pharm test 2- chp 20,21,22,23,24,25,26,&27
A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient?
administer the next drug dose with meals
The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?
adverse effects include hypertension and nercousness
The nurse is providing education to a client who has been prescribed monoamine oxidase inhibitor (MAOI) therapy following unsuccessful treatment with other agents. What foods should the nurse instruct the client to avoid? Select all that apply.
aged cheeses chocolate bananas coffee
Which would lead the nurse to suspect that a client is experiencing an adverse effect to an anticholinergic agent?
agitation
A client is undergoing an appendectomy under general anesthetic when the client's temperature rises to 105°F (40.6°C), accompanied by increased muscle rigidity. The perioperative nurse should anticipate what intervention?
STAT administration of dantrolene
When does a client with spinal cord injury-associated spasticity require treatment for this condition?
Safety, mobility, and activities of daily living are impaired.
A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client?
benzo toxicity
A client with a foreign body embedded in her hand requires local anesthesia for removal. What drug would be most appropriate?
benzocaine
After teaching a group of students about local anesthetic agents, the instructor determines that the teaching was successful when the students identify which as an example of an ester?
benzocaine
A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked?
blood cell count
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?
blood pressure
What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy?
blurred vision
A nurse is treating a patient who is receiving carbamazepine for a seizure disorder. The nurse knows that carbamazepine is contraindicated in patients with which diseases or disorders?
bone marrow depression
A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?
bowel patterns
A client is receiving a barbiturate intravenously. The nurse would monitor the client for:
bradycardia
The nurse is administering phenytoin to a client. For what adverse reaction should the nurse observe?
bradycardia
A client has a diagnosis of Parkinson disease, and the health care provider will prescribe carbidopa-levodopa. Before drug therapy, the client should be carefully assessed for the presence of:
closed-angle glaucoma
After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent?
clozapine
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
clozapine
The nurse is providing care for a client who has been prescribed trazodone for the treatment of depression. What assessment should the nurse prioritize?
cognition and LOC
A client with a history of schizophrenia has been receiving antipsychotic therapy for several years. Which would indicate to the nurse that the client is experiencing pseudoparkinsonism?
cogwheel rigidity
The nurse should not administer sedatives or hypnotic drugs to which client?
comatose client
Which would be most important to monitor in a client receiving ethosuximide?
complete blood count
A 72-year-old man should be aware that the adverse effects of centrally acting anticholinergic drugs include:
confusion
An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following?
confusion
The nurse administered morphine 30 minutes ago to a client in the postanesthesia recovery unit (PACU), and now notes that the client vital signs are: Temp: 97.9 F, Pulse: 98 bpm, Respirations: 9 breaths/min, and BP: 107/69. What is the nurse's next best action?
contact the HCP
A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order?
dantrolene
While most muscle relaxants drugs are central nervous system (CNS) depressants, which medication acts only on the muscle?
dantrolene
Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
decrease salivation, spasticity, and tremors.
The nurse is performing a preoperative assessment of a client who is scheduled for surgery. What aspect of the client's health status would most affect the decision whether or not to administer enflurane?
decreased GFR
The nurse is assessing a client who has just received haloperidol for an acute psychotic episode. For what therapeutic effect should the nurse initially assess following administration?
decreased agitation and combativeness
A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication?
decreased muscle spasms
A nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body?
decreased reuptake of norepinephrine
A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by:
decreasing the influx of sodium into neurons
When in postanesthetic recovery, the nurse should assess for what adverse effect when ketamine is included in a surgical client's balanced anesthesia?
delirium and agitation
When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include?
depression of motor nerve output
What medication belongs to the category of inhaled anesthetics?
desflurane
A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?
diazepam
Patients receiving chlorzoxazone should be cautioned that what will occur with administration?
discoloration of urine
The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit?
disorganized and often bizarre thinking
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
do not drive or operate machinery until drug effects are known
When teaching a patient on an MAO inhibitor, what would be important to include in the teaching?
do not take otc drugs
The nurse is reviewing the results of a hospital client's serum phenytoin level, which has just become available. The results indicate that the client's phenytoin level is 17.5 mcg/mL. What is the nurse's best action?
document the fact that the nurse checked the levels therapeutic range: 10-20
A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling?
dopamine
One of the neurotransmitters can become decreased in the area of the corpus striatum. This results in the manifestations of Parkinson's disease. Which neurotransmitter will cause this?
dopamine
Then nurse is caring for a client who has a diagnosis of schizophrenia. The nurse understands that the client's condition is thought to be most likely related to an increased level of activity of what neurotransmitter?
dopamine
A client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication?
drink frequent sips of water
A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?
drowsiness
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?
drowsiness
Which factor should the clinician reassess when combination therapy is ineffective?
drug-drug interactions
What may parkinsonism result from? (Select all that apply.)
drugs encephalitis
A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?
dry mouth
Common side effects of anticholinergics include:
dry mouth, urinary retention, constipation, and increased pulse rate.
A client taking an opioid for chronic pain management says, "I cannot have a bowel movement." Which suggestion will the nurse make to this client?
eat more fruits and vegetables
A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform?
educate the client about the need to take pills as scheduled
Three days after discontinuing diazepam with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status?
effects can persist for several days after discontinuation
A client with a complex medical history has been diagnosed with Parkinson's disease. The client's current medication regimen includes omeprazole, ranitidine, multivitamins, albuterol and ipratropium. Before the client begins treatment with levodopa, the nurse should:
ensure the multivitamin is discontinued by the provider
The community health nurse also assists the health care provider in the decision-making process for AED drug titration by performing which function?
ensuring the client makes the appointment for serum drug levels
Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children?
enurisis
The nurse is caring for a client in the emergency department who will need sutures. The health care provider plans to use lidocaine. The nurse prepares the suture tray and places lidocaine and what other drug on the tray that helps prolong the local anesthetic effects?
epinephrine
A 30-year-old client experiences migraines that appear closely linked to her menstrual cycle. What pharmacologic treatment is most specific to this client's particular experience of migraines?
estradiol
A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?
eszopiclone
A child suffers from absence seizures. What is the drug of choice for absence seizures?
ethosuximide
What would lead the nurse to suspect that a client is experiencing withdrawal symptoms associated with benzodiazepine use?
nightmares
The pathophysiology of pain begins with a signal from what source?
nociceptors
A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first?
notify the physician
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?
observe respirations frequently
Which client would the nurse identify as being opioid naive?
one who does not routinely take opioids
A client is prescribed clozapine. When developing the teaching plan for this client, the nurse would integrate knowledge of which of the following?
