NRS301 EAQ #4

A patient presents to the emergency department after using "crack." After receiving the following report, which drug will the nurse expect to administer? 1 Lorazepam 2 Nitroprusside 3 Beta blockers 4 Hypertonic sodium bicarbonate

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Which patient is a poor candidate for therapy with diazepam to treat generalized anxiety disorder? 1 One with a history of alcoholism 2 One with type 2 diabetes mellitus 3 One who had convulsions as a child 4 One who has had a myocardial infarction

1 A patient with a history of alcoholism is a poor candidate for therapy with diazepam because of the potential for substance abuse and the adverse effects of therapy. The patient has an addictive personality, meaning that the patient has resorted to habitual use of a substance to manage anxiety. As a means of preventing additional substance abuse, benzodiazepines should be withheld from this patient. Moreover, benzodiazepines can cause respiratory depression. If the patient takes a benzodiazepine with alcohol, the combination could result in respiratory failure. Diazepam may be indicated for a patient with a history of convulsions because diazepam has antiseizure properties. The use of diazepam by a patient who has had a myocardial infarction or who has diabetes is potentially suitable.

A patient with alcohol withdrawal is given carbamazepine. Which finding indicates a therapeutic effect? 1 Absence of seizures 2 Absence of cravings 3 Absence of respiratory depression 4 Absence of damage to the myocardium

1 Carbamazepine is an antiepileptic and is used to decrease withdrawal symptoms and prevent seizures. Atenolol and propranolol can help decrease cravings during withdrawal. Carbamezepine does not affect respiratory depression or damage to the myocardium; cessation of alcohol will help these effects.

A nurse cares for a patient with gastrointestinal bleeding who was admitted to a medical unit 3 days ago. Today, the patient is irritable and nauseated with an increased heart rate. The patient says to the nurse, "There are roaches everywhere in this hospital, and they've been crawling on me. I'm so scared of bugs." The nursing admission assessment shows that the patient drinks socially. How does the nurse analyze this situation? 1 The patient may have minimized use of alcohol and may be experiencing withdrawal. 2 Caring behaviors by the nursing staff have most likely been inadequate, and the patient is lonely. 3 The facility's infection control nurse should be consulted about the insect infestation. 4 The patient probably has dementia, which was inadequately assessed at the time of admission.

1 Chronic use of alcohol produces physical dependence, and abrupt withdrawal produces an abstinence syndrome. The patient is exhibiting withdrawal manifestations. Initial withdrawal symptoms appear 12 to 72 hours after the last drink. It is highly improbable that a pest infestation has happened in the sanitized environment of the hospital. It is not dementia that is causing the hallucination but alcohol withdrawal symptoms. Negligence is not a cause for hallucinations either.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate for bipolar disorder. The patient complains of hand tremors, nausea, vomiting, and diarrhea. The patient's gait is unsteady. What is the most likely explanation for these symptoms? 1 The patient developed lithium toxicity. 2 The patient developed tolerance to the lithium. 3 The patient did not take the lithium as directed. 4 The patient consumed some foods high in tyramine.

1 Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia. Tolerance and noncompliance are not associated with symptoms of toxicity. Tyramine is associated with adverse effects when taking monoamine oxidase inhibitors.

Which activity should the patient be cautioned to avoid while taking a monoamine oxidase inhibitor (MAOI)? 1 Eating aged cheese 2 Sunbathing at the pool 3 Participating in a bowling league 4 Smoking a low-nicotine cigarette

1 Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors. Sunbathing, participating in exercise and sport activities, and using nicotine are not contraindications while taking an MAOI.

The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium. What intervention is a priority for this patient? 1 Assessing lithium levels twice a week 2 Monitoring the patient's intake and output 3 Asking the patient about ringing in the ears 4 Monitoring for the recurrence of seizure activity

1 Lithium is the drug of choice to treat manic episodes associated with bipolar disorders. It has a narrow therapeutic range, and levels should be monitored twice weekly until the therapeutic level has been obtained and then monitored monthly on the maintenance dose. Intake and output and assessing for ringing in the ears are nursing interventions; however, they are not the priority. Lithium is used to treat mood disorders and bipolar disorder, not seizure disorders.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease (PD)? 1 Balance cholinergic and dopaminergic activity in the brain 2 Increase the amount of acetylcholine at the presynaptic neurons 3 Reduce the amount of dopamine available in the substantia nigra 4 Block dopamine receptors in presynaptic and postsynaptic neurons

1 PD results from a decrease in dopaminergic (inhibitory) activity leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath that started 30 minutes ago. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis is most likely? 1 Panic disorder 2 Bipolar disorder 3 Clinical depression 4 Generalized anxiety disorder

1 Panic disorder is characterized by symptoms similar to those of a myocardial infarction. Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

The nurse collects a patient's history of substance abuse on admission to inpatient rehabilitation. The patient reports increasing the drug dosage to get the same effect. What is the patient experiencing? 1 Tolerance 2 Addiction 3 Cross-dependence 4 Physiological dependence

1 Tolerance results from regular drug use and can be defined as a state in which a particular dose elicits a smaller response than it did with initial use. As tolerance increases, larger and larger doses are needed to elicit desired effects. Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences. Physical dependence can be defined as a state in which an abstinence syndrome will occur if drug use is discontinued. Cross-dependence refers to the ability of one drug to support physical dependence on another drug.

