study set pharm final

Anticholinesterase inhibitors

Mainstay of therapy TREAT BUT DOES NOT CURE Used to inhibit anticholinesterase, causing an increase in acetylcholine at the neuromuscular junction Increased acetylcholine improves muscle contraction and tone

Histamine Synthesis/storage (powerpoint)

Mast cells and basophils

Atypical antipsychotics: nurse role

Monitor RBC and WBC and hematologic side effects Observe for side effects and anticholinergic side effects monitor for decrease of psychotic symptoms Monitor for alcohol, illegal drug use, caffeine, nicotine use Monitor elderly closely

Conventional (typical) antipsychotics

Most effective for positive symptoms Monitor for: Decrease of psychotic symptoms, side effects Anticholinergic side effects Alcohol, illegal drug, caffeine, and nicotine use Cardiovascular changes Seizures and patient's environment Neuroleptic malignant syndrome (NMS)

Extrapyramidal symptoms

Muscle spasms of face, tongue, neck, or back *acute dystonias* Inability to rest and relax; pacing *akathisia* Tremor, muscle rigidity, stooped posture *secondary or pseudoparkinsonism* Lip smacking; wormlike movements of the tongue; uncontrolled chewing and grimacing *tardive dyskinesias*

Edrophonium chloride (Tensilon) side effects

Muscle weakness Bradycardia Hypotension Abdominal cramps Increased salivation Blurred vision Nausea Have atropine available Monitor HR, RR

What is the BRAND NAME for PHENELZINE?

NARDIL

What is the BRAND NAME for TRANYLCYPROMINE?

PARNATE

What is the BRAND NAME for FLUOXETINE?

PROZAC

A nurse is providing teaching for a client taking phenytoin (Dilantin). Which client statement indicates a good understanding of the teaching?

"Alcohol is contraindicated with Dilantin."

A client with a known seizure disorder is being treated with phenytoin (Dilantin). The client becomes pregnant. Which recommendation would be appropriate for the nurse to make?

"Contact your healthcare provider right away; you should not take Dilantin while pregnant."

The client has been started on phenytoin and reports to the nurse that he also takes ginkgo. What is the most accurate response from the nurse?

"Ginkgo can decrease the effectiveness of phenytoin."

A nurse is teaching a client about her health plan when taking phenytoin (Dilantin). Which instruction would not be included in the teaching plan?

"avoid use of oral contraceptives."

A client with a known seizure disorder is treated with several anticonvulsant medications. The client confides in the nurse, stating that he also has a strong belief in complementary medicine and takes several herbal supplements. Which is an appropriate response by the nurse?

"check with your healthcare provider to ensure there are no harmful drug interactions."

A client taking anticonvulsants for epilepsy should receive which instruction from the nurse?

"the medication is usually taken for a lifetime."

Causes of schizophrenia

*Cause not yet determined* -Genetic -Neurotransmitter imbalance *Symptoms seem to be associated with dopamine type 2 (D2) receptor in brain* Antipsychotic drugs enter dopaminergic synapses and compete with dopamine

What are the categories of antipsychotic drugs?

*Conventional or "typical" antipsychotics* Phenothiazines; example, chlorpromazine (early 1950s, "first generation") Nonphenothiazines *Atypical antipsychotics* 1970s, 1980s, called "second generation" Have fewer side effects "Third generation" also atypical; dopamine-serotonin system stabilizers; example, aripiprazole (Abilify)

Which antihistamine would be just fine for a kid with allergic rhinitis and itchy watery eyes, who can't sleep because his allergies are bothering him so much? How about for the allergic kid whose itchy, puffy eyes have been bothering him all spring making his school days miserable?

- A first gen is great for someone with allergies that cannot sleep or needs to take something right before bed. - A second generation is great for someone who needs to take it at or before school and needs to stay alert all day.

Be sure that you recognize the symptoms of anaphylaxis. Can antihistamines be used to treat anaphylaxis?

- Anaphylaxis is when you bronchoconstrict, have severe hypotension, and edema of the glottis. - You can also go into cardiac arrest. - Antihistamines CAN NOT be used for these because the reaction is not fast or - Use epinephrine.

What drugs should not be combined with first-generation antihistamines?

- Anything that also depresses the CNS. - Can include alcohol, benzodiazepines, and barbituates.

Is diphenhydramine (Benadryl) a first gen antihistamine? Promethazine? Hydroxyzine? Clemastine? Cetirizine? Fexofenadine? Loratidine?

- First gen- Diphenhydramine, Hydroxyzine, Promethazine. - Second gen- Cetirizine, Fexofenadine, and Loratadine.

Histamine Receptors

- H1 - H2

A child's mother has inadvertently overdosed her on antihistamines by using multiple OTC cold preps? What does toxicity look like? Is there an antidote we can give this child to rid the body of the medication? What do we do?

- It's rare to do so, but It's actually going to be the opposite of CNS depression. - It's going to be agitation, jittery, hot, dry, red skin. Anticholinergic effects. - There is NO antidote. You just have to treat the symptoms (IV fluids, something for anxiety).

Second-Generation H1 Antagonists

- Less sedation (dont bass the BBB) - Actions with alcohol and other CNS depressants are low -Do not have anticholinergic effects -Most need prescription and are pricey

Recall those anticholinergic effects, they are a prominent set of side effects of the drugs in this chapter.

- Occur with first generations. Can't see, can't spit, can't pee, can't ____. Blurry vision, dry mouth, constipation.

First-generation H1 antagonists

- Sedation can be a problem - CNS depression very common with the ethanolamines and less sedation in alkylamines - Cause anticholinergic effects

How do the drugs in this chapter work? For which conditions are they useful?

- These drugs are histamine antagonists. - They cover the H1 receptors, and SLOWLY reverse/help an allergic reaction. - They reduce itching and pain, mild allergies, and in some cases motion sickness. - They are useful for mild allergy problems/attacks.

What are the local effects of histamine (think about blood vessels, nerve endings) ? In which cells is histamines stored?

- When certain immune cells burst, packets of histamines come out. - Capillaries start to leak which causes swelling and edema, places constrict, places vasodilate, and you get pain, and itching.

What is a generalization that can be made about all "first generation" antihistamines? Along these lines, what is the important difference between first and second generation antihistamines?

-All first generation antihistamines cause CNS depression, so most importantly, drowsiness (can cause depression, confusion, etc.). -2nd gen. Less sedation. Synergism with alcohol and other CNS depressants is low. Have no anticholinergic actions.

Histamine Release

-Allergic (requires prior exposure) -Nonallergic (Drug induced or cell injury)

Role of Histamine in Allergic Responses Severe Allergic Responses

-Anaphylaxis (Bronchoconstriction, hypotension, edema) -Antihistamines are of little use in treatment -Epinephrine is the drug of choice for treatment)

H1 Antagonists Mechanism of action

-Block the actions of histamine at H1 receptors -Do not block H2 receptors -Some block to muscarinic receptors

H1 Antagonists Mechanism of action:

-Block the actions of histamine at H1 receptors -Do not block H2 receptors -Some block to muscarinic receptors

H1 Antagonists Drug interactions

-CNS depressants (barbiturates, benzo, opioids) -Use of pregnancy and lactation (should be used in nursing, only used when needed in pregnancy) -Acute toxicity (CNS and anticholinergic reactions, Hot, dry, red skin and delirium)

Role of Histamine in Allergic Responses Mild Allergic Responses

-Caused largely by histamine acting at H1 receptors -Rhinitis, itching, localized edema -Hay fever, mild transfusion reaction, acute urticaria -Usually responsive to antihistamine therapy

Mild Allergic Responses

-Caused largely by histamine acting at H1 receptors -Rhinitis, itching, localized edema -acute urticaria

Histamine

-Endogenous compound -Found in specialized cells -Important role in: Allergic reaction, Regulation of gastric acid secretion -Histamine use limited to diagnostic procedures

H1 Antagonists divided into two major groups:

-First-generation H1 antagonists (highly sedating) Diphenhydramine (Benadryl) Hydroxyzine (Vistaril) Promethazine (Phenergen) Chlorphiramine Clemastine (Tavist Allergy) -Second-generation H1 antagonists (nonsedating) Fexofenadine (Allegra) Cetirizine (Zyrtec) Levocetirizine (Xyza) Loratadine (Claritin, Tavist ND, Alavert) Desloratadine (Clarinex)

Allergic Responses

-Mediated by histamine and other compounds (which are more important in anaphylaxis and in pathophysiology of asthma) -Prostaglandins -Leukotrienes

H1 Antagonists Therapeutic uses

-Mild allergy -Severe allergy (Adjunct only, benefits may be limited) -Motion sickness (Promethazine, dimenhydrinate) -Insomnia -Common cold (May decrease rhinorrhea through anticholinergic properties, not H1 blockade)

H1 Antagonists Pharmacologic effects:

-Peripheral effects (Reduce localized flushing, Reduce itching and pain) -Effects on the CNS (CNS depression, 2nd gen depression nothing) -Overdose: CNS stimulation, Convulsions, Very young children especially sensitive to CNS stimulation

Histamine Distribution

-Present in practically all tissues -Especially high in skin, lungs, and GI tract -Low content in plasma

An elderly patient suffers from allergies. To which side effects would she be especially vulnerable. Which antihistamines would be the best choices for her?

-Second generation would be best for her. -A first gen's symptoms of confusion and sedation is worse in an elderly person.

