Pharmacology Test 2

What are the three antiemetics that treat nausea?

1. Serotonin antagonists 2. antihistamines 3. dopamine antagonists

What are the adverse drug reactions for misoprostol?

Diarrhea, abdominal pain Women: dysmenorrhea, uterine cramping, spotting, miscarriage

What are the nursing interventions for misoprostol?

Monitor for severe diarrhea, and abdominal pain Monitor for excessive menstrual pain or mid-cycle bleeding

What is the prototype for Histamine H2 antagonists? What are some other drugs in this category?

Ranitidine (Zantac)- prototype cimetidine (Tagamet) famotidine (Pepcid) *Drugs end in -tidine*

a nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug? a. headache b. sleepiness c. hypotension d. constipation

a. headache

a nurse is caring for a client who has a presciption for alosetron. The nurse should recognize that alosteron therapy is effective when the client reports which of the following a. one formed stool per day b. urination without burning c. cessation of nausea or vomiting d. reduced GI reflux effects

a. one formed stool per day

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over the counter cold products a. over the counter cold products can also contain guaifenesin b. blood glucose levels are increased c. rebound congestion is likely d. drug tolerance

a. over the counter cold products can also contain guaifenesin

a nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects? Select all that apply a. muscle tremors b. urinary retention c. dry mouth d. insomnia e. tachycardia

b,c

which of the following drugs has protocols that require clients to meet specific risk management criteria and sign a treatment agreement before the nurse can administer the drug a. lubiprostone b. azathioprine c. sulfasalazine d. alosetron

d. alosetron

A nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include? a. check apical pulse before taking the drug b. take the drug only as needed before exercising c. rinse mouth after using the drug d. have lab tests performed at regular intervals

d. have lab tests performed at regular intervals

which of the following instructions should the health care professional give a client about taking sucralfate to treat an acute duodenal peptic ulcer a. take it with a prescribed antacid b. reduce potassium intake c. take it with food d. increase fluid and fiber intake

d. increase fluid and fiber intake

a nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug? a. fever b. bruising c. polyuria d. palpitations

d. palpitations

a histamine h2 antagonist, inhibits gastric acid secretion. It treats gastric and duodenal ulcers relieves heartburn and dyspepsia and helps minimize symptoms of GERD

ranitidine

Antacids can ___________ absorption of histamine h2 receptors but has little effect on ranitidine

reduce

What is the prototype for prostaglandin E analog?

Misoprostol

___________ are erosive lesions that occur in the stomach and duodenum. They are typically caused by an infection of H. pylori.

Peptic Ulcers

T/F Antacids that contain magnesium will worsen the diarrhea if taken with prostaglandin E analogs

T

a nurse is teaching a client who is taking prednisone for an acute asthma exacerbation. Which of the following instructions should the nurse include a. avoid taking nonsteroidal anti-inflammatory drugs b. rinse your mouth after taking the medication to prevent a yeast infection c. stop taking the medication if you become nauseous d. change position slowly when standing up

a. avoid taking nonsteroidal anti-inflammatory drugs

The health care profession instructs a client about the therapeutic actions of sucralfate. She explains that this drug promotes ulcer healing by which actions a. creates a protective barrier b. increase gastric pH c. inhibits the proton pump d. neutralizes gastric acid

a. creates a protective barrier

a nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity a. seizures b. constipation c. normal sinus rhythm d. somnolence

a. seizures

stimulant laxative that reduces constipation by increasing peristalsis and increasing the amount of intestinal fluid; for constipation

bisacodyl

a nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects a. reduces inflammation b. reduces gastric acid c. prevents diarrhea d. prevents straining

d. prevents straining

a nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects? a. increases leukocyte activity b. blocks muscarinic receptors c. causes bronchodilation d. reduced inflammation

d. reduced inflammation

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons? a. phenytoin increases the metabolism of sucralfate b. phenytoin reduces the effectiveness of sucralfate c. sucralfate increases the risk for phenytoin toxicity d. sucralfate interferes with the absorption of phenytoin

d. sucralfate interferes with the absorption of phenytoin

a nurse is teaching a client about montelukast, which of the following instructions should the nurse include? a. use a spacer to improve inhalation b. take the drug at the onset of brochospasm c. rinse mouth to prevent an oral fungal infection d. take the drug once a day in the evening

d. take the drug once a day in the evening

which of the following information indicates that a client who is taking theophylline needs further instruction a. the client drive a school bus everyday b. the client drinks 8oz of wine with dinner c. the client exercises 1 hour each day d. the client drinks two cups of coffee each morning

d. the client drinks two cups of coffee each morning rationale: caffeine may increase CNS stimulation, causing nervousness, insomnia, and tremors. It may also increase stimulation and cause tachycardia. Instruct clients taking methylxanthines to avoid caffeine intake

stool softener

docusate sodium

What are the six categories of drugs to treat Peptic ulcers?