only 1 week supply is dispensed at a time
A nurse is caring for a client who has been prescribed diphenhydramine for the treatment of Parkinson disease in an older adult. The client reports diplopia and blurred vision. Which intervention would be most appropriate?
provide proper assistance with ambulation
In ophthalmology, anticholinergic drugs are used because they produce which effect?
pupil dilation
A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?
pyridoxine (vitmain B6)
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential?
raise BP
A client is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately?
rash
A child has been administered injectable lidocaine to allow for removal of several foreign bodies from an abrasion wound suffered in a bicycle crash. The medication was administered five minutes ago but the child still reports sensation. What is the nurse's best action?
reassess the client's sensation in five minutes
A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication?
recent MI
A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do?
reduce the dose
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?
reduced adverse effects
The nurse is providing education to a client who has been prescribed clozapine. The nurse should emphasize the importance of what monitoring routine during teaching?
regular CBC
A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with:
renal impairment
While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client's bedside table and scattered bruising over the client's extremities. What is the nurse's best action?
report findings immediately
A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction?
resp depression
A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:
resp disturbances and partial airway obstruction
The nurse is preparing to admit a client who has received conscious sedation. What is the most important area to assess when the client returns from the procedure using this type of anesthesia?
respirations
A client is scheduled for dental surgery and will be given nitrous oxide. What assessment should the nurse prioritize before administering the medication?
respiratory status
When reviewing a client's history, which condition would the nurse identify as contraindicating the use of a centrally acting skeletal muscle relaxant?
rheumatic disorder
A patient has been administered an antipsychotic. Which reaction should be reported immediately?
rigidity
A client with a recent history of muscle spasticity has been prescribed tizanidine. What finding on the client's most recent laboratory report should prompt the nurse to contact the care provider?
rise in liver enzymes
The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?
sit on the side of the bed for 1 minute before getting up
A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessments?
sleep patterns
A nurse is caring for a patient administered ethotoin. What are signs of toxicity for which the nurse should monitor the patient?
slurred speech
The induction of a local anesthetic would decrease the permeability of the nerve cell membrane to which element?
sodium
The nursing instructor is teaching students about anesthesia and instructs that general surgical anesthesia is divided into four different stages. In which stage would the nurse expect to see delirium?
stage 2
The client is undergoing surgery for a small bowel resection. At this time the client is experiencing complete respiratory paralysis and is in the most dangerous stage of general anesthesia. Which stage is this?
stage 4
A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?
extrapyramidal
The client has been taking chlorpromazine for more than 40 years. What adverse effect will the client most likely be experiencing?
extrapyramidal effects
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?
falls
The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for:
falls.
Barbiturates are considered the sedative and hypnotic drugs of choice.
false
Eszopiclone is thought to react with norepinephrine to achieve its action.
false
Larger doses of narcotic antagonists are needed to reverse the effects of morphine than for pentazocine.
false
The nurse is assessing a client for possible risk factors for the development of hepatotoxicity with the use of dantrolene. What situations would the nurse identify as requiring cautious use of the drug?
female gender
Naloxone (Narcan) will reverse the effects of which drug?
fentanyl
What is a common risk for epileptic seizures during late infancy to early childhood?
fever
Which agent would a nurse identify as a selective serotonin reuptake inhibitor?
fluvoxamine
What is the primary medication prescribed to relieve pain associated with shingles?
gabapentin
As a result of a drug error, a client has inadvertently been given an intra-arterial injection of a benzodiazepine. The care team should monitor closely for what complication?
gangrene
The nursing instructor is teaching the students about anesthesia and informs them that there are two types. What are those two types of anesthesia? (Select both that apply.)
general local
A 28-year-old patient has a history of malignant hyperthermia following anesthesia. Today, this patient is on the operating room schedule for a D&C;. Which method of anesthesia would not be acceptable for this patient?
general anesthesia with an inhalation agent
Which type of seizures involves a loss of consciousness?
generalized seizures
What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult?
give med as prescribed
A client has developed symptoms of rigidity and bradykinesia. Which medication has been linked to the development of such symptomology?
haloperidol
During recovery from general anesthesia, what would be a priority?
have emergency equipment readily available
A nurse is caring for an elderly patient undergoing antianxiety treatment. The patient is to be administered antianxiety drugs parenterally. What precautions should be taken by the nurse?
have resuscitative equipment ready
A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may:
have undiagnosed diabetes
A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed?
have you ever been diagnosed w/ narcolepsy?
A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status?
have you felt hopeless anytime lately?
Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client?
having the client walk to the bathroom
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which?
height and weight
The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching?
hepatitis
Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of:
hepatocellular disease.
A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?
history of seizure disorder
A client diagnosed with a migraine has been prescribed naproxen. What is the nurse's priority when the client reports being allergic to aspirin?
hold the medication
The parents of a teething infant ask about over-the-counter (OCT) solutions to help minimize the pain. What assessment question has priority when preparing to provide suggestions?
how old is your infant?
A nurse who is providing care on a pediatric client has conducted a medication reconciliation. In light of the fact that the client takes methylphenidate, the nurse is justified in considering a history of what health problem?
hyperactivity
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
hypertension
A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?
hypertension
A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe?
hypertensive crisis
The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI?
hypoglycemia
A 30-year-old pregnant client is 5 cm dilated and has just received epidural anesthesia for pain relief. Which adverse effect is most likely?
hypotension
A nurse is caring for a patient who has been administered a barbiturate. Which is a symptom of barbiturate toxicity that the nurse must monitor the patient for?
hypotension
The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?
hypotension
A client has been admitted to the emergency department after overdosing on oxycodone. What nursing diagnosis should the nurse prioritize?
impaired gas exchange
An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse's most appropriate action?
implement falls precautions
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?
importance of adherance
The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.
improved sleep decreased anxiety interest in physical activity
Following the subcutaneous (subcut) administration of pain medication, the nurse would know to check the client's vital signs in what amount of time?
in 20-30 minutes
Which laboratory value would prevent a client from being prescribed duloxetine?
increased ALT
A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?
increased blood glucose
The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about?
increased sedative effect
A client who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by:
increasing the effects of the neurotransmitter GABA.