Effects of H2 Stimulation

-Secretion of gastric acid

H1 Antagonists Adverse effects

-Sedation (Less with second and third generation) -Non sedative CNS effects (Dizziness, fatigue, coordination problems, confusion) -Gastrointestinal effects (Can cause nausea, vomiting, loss of appetite, constipation (give with food) -Anticholinergic effects (Weak atropine-like effects) -Severe respiratory depression -Severe local tissue injury -Cardiac dysrhythmias (Rare)

Histamine Synthesis/storage

-Synthesis/storage -Mast cells (skin/soft tissues) and basophils (blood) -Produced by neurons

H1 receptor stimulated

-Vasodilation (Skin of the face and upper body warmed and flushed, Extensive: can cause hypotension) -Increased capillary permeability (Edema) -Bronchoconstriction (Not the cause of asthma attack) no use in treating asthma -CNS effects (Role in cognition, memory, and sleep-waking cycles) -Other (Itching, pain, secretion of mucus)

H1 receptor stimulated:

-Vasodilation (Skin of the face and upper body) -Bronchoconstriction -CNS effects (Role in cognition, memory, and sleep-waking cycles)

High-Risk Patients

-contraindicated: During third trimester of pregnancy, Nursing mothers, Newborn infants -caution in: Young children, Older adults, Patients whose conditions may be aggravated by muscarinic blockade

Choose the normal level for creatinine for a female? 5 mg/dL to 15 mg/dL 4 - 36 IU/L 0.5 mg/dL to 1.1 mg/dL 12 to 16 gm/dL

0.5 mg/dL to 1.1 mg/dL

What is the THERAPEUTIC LEVEL for LITHIUM?

0.6-1.2

A client receiving warfarin (Coumadin) must have lab tests checked before the drug is administered. The laboratory test(s) that is/are monitored while a client receives warfarin is: 1. PT and INR 2. a platelet count 3. PTT and APTT 4. a CBC

1. PT and INR Response Feedback: These are the tests monitored with warfarin.

Two herbal supplements have been indicated for mild depression. These are: 1. St. John's wort and ginkgo 2. kaolin and garlic 3. ginger and ginseng 4. ephedra and kava kava

1. St. Johns work and ginkgo Response Feedback: These herbs may be recommended in the treatment of mild depression.

A nurse is discussing depression with a new nurse. The experienced nurse explains that major depression is thought to be related to the following hormonal changes: 1. a decrease in serotonin and norepinephrine levels 2. an increase in serotonin and decrease in norepinephrine levels 3. an increase in norepinephrine and decrease in serotonin levels 4. an increase in serotonin and increase in norepinephrine levels

1. a decrease in serotonin and norepinephrine levels Response Feedback: This is the current theory of the physiologic basis for depression.

In parkinsonism, which neurotransmitter is more plentiful, causing excitation and movement disorders? 1. acetylcholine 2. dopamine 3. epinephrine 4. norepinephrine .

1. acetylcholine Response Feedback: This is the chemical that is in excess amounts in clients with Parkinson's disease

Leukotriene is a chemical mediator that can cause: 1. inflammatory changes in the lungs 2. infectious lung disease 3. bronchodilation 4. acute asthmatic attack

1. inflammatory changes in the lungs Response Feedback: This is the function of a leukotriene.

A client is ordered to receive colchicine (Novocolchine) for an acute gout episode. Colchicine, an antigout drug, acts by inhibiting: 1. migration of leukocytes to the inflamed site 2. excretion of uric acid 3. uric acid synthesis 4. synthesis of white and red blood cells

1. migration of leukocytes to the inflamed site Response Feedback: This is the action of this medication.

A client is treated with two inhalers, albuterol (Proventil) and a glucocorticoid (beclomethasone [Vanceril]). The nurse is planning the care and knows that the client should: 1. use the Proventil inhaler first and wait 5 minutes before following with Vanceril 2. use Vanceril first, wait 2 minutes, and then follow with Proventil 3. use Vanceril first, wait 10 minutes, and follow with Proventil 4. use the Proventil inhaler first and follow immediately with Vanceril

1. use the Proventil inhaler first and wait 5 minutes before following with Vanceril Response Feedback: The bronchodilator is used first to open the airway; then the steroid is used.

A client is ordered to receive phenytoin (Dilantin). The client's serum phenytoin level is noted to be 15 mcg/mL. How does the nurse interpret this level?

10 to 20 mcg/mL is therapeutic

A nurse teaching a client is evaluating the client's knowledge of his medications. The nurse confirms that the client understands the function of oprelvekin (Neumega) if he states: 1. "It reduces the need for red blood cell transfusions." 2. "It prevents severe thrombocytopenia." 3. "It increases the need for platelet transfusion." 4. "It increases the white blood cell count."

2. "It prevents severe thrombocytopenia." Response Feedback: This medication bolsters platelet production.

Drug groups used to control cold symptoms include which of the following? 1. antivirals 2. antitussives 3. antifungals 4. antibiotics

2. antitussives Response Feedback: This medication is used to decrease coughs.

A client is to receive a peripheral vasodilator. Side effects include which of the following? 1. pallor 2. dizziness, lightheadedness 3. headache 4. bradycardia

2. dizziness, lightheadedness Response Feedback: Peripheral vasodilators cause a decrease in BP.

A new drug category with U.S. Food and Drug Administration approval is leukotriene inhibitors/modifiers. Leukotriene inhibitors are prescribed: 1. to enhance bronchoconstriction 2. for prophylactic and maintenance drug therapy for chronic asthma 3. to treat acute asthmatic attacks 4. to increase inflammatory response

2. for prophylactic and maintenance drug therapy for chronic asthma Response Feedback: These medications inhibit the inflammatory response in the airways.

The proton pump inhibitor (PPI) group of drugs act by: 1. increasing cytoprotective mucus in the gastrointestinal ulcer 2. inhibiting gastric acid secretion 3. blocking acetylcholine production 4. neutralizing gastric acid

2. inhibiting gastric acid secretion Response Feedback: This is the function of the PPI group.

An example of an A-II receptor antagonist is: 1. captopril (Capoten) 2. losartan potassium (Cozaar) 3. nifedipine (Procardia) 4. atenolol (Tenormin)

2. losartan potassium (Cozaar) Response Feedback: This is an example of an A-II receptor antagonist.

Histamine (H2) blockers are also effective for: 1. treating allergic reactions 2. preventing acid reflux in the esophagus 3. coating the ulcer, thus protecting the ulcer from acid and pepsin 4. preventing motion sickness

2. preventing acid reflux in the esophagus Response Feedback: This is another use for these medications.

A client with gout is ordered to receive a medication that acts by increasing uric acid excretion. This drug is: 1. allopurinol (Zyloprim) 2. probenecid (Benemid) 3. aurothioglucose (Solganal) 4. colchicine

2. probenecid (Benemid) Response Feedback: This is the action of this medication.

Asthma is treated according to severity. For quick relief of a single asthmatic symptom, a(n) ________ drug is recommended. 1. oral beta1 and beta2 2. short-acting inhaled beta2 agonist 3. theophylline preparation 4. inhaled glucocorticoid

2. short-acting inhaled beta2 agonist Response Feedback: This medication is ordered to provide

When using a mucolytic drug and a bronchodilator in a nebulizer, the nurse should instruct the client that: 1. the mucolytic drug should be given 30 minutes before the bronchodilator 2. the bronchodilator should be given 5 minutes before the mucolytic drug 3. the bronchodilator should be given 30 minutes before the mucolytic drug 4. the mucolytic drug should be given 5 minutes before the bronchodilator

2. the bronchodilator should be given 5 minutes before the mucolytic drug Response Feedback: The bronchodilator is given to open the airway, followed by the other medication.

The health care provider left an order to discontinue prednisone. The best response is to: 1. explain to the client that the drug should be immediately stopped 2. report the health care provider to a supervisor 3. ask the health care provider if he or she wants the prednisone dose to be tapered 4. decrease the prednisone dose without notifying the health care provider

3. ask the health care provider if he or she wants the prednisone dose to be tapered Response Feedback: Prednisone must be tapered to avoid adrenal insufficiency.

Clients with parkinsonism lack sufficient amounts of which of the following neurotransmitters? 1. acetylcholine 2. norepinephrine 3. dopamine 4. epinephrine

3. dopamine Response Feedback: This hormone is deficient in Parkinson's disease.

Dopamine agonists (e.g., amantadine hydrochloride and bromocriptine mesylate) act on dopamine receptors. They are used with some clients having parkinsonism. These drugs: 1. are used to decrease the amount of dopamine in the brain 2. are more potent than levodopa 3. may be used in combination with levodopa 4. enhance dopamine distribution in the peripheral tissues

3. may be used in combination with levodopa Response Feedback: Combination therapy sometimes is most effective in dealing with the varied symptoms of this disorder.

A client receiving warfarin (Coumadin) is noted to have significant bleeding from the gums while on therapy. The physician orders an antidote. If excess bleeding occurs because of warfarin accumulation in the body, the antidote is: 1. naloxone (Narcan) 2. vitamin E 3. protamine sulfate 4. aquamephyton (phytonadione)

4. aquamephyton (phytonadione) Response Feedback: This is the antidote for warfarin.

One of the severe adverse reactions of pseudoparkinsonism is tardive dyskinesia, which is characterized by: 1. feet constantly in motion, rocking back and forth 2. stooped posture and shuffling gait 3. tremors at rest and pill-rolling motion of the hand 4. protrusion of the tongue and sucking/smacking movements of the lips

4. protrusion of the tongue and sucking/smacking movements of the lips Response Feedback: This is the classic symptom of tardive dyskinesia.

