PHARM PRACTICE Q'S #3

The nurse assesses the client taking olanzapine (Zyprexa) for which of the following anticipated metabolic changes because of adverse drug effects? 1. Hyperglycemia 2. Hypoglycemia 3. Increased thyroxine levels 4. Decreased thyroxine levels

ANS: 1 Olanzapine appears to pose a significant risk for weight gain, hyperglycemia, and development of type 2 diabetes mellitus. This effect is also observed with other atypicals, particularly olanzapine.

The nurse notes that a client is taking an antipsychotic drug. The nurse understands that neuropsychiatric status is heavily influenced by which of the following neurotransmitters that are of primary importance to this health problem? 1.Acetylcholine 2.Histamine 3. serotonin 4. g-aminobutyric acid

ANS: 3 The central nervous system neurotransmitters of primary importance in mental health include norepinephrine, serotonin, and dopamine. Others, including acetylcholine, histamine, and -aminobutyric acid, also play a role in neuropsychiatric status.

When conducting client teaching about tricyclic antidepressants, the nurse includes information about which adverse effect that is the result of drug action on serotonin receptors? 1. Dry mouth 2. Urinary retention 3. Sedation 4. Tachycardia

ANS: 3 The effects at the serotonin receptor are believed to account for sedation, and effects at the muscarinic receptor account for dry mouth, urinary retention, constipation, and tachycardia.

A client with schizophrenia is noncompliant with drug therapy despite indicating a willingness to participate in drug therapy. This client could be an optimal candidate for which of the following drugs? 1. Fluphenazine (Prolixin) 2. Thioridazine (Mellaril) 3. Haloperidol decanoate (Haldol inj.) 4. Thiothixene (Navane)

ANS: 3 Use of long-acting haloperidol decanoate by intramuscular injection results in a prolonged duration of action of approximately 3 weeks. This formulation is often used for clients who do not adhere to conventional therapy.

The nurse is reviewing the medical record of a patient who is to receive wound care with topical silver sulfadiazine. Which finding, if noted, would be a potential contraindication? A. The patient has an open wound in a burn on her arm. B. The patient is allergic to sulfa drugs. C. The patient is allergic to iodine. D. The patient's burn wound has been débrided.

ANS: B Patients with allergies to sulfa drugs should not receive silver sulfadiazine. The other options are not correct.

The surgical nurse is ready to perform a skin prep with povidone-iodine (Betadine) on a patient who is about to have abdominal surgery. The nurse checks the patient's medical record for which allergies, if present, that would be a contraindication to the Betadine prep? A. Peanuts B. Shellfish C. Penicillin D. Latex

ANS: B Povidone-iodine, a widely used antiseptic, cannot be used in patients who are allergic to iodine or have shellfish allergies.

A teenage boy is taking tretinoin for his acne. Part of the information the nurse should include in the teaching plan is that A. he should avoid foods heavy in salt and oils. B. the drug may cause increased redness of the skin. C. he should use abrasive cleansers to remove old skin layers. D. extremes of weather and sunlight should not bother him during therapy.

ANS: B Tretinoin may cause increased redness and drying, and the patient should avoid weather extremes, ultraviolet light, and abrasive cleansers.

During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a] "The drug will be stopped when tremors and weakness are relieved." b] "If a dose is missed, take two doses to avoid significant decreases in blood levels." c] "Be sure to notify your physician if your urine turns brownish-orange in color." d] "Take care to change positions slowly to prevent falling due to a drop in blood pressure."

"Take care to change positions slowly to prevent falling due to a drop in blood pressure."

A patient is in the surgical suite for gallbladder surgery. Before performing the skin prep, the nurse checks the patient's allergies and sees that the patient is allergic to shellfish. Which skin preparation agent would be most appropriate to use for this patient's surgical IV prep? 1. povidone-iodine (Betadine®) 2. 70% isopropyl alcohol 3. chlorhexidine (Hibiclens®) 4. Dakin's solution

2. 70% isopropyl alcohol

6. A nurse is assessing the client who was started on drug therapy with carbidopa/levodopa (Sinemet). The nurse would observe for which of the following adverse effects of this drug? 1.Wheezing 2.Sedation 3.Joint swelling 4. Involuntary movements

4. Involuntary movements another name for it is dyskinesia

Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A. Dysphagia B. Increased libido C. Agranulocytosis D. Urinary retention

