Pharmacology Chapters 56, 57, 58
The nursing student learned in pharmacology class that drugs that affect the CNS do which of the following? (Check all that apply.) Alter mood Decrease K+ Alter sensation Alter the interpretation of information in the brain Lower glucose levels
Alter mood Alter sensation Alter the interpretation of information in the brain Explanation: Drugs that affect the CNS alter mood, sensation, and the interpretation of the information in the brain. They do not have any effect on blood glucose or blood K+.
A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding:
drug use. Explanation: Substance dependence denotes a maladaptive pattern of use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the resulting negative effects.
A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of
marijuana. Explanation: The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.
A client receiving outpatient therapy with antipsychotic therapy experiences dizziness from time to time. Which suggestion by the nurse would be appropriate?
"Get up slowly from the bed or chair." Explanation: If dizziness occurs when changing positions, the nurse should encourage the client to rise slowly when getting out of the bed or a chair. Frequent sips of water help alleviate dry mouth. Taking the drug with meals would have no effect on the client's dizziness. Limiting salt intake would have no effect on the client's dizziness.
A nurse is instructing a client who's to receive disulfiram (Antabuse). Which statement by the client demonstrates that the teaching was effective?
"I can use any antacids." Explanation: Antacids don't interact with disulfiram. The client should avoid anything containing alcohol, including aftershave lotion and some cough medicines and mouthwashes.
The high school nurse is explaining the dangers of substance abuse to the incoming freshman class. How would the nurse explain psychological dependence to the students?
"It involves feelings of satisfaction and pleasure from taking the drug." Explanation: Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug-abuse patterns, and return to drug-taking behavior after periods of abstinence. Physiologic adaptation to chronic use of a drug is physical dependence. Withdrawal results in unpleasant symptoms that occur when a physically dependent person stops taking a drug. Tolerance causes a decrease in the effects of a drug in a drug-dependent person, requiring increased doses to achieve the desired psychological effects or to avoid withdrawal.
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
Clozapine Explanation: Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.
The nurse is taking a history from a patient who states that she smokes marijuana daily. The patient says, "It mellows me out and helps me to cope with the stresses of life. I go sometimes without it and it doesn't bother me." What does the nurse determine is this patient's issue with the substance?
The patient has developed a psychological dependence for marijuana. Explanation: Psychological dependence, thought by some experts to be the most important factor in addiction, involves the compulsive use of and craving for a drug. It results from the direct influence of drugs on the brain chemistry. The drug causes an altered state of consciousness and distorted perceptions that are pleasurable and satisfying to the user. Patients with a psychological addiction are motivated by the feelings the drug provides, rather than the body's need of the drug.
Which test should be scheduled every week for a patient taking clozapine?
WBC count Explanation: Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.
What client is being treated with a typical antipsychotic?
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
A client has recently been placed on modafinil 200 mg PO once daily. Modafinil (Provigil) is first-line pharmacologic therapy for:
narcolepsy. Explanation: Modafinil is first-line pharmacologic therapy for narcolepsy, because it has high effectiveness and is easily tolerated. It also has fewer side effects than an amphetamine or amphetamine-like medications.
The nurse is providing care for a client physically dependent on an opioid. How is physical dependence best characterized?
physiologic adaptation that results in unpleasant symptoms when the drug is stopped Explanation: Physical dependence involves physiologic adaptation to chronic use of a drug so that unpleasant symptoms occur when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Attempts to avoid withdrawal symptoms reinforce psychological dependence and promote continuing drug use and relapses to drug-taking behavior. Tolerance is often an element of drug dependence in which increasing doses are required.
The client has been prescribed methylphenidate. The medication methylphenidate transdermal system should be removed after how many hours?
9 Explanation: Methylphenidate transdermal system is a patch placed on the hip and worn for up to 9 hours.
The client taking a CNS stimulant reports insomnia. The best option for the nurse in this case is to do which?
Administer the drug earlier in the day. Explanation: When CNS stimulants cause insomnia, the nurse should administer the drug early in the day to diminish sleep disturbances. The client should be provided with distracting activities and encouraged not to nap during the day.
The nurse is preparing to teach a client about the CNS stimulant which has been prescribed. When warning the client about potential sleeping difficulties, which steps will the nurse recommend to avoid these issues? Select all that apply. Administer the drug early in the day. Take frequent naps throughout the day. Avoid caffeine products. Stop taking the medication. Be active during the day.
Administer the drug early in the day. Avoid caffeine products. Be active during the day. Explanation: The nurse can instruct the client to administer the drug early in the day, avoid caffeine and other CNS stimulants, be active during the day, and not nap during the day to aid in sleep alteration caused by the use of a CNS stimulant.
A nurse is instructing a mother about a new drug her son was prescribed for ADHD. The nurse should include which instructions?
Always take the drug in the morning 30 to 45 minutes before breakfast and lunch. Explanation: Medications for ADHD should be given in the morning 30 to 45 minutes before breakfast and lunch. They should not be given in the late afternoon.
A patient that has been diagnosed with narcolepsy is prescribed drug therapy to help control the "sleep periods". What medications does the nurse anticipate will be prescribed for this patient?
Amphetamines Explanation: Amphetamines are anorexiants used medically in short term use for treating obesity, narcolepsy and attention deficit hyperactivity disorder.
The nurse is explaining diet restrictions to a client receiving dexmethylphenidate. Which drinks should the nurse encourage the client to avoid? Select all that apply. Coffee Black tea Cola drinks Milk Fruit juice
Coffee Black tea Cola drinks Explanation: CNS stimulants include tea, coffee, and cola drinks. Fruit juices and milk are caffeine free.
Charlie, a homeless heroin addict, has been admitted into care and needs immediate intervention. A visiting health care provider has begun Charlie on methadone maintenance. What fact should the nurse consider during this client's treatment for substance use?