A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam?
induces sleep
A client comes to the emergency department. The client is experiencing continuous seizure activity without any interruptions. Which anticonvulsant would the nurse anticipate that the primary health care provider would most likely prescribe initially?
lorazepam
An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?
malignant hyperthermia
An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?
measurement of height and body weight
A client has been admitted to the surgical floor and is scheduled for an elective minor procedure. During the health history, the client informs the nurse of difficulty sleeping until a few weeks ago when a hormone was recommended by a neighbor and started. To what hormone is this client referring?
melatonin
A client is prescribed selegiline. The nurse is aware that which analgesic should not be given to the client?
meperidine
The dopamine agonists selegiline and rasagiline, which are monoamine oxidase inhibitors, should not be administered with which drug as the combination increases the risk of serotonin syndrome?
meperidine
A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?
methadone
What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness?
status epilepticus
The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to:
stay in bed for the next half hour
An adult client is beginning to awaken in the postanesthesia care unit. The client appears anxious and states , "My arms and legs feel like tree trunks and my head feels "fuzzy. I can't think of the right words to say." What is the priority nursing intervention for this client?
stay with the client as much as possible and provide reassurance
The nurse is reviewing a prescription for chlorpromazine. The nurse would contact the prescribing health care provider regarding a contraindication for the client with what medical diagnosis? Select all that apply.
stroke cirrhosis Parkinson's
The nurse is caring for a teenage client who has recently been prescribed a selective serotonin reuptake inhibitor. What assessment should the nurse prioritize?
suicidal ideation
Clients taking levodopa should avoid what due to their ability to increase dopa decarboxylase action?
supplemental vitamins
Which instruction should a nurse give to a patient who is being administered lithium?
take frequent sips of water
A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do?
take with food or milk
A client's symptoms of Parkinson's disease have worsened despite the use of dopaminergics. The client's provider has prescribed the addition of rotigotine to the client's medication regimen. What is the nurse's best action?
teach the client and family how to correctly apply a transdermal patch
The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom?
temp of 102
How will the addition of nitrous oxide or IV anesthetics affect the minimum alveolar concentration (MAC) of isoflurane?
the MAC will decrease
What aspect of a client's health status would contraindicate the safe use of desflurane during surgery?
the client has COPD
When reviewing the medical record of a client who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring?
the client has respiratory depression from opioid analgesia
A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason?
the client is at risk for increased CNS depression
The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?
the client may begin to demonstrate symptoms of withdrawal
A 37-year-old client has received procaine hydrochloride (Novocain) in the mouth for a dental procedure. How would the nurse evaluate that the outcome of reduced pain related to a dental procedure has been met?
the clients facial expressional are calm and relaxed
One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide?
try taking at the same time as you eat some food
A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider?
upward trend in AST and ALT
A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method?
use a pain scale rating
What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?
use sugarless hard candies and gum to deal with dry mouth
A client who began treatment with clozapine 2 weeks ago is now reporting worsening flulike symptoms, including a high fever. The nurse's assessment should be conducted with the goal of identifying signs and symptoms of what possible adverse medication reaction?
agranulocytosis
A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor:
alanine aminotransferase and total bilirubin levels.
The nursing student identifies which people as qualified to administer anesthesia? (Check all that apply.)
anesthesiologist NA
The nurse instructs a client to use benzocaine to soothe the itching and pain related to an insect bite. Benzocaine is considered to be what type of dermatologic agent?
anesthetic
A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?
antiepilepsy drugs are teratogenic
The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose?
antihistamines
When counseling a patient about the proper use of Lidoderm (a local anesthetic patch) what instruction should the nurse include?
apply the patch to the most painful area of the skin
The nurse is caring for a 59 year-old female client who was diagnosed with multiple sclerosis two years ago. In recent weeks, the client has developed increasing muscle spasticity and the care team is considering the use of dantrolene. What assessment question should the nurse prioritize?
are you on hormone replacement therapy?
The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery?
ask for the pain medicine before the pain gets severe
An older adult client diagnosed with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention?
assess renal function
A surgical client's balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize?
assessing and protecting the clients airway
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize?
assessing the client for migraine pain
What is one of the registered nurse's primary roles in the administration of general anesthetic?
assessing the clients status during recovery from anesthetic
The nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize?
assessment for involuntary movements
A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapeutic effect of the treatment in the care of this client?
assessment of the clients behaviors and thought processes
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to:
avoid drinking for the duration of treatment
A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?
avoid driving until he is aware of the adverse effects.
A client has a history of seizures of which the client takes phenytoin on a regular basis. What should the nurse teach the client in order to ensure safety?
avoid gingko supplements
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?
avoid use of soy sauce in diet
A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?
baclofen
A nurse understands that which skeletal muscle relaxants should not be administered to a client with skeletal muscle spasms caused by systemic lupus erythematosus?
baclofen
Which skeletal muscle relaxant is also available in intrathecal form?
baclofen
Which medications are capable of central nervous system depression, hypnosis, deep coma, respiratory depression, and prescribed infrequently?
barbiturate's
The nursing student is reviewing information learned in anatomy and physiology class about the nervous system. The student recalls that the nervous system has how many divisions?
2
A client is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa. Why is this course of treatment most effective?
Levodopa restores dopamine, and carbidopa decreases peripheral breakdown of levodopa.
The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage?
2mcg therapeutic range 4-12
The nurse in a long term care facility cares for several clients with Parkinson's disease or parkinsonism. Which client should the nurse refer to his or her provider for the possible use of adjunctive agents?
A client who has been taking carbidopa-levodopa for three years but with decreasing therapeutic effects
The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence?
A client with a history of tonic-clonic seizures who takes phenobarbital
The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client? (Select all that apply.)
Administer naloxone Notify the health care provider Prepare for endotracheal intubation
In which clients should the nurse review medical conditions prior to administering a carbidopa/levodopa (Sinemet), as its use is contraindicated in these clients? (Select all that apply.)
Narrow angle glaucoma Renal disease Hepatic disease Use of MAOI antidepressants
A client is most likely to experience respiratory adverse effects from which method of administration of a local anesthetic?
Nebulizer
A client who received ketamine is requiring prolonged respiratory support. The client most likely received what other classification of drug?
Neuromuscular junction blockers
The nurse is assessing a 13-year-old client who has symptoms of depression and recognizes that what class of antidepressant medication would not be a drug of choice for an adolescent?
TCAs
A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?
TD
The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?
TD
Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention?
Take the pills with meals to minimize stomach upset.
A client's dose of Sinemet has recently been increased due to an exacerbation of the client's parkinsonian symptoms. What assessment finding would suggest that the client is experiencing adverse effects?
The client is retaining urine and has required a urinary catheter
A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?
The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.
A client with a laceration that requires suturing will be administered lidocaine to prevent pain during the procedure. The client expresses anxiety to the nurse, stating, "I'm really worried the freezing will wear off while the doctor is doing the sutures." When providing education to the client, the nurse should include what content?
The coadministration of epinephrine to prolong anesthesia
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?
The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.
Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics?
less CNS depression
For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?
levodopa
The nurse is caring for a client who has been diagnosed with both Parkinson's disease and narrow-angle glaucoma. What medication should cause the nurse concern?
levodopa
The nurse at an urgent care clinical is reviewing local anesthetics. What drug should the nurse recognize as an amide?
lidocaine
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
liver toxicity
A female client begins tolcapone therapy, and her health care provider arranges for laboratory testing to be completed on a routine basis. The nurse expects which laboratory study to be ordered?
liver transaminase enzymes
The nurse is working in a dental clinic assisting the dentist with a tooth extraction. The dentist numbs the gum with lidocaine before removing the tooth. This type of anesthetic is:
local infiltration
A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response?
"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."
A client has called the ambulatory clinic reporting headache, a "droopy eyelid" and malaise after receiving Botox injections at a friend's home the previous evening. The client is distressed, stating, "I had no idea that the injections could cause any problems." What is the nurse's best response?
"Come to the clinic so you can be assessed. You're likely having adverse reactions to the Botox injections."
A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies?
"Drugs do not cure these disorders; they instead enhance quality of life."
When the client prescribed entacapone asks the nurse to describe exactly how this medication works, what response is most appropriate?
"Entacapone inhibits COMT so that dopamine is active for a longer time."
A client has been diagnosed with depression following several months of worsening mood and affect. The client's provider has prescribed fluoxetine 20 mg PO daily. What education should the nurse provide to the client?
"For most people, the side effects of this drug aren't particularly serious or common."
The nurse is caring for a 12-year-old child who has been hospitalized with depression, and the health care provider has elected to treat the child with a TCA. The nurse understands that what laboratory test will be routinely ordered by the provider?
Blood pressure, ECG, and plasma drug levels
A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.)
Blue cheese Pepperoni Chocolate
A 12-year-old client will undergo surgery with spinal anesthesia. The client expresses a severe fear of needles. Which nurse response is appropriate and therapeutic for this client?
"I understand that you are nervous, but I'll hold your hand and be right there with you."
A patient has been diagnosed with cervical dystonia. The nurse would expect which medication to be ordered for this patient?
Botulinum toxin type B
The nurse is educating a client diagnosed with Parkinson's disease about the dietary implications of prescribed treatment with levodopa/carbidopa. Which statement by the nurse demonstrated an understanding of the proper administration of this medication?
"It's important to take this medication on a full stomach so that it doesn't make you nauseous."
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client?
"It's safest if you avoid drinking alcohol while you're taking this drug."
A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?
"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."
A client comes to the emergency department. The client has a small wound that requires suturing. The nurse would anticipate which type of anesthesia?
local infiltration anesthesia
A patient has been prescribed methocarbamol for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which statement by the patient indicates that the patient has an understanding of at least one of the significant side effects of methocarbamol?
"My urine could be discolored while I take this drug."
Anticholinergic effects such as dry mouth, sedation, and urinary retention are common adverse events occurring with the use of which classes of antidepressants?
tricyclic antidepressants
Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin?
tricyclic antidepressants
During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following?
"This drug is a gamma-aminobutyric acid (GABA) agonist."
An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?
"This is the result of neurologic factors over which you have no direct control."
A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?
"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities."
The parents of a child receiving a central nervous system stimulant for treatment of attention deficit disorder asks the nurse why they are stopping the drug for a time. Which statement by the nurse would be most appropriate?
"We need to check and see if he still has symptoms that require drug therapy."
An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family?
Monitor the client before ambulating.
A nurse is reviewing a client's serum lithium level and determines that the level is therapeutic by which result?
0.8
Benzocaine is a topical anesthetic that is short acting and has a quick onset. The duration is 30 to 60 minutes. How long is the onset of action of this medication?
1 minute
Prior to administering morphine sulfate to a client in the postanesthesia recover unit (PACU), what information must the nurse obtain? (Select all that apply.)
Pulse Respirations Blood pressure
The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed acetaminophen-aspirin-caffeine combination for abortive therapy. Which statement made by the client establishes the need for further clarification?
"I can take my over-the-counter cold remedies in addition to this drug for cold symptoms."
A client sustained a severe laceration to the right thumb and index finger that will require local anesthetic to facilitate suturing. Which statement should prompt the nurse to provide further client health education?
"I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out."
A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease?
"It is characterized by abnormalities in movement and posture."
A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works?
"It produces vascular constriction of cranial blood vessels."
A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client?
"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults."
A client is prescribed transdermal selegiline. What health education should the nurse provide?
"Place the patch on dry skin on your torso that has no cuts or openings."
A family member asks if a relative, who is taking prochlorperazine for schizophrenia, can go on a beach vacation. What is one point of education that the nurse would make sure the client and family understand?
"Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn."
The nurse's home care teaching for a client who takes baclofen will include which instructions? (Select all that apply.)
"Rise carefully from a seated to a standing position." "This medication may cause you to have to urinate more frequently." "This medicine may give you a headache or make sleeping difficult."
A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response?
"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."
A male client is prescribed levodopa for his Parkinson's disease. The dosage has been modified on multiple occasions. The client asks the nurse how the prescriber decides on the optimal dose. What is the nurse's best response?
"The optimal dose is the lowest one that allows the client to function adequately."
A client with myasthenia gravis has been prescribed dantrolene for the treatment of muscle spasticity. What education should the nurse provide to the client?
"You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic."
A client has a forearm laceration following a workplace accident. The care provider has administered lidocaine to facilitate stitches. What should the nurse teach the client about the use of this medication?
"You'll feel fully numb in about 10 or 15 minutes."
The parents of a child on methylphenidate want to know why they need to withhold the medication during the summer months. What is the nurse's best response?
"withholding the med will decrease the growth suppression"
When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time?
1-2 minutes
The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?
1100
A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?
4 weeks
A woman who has given birth to a baby girl by cesarean delivery is experiencing abdominal pain. The client receive a bolus dose of morphine intravenously. The nurse would recommend that the mother refrain from breast-feeding the baby for how long?
4-6 hours
The nurse administers an oral dose of morphine to a client at 3:00 PM. The nurse would expect the drug to peak at which time?
4pm
When is Parkinson's disease usually diagnosed?
60 years of age
A 13-year-old child is prescribed atomoxetine to be administered at 07:00. When will this medication reach its peak plasma level?
8 to 9
What client is most likely to benefit from Botox (incobotulinumtoxin A) injections?
A 54 year-old client who suffers debilitating migraines two to three days per week
Which patient would likely have the highest risk for hepatotoxicity from dantrolene?
A 57-year-old female who is on hormone replacement therapy
The nurse is working in the postanesthesia care unit, and several patients are having surgery today. Which patient would be at greatest risk for complications after surgery?