A. Dysphagia

Cholinergic (parasympathomimetic) drugs are indicated for which situation? A. Treating a postoperative patient who has bradycardia B. Lowering intraocular pressure in patients with glaucoma C. Inhibiting muscular activity in the bladder D. Preventing salivation and sweating

B. Lowering intraocular pressure in patients with glaucoma Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A) chlorpromazine (Thorazine) B) imipramine (Tofranil) C) lithium carbonate (Lithane) D) fluphenazine decanoate (Prolixin Decanoate)

D) fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

The nurse is giving medications to a patient. Which drug(s), when administered with lithium, increases the risk for lithium toxicity? a) Thiazides b) Levofloxacin c) Calcium citrate d) Beta-blockers

a) Thiazides

The nurse is instructing a patient on the use of lindane (kwell) shampoo for treatment of a child's head lice. Which statement by the parent indicates a need for further education? a. " I will wash his hair and them rinse out the shampoo immediately b. " I will leave the shampoo on his hair for 4 minutes before rinsing c. " After shampooing I will rinse and dry his hair d. " When the hair is dry I will comb the hair to remove the nits

a. " I will wash his hair and them rinse out the shampoo immediately

When the nurse is providing wound care with Dakin's solution for a patient who has a stage III pressure ulcer, the patient exclaims " I smell bleach! Why are you putting bleach on me?"What is the best explanation? a. "This is a very dilute solution and acts to reduce the bacteria in the wound so that it can heal" b. "This solution is used instead of medication to promote wound healing c. "This solution is used to dissolve the dead tissue in your wound" d. "Don't worry; we would never use bleach on a patient "

a. "This is a very dilute solution and acts to reduce the bacteria in the wound so that it can heal"

when the nurse is teaching a patient about the mechanism of action of tretinoin, which statement by the nurse is correct? a. "this medication acts by killing the bacteria that cause acne" b. "this medication actually cause skin peeling" c. "this medication acts by protecting your skin from UV sunlight" d. "this medication has antiinflammatory actions"

b. "this medication actually cause skin peeling"

The nurse will anticipate application of which medication to treat a client diagnosed with impetigo? a. Retinoic acid (Renova) b. Mupirocin (Bactroban) c. Isotretinoin (Amnesteem) d. Benzoyl peroxide (Benoxyl)

b. Mupirocin (Bactroban) Impetigo is a skin disorder caused by bacteria and is treated with a topical antibacterial agent, mupirocin.

What is another approved and indicated use for the antidepressant bupropion (Zyban)? a. Nocturnal enuresis b. Smoking cessation c. Tourette's syndrome d. Orthostatic hypotension

b. Smoking cessation Correct Zyban is a sustained-release form of bupropion that is useful in helping patients to quit smoking.

A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? a] Teach the patient to avoid foods containing tyramine. b] Monitor for dizziness. c] Inform the patient that this drug may cause urine discoloration. d] Monitor for tachycardia and palpitations.

b] Monitor for dizziness.

When assessing the medication history of a patient with a new diagnosis of Parkinson's disease, which conditions are a concern for the patient who will be taking levodopa-carbidopa? Select all that apply. A. Narrow-angle glaucoma B. History of melanoma C. Bladder difficulties D. Benign prostatic hypertrophy E. Concurrent use of monoamine oxidase inhibitors (MAOIs)

A. Narrow-angle glaucoma B. History of melanoma E. Concurrent use of monoamine oxidase inhibitors (MAOIs)

A client has an order for liquid haloperidol (Haldol). The nurse should avoid administering the medication with which of the following beverages? 1. Tea 2. Water 3. Apricot juice 4. Grape juice

ANS: 1 A special dropper should be used for oral liquid haloperidol administration; a precipitate will form if it is diluted with tea or coffee. If dilution is desired, use at least 60 mL of diluent (water or apricot or grape juice) and mix it just before administration to prevent precipitation.

The nurse working in a mental health outpatient setting is scheduling a follow-up visit for a client who is just beginning drug therapy with clozapine (Clozaril). The nurse makes an appointment for the client to return to the clinic in 1. 3 days. 2. 1 week. 3. 2 weeks. 4. 1 month.

ANS: 2 Because clozapine has the potential for causing agranulocytosis, a potentially life-threatening effect, it is reserved for treatment-resistant schizophrenia or for when adverse effects to other drugs preclude their continued use. Treatment with clozapine is closely monitored, with the manufacturer recommending that only weekly supplies be dispensed and that weekly white blood cell testing be performed.