Using methadone maintenance may lead to a dependence on methadone. Explanation: Methadone is an opioid with a dependence-producing liability. Although oral methadone dosing suppresses opioid withdrawal symptoms and the drug has a long duration of action, there is a risk of the client developing a dependence on methadone.
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 nervousness." Explanation: Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.
While the school nurse is providing health education to a group of children on the dangers of illicit drug use, a child asks the nurse what sniffing gasoline or glue does to the body. What response is most effective in addressing this question?
"Doing that damages the brain and other body organs." Explanation: Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Comparatively, damage to the nose is less significant. Damage is dose dependent, but it would be most appropriate to address possible areas of harm. While exploring the reasons behind the activity is appropriate, it does not address the question.
A client admitted with a diagnosis of substance abuse disorder asks the nurse, "When will I be released?" What is the nurse's best response?
"It will depend on the type and duration of treatment you require." Explanation: In general, treatment depends on the type, extent, and duration of drug-taking behavior and the particular situation for which treatment is needed. Long-term treatment of cocaine abuse, for instance, usually involves psychotherapy, behavioral therapy, and 12-step programs. In addition, many clients also abuse other drugs and need treatment for coexisting psychiatric disorders. Suggesting that discharge can take place after a fixed period (e.g., 72 hours) is inappropriate. Although treatment may involve medication and (possibly) community-based programs after discharge, the nurse should not suggest that treatment will be limited to any specific program.
The family of a client withdrawing from heroin asks a nurse why the client is receiving naltrexone (ReVia). Which response is correct?
"It's used to help reverse withdrawal symptoms." Explanation: Naltrexone is an opioid antagonist and helps reverse the symptoms of opioid withdrawal. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug isn't used in place of detoxification with methadone and doesn't decrease the client's memory of the withdrawal experience.
A client who has been taking oral aripiprazole for treatment of bipolar disorder asks, "I have started buying so many things online lately. Will this medication help me control that?" Which response will the nurse make to the client?
"This medication can cause uncontrollable urges to spend money or to shop." Explanation: Aripiprazole is the first of a new class of drugs called dopamine system stabilizers. In its oral form, the drug is used to treat bipolar disorder and has a variety of adverse effects. The U.S. Food and Drug Administration has confirmed that the medication can cause compulsive or uncontrollable urges to perform a variety of acts,including to shop or to spend money. The medication could be causing the client to exhibit this behavior. Compulsive spending could be associated with bipolar disorder, but if this behavior is new, the role of the medication should be considered. A support group might be available, but the client needs to know that the behavior is a potential effect of the medication.
A client has been admitted to the emergency department with a suspected opioid overdose and has been prescribed naloxone 1 mg IV STAT. The medication is available in a 10 mL vial at a concentration of 4 mg/10 mL. How many mL should the nurse draw up?
2.5 Explanation: The concentration of naloxone in the vial is 0.4mg/mL (4 mg divided by 10 mL). To obtain the required quantity, divide the dose desired by the dose available: 1 mg divided by 0.4 mg/mL = 2.5 mL.
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." Explanation: Periodically, the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which would indicate the need for continued treatment.
A client with a substance use disorder has been prescribed haloperidol 3.5 mg IM. The nurse obtains a vial of haloperidol 5 mg/mL. The nurse should draw up what quantity of the medication?
0.7 Explanation: To calculate the quantity of medication, divide the dose desired by the dose available: 3.5 mg divided by 5 mg/mL = 0.7 mL.
A child who is in first grade has been diagnosed with ADHD and has been initially prescribed atomoxetine 0.5 mg/kg PO. The child weighs 44 lb, so the nurse should prepare what dose?
10 Explanation: The child's weight must first be converted to kg: 44 lbs divided by 2.2 = 20 kg. The desired dose is 0.5 mg/kg, and 0.5 mg/kg X 20 kg = 10 mg.
The nurse at a community clinic administers methadone to clients in recovery from opioid addictions. A client is prescribed methadone 40 mg PO daily and the medication is available in an oral solution at 10 mg/5 mL. What quantity of methadone should the nurse administer?
20 Explanation: To obtain the correct quantity of methadone to administer, the nurse should divide the dose desired by the dose available. The dose available of 10 mg/5mL reduces to 2mg/mL. The dose desired is 40 mg, which divided by 2 mg/mL = 20 mL.
A 14 year-client with symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The client weighs 154 lbs. How many mg of pimozide should the client be administered?
3.5 Explanation: The client's weight in kg is 70 kg (154 ÷ 2.2). The prescription is for 0.05 mg/kg, and 0.05 X 70 = 3.5 mg.
A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame?
30 minutes Explanation: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes due to the potential for orthostatic hypotension and to prevent potential injuries related to a fall.
A client with a long history of alcohol abuse has been prescribed naltrexone 50 mg PO daily. What education should the nurse provide to this client? Select all that apply. Adhere closely to the recommended schedule of liver function testing. Concurrent use with alcohol will cause vomiting and seizures. Expect partial relief from cravings for alcohol. Take a PRN dose as prescribed if alcohol is consumed. Alcohol intake will not cause euphoria or change in level of consciousness.
Adhere closely to the recommended schedule of liver function testing. Expect partial relief from cravings for alcohol. Explanation: Naltrexone is used to reduce the cravings associated with alcohol abuse. It is hepatotoxic and liver function testing is a high priority. It does not mitigate the effects of alcohol intake nor does it cause disulfiram-type reaction. It is administered on daily PO dose or long-acting IM injection; it is not taken PRN.
A client taking a CNS stimulant may experience altered sleep patterns. What can the nurse instruct the client to do to help with altered sleep patterns? Select all that apply: Avoid other caffeine. Take frequent naps throughout the day. Be active during the day. Administer the drug early in the day. Stop taking the medication.
Avoid other caffeine. Be active during the day. Administer the drug early in the day. Explanation: The nurse can instruct the client to administer the drug early in the day, avoid caffeine and other CNS stimulants, be active during the day, and not nap during the day to aid in sleep alteration caused by the use of a CNS stimulant.
