2000 mL daily D) Withholding the drug until the client resumes usual bowel pattern E) Encouraging ambulation and exercise as appropriate

A, C, E Feedback: Appropriate interventions include encouraging a high-fiber diet, increasing fluid intake, and encouraging ambulation and exercise. It is not the nurse's decision to decrease the dosage. Withholding the drug until the client's bowel patterns return would be inappropriate.

2. A nurse would administer phentolamine to a client diagnosed with which condition? Select all that apply. A) Pheochromocytoma-induced hypertension B) Benign hypertension C) Preoperative hypertension D) Increased intraocular pressure E) Treatment of dopamine extravasation tissue damage

A, C, E Feedback: Phentolamine is an a-adrenergic blocker used in the treatment of pheochromocytoma-induced hypertension and preoperative hypertension and in the prevention and treatment of tissue damage caused by extravasation of dopamine.

12. A client taking a CNS stimulant may experience altered sleep patterns. Which of the following suggestions would be most helpful? Select all that apply. A) Administer the drug early in the day. B) Take frequent naps throughout the day. C) Avoid caffeine products. D) Stop taking the medication. E) Be active during the day.

A, C, E Feedback: The nurse can instruct the client to administer the drug early in the day, avoid caffeine and other CNS stimulants, be active during the day, and not nap during the day to aid in sleep alteration caused by the use of a CNS stimulant.

11. When assessing a client receiving antipsychotic drugs, the nurse would suspect that the client is experiencing extrapyramidal syndrome (EPS) based on assessment of which of the following? Select all that apply. A) Fine tremor B) Hypotension C) Akathisia D) Anhedonia E) Dystonia

A, C, E Feedback: The signs of EPS include fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, unsteady gait, akathisia, and dystonia. Anhedonia is a manifestation of schizophrenia.

10. Antidepressants can often have GI adverse reactions that can result in a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Which of the following would be appropriate for the nurse to suggest to minimize these effects? Select all that apply. A) Increase fiber intake. B) Decrease fiber intake. C) Increase fluid intake. D) Decrease fluid intake. E) Chew sugarless gum.

A, C, E Feedback: To help with antidepressant-induced constipation, the nurse can recommend increased fluid and fiber intake, and for antidepressant-induced dry mouth the nurse can recommend good oral hygiene, frequent sips of water, sugarless gum, and hard candy.

11. A nurse has administered dopamine to a client taking phenytoin (Dilantin) for a seizure disorder. The nurse would closely monitor the client for which adverse reaction? Select all that apply. A) Hypotension B) Hypoglycemia C) Bradycardia D) Tachypnea E) Seizures

A, C, E Feedback: When dopamine is administered to a client taking phenytoin, there is an increased risk of seizures, hypotension, and bradycardia.

7. The nurse would be alert for a client taking benztropine (Cogentin) to have increased anticholinergic effects if which of the following medications are also started? Select all that apply. A) Amantadine (Symmetrel) B) Quetiapine (Seroquel) C) Glycopyrrolate (Robinul) D) Perphenazine (Trilafon) E) Tiotropium (Spiriva)

A, D Feedback: A client taking benztropine (Cogentin) will have increased anticholinergic effects if amantadine or phenothiazines such as perphenazine are given together.

7. The nurse would closely monitor a client taking which of the following anticonvulsants for pancytopenia? Select all that apply. A) Carbamazepine (Tegretol) B) Phenytoin (Dilantin) C) Valproic acid (Depakote) D) Felbamate (Felbatol) E) Zonisamide (Zonegran)

A, D Feedback: A client taking carbamazepine (Tegretol) or felbamate (Felbatol) should be monitored closely for pancytopenia.

3. A nurse is administering an antianxiety agent to a client. The nurse understands that long-term use of which of the following anxiolytics would be most likely to lead to physical or psychological tolerance? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Doxepin

A, D Feedback: Although long-term use of benzodiazepines such as alprazolam and chlordiazepoxide and nonbenzodiazepines such as buspirone, hydroxyzine, and doxepin can result in physical or psychological dependence, benzodiazepines are more likely to result in physical dependence and tolerance.

2. When describing how analeptics increase the depth of respirations, the nursing instructor addresses the stimulation of chemoreceptors. The instructor would identify these chemoreceptors as being located in which area in the body? Select all that apply. A) Upper aorta B) Left ventricle C) Jugular vein D) Carotid artery E) Pulmonary vein

A, D Feedback: Analeptics increase the depth of respirations by stimulating chemoreceptors located in the carotid arteries and upper aorta.

2. After reviewing information about anticonvulsants, a nursing student demonstrates understanding of this group of drugs, identifying which of the following as acting to elevate the seizure threshold by decreasing postsynaptic excitation? Select all that apply. A) Clonazepam (Klonopin) B) Valproic acid (Depakote) C) Gabapentin (Neurontin) D) Lorazepam (Ativan) E) Trimethadione (Tridione)

A, D Feedback: Benzodiazepines (clonazepam and lorazepam) exert their effect by elevating the seizure threshold by decreasing postsynaptic excitation. Valproic acid increases the levels of GABA, gabapentin is a GABA agonist, and trimethadione decreases the repetitive synaptic transmission of nerve impulses.

8. A nurse would be alert for an increase in cholinergic effects if a client who is prescribed a cholinergic drug is also receiving which medication? Select all that apply. A) Prednisone B) Oxycodone C) Diclofenac D) Dexamethasone E) Ibuprofen

A, D Feedback: Cholinergic drugs administered concomitantly with corticosteroids, like prednisone and dexamethasone, can result in increased adverse effects of the cholinergic drug.

28. After teaching a group of nursing students issues and problems commonly associated with antiparkinson drug therapy, the instructor determines that the teaching was successful when the students identify which nursing diagnosis as common? Select all that apply. A) Risk for Injury B) Risk for Infection C) Diarrhea D) Impaired Physical Mobility E) Imbalanced Nutrition: More Than Body Requirements

A, D Feedback: Common drug therapy-related nursing diagnoses include Risk for Injury, Constipation, Impaired Physical Mobility, Imbalanced Nutrition: Less Than Body Requirements, and Disturbed Sleep Pattern.

13. A client has a nursing diagnosis of Impaired Comfort related to xerostomia from the daily administration of a cholinergic blocking drug. When assessing the client, the nurse would be alert for which of the following? Select all that apply. A) Dysphagia B) Tooth decay C) Gingivitis D) Impeded speech E) Gingival hyperplasia

A, D Feedback: Dry mouth caused by daily use of cholinergic blocking drugs can result in dysphagia and impeded, difficult-to-understand speech. Tooth decay, gingivitis, and gingival hyperplasia are not associated with dry mouth.

16. A nurse is preparing to administer an anxiolytic agent via intramuscular injection. Which of the following would be most important for the nurse to keep in mind? Select all that apply. A) The client should be monitored closely for 3 hours postinjection. B) Intramuscular injection should be given in chronic states. C) The client should remain in a lying position for about 30 minutes. D) The drug should be administered into a large muscle mass. E) The client should be kept conscious for at least 1 hour after administration.

A, D Feedback: Intramuscular administration of an anxiolytic should be done primarily in an acute state. The drug should be administered in a large muscle mass, the client should be observed closely for at least 3 hours, and the client should be kept lying down for 30 minutes to 3 hours after drug administration.

1. A nursing instructor is describing parkinsonism to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as a possible cause? Select all that apply. A) Drugs B) Stroke C) Myocardial infarction D) Encephalitis E) Epilepsy

A, D Feedback: Parkinsonism may result from the use of certain drugs, head injuries, and encephalitis.

12. When reviewing the medication records of several clients, the nurse notes documentation of nonergot dopamine receptor agonists. Which of the following would the nurse most likely note? Select all that apply. A) Pramipexole (Mirapex) B) Entacapone (Comtan) C) Amantadine (Symmetrel) D) Ropinirole (Requip) E) Benztropine (Cogentin)

A, D Feedback: Pramipexole (Mirapex) and ropinirole (Requip) are nonergot dopamine receptor agonists.

2. After teaching a group of students about sedatives and hypnotics, the instructor determines that the teaching was successful when the students identify which of the following as an example of a benzodiazepine-type hypnotic and sedative drug? Select all that apply. A) Temazepam B) Eszopiclone C) Secobarbital D) Triazolam E) Zaleplon

A, D Feedback: Temazepam and triazolam are examples of benzodiazepine-type hypnotic and sedative drugs.

25. A client is admitted to the health care facility with a diagnosis of Parkinson's disease. When assessing the client, which of the following would the nurse expect to find? Select all that apply. A) Slurred speech B) Erect posture C) Step-like gait D) Tremors E) Rapid, jerky movements

A, D Feedback: The cardinal signs of Parkinson's disease include tremors, rigidity, and slow movement (bradykinesia). Other symptoms of Parkinson's disease include slurred speech, a mask-like and emotionless appearance of the face, and difficulty chewing and swallowing. The patient assumes a rigid, bent-forward posture and the gait becomes unsteady and shuffled.

5. A nurse administers amitriptyline cautiously to which clients? Select all that apply. A) Clients with cardiac disease B) Clients with hypothyroidism C) Clients with diabetes D) Elderly clients E) Adolescent clients

A, D Feedback: Tricyclic antidepressants (TCAs) like amitriptyline can cause cardiac-related adverse reactions, so the nurse should give TCAs with caution to clients with pre-existing cardiac disease and elderly clients.

5. A client is receiving donepezil. When reviewing the client's medication history, the nurse determines that the client is at increased risk for GI bleeding if the client is also taking which drug? Select all that apply. A) Naproxen (Naprosyn) B) Oxycodone (OxyContin) C) Acetaminophen (Tylenol) D) Ibuprofen (Motrin) E) Meperidine (Demerol)

A, D Feedback: Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, in combination with donepezil place the client at an increased risk for GI bleeding. Oxycodone, acetaminophen, and meperidine do not increase the client's risk.

1. After teaching a group of nursing students about antianxiety drugs, the instructor determines that the teaching was successful when the students identify which as an example? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

A, D, E Feedback: Alprazolam, chlordiazepoxide, and lorazepam are examples of benzodiazepine antianxiety drugs. Buspirone and hydroxyzine are considered nonbenzodiazepines.

4. A nurse is administering an antianxiety agent that exerts its anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA). Which of the following might the nurse be administering? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

A, D, E Feedback: Benzodiazepines like alprazolam, chlordiazepoxide, and lorazepam exert their anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA). Nonbenzodiazepines exert their effects in different ways.

9. The nurse is assessing an infant at a well-child visit and notices that the infant has been losing weight and is lethargic. The mother is breastfeeding the child. The nurse questions the mother about any medications that she might be taking. Which of the following, if being taken by the mother, would alert the nurse to a problem? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

A, D, E Feedback: Benzodiazepines like alprazolam, chlordiazepoxide, and lorazepam taken by a breastfeeding mother can result in lethargy and weight loss in the infant. Buspirone and hydroxyzine do not appear to have the same effect.

9. Prior to administering bethanechol to a client, the nurse would assess which of the following? Select all that apply. A) Palpation of the bladder B) Palpation of the thyroid C) Blood glucose D) Blood pressure E) Pulse rate

A, D, E Feedback: Bethanechol is used to treat urinary retentions. The nurse's preadministration assessment should include palpation of the bladder, blood pressure, and pulse rate prior to its administration to a client.

15. Which of the following is a condition that may result in distributive shock? Select all that apply. A) Central line infection B) Acute myocardial infarction C) Congestive heart failure D) Spinal cord injury E) Allergic drug reaction

A, D, E Feedback: Central line infection, spinal cord injury, and allergic drug reactions can result in one of the different types of distributive shock.

20. A nurse is administering haloperidol to a client with schizophrenia. The nurse determines that the drug is effective when there is improvement in which of the following? Select all that apply. A) Agitation B) Alogia C) Concrete thinking D) Delusions E) Hallucinations

A, D, E Feedback: Haloperidol is a conventional antipsychotic that is used to control the positive symptoms of schizophrenia, such as agitation, delusions, and hallucinations. Effectiveness of the drug would lead to a decrease in these positive symptoms. Atypical antipsychotics help to diminish the negative symptoms such as alogia and problems with concrete thinking.

25. The nurse suspects that a client is experiencing major depression based on assessment of which of the following? Select all that apply. A) Feelings of hopelessness B) Minimal changes in weight C) Focused concentration D) Loss of energy E) Excessive guilt

A, D, E Feedback: Manifestations of depression include feelings of hopelessness or helplessness, significant weight loss or gain, inability to concentrate, and excessive guilt.

11. A client is receiving carbidopa\levodopa (Sinemet). When assessing this client for possible adverse reactions, which of the following might the nurse note? Select all that apply. A) Choreiform movements B) Hyperglycemia C) Hypotension D) Dry mouth E) Anorexia

A, D, E Feedback: The most common adverse reactions associated with carbidopa\levodopa include anorexia, nausea, vomiting, abdominal pain, dysphagia, dry mouth, mental changes, headache, dizziness, increased hand tremor, and choreiform and dystonic movements.

1. A nurse caring for a client taking amitriptyline for depression should monitor the client for which of the following adverse events? Select all that apply. A) Sedation B) Diarrhea C) Incontinence D) Dry mouth E) Photosensitivity

A, D, E Feedback: The use of tricyclic antidepressants like amitriptyline can cause the following side effects: sedation, dry mouth, visual disturbances, urinary retention, constipation, and photosensitivity.

1. A nursing instructor is planning a class for a group of nursing students about cholinergic drugs. When describing the enzyme acetylcholinesterase, which of the following would the instructor most likely include about this enzyme? Select all that apply. A) Makes the parasympathetic nervous system function differently B) Inactivates the neurotransmitter serotonin C) Activates the neurotransmitter acetylcholine D) Inactivates the neurotransmitter norepinephrine E) Results in the prevention of nerve synapses to continue nerve impulses

A, E Feedback: Acetylcholinesterase makes the parasympathetic nervous system function differently by inactivating the neurotransmitter acetylcholine, thereby preventing the nerve synapse from continuing the nerve impulse.

