NUR 1021 Exam 3

Antabuse (Disulfiram) is used for prevention of alcohol abuse. What happens when a client drinks and takes Antabuse?

· Causes violent illness within 5 minutes of contact with alcohol or narcotics · Effects last up to several hours · Acetaldehyde Dehydrogenase Inhibitor

A client is known to be on lithium therapy for the treatment of depression. What is the expected adverse effect of this drug? 1. Ataxia 2. Confusion 3. Blurred vision 4. Paradoxical anxiety

1. Ataxia Ataxia is the expected adverse effect in clients who are undergoing lithium therapy for the treatment of depression.

The nurse is preparing discharge instructions for a client who was prescribed Enalapril (Vasotec) for treatment of hypertension. Which instruction is appropriate for the nurse to include in the client's teaching? 1. Do not change to a standing position suddenly. 2. Lightheadedness is a common adverse effect that need not be reported. 3. The medication may cause a sore throat for the first few days. 4. Schedule blood tests weekly for the first 2 months.

1. Do not change to a standing position suddenly. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure. Clients should be advised to change positions slowly to minimize orthostatic hypotension.

The primary healthcare provider notices that a client exhibits a period of mania followed by hypomania and depression and prescribes lithium carbonate. What is the mode of administration of the prescribed drug? 1. Oral route 2. Sublingual route 3. Intravenous route 4. Transdermal route

1. Oral route

"Ace" inhibitors cause ___ and also have a ___ effect. Making them lower ___ and ___ status.

1. Vasodilation 2. Diuresis 3. Blood pressure 4. Fluid

Metoprolol (Lopressor) is prescribed for a client with hypertension. For which side effect should the nurse monitor the client? 1. Hirsutism 2. Bradycardia 3. Restlessness 4. Hypertension

2. Bradycardia Beta-blockers block stimulation of beta 1 (myocardial) adrenergic receptors, which decreases the heart rate and blood pressure. The client should be monitored for bradycardia, which can progress to heart failure or cardiac arrest.

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of Metoprolol (Lopressor) and Digoxin (Lanoxin). What outcome does the nurse anticipate when Metoprolol is administered with Digoxin? 1. Headaches 2. Bradycardia 3. Hypertension 4. Junctional tachycardia

2. Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate.

What client response must the nurse monitor to determine the effectiveness of amiodarone? 1. Absence of ischemic chest pain 2. Decrease in cardiac dysrhythmias 3. Improvement in fasting lipid profile 4. Maintenance of blood pressure control

2. Decrease in cardiac dysrhythmias

What should the nurse include in a teaching plan for a client taking calcium channel blockers such as Nifedipine (Procardia)? Select all that apply. 1. Reduce calcium intake. 2. Report peripheral edema. 3. Expect temporary hair loss. 4. Avoid drinking grapefruit juice.

2. Report peripheral edema. 3. Expect temporary hair loss. 4. Avoid drinking grapefruit juice. Changing positions slowly helps reduce orthostatic hypotension. Peripheral edema may occur as a result of heart failure and must be reported. Grapefruit juice affects the metabolism of calcium channel blockers and should be avoided.

Valsartan (Diovan), an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. 1. Constipation 2. Hypokalemia 3. Irregular pulse rate 4. Change in visual acuity 5. Orthostatic hypotension

3. Irregular pulse rate 5. Orthostatic hypotension Dysrhythmias are cardiovascular side effects of Valsartan (Diovan).

A pregnant client is treated with Sertraline (Zoloft) for depression. What can be inferred about the drug's action? 1. It will only affect the client. 2. It will only affect the fetus. 3. It will affect both the client and the fetus. 4. It will not have any effect on both client and the fetus.

3. It will affect both the client and the fetus. Drugs taken during pregnancy may act on both the client and the fetus as the drug passes through the placenta from the mother to the fetus.

A client with schizophrenia who has type II (negative) symptoms is prescribed Risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? Select all that apply. 1. There is less agitation. 2. There are fewer delusions. 3. More interest is shown in unit activities. 4. The client reports that the hallucinations have stopped. 5. The client performs activities of daily living independently.