The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to A. relieve anxiety and restless behavior of the patient. B. increase levels of acetylcholine in the brain by blocking its breakdown. C. block the effects of acetylcholine at the presynaptic neurons. D. help control associated urinary incontinence.

B. increase levels of acetylcholine in the brain by blocking its breakdown. Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. Donepezil is an indirect-acting anticholinesterase drug.

When doing an admission drug history, the nurse notes that the patient has a prescription for lithium (Lithobid). The nurse suspects that this patient has been diagnosed with which condition? a. Bipolar disorder b. Absence seizures c. Paranoid schizophrenia d. Obsessive-compulsive disorder

Bipolar disorder Correct Lithium is a mood-stabilizing drug for the treatment of manic episodes associated with bipolar disorders.

The nurse is assessing the skin of a teenage patient who has been using benzoyl peroxide product for 2 weeks as part of treatment for acne. Which assessment findings indicate that the patient is having an allergic reaction and will need ? a. Reddened skin over the treatment area b. Blistering skin over the treatment area c. Peeling skin over the treatment area d. Sensation of warmth when the product is applied

Blistering skin over the treatment area

What is the goal of pharmacologic therapy in treating Parkinson's disease? A) Increase the amount of acetylcholine at the presynaptic neurons. B) Decrease the amount of dopamine available in the substantia nigra. C) Balance cholinergic and dopaminergic activity in the brain. D) Block dopamine receptors in both presynaptic and postsynaptic neurons.

C) Balance cholinergic and dopaminergic activity in the brain. Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. By increasing dopamine, the neurotransmitter activity becomes more balanced and symptoms become controlled.

Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications? A) levodopa B) carbidopa C) selegiline D) diphenhydramine

C) Selegiline (Eldepryl) Selegiline is a selective monoamine oxidase (MAO) B inhibitor that has been shown to cause an increase in the levels of dopaminergic stimulation in the CNS and thus allow the dose of levodopa to be decreased.

The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brownish-orange urine. The nurse's response is based on the knowledge that A) the patient may be developing renal failure. B) the patient may be developing hepatic failure. C) brownish-orange urine signifies a lack of fluid intake. D) this is a normal occurrence related to entacapone (Comtan).

D) this is a normal occurrence related to entacapone (Comtan). Patients should be instructed that entacapone (Comtan) can turn urine a brownish-orange color, and this is not a harmful adverse effect.

Isotretinoin (Amnesteem) and tretinoin (Retin-A) are common dermatologic drugs used to treat which condition? a. Acne vulgaris b. Keloid scarring c. Fungal infections d. Male pattern baldness

a. Acne vulgaris Isotretinoin and tretinoin are effective topical treatments for acne vulgaris. Isotretinoin inhibits sebaceous gland activity, and tretinoin stimulates the turnover of epidermal cells, resulting in skin peeling.

A patient took an accidental overdose of a cholinergic drug while at home. He comes to the emergency department with severe abdominal cramping and bloody diarrhea. The nurse expects that which drug will be used to treat this patient? a. atropine (generic) b. physostigmine (Antilirium) c. bethanechol (Urecholine) d. phentolamine (Regitine)

a. atropine (generic)

The nurse is assessing a patient who has begun therapy with amantadine (Symmetrel) for Parkinson's disease. The nurse will look for which possible adverse effects? (Select all that apply.) a] Nausea b] Palpitations c] Dizziness d] Insomnia e] Edema

a] Nausea c] Dizziness d] Insomnia

The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? A. Diarrhea B. Urinary retention C. Risk for infection D. Insomnia

b. Urinary retention Anti-cholinergenic side effects include: urinary retention, dry mouth, blurred vidsion,photophobia, constipation , tachycardia

The client asks the nurse to explain the difference between levodopa-carbidopa (Sinemet) and ropinirole (Requip). What is the nurse's best response? ·a. Ropinirole is a dopamine agonist that has fewer side effects than levodopa-carbidopa. ·b. Levodopa-carbidopa is less effective than ropinirole in treating the symptoms of Parkinson's disease. ·c. Both drugs have the same pharmacodynamic and side effect profiles. ·d. Levodopa-carbidopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.

·a. Ropinirole is a dopamine agonist that has fewer side effects than levodopa-carbidopa. (Ropinirole (Requip) is a newer antiparkinson drug that directly stimulates specific dopamine receptors. Because the drug itself is not dopamine, there are fewer side effects related to peripheral dopamine levels than are noted with carbidopa.)