The nurse is participating in a health fair that is focusing on the use of illicit drugs in the community. Which recommendation should the nurse make if a person is suspected of having overdosed on an illicit opioid substance?
Call for a first responder for care. Explanation: Accidental deaths from synthetic opioids are on the rise and steps to deal with this crisis include making reversal agents readily available to first responders and the public. Should someone appear to have overdosed on an opioid substance, first responders should be notified. Giving the person water to drink will not help reverse the effects of the opioid. Transporting the person to an emergency department could take time that could have been more wisely used if first responders were contacted. There is no evidence that cardiopulmonary resuscitation is needed, and this intervention will not reverse the effects of the opioid.
A 7-year-old child is admitted to the emergency department with a diagnosis of an acute psychotic episode. Aripiprazole has been prescribed. Before administering the medication, what is the nurse's first priority?
Confirm the order with the prescriber. Explanation: Of the antipsychotics, chlorpromazine, haloperidol, pimozide, prochlorperazine, risperidone, thioridazine, and trifluoperazine are the only ones with established pediatric regimens. Aripiprazole has dosages for children 13 to 17 years of age but would not be appropriate for a 7-year-old child. Weighing the client and obtaining baseline vital signs are necessary assessment data but are not the first priority. Clarifying the order is a priority over IV access.
A client has been prescribed benzphetamine. The nurse would question administering this drug if which is noted in the client medical record?
Currently takes an antidepressant Explanation: The nurse should ensure that benzphetamine, or any other anorexiant, is not taken concurrently with antidepressant medications. The nurse should avoid or decrease the use of coffee, tea, and carbonated beverages containing caffeine. The drug should be taken early in the day, not around dinner time, to avoid insomnia.
In clients with acute psychosis, the treatment goal during the first week of treatment includes:
Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. Explanation: Overall, the goal of treatment is to relieve symptoms with minimal or tolerable adverse drug effects. In clients with acute psychosis, the goal during the first week of treatment is to decrease symptoms (e.g., aggression, agitation, combativeness, hostility) and normalize patterns of sleeping and eating. The next goals may be increased ability for self-care and increased socialization. Therapeutic effects usually occur gradually, over 1 to 2 months. Long-term goals include increasing the client's ability to cope with the environment, promoting optimal functioning in self-care and activities of daily living, and preventing acute episodes
Nurses can help prevent drug abuse by all of the following EXCEPT:
Demanding drug testing for all clients. Explanation: Because substance abuse often starts during childhood and adolescence, health professionals, parents, teachers, and others need to teach children about risks of drug abuse and strategies to resist peer pressure to use drugs of abuse; limit access to drugs of abuse; and support programs and activities designed to decrease drug abuse in this population. Nurses can help prevent drug abuse by administering drugs appropriately, using nondrug measures when possible, teaching clients about drugs prescribed for them, and participating in drug education programs.
The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?
Disorganized and often bizarre thinking Explanation: Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.
Which of the following medications are used as an alcohol deterrent?
Disulfiram (Antabuse) Explanation: Disulfiram (Antabuse) is a drug given to people recovering from alcoholism who cannot control the compulsion to drink. Ativan, Narcan, and Dolophine are not used as alcohol deterrents.
Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine?
Dopamine Explanation: Dopamine is the neurotransmitter that is most likely responsible for the rewarding and reinforcing effects of cocaine. Serotonin, epinephrine, and acetylcholine are not responsible for the rewarding and reinforcing effect of cocaine.
A client has lived with alcohol addiction for many years, and has relapsed after each attempt to stop drinking. The client has now been prescribed disulfiram. What education should the nurse provide to the client?
Drinking even small amounts of alcohol will cause illness. Explanation: The combination of disulfiram with alcohol may result in headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. The medication does not directly eliminate cravings and it must not be taken within 12 hours of drinking alcohol.
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?
Drinking frequent sips of water Explanation: Dry mouth and nasal congestion are generalized system reactions of aripiprazole. To relieve dry mouth, take frequent sips of water, suck on hard candy, or chew gum. Consuming more food will not address the dry mouth issue. The client is not feeling nervousness or restlessness. Calling the prescriber for an anticholinergic medication will exacerbate the dry mouth and nasal congestion issues.
After conducting an in-service presentation about CNS stimulants, the presenter determines that the teaching was successful when the group correctly chooses which disorders as a contraindication to their use? Select all that apply. Epilepsy COPD Glaucoma Diabetes GERD
Epilepsy COPD Glaucoma Explanation: The use of CNS stimulants is contraindicated in clients with known hypersensitivity, glaucoma, convulsive disorders, ventilation disorders, cardiac problems, severe hypertension, hyperthyroidism, or pregnant. CNS stimulants are a pregnancy category X medication. Diabetes and GERD are not contraindications for CNS stimulants.
A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?
Extrapyramidal Explanation: Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Sedation, anticholinergic effects, and hypotension can occur, but the risk for these is much less when compared with the risk for extrapyramidal effects.
A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects?
Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug.
Which antipsychotic would the nurse identify as a highly potent agent?
Fluphenazine Explanation: Fluphenazine is considered a highly potent antipsychotic. Chlorpromazine, thioridazine, and prochlorperazine are considered low-potency antipsychotics.
Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents?
How long has your son been exhibiting symptoms? Explanation: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.
A client treated with an antipsychotic medication might demonstrate which of the following behaviors if the antipsychotic medication was stopped? Select all that apply: Hallucinations Anhedonia Delusions Dystonia Flatten affect
Hallucinations Anhedonia Delusions Flatten affect Explanation: Antipsychotic medications help control symptoms associated with psychotic disorders such as hallucinations, delusions, disorganized speech, behavior disturbances, social withdrawal, flatten affect, and anhedonia.
The nurse works at a hospital-based methadone clinic. When interviewing heroin users, what is the most accurate assessment that the nurse can make concerning the client's heroin use?