The health care provider suggests that a client with an upper respiratory tract infection use a nasal decongestant spray. Most decongestants are from which drug group? 1. parasympathomimetics 2. parasympatholytics 3. sympatholytics 4. sympathomimetics

4. sympathomimetics Response Feedback: This is the function of this class of drugs that stimulates the sympathetic nervous system, opening the airway.

The nurse is caring for a patient treated with flumazenil (Anexate) for benzodiazepine toxicity. After administering flumazenil what will the nurse carefully assess for? A) Agitation, confusion, and seizures B) Cerebral hemorrhage and dystonia C) Hypertension and renal insufficiency D) Hypotension, dysrhythmias & cardiac arrest

A ~ Administration of flumazenil blocks the action of benzodiazepines. If the patient has been taking these medications for an extended period of time, the blockage of the drugs effects could precipitate an acute benzodiazepine withdrawal syndrome with symptoms including agitation, confusion, and seizures. Anexate does not cause cerebral hemorrhage and dystonia, hypertension, renal insufficiency, hypotension, dysrhythmias, and cardiac arrest.

Extrapyramidal symptoms are a side effect of perphenazine (Trilafon). The nurse should assess and observe for which sign of akathisia? a. Restlessness and constant moving about b. Facial grimacing c. Chewing motion d. Involuntary eye movement

A ~ Akathisia is described as restless, agitated movement.

The nurse administers promethazine (Phenergan) to the patient before sending the patient to the preoperative holding area. What is the rationale for administration of this drug? A) Sedation B) Oral secretions C) Hypotension and bradycardia D) Confusion

A ~ Antihistamines (promethazine, diphenhydramine [Benadryl]) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. Promethazine is not given for hypotension, bradycardia, confusion, or oral secretions.

A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurses best response to the patient would be what? A) These drugs are similar but some patients respond better to one drug than another. B) Did you take the amitriptyline like you should have? C) Maybe the old medicine wasnt working anymore. D) Clomipramine is newer and will be much better for you.

A ~ Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. In addition, the nurse might inform the physician of the patients question so the physician can explain his or her rationale for changing medications. By asking the patient if he took the medication as prescribed, the nurse is insinuating that he may not have and could damage the trusting nursepatient relationship. The nurse has no basis for commenting that the medication might not be working or that another drug would work better.

Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline

A ~ Clomipramine is now also approved for use in the treatment of OCD. Imipramine, nortriptyline, and amitriptyline are not approved for use in treating OCD.

A 75-year-old patient is brought to the emergency department by his family. The family relates that the patient is complaining of confusion, seizures, and abnormal perception of movement. The nurse reviews all of the medication bottles found in the house and suspects the patient overdosed on what medication? A) Benzodiazepine B) Antihypertensive C) Sedative D) Analgesic

A ~ Common manifestations of benzodiazepine toxicity include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures. These symptoms are not found in association with options B, C, or D.

A client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the nurse about abruptly discontinuing these agents. The nurses response is based on the knowledge that, when discontinuing these medications: a. the dosage must be tapered to avoid withdrawal. b. the client must be evaluated for hyperglycemia. c. hangover syndrome must be planned for. d. blood levels must be monitored.

A ~ Discontinuing anxiolytic agents abruptly may lead to withdrawal symptoms.

A client is ordered to receive chlordiazepoxide (Librium) for severe anxiety. The nurse monitors for which symptoms of severe anxiety or panic attack? a. Dyspnea and heart palpitations b. Trembling, shaking, and gastrointestinal upset c. Dizziness and anorexia d. Drowsiness and blurred vision

A ~ Dyspnea and heart palpitations are symptoms of severe anxiety; also experienced is chest pain, dizziness, or faintness.

A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline

A ~ Fluvoxamine is indicated for the treatment of OCD and is classified as a selective serotonin reuptake inhibitor (SSRI). SSRIs are indicated for the treatment of depression, OCD, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorder, social phobias, and social anxiety disorders. Phenelzine is indicated for depression not responsive to other agents. Desipramine and amitriptyline are tricyclic antidepressants indicated for treatment of depression especially if accompanied by anxiety or sleep disturbances.

The nurse is caring for a patient in a state of hypnosis, which means the patient is in what state? A) A state of extreme sedation in which the person no longer senses or reacts to incoming stimuli. B) A state of tranquility in which the person can be made to do whatever is suggested by others. C) A feeling of tension, nervousness, apprehension, or fear with high levels of awareness. D) A state in which the brain is no longer sending out signals to the body.

A ~ Hypnosis is an extreme state of sedation in which the person no longer senses or reacts to incoming stimuli. A state of tranquility is produced through minor tranquilizers by decreasing anxiety. Anxiety is a feeling of tension, nervousness, apprehension, or fear. Sedation is the loss of awareness and reaction to environmental stimuli, which may lead to drowsiness. The state of suggestibility often seen in television programs is not an appropriate definition of hypnosis. If the brain stopped sending signals, the patient would stop breathing and death would follow.

The client has been placed on Ativan. The nurse is planning a client instructional session. Which herbal preparation should the nurse emphasize that the client avoid taking with Ativan? a. Kava kava b. St. Johns wort c. Ginseng d. Ginger

A ~ Kava kava in combination with Ativan will increase the sedation effects of the Ativan.

A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patients depression. What interaction will the nurse assess for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Increase in appetite D) Increased total cholesterol

A ~ MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. This patient would have to be monitored closely and appropriate dosage adjustments made; he should be taught the importance of more frequent blood sugar monitoring. The drug combination in this question would not cause an increase in appetite or increased total cholesterol.

The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? A) Monoamine oxidase inhibitors (MAOIs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants (TCAs) D) Antianxiety antidepressants

A ~ MAOIs have several serious adverse effects that can be fatal. This patients symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs are not associated with these particular symptoms. Antianxiety antidepressants are not a classification of antidepressants.

The nurse is caring for a newborn who was delivered from a woman who took benzodiazepines for anxiety during the last 2 months of her pregnancy after her husband was killed in war. What will the nurse assess for in this newborn? A) Newborn withdrawal syndrome B) Hepatic dysfunction C) Failure to thrive D) Learning deficiencies

A ~ Neonatal withdrawal syndrome may result in a baby born to a mother who was taking benzodiazepines in the final weeks of pregnancy. The neonate may be given very small doses of benzodiazepines that are withdrawn gradually to prevent symptoms. Hepatic dysfunction in the neonate is not associated with use of benzodiazepines. Failure to thrive and learning deficiencies would be long-term problems and are not assessed during the neonatal period.

A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurses best response is what? A) Sarafem and Prozac are different brand names for the same generic medication. B) Before changing drugs it is important to consider how well you responded to Prozac. C) You cannot take both drugs at the same time so it will be important to decide which is best. D) When taking both of these drugs, it is best to take one in the morning and one at night.

A ~ Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the patients medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not recognize that both drugs are the same.

The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action? A) Assess the patient for physical problems. B) Call the provider and request an antianxiety drug order. C) Increase the patients social time, encouraging interaction with others. D) Suggest the family visit more often to reduce the residents stress level.

A ~ The patient should be screened for physical problems, neurological deterioration, or depression, which could contribute to the insomnia or anxiety. Only after physical problems are ruled out would the nurse consider nondrug measures such as increased socialization with other residents or family members. If nothing else is effective, pharmacological intervention may be necessary.

The nurse assesses the patient who had an abrupt withdrawal of benzodiazepines for withdrawal syndrome and would recognize what symptoms as part of the syndrome? (SATA) A) Headache B) Nightmares C) Malaise D) Bradycardia E) Hypotension

A, B, C ~ Abrupt cessation of benzodiazepines may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. Withdrawal symptoms may be caused by the abrupt separation of benzodiazepine molecules from their receptor sites and the resulting acute decrease in gamma-aminobutyric acid (GABA) neurotransmission. Because GABA is an inhibitory neurotransmitter, less GABA may produce a less inhibited central nervous system (CNS) and therefore symptoms of hyperarousal or CNS stimulation. The nurse would not categorize hypotension or bradycardia as indicating benzodiazepine withdrawal.

The nurse is caring for a patient who received a new diagnosis of cancer. The patient exhibits signs of a sympathetic stress reaction. What signs and symptoms will the nurse assess in this patient consistent with an acute reaction to stress? (SATA) A) Profuse sweating B) Fast heart rate C) Rapid breathing D) Hypotension E) Inability to interact with others

A, B, C ~ Anxiety is often accompanied by signs and symptoms of the sympathetic stress reaction that may include sweating, fast heart rate, rapid breathing, and elevated blood pressure. Chronically anxious people may be afraid to interact with other people but this is not usually seen in an acute stress reaction.

The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patients plan of care? (SATA) A) Recent suicide attempts B) Gastrointestinal (GI) obstruction C) Affect D) Physical pain E) Personal responsibilities

A, B, C ~ When caring for a patient with a diagnosis of depression it is always important for the nurse to assess for recent suicide attempts, suicidal ideation, and any suicidal plans. After starting the medication, as the patient begins to feel better, risk of suicide increases, so ongoing assessment is essential to the patients safety. Other assessments include allergies, liver and kidney function, glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery, or recent myocardial infarction, all of which could be exacerbated by the effects of the drug. Assess history of psychiatric problems, or myelography within the past 24 hours or in the next 48 hours, or is taking a monoamine oxidase inhibitor to avoid potentially serious adverse reactions. Physical pain and personal responsibilities may be assessed but are not priority assessments unless indicated by other diagnoses.

