NRS 308 Exam 2 Review

a stage of sleep inwhich eye movement does not occur

NREM

Your patient is being discharged home with a prescription for lorazepam (Ativan). The patient states, "Boy, that was a lot of information you gave me. What is the bottom line-what should I really look out for?" Which of the following is your best response? a. "Assess how much sedation you experience before you attempt anything that requires mental alertness." b. "Try to take the medication on an empty stomach." c. "Just let me know if you need a refi ll on your prescription." d. "Take your medication as freuqenly as you feel you need it

a. "Assess how much sedation you experience before you attempt anything that requires mental alertness."

A 40-year-old man has been treated for depression with sertraline, an SSRI antidepressant, for the last 6 months. At his last two visits, he reported that his depression had improved. Today he reports beginning to feel worse and more depressed again. When you ask if he is still taking the drug regularly, he admits he is not. Which of the following may have contributed to his lack of adherence? (Mark all that apply) a. Adverse effects of drug affecting sexuality b. Improved mood while on the drug c. Cost of medication d. No refi lls on the prescription

a. Adverse effects of drug affecting sexuality, c. Cost of medication, d. No refi lls on the prescription

Precautions for the use of sertraline (Zoloft) include patients 1. with compromised liver function. 2. with compromised renal function. 3. with chronic heart failure. 4. with seizure disorders. 5. who are of pediatric/adolescent age. a. Answers 1, 4, and 5 b. Answers 1, 2, and 4 c. Answers 2, 3, and 5 d. Answers 3, 4, and 5

a. Answers 1, 4, and 5

When performing a nursing assessment, which of these observations would be the most signifi cant fi nding of a patient who takes lithium (Eskalith)? a. Coarse hand tremor, severe GI distress, and blurred vision b. Photophobia, weight loss, and blurred vision c. Headache, sedation, and anxiety d. Fatigue, irritability, and increased blood pressure

a. Coarse hand tremor, severe GI distress, and blurred vision

Which of the neurotransmitters are inhibited by sertraline (Zoloft)? 1. Serotonin (5-HT) 2. Acetylcholine (Ach) 3. Dopamine (DA) 4. Histamine (H1) 5. Norepinephrine (NE) 6. Epinephrine (Epi) a. Answers 1, 2, and 6 b. Answers 2, 4, and 6 c. Answers 1, 3, and 5 d. Answers 3, 5, and 6

c. Answers 1, 3, and 5

Lorazepam (Ativan) is a pregnancy category _____ drug. a. A b. C c. D d. X

c. D

the ability of the brain structures to undergo refinement in response to the internal and external enviromen

neuroplasticity

a stage of sleep in which ete movement occurs

REM

Which of the following classes of antidepressants is the fi rst choice for treating depression? a. Selective serotonin reuptake inhibitors (SSRIs) b. Tricyclic antidepressants (TCAs) c. Monoamine oxidase inhibitors (MAOIs) d. Any of the above

a. Selective serotonin reuptake inhibitors (SSRIs)

Your 12-year-old patient is taking sertraline (Zoloft) for depression. This patient may have an increased risk for which of the following adverse effects? a. Suicidal tendencies b. Orthostatic hypotension c. Blood dyscrasias d. Weight gain

a. Suicidal tendencies

Your patient had a surgical repair of a fractured arm earlier today. The patient states, "I cannot fall asleep—I am going home in the morning and my mind is just racing. I'm anxious about how I'll manage at home" After reviewing the medication order sheet, you note that the patient has orders for morphine IV push every 4 to 6 hours as needed for pain, zaleplon (Sonata) as needed for sleep, and lorazepam (Ativan) as needed for anxiety. Which of these medications would be most appropriate for your patient? a. Zaleplon b. Morphine c. Lorazepam d. None of the above

a. Zaleplon

Your patient has started a regimen of phenelzine, a monoamine oxidase inhibitor to treat depression that has not responded to other drug therapy. To minimize adverse effects, you should teach the patient to avoid a. aged, cured meats and cheeses. b. semolina pasta. c. apples. d. orange juice.

a. aged, cured meats and cheeses.