The nurse anticipates that a client with hyperaldosteronism will have an order for which of the following diuretics? 1. Spironolactone (Aldactone) 2.Amiloride (Midamor) 3.Triamterene (Dyrenium) 4.Bumetanide (Bumex)

1. Spironolactone (Aldactone) Spironolactone is used in the treatment of primary hyperaldosteronism.

The nurse would assess the client taking lithium (Eskalith) for signs of toxicity whenever the serum lithium level rises above which of the following levels? 1. 0.5 mEq/L 2. 1.0 mEq/L 3. 1.5 mEq/L 4. 2.0 mEq/L

1.5 mEq/L remember normal is 0.5-1.5 dry mouth lethargy fatigue muscle weakness

A nurse working on an inpatient psychiatric unit hears in report that a client taking an antipsychotic drug has begun showing signs of dystonia. The nurse expects the client to exhibit which of the following on assessment? 1.Shuffling gait 2.Muscle quivering 3.Eyes rolled back in the head 4.Lip smacking

3.Eyes rolled back in the head Acute dystonic reactions typically present within 24 to 48 hours of an initial dose or dose increase of an antipsychotic drug and are more often observed in the high-potency/low-dose typical agents. Symptoms classically present as oculogyric crisis (eyes rolled back in the head), trismus (facial twisting to one side), a protruding and fixed tongue, and opisthotonus (neck arching and stiffness).

When teaching a patient about carbidopa-levodopa (Sinemet), the nurse responds based on knowledge that A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. B) carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. C) giving both drugs together minimizes side effects. D) carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

A) carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa inhibits the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal adverse effects caused by dopamine in the periphery, resulting in fewer unwanted adverse effects.

A client will be starting drug therapy with fluoxetine (Prozac). The nurse cautions the client not to stop taking the drug suddenly because this could result in which of the following symptoms? 1.Dizziness and agitation 2.Tachycardia and fever 3.Insomnia and sexual dysfunction 4.Urinary retention and abdominal cramps

ANS: Dizziness and agitation Fluoxetine is a selective serotonin uptake inhibitor. Discontinuation of these drugs is associated with a classic withdrawal response of dizziness, nausea, and agitation.

The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's response is based on knowledge that A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. B) carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease. C) both drugs have the same pharmacodynamic and side effect profiles. D) carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.

A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. Ropinirole stimulates specific dopamine receptors in the brain. It is more specific for the receptors associated with parkinsonian symptoms, the D2 subfamily of dopamine receptors. This in turn may have more specific antiparkinson effects, with fewer adverse effects associated with generalized dopaminergic stimulation.

Before beginning drug therapy with an antipsychotic agent, priority assessments done by the nurse would include which of the following? 1. Neurologic and respiratory 2. Neurologic and cardiovascular 3. Cardiovascular and renal 4. Respiratory and renal

ANS: 2 Before starting antipsychotic drug therapy, a client should undergo a complete history and physical assessment. Of particular importance is a neurologic examination and documentation of orientation, affect, and cognition as a baseline assessment. Obtaining a baseline assessment of pulse and blood pressure in the sitting, standing, and lying positions is also important.

The nurse is reviewing laboratory results for a patient and notes that the patient has positive results for nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA). The nurse anticipates an order for which medication? A. bacitracin B. mupirocin (Bactroban) C. clindamycin (Cleocin T) D. clotrimazole (Lotrimin)

ANS: B Mupirocin (Bactroban) is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization by MRSA. The other options are incorrect. Bacitracin and clindamycin are not indicated for the treatment of MRSA; clotrimazole is an antifungal drug

A father calls because his son has head lice. He reports that he has used "that special medicated shampoo three times, but nothing is happening. Now what?" What will the nurse advise first? A. Get a prescription for a second product, malathion. B. Try one of the lotion products that remain on the scalp for 8 hours. C. Be sure that he is using a nit comb to remove nits from the hair shafts. D. Comb through the hair with mineral oil to loosen the lice from the hair shafts.

ANS: C Before trying another product, ensure that he is performing the regimen correctly. Because he only mentioned shampooing, ensure that after each shampoo he is using a nit comb to remove nits, or eggs, from the hair shafts.