1. Histamine H2 Antagonists 2. Proton Pump inhibitors 3. Mucosal prostaglandins 4. antacids 5. Prostaglandin E analogs 6. Antibiotics

What are the adverse effects of histamine h2 antagonists?

1. Impotence 2. reduced libido with cimetidine (not ranitidine) 3. confusion 4. arrhythmia 5. aplastic anemia 6. agranulocytosis 7. Increased susceptibility to pneumonia

What should the nurse teach clients taking antacids?

1. Increase fluids and fiber, activity and exercise 2. Report abdominal pain and severe diarrhea 3. monitor phosphate and sodium intake 4. report any signs of GI bleeding 5. Do NOT take aluminum hydroxide within 1-2 hours of other medications

Nurse should teach the client that is taking prostaglandin E analogs

1. Report adverse drug effects 2. drink plenty of fluids 3. take with food to minimize GI effects 4. do not take with alcohol

Administration considerations of prostaglandin E analogs

1. administer 4x a day with meals and at bedtime 2. confirm pt is not pregnant 3. educate about contraceptions while taking this drug

Clients who test positive for H. pylori bacteria should take what antibiotics?

1. amoxicillin 2. metronidazole 3. tetracycline

What are the common uses of histamine h2 antagonists?

1.Gastric and duodenal ulcers 2. Heartburn and dyspepsia 3. Erosive esophagitis 4. GERD 5. Aspiration pneumonitis 6. hypersecretory disorders (Zollinger-Ellison syndrome, systemic mastocytosis)

Nursing interventions for histamine h2 antagonists

For clients who develop impotence, reduced libido, or CNS effects, recommend switching to ranitidine Monitor for confusion in older clients

___________ blocks histamine receptors in the stomach that are responsible for the secretion of stomach acid. They block the receptors located on the parietal cells on the stomach, which decreases the amount of stomach acid secreted, increasing the pH of the stomach.

Histamine H2 Antagonists

What is the prototype for proton pump inhibitors?

Omeprazole (Prilosec) *end in prazole*

Patients taking histamine h2 antagonists have an increased risk of developing ___________ due to elevated gastric pH, allowing bacteria to colonize in the stomach.

Pneumonia

_________________ inhibit the the hydrogen potassium ATPase enzyme system in the parietal cells of the stomach. This suppressed gastric acid production (both the basal rate the stomach constantly produces and the extra it produces secondary to ingestion of food).

Proton Pump inhibitors

Nurses should instruct the client that is taking histamine h2 antagonists...

Take all medications as prescribed, avoid smoking, avoid anything that irritates the GI, report signs of GI bleeding such as coffee-ground emesis

True/False Misoprostol is used to prevent gastric ulcers from long-term NSAID use

True

True/False Pregnancy is a contraindication of misoprostol

True

a female client of childbearing potential is starting therapy with misoprostol to prevent gastric ulcers. Which of the following instructions should you include when teaching this client (select all that aply) a. mid cycle spotting can occur b. take a pregnancy test prior to therapy c. report excessive menstrual pain d. use effective contraception e. avoid taking the drug at bedtime

a,b,c,d

a client is starting therapy with psyllium. You explain to the client that psyllium will have which of the following therapuetic effects. select all that apply a. relieve constipation b. increase gastric ph c. reduce diarrhea d. decrease gastric acid secretion e. alleviate nausea

a,c

a nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include (select all that apply) a. restlessness b. bradycardia c. insomnia d. muscle pain e. anxiety

a,c,e

a nurse is assessing a client who was administered ondansetron IV 1 hour ago. Which of the following findings should the nurse recognize as an adverse effect of this drug a. dizziness b. bradycardia c. tardive dyskinesia d. dyspepsia

a. dizziness

an immunosuppressant that reduces the inflammation of inflammatory bowel disease (unlabeled use)

