The Neurological System (Part 2) Test

A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops. Which of the following adverse effects should the nurse include in the teaching?

-Bradycardia Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1 receptors. Clients should check their pulse rate regularly and report any sustained decreases.

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity?

-Furosemide for hypertension Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity.

A nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past 2 weeks. Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome?

-Hallucinations Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome.

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions?

-Hypertensive crisis Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in clients who are taking phenelzine. Manifestations include hypertension, headache, and nausea.

A nurse is caring for a client who has admitted to the emergency department with a head injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. For which of the following adverse effects is the client at increased risk?

-Seizure activity Bupropion, an atypical antidepressant, can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically?

-​Thyroid function tests ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter.

A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. Which of the following client statements indicates an understanding of the teaching?

-"If I become pregnant, it is important to let my health care provider know." Diazepam can increase the risk of congenital malformations and is contraindicated for clients who are pregnant.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include?

-"If you have persistent headaches, let the provider know." The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction.

A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. Which of the following instruction should the nurse include?

-"Take a missed dose as soon as you remember." Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose.

A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle glaucoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

-Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the drug from entering the systemic circulation. -Do not touch the tip of the dropper The tip of the dropper should remain sterile. It is important that clients avoid touching the dropper's tip or touching it to the eye area. -Remove contact lenses prior to instilling the drops Clients should remove contact lenses before instilling eye drops because they can cause further irritation if left in place.

A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs.

-Imipramine Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients who take this drug should change positions slowly from sitting or lying to standing.

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instruction should the nurse include?

-Wear sunscreen when exposed to sunlight. Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors.

A nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects?

-Withdrawal symptoms Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.

A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine?

-​Phenelzine Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever.

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include?

Avoid taking NSAIDs. NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs.

A nurse is caring for a client who has a prescription for alprazolam. For which of the following adverse effects should the nurse monitor? (Select all that apply.)

-Tolerance Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Clients should use these drugs only as needed and for short periods of time. -Anxiety Paradoxical reactions, such as anxiety and insomnia, can develop when taking alprazolam, especially in older adults. Clients should report these findings. -Sedation CNS depression, manifested as sedation and drowsiness, is an adverse effect of benzodiazepines, such as alprazolam. Clients should take a benzodiazepine 30 min prior to bedtime. -Respiratory depression Benzodiazepines, such as alprazolam, can cause CNS depression when taken with other CNS depressants, especially for older adult clients. It is important to monitor for respiratory depression and recommend the lowest effective dose. Clients should avoid alcohol and other CNS depressants while taking a benzodiazepine.

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and who was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse suspect?

-Acute dystonia Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine.

A nurse is providing teaching to a client who has a prescription for buspirone. Which of the following instructions should the nurse include?

-Allow 2 to 4 weeks for full therapeutic effects. It can take up to 4 weeks for a client to feel the drug's full therapeutic effects.

A nurse is assessing a client who has been taking alprazolam for several days. Which of the following findings should the nurse identify as an adverse drug reaction caused by alprazolam?

-Anxiety The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the provider, who might consider a different medication.

A nurse should identify that timolol is contraindicated for a client who has which of the following disorders?

-Asthma Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients who have asthma or any disorder that compromises respiratory function should not use the drug.

A nurse is caring for a client who has schizoaffective disorder and who has been prescribed chlorpromazine. Which of the following laboratory values should the nurse monitor during and immediately after IV administration of the drug?

-Blood pressure Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV administration. They should remain supine for 30 min while the nurse monitors their blood pressure. It is essential to infuse the chlorpromazine solution slowly and not to mix it with other drugs.

A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. Which of the following instructions should the nurse include? (Select all that apply.)

-Change positions slowly from sitting or lying to standing Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension. Clients should move slowly from sitting or lying to standing. -Do not stop taking the drug abruptly. Relapse and withdrawal symptoms can occur with abrupt discontinuation of amitriptyline. When discontinuing the drug, it is important to reduce the dosage over a 2-week period to prevent or minimize withdrawal symptoms. -Take the drug at bedtime to prevent daytime drowsiness. Amitriptyline, a tricyclic antidepressant, can cause drowsiness. Clients should take the drug at bedtime and avoid activities that require alertness until they know how the drug will affect them. -Increase fiber and fluid intake. Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Clients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason fro the prescription modification?

-Renal function impairment Alprazolam dosage should be decreased for clients who have renal or hepatic impairment.

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? (Select all that apply.)

-Seasonal affective disorder Bupropion, an atypical antidepressant, helps prevent and treat seasonal affective disorder, a type of depression associated with the reduction of natural light during winter months. -Nicotine addiction Bupropion, an atypical antidepressant, is an appropriate adjunct for clients who are trying to quit smoking. -Depression Bupropion, an atypical antidepressant, can help treat depression.

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply.)

-Tremors A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. -Confusion Confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range. -Nausea Nausea, vomiting, and diarrhea are early indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Clients should report any of these adverse effects. -Muscle weakness Muscle weakness is an early indication of lithium toxicity that develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels periodically.