4. A nurse reviews a client's medical record for possible conditions that would contraindicate the use of carbidopa\levodopa (Sinemet). Which of the following would the nurse identify as a contraindication? Select all that apply. A) Narrow-angle glaucoma B) Renal disease C) Hepatic disease D) Diabetes E) Use of MAOI antidepressants

A, E Feedback: Carbidopa\levodopa (Sinemet) is contraindicated in clients who have known hypersensitivity to the drug or narrow-angle glaucoma or who use MAOI antidepressants.

17. A nurse is providing care to a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect which of the following as possibly being prescribed for treatment? Select all that apply. A) Methylphenidate B) Phentermine C) Modafinil D) Doxapram E) Dextroamphetamine

A, E Feedback: Methylphenidate and dextroamphetamine are CNS stimulants used in the treatment of ADHD. Phentermine is used to treat obesity. Modafinil is used to treat narcolepsy. Doxapram is used to treat respiratory depression.

4. A group of nursing students are reviewing information about sedatives and hypnotics. The students demonstrate understanding of the information when they identify which of the following as an example of a barbiturate-type hypnotic and sedative drug? Select all that apply. A) Pentobarbital B) Eszopiclone C) Zolpidem D) Triazolam E) Secobarbital

A, E Feedback: Pentobarbital and secobarbital are examples of barbiturate-type hypnotic and sedative drugs. Eszopiclone and zolpidem are nonbenzodiazepine sedative and hypnotic drugs. Triazolam is a benzodiazepine sedative and hypnotic drug.

1. Before administering cyclobenzaprine, a nurse reviews a client's medical record. Which condition if found would alert the nurse to a possible contraindication for this drug? Select all that apply. A) Recent myocardial infarction B) Diabetes C) Hepatic disease D) Hypertension E) Hyperthyroidism

A, E Feedback: The use of cyclobenzaprine (Flexeril) is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, hyperthyroidism, and known hypersensitivity to the drug and within 14 days of the administration of an MAOI.

24. A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame? A) 15 minutes B) 30 minutes C) 45 minutes D) 60 minutes

B Feedback: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes.

21. A nurse is caring for a client with seizure disorders who is admitted to the health care facility. The client is prescribed phenytoin. During therapy, which of the following would be most important for the nurse to include in the ongoing assessment?? A) Check the client's temperature every 3 to 4 hours. B) Obtain serum plasma drug levels regularly. C) Assess the client's respiratory rate. D) Evaluate the client's pulse rate and rhythm.

B Feedback: Although vital signs such as temperature, pulse rate and rhythm, and respiratory rate are commonly assessed routinely, it would be most important for the nurse to obtain serum plasma drug levels to evaluate the effectiveness of the therapy and also to prevent possible toxicity. Unless the client's vital signs are not within normal parameters, the nurse would monitor them based on the facility's policy.

29. A group of nursing students are reviewing information about the different types of CNS stimulants used. The students demonstrate understanding of the information when they identify drugs used for narcolepsy as being classified as which of the following? A) Anorexiant B) Analeptic C) Sympathomimetic D) Neuroleptic

B Feedback: Analeptics are drugs used to treat narcolepsy because they stimulate the respiratory center of the brain. Anorexiants are drugs used to suppress the appetite. Sympathomimetic agents are drugs that act by stimulating the sympathetic nervous system. Neuroleptics are antipsychotic drugs used to treat psychotic disorders.

22. The caregiver of a client who is started on antipsychotic drug therapy asks the nurse when the client's symptoms will improve. Which response by the nurse would be most appropriate? A) "You should notice an improvement in the next day or two." B) "It might take about 6 weeks or so before the drug is most effective." C) "There's no way to tell but usually it takes about a week." D) "Look for movements of his face, mouth, or jaw and that's the sign."

B Feedback: Antipsychotics take time to produce the optimal effect, sometimes 6 to 10 weeks. Evidence of tongue, facial, or mouth movements suggest tardive dyskinesia, a late-appearing reaction that requires discontinuation of the drug.

17. A client admitted to the health care facility for insomnia related to stress is prescribed a sedative. Which of the following would the nurse include in the plan of care to promote the effectiveness of the drug? A) Encourage plenty of fluids. B) Provide back rubs. C) Offer fiber-rich food. D) Give the client coffee or tea.

B Feedback: Back rubs are relaxing and help promote the effectiveness of the sedative. Fluids and fiber prevent constipation. Coffee and tea contain caffeine, which could interfere with the drug's effectiveness.

25. The daughter of a client with AD who is receiving cholinesterase inhibitor therapy tells the nurse that her father has been getting more and more clumsy lately, saying, "He's almost fallen several times and he often gets out of bed at night. That's when I'm most concerned that he will fall." The daughter reports that his appetite is fair and that he takes his medication as prescribed. When developing the client's plan of care, the nurse would identify which nursing diagnosis as the priority? A) Imbalanced Nutrition: Less Than Body Requirements B) Risk for Injury C) Ineffective Self Health Management D) Deficient Knowledge: drug therapy

B Feedback: Based on the daughter's report, the client is at high risk for injury and this would be the priority. Imbalanced nutrition might be appropriate based on the daughter's report that her father's appetite is fair. However, additional information is needed to determine if this nursing diagnosis would be more of a priority than the risk for injury. The client is receiving his medication as prescribed, so ineffective self health management is not a concern. There is no evidence to suggest that there is a lack of knowledge about the drug therapy.

22. A client has been prescribed an amphetamine as part of obesity treatment. Which of the following would the nurse document before initiating the prescribed regimen? A) Temperature B) Weight C) Blood glucose level D) Arterial blood gas results

B Feedback: Before administering amphetamine as part of obesity treatment, the nurse should record the client's weight. There is no need to record the client's temperature or blood glucose level. Arterial blood gas results are reviewed when a CNS stimulant is prescribed for respiratory depression but not for obesity treatment.

21. A client with a peptic ulcer visits a health care facility. The physician has prescribed belladonna as part of the treatment. Before administering this drug, the nurse would assess which of the following? A) Saliva B) Stools C) Urine pH D) Blood glucose level

B Feedback: Before administering belladonna, the nurse should check the stools of the client who has a peptic ulcer along with performing additional assessments such as color and signs of occult blood. The nurse need not check saliva, urine pH, or blood glucose level.

25. After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students identify which of the following as being used to treat osteoporosis? A) DMARDs B) Bone resorption inhibitors C) Skeletal muscle relaxants D) Uric acid inhibitors

B Feedback: Bone resorption inhibitors are used to treat osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are used to treat rheumatoid arthritis. Uric acid inhibitors are used to treat gout. Skeletal muscle relaxants are used to alleviate muscle spasms and cramping.

26. After administering an antiparkinson drug to a client, the nurse assesses the effectiveness of the drug. The nurse notes that the client's slow movements have improved. The nurse documents this as an improvement in which of the following? A) Akathisia B) Bradykinesia C) Achalasia D) Choreiform movements

B Feedback: Bradykinesia refers to the slow movements associated with Parkinson's disease. Akathisia refers to extreme restlessness and increased motor activity. Achalasia refers to the failure to relax, usually referring to the smooth muscle fibers of the GI tract. Choreiform movements refer to the involuntary muscular twitching of the limbs or facial muscles.

26. After teaching a group of nursing students about CNS stimulants, the instructor determines that the teaching was successful when the students identify which of the following as a contraindication? A) Parkinson's disease B) Severe hypertension C) Age younger than 20 years D) Renal dysfunction

B Feedback: CNS stimulants are contraindicated for clients with severe hypertension. CNS stimulants are not contraindicated in clients younger than 20 years or clients with Parkinson's disease. Even though CNS stimulants are not contraindicated in clients with renal dysfunction, they need to be administered with extreme caution.

16. A nurse is caring for a client who is prescribed carbamazepine. When reviewing the client's medical record, the nurse would notify the health care provider for a change in the order if the client has which of the following? A) Bipolar disorder B) Renal impairment C) Hearing impairment D) Respiratory depression

B Feedback: Carbamazepine is contraindicated among clients with renal impairment. It can be prescribed to treat bipolar disorder. The drug is not contraindicated in clients with hearing impairment or respiratory depression.

21. A client comes to the emergency department and tells the nurse, "I've been hiccoughing constantly for the past 6 or 7 hours and nothing I do to stop them seems to work." The nurse would expect the primary health care provider to prescribe which of the following? A) Prochlorperazine B) Chlorpromazine C) Haloperidol D) Olanzapine

B Feedback: Chlorpromazine may be used to treat uncontrolled hiccoughs. Prochlorperazine may be used as an antiemetic. Haloperidol and olanzapine are not indicated for uncontrolled hiccoughs.

24. A nurse is reviewing the medication orders for a client and notes an adrenergic blocker that is to be applied transdermally. Which medication would the nurse be preparing to administer? A) Methyldopa B) Clonidine C) Guanabenz D) Guanfacine

B Feedback: Clonidine is available in a transdermal formulation. Methyldopa may be administered IV or orally. Guanabenz and guanfacine are administered orally.

23. Which nursing diagnosis would most likely be a priority for a client receiving a hypnotic who is experiencing confusion and excessive drowsiness in the morning? A) Ineffective Breathing Pattern B) Risk for Injury C) Ineffective Coping D) Impaired Self Health Management

B Feedback: Confusion and excessive morning drowsiness would impact the client's ability to function safely, thereby placing the client at risk for injury. Ineffective Breathing Pattern would be appropriate if the client experienced respiratory depression. Ineffective Coping would be appropriate if more than short-term use of the agent would be required. Impaired Self Health Management would be appropriate if the client was unable to comply with or adhere to the prescribed medication regimen.

28. A client is prescribed a benzodiazepine as treatment for anxiety. After administration of the drug, the client reports dizziness and lightheadedness. Which nursing diagnosis would the nurse identify as a priority? A) Impaired Comfort B) Risk for Injury C) Ineffective Coping D) Deficient Knowledge

B Feedback: Dizziness and lightheadedness place the client at risk for falls; therefore, Risk for Injury would be the priority. Impaired Comfort would be appropriate if the client reported problems such as dry mouth or constipation. Ineffective Coping would be appropriate if the client reported continued feelings of anxiety. There is no evidence to suggest that the client lacks knowledge of the drug therapy.

3. A nurse understands that lorazepam (Ativan) is the drug of choice for treating status epilepticus but that its effects last for less than 1 hour. The nurse would expect which of the following to be prescribed along with lorazepam (Ativan) during status epilepticus? Select all that apply. A) Ethosuximide (Zarontin) B) Phenytoin (Dilantin) C) Ethotoin (Peganone) D) Zonisamide (Zonegran)

B Feedback: Due to the short effects of lorazepam (Ativan), a longer-acting anticonvulsant, such as phenytoin (Dilantin), is given to continue control of seizure activity.

30. A client who is receiving a benzodiazepine tells the nurse that his mouth feels really dry. Which of the following would the nurse include in the teaching plan for this client? A) "Try drinking about 8 ounces of water at least every 2 hours." B) "Sucking on hard sugarless candy might help you." C) "Make sure you eat a lot of green leafy vegetables." D) "Change your position slowly as you get out of bed."

B Feedback: For dry mouth, the nurse should suggest sucking on hard, sugarless candies or chewing sugarless gum. Frequent sips of water would also help, but drinking 8 ounces of water every 2 hours could lead to fluid overload. Eating green leafy vegetables would help with constipation. Changing positions slowly would be appropriate if the client reported dizziness or lightheadedness.

25. A client is experiencing photophobia secondary to the administration of a cholinergic blocking drug. Which of the following would be most appropriate? A) Keeping the client's room brightly lit B) Limiting the use of overhead lights C) Encouraging the client to use sunscreen D) Suggesting the client avoid watching television

B Feedback: If photophobia is a problem, the patient may need to wear shaded glasses when going outside, even on cloudy days. Rooms are kept dimly lit and curtains or blinds closed to eliminate bright sunlight in the room. Those with photophobia may be more comfortable in a semi-darkened room, especially on sunny days. It is a good idea to use overhead lights as little as possible. Sunscreen would be appropriate for photosensitivity, not photophobia. Avoiding television would be appropriate if the client experienced mydriasis and cycloplegia.

27. A nurse is reviewing the action of memantine. The nurse understands that this drug addresses which of the following? A) Acetylcholine B) Glutamate C) Serotonin D) Dopamine

B Feedback: Memantine, an NMDA receptor antagonist, is thought to work by decreasing the excitability of neurotransmission caused by an excess of the amino acid glutamate in the CNS.

24. After teaching the caregiver of a client prescribed transdermal rivastigmine, the nurse determines that the teaching was successful when the caregiver states which of the following? A) "I'll apply a new patch every other day." B) "The patch should be placed on a hairless area." C) "I'll make sure to put the patch where he can see it." D) "I can use the same spot once or twice a week."

B Feedback: Rivastigmine patches are changed on a daily basis and rotated to a clean, dry, and hairless area. Because the patient is experiencing dementia, the site for application should be where the patient is not able to pick at or remove the patch. The upper or lower portions of the back are recommended for patch administration. Because the same site should not be used more than once every 2 weeks, the caregiver should be instructed to make a chart of the back and indicate where patches have been applied during the last 14 days.

20. A nurse is teaching a client about the increased risk of heat prostration during the hot summer months related to his prescribed scopolamine therapy. The nurse determines that the teaching was successful when the client identifies which of the following as a sign of this condition? A) Dry mouth B) Fever C) Skin rash D) Urinary retention

B Feedback: Signs of heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion.