3. More interest is shown in unit activities. 5. The client performs activities of daily living independently.

Lithium therapy is initiated for a client diagnosed with manic episodes. Laboratory testing shows that the client's lithium level is 1.2 mEq/L (1.2 mmol/L). Why would the healthcare provider reduce the client's lithium dosage? 1. To promote the drug excretion 2. To reduce the risk of side effects 3. To maintain the serum drug level 4. To reduce the risk of drug accumulation

3. To maintain the serum drug level Plasma lithium levels must be kept below 1.5 mEq/L (1.5 mmol/L) to reduce the risk of toxicity. Normal lithium levels should range from 0.8 to 1.4 mEq/L (0.8-1.4 mmol/L).

A healthcare provider prescribes Milrinone (Primacor) for a client with a diagnosis of congestive heart failure who was unresponsive to conventional drug therapy. What is most important for the nurse to do first? 1. Administer the loading dose over 10 minutes. 2. Monitor the ECG continuously for dysrhythmias during infusion. 3. Assess the heart rate and blood pressure continuously during infusion. 4. Have the prescription, dosage calculations, and pump settings checked by a second nurse.

4. Have the prescription, dosage calculations, and pump settings checked by a second nurse. Accidental overdose can cause death.

A client is receiving a monoamine oxidase inhibitor (MAOI). What does the nurse teach the client? 1. It is necessary to avoid the sun. 2. Drowsiness is an expected side effect of this medication. 3. The therapeutic and toxic levels of the drug are very close. 4. Many prescribed and over-the-counter drugs cannot be taken with this medication.

4. Many prescribed and over-the-counter drugs cannot be taken with this medication.

A client taking antipsychotics comes to the clinic concerned about getting sun burned even on cloudy days. What antipsychotics can cause photosensitivity?

Amiodarone (Cordarone) & Imipramine (Tofranil)

What signs and symptoms would alert a nurse that digibind needs to be given?

Digoxin toxicity: o Hyperkalemia o Bradycardia (life-threatening cardiac dysrhythmias) o Life-threatening digoxin overdose (>10 mg in adults) o Given IV o Monitor s/s of toxicity

How would the nurse treat overdose in a client taking Lorazepam (Ativan/Benzodiazepine)?

Flumazenil (Romazicon) administered IV - onset is 1 to 2 minutes with full effects in 6 to 10 minutes. Repeat after 20 minutes if needed

A client has been taking Haloperidol (Haldol) and the physician has ordered the client to stop taking this medication and begin another antipsychotic. How should the nurse educate the client on this process?

Slowly taper off

Medications for ADHD especially methylphenidate (Ritalin) can cause growth delays. What should a nurse monitor in an adolescent client?

o Monitor child for continued physical growth, including height & weight o Instruct parents to keep a journal to monitor a child's response to therapy (behaviors) o Drug "holidays" may be ordered to decrease addiction risk

When placing a client on any type of medication for cognition what should be the nurses priority assessment?

· Baseline behavioral and neurological assessment

How would a nurse recognize s/s of withdrawal in a client who has been taking Lorazepam (Ativan/Benzodiazepine)?

· Agitation · GI upset and cramps · Insomnia, seizure activity

What is usually the first s/s of EPS?

· Shuffled gait · tremors · Bradykinesia · Facial grimacing · Smacking or chewing of the lips · Tardive dyskinesia: irreversible, lip chewing, face grimacing, puffing of cheeks · Akathisia: extreme restlessness & motor activity/ twitching or tremors

The healthcare provider prescribes nitroglycerin ointment for a client who was admitted for chest pain and a myocardial infarction (MI). Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? 1. "I may experience a headache." 2. "Confusion is a common adverse effect." 3. "A slow pulse rate in an expected side effect." 4. "Increased blood pressure readings may occur initially."

1. "I may experience a headache."