azathioprine

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client a. Ipratropium b. Beclomethasone c. Acetylcysteine d. Azelastine

c. Acetylcysteine

a nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions a. decrease viscosity of nasal secretion's b. block H2 receptors c. prevent histamine from binding to receptors d. reduce nasal congestion

c. prevent histamine from binding to receptors

a nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make? a, blood pressure b. apical heart rate c. respirations d. level of conciousness

c. respirations

you are instructing a client who has a new prescription for cetrizine. Which of the following information should you be sure to include a. restrict fluids to minimize the drugs adverse effects b. take the drug in the morning to reduce adverse effects c. take the drug on an empty stomach to increase absorption d. administer the drug prophylactically during allergy seasons

d. administer the drug prophylactically during allergy seasons rationale: cetrizine is a second generation antihistamine used primarily to relieve symptoms associated with seasonal allergic rhinitis.

Important administration considerations for histamine h2 antagonists

Given orally, IM, or IV ORALLY: -Give with or without food (given with food or immediately after meals or at bedtime prolongs effects) -make sure clients dissolve tablets in water!! Do not chew, swallow whole, or let dissolve on tongue -Do NOT give antacids within 1 HOUR of administration IV: -Administer slowly to prevent bradycardia

_________ is an endogenous prostaglandin. it decreases gastric acid secretion, increases the secretion of bicarbonate, increases secretion of mucus and increases vasodilation of blood flow in the gastric wall.

Misoprostol

a nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor the manifestation of which of the following conditions. a. gout b. constipation c. insomnia d. hirsutism

a. gout

a client is about to start taking aluminum hydroxide tablets to reduce gastric acid. Which instructions should you include when talking with the client about taking this drug. Select all that apply a. take the drug with large meals b. chew the tablets thoroughly c. drink a galss of water after taking it d. increase fluid and fiber intake e. take it once daily

b,c,d

a nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions a. a seizure disorder b. rheumatoid arthritis c. a positive pregnancy test d. heart failure

c. a positive pregnancy test

a nurse is teaching a client who is beginning fluticason propionate/ salmetrol therapy. Which of the following instructions should the nurse include a. take the drug as needed for acute asthma b. follow a low sodium diet c. use an alternate day dosing schedule d. increase weight bearing activity

d. increase weight bearing activity

A nurse is planning care for a client who is receiving chemotherapy and has a new persciption for ondansetron. Which of the following actions should the nurse plan to take. Select all that apply a. infuse the drug 30 min prior to chemotherapy b. administer the drug when the client reports nausea c. infuse the drug slowly over 15 minutes d. administer the drug immediately following chemotherapy e. repeat the dose 4 hours after chemo

a,c,e

The health care professional is providing instructions to the client on taking aluminum hydroxide. Which of information should be included? select all that apply a. check labels for sodium and phosphate content b. decrease activity and exercise c. increase fluid and fiber intact d. report whitish colored stools e. monitor for signs of constipation

a,c,e

a nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include a. "avoid driving or activities requiring alertness" b. "if you miss a dose, double the next dose" c. "Rinsing the mouth with alcohol based mouth wash can reduce dryness" d. "Having one glass of wine each night can improve medication effectiviness"

a. "avoid driving or activities requiring alertness"

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make a. "use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn" b. "the medication can stain your contact lenses green" c. "the medication can color your urine dark brown" d. "Take an iron supplement when you take sulfasalazine to prevent anemia"

a. "use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn" photo sensitivity is a possible adverse effect of sulfasalazine that makes the skin sensitive to light. The nurse should instruct the client to wear sunscreen and protective clothing when outdoors to prevent burning

you are instructing a client about using cromolyn via inhalation to treat exercise induced bronchospasm. You advise the client to take the drug a. 15 minutes before exercising b. if needed to stop bronchospasm c. after strenuos activity d. once in the evening at bedtime

a. 15 minutes before exercising rationale: cromolyn may prevent exercise induced asthma if used 15 minutes before exercising and be used by nebulizer up to 4 times per day

you should instruct a client zileuton to report which of the following possible indications of a serious adverse effect of this drug? a. abdominal pain b. dysphagia c. blurred vision d. bradycardia

a. abdominal pain rationale: Zileuton may cause liver damage and hepatitis. Clients should report signs of hepatic, such as abdominal pain or jaundice.