15. When reviewing a client's medical record, which condition would the nurse identify as contraindicating the use of donepezil? A) Bronchitis B) Asthma C) Vitamin deficiency D) Amnesia

B Feedback: The administration of donepezil is contraindicated in clients with asthma. The drug is not contraindicated in clients with bronchitis, beriberi, or amnesia.

24. A nurse is teaching a client how to use an auto-injector as treatment for an allergic reaction. Which statement by the client indicates the need for additional teaching? A) "I should not touch the orange or black tip on the small end." B) "I should administer the dose and then call 9-1-1 if I'm alone." C) "I should inject the black tip into my outer thigh." D) "I need to massage the site after removing the device."

B Feedback: The client should call the emergency number first and then administer the dose if he or she is alone. The client should not touch the orange or black tip on the end. The dose is administered into the outer thigh and the site is massaged for 10 seconds after removing the device.

16. A nurse is caring for a client with urinary retention who is prescribed bethanechol. The nurse would administer this drug cautiously if the client has which of the following? A) Raynaud's disease B) Bradycardia C) Coronary artery disease D) Hyperthyroidism

B Feedback: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Cautious use is not necessary if the client has Raynaud's disease, coronary artery disease, or hyperthyroidism.

14. A nurse is caring for a client who has been prescribed pramipexole for the treatment of Parkinson's disease. From the client's medical records, the nurse understands that the client is taking verapamil. The nurse understands that the client is at increased risk for which effect from the interaction of the two drugs? A) Cardiac symptoms B) Agonist effectiveness C) Toxicity of both drugs D) Psychotic behavior

B Feedback: The nurse should assess for an increased risk of agonist effectiveness in the client. Increased risk of cardiac symptoms and increased risk of toxicity of both drugs are the effects of the interaction of COMT inhibitors with MAOI antidepressants and adrenergic drugs. Increased risk of psychotic behavior is the effect of the interaction of cholinergic blocking drugs with haloperidol.

23. A client has been administered dobutamine. The client is also receiving a beta-adrenergic blocking drug. The nurse would monitor the client for the development of which of the following resulting from the use of these two drugs? A) Bradycardia B) Hypertension C) Depression D) Dehydration

B Feedback: The nurse should assess for hypertension in a client who is being administered dobutamine and beta-adrenergic blocking drugs. Combining dobutamine and beta-adrenergic blocking drugs does not increase the risk of bradycardia, depression, or dehydration.

26. A client who experiences panic attacks in social situations has been prescribed an antianxiety medication. The nurse would assess which of the following before administering the drug? A) Temperature B) Blood pressure C) Blood sugar D) Red blood cell count

B Feedback: The nurse should check the client's blood pressure before administering the antianxiety drug because physiologic manifestations of panic attacks can include increased blood pressure. Temperature, blood sugar, and RBC count are not adversely affected by antianxiety drugs.

18. A nurse is caring for a client admitted to the health care facility. The client is receiving a cholinergic blocking drug as treatment for bladder overactivity. Which intervention would be most appropriate for the nurse to include as part of the client's ongoing assessment? A) Assessment of the client's medical history B) Evaluation of symptoms related to the client's diagnosis C) Monitoring of the client's vital signs every 24 hours D) Observation for behavioral changes in the client

B Feedback: The nurse should evaluate the symptoms and complaints related to the client's diagnosis during the ongoing assessment of the treatment. The nurse should assess the medical history of the client before administration of the drug as part of the preadministration assessment. The vital signs of the client should be monitored regularly instead of every 24 hours. The nurse need not observe for behavioral changes in the client based on the client's diagnosis and condition.

20. A client is admitted to a local health care facility for chronic insomnia. The primary health care provider prescribes eszopiclone. Which of the following would the nurse encourage the client to avoid when teaching the client about this drug? A) Strenuous work B) Alcohol consumption C) Tobacco use D) Direct sunlight

B Feedback: The nurse should instruct the client to avoid alcohol during the period of eszopiclone therapy as alcohol interacts with eszopiclone to cause CNS depression. Strenuous work, use of tobacco, and exposure to sunlight are not of concern.

21. A nurse is caring for an individual who is to receive antidepressant therapy on an outpatient basis. What precaution should the nurse suggest to prevent risk of injury if the client experiences dizziness when getting out of bed? A) Strictly avoid movements if dizziness occurs. B) Rise slowly when getting out of bed. C) Have breakfast before getting out of bed. D) Have a glass of water to overcome dizziness.

B Feedback: The nurse should instruct the client to rise slowly when getting out of bed. Strictly avoiding movements will restrict the patient's mobility, which is unadvisable. Having breakfast or a glass of water before getting out of bed will not help the client to overcome dizziness because the dizziness is not due to lack of nourishment.

24. A 10-year-old child is receiving a CNS stimulant as treatment for ADHD. When developing the teaching plan for the parents, the nurse would include instructions about recording which of the following periodically? A) Social interaction B) Weight and growth C) Voiding pattern D) Sleeping pattern

B Feedback: The nurse should instruct the parents to monitor the weight and growth patterns of the child. The child's social interaction or sleeping pattern need not be recorded unless specified by the primary health care provider. Since the drugs administered for ADHD do not cause urinary retention, there is no need to monitor urinary patterns.

17. A nurse is caring for a client receiving donepezil for treatment of Alzheimer's disease. Which of the following factors should the nurse monitor when assessing the client before administering the drug? A) Sexual habits B) Body weight C) Sleeping patterns D) Eating habits

B Feedback: The nurse should monitor body weight and the vital signs of the client during the initial assessment. The nurse need not monitor the sexual habits, sleeping patterns, or eating habits of the client when administering cholinesterase inhibitors.

25. A client has been prescribed modafinil for the treatment of narcolepsy. The nurse would assess the client for which of the following as a common adverse reaction? A) Insomnia B) Nausea C) Urinary retention D) Tremors

B Feedback: The nurse should monitor for nausea because it is one of the common adverse reactions associated with analeptics such as modafinil. Insomnia, urinary retention, and tremors are not reactions generally associated with analeptic drugs.

18. When assessing a client for depression, which of the following would the nurse most likely find? A) Drowsiness B) Extreme sadness C) Severe headache D) Dilated pupils

B Feedback: The nurse should monitor the client for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are symptoms of hypertensive crisis.

20. A client with cardiac arrhythmia is treated with a centrally acting antiadrenergic drug. The nurse would assess the client for which of the following as a possible adverse reaction? A) Lightheadedness B) Malaise C) Bradycardia D) Weakness

B Feedback: The nurse should monitor the client for malaise as a generalized reaction with antiadrenergic drugs that are centrally acting when administered to clients with cardiac arrhythmias. Lightheadedness, bradycardia, and weakness are the adverse reactions associated with peripherally acting antiadrenergic drugs.

17. The nurse suspects that the client is developing toxicity if assessment reveals which of the following? A) Constipation B) Slurred speech C) Diarrhea D) Urinary frequency

B Feedback: The nurse should monitor the client for slurred speech, which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are not signs of ethotoin toxicity.

22. A nurse is administering a cholinergic blocking drug preoperatively to a client. What intervention should the nurse perform after administering the drug to the client? A) Provide cold milk to the client. B) Raise the side rails of the bed. C) Tell the client to lie completely flat in bed. D) Provide frequent sips of water.

B Feedback: The nurse should raise the side rails of the client's bed after administration of the drug. The nurse need not provide cold milk or provide frequent sips of water as fluids cannot be given after administering the drug. The client needs to remain in bed, but he or she can assume a position of comfort. There is no need to lie completely flat.

25. A group of nursing students are reviewing information about the parasympathetic nervous system. The students demonstrate understanding of the information when they identify that which type of receptor is involved with stimulating smooth muscle in the parasympathetic nervous system? A) Nicotinic B) Muscarinic C) Alpha D) Beta

B Feedback: There are two types of receptors in the parasympathetic nervous branch: muscarinic receptors (which stimulate smooth muscle) and nicotinic receptors (which stimulate skeletal muscle). Alpha and beta receptors are found in the sympathetic nervous system.

18. A client is prescribed clozapine. The nurse instructs the client on the need for weekly laboratory testing for which of the following? A) Serum lithium B) WBC count C) Blood glucose D) pH level

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

23. The primary health care provider prescribes diazepam 10 mg IV to be administered to a client to control his seizures. The nurse would administer this drug over which time frame? A) 1 minute B) 2 minutes C) 5 minutes D) 10 minutes

B Feedback: When used to control seizures, diazepam is administered IV pushed slowly as close as possible to the IV site, allowing at least 1 minute for each 5 mg of drug. For a dosage of 10 mg, the nurse would administer the drug over 2 minutes.

26. A client is prescribed zolpidem. As part of the teaching plan, the nurse would emphasize the need to plan for the proper amount of sleep. The nurse determines that the teaching plan was successful when the client states that he will plan for how many hours of sleep at night? A) 5 to 6 hours B) 7 to 8 hours C) 9 to 10 hours D) 11 to 12 hours

B Feedback: With zolpidem it is important that the client plan to have 7 to 8 hours of sleep to reduce the risk of memory loss and confusion with this drug.

6. A nurse is administering glycopyrrolate to a client with a peptic ulcer. The nurse would assess the client for which of the following as a possible GI system adverse reaction? Select all that apply. A) Diarrhea B) Dry mouth C) Constipation D) Nausea E) Dysphagia

B, C, D, E Feedback: A nurse administering glycopyrrolate to a client with a peptic ulcer should monitor the client for dry mouth, nausea, vomiting, constipation, and dysphagia.

7. A nurse should administer adalimumab (Humira) cautiously to a client with a history of which of the following? Select all that apply. A) Hepatitis A B) Diabetes C) Obesity D) Hepatitis B E) Hepatitis C

B, C, D, E Feedback: Adalimumab (Humira) is used with caution in clients with obesity, diabetes, and hepatitis B or C.

29. A group of nursing students are reviewing information about antidepressants. The students demonstrate understanding of the information when they identify which of the following as an example of a serotonin\norepinephrine and dopamine\norepinephrine reuptake inhibitor? Select all that apply. A) Doxepin B) Venlafaxine C) Bupropion D) Sertraline E) Escitalopram

B, C Feedback: Bupropion and venlafaxine are examples of serotonin\norepinephrine and dopamine\norepinephrine reuptake inhibitors. Doxepin is a tricyclic antidepressant; sertraline and escitalopram are selective serotonin reuptake inhibitors.

1. When describing the action of cholinesterase inhibitors to a class of nursing students, the instructor would include which of the following about their action? Select all that apply. A) The drugs decrease the level of acetylcholine in the CNS. B) They inhibit the breakdown of acetylcholine. C) The drugs slow neural destruction. D) They stop neural breakdown. E) The drugs increase excitatory neurotransmitters in the CNS.

B, C Feedback: Cholinesterase inhibitors act to increase the level of acetylcholine in the CNS by inhibiting its breakdown and slowing neural destruction.

17. A client who is prescribed an anxiolytic tells the nurse that she is constipated. Which of the following would be most appropriate for the nurse to suggest? Select all that apply. A) Stop taking the drug. B) Increase fluid intake. C) Increase fiber intake. D) Ask to have the drug given by injection. E) Take the drug on an empty stomach.

B, C Feedback: Clients receiving an anxiolytic should be advised to increase fluid and fiber intake to address constipation. The drug should not be stopped or changed to an injectable form. Taking the drug on an empty stomach may lead to GI upset.

11. A nurse should notify the physician immediately if a client taking a cholinergic drug develops which of the following? Select all that apply. A) Hypoglycemia B) Excessive salivation C) Severe abdominal cramping D) Muscle rigidity E) Muscle spasms

B, C, D, E Feedback: A client receiving a cholinergic drug is at risk for a cholinergic crisis. The signs of cholinergic crisis include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Any of these symptoms should be reported to the physician immediately.

7. A client asks the nurse about using the herb ginkgo to improve his memory and thinking. Which of the following would the nurse need to integrate into the response about this herb? Select all that apply. A) There is scientific proof that this herb is effective. B) The effects may take at a minimum 4 weeks to occur. C) Mild GI discomfort and headache may occur with the herb. D) The herb needs to be taken at least four times a day to be effective. E) The herb if taken in large doses rarely leads to problems.

B, C Feedback: Conflicting research both supports and disputes ginkgo's ability to enhance memory. Medical studies in both the United States and England have not demonstrated increases in mental function. Despite this research, the "brain herb" is still taken by healthy adults hoping to retain their current memory and cognitive function. The recommended dose is 40 mg standardized extract ginkgo three times daily. The effects of ginkgo may not be evident until after 4 to 24 weeks of treatment. The most common adverse reactions include mild GI discomfort, headache, and rash. Excessively large doses have been reported to cause diarrhea, nausea, vomiting, and restlessness.

1. After teaching a group of nursing students about sympatholytic drugs, the instructor determines that the teaching was successful when the students identify which of the following as an example? Select all that apply. A) Angiotensin-converting enzyme inhibitors B) a-adrenergic blockers C) b-adrenergic blockers D) Angiotensin receptor blockers E) Loop diuretics

B, C Feedback: a- and b-adrenergic blockers are classified as sympatholytic drugs.

11. The nurse suspects that a client has consumed an excessive dose of ginkgo based on assessment of which of the following? Select all that apply. A) Constipation B) Diarrhea C) Vomiting D) Restlessness E) Drowsiness

B, C, D Feedback: A client who takes an excessive dose of ginkgo may exhibit the following adverse reactions: diarrhea, nausea, vomiting, and restlessness.