A client is receiving Metoprolol (Lopressor). Which side effect should the nurse teach the client to expect? 1. Dizziness with strenuous activity 2. Acceleration of the heart rate after eating a heavy meal 3. Flushing sensations for a few minutes after taking the drug 4. Pounding of the heart for a few minutes after taking the drug

1. Dizziness with strenuous activity

A client with hypertension has received a prescription for Metoprolol (Lopressor). Which information should the nurse include when teaching this client about Metoprolol? 1. Do not abruptly discontinue the medication. 2. Consume alcoholic beverages in moderation. 3. Report a heart rate of less than 70 beats per minute. 4. Increase the medication dosage if chest pain occurs.

1. Do not abruptly discontinue the medication. Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction.

A nurse is providing discharge instructions for a client with angina who has a prescription for sublingual nitroglycerin tablets. What will the nurse identify as an indicator that the nitroglycerin sublingual tablets have lost their potency? 1. Sublingual tingling is experienced. 2. The tablets are more than 3 months old. 3. The pain is unrelieved, but facial flushing is increased. 4. Onset of relief is delayed, but the duration of relief is unchanged.

2. The tablets are more than 3 months old.

A primary healthcare provider prescribes lithium salts to a client. Which symptoms presented by the client necessitates the prescription of this drug? 1. Obesity 2. Seizures 3. Urinary incontinence 4. Periodic swings of mania and depression

4. Periodic swings of mania and depression Periodic swings of mania and depression indicate bipolar disease, the treatment of which includes the prescription of mood stabilizers such as lithium salts.

Sertraline (Zoloft) is prescribed for a depressed client. What information does the nurse include when teaching the client about this drug? 1. The drug can cause a hypertensive crisis. 2. The drug interferes with the reuptake of norepinephrine. 3. Specific foods should be avoided when one is taking the drug. 4. Several weeks may pass before the effects of the drug become evident.

4. Several weeks may pass before the effects of the drug become evident.

A client is receiving Imipramine (Tofranil), a tricyclic antidepressant, for depression. The nurse assesses the client for side effects and adverse effects. Which adverse effect requires further assessment and possible medical intervention? 1. Dry mouth 2. Weight gain 3. Blurred vision 4. Urinary hesitancy

4. Urinary hesitancy Urinary hesitancy and retention are adverse effects of Imipramine that may require immediate medical intervention.

Digoxin (Lanoxin/Cardiac Glycoside) works to:

Works similar to ACE inhibitor except the actual Angiotensin II receptors are blocked causing potent vasodilation; decrease systemic vascular resistance (afterload)

What should a nurse teach a client about taking Digoxin (Lanoxin/Cardiac Glycoside)?

· Do not cause dry cough & hyperkalemia as much · Monitor potassium · Do not administer supplemental K or K sparing diuretics · Monitor renal function BUN & creatinine · Use cautiously with NSAID · Do not use during pregnancy

What should a nurse understand about the role of glutamate?

· Glutamate is a precursor for GABA, but too much actually results in neuronal death & decreases messages across a synapse · Named is glutamate antagonist

What are the effects of stimulation of the sympathetic nervous system?

· Increase heart rate · Dilate bronchioles · Improve circulation · Dilate pupils · Increased metabolism

What adverse effects of antipsychotics (Haldol & Risperdal) should a nurse monitor for?

· Increased appetite · Hyperglycemia · weight gain · Dry mouth · Impaired erection · Sedation · Orthostatic hypotension · Photosensitivity

What nursing considerations should a nurse understand for Alpha blockers?

· Monitor HR & BP · Monitor for fluid retention & edema · Teach patient about first dose effect · Change positions slowly · Do not suddenly discontinue · Avoid OTC medications & alcohol · Therapeutic effects may take 4-6 weeks

What labs should a nurse monitor for a client on "Ace" inhibitors ("pril")?

· Potassium (hyperkalemia) · BUN (increase) · Creatinine

What would a nurse teach a client when starting Alpha blockers?

· Reduce nightmares in PTSD (Prazosin) · First dose effect: low BP, dizziness, orthostatic hypotension, & fainting · Take the first dose at bedtime