A 72-year-old female who had general anesthesia for lung removal
A registered nurse who oversees the care in a large long-term care facility cares for several clients with Parkinson's disease. When reviewing the assessment findings from the practical nurses at the facility, what finding should the RN prioritize for follow-up?
A client who began taking a dopaminergic three days ago and who is uncharacteristically disoriented.
What accurately defines hypnosis?
A extreme state of sedation in which the person no longer senses or reacts to incoming stimuli
The client is to have a spinal anesthesia for surgery. While educating the client, which statement by the nurse is correct regarding the insertion of the needle?
A small gauge needle will be inserted into the subarachnoid space and medication will be administered into the cerebrospinal fluid.
A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone. Which explanation by the nurse is correct?
Abrupt reversal of opioid-induced respiratory depression may cause vomiting
An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results?
Advise the client to have his blood redrawn today to ensure that it is not at a toxic level.
A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?
Antipsychotics do not improve memory loss and may further impair cognitive functioning.
A client is receiving chemotherapy and has developed mouth ulcers, for which viscous lidocaine has been prescribed. What education should the nurse provide to the client before administration of this local anesthetic?
Avoid drinking liquids for one hour after gargling.
The circulating nurse knows that what is the most important nursing intervention during Stage II of general anesthesia?
Avoid unnecessary noise in the operating room.
The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?
BP
The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply.
BP temp LOC
A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize?
BP monitoring
When describing the action of ergot derivatives, the nurse would incorporate understanding of:
Blockage of alpha-adrenergic receptors
A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following?
CNS
A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital?
CNS depression
A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?
CNS depression
The nurse has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect?
CNS depression
The nurse has administered a dose of naloxone and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next?
Call the provider as another dose of opioid antagonist may be necessary.
A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents?
Carbidopa
When administering entacapone, the nurse understands that this drug affects which enzyme?
Catecholamine-O-methyl transferase
Which represent the nurse's responsibilities to a client in the PACU? (Select all that apply.)
Checking airway patency Positioning the client to prevent aspiration of secretions Reviewing the client's surgical and anesthesia records Checking the client's vital signs
The nurse educates the client who has just been given a prescription for ergotamine to call the health care provider if the client develops which symptoms? (Select all that apply.)
Chest pain Weakness Palpitations
Which factor affects the choice of general anesthesia medication used in a particular client? (Select all that apply.)
Client's general physical condition Area to be operated on Anticipated length of the surgery
A new resident who has Parkinson's disease has been admitted to long term care. The client's admission orders include "levodopa-carbidopa 100/25 mg PO daily." What is the nurse's best action when processing this prescription?
Contact the provider to question the frequency of administration
The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine?
Cyclobenzaprine produces an anticholinergic response
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?
DM
The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism?
Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus
Which information should be included in the teaching plan of a client who is taking a sedative for a diagnosis of insomnia? Select all that apply.
Do not drive or operate heavy machinery while taking the medication. Do not drink alcoholic beverages 2 hours before or within 8 hours after taking the drug.
The nurse receives a phone call from a male client who has become constipated while taking the opioid analgesic prescribed for his pain. The nurse instructs the client to do what to help relieve this problem? (Select all that apply.)
Drink 2 to 3 quarts of water per day Take a daily stool softener Try to establish a regular bowel routine
A client has a serum lithium level of 1.8 mEq/L. Which would the nurse assess? (Select all that apply.)
Electrocardiogram changes Slurred speech Polyuria
A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action?
Ensure all members of the care team are aware of the risk for hepatotoxicity
What is the most important nursing action when a client is admitted to the postanesthesia recovery unit (PACU)?
Ensure the client has adequate respirations.
The nurse is caring for a woman who received epidural anesthesia during the labor and delivery of her baby. The client is anxious to get up and take a shower. What is the nurse's best action in this situation?
Ensure the woman has return of normal feelings and movement in the lower extremities.
What is true regarding the difference between ester-type local anesthetics and amide-type local anesthetics?
Esters break down quickly; they have a lower risk of systemic toxicity than amides.
An older adult client experiencing recurrent tension headaches reports taking an over-the-counter (OTC) combination of acetaminophen, aspirin, and caffeine several times a week. The nurse should recognize that this combination medication may be contraindicated if the client has a history of what medical condition?
GI bleeding
The anesthesia care provider visits with the client prior to surgery. The choice of type of drugs to administer to the client during surgery are based on what factors? Select all that apply.
General physical condition of the client Area, organ, or system being operated on Anticipated length of the surgical procedure
A male client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that what action could help him?
He could talk with his health care provider and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.
The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize?
How would you describe your mood and energy level today?
Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do these drugs have? (Mark all that apply.)
Hypotension Weakness Dizziness
The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy?
I may always have to take this medication
What represents routes in which general anesthesia is most commonly achieved? (Select all that apply.)
IV inhalation
A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client?
Imbalanced nutrition: less than body requirements
The etiology of anxiety involves which physiologic process?
Increased activation of the autonomic nervous system
The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means?
Increasing levels of both serotonin and norepinephrine
The client is about to undergo surgery. The circulating nurse knows that methohexital is used for which purposes? Select all that apply.
Induction of anesthesia Supplement to other anesthetics Depress the central nervous system to produce hypnosis
The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include?
Informing the client and family that seizure control is not gained immediately
A client has been prescribed naproxen for relief from migraines. The nurse should recognize that the drug achieves a therapeutic effect through which means?
Inhibiting the synthesis of COX-1 and COX-2
When preparing a client for the application of a local anesthetic, what would be most important?
Inspecting the application area for intactness
The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects?
Inspection for muscle spasticity and range of motion assessment
Which would a nurse include when describing the action of dantrolene?
Interference with calcium release from the muscles
The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means?
It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops.
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?
MAOI
A client with a complex medical history has been diagnosed with Parkinson's disease and prescribed carbidopa-levodopa. What aspect of this client's health status should most prompt the nurse to monitor the client closely?
MI ten months ago
A 30-year-old client is to receive tetracaine via spinal anesthesia for an abdominal procedure. What should the nurse do to prevent side effects of this type of anesthesia?
Maintain the client in a supine position following the procedure.
A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.
Which is true regarding the anesthetic properties midazolam (Versed)? (Select all that apply.)
Midazolam can be used for induction of anesthesia. Midazolam can be used for conscious sedation prior minor procedures. Midazolam can be used to supplement nitrous oxide and oxygen for short surgical procedures.
A female client relates that she is taking diazepam for a muscle relaxant and modafinil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include:
Modafinil may decrease the effects of her contraceptive, and she may need to use other protection.