Upon admission, the nurse notes zolpidem on a patient's drug history. The nurse recognizes that this drug is commonly prescribed to treat which condition? 1 Insomnia 2 Absence seizures 3 Paranoid schizophrenia 4 Obsessive-compulsive disorder (OCD)

1 Zolpidem is a hypnotic approved for short-term treatment of insomnia. Zolpidem is not used to treat absence seizures, paranoid schizophrenia, or OCD.

When comparing benzodiazepines to barbiturates, the nurse identifies which statements as true? Select all that apply. 1 Benzodiazepines have a higher safety profile. 2 Benzodiazepines are less likely to cause tolerance. 3 Benzodiazepines have a decreased abuse potential. 4 Benzodiazepines are associated with an increased suicide potential. 5 Benzodiazepines are better able to depress central nervous system function.

1, 2, 3 Benzodiazepines have an increased safety profile and a decreased abuse potential compared with barbiturates, and they are less likely to cause tolerance. Benzodiazepines also have a decreased suicide potential and a decreased ability to cause central nervous system depression.

Which statements about caffeine does the nurse identify as true? Select all that apply. 1 Caffeine is a diuretic. 2 Caffeine promotes bronchodilation. 3 Caffeine promotes constriction of cerebral blood vessels. 4 Caffeine reduces the capacity for prolonged intellectual exertion. 5 Caffeine can restore mental functioning during alcohol intoxication.

1, 2, 3 Caffeine is a diuretic, promotes bronchodilation, and constricts cerebral blood vessels. Caffeine increases the capacity for prolonged intellectual exertion. It is a myth that caffeine can restore mental functioning during alcohol intoxication, although it may delay one from passing out.

A patient has quit smoking. Which symptoms will the nurse assess if the patient experiences abstinence syndrome? Select all that apply. 1 Cravings 2 Irritability 3 Nervousness 4 Decreased appetite 5 Increased concentration

1, 2, 3 Individuals who discontinue smoking will experience an abstinence syndrome. Prominent symptoms are cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, and weight gain.

Which food will the nurse teach the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? Select all that apply. 1 Figs 2 Cheese 3 Pepperoni 4 White bread 5 Smoked salmon

1, 2, 3, 5 Foods high in tyramine can cause reactions in patients taking MAOIs. Figs, smoked fish, most cheeses, and sausage, including pepperoni, salami, and bologna, all can contribute to a reaction. Patients should be taught about foods to avoid and receive a list of substitute foods. White bread is safe to eat while taking an MAOI.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? Select all that apply. 1 Schizophrenia is characterized by disordered thinking and losing touch with reality. 2 Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. 3 Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. 4 The lipid levels of patients receiving second-generation antipsychotics should be monitored. 5 The second-generation antipsychotics generally are more effective than the first-generation agents.

1, 2, 4 The first- and second-generation antipsychotics are considered equally effective even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side or adverse effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

A patient who has been taking alprazolam and has been compliant with the therapeutic regimen for 6 weeks is now complaining of adverse effects of the medication. Which substances will the nurse instruct the patient to avoid to help prevent intensification of this medication's adverse effects? Select all that apply. 1 Alcohol 2 Opioids 3 Tobacco 4 Antihistamines 5 Muscle relaxants 6 Caffeinated drinks

1, 2, 4, 5 Because they are also central nervous system (CNS) depressants, the nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants; when taken together with alprazolam, they can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines.

A nurse is preparing a teaching session about factors that contribute to drug abuse. Which information should the nurse include? Select all that apply. 1 Social factors 2 Drug availability 3 High tolerance for frustration 4 Vulnerability of the individual 5 Difficult procurement of drugs 6 Reinforcing properties of drugs

1, 2, 4, 5 By making people feel "good," drugs reinforce the reasons for their use. Social factors can play an important role in the development of abuse. Drug availability is clearly a factor in the development and maintenance of abuse. Abuse can flourish only in environments where drugs can be readily obtained. In contrast, where procurement is difficult, abuse is minimal. Some individuals are more prone to becoming drug abusers than others. A low tolerance for frustration contributes to drug abuse, not high tolerance.

Which symptoms are associated with Parkinson's disease (PD)? Select all that apply. Rigidity Tremors Seizures Tachycardia Bradykinesia

1, 2, 5 Bradykinesia, or slowing down of movements, is a prominent symptom of PD. Tremors occur because of involuntary contractions of the muscles. Rigidity occurs as a result of resistance to passive movement. Tachycardia and seizures are not symptoms of PD. Tachycardia may not be caused by the degeneration of the substantia nigra because this brain area does not regulate heart function. Seizures are not associated with depleting concentrations of dopamine.