A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the physician's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate? A. "Increase the dosage to twice daily." B. "It takes time for the cure to take effect." C. "It may take up to 6 weeks to see an improvement." D. "Take the medication on an empty stomach for improved absorption."

ANS: C Donepezil therapy is not a cure for Alzheimer's disease, but it may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals, and the medication should not be abruptly stopped or the dosage increased without the physician's approval because of the possibility of serious complications.

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's action? A. Prevents memory loss in later stages B. Reverses the course of Alzheimer's disease C. Provides sedation to prevent agitation and restlessness D. May help to improve the symptoms of Alzheimer's disease

ANS: D Donepezil is used to treat mild to moderate dementia occurring in Alzheimer's disease and may improve the symptoms of the disease.

Which comment to the nurse indicates more teaching is needed for a client taking carbidopa/levodopa? A. "I know I need to take this drug once a day." B. "I know I shouldn't stop taking this drug abruptly." C. "I understand my urine may become dark and discolored." D. "I know it may take a few weeks or months to control my symptoms."

Answer: A Rationale: A statement from the client such as "I know I need to take this drug once a day" indicates that more teaching is needed because carbidopa/levodopa has a short half-life and must be taken 3 or 4 times per day. The other answers are true.

A patient with Parkinson's disease discusses with the nurse experiencing insomnia recently. The patient asks the nurse, "Can I take my old prescription of benzodiazepine that is prescribed to treat my insomnia?" What does the nurse know about the use of benzodiazepines in patients taking levodopa (Larodopa)? a. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease. b. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease. c. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease. d. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease.

Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease. Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson's disease.

A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication? a. Avoid eating aged cheese. b. Encourage use of fiber supplements. c. Explain the symptoms of tardive dyskinesia. d. Emphasize that tremors are a common adverse effect.

a. Avoid eating aged cheese. Correct Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

A patient is prescribed selegiline (Eldepryl), an MAO-B inhibitor, as adjunctive therapy in treatment of Parkinson's disease. What potential adverse effects should the nurse include in education for this patient? (Select all that apply.) a. Headache b. Insomnia c. Weight gain d. Depression e. Blood pressure changes

a. Headache b. Insomnia d. Depression e. Blood pressure changes MAO-B inhibitors have many potential adverse effects, including dizziness, insomnia, hallucinations, ataxia, agitation, depression, paresthesia, somnolence, headache, dyskinesia, nausea, diarrhea, hypotension or hypertension, chest pain, weight loss, dermatologic reactions, rhinitis, and pharyngitis.

A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a] Notify the patient that this drug causes discoloration of the urine. b] Limit the patient's intake of tyramine-containing foods. c] Monitor results of renal studies because this drug can seriously affect renal function. d] Force fluids to prevent dehydration.

a] Notify the patient that this drug causes discoloration of the urine.

A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a] the entacapone can reduce on-off effects. b] the levodopa may be stopped in a few days. c] there is less GI upset with entacapone. d] it does not cause the cheese effect.

a] the entacapone can reduce on-off effects.

In caring for a patient experiencing alcohol withdrawal, the nurse knows that which medication or medication class is most likely to be ordered as treatment for this condition? a) Lithium (Eskalith) b) Benzodiazepines c) Buspirone (BuSpar) d) Antidepressants

b) Benzodiazepines

The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a) The patient should be told which foods contain tyramine and instructed to avoid these foods. b) The patient should be instructed to use caution when standing up from a sitting position. c) The patient should be told that if sexual dysfunction occurs, the drug will be stopped. d) This medication should not be stopped abruptly. e) Drug levels may become toxic if dehydration occurs. f) The patient should be told to check with the prescriber before taking any over-the-counter medications.

b) The patient should be instructed to use caution when standing up from a sitting position. d) This medication should not be stopped abruptly f) The patient should be told to check with the prescriber before taking any over-the-counter medications.

A patient is prescribed bacitracin topical ointment. What does the nurse suspect as the possible diagnosis based on the medication prescribed? a. Fungal infection b. Bacterial infection c. Parasitic infection d. Viral infection

b. Bacterial infection Correct Bacitracin is a polypeptide antibiotic that is applied topically for the treatment or prevention of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms such as staphylococci, streptococci, anaerobic cocci, corynebacteria, and clostridia.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? a. Decrease the catecholamine release into the blood b. Block the reuptake of neurotransmitters at nerve endings c. Inhibit an enzyme that stops the action of neurotransmitters d. Stimulate areas of the brain associated with mental alertness

b. Block the reuptake of neurotransmitters at nerve endings The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin. The monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme that stops the actions of neurotransmitters such as dopamine, serotonin, and norepinephrine. Amphetamines stimulate areas of the brain associated with mental alertness.