A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions?
Monitor the client closely for bleeding and review coagulation indices when available.
The nurse assists the health care provider during a diagnostic procedure as the health care provider administers by infiltration 2% chloroprocaine with preservatives to an adult client. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.
Monitor vital signs and report the development of tachycardia and hypertension to the health care provider. Assess the respiratory status, including lung sounds, and report any development of bronchospasms. Ask if the client feels any pain, pressure, or discomfort before or during the procedure.
A client with Parkinson's disease is experiencing fewer therapeutic benefits of carbidopa-levodopa in recent weeks so the provider has prescribed selegiline 5 mg PO b.i.d. In addition to assessing for therapeutic effects on the client's Parkinson's symptoms, the nurse should prioritize what assessment?
Monitoring BP
A postpartum nurse has just admitted a client from the labor and delivery area, where the client received epidural anesthesia. What action will best prepare the nurse to monitor for signs and symptoms of local anesthetic systemic toxicity (LAST)?
Note the timing and dose of the most recent administration of local anesthetic.
The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid filled blisters and purpuric areas all over the client's body. Which actions should the nurse take? Select all that apply.
Notify the primary care provider immediately. Assess vital signs. Document the skin assessment.
A client who has been receiving long-term levodopa therapy tells the nurse, "I was making good progress and then it was like the drug stopped working." The nurse interprets this as which of the following?
On-Off phenomenon
What are examples of barbiturate-type hypnotic and sedative drugs? (Select all that apply.)
Pentobarbital (Nembutal) Secobarbital (Seconal)
The nurse is to administer an opioid antagonist. The nurse knows that the valid reasons for administering this type of medication include what reasons? (Select all that apply.)
Postoperative acute respiratory depression Suspected or known acute opioid overdosage Adverse effects related to opioid administration
The nurse prepares to receive a client after a cesarian section who received isoflurane during general anesthesia. Based upon the drug's adverse effects, which measures would the nurse provide postoperatively? Select all that apply.
Provide warm blankets. Administer prescribed antiemetic. Assess for increased bleeding. Monitor oxygenation and vitals frequently.
The post-anesthetic recovery unit nurse is caring for a client whose balanced anesthesia included midazolam. The nurse should prioritize assessments for what health problems?
Respiratory depression and CNS suppression
What are nonpharmacological methods that can be used for tension headaches? Select all that apply.
Rest Deep breathing exercises Stress reduction strategies
A nurse is making a care plan for a client with Parkinson's disease and has started on an antiparkinson medication. Which nursing diagnosis would be appropriate for this client's care plan? (Select all that apply.)
Risk for Injury Imbalanced Nutrition: Less than Body Requirements Altered Bowel Movements: Constipation
Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?
SSRI
A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?
SSRIs prevent serotonin from being reabsorbed
A client diagnosed with multiple sclerosis-induced spasticity asks why deep tissue massages do not relieve the associated pain. What facts about spasticity should be the basis of the nurse's response?
Spasticity is caused by nerve damage in the brain and spinal cord, and it is a permanent condition.
A client diagnosed with Parkinson's disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death?
St. John's Wort
Which stages of anesthesia are correctly paired? (Select all that apply.)
Stage II - delirium Stage IV - respiratory paralysis Stage I - analgesia
The nurse knows that the client is completely pain-free and ready for the surgical procedure during which stage of surgery?
Stage III
What are sedatives and hypnotics used to treat? (Select all that apply.)
Status epilepticus Preoperative sedation Insomnia
Which adverse reactions may occur as a result of administering an opioid antagonist?
Sweating, tachycardia, and increased blood pressure
The following sensations are lost when local anesthetics are administered in increasing doses. Place the sensations in the proper sequence starting with the sensation lost first.
Temperature Touch Proprioception Skeletal muscle tone
The nurse reads that total intravenous anesthesia (TIVA) is indicated for a client to undergo a surgical repair of a meniscus. What is the most likely rationale for this intervention?
The client has previously experienced severe postoperative nausea and vomiting.
An adult client underwent diagnostic testing after experiencing an absence seizure for the first time. What aspect of this client's health history may result in impaired drug excretion?
The client has recently been diagnosed with diabetic nephropathy
A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication?
The importance of ensuring safety related to possible sedation
If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern?
The infant may experience withdrawal symptoms during the postnatal period.
Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?
The medications have fewer anticholinergic effects than alternatives.
A male patient is being discharged home from the hospital after having pneumonia. At home, the patient will be taking the same drugs he was taking before he was hospitalized. These drugs include an anti-anxiety medication and a medication for insomnia. During the home care nurse's initial visit, what should the nurse review with the patient?
The risks of injuries if mental and physical responses are slowed by drugs
When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)
Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.
A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms?
There is an imbalance between dopamine and acetylcholine.
A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment?
This will likely make you drowsy, so don't take it before doing anything that would require alertness."
A female client is diagnosed with Parkinson's disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose?
To improve motor performance and improve ability to participate in usual activities of daily living
The nurse anesthetist correctly identifies the following to be types of local anesthesia. (Select all that apply.)
Topical application Local infiltration Regional anesthesia
A health care provider has asked the nurse to educate a client with Parkinson disease regarding the client's medication regimen. Because the client is taking carbidopa-levodopa, the nurse will assess the client's existing medication regimen for:
Tricyclic antidepressants
A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of
activation of the woman's delta and C nociceptors.
When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing?
acute somatic pain
A client has received lidocaine 2% for a skin laceration repair. Before the repair begins, how would the nurse assess this client for adequate pain relief?
Wait 2 to 5 minutes and assess the area for pain and sensitivity to touch or pressure.
The nurse is preparing to administer oral chlorpromazine to a client. What action should the nurse include in administration?
administer the days last dose 1-2 hours before bedtime
A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction?
Wear appropriate clothing and sunscreen whenever he is in direct sunlight.
A client, newly diagnosed with a seizure disorder, asks the nurse why the client is receiving a specific drug. What would be the best answer by the nurse?
When prescribing an AED, the health care provider takes into account the type of seizure the client is having.
A male client is admitted to the emergency department via ambulance. He is attempting to pull out his IV line, exhibiting symptoms of agitation, and thrashing about. The physician orders a benzodiazepine-type sedative. What information is needed prior to administration of the drug?
Whether the client is experiencing drug intoxication or withdrawal
A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine?
With amantadine, excretion is primarily via the kidneys.
The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?
Within one to five minutes, an effect may be seen.