The nurse is caring for a patient who is prescribed a typical antipsychotic drug for schizophrenia. What should the nurse identify as positive symptoms in the patient? Select all that apply. 1 Agitation 2 Hallucination 3 Poor self-care 4 Social withdrawal 5 Disorganized speech

1, 2, 5 Schizophrenia symptoms are divided into two groups: positive symptoms and negative symptoms. A patient with positive symptoms may have an exaggeration of a normal function, such as agitation. The patient may also experience hallucinations. Disorganized or incoherent speech is observed in patients with positive symptoms, while patients with negative symptoms have poverty of speech. A patient with negative symptoms of schizophrenia exhibits poor self-care and is socially withdrawn. Negative symptoms tend to be more chronic and persistent.

What are the signs and symptoms of acute caffeine toxicity? Select all that apply. 1 Tinnitus 2 Lethargy 3 Tachypnea 4 Narcolepsy 5 Polyphagia

1, 3 Signs and symptoms of acute caffeine toxicity include tinnitus and tachypnea. Excitation, restlessness, and insomnia are associated with caffeine toxicity. Lethargy, polyphagia, and narcolepsy are not expected symptoms of acute caffeine toxicity.

The nurse should hold the next dose of antipsychotic medication for which patients? Select all that apply. 1 The patient who has a sudden high fever 2 The patient who has pill-rolling motions of the hand 3 The patient who has smacking movements of the lips 4 The patient who presents with protrusion and rolling of the tongue 5 The patient with a blood pressure of 130/90 mm Hg when sitting and 100/80 mm Hg when standing

1, 3, 4 The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate parkinsonian-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

A patient presents to the emergency department with suspected methamphetamine ("crystal meth") abuse. Which assessment findings will help support the diagnosis of current use? Select all that apply. 1 Paranoia 2 Sleepiness 3 Weight loss 4 Elevated mood 5 Severe tooth decay

1, 3, 4, 5 Methamphetamine abuse causes elevated mood from an increasing release of norepinephrine and dopamine. By suppressing appetite, methamphetamine can cause significant weight loss. Heavy use can promote severe tooth decay, known informally as "meth mouth." All amphetamines can produce a psychotic state characterized by delusions, paranoia, and auditory and visual hallucinations that make patients appear to have schizophrenia. Current usage of "meth" increases arousal, not sleepiness; however, withdrawal could lead to prolonged sleep.

What interventions does the nurse implement for a patient who is prescribed a benzodiazepine for anxiety? Select all that apply. 1 Teach relaxation methods. 2 Assess for urinary retention. 3 Instruct the patient not to drive during therapy. 4 Instruct the patient to change positions slowly. 5 Teach the patient to avoid alcohol during therapy.

1, 3, 4, 5 The nurse must instruct the patient to change positions slowly to prevent dizziness due to orthostatic hypotension. Benzodiazepines cause sedation; therefore, the nurse must instruct the patient not to drive during therapy. The drug can increase central nervous system depression if it is taken with alcohol, so the patient must be taught to avoid alcohol during therapy. The patient may develop urinary incontinence during treatment, not urinary retention. The patient is generally taught relaxation techniques to assist with anxiety management.

The nurse is teaching a patient about malnutrition related to alcohol use. Which of the following statements should the nurse include in the teaching plan? Select all that apply. 1 "Malabsorption results from alcohol-induced damage to the gastrointestinal mucosa." 2 "A diet high in protein and fat adds to the malnourished state." 3 "Fluid replacement may be necessary because of vomiting or gastritis." 4 "It is more important to take vitamin supplements than to change the diet." 5 "B vitamins (thiamine, folic acid, and cyanocobalamin) are especially needed."

1, 3, 5 Malabsorption results from alcohol-induced damage to the gastrointestinal mucosa. Poor diet occurs in part because alcoholics meet up to 50% of their caloric needs with alcohol and therefore consume suboptimal amounts of foods with high nutritional value. Because of their poor nutritional state, alcoholics are in need of fat, protein, and vitamins. The B vitamins (thiamine, folic acid, and cyanocobalamin) are especially needed. To correct nutritional deficiencies, a program of dietary modification and vitamin supplements should be implemented. Fluids are needed to replace fluids lost because of gastritis or because of vomiting associated with withdrawal.

A nurse is assessing a patient with acute opioid toxicity. Which findings does the nurse expect to observe? Select all that apply. 1 Coma 2 Hyperpyrexia 3 Pinpoint pupils 4 Hemorrhagic stroke 5 Respiratory depression

1, 3, 5 Opioid overdose (acute toxicity) produces a classic triad of symptoms: respiratory depression, coma, and pinpoint pupils. Hyperpyrexia and hemorrhagic stroke are symptoms of cocaine overdose.

The nurse is conducting discharge teaching related to a new prescription for phenytoin. Which statements are appropriate to include in the teaching for this patient and family? Select all that apply. 1 "It is very important to have good oral hygiene and to visit your dentist regularly." 2 "You may continue to have wine with your evening meals but only in moderation." 3 "This drug may cause easy bruising. If you notice this, call the clinic immediately." 4 "Be sure to call the clinic if you or your family notice increased anxiety or agitation." 5 "You may have some mild sedation. Do not drive until you know how this drug will affect you."