The most frequently occurring adverse effects of nortriptyline (Pamelor) are a. anticholinergic effects and headache. b. hypertension and bronchospasm. c. sedation and anticholinergic effects. d. diarrhea and GI distress.

a. anticholinergic effects and headache.

In the treatment of bipolar affective disorder, ______ is the drug of choice. a. lithium carbonate (Eskalith) b. carbamazepine (Tegretol) c. valproic acid (Depakene) d. gabapentin (Neurontin)

a. lithium carbonate (Eskalith)

. Paradoxical reactions with lorazepam (Ativan) are most likely to occur in patients with a. psychiatric disorders. b. hepatic insuffi ciency. c. renal failure. d. seizure disorders.

a. psychiatric disorders.

feeling of unease that something bad or undesirble may happen

anxiety

drugs that ease the sensation of axniety

anxiolytics

Your patient is being discharged home with a prescription for nortriptyline (Pamelor). Discharge instructions should include a. "Be sure to drink lots of fl uids to avoid dehydration." b. "Be sure to keep this medication out of the reach of your children." c. "Watch your intake of foods that contain tyramine." d. "This drug may keep you awake; use an overthe-counter sleep preparation if needed."

b. "Be sure to keep this medication out of the reach of your children."

Your patient is taking nortriptyline, a tricyclic antidepressant, and reports a severe dry mouth after 1 week of drug therapy. The patient states, "My depression isn't better. I want to stop taking the nortriptyline." Your best response to her would be a. "The dry mouth is a sign of an allergic response. You should stop taking the drug now." b. "Dry mouth can occur when you take this drug, but it often goes away after you are on the drug awhile. You will need to stay on the drug for a few weeks until the full antidepressant effect occurs." c. "Dry mouth can be bothersome with use of this drug. But the drug should have relieved your depression by now. Contact the doctor." d. "Dry mouth is an unusual occurrence fromnortriptyline. Are you sure you are taking the drug as prescribed?"

b. "Dry mouth can occur when you take this drug, but it often goes away after you are on the drug awhile. You will need to stay on the drug for a few weeks until the full antidepressant effect occurs."

Your patient experiences intermittent panic attacks. The prescriber has ordered sertraline (Zoloft). The patients states, "What's with this doctor? My friend takes this drug for depression. I am not depressed." What is the nurse's best response? a. "You may not feel depressed, but your behavior indicates that you are." b. "This drug keeps the neurotransmitter serotonin working longer. People with panic disorders have a decreased amount of this neurotransmitter." c. "This drug will sedate you so that you will not respond to your feeling of panic." d. "This drug stops your anxiety by blocking the release of a neurotransmitter called serotonin."

b. "This drug keeps the neurotransmitter serotonin working longer. People with panic disorders have a decreased amount of this neurotransmitter."

Your patient with anxiety has been taking benzodiazepine for the past year. Which of the following laboratory tests should you coordinate at the patient's next clinic visit? 1. 24-hour urine 2. CBC 3. Liver enzymes 4. BUN 5. Creatinine a. Answers 1, 3, and 5 b. Answers 2, and 3 c. Answers 1, 2, and3 d. Answers 1, 2, 3, 4, and 5

b. Answers 2, and 3

Your clinic patient has been taking lithium (Eskalith) for 2 years and comes to the clinic for a routine recheck. For which of the following laboratory assessments should you prepare? 1. Serum glucose 2. Cholesterol level 3. EKG 4. Cardiac enzymes 5. Thyroid function 6. Renal function a. Answers 1, 2, and 6 b. Answers 3, 5, and 6 c. Answers 1, 5, and 6 d. Answer 3 only

b. Answers 3, 5, and 6

Which of the following is not a disorder treated with sertraline (Zoloft)? a. Post-traumatic stress disorder b. Bulimia c. Panic disorder d. Obsessive-compulsive disorder