25. A nurse is developing a plan of care for a client receiving anticonvulsant therapy and identifies a nursing diagnosis of Risk for Injury. Which assessment findings would support this nursing diagnosis? Select all that apply. A) Epistaxis B) Reports of blurred vision C) Complaints of dizziness D) Photosensitivity E) Scaling red rash

B, C, D Feedback: A client would be at risk for injury if the client was experiencing blurred vision, dizziness, and photosensitivity. Epistaxis would support a nursing diagnosis of a possible Risk for Injury related to a reduction in platelets from hematologic adverse reactions. A scaling red rash would support a nursing diagnosis of Impaired Skin Integrity.

13. Which of the following would the nurse include in the teaching plan for a client who is being discharged with a prescription for alendronate? Select all that apply. A) Take the medication in the evening. B) Take the medication with 6 to 8 ounces of water. C) Remain upright for at least 30 minutes after administration. D) Wait 30 minutes before taking any other food or drink. E) Take a calcium supplement at the same time with the medication.

B, C, D Feedback: A nurse should include the following administration instructions to a client being discharged with a prescription for alendronate (Fosamax): take the medication in the morning with 6 to 8 ounces of water, remain upright for at least 30 minutes after administration, and do not take any other food, drink, medication, or supplement until at least 30 minutes after administration of the medication.

14. As part of the teaching plan for a client receiving midodrine, the nurse would instruct the client to report which of the following? Select all that apply. A) Fine tremors B) Pounding headache C) Bradycardia D) Difficulty urinating E) Constipation

B, C, D Feedback: Clients taking midodrine should be told to report any of the following reactions: pounding headache when lying down, bradycardia, or difficulty urinating.

3. A nurse is preparing to administer a sympathomimetic drug. Which of the following might the nurse be preparing to give? Select all that apply. A) Clonidine (Catapres) B) Isoproterenol (Isuprel) C) Midodrine (ProAmatine) D) Epinephrine (EpiPen) E) Reserpine (Serpalan)

B, C, D Feedback: Isoproterenol, midodrine, and epinephrine are examples of sympathomimetic drugs.

4. A nurse recognizes the class of medication being administered to help plan ongoing assessment and client education. The nurse would identify which drug as an example of a b-adrenergic blocker? Select all that apply. A) Carvedilol (Coreg) B) Propranolol (Inderal) C) Metoprolol (Lopressor) D) Atenolol (Tenormin) E) Labetalol (Trandate)

B, C, D Feedback: Propranolol, metoprolol, and atenolol are b-adrenergic blockers, but carvedilol and labetalol are a\b-adrenergic blockers.

5. A nurse anticipates the use of a sedative and hypnotic for which of the following? Select all that apply. A) Headache B) Status epilepticus C) Preoperative sedation D) Insomnia E) Hypertension

B, C, D Feedback: Sedatives and hypnotics are used in the treatment of insomnia, convulsions, status epilepticus, and seizures and in preoperative and conscious sedation.

8. A nurse is caring for a client who has recently suffered an acute myocardial infarction. The nurse would closely monitor this client for which of the following that would suggest that the client is developing shock? Select all that apply. A) Increased blood pressure B) Decreased urinary output C) Hypoxia D) Tachypnea E) Bradycardia

B, C, D Feedback: Signs and symptoms of shock include cold and clammy skin, sweating, hypotension, tachycardia, hypoxia, tachypnea, and decreased urinary output.

11. A client is receiving hydroxychloroquine. Which of the following adverse reactions should the nurse immediately report to the primary health care provider? Select all that apply. A) Diarrhea B) Tinnitus C) Fever D) Visual changes E) Nausea

B, C, D Feedback: The nurse should report any of the following adverse reactions to the physician immediately if observed in a client taking hydroxychloroquine (Plaquenil): skin rash, fever, cough, easy bruising, visual changes, tinnitus, or hearing loss.

13. For a client who is receiving a cholinesterase inhibitor, which of the following can the nurse recommend to the client's caregiver to decrease the client's risk for injury? Select all that apply. A) Observe frequent drug holidays. B) Encourage the use of assistive devices. C) Keep the bed in a low position. D) Use night lights. E) Decrease drug dose if mobility worsens.

B, C, D Feedback: To minimize the client's risk for injury, the nurse should encourage using assistive devices and keeping the bed in a low position, using night lights, and frequent monitoring by the caregiver.

14. Based on the nurse's understanding of which body systems are affected by cholinergic drug adverse reactions, the nurse would be alert for adverse reactions involving which body system? Select all that apply. A) Endocrine B) Circulatory C) Respiratory D) Gastrointestinal E) Central nervous

B, C, D, E Feedback: Cholinergic drug adverse reactions affect the circulatory, respiratory, gastrointestinal, and central nervous systems.

4. Which condition would require the nurse to cautiously monitor a client who is receiving donepezil? Select all that apply. A) Hyperthyroidism B) Seizure disorder C) Renal disease D) Asthma E) GI bleeding

B, C, D, E Feedback: Cholinesterase inhibitors, like donepezil, are used cautiously in clients with renal or hepatic disease, bladder obstruction, seizure disorder, sick sinus syndrome, GI bleeding, history of ulcer disease, and asthma.

17. A nurse understands that duloxetine may be used to treat which of the following? Select all that apply. A) Obsessive-compulsive disorder B) Depression C) Fibromyalgia D) Diabetic neuropathy E) Stress incontinence

B, C, D, E Feedback: Duloxetine can be used to treat clients with depression, fibromyalgia, diabetic neuropathy, and stress incontinence.

10. A nurse caring for a client receiving clozapine (Clozaril) needs to be mindful of the symptoms that indicate bone marrow suppression. Assessment of which of the following would lead the nurse to suspect that the client is experiencing bone marrow suppression? Select all that apply. A) Hypertension B) Sore throat C) Fever D) Chills E) Weakness

B, C, D, E Feedback: Symptoms that indicate bone marrow suppression include lethargy, weakness, fever, sore throat, malaise, mucous membrane ulceration, and "flu-like" complaints.

9. To assess a client's cognitive ability, the nurse uses the Mini-Mental Status Examination. Which areas would the nurse assess? Select all that apply. A) Reading comprehension B) Calculation C) Orientation D) Recall E) Language

B, C, D, E Feedback: The Mini-Mental Status Examination assesses a client's abilities on items such as orientation, calculation, recall, and language.

14. A nurse would assess the client for an increase in anticholinergic symptoms if the client is prescribed cimetidine with which antidepressant? Select all that apply. A) Phenelzine B) Sertraline C) Venlafaxine D) Clomipramine E) Escitalopram

B, C, D, E Feedback: The concomitant use of cimetidine and tricyclic antidepressants (clomipramine), serotonin reuptake inhibitors (escitalopram and sertraline), and atypical antidepressants (venlafaxine) results in increased anticholinergic symptoms.

8. The nurse should observe elderly clients taking metoprolol (Lopressor) for which of the following adverse effects as they are more likely to occur in elderly clients? Select all that apply. A) Hyperglycemia B) Heart failure C) Peripheral vascular insufficiency D) Confusion E) Worsening angina

B, C, D, E Feedback: The nurse should observe elderly clients taking metoprolol (Lopressor) for confusion, heart failure, worsening angina, shortness of breath, and peripheral vascular insufficiency.

14. The nurse would assess an older adult client who is receiving sedatives or hypnotics for an increased risk for which of the following? Select all that apply. A) Hypertension B) Paradoxical reactions C) Dizziness D) Confusion E) Ataxia

B, C, D, E Feedback: The older adult client is at greater risk for oversedation, dizziness, confusion, ataxia, and paradoxical reactions to sedative and hypnotic drugs.

9. Which of the following adverse reactions would the nurse include in the teaching plan for a client who is prescribed labetalol? Select all that apply. A) Hypoglycemia B) Insomnia C) Drowsiness D) Tachycardia E) Fatigue

B, C, E Feedback: Adverse effects from the use of a\b-adrenergic blockers like labetalol include fatigue, dizziness, hypotension, drowsiness, insomnia, weakness, diarrhea, dyspnea, chest pain, bradycardia, and skin rash.

2. The nurse is reviewing the medication record of a client who is prescribed a nonbenzodiazepine. Which of the following would the nurse expect to find? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Doxepin

B, C, E Feedback: Buspirone, doxepin, and hydroxyzine are examples of nonbenzodiazepine antianxiety drugs. Alprazolam and chlordiazepoxide are benzodiazepines.

1. After teaching a group of nursing students about central nervous stimulants, the instructor determines that the teaching was successful when the students state which of the following as an effect of caffeine on the body? Select all that apply. A) Skeletal muscle relaxation B) Respiratory stimulation C) Central nervous system (CNS) stimulation D) Cardiac relaxation E) Diuresis

B, C, E Feedback: Caffeine exerts the following effects on the body: stimulates the CNS, cardiac system, and respiratory system and results in mild diuresis.

12. During assessment of a client, a nurse suspects that the client is experiencing anxiety. Which of the following would support the nurse's suspicion? Select all that apply. A) Facial flushing B) Tense posture C) Extreme restlessness D) Somnolence E) Facial grimaces

B, C, E Feedback: During the intake history, the nurse observes the client for behavioral signs indicating anxiety (e.g., inability to focus, extreme restlessness, facial grimaces, tense posture).

3. A nurse is preparing to administer a sedative and hypnotic drug to a client. The nurse identifies the drug as a nonbenzodiazepine-type hypnotic and sedative drug. Which of the following might the nurse be preparing to administer? Select all that apply. A) Temazepam B) Eszopiclone C) Zolpidem D) Triazolam E) Zaleplon

B, C, E Feedback: Eszopiclone, zolpidem, and zaleplon are examples of nonbenzodiazepine-type hypnotic and sedative drugs. Temazepam and triazolam are benzodiazepines.

4. The nurse administers isoproterenol (Isuprel) to a client. Which of the following would most likely occur? Select all that apply. A) Decreased heart rate B) Increased use of glucose C) Decreased gastric motility D) Constriction of coronary blood vessels E) Wakefulness

B, C, E Feedback: Isoproterenol (Isuprel) will most likely cause increased heart rate, increased use of glucose, decreased gastric motility, dilation of coronary blood vessels, and wakefulness.

7. After administering a cholinergic blocking drug to a client, assessment of which of the following would lead the nurse to suspect that the client is experiencing a visual adverse reaction to the drug? Select all that apply. A) Miosis B) Photophobia C) Mydriasis D) Diplopia E) Cycloplegia

B, C, E Feedback: Possible adverse effects include blurred vision, mydriasis, photophobia, cycloplegia, and increased ocular tension.

14. The nurse is assessing a client who is receiving felbamate. The nurse suspects that the client may be developing pancytopenia based on which assessment finding? Select all that apply. A) Gingival hyperplasia B) Sore throat C) Epistaxis D) Skin rash E) Bruising

B, C, E Feedback: Signs of pancytopenia include sore throat, fever, general malaise, bleeding of the mucous membranes, epistaxis (bleeding from the nose), and easy bruising. Gingival hyperplasia and skin rash are examples of adverse reactions, but these are not associated with pancytopenia.

13. A client tells the nurse that he takes the drug Stalevo. The nurse understands that this drug is a combination of which of the following? Select all that apply. A) Benztropine B) Levodopa C) Carbidopa D) Tolcapone E) Entacapone

B, C, E Feedback: Stalevo is a brand-name combination product that contains carbidopa, levodopa, and entacapone.

24. After teaching a group of nursing students about the parasympathetic nervous system, the instructor determines that the teaching was successful when the students identify which of the following as an action? Select all that apply. A) Decreased salivary gland production B) Vasodilation C) Increased peristalsis D) Bronchodilation E) Pupillary constriction

B, C, E Feedback: Stimulation of the parasympathetic nervous system results in the opposite reactions to those triggered by the adrenergic system: blood vessels dilate, sending blood to the gastrointestinal (GI) tract; secretions and peristalsis are activated and salivary glands increase production; the heart slows and pulmonary bronchioles constrict; the smooth muscle of the bladder contracts; and the pupils of the eyes constrict.

26. A client with schizophrenia is prescribed antipsychotic therapy. When developing the plan of care for the client, the nurse integrates understanding that the client is at risk for extrapyramidal syndrome. The nurse would expect to assess the client for this adverse reaction at which time? A) Once a week B) At the initiation of therapy C) When the dose is reduced D) Every 3 months E) When the dose is increased

B, C, E Feedback: The nurse should assess for EPS during initial therapy and whenever the dosage is increased or decreased.

11. Which of the following would the nurse report to the primary health care provider if assessed in a client receiving an antidepressant? Select all that apply. A) Weight gain B) Expressions of guilt C) Indirect threats of suicide D) Somnolence E) Insomnia

B, C, E Feedback: The nurse should report any of the following to the client's primary health care provider if observed: expressions of guilt, hopelessness, or helplessness; insomnia; weight loss; and direct or indirect threats of suicide.

4. A nurse would monitor a client receiving a cholinergic blocking drug for an increased effect when the drug is administered with which of the following? Select all that apply. A) Fluconazole (Diflucan) B) Meperidine (Demerol) C) Haloperidol (Haldol) D) Amitriptyline (Elavil) E) Digoxin (Lanoxin)

B, D Feedback: A nurse may notice an increased effect of the cholinergic blocking drug when it is administered with meperidine (Demerol) and amitriptyline (Elavil) because meperidine and tricyclic antidepressants increase the effect of the cholinergic blockers. If given with fluconazole, an antifungal agent, the effectiveness of the antifungal agent decreases. If given with haloperidol, haloperidol's effectiveness is decreased. If given with digoxin, the risk for digoxin toxicity increases.