1, 4, 5 Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior, such as anxiety and agitation, beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these signs immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

The nurse teaches about side effects associated with taking amphetamine medications. Which side effects are included in the teaching? Select all that apply. 1 Tachypnea 2 Depression 3 Weight gain 4 Dysrhythmia 5 Extreme talkativeness

1, 4, 5 Side effects associated with amphetamine medication use are tachypnea, dysrhythmia, and extreme talkativeness. Improved mood (not depression) and weight loss (not gain) are associated with this medication.

A parent asks the nurse about the signs and symptoms of attention-deficit/hyperactivity disorder (ADHD). Which term(s) best describe(s) a child with ADHD? Select all that apply. 1 Fidgety 2 Tolerant 3 Focused 4 Impulsive 5 Interruptive

1, 4, 5 Terms that describe a child with ADHD include fidgety, impulsive, and interruptive. Intolerant, impatient, and not focused/unable to concentrate are also terms that describe a child with ADHD.

A patient is a known user of street drugs. For which opioid should the nurse assess first in this patient? 1 LSD 2 Heroin 3 Cocaine 4 Oxycodone

2 Among street users, heroin is the traditional opioid of choice. Because of its high lipid solubility, heroin crosses the blood-brain barrier with ease, causing effects that are both immediate and intense. Although oxycodone is an opioid, it is not the traditional choice of street users. LSD and cocaine are not opioids. LSD is a psychedelic, while cocaine is a psychostimulant.

What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? 1 "Do not take the medication if you have a fever. " 2 "Wait to see how you react to the medication before driving. " 3 "Lie in bed for at least an hour after taking any antiepileptic agent. " 4 "Take the antiepileptic agent with milk or juice to prevent stomach upset. "

2 Antiepileptic medications suppress the central nervous system, causing sedation. The patient should know how he or she responds to the medication before attempting tasks such as driving. The patient does not have to lie in bed for an hour after taking an antiepileptic. Several medications cannot be taken with milk or fruit juice as they may alter absorption of the medication, and the nurse should not instruct the patient to administer medication in this manner. A fever is not a contraindication to taking an antiepileptic agent.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? 1 Elevate mood during the severe manic episode 2 Help control symptoms during the severe manic episode 3 Produce sedating effects during the severe manic episode 4 Reduce the amount of physical pain the patient experiences during the severe manic episode

2 Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes. Antipsychotics do not relieve pain.

The nurse notes that the healthcare provider is considering starting the patient on a benzodiazepine for anxiety. Which medication does the nurse anticipate administering to the patient? 1 Amitriptyline 2 Diazepam 3 Doxepin 4 Imipramine

2 Diazepam is a benzodiazepine commonly administered for generalized anxiety disorder. Amitriptyline, doxepin, and imipramine are tricyclic antidepressants.

The nurse is working with a patient who asks for medication for anxiety and a drug to relieve muscle spasms. Which benzodiazepine does the nurse anticipate will be ordered for the patient? 1 Quazepam 2 Diazepam 3 Temazepam 4 Clonazepam

2 Diazepam is known for being used to treat anxiety and muscle spasm and spasticity. Temazepam and quazepam are used to treat insomnia. Clonazepam is used to treat seizures and anxiety.

A nurse is caring for a patient abusing 3,4-methylenedioxymethamphetamine (MDMA, ecstasy). Which signs and symptoms does the nurse anticipate in this patient? 1 Sedation 2 Hallucinations 3 Excessive anger 4 Respiratory depression

2 Ecstasy causes hallucinations. It does not cause sedation, excessive anger, or respiratory depression.

A patient is experiencing constant impairment of voluntary actions after taking levodopa. Which medication should the nurse expect the primary healthcare provider to prescribe? 1 Ropinirole 2 Entacapone 3 Benztropine 4 Amantadine

2 Entacapone is a catechol O-methyltransferase inhibitor (COMT), which is used along with levodopa for reducing the on-off effects caused by the fluctuations of dopamine. Ropinirole is a nondopamine receptor agonist. It can be used in early and late Parkinson's disease, and it delays the need to prescribe levodopa. Because the patient is already taking levodopa, this medication may not be effective. Amantadine is a dopamine modulator that helps release dopamine from the vesicles in the presynaptic nerve fibers. The drug does not stabilize the concentration of dopamine and hence cannot be used to treat the on-off syndrome. Benztropine is an anticholinergic drug that blocks the cholinergic receptors and increases the effect of adrenergic drugs. It cannot help maintain stable dopamine levels in patients experiencing the on-off phenomenon.

What is the major neurotransmitter in the reward circuit of the brain that is related to addiction? 1 Serotonin 2 Dopamine 3 Epinephrine 4 Norepinephrine

2 Molecular changes occur in the so-called reward circuit—a system that normally serves to reinforce behaviors essential for survival such as eating and reproductive activities. Their major transmitter is dopamine . Serotonin, epinephrine, and norepinephrine are not the major neurotransmitters involved in the reward circuit.