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
a 45 yr old man with angina pectoris
A client diagnosed with Parkinson's disease and hepatic disease is to begin tolcapone therapy. What intervention should be included in the client's plan of care?
a baseline liver function test
A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions?
a client receiving pregabalin who is not responsive to verbal stimuli
The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects?
a plan to address the child's loss of appetite
When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:
a return to normal RR, rhythm, and depth.
The psychiatric-mental health nurse is overseeing care of several clients who are being treated with selective serotonin reuptake inhibitors. Which client should the nurse monitor most closely for adverse effects?
a severly depressed 14 yr old who is recieving inpatient care
The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?
a woman 85 years of age
The nurse is aware that which medication will be used in the provision of local infiltrate anesthesia?
bupivacaine
Which medication used for local and regional anesthesia has the longest duration of action?
bupivacaine
A nurse is preparing to administer an antidepressant that affects the neurotransmission of norepinephrine, serotonin, and dopamine. Which drug would the nurse be most likely to administer?
bupropion
What drugs are examples of second-line opioid agonists/antagonists prescribed for the treatment of moderate-to-severe pain? Select all that apply.
butorphanol nalbuphine pentazocine
A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms?
cardiac arrhythmias
A high-school-age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?
cardiac monitoring
A patient admitted to a local health care facility for surgery is to be administered general anesthesia. What are the nurse's responsibilities when caring for a patient receiving general anesthesia?
checking the chart for any abnormal lab results
The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed?
chlorpromazine
Administration of which class of medications can decrease secretions of the upper respiratory tract?
cholinergic antagonists
A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.
clomipramine
A client comes to the health care provider's office. The client is to receive botulinum toxin. What, if assessed, would suggest to the nurse that the drug administration should be postponed?
infection at the intended site of administration
The nurse is caring for a patient who will receive an epidural block. In what surgeries would an epidural block be useful for pain control?
inguinal hernia repair
A client with spastic hypertonia resulting from cerebral palsy has not responded appreciably to oral baclofen. During the client's care conference, the nurse should anticipate a discussion about what possible treatment?
intrathecal baclofen infusion
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?
involuntary movements
When participating in care planning for a child who has been diagnosed with schizophrenia, the nurse should be aware of what fact?
it is not clear which drugs are safest and most effective in children with schizophrenia
The nurse provides drug teaching to a client who has Parkinson's disease and who has been prescribed amantadine. How should the nurse describe the action of this drug?
it stimulates the natural release of dopamine
A hospital client has been prescribed morphine for the treatment of post-surgical pain. The client tells the nurse, "I'm determined to push through my pain if I can, because there's no way I want to end up addicted to narcotics." What should the nurse teach the client?
it's highly unlikely that the client would become addicted to narcotics used for this purpose
Which anesthetic is associated with a bizarre state of unconsciousness in which the client appears to be awake and yet cannot feel pain?
ketamine
A nurse should review a client's medical conditions prior to administering a dantrolene as its use is contraindicated in clients with which issues? (Select all that apply.)
lactation hepatic disease
Which is the drug of choice in children who need to be treated with tetanus?
methocarbamol
A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure?
midazolam
What is the central nervous system stimulant of choice to treat narcolepsy?
modafinil
Which action would be a priority for a client receiving apomorphine?
monitoring cardiac status
A client has been receiving chlorpromazine as treatment for psychosis. Which assessment finding indicates to the nurse that the client is experiencing an extrapyramidal effect of the medication?
motor restlessness
A nurse in the postanesthetic recovery unit is performing an assessment of a client whose balanced anesthesia includes the use of vecuronium. The nurse should recognize an increased risk of recurarization due to the client's history of what medical condition?
myasthenia gravis
A nurse is reviewing a client's history for conditions that would contraindicate the use of anticholinergics for Parkinson's disease. Which would cause the nurse to be concerned?
myasthenia gravis
The nurse would monitor the client for what during recovery from etomidate?
myoclonic movements and vomiting
The emergence of psychotropic medications has given us the ability to target specific actions in the brain as treatment for mental illness. What psychotropic medication is an MAO inhibitor?
nardil
A nurse is assessing a client who is receiving an antipsychotic agent for possible anticholinergic effects. What would the nurse assess?
nasal congestion
A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by:
nerve damage in the brain and spinal cord, and it is a permanent condition.
Which would a nurse expect to assess as a potential adverse effect of dopaminergic therapy?
nervousness
A client is prescribed methsuximide. The nurse should expect to administer this drug by which route?
oral
A client is to receive naltrexone. The nurse would expect to administer this drug by which route?
oral
A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route?
oral
ethotoin
oral
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?
orthostatic hypotension
While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan?
orthostatic hypotension
Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?
oxygen
A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?
pain scale
After teaching a group of nursing students about seizures, the instructor determines that the teaching was successful when the group identifies seizures that do not impair consciousness but can involve the senses or motor ability as which type?
partial seizures
A nurse is caring for a patient with insomnia. For which type of patient should the nurse exercise caution when administering sedatives and hypnotics?
patients who are lactating
A nurse is assigned to care for a 40-year-old patient with a hepatic injury that has occurred due to the administration of tolcapone. Which interventions should the nurse perform when caring for this patient?
perform regular blood tests of the patient
The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?
phenelzine
After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype?
phenobarbital
A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse be most likely to administer?
phenytoin
Which anticonvulsants exert their effect by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain? (Select all that apply.)
phenytoin ethotoin
A male client is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The health care provider advises the nurse to pay attention to the clinical management of the client's pain to allow proper agonist coverage during the change in drug dosage. Why is the client likely to suffer unnecessary pain and discomfort if proper management is not ensured?
physical dependence on the drug
The nurse is participating in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication?
potential for abuse
The nurse is reviewing the medical record of a client with partial seizures who is prescribed drug therapy. The nurse would question the order for what if the nurse finds that the client has a history of alcohol abuse?
pregabalin
Which medications can be administered for a client experiencing migraine-triggered nausea and vomiting? Select all that apply.
prochlorperazine chlorpromazine metoclopramide
What beta-adrenergic antagonist is used for migraine prophylaxis?
propanolol
A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses?
risk for falls
A nurse is planning the care of a client who has been diagnosed with schizophrenia and who will begin treatment with a typical antipsychotic. The nurse should identify what nursing diagnosis?
risk for injury r/t cns depression
The nurse is participating in the care of a client in status epilepticus who is receiving phenobarbital IV. Which nursing diagnosis should the nurse prioritize during this client's current care?
risk for injury r/t seizure activity
A client is scheduled for the surgical removal of a spinal tumor. During the induction phase of anesthesia, what event will occur?
securing a patent airway
cns contraindicated
severe hypertension
Which assessment finding would support a client's report of migraine headaches?
severe unilateral pulsating pain
The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action?
since she is taking oral contraceptives, she will need to use an additional form of birth control.
Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine?
the route of administration
A nurse is preparing a presentation about the use of antidepressants in children and adolescents. What would the nurse need to keep in mind?
the smallest amount of drug that is feasible should be dispensed
A client has been diagnosed with Parkinson's disease and the nurse is providing health education. The client asks the nurse, "Why can't I take a dopamine pill if that's what is lacking?" When responding, the nurse should address what topic?
the structure and function of the blood-brain barrier
A nurse is providing care for a patient who suffered extensive burns to the extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all the burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that:
there is a risk of systemic absorption of the lidocaine through the patient's traumatized skin.
An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:
there is risk of an extremely high dose available all at once if the tablet is crushed.
The use of what would a nurse identify as placing a client receiving lithium therapy at increased risk for toxicity?
thiazide diuretic
When epinephrine is mixed with a local injectable anesthetic, it is done for what purpose?
to cause vasoconstriction
An older adult client was successfully treated for shingles but continues to experience pain to his trunk and torso. The nurse should advocate for what form of local anesthetic to relieve this client's pain?
topical lidocaine
While reviewing a medication history, the nurse sees that a school-age client has been prescribed haloperidol. Based on this information, the nurse suspects that the client may have been diagnosed with what disease process?
tourettes
A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism?
vadoconstriction of blood vessels
After teaching a group of students about anticonvulsant therapy, the instructor determines that the teaching was successful when the group identifies which drug as eliciting its effects by increasing levels of gamma-aminobutyric acid (GABA), which stabilizes cell membranes?
valproic acid
Which drug would the nurse expect to be ordered as the drug of choice for the treatment for myoclonic seizures?
valproic acid
A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?
venlafaxine
Which would a nurse expect to assess in a client who has had general anesthesia using methohexital?
vomiting
The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital?
will take meds as prescribed
A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?
yogurt
A client has been prescribed a benzodiazepine daily for treatment of an anxiety disorder. In order to minimize the chances of withdrawal symptoms, the nurse knows to include what precaution in client teaching?
tapering the dose of drug over a prolonged period of time
What goal should the nurse identify for a client prescribed chlordiazepoxide?
the client will not appear restless or confused
What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?
they may cause dangerous interactions with some foods and drugs
A nurse is planning teaching with a client who has had an anti-anxiety medication prescribed. A priority action for would be to:
try to identify and avoid factors that cause nervousness or insomnia.
What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide?
when did you have your last drink of alcohol?
A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?
dangerous drug interactions
After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?
selective serotonin reuptake inhibitors
A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?
serotonin
The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal?
severe insomia for the past several nights
A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?
A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug
A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse?
client is diagnosed with hep c
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?
salami
A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
The nurse is preparing to administer prescribed diazepam intravenously to a client. How soon after administration does the nurse expect to observe onset of action?
1-5 minutes
A client is receiving ramelteon for insomnia. The nurse would instruct the client to take the drug at which time?
1/2 hour before going to bed
How long does a patient need to wait after stopping a phenelzine before starting paroxetine?
14 days
A client asks, "How long before sleep should I take ramelteon?" Which time frame will the nurse give this client as part of client teaching?
45 minutes
Zolpidem is prescribed for a hospitalized 58-year-old client having difficulty falling asleep at night. What is the best time for the nurse to administer this medication?
9pm
How should the nurse explain the major difference between normal and abnormal anxiety?
Abnormal anxiety is prolonged and impairs normal function.
A nurse should not give a benzodiazepine to a client with which medical conditions because their use in those clients is contraindicated? (Select all that apply.)
Acute narrow-angle glaucoma Psychoses Pregnancy
The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?
Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans
A nurse is caring for a patient who has just been transported to the operating room. Twenty minutes prior to leaving for the operating room, this patient was medicated with topical promethazine. What is the rationale for giving promethazine prior to surgery?
Anxiety, nausea, and vomiting
The nurse is assessing a breastfed infant at a well-child visit and determines the child is lethargic and losing weight. Which assessment question should the nurse prioritize? Select all that apply.
Are you currently taking any medications?
The nurse obtains the following vital signs on a client: BP 160/85, P 90, RR 24. The client is recently divorced and reports taking alprazolam for the past seven weeks but stopped the medication yesterday. What is the nurse's first action?
Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors.
The nurse is doing a physical assessment on admission of a client diagnosed with elevated blood pressure due to anxiety. What are the most important physical assessments for a nurse to perform? Select all that apply.
Blood pressure Respiratory rate Skin temperature and color
When describing the action of benzodiazepines as anxiolytics, what would the nurse need to keep in mind?
Enhanced action of gamma-aminobutyric acid
What are examples of nonbenzodiazepine-type hypnotic and sedative drugs? (Select all that apply.)
Eszopiclone (Lunesta) Zolpidem (Ambien) Zaleplon (Sonata)
The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response?
Monitor for increased signs of confusion or forgetfulness.
A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.
A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:
a dose adjustment should be made if these symptoms persist
What might occur if a client inadvertently receives a benzodiazepine intra-arterially?
arteriospasm
Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety?
buspirone
A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?
client has dysphagia
In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?
decreased cardiac workload
The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching?
dependence
The nurse is providing health education to a client who has been prescribed a barbiturate. The nurse should describe what mechanism of action?
depression of the cerebral cortex
A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug?
difficulty falling asleep at night
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?
extreme sadness
A nurse is preparing to administer an anxiolytic to a client. What would be most appropriate for the nurse to do before administering the drug?
have the client void
The nurse is reviewing a client's current drug regimen and notes that the client takes 30 mg flurazepam daily. The nurse should suspect what health problem?
insomnia
A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?
it may take up to two more weeks before the client feels better
A nurse is caring for a patient whose physician has ordered a benzodiazepine sedative-hypnotic. The nurse knows that most of these drugs are used with caution in patients with which disorders?
liver disease
A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?
lower dose of the antidepressant
An adult client with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an in-client basis. When administering chlordiazepoxide, the nurse should implement which client-focused intervention?
monitoring VS closely
A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:
nausea
One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication?
paradoxical excitement
A nurse knows that when elderly clients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction?
paradoxical reaction
The nurse is caring for a client who has been prescribed suvorexant (Belsomra). The nurse should teach the client to:
plan to stay in bed for seven hours after taking the drug
A patient admitted to the health care facility for insomnia related to stress is prescribed a sedative. What intervention should the nurse perform to promote the effects of the sedative?
provide back rubs
A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?
question prescriber about the dose
A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving Halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?
risk for injury