The nurse is teaching a class for nurses working in prenatal clinics about the danger associated with use of benzodiazepines during pregnancy and explains that what fetal anomalies result from maternal use of benzodiazepines during the first trimester of pregnancy? (SATA) A) Cleft lip or palate B) Inguinal hernia C) Cardiac defects D) Microencephaly E) Gastroschises

A, B, C, D ~ Benzodiazepines are contraindicated in pregnancy because a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, or pyloric stenosis occurs when they are taken in the first trimester. Gastroschises, when the abdominal organs are found outside the abdominal cavity, is not associated with use of benzodiazepine use in the first trimester.

What reasons can the nurse give for why barbiturates are no longer considered the mainstay for treatment of anxiety? (SATA) A) Adverse effects are more severe. B) There is an increased risk of physical tolerance. C) There is an increased risk of psychological dependence. D) The most common adverse effects are related to cardiac arrhythmias. E) Hypersensitivity reactions can sometimes be fatal.

A, B, C, E ~ The adverse effects caused by barbiturates are more severe than those associated with other, newer sedatives/hypnotics. For this reason, barbiturates are no longer considered the mainstay for the treatment of anxiety. In addition, the development of physical tolerance and psychological dependence is more likely with the barbiturates than with other anxiolytics. The most common adverse effects are related to central nervous system (CNS) depression. Hypersensitivity reactions to barbiturates are sometimes fatal.

Which medications have an effect on the RAAS (Renin-Agiotensin) system? A. "sartan" B. -"olol" C.-"zosin" D.-"pril" E. "nitro"---- F. Eplerenone G. -"dipine"

A, B, D, F

Nitroprusside: Mark all that apply A. is given for hypertensive crisis for b/p greater than 180/120 B. is given to increase heart rate C. may be given slow intravenous push D. may have synergistic effect of hypotension with concurrent use of Ca+ channel blockes E. is the drug of choice in the maternity ward for hypertension for 160/98 F. needs to be placed on IV pump and titrated to acheive a drop in blood pressure

A,D,F

A client with myasthenia gravis and his family are receiving instructions from the nurse. The nurse teaches the client that insufficient dosing of cholinesterase inhibitor may result in myasthenia crisis. The client is taught about which signs and symptoms of myasthenia crisis? a. Muscle weakness; difficulty in breathing and swallowing b. Increased salivation and sweating c. Muscle weakness and increased salivation d. Decreased muscle strength in the lower extremities

A.Muscle weakness; difficulty in breathing and swallowing Response Feedback: These are the major signs of myasthenia gravis, which may be undertreated with insufficient dosing of the medication. Increased salivation is related to cholinergic crisis.

What is the BRAND NAME for ARIPIPRAZOLE?

ABILIFY

What is the BRAND NAME for LORAZEPAM?

ATIVAN

Schizophrenia

Abnormal thoughts and thought processes Disordered communication Withdrawal from other people and outside environment Severe depression High risk for suicide Most common psychotic disorder Manifests in men aged 15 to 24 years Manifests in women aged 25 to 34 years

Histamine Important role in:

Allergic reaction Regulation of gastric acid secretion

The nurse determines that the teaching plan for a client prescribed sertraliine (Zoloft) has been effective when the client makes which statement? 1. "I should not decrease my sodium or water intake." 2. "The drug can be taken concurrently with the phenelzine (Nardil) that I'm taking." 3. "It may take up to a month for the drug to reach full therapeutic effect and I'm feeling better." 4. "There are no other drugs I need to worry about, Zoloft does not react with them."

Answer Feedback: SSRI antidepressant drugs such as sertraline (Zoloft) may not have full effects for a month or longer but some improvement in mood and depression should be noticeable after beginning therapy. Options 1,2, and 4 are incorrect. Sodium and fluid intake is a concern with lithium but does not adversely affect the SSRI's. The SSRIs should not be used concurrently with MAOI's because of an increased risk for hypertensive crisis. They also have many interactions with other drugs. Response Feedback: SSRI antidepressant drugs such as sertraline (Zoloft) may not have full effects for a month or longer but some improvement in mood and depression should be noticeable after beginning therapy.

The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid, dopamine, and epinephrine

B ~ A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Acetylcholine is a neurotransmitter that communicates between nerves and muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is released in the sympathetic branch of the autonomic nervous system and can be hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid is a neurotransmitter that inhibits nerve activity and prevents over excitability or stimulation.

A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse would anticipate administering a medication in which category? a. Cholinergics b. Anticholinergics c. Antidepressants d. Dopamine agonists

B ~ Anticholinergics, such as benztropine (Cogentin), are used to decrease the EPS effects associated with antipsychotic medications.

Client teaching is important when antipsychotics are taken after discharge from the hospital. Nursing instruction should include giving which information to the client and family? a. Therapeutic effect should occur in 2 to 3 days with maximum effect in 1 week. b. The drugs should not be discontinued without consulting a healthcare provider. c. Taking barbiturates in small dosages with the drug is usually permissible. d. Rapid change in position has little effect on dizziness or blood pressure.

B ~ Antipsychotic medications affect symptoms while they are used. If they are stopped, the symptoms will recur.

A client is brought to the emergency department unconscious. The clients spouse tells the nurse that the client was found in bed with an empty pill bottle nearby. The clients spouse believes that there were 20 to 25 diazepam (Valium) pills in the bottle. What represents an appropriate nursing priority? a. Administer an emetic agent followed by activated charcoal. b. Lavage the stomach using a nasogastric tube. c. Prepare the client for emergency surgery. d. Monitor the client because there is no antidote.

B ~ Because the client is unconscious, this is the correct course of action.

The nurse is caring for a patient who has a sedative hypnotic ordered. The nurse would consider this drug contraindicated if the patient had what disorder? A) Neurological diseases B) Liver failure C) Endocrine disorders D) Heart disease

B ~ Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

What anxiolytic drugs would be given to a premenopausal patient who is a registered nurse planning to return to work at the hospital after anxiety is controlled? A) Alprazolam (Xanax) B) Buspirone (BuSpar) C) Diazepam (Valium) D) Clorazepate (Tranxene)

B ~ Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the patient needs to be alert such as when driving or working. Alprazolam, diazepam, and clorazepate are benzodiazepines, which cause drowsiness, sedation, depression, lethargy, confusion, and decreased mental alertness. It would be unsafe for a nurse to function in her role while taking one of these drugs.

When compared with benzodiazepines, buspirone (BuSpar) stands out as unique among antianxiety drugs because of what factor? A) Increases the central nervous system (CNS) depression of alcohol and other drugs. B) Lacks muscle relaxant and anticonvulsant effects. C) Causes significant physical and psychological dependence. D) Rapidly absorbed from the gastrointestinal (GI) tract and metabolized in the liver.

B ~ Buspirone, a newer antianxiety agent, has no sedative, anticonvulsant, or muscle-relaxant properties, and its mechanism of action is unknown. However, it reduces the signs and symptoms of anxiety without many of the central nervous system effects and severe adverse effects associated with other anxiolytic drugs. Most of the antianxiety drugs are rapidly absorbed from the GI tract, metabolized in the liver, have a significant drugdrug interaction with alcohol and other drugs, and can result in psychological dependence.

The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patients chart before administering the medication. What preexisting condition would require cautious use of this drug? A) Osteosarcoma B) Cardiovascular disorders C) Closed head injury D) Bleeding ulcer

B ~ Caution should be used with tricyclic antidepressants in patients with preexisting cardiovascular (CV) disorders because of the cardiac stimulatory effects of the drug and with any condition that would be exacerbated by the anticholinergic effects (e.g., angle-closure glaucoma, urinary retention, prostate hypertrophy, GI or genitourinary surgery). There is no indication that caution is needed with patients diagnosed with osteosarcoma, closed head injury, or bleeding ulcer.

The client has been placed on Risperdal. He complains to the nurse of experiencing headaches. The highest priority action on the part of the nurse is to recognize that this is a(n) ________ the medication and call the physician. a. adverse reaction to b. expected side effect of c. life-threatening reaction to d. anaphylactic reaction to

B ~ Headaches are an expected side effect of treatment with Risperdal.

An elderly patient has been taking zolpidem (Ambien) as a sleep aid for the past 2 months. On admission to the assisted-living facility, it is determined that the drug is no longer needed. What is an important nursing consideration concerning this drug? A) Hallucinations are common. B) The drug needs to be withdrawn gradually. C) Another anxiolytic will need to be substituted. D) Sundowning is common with withdrawal from this drug.

B ~ It is important for the nurse to understand that zolpidem must be withdrawn gradually over a 2-week period after prolonged use. If chloral hydrate is stopped suddenly, it will result in serious adverse effects. Hallucinations and sundowning are not common with withdrawal of the drug. The prescriber and the patient would determine the need for chloral hydrate to be substituted for another anxiolytic.

The client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered? a. Tranxene b. Romazicon c. BuSpar d. Librium

B ~ Romazicon is considered to be the benzodiazepine antagonist.

The nurse is caring for a resident in a long-term care facility who is African American with a history of an anxiety disorder. The patient is receiving oral lorazepam (Ativan) 2 mg t.i.d. When developing this patients plan of care, what priority assessment will the nurse include? A) Depression B) Extreme sedation C) Phlebitis D) Nightmares

B ~ Special care should be taken when anxiolytic or hypnotic drugs are given to African Americans. About 15% to 20% of African Americans are genetically predisposed to delayed metabolism of benzodiazepines. As a result, they may develop high serum levels of these drugs, with increased sedation and an increased incidence of adverse effects. Depression is not a common adverse effect. Phlebitis can occur at injection sites but this patient is taking the medication orally. Nightmares occur during drug withdrawal.

Why would the nurse expect the patient with liver disease to receive a smaller dose of benzodiazepines? A) Excretion of the drug relies on liver function. B) The drugs are metabolized extensively in the liver. C) They are lipid soluble and well distributed throughout the body. D) The drugs are well absorbed from the gastrointestinal tract.