b. Bulimia

Your 40-year-old male patient comes to the clinic and states, "I'm just not going to take sertraline (Zoloft) anymore." The patient refuses to discuss the decision to discontinue use of the medication. With your knowledge of sertraline, which adverse effect do you suspect he may be experiencing? a. Weight gain b. Sexual dysfunction c. Blood dyscrasias d. Headache

b. Sexual dysfunction

Contraindications for lithium (Eskalith) therapy include a. hepatic and renal insuffi ciency. b. cardiovascular and renal disease. c. seizure disorders. d. peptic ulcer disease.

b. cardiovascular and renal disease.

The unlabeled pharmacotherapeutics of nortriptyline (Pamelor) include a. enuresis in children. b. chronic pain syndromes. c. bipolar disorder. d. atypical psychoses.

b. chronic pain syndromes.

The most serious potential adverse effect with phenelzine (Nardil) is a. anticholinergic effects. b. hypertensive crisis. c. blood dyscrasias. d. sexual dysfunction.

b. hypertensive crisis.

After 1 week of sertraline (Zoloft) therapy, your patient states, "I still feel so depressed." Your response is based on the fact that a. the dose should be increased. b. it takes at least 10 days of drug therapy before effects are noted. c. the dose should be decreased. d. the patient is probably being non compliant

b. it takes at least 10 days of drug therapy

Your 70-year-old Asian patient has been ordered benzodiazepine for sleep during the patient's hospitalization. You would expect the dose of benzodiazepine to be a. higher than normal. b. lower than normal. c. the same as for any adult

b. lower than normal.

A 15-year-old patient who was severely depressed started a regimen of sertraline. After 2 weeks of the drug therapy, the patient's parent reports that the child is no longer spending all of her time lying on the couch, but the child's mood seems unimproved. The nurse should be certain to educate the parent that a. the full therapeutic effect of sertraline should be evident by now; another drug may be needed. b. the child may be at increased risk of suicide at this time and should be monitored closely for any changes. c. the child is unlikely to commit suicide because of her age. d. the increase in energy is a sign that the depression has fully lifted.

b. the child may be at increased risk of suicide at this time and should be monitored closely for any changes.

Your patient is severely depressed and tells you "Life isn't worth living. I wish I could just end it all." He has been prescribed nortriptyline, a tricyclic antidepressant. To maximize therapeutic effects and minimize adverse effects, you should a. instruct the patient to discontinue use of the drug if he is still depressed after 1 week of therapy. b. verify that the prescription is for only a limited number of pills. c. discourage the patient from continuing with psychotherapy now that he is receiving drug therapy. d. Do all of the above

b. verify that the prescription is for only a limited number of pills.

Acute cessation of long-term benzodiazepine therapy may induce a. increased sedation. b. withdrawal symptoms. c. diarrhea. d. blurred vision.

b. withdrawal symptoms.

. Your patient has been taking lorazepam (Ativan) for an anxiety disorder for the past year. The patient is now admitted to your unit for appendicitis. What nursing intervention related to the patient's long-term use of lorazepam would you do? a. Obtain an order for restraints as needed b. Obtain an order for liver function tests c. Obtain an order for a benzodiazepine taper d. Obtain an order for vital sign checks every half-an-hour

c. Obtain an order for a benzodiazepine taper

Your patient is 70 years old and is to receive lorazepam as a sedative tonight before surgery tomorrow morning. You would expect to administer a. an average adult dose. b. a dose larger than the average adult dose. c. a dose smaller than the average adult dose. d. none of this drug because it is contraindicated in older adults.

c. a dose smaller than the average adult

CNS effects of lorazepam (Ativan) may be potentiated when given concurrently with a. phenytoin (Dilantin). b. fl umazenil (Romazicon). c. alcohol. d. levodopa (Dopar).

c. alcohol.