6. A nurse administers atenolol (Tenormin) to a client suffering an acute MI based on the understanding that this drug will result in which of the following changes in the client? Select all that apply. A) Increase the heart's excitability B) Decrease the heart's workload C) Increase the heart's oxygen consumption D) Decrease heart rate E) Constrict blood vessels

B, D Feedback: Atenolol (Tenormin) is a b-adrenergic blocking drug. Blockade of b-adrenergic receptors results in decreased heart rate, dilation of blood vessels, a decrease in the heart's excitability, and a decrease in cardiac workload and oxygen consumption and provides membrane-stabilizing effects.

6. A nurse is reviewing the medical record of a client. Which of the following conditions, if found, would the nurse identify as a condition in which CNS stimulants should be avoided? Select all that apply. A) Severe hypotension B) Hyperthyroidism C) Diabetes D) Cardiac disease E) Seasonal allergies

B, D Feedback: CNS stimulants should not be given to clients with cardiac disease, severe hypertension, or hyperthyroidism. Diabetes and seasonal allergies are not contraindications for use of CNS stimulants.

7. When assessing a client receiving a cholinergic drug, the nurse would assess the client for increased neuromuscular blocking effects if the client is also receiving which of the following? Select all that apply. A) Amoxicillin B) Tobramycin C) Cephalexin D) Neomycin E) Clarithromycin

B, D Feedback: Cholinergic drugs administered concomitantly with aminoglycoside antibiotics, like tobramycin and neomycin, can result in increased neuromuscular blocking effects.

6. A client is prescribed ambenonium. The nurse would assess the client closely if the client has a history of which of the following? Select all that apply. A) Diabetes B) Hypertension C) Tachycardia D) Epilepsy E) Megacolon

B, D Feedback: Cholinergic drugs, like ambenonium, are used cautiously in clients with hypertension, epilepsy, cardiac arrhythmias, bradycardia, recent coronary occlusion, and megacolon.

3. A nurse is administering cholinergic eye drops to a client. The nurse would be alert for which of the following as a possible adverse reaction? Select all that apply. A) Nausea B) Headache C) Nasal congestion D) Decreased visual acuity E) Decreased auditory acuity

B, D Feedback: Cholinergic eye drops are used to treat glaucoma. Topical administration usually produces few adverse reactions, but a temporary reduction of visual acuity and headache may occur.

2. A nurse suspects that a client who has received scopolamine is experiencing an idiosyncratic reaction to the drug based on assessment of which of the following? Select all that apply. A) Drowsiness B) Restlessness C) Hypotension D) Insomnia E) Dry mouth

B, D Feedback: Excitement, delirium, restlessness, and insomnia represent idiosyncratic reactions to scopolamine.

4. A nurse should be able to differentiate between the typical and atypical antipsychotics. Which of the following would the nurse identify as an atypical antipsychotic? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Prochlorperazine (Compazine) E) Clozapine (Clozaril)

B, E Feedback: Aripiprazole (Abilify) and clozapine (Clozaril) are classified as atypical antipsychotics.

1. When describing the anticonvulsants to a group of nursing students, the instructor describes which of the following as acting to stabilize the hyperexcitability postsynaptically in the motor cortex of the brain? Select all that apply. A) Ethosuximide (Zarontin) B) Phenytoin (Dilantin) C) Valproic acid (Depakote) D) Ethotoin (Peganone). E) Topiramate (Topamax)

B, D Feedback: Hydantoins, like phenytoin (Dilantin) and ethotoin (Peganone), exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Ethosuximide depresses the motor cortex, valproic acid increases levels of GABA to stabilize the cell membranes, and topiramate blocks seizure activity instead of raising the threshold.

12. If a cholinergic blocking drug is administered prior to surgery, which of the following would be most appropriate? Select all that apply. A) Encourage the client to void after the drug is given. B) Tell the client that his mouth may feel dry. C) Allow the client to take sips of fluids. D) Have the client remain in bed after drug administration. E) Encourage the client to sit in the chair for about 30 minutes.

B, D Feedback: If a cholinergic blocking drug is administered prior to surgery, the nurse instructs the client to void before the drug is given, that an extremely dry mouth is normal but that no fluid should be ingested, and that the client should remain in bed, not sit in a chair.

4. A client is prescribed pyridostigmine. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? Select all that apply. A) Constipation B) Nausea C) Dry mouth D) Skin flushing E) Muscle rigidity

B, D Feedback: Pyridostigmine is an oral cholinergic medication used in the treatment of myasthenia gravis. General adverse reactions associated with oral administration include nausea, diarrhea, abdominal cramping, salivation, skin flushing, cardiac arrhythmias, and muscle weakness.

15. A child is prescribed dexmethylphenidate. When developing the teaching plan for the child and parents, the nurse instructs the parents to administer the drug at which time? Select all that apply. A) After breakfast B) Before breakfast C) After lunch D) Before lunch E) At bedtime

B, D Feedback: The nurse should instruct the client's parents to administer dexmethylphenidate 30 to 45 minutes before breakfast and before lunch.

5. A nurse understands that while most b-adrenergic receptors are found in the heart, they are also commonly found in which other organs? Select all that apply. A) Pancreas B) Eyes C) Liver D) Lungs E) Skin

B, D Feedback: b-adrenergic receptors are also found in the eyes and lungs. The blockage of these receptors can be beneficial in treatment of glaucoma or cause adverse reactions in the lungs (bronchospasms).

11. When developing the teaching plan for a client receiving ethosuximide (Zarontin), the nurse would include instructions to notify the primary health care provider if which of the following occur? Select all that apply. A) Ataxia B) Blurred vision C) Slurred speech D) Joint pain E) Bruising

B, D, E Feedback: A nurse educating a client and family about ethosuximide (Zarontin) should tell them to notify the physician if skin rash, joint pain, unexplained fever, sore throat, unusual bleeding or bruising, drowsiness, blurred vision, or pregnancy occurs.

16. A nurse is conducting a class for a local community group about caffeine. The nurse discusses conditions in which over-the-counter caffeine products should be avoided. Which of the following would the nurse include in this discussion? Select all that apply. A) Hyperlipidemia B) Peptic ulcer disease C) GERD D) Hypertension E) Heart disease

B, D, E Feedback: Clients with heart disease, hypertension, and peptic ulcer disease should avoid the use of over-the-counter caffeine preparations.

16. A client is prescribed metaraminol. The nurse demonstrates understanding of this drug, identifying that it can be administered by which route? Select all that apply. A) Orally B) Subcutaneously C) Topically D) Intramuscularly E) Intravenously

B, D, E Feedback: Metaraminol may be administered subcutaneously, intramuscularly, and intravenously.

6. A nurse is reviewing the different types of shock that may occur. The nurse demonstrates understanding of the information when the nurse identifies which of the following as a type of distributive shock? Select all that apply. A) Cardiogenic-obstructive shock B) Septic shock C) Hypovolemic shock D) Anaphylactic shock E) Neurogenic shock

B, D, E Feedback: Septic shock, anaphylactic shock, and neurogenic shock are types of distributive shock. Cardiogenic and hypovolemic are other types of shock.

6. A nurse understands that the antidepressant drug paroxetine (Paxil) can be used to treat which of the following medical conditions? Select all that apply. A) Enuresis B) Depressive episodes C) Anorexia D) Obsessive-compulsive disorders E) Bulimia nervosa

B, D, E Feedback: Serotonin reuptake inhibitors like paroxetine (Paxil) are used in the treatment of depressive episodes, obsessive-compulsive disorders, and bulimia nervosa.

7. When describing tardive dyskinesia (TD) associated with the use of antipsychotic medication, which of the following would the nurse integrate into the teaching plan? Select all that apply. A) TD is an early-appearing adverse reaction. B) TD involves rhythmic, involuntary movements of the facial structures. C) TD is a reversible adverse effect of antipsychotic drugs. D) TD is less likely to occur with the use of atypical psychotics. E) TD can occur after discontinuation of antipsychotic drug therapy.

B, D, E Feedback: TD is a late-appearing reaction that is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. TD is nonreversible, can occur during antipsychotic drug therapy or after discontinuation, and is less likely to occur with the use of atypical antipsychotics.

10. A review of a client's history reveals that the client takes ginkgo. Which of the following would the nurse assess for in the client as a common adverse reaction? Select all that apply. A) Hyperglycemia B) Headache C) Hypotension D) Rash E) GI discomfort

B, D, E Feedback: The most common adverse reactions associated with ginkgo include mild GI discomfort, headache, and rash.

8. A nurse is reviewing the medical record of a client with anxiety who is to receive an antianxiety agent as part of the treatment. The nurse recognizes that benzodiazepines would not be used based on which of the following conditions? Select all that apply. A) Cataracts B) Acute narrow-angle glaucoma C) Hypotension D) Psychoses E) Pregnancy

B, D, E Feedback: The use of benzodiazepines is contraindicated in clients with known hypersensitivity, psychoses, acute narrow-angle glaucoma, and pregnancy.

9. A client comes to the clinic for a follow-up visit. It is a hot July afternoon. The client has been prescribed a cholinergic blocking drug. Which of the following would lead the nurse to suspect that the client is experiencing heat prostration? Select all that apply. A) Chills B) Flushing C) Bradycardia D) Cool, moist skin E) Mental confusion

B, E Feedback: Cholinergic blocking drugs can cause decreased sweating, increasing a client's risk for heat prostration. The signs of heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion.

8. The nurse is assessing a client for gingival hyperplasia based on the understanding that this adverse reaction is commonly associated with long-term administration of which of the following? Select all that apply. A) Carbamazepine (Tegretol) B) Phenytoin (Dilantin) C) Valproic acid (Depakote) D) Felbamate (Felbatol) E) Ethotoin (Peganone)

B, E Feedback: Gingival hyperplasia, although it can occur with any anticonvulsant, is commonly associated with long-term hydantoin therapy such as with phenytoin or ethotoin.

3. A nurse is providing care to a client with COPD. The nurse anticipates that which of the following would be appropriate to be prescribed for this client? Select all that apply. A) Darifenacin (Enablex) B) Ipratropium (Atrovent) C) Benztropine (Cogentin) D) Biperiden (Akineton) E) Tiotropium (Spiriva)

B, E Feedback: Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).

5. A nurse is preparing to administer phenytoin to a client. The nurse understands the need to administer this drug cautiously if the client has a history of which of the following? Select all that apply. A) Hyperthyroidism B) Hypotension C) Diabetes D) Asthma E) Hepatic impairment

B, E Feedback: Phenytoin (Dilantin) is used cautiously in clients with hypotension, severe myocardial insufficiency, and hepatic impairment.

6. A nurse reviews a client's medical history for conditions that would contraindicate use of methotrexate. Which of the following would the nurse identify as a possible contraindication? Select all that apply. A) Hypertension B) Folate deficiency C) Vitamin B12 deficiency D) Diabetes E) Liver disease

B, E Feedback: The use of methotrexate is contraindicated in clients with known hypersensitivity to the drug and clients with renal insufficiency, liver disease, alcohol abuse, pancytopenia, or folate deficiency.

24. A nurse is preparing an in-service presentation about hypnotics. Which of the following would the nurse plan to include? A) Usually given during the daytime hours B) Helpful in reducing anxiety C) Most likely administered at bedtime D) Exert a calming effect

C Feedback: A hypnotic is a drug that induces drowsiness or sleep, meaning it allows the patient to fall asleep and stay asleep. Hypnotics are given at night or bedtime. A sedative is a drug that produces a relaxing, calming effect. Sedatives are usually given during daytime hours, and although they may make the patient drowsy, they usually do not produce sleep.

18. A nurse is assigned to care for a 40-year-old client with a hepatic injury that has occurred due to the administration of tolcapone. Which of the following interventions should the nurse perform when caring for this client? A) Monitor the client for signs of tactile hallucinations. B) Monitor the client for signs of dystonic movements. C) Perform regular blood tests of the client. D) Perform serum transaminase level testing every day.

C Feedback: A serious and potentially fatal adverse reaction to tolcapone is hepatic injury. The nurse should, therefore, perform regular blood testing to monitor liver function of the client as prescribed. The testing of serum transaminase levels may be ordered at frequent intervals such as every 2 weeks for the first year and every 8 weeks thereafter. The nurse need not perform serum transaminase level testing every day. The nurse should monitor for signs of dystonic movements when caring for a client receiving carbidopa and levodopa, not tolcapone. The nurse should monitor for signs of tactile hallucinations when caring for an elderly client receiving tolcapone.

24. The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route? A) Orally B) Intramuscularly C) Subcutaneously D) Intravenously

C Feedback: Adalimumab, a DMARD, is administered by subcutaneous injection. Abatacept and infliximab are examples of DMARDs that are administered IV. Methotrexate, sulfasalazine, and leflunomide are examples of DMARDs that can be given orally.

27. After teaching a group of nursing students about adrenergic drugs and their effects, the instructor determines that the teaching was successful when the students identify which of the following as an effect of these drugs? A) Decreased myocardial contractility B) Vasodilation C) Increased cardiac output D) Improved airway clearance

C Feedback: Adrenergic drugs improve hemodynamic status by improving myocardial contractility and increasing heart rate, which results in increased cardiac output. Peripheral resistance is increased by vasoconstriction. The drugs do not improve airway clearance.

19. Antipsychotic therapy with a conventional antipsychotic has been started for a client with schizophrenia. Assessment reveals that the client is experiencing drowsiness that is affecting his ability to function. The nurse notes that the client needs assistance with his activities of daily living and ambulating. Which nursing diagnosis would the nurse most likely identify? A) Risk for Infection B) Risk for Unstable Blood Glucose Level C) Risk for Injury D) Impaired Physical Mobility

C Feedback: Antipsychotic drugs may cause extreme drowsiness and sedation, especially during the first or second weeks of therapy. This reaction may impair mental or physical abilities. The patient may need assistance with activities of daily living due to the experience of extreme sedation. This includes cueing or help with eating, dressing, and ambulating. Therefore, Risk for Injury would be most appropriate. Risk for Infection would be appropriate if the client was receiving clozapine. Risk for Unstable Blood Glucose Level would be appropriate if the client was receiving an atypical antipsychotic due to the increased risk for weight gain and subsequent development of diabetes. Impaired Physical Mobility would be appropriate if the client was experiencing EPS or TD.