B ~ The benzodiazepines are metabolized extensively in the liver. Patients with liver disease must receive a smaller dose and be monitored closely. Excretion is primarily through the urine. All of the answer options are true, but only the fact that the benzodiazepines are metabolized in the liver explains why a patient with liver disease would require smaller dosages.

The nurse is caring for a patient in intensive care unit receiving IV lorazepam (Ativan) to reduce anxiety related to mechanical ventilation. While injecting the medication the nurse notes a decrease in blood pressure and bradycardia. What is the nurses priority action? A) Discontinue drug administration. B) Give the IV drug more slowly. C) Notify the patients health care provider. D) Document the reaction to the drug.

B ~ The nurses priority action is to slow the rate of injection because rapid injection of benzodiazepines can result in hypotension and bradycardia and can lead to cardiac arrest.

A nurse is discussing the use of alprazolam (Xanax) with a 68-year-old patient. What statement indicates that the patient has an understanding of the drug? A) When I stop having panic attacks, I can stop taking the drug. B) This drug will calm me down in about 30 minutes after I take it. C) One dose will keep me calm for about 24 hours. D) I am taking an increased dose because of my age.

B ~ The onset of alprazolam is about 30 minutes. The drug must be tapered after long-term use and the duration is approximately 4 to 6 hours. Elderly patients usually have a reduced dosage.

The nurse evaluates teaching as effective when a patient taking a benzodiazepine states, A) I should always take the medication with meals. B) I should not stop taking this drug without talking to my health care provider first. C) I cannot take aspirin with this medication. D) I will have to take this medication for the rest of my life.

B ~ The patient makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines require careful monitoring and should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not contraindicated, and the medication need only be taken while the condition being treated continues. Patients with anxiety may only need the medication for a few weeks whereas those with a seizure disorder may take it for longer periods of time.

A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular injection. What is the most important nursing intervention related to the injection? a. Massage the site vigorously after injection. b. Administer the drug using Z-tracking. c. Avoid rotating the injection sites. d. Select a 22- to 23-gauge needle.

B ~ This medication is very viscous and requires Z-track, deep IM injection to avoid muscle irritation.

The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should be used when administering a benzodiazepine to the elderly because of what possible adverse effect? A) Acute renal failure B) Unpredictable reactions C) Paranoia D) Hallucinations

B ~ Use benzodiazepines with caution in elderly or debilitated patients because of the possibility of unpredictable reactions and in patients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such patients. Acute renal failure, paranoia, and hallucinations are not commonly related to therapy with these medications in the elderly.

What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)

B ~ Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. Fluvoxamine is a selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and imipramine is a tricyclic antidepressant that are not indicated for treatment of anxiety disorder and addictive behavior.

A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (SATA) A) Fever B) Myocardial Infarction C) Stroke D) Dry mouth E) Gynecomastia

B, C, D ~ Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Cardiovascular effects (e.g., orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, stroke) may occur. Fever and gynecomastia are not normally attributed to amitriptyline therapy.

What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (SATA) A) Take medication at bedtime. B) Monitor blood pressure. C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Report double vision right away E) Reduce tyramine intake

B, C, E ~ MAOIs can cause drug-drug and drug-food interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure which will elevate with tyramine ingestion and the importance of not taking any OTC without physician or pharmacist consultation due to multiple drug-drug interactions. When taking an MAOI, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred, but not double, vision is an adverse effect of an MAOI.

Which medication(s) treat Myasthenia Gravis? a.Hydroxycholorquine b. Pryidostigmine c. Bethanechol d. Methotrexate e. Baclofen f. Edrophonium

B, F Response Feedback: A Myasthenia Gravis patient is lacing acetylcholine resulting in weak muscles. The goal is to increase acetylcholine levels utilizing choinestrase inhibitors. These will block the acetylcholine enzyme, cholinesterase, allowing more acetylcholine into the system. The cholinesterase inhibitors are: pyrdostigmine and edrophonium

Ginkgo

Brain Decreases dizziness and improve memory

What would the nurse assess for when benzodiazepines are abruptly stopped? A) Urinary retention and change in sexual functioning B) Dry mouth, constipation, nausea, and vomiting C) Nausea, headache, vertigo, malaise, and nightmares D) In most cases nothing significant

C ~ Abrupt cessation of these drugs may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. When benzodiazepines are stopped abruptly the likelihood of withdrawal symptoms increases with the length of time the patient took the medication. Urinary retention, change in sexual functioning, dry mouth, constipation, nausea, and vomiting are all common adverse effects of the medications classified as benzodiazepines.

A patient presents at the free clinic complaining of nervousness, worrying about everything, and feeling very tense. What diagnose would the nurse suspect? A) Neurosis B) Psychosis C) Anxiety D) Depression

C ~ Anxiety is a common disorder that may be referred to as nervousness, tension, worry, or using other terms that denote an unpleasant feeling. The other options would not be described by these symptoms.

A patient arrives at the emergency room after attempting suicide by taking an entire bottle of diazepam. What antidote will the nurse most likely administer? A) Phenobarbital (Luminal) B) Dexmedetomidine (Precedex) C) Flumazenil (Romazicon) D) Ramelteon (Rozerem)

C ~ Flumazenil is an antidote to benzodiazepine overdose and is administered to reverse the effects of benzodiazepines when used for anesthesia. Phenobarbital, a barbiturate, would further depress the body functions of this patient. Dexmedetomidine is a new hypnotic drug used in the intensive care unit for mechanically ventilated patients. Ramelteon is also new; it is used as a hypnotic. Adverse effects of this drug include depression and suicidal ideation.

A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)

C ~ Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drugfood interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.

Hypnotic drugs are used to aid people in falling asleep. What physiological system does a hypnotic act on to be effective in helping a patient to sleep? A) Limbic system B) Sympathetic nervous system C) Reticular activating system D) Lymph system

C ~ Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system and block the brains response to incoming stimuli. Hypnosis, therefore, is the extreme state of sedation, in which the person no longer senses or reacts to incoming stimuli. The other options are incorrect.

The client has been diagnosed with schizophrenia and is exhibiting a loss of function and motivation. The nurse recognizes that these symptoms are categorized as: a. positive. b. paranoiac. c. negative. d. incoherent.

C ~ Negative symptoms are manifested as the inability to initiate voluntary motor function. The others are considered positive symptoms.

The nurse is caring for a 36-year-old man who experienced a seizure 30 minutes before coming into the emergency room, where he begins to have another. What barbiturate has the fastest onset and would be most appropriate to give to the patient to quickly stop the seizure? A) Amobarbital (Amytal Sodium) B) Mephobarbital (Mebaral) C) Phenobarbital (Luminal) D) Secobarbital (Seconal)

C ~ Phenobarbitals onset is between 10 and 60 minutes, depending on the route administered, and most likely this would be given to the patient. Amobarbital is given for convulsions and the onset is between 15 and 60 minutes. Mephobarbitals onset is between 30 and 60 minutes. Secobarbital is given for convulsive seizures of tetanus and has an onset of 1 to 4 hours.

A nurse is caring for a 4-year-old child who is receiving a barbiturate. What common adverse effect would the nurse assess for? A) Decrease in respirations B) Vomiting C) Excitability D) Dry mucous membranes

C ~ The barbiturates, being older drugs, have established pediatric dosages. These drugs must be used with caution because of the often unexpected responses. Children must be monitored very closely for central nervous system (CNS) depression and excitability. The most common adverse effects are related to general CNS depression. Other CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, a feeling of a hangover, thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Alteration in respirations and dried mucous membranes are adverse effects of antihistamines, which can be given to calm children or induce sleep. Vomiting could occur with the use of paraldehyde due to the unpleasant taste and odor of the drug.

A client has been taking a phenothiazine for 1 week. She contacts the crisis intervention clinic because she is still having symptoms. The nurses response is based on the premise that the desired effects usually take _____ to manifest. a. 1 week b. 1 to 3 weeks c. 3 to 6 weeks d. 3 to 5 months

C ~ The client may feel some effect in 7 to 10 days, but generally it takes 6 weeks for the medication to take full effect.

The client is an older adult who has been placed on Librium. The nurse recognizes that the dose of the drug _____ for this client. a. is contraindicated b. should be increased c. should be decreased d. will not change

C ~ The dose of Librium should be decreased for an older adult.

The nurse is caring for a patient who experiences anxiety and insomnia and is prescribed benzodiazepines. When developing the plan of care, what would be an appropriate nursing diagnosis related to potential adverse effects of the drug? A) Provide patient teaching about drug therapy. B) Anxiety related to drug therapy. C) Risk for injury related to central nervous system (CNS) effects. D) Avoid preventable adverse effects, including abuse and dependence.

C ~ The most appropriate nursing diagnosis related to adverse effects of the drug is risk for injury related to CNS effects because benzodiazepines can have many CNS adverse effects. Anxiety is the condition for which drug therapy is prescribed not related to drug therapy. Patient teaching and avoiding adverse effects are interventions and not nursing diagnoses.

A client is to be treated with Prolixin. The highest priority nursing intervention related to the clients vital signs is to monitor for: a. bradycardia. b. hypertension. c. hypotension. d. tachypnea.

C ~ The phenothiazine groups major side effect is hypotension.

A nurse is about to administer a parenteral benzodiazepine to a female patient in the hospital before the performance of a procedure. What is the priority nursing action before administration of the drug? A) Make sure that the side rails are up and the bed is in the lowest position. B) Close the blinds and ensure appropriate room temperature for the patient. C) Help the patient out of bed to the bathroom and encourage her to void. D) Ask all visitors to leave the room and remain in the waiting area.