Heroin addicts may overstate the amount used in attempts to obtain higher doses of methadone. Explanation: Heroin addicts may overstate the amount used in attempts to obtain higher doses of methadone.
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?
Improving Explanation: CNS stimulants improve behavior and attention in clients with ADHD.
A patient arrives at the emergency department accompanied by a friend. The friend states that the patient was found stumbling and vomiting, with slurred speech. The nurse observes sores around the patient's mouth and a chemical odor of the breath. What does the nurse suspect the patient has been using?
Inhalants Explanation: The nurse should suspect inhalant abuse when observing paint or stains on the body or clothing, spots or sores around the mouth, red or runny eyes and nose, chemical odor on the breath, a drunken or dazed appearance, loss of appetite, excitability, and irritability.
The nurse is assisting a patient who is having conscious sedation. The anesthetist is using a medication that is producing some hallucinogenic effects in the patient. What drug does the nurse determine the anesthetist is using for this patient?
Ketamine Explanation: Ketamine is an anesthetic used in animals, and is used frequently for conscious sedation in humans. It produces some emergent hallucinogenic effects that immobilize the user and detach him or her from reality. This is considered dissociative anesthesia.
A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia?
Lack of interest in normal activities Explanation: The negative symptoms of schizophrenia include flat or blunted emotions, lack of pleasure or interest in things (anhedonia), and limited speech. The positive symptoms of schizophrenia, and the most recognizable symptoms, include delusions (e.g., paranoia or distorted perceptions of other people's intentions) and hallucinations.
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
Lip smacking Explanation: Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.
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. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.
A client recently diagnosed with ADHD is to begin a prescribed medication. The nurse should be prepared to teach the client and caregivers about which medications? Select all that apply. Methylphenidate Phentermine Modafinil Doxapram Dextroamphetamine
Methylphenidate Dextroamphetamine Explanation: Methylphenidate and dextroamphetamine are CNS stimulants used in the treatment of ADHD. Phentermine is used to treat obesity. Modafinil is used to treat narcolepsy. Doxapram is used to treat respiratory depression.
A nurse is administering a CNS stimulant to a client with narcolepsy. The nurse understands that this drug does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Which drug is the nurse administering?
Modafinil Explanation: Modafinil is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Caffeine is a CNS stimulant and can cause increased heart rate. Doxapram is a respiratory stimulant that increases respiratory rate and tidal volume. Dexmethylphenidate is a CNS stimulant used to treat ADHD and narcolepsy; it is highly addictive and can be psychologically dependent.
Which drug would be indicated for the treatment of narcolepsy?
Modafinil Explanation: Modafinil would be indicated for the treatment of narcolepsy. Atomoxetine, dexmethylphenidate, and lisdexamfetamine are indicated for the treatment of attention deficit disorders.
An adolescent client has been prescribed dextroamphetamine for the treatment of ADHD. How can the nurse best prevent the risks associated with this medication?
Monitor the client closely for indications of medication abuse or dependence. Explanation: Dextroamphetamine carries serious risks of abuse and dependence, as communicated in the black box warnings. This medication is not hepatotoxic and does not normally require scheduled bloodwork. While the client should certainly avoid drinking any alcohol, the most serious risks of this medication are around the abuse potential.
Which of the following medication is a narcotic antagonist?
Naloxone (Narcan) Explanation: Narcan is a narcotic antagonist. Dolophine is a synthetic narcotic. Catapres is a alpha-adrenergic blocker. Oxycontin is a opiate drug.
A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?
Nausea Explanation: The effectiveness of Antabuse relies on a drug interaction between ethanol and disulfiram to produce unpleasant and undesirable symptoms as a deterrent to alcohol ingestion. Symptoms include facial flushing, throbbing headache, hyperventilation, tachycardia, palpitations, nausea and copious vomiting, hypotension, shortness of breath, vertigo, syncope, confusion, and profuse diaphoresis.
A nurse observing a client notices the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which of the following?
Neuroleptic malignant syndrome (NMS) Explanation: NMS is a rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance. TD is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome is characterized by Parkinson-like symptoms, akathisia, and dystonia. Agranulocytosis is a reduction in white blood cells that can occur with clozapine.
A client diagnosed with a substance use disorder asks the nurse why it is necessary to attend counseling in addition to taking the prescribed medication. What statement should inform the nurse's response?
Plans that combine methods of therapy are typically more successful. Explanation: Overall, treatment regimens that combine counseling and behavioral therapy with drug therapy are more successful than those using drug therapy alone. This does not mean, however, that psychological disorders always underlie addiction. While discussion with the health care provider is strongly suggested, it is not binding.
A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior?
Psychological dependence Explanation: The client is describing psychological dependence which involve feelings of satisfaction and pleasure from taking a drug. These feelings of dependence return the client to drug-taking behavior after periods of abstinence. Physical dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating a person continues to use a substance of abuse despite significant substance-related problems. Tolerance is the need for increasingly larger or more frequent doses of a substance to obtain the desired effects originally produced by a lower dose. Withdrawal is development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitant due to the cessation of or reduction in heavy and prolonged substance use.
A nurse is preparing a teaching plan for a client with schizophrenia who is prescribed olanzapine in a disintegrating tablet form. Which instruction should the nurse include in the teaching?
Remove the tablet with dry hands. Explanation: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in their mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee.
A 17-year-old male is brought to the emergency department after taking diazepam with alcohol. The ED nurse knows to monitor the patient for which of the following adverse reactions?
Respiratory depression Explanation: When taken with alcohol or other drugs, benzodiazepines (such as diazepam) can cause respiratory depression and death. On its own, benzodiazepine overdose can cause oversedation, memory impairment, poor motor coordination, and confusion.
After teaching a group of nursing students about central nervous stimulants, the instructor determines that the teaching was successful when the students correctly choose which as an effect of caffeine on the body? Select all that apply. Skeletal muscle relaxation Respiratory stimulation Central nervous system (CNS) stimulation Cardiac relaxation Diuresis
Respiratory stimulation Central nervous system (CNS) stimulation Diuresis Explanation: Caffeine exerts the following effects on the body: stimulates the CNS, cardiac system, and respiratory system and results in mild diuresis.