A nurse is conducting health screenings for the health care staff at a hospital. Which drug assessment will be a priority? 1 LSD 2 Opioids 3 Marijuana 4 Depressants

2 Opioid abuse (usually meperidine) by health care providers deserves special consideration. It is well established that physicians, nurses, and pharmacists, as a group, abuse opioids to a greater extent than all other groups with similar educational backgrounds. The vulnerability of healthcare professionals to opioid abuse is due primarily to drug access. LSD, marijuana, and depressants are not abused as often.

To help prevent liver failure in a patient who drinks alcohol frequently, the nurse will instruct the patient to avoid which drug? 1 Opioids 2 Acetaminophen 3 Any antihypertensive agent 4 Nonsteroidal antiinflammatory drugs

2 The combination of acetaminophen with alcohol poses a risk of potentially fatal liver injury. Accordingly, some authorities recommend that people who drink take no more than 2 gm of acetaminophen a day (ie, half the normal dosage). Antihypertensive drugs reduce blood pressure. Because alcohol raises blood pressure, it tends to counteract the effects of antihypertensive medications, leading to hypertension, not liver failure. Like alcohol, aspirin, ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDs) can injure the gastrointestinal mucosa. The combined effects of alcohol and NSAIDs can result in significant gastric bleeding but not liver failure.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? 1 An imbalance of dopamine and acetylcholine in the CNS 2 Inflammation and myelin destruction in the central nervous system (CNS) 3 A high-frequency discharge of neurons from a specific focus area of the brain 4 An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone

2 The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the CNS. The demyelination leads to the characteristic neurologic symptoms associated with MS.

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement made by the nurse is the most helpful? 1 "The primary treatment is benzodiazepine for anxiety." 2 "The primary treatment is therapy in combination with drugs." 3 "The primary treatment is a combination of multiple medications." 4 "The primary treatment is monotherapy with a selective serotonin reuptake inhibitor (SSRI)."

2 sPost-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one serotonin-norepinephrine reuptake inhibitor (venlafaxine). Of these four drugs, only two—paroxetine and sertraline—are approved by the U.S. Food and Drug Administration for treatment of PTSD. If none of the first-line drugs is effective, the guidelines suggest several alternatives: mirtazapine, a tricyclic antidepressant such as amitriptyline or imipramine, or a monoamine oxidase inhibitor such as phenelzine. Current evidence does not support the use of monotherapy with either bupropion, buspirone, trazodone, or a benzodiazepine.

Which statements are true about central nervous system (CNS) stimulants? Select all that apply. 1 They decrease the activity of CNS neurons. 2 They can elevate mood by causing excitation. 3 They have the potential to cause convulsions. 4 They increase the blood pressure and heart rate. 5 They are primarily used for bradycardia and narcolepsy.

2, 3, 4 Central nervous system stimulants can elevate mood and cause excitation. They increase the blood pressure and heart rate and have the potential to cause convulsions in high doses. They increase the activity of the CNS neurons and have two primary indications: attention-deficit/hyperactivity disorder and narcolepsy.

Which of the following statements about disulfiram are true? Select all that apply. 1 Disulfiram reduces the high from drinking alcohol. 2 Disulfiram has no applications outside the treatment of alcoholism. 3 Acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol. 4 In the absence of alcohol, disulfiram rarely causes significant effects. 5 Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol.

2, 3, 4, 5 Disulfiram helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested. Disulfiram has no applications outside the treatment of alcoholism. This reaction, which may last from 30 minutes to several hours, can be brought on by consuming as little as 7 mL of alcohol. In the absence of alcohol, disulfiram rarely causes significant effects. Patients should be made aware that the effects of disulfiram will persist for about 2 weeks after the last dose, and thus continued abstinence is necessary. Naltrexone reduces the high from drinking alcohol.

The nurse is assessing a patient with a severe cocaine overdose. Which severe symptoms of overdose should the nurse monitor for in this patient? Select all that apply. 1 Agitation 2 Convulsions 3 Hyperpyrexia 4 Blurred vision 5 Dysrhythmias

2, 3, 5 Severe overdose can produce hyperpyrexia, convulsions, ventricular dysrhythmias, and hemorrhagic stroke. Mild overdose produces agitation, dizziness, tremor, and blurred vision.

Why is levodopa the mainstay of treatment for a patient with Parkinson's disease? 1 It enhances dopamine release. 2 It impairs dopamine breakdown. 3 It promotes dopamine synthesis. 4 It provides a dopamine precursor.

4 Levodopa is a biologic precursor of dopamine that must be combined with carbidopa so the brain can use it to synthesize dopamine; it is the only agent that acts in this manner. Other dopaminergic agents increase the brain's dopamine by stimulating its release, directly and indirectly; inhibiting enzymes that degrade it; and stimulating its synthesis.

A patient verbalizes an intense need for psychoactive drugs. The nurse recognizes this behavior as what? 1 Addiction 2 Drug tolerance 3 Physical dependence 4 Psychologic dependence

4 Psychologic dependence is defined as an intense subjective need for a drug. Physical dependence is a state in which withdrawal symptoms occur when use of the drug is discontinued. Tolerance is the state in which higher and higher doses are needed to produce the same effect. Addiction is a disease process characterized by continued use of a substance despite the risk for physical, psychologic, or social harm.