C ~ The priority action would be to help the patient up to void. After the medication is administered the patient should not get out of bed because of possibly injury due to drowsiness. Safety should always be the priority concern. After administration of the drug the nurse would ask visitors to leave before beginning the procedure, make the room conducive to rest and sleep, and make sure that both side rails are up and the bed is in the lowest position.

A client is ordered to receive fluphenazine (Prolixin) to manage the psychotic symptoms of schizophrenia. The nurse assesses for which signs of anticholinergic effects? a. Bradycardia and orthostatic hypotension b. Diarrhea and tachycardia c. Urinary retention and dry mouth d. Constipation and hypertension

C ~ Urinary retention & dry mouth are the side effects of anticholinergics.

A patient is experiencing an acute asthma attack. The nurse would expect the immediate treatment to include: a. cromolyn via metered-dose inhaler (MDI). b. fluticasone via metered-dose inhaler (MDI). c. albuterol via nebulizer. d. oral montelukast.

C. ALBUTEROL Response Feedback: Beta-agonists are commonly used for the treatment of acute asthmatic attacks. Fluticasone and cromolyn are used to reduce inflammation associated with asthma; montelukast is used for prophylaxis.

What is the BRAND NAME for CITALOPRAM?

CELEXA

H1 Antagonists Overdose

CNS stimulation Convulsions

What are some conditions that may mimic the behaviors of schizophrenia?

Chronic amphetamine or cocaine use Brain neoplasm Infections Hemorrhage

A client is receiving an antipsychotic agent. Which laboratory result is of most concern? a. Serum sodium level of 138 mEq/L b. Blood glucose level of 100 mg/dl c. White blood cell count of 6000/mm3 d. Serum medication level below normal limits

D ~ A serum medication level below normal limits is a concern because subtherapeutic levels may allow for breakthrough psychotic symptoms.

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication

D ~ Adverse effects of fluoxetine include anorexia and weight loss. Although teaching about healthy eating is a good idea, it is more important to teach the patient how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The patient should increase caloric intake, not just fluid intake. The patient should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. More information about the patients baseline weight is needed before congratulating the patient because a patient who is already too thin would not appreciate the nurses comment.

A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication? A) Take medication after eating breakfast. B) Take medication with at least 8 ounces of liquid. C) The dosage may need to be increased if the patient is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.

D ~ Fluvoxamine is a selective serotonin reuptake inhibitor that should be taken once a day before bedtime. The medication does not require 8 ounces of fluid for absorption. It should be taken for at least 4 weeks before a therapeutic effect is noted.

For what purpose would the nurse choose to administer a hypnotic instead of another classification of antianxiety drug? A) Treating insomnia B) Treating seizure disorder C) Treating panic attach D) Treating confusion and agitation

D ~ Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system (RAS) and block the brains response to incoming stimuli. Hypnotics would not be the most effective drugs to treat seizure disorders, panic attack, or confusion with agitation.

The nurse is preparing a dose of Mellaril. What is the highest priority intervention for the nurse while preparing the dose? a. Draw up the dosage of the liquid in an oral syringe. b. Use a 21-gauge needle to administer the injection. c. Start a new IV site before administering the drug. d. Avoid spilling the liquid on exposed skin.

D ~ If Mellaril is allowed to come in contact with exposed skin, contact dermatitis can result.

An older adult African American patient comes to the clinic and is diagnosed with generalized anxiety disorder (GAD). The physician orders oral flurazepam 30 mg. What is the nurses priority action? A) Teach the patient about the prescribed medication. B) Administer the first dose of medication. C) Tell patient to take first dosage after driving home. D) Talk to the physician about the dosage.

D ~ If an anxiolytic or hypnotic agent is the drug of choice for an African American patient, the smallest possible dose should be used, and the patient should be monitored very closely during the first week of treatment. Dosage adjustments are necessary to achieve the most effective dose with the fewest adverse effects. In addition, older adults also require careful titration of dosage. Older patients may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) adverse effects including increased sedation, dizziness, and even hallucinations. Dosages of all of these drugs should be reduced and the patient should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur. As a result, the priority action is to talk to the physician about the dosage. The other actions may be appropriate after a proper dosage is ordered.

A client is ordered to receive diazepam (Valium). The nurse is teaching the client about her medication. Which information would be included in the teaching plan? a. The medication causes high levels of energy and activity. b. The medication is effective in aiding clients with suicidal ideations. c. The medication may be taken concurrently with other benzodiazepines. d. The client may develop tolerance after prolonged use.

D ~ Patients may become tolerant to Valium.

A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the patient for severe headaches. D) Implement suicide precautions.

D ~ Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patients safety.

What is the physiological action of tricyclic antidepressants (TCAs)? A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases the levels of norepinephrine D) Inhibiting reuptake of norepinephrine and serotonin

D ~ TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

A nurse is caring for a 9-year-old patient and has received an order for diazepam (Valium) 10 mg given orally q.i.d. What is the nurses priority action? A) Perform hand hygiene and prepare the drug. B) Send the order to the hospital pharmacy. C) Determine when to administer the first dose. D) Call the physician and question the order.

D ~ The first action of the nurse would be to call the physician and question the order. The normal oral dosage for a pediatric patient is 1 to 2.5 mg t.i.d. or q.i.d. The ordered dose would be unsafe for this patient. If the dosage was changed and the correct amount administered, the nurse would order the medication from the pharmacy if necessary and determine what time to start the medication. She would then wash her hands in preparation for administering the medication, but not until obtaining an appropriate dosage of medication.

A patient is being discharged home from the hospital after receiving treatment for pneumonia. The patient is going home and continuing to take the same drugs he or she was taking before he or she was hospitalized. These drugs include an antianxiety medication and a medication for insomnia. The home care nurse is following this patient. On the initial visit what is the nurses priority teaching point? A) The names and purposes of medications prescribed B) How to contact the provider if needed C) The importance of taking medications for insomnia only occasionally D) Warning signs that may indicate serious adverse effects

D ~ The home care nurse should provide thorough patient teaching, with a priority teaching point being the warning signs the patient may experience that indicate a serious adverse effect. Although this may have been discussed by the discharging nurse in the hospital, this is essential information for the patient to thoroughly understand. By the time the home care nurse visits, the patient should already have filled the prescriptions and know the names and purposes of the medications prescribed from the hospital nurse but it is a good idea to review this information, although it is not a priority. Medications for insomnia should be taken as prescribed. The patient should have received the providers contact information when leaving the hospital but the home care nurse may need to review this, even though it is not the priority teaching point.

The nurse is caring for a patient who has not been able to sleep. The physician orders a barbiturate medication for this patient. What adverse effect should the nurse teach the patient about? A) Double vision B) Paranoia C) Tinnitus D) Thinking abnormalities

D ~ The most common adverse effects are related to general central nervous system (CNS) depression. CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, a resembling a hangover, thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Barbiturate drugs generally do not cause double vision, paranoia, or tinnitus.

What is a common side effect for which the nurse must monitor during administration of both phenothiazine and non-phenothiazine medications? a. Hypertension b. Renal failure c. Increase in number of white blood cells d. Extrapyramidal symptoms

D ~ These medications are known for their extrapyramidal symptoms.

A patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess this patient for? A) Seizures B) Tachycardia C) Headache D) Coma

D ~ Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Seizures, tachycardia, and headache would not normally be associated with benzodiazepine toxicity.

A 72-year-old patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening. The nurse suspects benzodiazepine overdose and would expect what drug to be ordered? A) Valium B) Phenergan C) Hydroxyzine D) Flumazenil

D ~ Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil is an antidote for the benzodiazepines. Hydroxyzine is an antihistamine with anticholinergic effects and would not be appropriate for this patient. Valium would enhance the effects of benzodiazepines. Phenergan is not indicated for this patient; it is similar in actions to hydroxyzine.

A nurse is care for a client who received a bolus dose of succinycholine (Anectine) IV before an endoscopy procedure. During the procedure, the client suddenly develops rigidity, and his body temperature begins to rise. The nurse should anticipate a prescription for which of the following medications? A second dose of succinycholine (Anectine) Naloxone (Narcan) as an antagonist at receptor sites. Dantrolene (Dantrium) to slow metabolic activity of muscles. Vecuronium (Norcuron) as an adjunct to muscle relaxation.

Dantrolene (Dantrium) to slow metabolic activity of muscles.

Nonpharm approaches to difficulty concentrating

Decrease caffeine, stimulus, quiet time, high glucose diets

What is the BRAND NAME for AMITRIPTYLINE?

ELAVIL

Anticholinesterase inhibitors Medications

Edrophonium chloride (Tensilon) used only to diagnose MG Neostigmine bromide (Prostigmin) Pyridostigmine bromide (Mestinon) Maintenance drug of choice for MG Ambenonium (Mytelase) Not tolerating other drugs Atropine Sulfate Anticholinergic agent used as an antidote

Neuroleptic malignant syndrome

Elevated temperature (102 or higher) Unstable blood pressure profuse sweating dyspnea muscle rigidity incontinence

Histamine Distribution (powerpoint)

Especially high in skin, lungs, and GI tract

Nonpharm approaches to difficuly sleeping

Exercise Yoga Meditation Breathing exercises massages avoiding large meals no caffeine or nicotine

A patient receiving Lorazepam is complaining of shortness of breath, and the b/p is now beginning to drop. What do expect the physican to order? 1. Naloxone 2. Acetylcystiene 3. Activated Charocoal 4. Flumazenil

Flumazenil

What is the BRAND NAME for ZIPRASIDONA?