30. A nursing student is preparing a class presentation about CNS stimulants and their uses. After completing the presentation, the student determines that additional explanation is necessary when the class identifies which of the following as a CNS stimulant? A) Anorexiant B) Amphetamine C) Antipsychotic D) Analeptic

C Feedback: Antipsychotics are not CNS stimulants. CNS stimulants include anorexiants, amphetamines, and analeptics.

31. A child is diagnosed with attention deficit hyperactivity disorder and is prescribed lisdexamfetamine. The child and his parents return to the clinic for a follow-up visit. The mother reports that his behavior has improved and "he's been sleeping okay at night." She also says, "He seems to eat like a bird sometimes and he's so thin." The child's weight and height are within the lower percentiles for his age. When developing the plan of care for this child, which nursing diagnosis would the nurse most likely identify as the priority? A) Disrupted Sleep Patterns B) Ineffective Coping C) Imbalanced Nutrition: Less Than Body Requirements D) Ineffective Breathing Pattern

C Feedback: Based on the assessment findings, the child is clearly having difficulty with nutritional intake. Therefore, Imbalanced Nutrition: Less Than Body Requirements would be the priority. The mother reports that the child's sleeping is "okay," so disturbed sleep patterns would not be an issue. There is no evidence to suggest ineffective coping or ineffective breathing pattern.

23. A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department complaining of abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which of the following? A) Underdosage of the drug B) Tolerance to the drug C) Cholinergic crisis D) Underlying infection

C Feedback: Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing. Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing. There is no information to suggest that the client has an underlying infection.

25. A client receiving antianxiety drug therapy complains of constipation. The nurse understands that this is the result of which of the following? A) Excess fibrous food in the diet B) Overdose of an antianxiety drug C) Slowed intestinal transit time D) Oral administration of the drug

C Feedback: Constipation results from the action of the antianxiety agents, which slow intestinal transit time. An increased fiber intake would help combat the constipation. Constipation does not result from an overdose of the drug or from oral administration.

29. A client is brought to the emergency department with suspected overdose of a benzodiazepine. Which of the following should the nurse anticipate administering to counteract the effects of the overdose? A) Naloxone B) Naltrexone C) Flumazenil D) Diazepam

C Feedback: Flumazenil is the antidote for benzodiazepine toxicity. Naloxone is used to reverse the effects of opioids. Naltrexone is used primarily to treat alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence. Diazepam is a benzodiazepine and would only increase the client's toxicity.

18. A client is prescribed flurazepam. When explaining the drug to the client, the nurse would include which of the following as its effect? A) Decreased stress B) Easing of pain C) Induction of sleep D) Improvement in circulation

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

20. A client with partial seizures has been prescribed a succinimide anticonvulsant. The client complains of GI upset after taking the drug. The nurse would suggest taking the drug in which manner? A) Daily at bedtime B) Immediately before eating a meal C) With some food or milk D) First thing in the morning on arising

C Feedback: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.

23. After teaching a group of nursing students about cholinesterase inhibitors, the instructor determines that additional teaching is needed when the students identify which drug as an example? A) Rivastigmine B) Donepezil C) Memantine D) Galantamine

C Feedback: Memantine is an example of an NMDA receptor antagonist. Rivastigmine, donepezil, and galantamine are cholinesterase inhibitors.

20. A client is prescribed donepezil for dementia. Review of the client's medication history reveals that the client uses NSAIDs for arthritis. The nurse would assess the client closely for which of the following? A) Decreased effectiveness of the NSAID B) Increased risk of NSAID toxicity C) Increased risk of GI bleeding D) Decrease GI absorption of the donepezil

C Feedback: NSAIDs in conjunction with donepezil increase the client's risk for GI bleeding. The effectiveness of the NSAID does not decrease, nor does the GI absorption of donepezil. There is no increase in the risk for NSAID toxicity.

16. A 14-year-old client with insomnia is prescribed estazolam. After administering the drug, the nurse would assess the client for which of the following as an adverse reaction? A) Muscle pain B) Chest pain C) Heartburn D) Taste change

C Feedback: One of the adverse reactions of estazolam is heartburn. Muscle pain is an adverse reaction of zolpidem tartrate. Chest pain and taste change are caused by eszopiclone.

15. A client is prescribed phenytoin daily for seizures. The nurse teaches the client about the importance of adhering to the dosage schedule based on the understanding that which of the following may occur if a single dose is missed? A) CNS depression B) Hypotension C) Recurrence of seizures D) Nystagmus

C Feedback: Recurrence of seizure activity may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.

28. A nurse is reviewing the effects of adrenergic drugs on the body. The nurse demonstrates understanding of this group of drugs by identifying that which of the following would occur if the drug stimulates beta-1 receptors? A) Vasoconstriction of peripheral blood vessels B) Decreased gastrointestinal tract secretions C) Increased force of myocardial contractions D) Bronchodilation

C Feedback: Stimulation of beta-1 receptors leads to an increase in heart rate and an increase in the force of myocardial contraction. Peripheral vasoconstriction occurs when alpha-1 receptors are stimulated. Decreased gastrointestinal motility and secretions occur when alpha-2 receptors are stimulated. Bronchodilation occurs when beta-2 receptors are stimulated.

15. A nurse observes rhythmic, involuntary facial movements in a client who has been receiving antipsychotic drugs. The client also makes chewing movements and, at times, his tongue protrudes. The nurse interprets these findings as which of the following? A) Stevens-Johnson syndrome B) Neuroleptic malignant syndrome C) Tardive dyskinesia D) Extrapyramidal syndrome

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

20. A client who is prescribed buspirone therapy also is receiving digoxin for heart failure. The nurse understands that this client would be at increased risk for which of the following? A) Sedation B) Respiratory depression C) Digitalis toxicity D) Central nervous system depression

C Feedback: The client faces an increased risk for digitalis toxicity due to the effect of interaction of buspirone with digoxin. Increased risk for sedation and respiratory depression are caused by the interaction of buspirone with tricyclic antidepressants and antipsychotics. Increased risk for central nervous system depression is caused by the interaction of buspirone with alcohol.

27. A client tells the nurse that she takes her prescribed medication immediately upon arising each morning and does not eat or drink anything for 30 minutes while she stays in an upright sitting position. The nurse determines that the client is adhering to the medication regimen because which drug has been prescribed? A) Methotrexate B) Allopurinol C) Risedronate D) Baclofen

C Feedback: The client is taking a bisphosphonate, which requires that it be taken upon arising in the morning with 6 to 8 ounces of water, with the client remaining in an upright position. Methotrexate (a DMARD), allopurinol (uric acid inhibitor), and baclofen (skeletal muscle relaxant) are taken with or immediately after meals to minimize gastric distress.

16. A client in the initial phase of gout is prescribed colchicine. After administering the drug, the nurse would continue to monitor the client for which of the following? A) Stomatitis B) Stevens-Johnson syndrome C) Bone marrow depression D) Exfoliative dermatitis

C Feedback: The nurse needs to closely monitor the client for bone marrow depression, an adverse reaction of colchicine. Stomatitis, Stevens-Johnson syndrome, and exfoliative dermatitis are not adverse reactions of colchicine. Stomatitis is an adverse reaction of immunosuppressive drugs. Stevens-Johnson syndrome and exfoliative dermatitis are adverse reactions of allopurinol.

22. A nurse is preparing to administer a centrally acting adrenergic blocker to a group of clients. The nurse would be especially cautious when administering the drug to which client? A) Client with diabetes B) Client with chronic bronchitis C) Client with renal function impairment D) Client with impaired hepatic function

C Feedback: The nurse should administer centrally acting adrenergic blockers cautiously to clients with renal function impairment. The a\b-adrenergic blocking drugs should be used cautiously in clients with diabetes, chronic bronchitis, and impaired hepatic function.

19. A nurse is caring for a client who is receiving alprazolam. The nurse would be alert for which of the following as an initial adverse reaction with this drug? A) Heartburn B) Anorexia C) Headache D) Allergy

C Feedback: The nurse should assess for headache as the initial adverse reaction in the client after administering alprazolam. Heartburn, anorexia, and allergy are adverse reactions observed in the client after administering salicylates.

23. A nurse is caring for a client who has been prescribed belladonna for the treatment of prolonged diarrhea. Which of the following nursing interventions should the nurse perform before administering the drug? A) Check stools of the client. B) Monitor for abdominal pain. C) Assess weight of the client. D) Monitor vital signs every 2 hours.

C Feedback: The nurse should assess the client's weight when caring for this client with prolonged diarrhea. The nurse should check the stools of the client who has been administered belladonna alkaloids for the treatment of peptic ulcer. The nurse need not monitor for abdominal pain or monitor the client's vital signs every 2 hours when caring for a client with diarrhea.

24. A nurse is caring for a client receiving cholinergic blocking drug therapy. The client complains of a cotton-mouth feeling. Which of the following would be most appropriate? A) Inspect the throat for signs of an infection. B) Suggest the client avoid ingesting water before taking the drug. C) Check the oral cavity daily for soreness or ulcerations. D) Suggest the client avoid the use of ice or cold beverages.

C Feedback: The nurse should check the oral cavity daily for soreness or ulcerations when caring for a client with severe mouth dryness. The nurse should encourage the client to take a few sips of water before and while taking the drug and to sip water at intervals during meals. If allowed, hard candy slowly dissolved in the mouth and frequent sips of water during the day may help relieve persistent oral dryness. There is no need to inspect the throat for infection or to avoid ice and cold beverages.

19. A client with AD receiving a cholinesterase inhibitor has a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Which of the following would be most appropriate? A) Provide nutritious meals three times a day. B) Give foods that have the same consistency. C) Encourage careful chewing. D) Encourage visitors during mealtime.

C Feedback: The nurse should encourage chewing action when feeding. The nurse need not provide nutritious meals three times a day; instead, frequent small nutritious meals would be more beneficial. Offering foods of different consistency and flavor is important in case the patient can handle one form better than another. The nurse should not encourage visitors during mealtime; mealtime should be simple and calm.

23. A client has been prescribed benzphetamine. Which intervention would be most appropriate for the nurse to implement while administering the drug? A) Provide tea, coffee, and other stimulants. B) Administer the drug around dinner time. C) Avoid administering antidepressants. D) Encourage the intake of carbonated caffeine beverages.

C Feedback: The nurse should ensure that benzphetamine, or any other anorexiant, is not taken concurrently with antidepressant medications. The nurse should avoid or decrease the use of coffee, tea, and carbonated beverages containing caffeine. The drug should be taken early in the day, not around dinner time, to avoid insomnia.

23. A client with Parkinson's disease is undergoing treatment in a health care facility. Which of the following nursing interventions should the nurse perform as part of the client's ongoing assessment? A) Assess the client for ability to perform the daily activities. B) Observe the current mental condition of the client. C) Observe the client for various neuromuscular signs. D) Prepare a baseline for future evaluations of the client's drug therapy.

C Feedback: The nurse should evaluate the client's response to drug therapy by observing the client for various neuromuscular signs to compare these observations with the data obtained during the initial physical assessment. The nurse should assess the client's ability to perform daily activities and observe the client's current mental condition before the drug is administered to the client as part of the preadministration assessment. During the preadministration assessment, before starting the drug therapy, the nurse also performs a physical assessment of the client to provide a baseline for future evaluations of drug therapy.

17. After administering an antipsychotic to a client, the nurse would immediately report which of the following? A) Orthostatic hypotension B) Dry mouth C) Rigidity D) Drowsiness

C Feedback: The nurse should immediately report to the primary health care provider if the client displays signs of rigidity. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.

21. Which of the following instructions should the nurse specifically stress when administering drugs used for muscle spasm and cramping? A) Take the drug with food. B) Stay upright for 30 minutes after taking the drugs. C) Avoid alcohol or other CNS depressants. D) Take the drug with 6 to 8 ounces of water.

C Feedback: The nurse should instruct the client to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct clients taking drugs for osteoporosis to take them with 6 to 8 ounces of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct clients with gout to take drugs for treating gout with food.

28. A client is prescribed modafinil as treatment for narcolepsy. When teaching the client about the drug, which of the following would the nurse include in the instructions for the client? A) Record any changes in weight. B) Avoid coffee or tea. C) Record number of periods of sleepiness. D) Take over-the-counter antidepressants for depression.

C Feedback: The nurse should instruct the client to keep a record of the number of times per day that periods of sleepiness occur and to bring this record to each visit to the primary health care provider or clinic. There is no need to avoid tea or coffee or to record weight. The client should be instructed not to take antidepressants for the duration of the dosage regimen.

17. A client is receiving medication for gout. The nurse would include instructions about which of the following during the course of treatment? A) Taking drug on an empty stomach B) Using protection against sunlight C) Reporting any skin rash D) Wearing a brace to get out of bed

C Feedback: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks.

16. A nurse is assigned to care for a client with biliary colic in a health care facility. The client has been prescribed atropine. The nurse reviews the client's medical record and determines that the client should not receive this drug because the client has a history of which of the following? A) Hepatic disease B) Benign prostatic hypertrophy C) Myocardial infarction D) Urinary retention

C Feedback: The nurse should know that the use of atropine is contraindicated in clients with myocardial infarction. Other contraindications include myasthenia gravis, tachyarrhythmia, and congestive heart failure (unless bradycardia is present). Hepatic disease, benign prostatic hypertrophy, and urinary retention are conditions requiring cautious administration and are not contraindications for use.