Which neurotransmitter level is decreased by as much as 90% in patients with severe Alzheimer's disease (AD)? 1 Serotonin 2 Dopamine 3 Acetylcholine 4 Norepinephrine

3 Acetylcholine levels naturally decline by a small percentage with age. Patients with severe AD may have acetylcholine levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD. Alterations in serotonin, dopamine, and norepinephrine levels do not explain the pathophysiology of AD.

The nurse is caring for a patient with Parkinson's disease who has been prescribed levodopa/carbidopa. Which statement, if made by the patient, indicates a need for further teaching? 1 "It's common to feel heart palpitations on this medication." 2 "I will come to a standing position slowly to avoid getting dizzy." 3 "I will take this medication with a high-protein meal to avoid nausea." 4 "I will take this medication on an empty stomach to achieve the maximum effect."

3 Amino acids, found in protein, compete with levodopa/carbidopa for absorption from the intestine and for transport across the blood-brain barrier; therefore, patients should not take levodopa/carbidopa with a high-protein meal. Therefore, if the patient expresses plans to take the medication with a high-protein meal, this indicates a need for further teaching. Orthostatic hypotension is a common side effect of this medication, and the patient should come to a standing position slowly. The medication should be taken with food to avoid nausea but not a high-protein meal. Heart palpitations are not uncommon on this medication, but the healthcare provider should be alerted to this side effect.

The patient received a benzodiazepine intravenously. What is the nurse's priority action? 1 Neurologic assessment 2 Assessment of blood levels 3 Cardiovascular assessment 4 Assessment of complete blood count (CBC)

3 Benzodiazepines, when administered intravenously, can produce profound hypotension and even cardiac arrest. Although a neurologic assessment and assessment of blood levels are important nursing interventions, they have a lower priority than a cardiovascular assessment. Benzodiazepines do not affect a patient's CBC.

The nurse is administering morning medications. Which administration technique is an error? 1 The nurse administers intravenous Dilantin with a filter. 2 The nurse administers phenobarbital elixir with fruit juice. 3 The nurse administers carbamazepine with grapefruit juice. 4 The nurse administers gabapentin without determining when the patient ate.

3 Carbamazepine is not to be given with grapefruit juice, as this can lead to increased toxicity of the drug. Dilantin is administered intravenously (IV) with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.

The nurse is caring for a patient with pre-existing cardiac disease. The patient has been prescribed citalopram. What is the nurse's priorityassessment? 1 Neurologic assessment 2 Genitourinary assessment 3 Cardiovascular assessment 4 Gastrointestinal assessment

3 Citalopram prolongs the QT interval and may pose a risk of fatal dysrhythmias, especially when the dosage exceeds 40 mg/day. The nurse should assess the patient's cardiovascular system. Risk is increased in patients with heart disease. The most common side effects for citalopram are nausea, somnolence, dry mouth, and sexual dysfunction. The neurologic, genitourinary, and gastrointestinal assessments also will be completed; however, these are not the priority based on the adverse effects of citalopram.

The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the healthcare provider will prescribe which medication? 1 Oxazepam 2 Lorazepam 3 Flumazenil 4 Buspirone HCl

3 Flumazenil is a benzodiazepine antagonist used to reverse benzodiazepine overdoses. Oxazapam and lorazepam are benzodiazepines; therefore, they would worsen the patient's condition. Buspirone HCl is another anti-anxiety medication.

The nurse is caring for a patient receiving fluoxetine for depression. Which side effect is most likely associated with this drug? 1 Dry mouth 2 Bradycardia 3 Sexual dysfunction 4 Orthostatic hypotension

3 Fluoxetine, a selective serotonin reuptake inhibitor, does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common side effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse observes that a patient has hallucinations, delusions, and agitation. The nurse determines that the patient most likely will be treated for what condition? 1 Depression 2 Complex anxiety 3 Positive symptoms of schizophrenia 4 Negative symptoms of schizophrenia

3 Hallucinations, delusions, and agitation, along with combativeness and paranoia, describe positive symptoms of schizophrenia. Negative symptoms include decreased motivation, poor speech, blunted affect, and poor self-care. Depression involves feeling little or no pleasure in doing things the patient typically enjoys. Complex anxiety includes feeling restless and being unable to relax.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? 1 Phenytoin 200 mg IV over 4 minutes 2 Phenobarbital 30 mg intramuscularly (IM) 3 Lorazepam 4 mg intravenously (IV) over 2 minutes 4 Valproic acid 250 mg in 100 mL of normal saline infused IV over 60 minutes

3 Intravenous benzodiazepines, such as lorazepam or diazepam, are used to abruptly terminate convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. After seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines. Phenobarbital may be used to treat continuous seizures, but the IM route would delay the effects.