A patient has been administered an antipsychotic. Which reaction should be reported immediately?
Rigidity Explanation: The nurse should immediately report to the primary health care provider if the patient displays signs of rigidity. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.
The nurse is teaching a client and caregiver about the antipsychotic medication which has been prescribed. The nurse determines the teaching is successful when they correctly choose which reaction should be reported immediately to the health care provider?
Rigidity Explanation: The nurse should immediately report to the primary health care provider the following: rigidity, restlessness, inability to sit still, muscle spasms, mask-like expression, tremors, drooling, or involuntary rhythmic movements of the face, mouth, or extremities. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.
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 related to central nervous system depression Explanation: Typical antipsychotics cause significant sedation, which creates a risk for injury. These drugs are not severely hepatotoxic and are not linked to bowel incontinence. Thermoregulatory disruptions are similarly unlikely.
Which of the following is a clinical manifestation of alcohol withdrawal?
Seizures Explanation: A clinical manifestation of alcohol withdrawal include seizures. Tachycardia, hypertension, and diaphoresis are additional clinical manifestations.
The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?
Tardive dyskinesias Explanation: Consider warning patient or patient's guardians about the risk of development of tardive dyskinesias with continued use so they are prepared for that neurological change. Oral neuroleptic agents do not cause urge incontinence, orthostatic hypotension or bradycardia.
A client with chronic pain has trialed several different pain-control regimens, the most recent of which was oral oxycodone 10 days ago; the client has described adequate pain relief from the oxycodone. When performing a follow-up assessment, what finding most warrants the nurse's follow-up?
The client admits to enjoying the euphoria that follows a scheduled dose. Explanation: The client's admission of deriving satisfaction from the medication should caution the nurse about the possibility of psychological dependence. Many clients mistrust nonpharmacologic interventions, but this can often be addressed with client education and an evidence-based selection of interventions. Asking about alternative delivery modes is something the nurse should discuss with the client, but this is not necessarily a "red flag." An incremental increase in dose is common, and denotes drug tolerance, which is not necessarily pathological or a sign of looming addiction.
A client has been prescribed dextroamphetamine-amphetamine for the treatment of ADHD. What assessment finding would most clearly suggest that the client's dose is excessive?
The client reports feeling agitated and restless during the day. Explanation: Excessive central nervous system stimulants such as dextroamphetamine-amphetamine can cause hyperactivity, agitation, and restlessness, suggesting a change in drug or dose is necessary. This is usually accompanied by a decrease, not an increase, in appetite. Sleep disturbances would be more likely during the first half of the night, due to CNS stimulation from daytime doses. Stimulants do not normally cause mood depression.
A family expresses concern when a family member withdrawing from alcohol is given lorazepam (Ativan). What information should be given to the family about the medication?
The medication is given for a short time to help the client complete the withdrawal process Explanation: Lorazepam is a short-acting benzodiazepine that may be given for 1 week to help the client in alcohol withdrawal. However, there's some debate over its use due to a potential risk for cross-addiction. The medication isn't given to help forget the experience; it lessens the symptoms of withdrawal. It isn't used to treat coexisting cardiovascular problems or promote a sense of well-being.
The patient tells the nurse, "I have been having to take more and more of my pain medication to alleviate this pain in my back. It is not working as well as it was." What does the nurse understand is occurring with the medication?
The patient has developed a tolerance to the medication and requires more medication to get the same effect. Explanation: With drug use over time, tolerance develops. Tolerance occurs when the body develops a natural resistance to the drug's physical or euphoric effects, making it necessary to take increasing doses more frequently to achieve the desired effect.
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?
The patient will take medications as prescribed. Explanation: Goals that relate to care following discharge may include ensuring that the patient takes medications as prescribed and returns for all scheduled follow-up appointments with health care providers. Normalizing sleep and eating patterns and decreasing symptoms are short-term (e.g., within the first week of treatment) goals of patients who experience acute psychotic episodes.
The nurse is caring for a client for whom a psychological therapy has been ordered to assist with recovery from an addictive disorder. The nurse understands that what statement is true about psychological rehabilitation efforts?
They should be part of any treatment program for a drug-dependent person. Explanation: Psychological rehabilitation efforts should be part of any treatment program for a drug-dependent person.
The home health nurse is gathering a client's medication prior to going to see the physician. The nurse cannot find the bottle for the methylphenidate, Daytrana. What would be the reason for this?
This is a transdermal patch medication. Explanation: Daytrana is a transdermal patch, which delivers the medication slowly through the skin. Nurses do not normally misplace medications. Medications are kept in specific places with many safeguards in place for proper administration. Daytrana is not given IM or IV.
The nurse understands that the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. What is a secondary goal for their use?
To have clients use the drugs appropriately Explanation: The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately.
Which of the following refers to the reduction in a drug's effect that follows persistent use?
Tolerance Explanation: Tolerance refers to the reduction in a drug's effect that follows persistent use. Addiction is drug-seeking behaviors that interfere with work, relationship, and normal activities. Withdrawal refers to the physical symptoms and craving for a drug that occur then a person abruptly stops using an abused substance.
The mental health nurse is conducting an assessment interview with a new client. What should this initial assessment be directed toward? (Mark all that apply.) What substance was first used Type of substance being used Amount and frequency of use Method of administration Length of time between uses
Type of substance being used Amount and frequency of use Method of administration
What are common skin reactions that a nurse should warn a client about when they are initiated on antipsychotic therapy? (Select all that apply.) Toxic epidermal necrolysis Stevens-Johnson syndrome Hyperpigmentation Urticaria Photosensitivity
Urticaria Photosensitivity Explanation: Urticaria and photosensitivity are common skin reactions that a nurse should warn a client about when they are initiated on antipsychotic therapy.