19. A nurse is caring for a 60-year-old client with a peptic ulcer. The client is prescribed belladonna. The nurse would closely monitor this client for which of the following? A) Disorientation B) Lightheadedness C) Blurred vision D) Mydriasis

C Feedback: The nurse should monitor for blurred vision in the client after administration of the belladonna alkaloid drug. The other conditions observed are drowsiness, tachycardia, dry mouth, and urinary hesitancy. Disorientation, lightheadedness, and mydriasis are adverse reactions associated with the administration of trihexyphenidyl.

18. A nurse is caring for a client with myasthenia gravis at a health care facility. The client is receiving ambenonium. The nurse suspects that the dosage is insufficient based on assessment of which of the following? A) Clenching of the jaw B) Muscle spasms C) Difficulty breathing D) Abdominal cramping

C Feedback: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Clenching of the jaw and muscle spasms are symptoms of drug overdosage. Abdominal cramping may occur in the client who is receiving guanidine.

17. A client with an overactive bladder has been prescribed solifenacin by the physician. The client is also taking digoxin for the treatment of a cardiac condition. The nurse should monitor the client for an increase in which of the following resulting from the interaction of these two drugs? A) Increased neuromuscular blocking effect B) Increased effectiveness of digoxin C) Increased serum levels of digoxin D) Increased effectiveness of solifenacin

C Feedback: The nurse should monitor for increased serum levels of digoxin that occur due to the interaction of solifenacin and digoxin. Increased neuromuscular blocking is an effect of the interaction of aminoglycoside antibiotics with cholinergic drugs. Increased effectiveness of digoxin and solifenacin are not the effects associated with the interaction of solifenacin and digoxin.

14. A nurse assesses a client receiving antipsychotic drugs for which of the following adverse reactions? A) Hypertension B) Skin dryness C) Dry mouth D) Bradycardia

C Feedback: The nurse should monitor the client for mouth dryness. Antipsychotic drugs cause hypotension, not hypertension. Skin dryness and bradycardia are not adverse reactions related to the administration of antipsychotic drugs.

19. A nurse is caring for a 70-year-old client undergoing antiparkinsonism drug therapy. The client is prescribed pramipexole by the physician. The nurse should monitor the client's condition for the development of which of the following adverse reactions associated with the use of this drug? A) Blurred vision B) Memory loss C) Visual hallucinations D) Muscular rigidity

C Feedback: The nurse should monitor the elderly client who is administered a dopamine receptor antagonist for signs of visual, auditory, or tactile hallucinations. Hallucinations occur more often in older adults than in younger adults receiving the antiparkinsonism drugs, especially when taking the dopamine receptor agonists. The incidence of hallucinations appears to increase with age. The nurse need not monitor the client's condition for signs of blurred vision, memory loss, and muscular rigidity as these conditions are not known to occur in elderly clients due to the use of dopamine receptor agonists.

19. Which of the following would be most important for the nurse to assess when administering a bisphosphonate to a client with Paget's disease? A) Altered renal function B) Increased skin rashes C) Serum calcium levels D) Hematology function

C Feedback: The nurse should monitor the serum levels of calcium before, during, and after bisphosphonate therapy, because bisphosphonates act primarily on the bone by inhibiting normal and abnormal bone resorption. These drugs are used cautiously in clients with renal function impairment but do not alter renal function. The nurse should monitor the client's renal function when allopurinol is administered and hematology function when methotrexate is administered.

19. The nurse is developing a teaching plan for a client who is receiving outpatient therapy with a cholinergic drug. Which of the following would be appropriate for the nurse to include? A) Instructions to avoid fiber-rich food during therapy B) Importance of adopting a self-monitoring blood pressure program C) Review of the purpose of the drug therapy with the client and family D) Evaluation of the client's previous history of disorders

C Feedback: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client receiving outpatient therapy with a cholinergic drug. Instructing the client to avoid fiber-rich food during therapy, suggesting the client adapt a self-monitoring blood pressure program, and evaluating the client's previous history of disorders would be inappropriate to include in the teaching plan.

18. A nurse is preparing to administer propranolol to a client for the treatment of cardiac arrhythmias. The nurse checks the client's apical pulse rate and blood pressure before administration and notes that the pulse rate is below 60 bpm. Which of the following would the nurse do next? A) Provide proper ventilation to the client. B) Delay drug administration for some time. C) Withhold the drug and contact the primary health care provider. D) Immediately give oxygen via face mask.

C Feedback: The nurse should withhold the drug and contact the primary health care provider if the pulse rate of the client is below 60 bpm. Providing proper ventilation to the client, delaying drug administration for some time, or providing oxygen support to the client would be inappropriate for this client.

22. A caregiver of a client diagnosed with AD asks the nurse about the cholinesterase inhibitor galantamine prescribed for the client. Which response by the nurse would be most appropriate? A) "The drug will help to cure the memory problems the client is experiencing." B) "Once the symptoms improve, the drug will most likely be stopped." C) "These drugs help to slow the progression of the disease." D) "This drug is primarily given to control the delirium the client is experiencing."

C Feedback: The progression of memory loss associated with dementia is treated with cholinesterase inhibitors. These drugs slow progression but do not cure dementia. These drugs are given to clients with mild to moderate dementia, but they do not treat any delirium that the clients may experience. Cholinesterase inhibitors are not frequently used in late-stage AD.

27. A client has been prescribed doxapram. The nurse would closely assess the client for which of the following after administration? A) Visual acuity B) Heart rate C) Urinary pattern D) Auditory function

C Feedback: Urinary retention may result from doxapram administration, so the nurse should measure fluid intake and output and notify the primary health care provider if any problems occur. Analeptics do not cause impaired vision or tinnitus, nor do they cause tachycardia, so monitoring visual acuity, heart rate, and auditory function are not indicated.

27. After teaching a client who is prescribed lithium about the drug, the nurse determines that the teaching was successful when the client states which of the following? A) "I need to limit how much I drink." B) "Salt is something that I need to avoid." C) "I should take the drug with food." D) "I need to call the doctor if I have a painful erection."

C Feedback: With lithium, the client should take the drug with food or immediately after meals, drink at least 10 large glasses of fluid each day, and add extra salt to food. Painful erections are not associated with lithium use.

3. A client is prescribed an antipsychotic drug that also has an antiemetic effect. Which of the following would the nurse identify as having this effect? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Prochlorperazine (Compazine) E) Clozapine (Clozaril)

C, D Feedback: Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are antipsychotic medications that have antiemetic effects. Lithium, aripiprazole, and clozapine do not.

12. When caring for a client who is receiving acebutolol (Sectral), the nurse would ensure that which of the following is avoided to promote optimal effectiveness of acebutolol? Select all that apply. A) Sertraline (Zoloft) B) Phenelzine (Nardil) C) Naproxen (Naprosyn) D) Oxaprozin (Daypro) E) Fluoxetine (Prozac)

C, D Feedback: NSAIDs (naproxen and oxaprozin) can result in decreased effects of b blockers such as acebutolol.

2. When describing the action of antidepressants, the nursing instructor would include the belief that they exert their effect by causing slow adaptive changes to which of the following receptor systems? Select all that apply. A) Beta-adrenergic B) Baroreceptors C) Norepinephrine D) Serotonin E) Nicotinic

C, D Feedback: New research indicates that the effects of antidepressants are related to slow adaptive changes in norepinephrine and serotonin receptor systems.

14. A nurse suspects that a client is experiencing anxiety. Which physical assessment findings would support the nurse's suspicion? Select all that apply. A) Hypotension B) Decreased respiratory rate C) Increased muscle tension D) Pale skin E) Bradycardia

C, D Feedback: Physiological manifestations of anxiety can include hypertension, tachycardia, increased rate and depth of respirations, increased muscle tension, and cool, pale skin.

15. A client is prescribed secobarbital. The nurse understands that the client is at increased risk of respiratory depression. The nurse plans to assess the client's respiratory status at which time? Select all that apply. A) 5 to 10 minutes after drug administration B) 10 to 15 minutes after drug administration C) 30 to 60 minutes after drug administration D) Before drug administration E) 60 to 90 minutes after drug administration

C, D Feedback: The nurse carefully assesses respiratory function before administering a sedative, 30 to 60 minutes after administering the drug, and frequently thereafter.

12. A client taking phenelzine (Nardil) is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department (ED). This client might be experiencing a hypertensive crisis. What other symptoms might the nurse in the ED assess if the client is experiencing a hypertensive crisis? Select all that apply. A) Constricted pupils B) Chills C) Chest pain D) Tachycardia E) Stiff neck

C, D, E Feedback: A client experiencing a hypertensive crisis can exhibit the following symptoms: stiff or sore neck, nausea, vomiting, headache, sweating, fever, chest pain, dilated pupils, and bradycardia or tachycardia.

3. A nurse would suspect that a client is taking amphetamines based on the assessment of which of the following? Select all that apply. A) Decrease in blood pressure B) Sleepiness C) Increased pulse D) Euphoria E) Decreased pulse

C, D, E Feedback: A client taking amphetamines may have elevated blood pressure, wakefulness, and an increase or decrease in pulse. Amphetamines also produce a euphoric state; this pleasurable feeling is what increases their dependency potential.

10. Which of the following would the nurse assess before administering ambenonium to a client? Select all that apply. A) Palpation of the bladder B) Palpation of the thyroid C) Evidence of muscle weakness D) Signs of difficulty breathing E) Drooping of eyelids

C, D, E Feedback: Ambenonium is used to treat myasthenia gravis. The nurse's preadministration assessment should include assessment for signs of muscle weakness, such as drooling, inability to chew and swallow, drooping eyelids, inability to perform repetitive movements, difficulty breathing, and extreme fatigue.

5. A client is prescribed carbidopa\levodopa. The nurse understands that this drug should be administered cautiously to clients with which condition? Select all that apply. A) Hyperthyroidism B) Seizure disorder C) Renal disease D) Asthma E) Peptic ulcer disease

C, D, E Feedback: Carbidopa\levodopa (Sinemet) is used cautiously in clients with cardiovascular or pulmonary disease (asthma), peptic ulcer disease, renal or hepatic disease, and psychosis.

5. After teaching a group of nursing students about antipsychotics, the instructor determines that the teaching was successful when the students identify which of the following as a typical antipsychotic? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Haloperidol (Haldol) E) Fluphenazine (Prolixin)

C, D, E Feedback: Chlorpromazine, haloperidol, and fluphenazine are classified as typical antipsychotics.

27. A nursing instructor is conducting a class for a group of nursing students about cholinergic blocking drugs. The instructor determines that the teaching was successful when the students identify which of the following as a cholinergic blocking drug used to treat Parkinson's disease? Select all that apply. A) Fesoterodine B) Trospium C) Benztropine mesylate D) Biperiden E) Trihexyphenidyl

C, D, E Feedback: Cholinergic blocking drugs used to treat Parkinson's disease include benztropine mesylate, biperiden, and trihexyphenidyl. Fesoterodine and trospium are cholinergic blocking antispasmodics.

9. A nurse determines the need to administer a prescribed antidepressant in the morning because of the increased likelihood of insomnia. Which drug would this most likely be? Select all that apply. A) Amitriptyline B) Bupropion C) Citalopram D) Paroxetine E) Sertraline

C, D, E Feedback: It is best to administer serotonin reuptake inhibitors, such as citalopram, paroxetine, and sertraline, in the morning as they have a greater likelihood to cause insomnia.

5. A nurse is reviewing the medical record of a client who is to be prescribed a cholinergic drug. Which condition, if found, would alert the nurse to a possible contraindication to the prescribed therapy? Select all that apply. A) Pancreatitis B) Diabetes C) Asthma D) Hyperthyroidism E) Peptic ulcer disease

C, D, E Feedback: The use of cholinergic drugs is contraindicated in clients with known hypersensitivity to the drugs, asthma, peptic ulcer disease, coronary artery disease, and hyperthyroidism.

25. A client is prescribed norepinephrine IV. Which of the following would be appropriate for the nurse to do? Select all that apply. A) Administer the drug via a gravity infusion. B) Dilute the drug with sterile saline. C) Continuously monitor the client's blood pressure. D) Check the IV insertion site for leakage. E) Assess the client's urinary output hourly.

C, D, E Feedback: When giving norepinephrine IV, the nurse should use an electronic infusion pump, not dilute the norepinephrine solution, continuously monitor the client's blood pressure, check the IV site for leakage or extravasation, restart the IV in another location if extravasation occurs and institute extravasation protocol according to the facility's policy, and assess the client's urine output hourly.

16. After teaching a group of nursing students about possible adverse reactions associated with trazodone, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply. A) Sexual dysfunction B) Insomnia C) Priapism D) Diarrhea E) Dry mouth

C, E Feedback: The following are possible adverse reactions that may occur with trazodone: priapism, drowsiness, dizziness, dry mouth, nausea, vomiting, constipation, fatigue, and nervousness.

16. 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. A) Intravenously B) Intramuscularly C) Orally D) Subcutaneously E) Transdermally

C, E Feedback: The nurse should administer rivastigmine orally or transdermally to the client. Rivastigmine is not administered intravenously, intramuscularly, or subcutaneously.

2. Before administering dantrolene to a client, the nurse checks the client's medical history for possible contraindications for use. Which condition would the nurse identify as problematic? Select all that apply. A) Hypertension B) Atrial fibrillation C) Hepatic disease D) Diabetes E) Lactation

C, E Feedback: The use of dantrolene is contraindicated during lactation and in clients with active hepatic disease and muscle spasm caused by rheumatic disorders.

12. A nurse caring for a client with gout should monitor the client's fluid intake and output, as increased urinary output is needed to excrete uric acid. The nurse would encourage the client to achieve an intake of how much fluid per day? A) 1000 mL B) 1500 mL C) 2000 mL D) 3000 mL

D Feedback: A client with gout is encouraged to drink at least 3000 mL of fluid per day to promote uric acid excretion.