GEODON?

Ginger

GI tract decreases nausea and vomiting

What are some considerations with antipsychotics and drug compliance?

Goal is to reduce psychotic symptoms so patients have ability to self-care Drugs do not cure mental illness Patients must continue drug regimen to remain in remission Relapse rate for those who discontinue medication 60% to 80%

If they are having a myasthenic crisis, they don't have enough medicine on board?

If you give them a tensilon, then it will get better.

Edrophonium chloride (Tensilon) action

Inhibits destruction of acetylcholine by acetylcholinesterase Increases acetylcholine at the neuromuscular junction and improves neuromuscular contraction

Pyridostigmine (Mestinon) action

Inhibits the destruction of acetylcholine by acetylcholinesterace Increases acetylcholine at the neuromuscular junction...improves neuromuscular contraction

If they are having a cholinergic crisis and you give them tensilon what will happen?

It will worsen

What is the BRAND NAME for ESCITALOPRAM?

LEXAPRO

What is the BRAND NAME for ISOCARBOXAZID?

MARPLAN

Mrs. Balboa, a client wiht congestive heart failure, has a slighly elevated BUN. What is the most likely explanation for the abnormal BUN? 1. Impaired liver function 2. Poor renal perfusion 3. Plasma dilution caused by aldosterone increase 4. Increased protein breakdown cause by stress

Poor renal perfusion

What is the BRAND NAME for RISPERIDONE?

RISPERDAL

H1 Antagonists Peripheral effects

Reduce localized flushing Reduce itching and pain

Extrapyramidal symptoms (EPS), also called pseudoparkinsonism, are a side effect of perphenazine (Trilafon). The nurse should assess and observe for signs of akathisia, which is: 1. chewing motion 2. involuntary eye movement 3. restlessness and constant moving about 4. facial grimacing

Response Feedback: Akathisia is described as restless, agitated movement, not associated with psychotic symptoms.

A client receiving clopidogrel (Plavix) has the following conditions as part of the health history. Which causes the greatest concern to the nurse? 1. active peptic ulcer 2. glaucoma 3. asthma 4. allergy to shellfish

Response Feedback: An active peptic ulcer may bleed subsequent to use of this medication.

A client who is taking digoxin also has a history of gastroesophageal reflux disease. The client takes Mylanta II (magnesium and aluminum hydroxide) and Tums (calcium carbonate). The client needs to space the medications apart because antacids taken with digoxin cause: 1. diarrhea 2. increased absorption of digoxin 3. decreased absorption of digoxin 4. anorexia and nausea

Response Feedback: Antacids interfere with the absorption of digoxin.

Side effects associated with antihistamines and anticholinergics include: 1. bradycardia and fatigue 2. abdominal cramps and nausea 3. tachycardia and dyspnea 4. drowsiness and dry mouth

Response Feedback: Anticholinergics cause salivary depression and fatigue.

The new anticholinergic drug used to treat asthmatic conditions by dilating the bronchioles is: 1. Aristocort 2. Amcort 3. theophylline (Theo-Dur) 4. ipratropium (Atrovent)

Response Feedback: Anticholinergics open the airway by suppressing the parasympathetic response. Option 4 is the only medication that is an anticholinergic; the others are not

Choose a medication used as a urinary stimulant: a. Bethanechol b. Cyclophosphamide c. Tolterodine Tartrate d. Infliximab

Response Feedback: Bethanechol is a urinary stimulant.

A client is admitted with the diagnosis of Parkinson's disease. The nurse is vigilant for which of the following symptoms? 1. disorientation 2.inability to remember his name 3.bradykinesia (slow movement) 4.gastrointestinal upset

Response Feedback: Bradykinesia, or slow voluntary movement, is characteristic of this disorder.

A client enters the emergency clinic with the following symptoms: difficulty walking, pain in his toes, and aches in his feet. The nurse would anticipate giving which of the following medications to treat his acute gout episode? 1. gold (auranofin) 2. colchicine (Novocolchine) 3. allopurinol (Xyloprim) 4. ibuprofen (Advil)

Response Feedback: Colchicine is used for acute gouty episodes.

A client with chronic and progressive multiple sclerosis is ordered to receive cyclophosphamide (Cytoxan) to decrease symptoms. Based on this class of drug, which nursing diagnosis is a priority during this treatment? a. Risk for infection owing to immunosuppression b. Risk for deficient fluid volume owing to diuresis c. Risk for constipation owing to neurotoxicity d. Risk for injury owing to seizure activity

Response Feedback: Cytoxan is an immunosuppressant and may cause life-threatening neutropenia.

Prazosin (Minipress) and minoxidil (Loniten) cause vasodilation to control hypertension and can cause sodium and water retention. The drugs that may be used with these antihypertensives are: 1. diuretics 2. cortisone preparations 3. narcotics 4. digoxin derivatives

Response Feedback: Diuretics may be used in conjunction with these agents to lower water volume in the body.

A nurse is teaching a client about lifestyle changes when taking a potassium-sparing diuretic. Which of the following statements indicates a need for more teaching? 1. "I need to have my blood drawn frequently." 2. "I need to eat foods high in potassium, like bananas." 3. "I need to be careful when out in the sun." 4. "I need to call the clinic if I notice I am not urinating as much as usual."

Response Feedback: Eating high-potassium foods with potassium-sparing diuretics can lead to hyperkalemia.

A client receiving anticonvulsants for epilepsy should be instructed that: 1. "Seizure disorders are cured with anticonvulsants such as Dilantin." 2. "The medication is taken for a lifetime." 3. "The medication is taken until you are seizure-free." 4. "Seizures are unpredictable, and therefore so is the drug regimen."

Response Feedback: Epilepsy usually requires a lifelong regimen of anticonvulsant medications.

The nurse determines that a client taking phenytoin (Dilantin) is admitted to the emergency department with a level of 30 mcg/ml. The nurse would evaluate for which one of the following severe side effects? 1. abdominal distention 2. gingival hyperplasia (gingivitis) 3. hypertension 4. abdominal cramps

Response Feedback: Gingival hyperplasia is a known and common side effect of high phenytoin levels.

Ipratropium as a bronchodilator is classified as a(n): a. xanthine derivative. b. beta2 adrenergic agonist. c. antiallergy. d. anticholinergic.

Response Feedback: Ipratropium is an anticholinergic drug that works by inhibiting the component of bronchoconstriction that is mediated by the parasympathetic nervous system. The other responses are incorrect.

Intranasal glucocorticoids (steroids) are effective for treating allergic rhinitis. The use of intranasal glucocorticoids: 1. should occur during symptoms, because most allergic rhinitis is seasonal 2. should not be done in combination with other intranasal rhinitis medications 3. could cause systemic effects when used longer than 30 days 4. causes an increase in inflammatory action during allergic rhinitis

Response Feedback: It is rare for systemic effects of steroids to occur, but they are more likely to result with the use of intranasal dexamethasone, which should not be used for longer than 30 days.

A client is receiving atorvastatin (Lipitor) for high blood cholesterol level. Which of the following warrants the client's immediate contacting of the health care provider? 1. GI distress 2. constipation 3. flushing of the skin 4. muscle aches

Response Feedback: Muscle aches may be an early sign of a serious condition known as rhabdomyolysis.

A patient has been given an albuterol metered dose inhaler (MDI). During patient teaching, the health care provider instructs the patient to wait how long between puffs of the drug? a. 10 seconds b. 2 minutes c. 30 seconds d. 5 minutes

Response Feedback: Patients should be taught to wait 2 minutes before administering the second puff of albuterol to permit adequate delivery of the drug to respiratory tissues.

Phenytoin is contraindicated during pregnancy because of the possibility of: 1. aborting the fetus 2. teratogenic effects on the fetus 3. severe abdominal cramps 4. severe vomiting and diarrhea

Response Feedback: Phenytoin taken during pregnancy, especially the first trimester, may lead to teratogenic effects.

Antihistamines are divided into first and second generations. Second-generation antihistamines: 1. have fewer anticholinergic symptoms 2. cause many anticholinergic symptoms 3. cause drowsiness and dry mouth 4. can cause central nervous system depression with alcohol use

Response Feedback: Second-generation antihistamines are formulated with fewer anticholinergic symptoms.

A client who smokes is receiving theophylline products. Because of his history of smoking, the nurse would expect that the dose would be: 1. decreased 2. increased 3. the same 4. closely monitored

Response Feedback: Smoking interferes with theophylline metabolism; the dose will need to be increased in order to have a therapeutic effect.

The client is being treated with a glucocorticoid medication. The nurse plans to monitor him closely for evidence of: a. hypoglycemia. b. hyperkalemia. c. hypertension. d. hypovolemia.

Response Feedback: Steroids may lead to fluid overload and hypertension.

Which nursing intervention would be the highest priority to prevent systemic absorption of eye drops? a. Have the patient perform the Valsalva maneuver during administration. b. Apply the drops in the outer canthus of the eye. c. Have the patient close the eyes for 2 minutes after instillation. d. Apply pressure to the lacrimal duct after administration.

Response Feedback: The application of pressure to the lacrimal duct after administration of eye drops will prevent systemic absorption of the drops.

A client has been taking a phenothiazine for 1 week. He contacts the crisis intervention clinic because he is still having symptoms. The nurse's response is based on the premise that the desired effects usually take: 1. 1 to 3 weeks 2. 3 to 6 weeks 3. 1 week 4. 3 to 5 months

Response Feedback: The client may feel some effect in 7 to 10 days, but generally it takes 6 weeks for the medication to take full effect.