Because of its ability to block alpha-1 and alpha-2, trazodone (Desyrel) may induce a. hypertension. b. bronchospasm. c. orthostatic hypotension. d. nervousness.

c. orthostatic hypotension.

Your patient is being discharged from the hospital with a prescription for phenelzine (Nardil). Which of the following patient instructions is incorrect? a. "You must monitor your diet for foods that contain tyramine." b. "You should limit your exposure to sunlight." c. "Refrain from drinking alcohol." d. "This drug may make you gain weight; try using an over-the-counter weight-loss medication."

d. "This drug may make you gain weight; try using an over-the-counter weight-loss medication."

The optimal therapeutic effect of sertraline (Zoloft) takes a. 4 to 7 days. b. 3 days. c. 1 to 2 weeks. d. 10 days to 4 weeks

d. 10 days to 4 weeks

Your patient is a 33-year-old woman who has been prescribed lorazepam, a benzodiazepine, as an anxiolytic. What would you include in your teaching for this patient regarding drug therapy? a. "Avoid activities requiring mental alertness initially." b. "Avoid drinking alcohol." c. "Avoid becoming pregnant while taking this drug." d. All of the above

d. All of the above

Which of the following groups of patients should receive a lower dose of lorazepam (Ativan)? a. Children and elder patients b. Children and Asian patients c. Elder and Native-American patients d. Children, elder, and Asian patient

d. Children, elder, and Asian patient

Your patient is a 60-year-old woman who was seen today in the outpatient department. She is to begin a regimen of lorazepam to treat anxiety she has had since her husband died suddenly a month ago. She is to take the drug twice a day. She has told you, the nurse, that she has a two-story house, with her bedroom and bathroom upstairs. To minimize adverse effects, teach this patient to a. use the handrail when going down the stairs. b. take the evening dose at bedtime. c. take the larger portion of the day's dose at night. d. Do all of the above

d. Do all of the above

Which of the following patients should avoid the use of lorazepam (Ativan)? a. Malcom, with a history of mitral valve prolapse b. Christy, with a history of peptic ulcer disease c. Tyler, age 45 d. Myrna, 18 weeks' pregnant

d. Myrna, 18 weeks' pregnant

Which of the following adverse effects is associated with bupropion (Wellbutrin)? a. Headache b. Renal failure c. Blood dyscrasias d. Seizure activity

d. Seizure activity

For the management of seizure disorders, benzodiazepines affect the a. spinal cord. b. cerebellum. c. limbic area. d. brain stem

d. brain stem

The most serious potential adverse effect of tricyclic antidepressants is a. migraine headache. b. hyperpyrexia c. metabolic acidosis. d. cardiovascular toxicity

d. cardiovascular toxicity

Phenelzine (Nardil), a monoamine oxidase inhibitor, is used in the treatment of a. enuresis in children. b. manic phase of bipolar disease. c. schizophrenia. d. depression unresponsive to other therapies

d. depression unresponsive to other therapies

Your patient received lorazepam nightly for the last 6 months to treat a sleep disorder secondary to depression. Counseling has helped lift the patient's mood, and the patient would like to stop taking the lorazepam. The best way for the patient to do this would be to a. stop taking the drug tonight. b. take half of the usual dose tonight with a glass or two of wine, then stop the drug tomorrow. c. take half of the usual dose tonight, then stop taking the drug starting tomorrow. d. taper the dose of the drug slowly before discontinuing it.

d. taper the dose of the drug slowly before discontinuing it.

Your patient has been transferred from the medical surgical unit to the CICU because of a suspected myocardial infarction (MI). You note that the orders state to continue previous medications, which include nortriptyline (Pamelor). Before giving this medication, you would a. take the patient's blood pressure. b. measure a capillary blood glucose. c. assure adequate urine output. d. verify the order with the prescribing health care professional.

d. verify the order with the prescribing health care professional.

an inhibitory neurotransmiter

gaba

inability to fall or stay asleep

insomnia