A patient prescribed lorazepam (Ativan) for the treatment of anxiety states, "I feel drowsy all the time, and it's interfering with every aspect of my life." The nurse knows that a better drug therapy option for this patient is which anxiolytic medication? a. Alprazolam (Xanax) b. Buspirone (BuSpar) c. Chlordiazepoxide (Librium) d. Hydroxyzine hydrochloride salt (Vistaril)

b. Buspirone (BuSpar) Buspirone (BuSpar) has the advantage of having fewer adverse effects such as sedation and lack of dependency potential. All of the other options are sedatives as well as anxiolytics.

A client has been taking benztropine (Cogentin). What outcome assessment helps the nurse to verify therapeutic effects of this medication? a. Client is unable to talk. b. Client has had a decrease in tremors. c. Client can sit up unassisted. d. Client has an increased heart rate.

b. Client has had a decrease in tremors. (Anticholinergic drugs help to reduce the rigidity and tremors characteristic of Parkinsonism.)

The nurse is discussing with a client over-the-counter and prescription topical medications available for treatment of acne. Which drugs are used in the treatment of acne? (Select all that apply.) a. Isotretinoin (Claravis) b. Clindamycin (Cleocin) c. Benzoyl peroxide (Benoxyl) d. Vitamin A acid (Ascor L 500) e. Norethindrone and ethinyl estradiol

b. Clindamycin (Cleocin) Correct c. Benzoyl peroxide (Benoxyl) Correct d. Vitamin A acid (Ascor L 500) Correct Benzoyl peroxide, clindamycin, and vitamin A acid are available in topical treatment options for acne. Isotrentinoin is only an oral option. Acne vulgaris is an off-label use for the oral contraceptive norethindrone and ethinyl estrdiol (Ortho-Novum).

Which laboratory test should be monitored closely to assess for a potential life-threatening adverse effect to clozapine (Clozaril)? a. Liver function studies b. Complete blood count c. Immunoglobulin levels d. Glomerular filtration rate

b. Complete blood count Correct Patients taking clozapine must be monitored for the life-threatening adverse effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

The nurse is performing wound care on a burned area using silver sulfadiazine cream in a patient with an arm wound. Which actions by the nurse are correct?(select all that apply) a. Applying the cream over the previous layer to avoid disturbing the wound bed b. Gently cleansing the wound to remove the previous layer of cream and wound debris c. Using clean gloves to apply the ointment d. Using sterile gloves to apply the ointment e. Always covering the wound with a dressing after applying the cream f. Washing hands before and after the procedure

b. Gently cleansing the wound to remove the previous layer of cream and wound debris d. Using sterile gloves to apply the ointment f. Washing hands before and after the procedure

The nurse is providing education to a patient on the primary uses of cholinergic drugs. Which uses would the nurse include in the teaching? (Select all that apply.) a. Increase heart rate b. Stimulate peristalsis c. Dilate pulmonary airways d. Stimulate bladder emptying e. Decrease intraocular pressure

b. Stimulate peristalsis d. Stimulate bladder emptying e. Decrease intraocular pressure Cholinergic drugs are used primarily for their effects on the GI tract, bladder, and eye. These drugs stimulate the intestine and bladder, which results in increased gastric secretions, GI motility, and urinary frequency. They also stimulate constriction of the pupil, or miosis. This helps decrease intraocular pressure. In addition, cholinergic drugs cause increased salivation and sweating. Cardiovascular effects include reduced heart rate and vasodilation. Pulmonary effects include causing the bronchi of the lungs to constrict and the airways to narrow.

A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication? a. There are no drug or food contraindications with this medication. b. There is a risk of toxicity when this medication is taken with alcohol. c. Take St. John's wort every day to minimize the adverse effects of the medication. d. This drug does not cause problems with sleep, constipation, or low blood pressure.

b. There is a risk of toxicity when this medication is taken with alcohol. Correct There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

A client has been prescribed clotrimazole (Lotrimin, Mycelex-G) for the treatment of jock itch. To document this diagnosis in the client's medical record, the nurse should use which fungal infection name? a. Tinea pedis b. Tinea cruris c. Tinea capitis d. Tinea corporis

b. Tinea cruris Correct Infections caused by dermatophytes are called tinea, or ringworm, infections. Tinea infections are identified by the body location where they occur: tinea pedis (foot), tinea cruris (groin), tinea corporis (body), and tinea capitis (scalp). Tinea infections of the foot are also known as athlete's foot and those of the groin as jock itch.