A client is ordered to receive a nitrate to relieve stable angina. A common side effect to anticipate in a client receiving this medication includes: 1. a pounding headache 2. pruritus and skin rash 3. increased blood pressure 4. nausea and vomiting

Response Feedback: The pounding headache is related to vasodilation of the cerebral vessels.

What laboratory tests should be monitored while a client receives treatment with the statin medications? 1. liver enzymes 2. electrolytes 3. urinalysis 4. CBC

Response Feedback: The statin medications are hepatotoxic.

The phenothiazines and non-phenothiazines are effective for treating positive symptoms of psychotic behavior. A common side effect for which the nurse must monitor is: 1. extrapyramidal symptoms (EPS) 2. increase in number of white blood cells (WBCs) 3. renal failure 4. hypertension

Response Feedback: These medications are known for their extrapyramidal symptoms.

Drugs that loosen bronchial secretions are from which of the following groups? 1. expectorants 2. decongestants 3. antihistamines 4. antitussives

Response Feedback: This is the definition of expectorants—breaking up mucus.

A client is to be treated with a carbonic anhydrase inhibitor as a means to decrease intraocular pressure. What priority instruction should be included in the nurse's teaching plan? Allow 5 to 10 minutes after instillation before using another medication. Provide strict fluid restrictions at all times. Provide environmental safety and seizure precautions. Encourage the client to sit in sunlight to enhance metabolism of the drug.

Response Feedback: To promote maximum absorption, the client should allow 5 to 10 minutes after the drops are

Alpha1 -adrenergic blockers promote vasodilation, causing: 1. rapid respiration 2. increased blood pressure 3. decreased blood pressure 4. decreased pulse rate

Response Feedback: Vasodilation leads to a decrease in blood pressure.

A client is ordered to receive digoxin. Based on its half-life of 36 hours, the nurse would anticipate administering the maintenance dose: 1. once a week 2. three times a day 3. once a day 4. twice a day

Response Feedback: With its half-life, digoxin will be administered daily.

The asthma medication that works to prevent leukotrienes from causing inflammation in the airways is: Answers: a. isoproterenol (Isuprel). b. epinephrine (Primatene) c. zarfirlukast (Accolate). d. theophylline (Theo-Dur).

Response Feedback: Zarfirlukast is classified as an antileukotriene agent and works by blocking the action of leukotrienes, thus reducing inflammation in the airways. Epinephrine and isoproterenol are beta-agonists; theophylline is a xanthine derivative. Both of these classes of medications work as bronchodilators.

Pyridostigmine (Mestinon) Uses

Reverses nondepolarizing neuromuscular blockers Treat MG Once they start it, they will take it for the rest of their life. Looking for improvement in symptoms Looking at the quality of respirations, VC

What is the BRAND NAME for QUETIAPINE?

SEROQUEL

Pyridostigmine (Mestinon) side effects

Seizures Bradycardia Bronchospasm Bronchoconstriction Increased secretions Atropine as reversal Monitor HR, RR

A client who has osteoporosis has a new prescription for alendronate (Fosamax). Which of the following instructions should the nurse provide for the client? (Select all that apply) Take medication in the morning before eating Chew tablets to increase bioavailability. Drink a full glass of water with each tablet. Take Fosamax with an antacid if heartburn occurs. Avoid lying down after taking this medication.

Take medication in the morning before eating Drink a full glass of water with each tablet Avoid lying down after taking this medication.

when should patients take Mestinon?

Take same time every day!!!! patients dose it based on what is good for them ex. they will take it around meals so that they can chew effectively

Edrophonium chloride (Tensilon) Uses

Test the neuromuscular junction in order to diagnose MG Also used to differentiate between myasthenia and cholinergic crises

H1 Antagonists Effects on the CNS

Therapeutic dose: CNS depression (can cross BBB) Second-generation negligible CNS depression

Symptoms of schizophrenia

Variety - may change over time *Postive symptoms* - add to normal behavior -hallucinations, delusions, paranoia -strange/irrational behavior, actions -rapid alteration between extreme hyperactivity and stupor *Negative symptoms* - subtract from normal behavior -lack of motivation, detachment -deterioration of hygiene, job, academic performance -withdrawal from social and interpersonal relationships

What is the BRAND NAME for OLANZAPINE?

ZYPREXA

The client with ________ would not be a candidate for treatment with valproic acid (Depakene).

a liver disorder

Phenothiazines: adverse effects

acute dystonia akathisia anticholinergic effects disparity hypotension neuroleptic malignant syndrome secondary parkinsonism sedation sexual dysfunction tardive dyskinesia

Another name for sympathomimetic is: 1. cholinergic blockers 2. adrenergic agonists 3. adrenergic blockers 4. cholinergic agonists

adrenergic agonists Response Feedback: This is a synonym for sympathomimetic.

Gastric irritation may occur when taking ethosuximide (Zarontin). The nurse suggests taking the drug:

at mealtime or immediately after a meal

A client has increased intraocular pressure, and pilocarpine (Isopto Carpine, Pilopine HS, others) has been ordered. The nurse needs to review the medical history because this drug would be contraindicated for the client with: a. kidney disease. b. asthma. c. cardiovascular disease. d. ulcer disease.

b. asthma Response Feedback: This medication, while dilating the pupils, may constrict the airway

Atypical antipsychotics: mechanism of action

block dopamine type 2 receptors, serotonin and alpha-adrenergic receptors

Nonphenothiazines: mechanism of action

blocking of the dopamine type 2 receptor

Phenothiazines: mechanism of action

blocks positive symptoms of schizophrenia

A client is receiving a thrombolytic drug, alteplase (Activase), following an acute myocardial infarction. Which of the following effect is most likely attributed to this drug? skin rash with urticaria wheezing with labored respirations bruising and epitaxis temperature elevations of 100.8 F

bruising and epitaxis

A child is brought to the healthcare provider's office. The child has been receiving phenytoin (Dilantin) for seizure activity. The family reports that despite the child's previously reported controlled seizures, the child has been seizing two or three times a day. The nurse would anticipate that the:

child's phenytoin level will be drawn

Phenothiazines: prototype drug

chlorpromazine

A patient with asthma has an order for salmeterol, 2 puffs every 12 hours. The nurse would assess which of the following to detect adverse effects following a dose of this drug? a. Pupillary reaction b. Level of consciousness c. Deep tendon reflexes d. Heart rate

d. Heart rate Response Feedback: As a beta2 adrenergic agonist, salmeterol can cause cardiac stimulation, resulting in increased heart rate and palpitations.

Osmotic diuretics are primarily prescribed for: 1. lowering the blood pressure 2. lowering pulse rate 3. decreasing intracranial and intraocular pressures 4. maintaining serum potassium level

decreasing intracranial and intraocular pressures Response Feedback: These are the major uses of osmotic diuretics.

A child enters the emergency department. The paramedics report that the child has been having a seizure that has lasted for 45 minutes. In addition to securing and maintaining an airway, what is a priority intervention on the part of the nurse?

diazepam (Valium)

A client enters the emergency department in status epilepticus. The nurse anticipates the administration of:

diazepam (Valium)

Which of the following dietary restrictions is indicated with carbamazepine (Tegretol)?

do not drink grapefruit juice

A client with a known seizure disorder enters the emergency department. The nurse notes that his gums are swollen and bleeding. What is a priority nursing intervention?

draw a phenytoin level

A client is ordered to receive an anticonvulsant for seizure activity. Which side effects are most prevalent with clients who take drugs in this class?

drowsiness and lethargy

A client has been receiving phenytoin (Dilantin) for 15 years. The nurse implements which diagnostic test to assess for a common adverse reaction to long-term medication use?

fasting blood glucose level

Atypical antipsychotics: adverse effects

fewer than those of phenothiazines and nonphenothiazines, but obesity and its risk factors need to be monitored

Phenothiazines: primary use

for severe mental illness

A client taking phenytoin (Dilantin) is admitted to the emergency department with a level of 30 mcg/mL. The nurse would evaluate for the severe side effect of:

gingival hyperplasia

Nonphenothiazines: prototype drug

haloperidol (Haldol)

A client has been taking phenytoin (Dilantin) for 10 years. This client should be evaluated for:

hyperglycemia

Nonphenothiazines: adverse effects

identical to those of phenothiazines

Valerian and melatonin

improve sleep

A positive inotropic action is one of the effects of digitalis drugs. Positive inotropic action means: 1. decreased heart rate 2. decreased myocardial contraction 3. increased myocardial contraction 4. decreased conduction of the myocardium

increased myocardial contraction Response Feedback: Inotropic means myocardial contractility.

The client has been started on phenytoin. He reports experiencing reddish-colored urine. What is the nurse's highest priority intervention?

instruct the client that this is an expected side effect of the medication

A client with a new seizure disorder is ordered to receive phenobarbital (Luminal) for seizures. The nurse would expect:

lethargy

Rebound congestion may result if a client overuses a nasal decongestant spray. Rebound congestion is: 1. reduction of nasal congestion 2. rebound vasoconstriction of the nasal mucosa 3. reduction in fluid secretion 4. rebound vasodilation of the nasal mucosa

rebound vasodilation of the nasal mucosa Response Feedback: Congestion is caused by vasodilation and may result from overuse of decongestants.

Atypical antipsychotics: prototype drug

risperidone (Risperdal)

Nonphenothiazines: primary use

severe mental illness

Atypical antipsychotics: primary use

severe mental illness treats both positive and negative symptoms

The client has been started on valproic acid. Her level of the medication is drawn and is found to be 60 mcg/mL. The nurse notes that this is a(n) _____ level.

therapeutic