A client who is obese is to start receiving amphetamine as part of the treatment. Which factor should the nurse prioritize in the preadministration assessment?
Weight Explanation: Before administering amphetamine as part of obesity treatment, the nurse should record the client's weight. There is no need to record the client's temperature or blood glucose level. Arterial blood gas results are reviewed when a CNS stimulant is prescribed for respiratory depression but not for obesity treatment.
A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically?
Weight and growth Explanation: The nurse should instruct the parents to monitor the weight and growth patterns of the child. Child's social interaction or sleeping pattern need not be recorded unless specified by the primary-care provider. Since the drugs administered for ADHD do not cause urinary retention, there is no need to monitor urinary patterns.
A child has been receiving a CNS stimulant for long-term treatment of attention-deficit hyperactivity disorder (ADHD). The nurse would be especially alert for which finding? Select all that apply. Weight loss Growth Respiratory depression Hyperglycemia Hypotension
Weight loss Growth Explanation: Children taking CNS stimulants for the long-term treatment of ADHD should be monitored closely for weight loss and growth patterns. CNS stimulants used for long-term treatment of ADHD have not shown adverse effects of hyperglycemia, hypotension, or respiratory depression.
For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months?
White blood cells Explanation: Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs
The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what client would the nurse expect to require a standard dosage?
White young adult client diagnosed with bipolar disorder Explanation: Only the White young adult has no indications for administering a smaller than usual dosage. Black and African American clients respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these clients should be started off at the lowest possible dose and monitored closely. Clients in Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in clients in the United States. Arab American clients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians. Additionally, because older adults may be more susceptible to adverse effects, doses are typically lower than in younger clients.
A 22-year-old client comes into the emergency department. He is highly active, and says his heart is pounding. On further questioning, he says he took several pills at a party. What type of medication does the nurse suspect he took at the party?
amphetamine Explanation: Amphetamines are sympathomimetic drugs that stimulate the central nervous system to speed up. This results in increased blood pressure, wakefulness, and increased pulse rate. Antidepressants are given for clients with depression or mood disorders. Anorexiants suppress the appetite. Analeptic drugs stimulate the respiratory center of the brain and CV system.
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?
blood pressure Explanation: Haloperidol can cause hypotension in clients who are volume depleted or receiving antihypertensive drugs. The client is unlikely to develop hyperthermia, diminished reflexes, or visual dysfunctions.
An older client with dementia-related psychosis has been receiving haloperidol for several days. Which body system will the nurse prioritize when assessing the client?
cardiovascular Explanation: Haloperidol is used to control the symptoms of psychotic disorders. However, this medication has a U.S. Food and Drug Administration Black Box Warning stating that older clients who have dementia-related psychosis are at increased risk of death from cardiovascular diseases. Because of this, the nurse should priortize the assessment on the cardiovascular system, even though the other systems should be included in the overall assessment.
The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment?
central nervous system (CNS) stimulants Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent hyperactivity, short attention span, and difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used; they do not affect CNS stimulation.
A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?
chlordiazepoxide Explanation: Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants. Varenicline and bupropion are used for smoking cessation. Cannabis is medical marijuana and not used for acute alcohol withdrawal.
A client with chronic pain was prescribed oxycodone several months ago and has developed a tolerance, requiring gradual increases in dose. As well, the client admits to experiencing psychological dependence and is showing signs and symptoms of physical dependence. The nurse should advocate for what approach?
close monitoring and gradual tapering down of the dose Explanation: Opioid-dependent clients should have their dose gradually reduced, under close supervision. Tolerance is a purely physiologic phenomenon and is not something that can be overcome with education (unlike psychological dependence or addiction). Abrupt discontinuation can result in pain, withdrawal, and physical distress. Naloxone is an emergency measure but does not address the client's underlying challenge.
A 28-year-old patient comes into the emergency department with chest pain. The client's blood pressure is 170/108, heart rate 116, and respiratory rate 32. The client states having "used drugs." The nurse would question the client about the use of:
cocaine. Explanation: The most commonly abused CNS stimulants include cocaine and methamphetamine. These CNS stimulants initially increase heart rate and blood pressure. Excess amounts can cause insomnia, hypertension, and cardiovascular problems.
An adult client has been diagnosed with ADHD and the care team is considering the use of methylphenidate. What aspect of the client's most recent diagnostic workup may preclude the safe use of this medication?
creatinine 6.0 mg/dL (530 µmol/L) Explanation: The client's elevated creatinine level may suggest compromised renal function, complicating the administration of methylphenidate. The increased WBC level may indicate an infectious process, but this does not necessarily rule out the use of this drug. The client's INR and sodium are within reference ranges.
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
electrocardiogram (ECG). Explanation: In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
The emergency room nurse is admitting a client brought in after exhibiting threatening and unpredictable behavior, suspected to be the result of a recent binge of methamphetamine use. In addition to ensuring the client's immediate safety and that of others, what is the nurse's priority action?
facilitating detoxification Explanation: All of the listed actions are relevant to the client's short-term and long-term well-being. However, the immediate priority is to assist with the process of detoxification, since this poses an immediate threat to the client's short-term physical and psychosocial status. Once detoxification has been safely achieved, the nurse can facilitate the other measures aimed at longer-term benefits.
A parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be appropriate for the nurse to use?
gluteus Explanation: When giving an antipsychotic parenterally, the drug should be given IM in a large muscle mass such as the gluteus muscle. The deltoid muscle is not a large muscle. The vastus lateralis and the ventrogluteal are not large muscles when a client is aggressive; the larger the muscle the better; thus gluteus is the best choice.
The client is admitted to the medical floor with a diagnosis of narcolepsy. The nurse can anticipate the health care provider to order which medication to treat this disorder?
modafinil Explanation: Modafinil is used to treat narcolepsy by binding to dopamine, thereby reducing the number of episodes. Benzphetamine and diethylpropion are anorexiants used to depress appetite. Doxapram is used to treat respiratory depression.