The nurse is assessing a patient with depression who has been prescribed nortriptyline. Following the assessment, the nurse finds that the patient has constipation and urinary retention due to interaction between the prescribed medications. Which class of medication found in the patient's prescription is responsible for these effects? 1 Diuretics 2 Anxiolytics 3 Anticholinergics 4 Antihypertensives

3 Nortriptyline is a tricyclic antidepressant. These medications interact with anticholinergics and potentiate the effects by blocking the cholinergic receptors. This can in turn lead to constipation and urinary retention. The diuretics cause increased urinary outflow; they do not lead to constipation or urinary retention. Anxiolytics may cause increased sedation and hypnosis in the patient. Antihypertensive drugs may cause hypotension in the patient. Therefore, diuretics, anxiolytics, and antihypertensive medications will not cause constipation and urinary retention.

The college nurse provides a program on drug abuse to students with diverse majors. Which profession will the nurse identify as most likely to abuse opioid drugs? 1 Music professionals, such as musicians, song writers, and record producers 2 Science professionals, such as chemists, biologists, and botanists 3 Health professionals, such as physicians, nurses, and pharmacists 4 Mathematics professionals, such as accountants, statisticians, and engineers

3 Physicians, nurses, and pharmacists abuse opioids to a greater extent than other similarly educated groups due to ease of access. Science, music, and mathematics professionals are not the most likely to abuse opioids.

The nurse is caring for a group of patients being treated for depression. Why might a selective serotonin reuptake inhibitor (SSRI) be chosen over a tricyclic antidepressant? 1 To help prevent sexual dysfunction 2 To prevent the risk of serotonin syndrome 3 To reduce the risk of suicide with overdose 4 To avoid weight gain and other gastrointestinal effects

3 The SSRIs may be chosen because they have fewer side effects and are safer if an overdose occurs. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

A patient who has taken fluoxetine for 2 weeks to treat an anxiety disorder complains of dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen? 1 This medication usually requires titration. 2 The adverse effects can be managed well. 3 You have not given the medication enough time to work. 4 Relaxation exercises can offer some relief from medication therapy.

3 The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame offers the patient realistic hope and provides a motivation to adhere to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

Which statements about the treatment of bipolar disorder does the nurse identify as true? Select all that apply. 1 A lithium level of 2.0 mEq/L is considered therapeutic. 2 Antipsychotics are used to treat depressive episodes. 3 Mood stabilizers are used to prevent recurrent manic-depressive episodes. 4 Lithium and valproate are the preferred mood stabilizers for bipolar disorder. 5 Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression.

3, 4, 5 The preferred mood stabilizers for the management of both acute and recurrent manic episodes of bipolar disorder are lithium and valproate; when patients have bipolar depression, an antidepressant should also be used. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

A patient is admitted following a suspected heroin overdose. This condition is most often manifested by which symptoms? Select all that apply. 1 Hypertension 2 Dilated pupils 3 Decreased respiratory rate 4 Restlessness and agitation 5 Decreased level of consciousness

3, 5 Overdose of heroin and other opioids is characterized by the classic triad of symptoms that include respiratory depression, coma, and pinpoint pupils. Hypertension, dilated pupils, restlessness, and agitation are not associated with heroin overdose.

The nurse encourages a patient with cardiovascular disease to quit smoking. The nurse makes this decision based on which cardiovascular effects of nicotine? Select all that apply. 1 Nicotine causes hypotension. 2 Nicotine dilates blood vessels. 3 Nicotine accelerates the heart. 4 Nicotine decreases cardiac work. 5 Nicotine increases force of ventricular contraction.

3, 5 The cardiovascular effects of nicotine result primarily from activating nicotinic receptors in sympathetic ganglia and the adrenal medulla. Activation of these receptors promotes release of norepinephrine from the sympathetic nerves and release of epinephrine (and some norepinephrine) from the adrenals. Norepinephrine and epinephrine act on the cardiovascular system to constrict blood vessels, accelerate the heart, and increase the force of ventricular contraction. The net result is elevation of blood pressure and increased cardiac work. Very little tolerance develops to the cardiovascular effects.

The nurse is providing patient teaching about nicotine replacement therapy. The nurse knows the patient needs further teaching about available nicotine delivery systems if the patient says he wishes to take his nicotine in which form? 1 Patch 2 Lozenge 3 Nasal spray 4 Subcutaneous injection

4 The U.S. Food and Drug Administration (FDA) has approved five delivery systems for nicotine replacement therapy: chewing gum, lozenges, a transdermal patch, a nasal spray, and an inhaler. Subcutaneous injections are not available for nicotine replacement therapy.

A patient newly diagnosed with multiple sclerosis (MS) asks the nurse how a person gets this disease. Which response by the nurse is mostaccurate and appropriate? 1 "MS is a congenital condition that typically manifests itself in late adulthood." 2 "MS is a disease believed to be caused by exposure to drugs during a mother's pregnancy." 3 "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system." 4 "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger."

4 Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS also may be associated with the Epstein-Barr virus, human herpes virus 6, and Chlamydia pneumoniae infection.

A nurse is caring for a patient who has chronically abused barbiturates. Which assessment is a priority? 1 Heart rate 2 Temperature 3 Blood pressure 4 Respiratory rate

4 As barbiturate use continues, the dose needed to produce subjective effects moves closer and closer to the dose that can cause respiratory arrest. Patients never develop tolerance to respiratory depression. Although heart rate, temperature, and blood pressure are important, they are not as high a priority as respirations.