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler a. albuterol will increase the absorption of fluticasone b. albuterol will decrease inflammation c. albuterol will reduce nasal secretions d. fluticasone will reduce the adverse effects of albuterol

a. albuterol will increase the absorption of fluticasone

a nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider? a. allopurinol delays the conversion of azathioprine b. azathioprine increase the effectiveness of allopurinol c. allopurinol increases the metabolism of azathioprine and can require an increased dosage d. azathioprine decreases the effectiveness of allopurinol

a. allopurinol delays the conversion of azathioprine

you should recognize that which of the following is a contraindication for taking codeine a. emphysema b. cataracts c. hyperthyroidism d. nonproductive cough

a. emphysema rationale: codine is unsafe for clients who have decreased respiratory reserve, such as with empysema or asthma

A nurse should recognize that diphenoxylate/ atrophine should be used with caution for a client who has which of the following conditions? a. inflammatory bowel disease b. thrombophlebitis c. agranulocytosis d. immunization with a live virus vaccine within the last 6 weeks

a. inflammatory bowel disease

a nurse is caring for an older adult client who has renal impairement and a new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestions a. lethargy b. cellulitis c. dry mouth d. myalgia

a. lethargy

you should instruct a client using phenylephrine spray for nasal congestion to do which of the following to avoid rebound congestion a. limits the drugs use to 3-5 days b. add an intranasal glucocorticoid c. taper the dose before discontinution d. restrict the drugs use to one nostril at a time

a. limits the drugs use to 3-5 days rationale: short term use to prevent rebound congestion.

a nurse is caring for a client who is takin lubiprostone. The nurse should tell the client that lubiproston can cause which of the following adverse drug reactions a. nausea b. constipation c. urinary retention d. sore throat

a. nausea

A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron? a. the drug is prescribed to female clients who have IBS-D lasting longer than 6 months b. this drug is prescribed to clients who have chronic diarrhea lasting more than 12 months c. the drug is the most beneficial for male clients who have inflammatory bowel disease d. the drug is most beenficial in treating clients who have constipation

a. the drug is prescribed to female clients who have IBS-D lasting longer than 6 months

for which of the following reasons should a client attach a spacer to a metered dose inhaler a. to increase the amount of the drug delivered to the lungs b. to increases the same amount of drug delivered to the oropharynx c. to increase the amount of drug delivered on exhalation d. to increase the speed of drug delivery into the mouth

a. to increase the amount of the drug delivered to the lungs

you should advise a client who is taking beclomethasone to watch for which of the following possible interactions of an adverse effect of this drug a. white coating in the mouth b. abdominal pain c. muscle twitching d. palpitations

a. white coating in the mouth rationale: beclomethasone, an inhaled glucocorticoid may cause oropharyngeal candidiasis.

you are obtaining a heath history from a client who is to start using a new ipratropium inhaler. Which of the following information from the client's history alerts you to take further action. Select all that apply a. seizure disorder b. peanut allergy c. depression treated with a monoamine oxidase inhibitor (MAOI) d. hypothyroidism treated with synthetic thyroid hormone e. glaucoma

b, e rationale: clients who are allergic to peanuts or do not take ipratropium, an anticholinergic drug, because the medication preparation may contain peanut oil and soy.

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? Select all that apply a. level of consciousness b. skin integrity c. temperature d. urine output e. CBC

b,c,e

knowing the adverse drug reactions of ranitidine, the primary care providers assistant should instruct a client to watch for and report which of the following a. hyperactivity b. CNS depression c. hypertension d. bone pain

b. CNS depression

a nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the clients phosphorus levels when administering which of the following drugs a. omeprazole b. aluminum hydroxide c. sucralfate d. ranitidine

b. aluminum hydroxide

a nurse should recognize that sulfasalazine is contraindicated for clients which of the following conditions? a. pancreatitis b. aspirin sensitivity c. bronchitis d. GERD

b. aspirin sensitivity

you are about to administer ondansetron to a client to prevent anesthesia induced nausea and vomiting. You prepare to monitor the client for which of the following adverse effects of this drug a. bronchospasm b. dizziness c. hypertension d. anxiety

b. dizziness

a nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug? a. muscle tremors b. drowsiness c. excitation d. insomnia

b. drowsiness

Legal restrictions apply to the purchase of pseudoephedrine (Sudafed) because of which of the following risks? a. respiratory depression b. drug abuse c. drug tolerance d. rebound congestion