The nurse is conducting a follow-up assessment of a school-aged child whose ADHD has been treated with dextroamphetamine for several months. What assessment should the nurse prioritize?
height and weight Explanation: Dextroamphetamine can have a profound effect on growth and weight gain in children. As such, the nurse should prioritize this assessment. Respiratory status is rarely affected. The medication affects behavior but is unlikely to affect orientation. CNS stimulants can affect sleep quality if the timing is not planned thoughtfully, but the risks to growth are more common and more significant.
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 Explanation: Clozapine is contraindicated for use in a client with a history of seizure disorders. The medication is not contraindicated for any specific eating plan. Treatment for rheumatoid arthritis is not a contraindication for this medication. The type of employment is not identified as a contraindication for this medication.
The nurse is caring for an older client with dementia. For which reasons will the nurse question giving the client a prescribed antipsychotic medication? Select all that apply. increases the risk of mortality leads to greater cognitive decline enhances extrapyramidal adverse effects increases the risk of cerebrovascular accident, or stroke prevents neurotransmitters from interacting with the receptor sites
increases the risk of mortality leads to greater cognitive decline increases the risk of cerebrovascular accident, or stroke Explanation: All antipsychotics are identified in the Beers criteria as potentially inappropriate medications in clients 65 years and older with dementia. Antipsychotics should be avoided because they increase the risk of mortality, lead to greater cognitive decline, and increase the risk of cerebrovascular accident, or stroke. Antipsychotics do not enhance extrapyramidal adverse effects. The intended action of antipsychotic medications is prevention of the neurotransmitters dopamine and serotonin from attaching to receptor sites.
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Explanation: Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.
The nurse is assessing a client who takes benzodiazepines for the treatment of anxiety disorder. The client has presented nonresponsive and the client's partner reports he has recently taken oxycodone recreationally. The nurse should place the highest priority on what assessment?
respiratory function Explanation: The nurse would include each of these assessments because each would be affected by the client's medication use. However, the combination of benzodiazepines and opioids presents a profound threat to the client's respiratory function and oxygenation. For this reason, respiratory assessment would be the highest priority.
When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for?
sedation Explanation: The side effects of benzodiazepines are sedation, confusion, restlessness, bradycardia, tachycardia, urinary retention or incontinence, and drug dependence. The nurse should observe the client for excessive sedation and should use benzodiazepines cautiously in clients with impaired kidney or liver function. Insomnia, increased thirst, and anxiety are common side effects in drugs used in recovery from chemical dependence, but are not most commonly associated with benzodiazepines.
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 Explanation: Because methylphenidate is a central nervous system (CNS) stimulant, it carries the potential to disturb sleep patterns. The client's pupillary response, orientation, and sexual function are less likely to be affected.
A child was diagnosed with attention-deficit hyperactivity disorder (ADHD), and methylphenidate was prescribed for treatment to be taken once a day in a sustained-release form. On future visits, what is a priority nursing assessment for this child?
weight and height Explanation: The nurse needs to carefully track this child's weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." Explanation: Dopamine is a neurotransmitter in the sympathetic nervous system that deals with pleasure and reward in the brain. Dopamine is not an enzyme or a part of the brain. Dopamine is a medication, but it does not fight infection or help with pain.
The nurse is teaching the parents of a child diagnosed with attention-deficit hyperactivity disorder how to administer extended release methylphenidate. What should the nurse teach the parents?
"It's best to give it at breakfast every day." Explanation: Several long-acting formulations of methylphenidate have become available that allow the drug to be given only once a day. It should always be given in the morning because administration at dinnertime or bedtime could result in insomnia. The nurse should not defer to the school nurse.
The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly-diagnosed schizophrenia. The client's symptoms have improved only slightly, and the client's parents wonder if the client is "beyond hope." What is the nurse's best response?
"It's common for clients to have to try different drugs until the most effective one is identified." Explanation: A client who does not respond to one drug may react successfully to another agent. It is not common to have a client who does not demonstrate some improvement from medications so it would be incorrect to tell the parents that the child won't respond to any drug after trying only one medication. It is not common for a client to require "several" antipsychotics concurrently. Asking "Do you feel like you've given the medication enough time to work?" is inappropriate: if the question is rhetorical, it is condescending; if it is genuine, it is not something the parents can determine.
The nurse is talking with a patient who is in the hospital from complications related to alcoholism. The patient states, "My father and grandfather were alcoholics. Do you think this is why I am?" What is the best response by the nurse?
"Many studies say that certain genes can cause alcoholism." Explanation: Genetic factors also play an important role in drug dependence. Certain genes may predispose a person to, or protect the person from alcoholism. Several studies emphasize the effects of heredity and maintain that the disease of addiction is a consequence of genetic deficiencies in brain tissues or neurotransmitters.
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
"Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes." Explanation: Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.
A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client?
Benzodiazepines Explanation: Benzodiazepines are the drugs of choice for treating withdrawal from alcohol and other CNS depressants. Beta adrenergic antagonists or beta blockers lower the blood pressure. Antidepressants work for those with depression. Antibiotics are used for infections.
A client with obesity is to receive an anorexiants. Which preadministration assessments should the nurse prioritize? Select all that apply. Blood pressure Pulse Weight Respiratory rate Review of recent lab work
Blood pressure Pulse Weight Respiratory rate Explanation: The nurse's preadministration assessment of a client receiving a CNS stimulant for the treatment of obesity should include blood pressure, pulse, respiratory rate, and weight. A review of recent lab work would not be necessary.
As a school nurse, you are preparing to do a presentation on cannabis and the long-term sequelae of its heavy use. To what body system or function do you understand cannabis use can cause the most damage?
Brain Explanation: Cannabis use causes the greatest damage to the brain. This is because cannabinoid receptors are concentrated most heavily in the cerebellum, the part of the brain that controls motor coordination, and in the hippocampus, which governs learning and memory.