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug? 1 Constipation 2 Heart block 3 Myelin degeneration 4 Cardiac dysrhythmias

4 Caffeine stimulates the central nervous system, causing sympathomimetic effects, including cardiac dysrhythmias. Myelin degeneration, constipation, and heart block are not known to be exacerbated by caffeine.

A patient is in status epilepticus. What is an appropriate nursing action? 1 Apply restraints. 2 Hold the patient's limbs steady. 3 Administer intravenous pain medications. 4 Administer intravenous antiepileptic drug therapy.

4 During status epilepticus, the patient is unable to swallow medications, and the appropriate treatment is to administer intravenous drug therapy to stop the seizure. Pain medications are not necessary. The nurse should not restrain the patient or hold the limbs during this time, but the nurse should make certain the patient is not injured.

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? 1 "Epilepsy medication does not reduce seizures in most patients." 2 "These drugs will help control your seizures until you have surgery." 3 "With proper treatment, we can completely eliminate your seizures." 4 "Our goal is to reduce your seizures to an extent that helps you live a normal life."

4 Epilepsy is treated successfully with medication in most patients and can help the patient live a normal life. The dosages needed to completely eliminate seizures, however, may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

A patient with severe generalized anxiety disorder needs immediate relief of symptoms. Which class of medications is the drug of choice? 1 Buspirone 2 Antipsychotics 3 Antidepressants 4 Benzodiazepines

4 First-line approved choices for generalized anxiety disorder are benzodiazepines, buspirone, and four antidepressants: venlafaxine, paroxetine, escitalopram, and duloxetine. With the benzodiazepines, onset of relief is rapid, so they will meet the need for immediate symptom relief. In contrast, onset is delayed with buspirone and the antidepressants.

The nurse is providing care to a patient diagnosed with an overdose. The provider has ordered flumazenil for the patient. Which type of overdose does the nurse suspect? 1 Opioid 2 Cocaine 3 Barbiturate 4 Benzodiazepine

4 If severe overdose occurs with benzodiazepines, signs and symptoms can be reversed with flumazenil, a benzodiazepine antagonist. Naloxone can be given for opioid overdose. There is no specific antidote for barbiturate or cocaine overdose.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline. Which question is most important for the nurse to ask the patient? 1 "When was your last bowel movement?" 2 "Have you noticed dry mouth or blurred vision?" 3 "Have you had any changes in your urine function?" 4 "Have you had any changes in your mood or anxiety level or thoughts of suicide?"

4 In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline, but assessing suicide risk is the most important intervention.

A patient with alcoholism is prescribed a barbiturate. The nurse has advised the patient to stop drinking alcohol. Which risk is the nurse trying to prevent by giving this advice? 1 Delirium tremens 2 Trigeminal neuralgia 3 Korsakoff's syndrome 4 Respiratory depression

4 The central nervous system (CNS) effects of alcohol are additive with those of other CNS depressants (eg, barbiturates, benzodiazepines, and opioids). Consumption of alcohol with other CNS depressants intensifies the psychologic and physiologic manifestations of CNS depression and greatly increases the risk of death from respiratory depression. Delirium tremens is a severe form of alcohol withdrawal. Korsakoff's psychosis is a neuropsychiatric syndrome common in alcoholics and is caused by thiamine deficiency. Injection of alcohol is used to relieve pain from trigeminal neuralgia.

Upon reading the history, a nurse discovers the patient crushed this controlled-release tablet and then snorted the powder. Which drug does the nurse suspect the patient is abusing? 1 Heroin 2 Morphine 3 Meperidine 4 Oxycodone

4 The controlled release tablets of oxycodone were designed to provide steady levels of oxycodone over an extended time and are safe and effective when swallowed intact. However, abusers do not ingest the tablets whole. Rather, they crush the tablets and then either snort the powder or dissolve it in water and inject the liquid intravenously. Heroin, morphine, and meperidine are not abused in this manner.

Which is the most important benefit of a parenteral formulation of an antipsychotic medication? 1 Patient consent for treatment is avoided. 2 Parenteral administration is faster than oral administration. 3 Parenteral formulation is more effective than oral formulations. 4 Parenteral formulation improves adherence for acutely psychotic patients.

4 The primary benefit of administering a parenteral form of an antipsychotic agent is that patient adherence to therapy improves because fewer doses are required to achieve therapeutic effectiveness. It is very effective when used for acutely psychotic patients. Parenteral antipsychotic agents are long-acting medications. Route of administration does not have much effect on the drug's effectiveness or duration of action. Patient consent for medication administration is required regardless of the route of administration.

The nurse is caring for a patient who is prescribed a sedative-hypnotic. What is a primary effect of this class of medications? 1 Cardiac stimulation 2 Respiratory depression 3 Prevention of psychosis 4 Central nervous system depression

4 The sedative-hypnotics drugs depress central nervous system function. They are used primarily for two common disorders: anxiety and insomnia. Sedative-hypnotics are not cardiac stimulants. Respiratory depression is an adverse effect. Some individuals may experience psychosis as a paradoxical effect after taking a sedative-hypnotic medication.