While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by A. rigid, tense muscles. B. difficulty in performing voluntary movements. C. limp extremities with weak muscle tone. D. confusion and altered mental status.

b. difficulty in performing voluntary movements.

When giving intravenous cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (Select all that apply.) a. peripheral tingling b. hypotension c. dry mouth d. syncope e. dyspnea f. tinnitus

b. hypotension d. syncope e. dyspnea

After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern should the nurse know to look for during the conversation with the patient? a) Weakness b) Hallucinations c) Suicidal ideations d) Difficulty with urination

c) Suicidal ideations

The family of a patient who has been recently diagnosed with Alzheimer's disease is asking about the new drug prescribed to treat this disease. The patient's wife says, "I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment." Which reply from the nurse is appropriate? a. "The sooner he starts the medicine , the sooner it can have this effect" b. "These effects won't be seen for a few months" c. "These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy" d. "His response to this drug therapy will depend on how far along he is in the disease process"

c. "These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy"

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement? a. Zinc b. Vitamin E c. St. John's wort d. Glucosamine chondroitin

c. St. John's wort Correct Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.

A female client of childbearing age is prescribed isotretinoin (Amnesteem) for the treatment of severe recalcitrant cystic acne. Which information is MOST important for the nurse to include in the education of the client? a. The drug is supplied in oral and buccal forms. b. The drug is used in treatment of severe acne. c. Use at least two forms of contraception while taking this medication. d. Health care providers who prescribe this medication must be certified.

c. Use at least two forms of contraception while taking this medication. The most important and mandatory teaching by the U.S. Food and Drug Administration is the requirement to use at least two different reliable forms of contraceptive methods during therapy with isotretinoin and for 1 month after completion of therapy.

The nurse is monitoring for an allergic reaction to topical bacitracin which would be evident by presence of a. petechia b. thickened skin c. itching and burning d. purulent drainage

c. itching and burning

Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease? a] Diarrhea b] Tremors c] Angle-closure glaucoma d]Unstable gait

c] Angle-closure glaucoma

When a patient is taking an anticholinergic such as benztropine as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan? A. Minimize the amount of fluid taken while on this drug. B. Discontinue the medication immediately if adverse effects occur. C. Take the medication on an empty stomach to enhance absorption. D. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

Which statement by the patient indicates the need for additional teaching on phenothiazine (Thorazine) drug therapy? a. "I need to change positions slowly to prevent dizziness." b. "I will call my health care provider for abnormal tongue movements" c. "I will need to wear sunscreen and protective clothing when outdoors." d. "It is okay to take this drug with a small glass of wine to help relax me."

d. "It is okay to take this drug with a small glass of wine to help relax me." Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

A patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) asks the nurse, "Why have I suddenly developed a relapse of my symptoms." Which explanation by the nurse is appropriate? a. "You have developed drug tolerance to your current b."This is very common and it is temporary. Continue to take the medicine, and you will feel better in a few weeks." c. "You have developed medication toxicity. Thus, the drug dose will be reduced to avoid potentially toxic drug blood levels." d. "This is called the "on-off phenomenon." Your health care provider can change your medication regimen to help manage this effect."

d. "This is called the "on-off phenomenon." Your health care provider can change your medication regimen to help manage this effect." Patients who have been taking levodopa for a period of time may experience periods of symptom return. Changing to Sinemet controlled release or adding another medication can help reduce the on-off phenomenon.

The health care provider prescribes donepezil (Aricept) for a patient. The patient states to the nurse, "I have no idea why I take this medication." The nurse knows the administration of donepezil (Aricept) is MOST commonly associated with what condition? a. Bladder retention b. Urinary retention c. Parkinson's disease d. Alzheimer's disease

d. Alzheimer's disease Donepezil (Aricept) is a cholinesterase inhibitor drug that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease

A client who is prescribed the drug miconazole (Monistat), a topical antifungal, has MOST likely been diagnosed with which condition? a. Pruritus b. Eczema c. Folliculitis d. Candidiasis

d. Candidiasis Miconazole is used in the treatment of candidiasis, which is commonly known as a yeast infection.