b. drug abuse

a nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurses should recognizes that which of the following drugs interacts with ranitidine? a. phenobarbital sodium b. ketoconazole c. lisinopril d. hydrochlorothiaziade

b. ketoconazole

a nurse should identify that dextromethorphan can have which of the following effects when combined with morphine a. reduced antitussive effect of dextromethorphan b. potentiation of depression of CNS actions c. increased renal reabsorption of the dextromethorphan d. delayed analgesic effect of the opiod

b. potentiation of depression of CNS actions

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects? a. suppresses the cough stimulus b. reduces surface tension c. reduces inflammation d. dries mucous membranes

b. reduces surface tension

a nurse is providing teaching to a client who has a new presciption for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include a. take the drugs with food b. swallow the capsule whole c. dissolve the tablets in water d. take the drug at bedtime

b. swallow the capsule whole

which of the following information should you include when teaching a client about the use of an albuterol inhaler for asthma management a. use it every 12 hours b. use it periodically to prevent exercise induced asthma c. store the drug canister in the fridge d. watch for an oral yeast infection

b. use it periodically to prevent exercise induced asthma rationale: albuterol is a shorta acting betas2 agonist that clients should use only as needed to stop an acute asthma exacerbation or 30 minutes before exercising to prevent exercise induced brochospasm

a nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include? a. do not drink anything for 30 minutes after using the drug b. wait 5 minutes between using the drug and another inhaled drug c. this drug is used to thin respiratory secretions d. check pulse rate after inhaling the drug

b. wait 5 minutes between using the drug and another inhaled drug

a nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects? a. suppresses the cough stimulus b. reduces inflammation c, thins and loosens mucous d. dries secretions

c, thins and loosens mucous

A nurse is providing teaching to a client who has a new persciption for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include. Select all that apply a. sit upright for 30 minutes after taking the drug b. avoid antacids c. take the drug 30-60 minutes before activities that trigger nausea d. avoid activities that require alertness e. increase fluid and fiber intake

c,d,e

a nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include. Select all that apply a. expect results in 6-12 hours b. urinarte every 4 hours c. take the drug with at least 8 oz (237 ml) of fluid d. avoid activities that require alertness e. increase the fluid and fiber intact

c,e

a nurse is caring for a client who has a new prescription for alostron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug a. headache b. drowsiness c. abdominal pain d. sore throat

c. abdominal pain

a nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give. a. start at a low dose and gradually increase it b. take the drug as needed for nasal congestion c. allow at least 2 weeks for the full therapeutic effect d. use the drug prior to exercise

c. allow at least 2 weeks for the full therapeutic effect

a nurse is providing teaching to a client who has a new presciption for loperamide. Which of the following instructions should the nurse include? a. dissolve the powder thoroughly in 8 oz (237 ml) of water b. take with diphenhydramine to prevent extrapyramidal effects c. avoid activities that require alertness d. take 30 minutes before activities that trigger nausea

c. avoid activities that require alertness

a client is about to start taking omeprazole to treat a duodenal ulcers. Which of the following instructions should you include when talking with the client about taking this drug a. take it with food b. avoid using aluminum based antacids c. consume adequate amounts of fluid d. do not drink grapefruit juice

c. consume adequate amounts of fluid

a nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects? a. thins mucous b. relaxes bronchial smooth muscle c. decrease inflammation d. increases the cough threshold

c. decrease inflammation

a client is going to take ranitidine in the form of effervescent tablets. Which administration instructions for this drug formulation should be included a. swallow the tablets whole b. chew the tablets before swallowing c. dissolve the tablets in water before drinking d. place the tablets under the tongues

c. dissolve the tablets in water before drinking

you are about to administer diphenoxylate plus atrophine to a client to reduce diarrhea. which drugs should you have available to treat an overdose of this drug combination a. acetylcysteine b. flumazenil c. naloxone d. diphenhydramine

c. naloxone

a nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least one hour between ranitidine and which of the following over the counter drugs a. ginkgo biloba b. antidiarrheals c. st johns worts d. antacids

d. antacids

a nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautions use with clients who have which of the following conditions a. peptic ulcer disease b. a seizure disorder c. anemia d. coronary artery disease

d. coronary artery disease

you should monitor a client taking dextromethorphan because of the potential for which of the following a. tachycardia b. fluid retention c. blurred vision d. drug abuse

d. drug abuse rationale: dextromethorphan can cause euphoria and hallucinations at high doses.