Practice Exam 3 Pharm

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Crushing the medication may precipitate an overdose. P444 Explanation: Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?

14 days P358 and 361

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

Avoid use of soy sauce in the diet P358 The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

Prior to the administration of an opioid antagonist, what must the nurse obtain? (Select all that apply.)

Blood pressure Pulse Respiratory rate Explanation: p450 Prior to the administration of an opioid antagonist, the nurse must obtain the client's blood pressure, pulse, and respiratory rate.

A nurse who is providing health education for a client recently diagnosed with migraines should convey what point?

the importance of avoiding foods that may precipitate migraines Explanation: Foods that precipitate migraine effects include aged cheeses, fermented foods, aspartame, monosodium glutamate, and chocolate. Stress is not a known salient causative factor. Herbal supplements and increased light exposure are unlikely to be of benefit.

The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?

1.8 mEq/L P381 Explanation: Therapeutic serum lithium levels range from 0.6 mEq/L to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic. All of the other levels would be considered therapeutic.

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks P360 Explanation: It may take up to 4 weeks before the full effect of an SSRI is noted.

The normal function of which neurotransmitter is most likely impaired when a client expresses feelings of gloom and the inability to perform activities of daily living?

serotonin P352 Explanation: Serotonin helps regulate several behaviors that are disturbed in depression. Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.

A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?

A client has dysphagia Explanation: P354. Antidepressants are almost exclusively administered in oral form not IV or IM. For clients with dysphagia, they have the potential for aspiration.

The client has been perscribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans - p358 MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension P357 Explanation: MAO inhibitors may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Clients who take MAO inhibitors should avoid foods that contain tyramine, such as aged cheese

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?

Methadone P442 Explanation: Methadone is used for detoxification and temporary maintenance treatment of narcotic addiction. Oxycodone is used for the relief of moderate to severe pain in adults. Oxymorphone is used for the relief of moderate to severe pain in adults, preoperative medication, and obstetrical analgesia. Tramadol is used for the relief of moderate to moderately severe pain, and its use should be limited in clients with a history of addiction.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan P449 Explanation: Narcan has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-q injection and last 1 to 2 hour

The pathophysiology of pain begins with a signal from what source?

Nociceptors P438 For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroreceptors are not directly involved in pain transmission.

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which?

Pneumonia P444 Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia. The drug does not cause myocardial infarction or renal impairment. A common cold is not known to cause hypersensitivity to the morphine.

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors P360 Explanation: Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.

The nurse should prioritize which assessment when caring for a teenager who has recently been prescribed a selective serotonin reuptake inhibitor (SSRI)?

Suicidal ideation P360-361 The FDA has issued a black box warning alerting health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. VTE, arrhythmias, and hypomania are not likely adverse effects.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives. P360 Explanation: Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm). SSRIs do not necessarily eliminate the risk of suicide.

A 30-year-old client is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

dizziness. P358 Explanation: The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

middle-aged client describes her headaches as "utterly debilitating" and tells the nurse, "It's hard to explain, but I just know when one is coming, and I'm never wrong." This client's statement suggests what diagnosis?

migraines P451 Explanation: The severity of her headaches coupled with the fact that she experiences a prodrome suggests that she experiences migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.