The nurse is providing care for a patient with a diagnosis of Parkinson's disease who has preexisting liver failure. What class of medications, if prescribed, would the nurse question? a. Anticholinergics b. Ergot derivative c. Dopamine modulator d. Catechol ortho-methyltransferase (COMT) inhibitors

d. Catechol ortho-methyltransferase (COMT) inhibitors COMT inhibitors are contraindicated in patients with liver failure or liver disease. Potential liver failure is also a known adverse effect.

A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? A. Decreased appetite B. Gradual development of cogwheel rigidity C. Occurrence of adverse effects, such as confusion, anxiety, irritability, and headache D. Improved mental status, as well as improved ability to perform activities of daily living

d. Improved mental status, as well as improved ability to perform activities of daily living

Cholinergic (parasympathomimetic) drugs have which therapeutic effect? a. Pupil dilation b. Urinary retention c. Blood vessel vasoconstriction d. Increased gastrointestinal (GI) motility

d. Increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the body digest. Urinary retention, mydriasis (pupil dilation), and blood vessel vasoconstriction are sympathetic nervous system responses.

The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates an adverse effect of this drug? a. Dry mouth and constipation b. Blood pressure of 80/50 mm Hg c. Presence of myoglobin in the blood d. Muscle cramps of the head and neck

d. Muscle cramps of the head and neck Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed. The other adverse effects also occur but are not extrapyramidal effects.

What atypical antipsychotic medication should the nurse anticipate the health care provider prescribing for treatment of refractory schizophrenia? a. Phenelzine (Nardil) b. Prazodone (Desyrel) c. Amoxapine (Asendin) d. Risperidone (Risperdal)

d. Risperidone (Risperdal) Risperidone is effective for schizophrenia, including negative symptoms. The other medications listed are antidepressants.

When planning care for a burn client, the nurse would anticipate applying which topical medication? a. Lindane (Kwell) b. Minoxidil (Rogaine) c. Erythromycin (E-Mycin) d. Silver sulfadiazine (Sulfadine)

d. Silver sulfadiazine (Sulfadine) Silver sulfadiazine is a topical antiinfective drug used to treat and prevent infection in second- and third-degree burns.

The nurse is reviewing the use of topical anesthetic drugs. Which of these is an appropriate use for the lidocaine / prilocaine combination cream know as EMLA? a. To reduce the discomfort of insect bites b. To reduce the pain of sunburn c. To relieve the itching associated with poison ivy d. To reduce pain before a needle insertion

d. To reduce pain before a needle insertion

A patient has a new order for a catechol-O-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that an advantage of this drug class is that it A. has a shorter duration of action. B. causes less gastrointestinal distress. C. has a slower onset than traditional Parkinson disease agents. D. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

d. is associated with fewer wearing-off effects and has prolonged therapeutic benefits.

When considering the variety of OTC topical corticosteriod products the nurse is aware that which type of prepartion is generally most penetrating and effective? a. Gel b. lotion c. spray d. ointment

d. ointment

The nurse explains that a "drug-free holiday" for a client taking a phenothiazine type of antipsychotic drug may be necessary to help prevent which of the following? 1.Noncompliance 2.Higher costs 3.Destructive behaviors 4.Tardive dyskinesia

tardive dyskinesia "This helps to prevent tardive dyskinesia and other extrapyramidal reactions." Tardive dyskinesia is caused by long-term use of neuroleptic drugs, which are used to treat psychiatric conditions. Tardive dyskinesia causes repetitive, involuntary movements, such as grimacing and eye blinking.

The client is started on selegiline (Eldepryl) therapy. What information is most important for the nurse to teach the client about this medication? ·a. "This medication will cure your disease." ·b. "This medication is used when other drugs do not work." ·c. "This medication blocks breakdown of dopamine." ·d. "You will need to restrict your intake of certain foods and drinks."

·d. "You will need to restrict your intake of certain foods and drinks." (This medication may inhibit MAO-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the client.)

The nurse is teaching the client who is prescribed an anticholinergic about dietary changes that might be necessary. What instruction is the most appropriate for this client? ·a. Do not drink milk while on this medication. ·b. Increase your intake of fatty foods while on this therapy. ·c. Do not eat carbohydrates with this medication. ·d. Increase your intake of fluids while on this medication.

·d. Increase your intake of fluids while on this medication. (The client should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation.)