26. A client with motion sickness is prescribed transdermal scopolamine. The nurse would instruct the client to apply the patch at which frequency? A) Every 8 hours B) Every 24 hours C) Every 48 hours D) Every 72 hours

D Feedback: A scopolamine patch is applied 4 hours before travel every 3 days or every 72 hours.

21. The nurse would monitor a client who is receiving caffeine for which of the following? A) Decease in heart rate B) Decrease in urinary output C) Feeling of euphoria and well-being D) Skeletal muscle stimulation

D Feedback: Caffeine leads to skeletal muscle stimulation. Caffeine results in an increase, not decrease, in heart rate. Caffeine is a diuretic and it increases, not decreases, urinary output. Caffeine does not lead to a feeling of euphoria or well-being.

23. A client is receiving anakinra. After administering the drug, the nurse would continue to assess the client for which of the following? A) Constipation B) Abdominal pain C) Retinal changes D) Pancytopenia

D Feedback: Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes.

12. After teaching a group of nursing students about cholinergic drugs, the instructor determines a need for additional teaching when the students identify which drug as being administered orally? A) Ambenonium B) Bethanechol C) Pyridostigmine D) Edrophonium

D Feedback: Edrophonium is a cholinergic drug that is administered intravenously. Ambenonium, bethanechol, and pyridostigmine are administered orally.

30. When developing the plan of care for a client who is receiving lithium therapy, which nursing diagnosis would the nurse most likely identify as a priority? A) Self-Care Deficit B) Disturbed Sleep Pattern C) Imbalanced Nutrition: Less Than Body Requirements D) Imbalanced Fluid Volume

D Feedback: Fluid balance determines the concentration of lithium in the blood and thus the client's risk for toxicity. Therefore, imbalanced fluid volume is a priority. Self-care deficit, disturbed sleep pattern, and imbalanced nutrition also may apply, but imbalanced fluid volume would be the priority.

22. A primary health care provider prescribes phenytoin to be administered parenterally to a client with a seizure disorder. The nurse prepares the drug to be given by which method? A) Intradermally B) Subcutaneously C) Intramuscularly D) Intravenously

D Feedback: Phenytoin can be administered orally and parenterally. If the drug is administered parenterally, the intravenous (IV) route is preferred over the intramuscular (IM) route, because with the IM route erratic absorption of phenytoin causes pain and muscle damage at the injection site. The drug is not administered intradermally or subcutaneously.

26. A group of nursing students are reviewing the stages of AD. They demonstrate understanding of the information when they identify which of the following as characteristic of preclinical AD? A) Client's changes in thinking are readily evident to family members. B) The client may exhibit moderate levels of anxiety. C) The ability to function is significantly limited. D) There are no cognitive changes noted.

D Feedback: Preclinical AD is characterized by no changes in cognitive or functional ability. With mild cognitive impairment, the changes in thinking are noticeable to the client and family members, and the person may experience mild to moderate anxiety. In dementia due to AD, memory, thinking, and behavior limit the person's ability to function.

19. A nurse is preparing to administer a prescribed adrenergic agent to a client who is in shock. Before administering the drug, the nurse would assess for and document which of the following as a sign of shock? A) Increased temperature B) Reddish\pinkish skin C) Dry, dehydrated skin D) Changes in consciousness

D Feedback: Symptoms of shock, such as a change in the level of consciousness, should be recorded by the nurse as part of the preadministration assessment. Cool skin, not elevated temperature, is another symptom of shock. The nurse also needs to record signs of diaphoresis and cyanosis, not reddish\pinkish or dry, dehydrated skin.

24. Assessment of a client receiving anticonvulsant therapy reveals the following: sore throat, chills, fever, gingival bleeding, and bruising. Which nursing diagnosis would the nurse most likely identify? A) Risk for Impaired Skin Integrity B) Impaired Oral Mucous Membranes C) Risk for Injury D) Risk for Infection

D Feedback: The assessment findings suggest pancytopenia, so Risk for Infection would be most likely. Risk for Impaired Skin Integrity would be appropriate if the client developed a rash. Impaired Oral Mucous Membranes would be appropriate if the client was exhibiting signs of gingival hyperplasia. Risk for Injury would be appropriate if the client was experiencing drowsiness, ataxia, and vision disturbances related to the drug therapy.

18. A client is receiving hydroxychloroquine for a musculoskeletal disorder. Which of the following adverse reactions is irreversible and needs to be reported by the nurse? A) Easy bruising B) Skin rash C) Fever D) Visual changes

D Feedback: The nurse needs to report complaints of visual changes in a client receiving hydroxychloroquine, because irreversible retinal damage may occur. Although easy bruising, skin rash, and fever are adverse reactions of the drug, they are not irreversible.

22. A nurse is caring for a client who has received carbidopa\levodopa. After administration of the first dose of the drug, the client has developed gastrointestinal disturbances. Which of the following nursing interventions would be most appropriate? A) Administer the next drug dose with milk. B) Withhold the next drug dose. C) Observe for alterations in blood pressure. D) Administer the next drug dose with meals.

D Feedback: The nurse should administer the next drug dose with meals to manage gastrointestinal disturbances in a client who has been administered antiparkinsonism drugs. Withholding the next drug dose, administering the next drug dose with milk, or observing alterations in the client's blood pressure are not appropriate interventions when caring for a client who is experiencing GI disturbances with the first dose of antiparkinsonism drugs.

23. A nurse is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI). Which of the following should the nurse instruct the client to avoid? A) Milk B) Butter C) Rice D) Yogurt

D Feedback: The nurse should ask the client to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when the client is undergoing treatment with MAOIs.

20. A nurse is caring for an older adult client who has been prescribed amoxapine for depression accompanied by anxiety. After administration of the drug, the nurse observes muscle rigidity and sweating. The nurse identifies these as the symptoms of neuroleptic malignant syndrome. Which of the following would the nurse do next? A) Suggest the client engage in exercise. B) Get the client to drink a glass of cold water. C) Encourage the client to breathe deeply. D) Stop the drug and contact the physician.

D Feedback: The nurse should discontinue the drug administration and contact the physician. Exercising, drinking cold water, and encouraging deep breaths will not help the client with symptoms of neuroleptic malignant syndrome.

27. A nurse is caring for an older adult client who is prescribed an antianxiety agent parenterally. Which of the following would be most important for the nurse to do? A) Arrange for a blood transfusion. B) Provide fiber-rich food. C) Provide plenty of fluids. D) Have resuscitative equipment ready.

D Feedback: The nurse should have resuscitative equipment ready because older adult clients may experience apnea and cardiac arrest during the treatment. Providing fiber-rich food and plenty of fluids is appropriate to prevent constipation and is unrelated to the use of the parenteral route. The need for a blood transfusion would not arise during the treatment.

24. A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression. During the initial interview with the client, the nurse understands that the client is also receiving an adrenergic agent. The nurse would be alert for which of the following? A) Increased risk for hypertensive episodes B) Increased risk for severe convulsions C) Increased risk for hyperpyretic episodes D) Increased risk for cardiac arrhythmias

D Feedback: The nurse should identify increased risk for cardiac arrhythmias because of the effects of interaction between MAOIs and adrenergic agents. Increased risk for hypertensive episodes, severe convulsions, and hyperpyretic episodes occur when an MAOI and meperidine are used together.

15. A client with a cardiac problem is treated with b-adrenergic blocking drugs. Which of the following should the nurse identify as a cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client? A) Vomiting B) Hyperglycemia C) Nausea D) Vertigo

D Feedback: The nurse should identify vertigo as the cardiac reaction that impacts the body when a b-adrenergic blocking drug is given to the client. Vomiting, nausea, and hyperglycemia are not cardiac reactions; they are gastrointestinal reactions that are observed when the client is administered b-adrenergic blocking drugs.

20. A nurse is providing care to a client who is receiving an ophthalmic cholinergic drug. When reviewing the client's medical history, which of the following, if found, would the nurse identify as a contraindication? A) Cataracts B) Diabetic retinopathy C) Megacolon D) Corneal abrasion

D Feedback: The nurse should know that ophthalmic cholinergic drugs are contraindicated in clients with corneal abrasions. The use of ophthalmic cholinergic drugs is not contraindicated in clients with cataracts, diabetic retinopathy, or megacolon. Cholinergic drugs are used cautiously in clients with megacolon.

15. A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which of the following? A) Seizure disorder B) Reduction of visual acuity C) Abdominal discomfort D) Cardiac arrhythmias

D Feedback: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol chloride for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol chloride and not pyridostigmine.

15. A nurse is caring for a 55-year-old client with Parkinson's disease who is prescribed entacapone. The nurse would monitor this client for which adverse reaction? A) Increased hand tremor B) Constipation C) Urinary retention D) Dyskinesia

D Feedback: The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hyperkinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs.

17. A nurse is caring for an older adult client who is prescribed isoproterenol. After administering the drug, the nurse would immediately report which of the following changes to the primary health care provider? A) Blood glucose level B) Appetite C) Temperature D) Pulse rate

D Feedback: The nurse should report any changes observed in pulse rate or rhythm immediately. Changes in glucose level, appetite, or temperature need not be reported immediately to the primary care provider unless they are severe.

24. A client admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. The nurse instructs the client about the need for cessation of alcohol consumption based on the understanding that the client would be at increased risk for which of the following? A) Antianxiety drug toxicity B) Respiratory depression C) Sedation D) CNS depression

D Feedback: The nurse should suggest that the client stop consuming alcohol while therapy is going on because such consumption increases the risk for CNS depression. Increased risk for digitalis toxicity is identified when the client is taking digoxin for management of cardiac problems. Increased risk for sedation and respiratory depression is identified when tricyclic antidepressants or antipsychotics are being used simultaneously with an antianxiety agent.

22. A nurse is assigned to care for a hospitalized client with anxiety. Buspirone is prescribed. When reviewing the client's history, which of the following, if found, would the nurse identify as a contraindication for this drug? A) Cataract B) Diabetic retinopathy C) Acute gout D) Psychoses

D Feedback: The use of buspirone is contraindicated in clients with hypersensitivity, psychoses, and acute narrow-angle glaucoma. Ethambutol is contraindicated in clients with cataracts and diabetic retinopathy. Pyrazinamide is contraindicated in clients with acute gout.

26. A client is prescribed lithium. The nurse suspects lithium toxicity based on which lithium drug level? A) 0.8 mEq\L B) 1.0 mEq\L C) 1.3 mEq\L D) 1.6 mEq\L

D Feedback: Toxicity may occur when serum lithium levels are greater than 1.5 mEq\L.

22. The nurse administers a prescribed oral dose of bethanechol to a client with urinary retention at 9:30 a.m. The nurse would notify the primary health care provider if the client has not voided by which time? A) 9:45 a.m. B) 10 a.m. C) 10:30 a.m. D) 11 a.m.

D Feedback: When bethanechol is administered orally, the client should void within 30 to 90 minutes. Therefore, if the client has not yet voided by 11 a.m., the nurse should notify the primary health care provider.

26. A client with gout has not responded to the usual medications. The primary health care provider prescribes a pegloticase infusion. Based on the nurse's understanding of this drug, which nursing diagnosis would be most appropriate? A) Risk for Injury B) Acute Pain C) Impaired Comfort: Gastric Distress D) Risk for Allergic Response

D Feedback: When first-line treatments for gout are not successful, sometimes drugs that are more toxic may be prescribed, such as the pegloticase infusion. During the infusion the patient is closely monitored for the development of adverse reactions, in particular anaphylaxis. Should an anaphylactic reaction occur, the infusion center staff members are prepared to start resuscitative measures as emergency personnel are notified.

10. A nurse is reviewing the medical record of a client who is to receive a cholinergic blocking drug. Which of the following would the nurse identify, if found, as contraindicating the use of the drug? Select all that apply. A) Pancreatitis B) Diabetes C) Asthma D) Glaucoma E) Myocardial infarction

D, E Feedback: The use of a cholinergic blocking drug is contraindicated in clients with known hypersensitivity to the drugs, glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction, and congestive heart failure (unless bradycardia is present).

23. A group of nursing students are reviewing information about adrenergic blockers in preparation for an examination. The students demonstrate understanding of the information when they identify which of the following as an a\b-adrenergic blocker? Select all that apply. A) Phentolamine B) Bisoprolol C) Nadolol D) Carvedilol E) Labetalol

D, E Feedback: Carvedilol and labetalol are a\b-adrenergic blockers. Phentolamine is an a-adrenergic blocker. Bisoprolol and nadolol are b-adrenergic blockers.

3. A nurse is reviewing the medication record of several clients with Parkinson's disease. The nurse identifies which drug if included in the client's record as being classified as a catechol-O-methyltransferase (COMT) inhibitor drug? Select all that apply. A) Amantadine (Symmetrel) B) Bromocriptine (Parlodel) C) Biperiden (Akineton) D) Entacapone (Comtan) E) Tolcapone (Tasmar)

D, E Feedback: Entacapone (Comtan) and tolcapone (Tasmar) are classified as COMT inhibitors. Amantadine and bromocriptine are dopaminergic drugs. Biperiden is a cholinergic blocking drug.

4. Which of the following antidepressants exert their effects by inhibiting the reuptake of serotonin? Select all that apply. A) Amitriptyline B) Bupropion C) Clomipramine D) Fluoxetine E) Escitalopram

D, E Feedback: Selective serotonin reuptake inhibitors like fluoxetine and escitalopram exert their effects by inhibiting the reuptake of serotonin. Tricyclic antidepressants like amitriptyline and clomipramine exert their effects by inhibiting the reuptake of norepinephrine and serotonin. Bupropion is believed to affect serotonin, norepinephrine, and dopamine receptors.