A 75-year-old male client is given an order for a CNS stimulant secondary to a new diagnosis of narcolepsy. He begins to experience signs and symptoms of excessive CNS stimulation. The nurse knows that the client is likely to also experience an exacerbation of which preexisting condition?
Cardiac arrhythmias Explanation: Older adults are likely to experience anxiety, confusion, insomnia, and nervousness from excessive CNS stimulation. In addition, older adults often have cardiovascular disorders (e.g., angina, arrhythmias, hypertension) that may be aggravated by the cardiac-stimulating effects of the drugs, including dietary caffeine. In general, reduced doses are safer in older adults.
Which of the following effects can be noticed in a patient who has been administered amphetamines?
Decreased appetite Explanation: Amphetamines have the ability to suppress appetites so the patient will show a decrease in appetite. Their drug action results in high blood pressure, not low blood pressure. The patient also experiences wakefulness, not drowsiness. Amphetamines produce a euphoric state, not depression.
A nurse is explaining to another nurse the difference between first-generation antipsychotics and second-generation antipsychotics. What is the biggest benefit of the second-generation antipsychotics?
Decreased extrapyramidal effects Explanation: Second-generation antipsychotics have decreased extrapyramidal side effects. The cost of second-generation antipsychotics depends on the exact medication. Second-generation antipsychotics work on both dopamine and serotonin receptors.
There are several reasons why drug therapy is of limited use in treating substance dependence. Which of the following statements accurately describes a potentially serious risk of such therapy?
Drug therapy could substitute one abused drug for another. Explanation: One of the main limitations in using drug therapy to treat dependence is the high risk of substituting one abused drug for another. A second limitation is that specific antidotes are available only for benzodiazepines and opioid narcotics.
The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication?
Dry mouth Explanation: Antipsychotics such as loxapine may cause adverse effects of dry mouth, drowsiness, akathisia, EPS, headache, and orthostatic hypotension. Antipsychotics are contraindicated in clients with severe hypertension. Bradycardia can be a sign of hypertensive crisis, which is an adverse effect of MAOIs. Skin dryness is a recognized adverse effect to clofazimine, a drug used to treat M. leprae.
A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?
It reduces the likelihood of drug dependence or diversion. Explanation: When a CNS stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed).
During his assessment, Drew reveals that he is a frequent user of crack and has been on a binge for several days. The nurse realizes that he requires frequent cardiac assessments. The reason for this increased assessment of the cardiac system is because of the major risk for what condition as a result of crack cocaine use?
Rupture of the aorta Explanation: While nasal mucosal atrophy, hepatotoxicity, and renal ischemia are common adverse effects of cocaine, a person using crack faces an additional, usually fatal risk of sudden death due to acute myocardial infarction or rupture of the aorta. Cocaine sensitizes cardiac cells and causes an increase in contractility. Corresponding high levels of epinephrine secondary to excitement from cocaine cause the individual to be particularly susceptible to cardiac arrest.
After teaching a group of nursing students about CNS stimulants, the instructor determines that the teaching was successful when the students correctly choose which factor as a contraindication?
Severe hypertension Explanation: CNS stimulants are contraindicated for clients with severe hypertension. CNS stimulants are not contraindicated in clients younger than 20 years or clients with Parkinson disease. Even though CNS stimulants are not contraindicated in clients with renal dysfunction, they need to be administered with extreme caution.
A client was prescribed oral hydromorphone two weeks ago for the treatment of cancer pain. The client was able to achieve pain relief with 2 mg doses for the first 10 days, but has recently needed 3-4 mg to achieve the same effect. The client has expressed concern to the nurse that he is becoming addicted to hydromorphone. What should the nurse teach the client?
The client is developing a tolerance, which is not the same as addiction. Explanation: Tolerance is characterized by needing larger doses of a medication to achieve the effect that lower doses produced in the past. The client has not described the feelings of satisfaction and euphoria that characterize psychological dependence. Even though the client is taking this medication for legitimate reasons, this does not mean that addiction is not possible. There are indeed interventions to address addiction, but this is not a necessary teaching point at this time because there are no obvious signs of addiction.
The nurse is providing ongoing care for an adolescent client whose ADHD is being treated with dextroamphetamine and amphetamine. What assessment finding should prompt the nurse to investigate the possibility of drug diversion?
The client's medication supply often runs out ahead of schedule. Explanation: Unexplained supply shortages should cue the nurse to the possibility that a drug is being diverted to unprescribed users for recreational purposes. Desired changes in the release time (extended vs immediate) are not normally associated with drug diversion, nor is the need for reminders to take the medication. A lack of insight is common among medications intended to change behavior, but this is not suggestive of drug diversion.
A client admits to smoking marijuana several times a day but denies being dependent on the drug. The nurse should base the discussion with the client on what characteristic of psychological dependence?
Using the drug creates the feeling of satisfaction and pleasure. Explanation: Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug abuse patterns, and return to drug-taking behavior after periods of abstinence. Physical dependence results in unpleasant symptoms when the drug is stopped. Laboratory findings congruent with frequent intoxication would be further evidence of physical dependence. Tolerance is the need to increase drug usage to obtain the desire effect. The other options are also related directly to physiologic dependency.
When would treatment with medication be considered for a child with attention deficit hyperactivity disorder (ADHD)? Select all that apply. Within 2 to 4 weeks of the onset of symptoms When symptoms are moderate to severe When symptoms interfere with social and academic functioning When symptoms interfere with behavioral functioning Before beginning psychotherapy
When symptoms are moderate to severe When symptoms interfere with social and academic functioning When symptoms interfere with behavioral functioning Explanation: Pharmacological treatment may be necessary when symptoms are moderate to severe, persist beyond 4 weeks, and the child has difficulty with social, academic, or behavioral functioning. Psychotherapy is generally recommended before pharmacological therapy.
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 Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Anticholinergic effects, stroke, and hyperglycemia are not addressed in a black box warning for this drug.
