WITC - Pharmacology Test 2

What suffix do beta blockers have at the end of their names?

You'll see - olol for most beta blockers (propranolol, nadolol, metoprolol)

What are four adrenergic receptors?

alpha 1, alpha 2, beta 1, beta 2

What are three serious side effects of anticholinergic medications?

Confusion, depression, hallucinations, nightmares, palpitations, dysrhythmias.

Anticholinergic effects: Mydriasis - what is it? Who might Cholinergic effects: Miosis - what is it?

Mydriasis is dilation of the pupil of the eye.

What are three responses when alpha receptors are stimulated?

Vasoconstriction, increased circulation, increased BP

Why do we tell patients not to suddenly stop taking (or poorly adhere to schedule of) an adrenergic beta blockers? How slowly should they taper off?

Exacerbations of anginal symptoms may happen as well as possible myocardial infarction. Taper over 1 to 2 weeks with careful monitoring.

What affect do anticholinergic drugs do?

Block the action of acetylcholine in the parasympathetic nervous system.

What are primary uses for sedative hypnotic medications ?

1) To improve the sleep patterns for the temporary treatment of insomnia. 2) To decrease the level of anxiety and increase relaxation or sleep before diagnostic procedures or operative procedures. (p189)

Nursing consideration for adrenergic blocking agents. When would you withhold the med?

Check vitals. If pulse is less than 60 or systolic BP is less than 90mmHG, hold drug.

Where are they located and when stimulated, what do Alpha 2 receptors do?

Located in the postganglionic sympathetic nerve endings. When these receptors are stimulated, they inhibit the release of norepinephrine, leading to a decrease in vasoconstriction. This results in vasodilation and a decrease in blood pressure.

What's the difference between a sedative and a hypnotic drug?

Sedative = feelings of relaxation and rest. Hypnotic = produces sleep.

What are three common adverse effects of anticholinergic medications?

Sensory blurred vision, constipation, urinary retention, dryness of mucosa of the mouth, nose and throat.

11. The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for treatment of depression. Which physical assessment finding is most important for the nurse to report to the health care provider immediately? a. Bradycardia b. Dizziness c. Drowsiness d. Urinary retention

ANS: A Bradycardia with a drop in 15 beats/min is to be reported to the health care provider immediately; withholding the dose is warranted until approved. Dizziness, drowsiness, and urinary retention are common adverse effects that would not need to be reported to the health care provider.

6. The nurse is preparing to educate a patient and significant other about antianxiety medications before the patients discharge. What is pertinent information to be included in the teaching plan? a. Discuss, review, and validate the behavior monitoring system and intervention flow sheet the patient and significant other will continue to use following discharge. b. Discuss the possible dependence associated with the medication at length to make sure the patient does not overuse the drug. c. Instruct the patient to educate family members about the medication therapy, based on recollection of discussions with the nurse. d. Provide all instructions verbally, with repetition as needed when requested by the patient.

ANS: A It is the responsibility of the nurse to educate patients about their therapy, monitoring for therapeutic benefit and adverse effects to expect and report, and intervening whenever possible to optimize therapeutic outcomes. Making the patient fearful of the medication therapy defeats the purpose of using the drug to control anxiety. The topic should be mentioned because it is important, but it should not be emphasized. Family members or significant others should participate in discussions with the nurse whenever possible, and the patient should be given written instructions to refer to after discharge. Verbal instruction should be backed up with written documents for the patient to refer to after discharge.

17. What can occur as a result of rapid withdrawal from long term use of barbiturate therapy? (Select all that apply.) a. Anxiety b. Delirium c. Weakness d. Grand mal seizures e. Severe pain

ANS: A, B, C, D Anxiety, delirium, weakness, and grand mal seizures can be symptoms of rapid withdrawal from long term use of barbiturate therapy. Severe pain is not a symptom of rapid withdrawal from long term use of barbiturate therapy.

15. What important point(s) of patient education should be included about disulfiram (Antabuse) therapy? (Select all that apply.) a. The patient should return for liver function tests in 10 to 14 days following initiation of therapy. b. Headache, fatigue, and a metallic taste are common adverse effects that usually resolve. c. Avoid alcohol ingestion to prevent a reaction. d. Carefully read all labels for possible alcohol content, including perfumes, and over the counter (OTC) medications such as cough syrups. e. Report to the health care provider any allergic symptoms, such as hives or pruritus.

ANS: A, B, C, D Baseline laboratory data include liver function tests and alcohol screening. Headache, fatigue, and a metallic taste are common adverse effects of disulfiram. Disulfiram is a drug used to treat chronic alcoholism that produces a very unpleasant reaction to alcohol. Patients should be instructed to read all labels of topical substances and OTC drugs for alcohol content, as well as avoiding any foods that may be prepared with alcohol. Disulfiram is unlikely to cause allergic reactions.

15. Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia

ANS: A, B, C, D Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome. Bradycardia is not a sign of neuroleptic malignant syndrome.

15. Why are benzodiazepines often preferred over barbiturates? (Select all that apply.) a. They have selective action at specific receptor sites. b. There is a wide range of safety between therapeutic and lethal levels. c. REM sleep is decreased to a lesser extent. d. Accidental overdoses are well tolerated. e. There are no hypotensive episodes when rising to a sitting position.

ANS: A, B, C, D The selectivity of specific drugs at receptor sites accounts for the wide variety of uses. There is a wide safety margin between the therapeutic and lethal dosages for these drugs. Benzodiazepines decrease REM sleep to a lesser extent. Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal. There are transient hypotensive episodes with benzodiazepine therapy.

16. Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia

ANS: A, B, D, F Antipsychotic drugs can cause neuroleptic malignant syndrome and motor dysfunctions such as dystonia, akathisia, and tardive dyskinesia. Antipsychotic drugs may cause weight gain and hyperglycemia.

3. A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of 106 F. The admitting diagnosis is neuroleptic malignant syndrome resulting from antipsychotic medication. Which drug is indicated in treatment of this condition? a. Edrophonium (Tensilon) b. Dantrolene (Dantrium) c. Baclofen (Lioresal) d. Metaxalone (Skelaxin)

ANS: B Dantrolene, a direct acting skeletal muscle relaxant, is used to treat neuroleptic malignant syndrome associated with the use of antipsychotic agents. Edrophonium is an antidote for neuromuscular-blocking agents. Baclofen is a skeletal muscle relaxant used for the treatment of muscle spasticity resulting from multiple sclerosis (MS) and cerebral palsy. Metaxalone is used for muscle spasms. Succinylcholine (Anectine), a neuromuscular-blocking agent, is used to paralyze muscles while a patient is on a ventilator.

8. How long after the administration of a parenteral pain medication will the nurse complete the next pain assessment to evaluate the effectiveness of the medication? a. 10 minutes b. 30 minutes c. 1 hour d. 2 hours

ANS: B Evaluation of pain effectiveness of parenteral pain medications needs to occur within 15 to 30 minutes of administration. Ten minutes, 1 hour, and 2 hours are not accurate time frames to evaluate the effectiveness of parenteral medications.

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

ANS: B Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood.

2. Which is a benzodiazepine of choice when treating anxiety associated with alcohol withdrawal? a. Chlordiazepoxide (Librium) b. Oxazepam (Serax) c. Diazepam (Valium) d. Clorazepate (Tranxene)

ANS: B Oxazepam and lorazepam are the drugs of choice in treating anxiety disorders because they have no active metabolites. Chlordiazepoxide and clorazepate are not the drugs of choice when treating anxiety associated with alcohol withdrawal. Diazepam has not been studied as fully as oxazepam in treating patients who have hepatic function impairment.

8. The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching? a. This medication will help slow the development of symptoms. b. I will place the tablet on my tongue before breakfast. c. I may need to use a stool softener for constipation. d. I should not push the tablet through the foil.

ANS: B Selegiline orally disintegrating tablets should be taken in the morning before breakfast, without liquid. This medication is used to slow the development of symptoms and progression of disease. Constipation is a common adverse effect that may require the use of stool softeners. Patients should not attempt to push selegiline orally disintegrating tablets through the foil backing. Patients should peel back the backing of one or two blisters (as prescribed) with dry hands and gently remove the tablet(s).

16. An employee at a factory has not been to work because of low back muscle spasms. His wife contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Based on the medication action, what will the nurse tell her? (Select all that apply.) a. The health care provider should be notified because these drugs are contraindicated in the treatment of low back pain. b. Your husband should avoid activities requiring alertness, such as driving or operating power equipment. c. I need additional and specific information regarding the amount of your husbands sedation. d. I will review baseline laboratory studies, discuss your husbands status with the health care provider, and call you back. e. Sedation is an adverse effect of these medications and tends to resolve with continued therapy.

ANS: B, C, D, E Patients should be instructed to avoid activities that require alertness, such as driving or operating heavy machinery, for safety. When obtaining patient information regarding adverse effects, additional information may be needed to fully assess the degree of adverse effects the patient may be experiencing. Review of baseline liver and kidney function and CBC laboratory data is necessary. Centrally acting skeletal muscle relaxants are used to relieve acute muscle spasm. They act on the CNS, and sedation may be an adverse effect associated with usage. This tends to be mild and will resolve with continued use. These drugs are indicated for the treatment of low back pain.

14. Patients with which conditions must be carefully assessed to determine whether they would tolerate treatment with a neuromuscular-blocking agent? (Select all that apply.) a. Pregnancy b. Hepatic disease c. Pulmonary disease d. Renal disease e. Neurologic disorders f. Psychiatric disorders

ANS: B, C, D, E Patients with hepatic disease, pulmonary disease, renal disease, and neurologic disorders such as myasthenia gravis, spinal cord injury, or MS must be fully evaluated to assess their ability to tolerate neuromuscular-blocking agents. Neuromuscular-blocking agents can usually be used safely with the pregnant patient and the psychiatric patient.

3. Which cholinergic symptoms of Parkinsons disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

ANS: C

12. A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patients current list of medications, the nurse decides to hold the next dose of: a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium.

ANS: C Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising rasagiline serum levels and potentially causing significant hypertension. Dextromethorphan, levodopa, and Valium are not related to significant hypertensive changes when used in conjunction with rasagiline.

10. Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety? a. Excessive thirst b. Hand tremor c. Drowsiness d. Diarrhea

ANS: C Drowsiness is a common adverse effect, and people who work with machinery, drive a car, administer medicines, or perform other duties in which they must remain mentally alert should not take trazodone while working.

8. To what does potency of an antipsychotic medication refer? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior

ANS: C Low and high potency refers only to the milligram doses used for the medications and does not suggest any difference in effectiveness. Potency is not related to severity of adverse effects or onset of action. Potency does not refer to effectiveness.

10. Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low fiber diet. c. Measure the patients waist circumference. d. Monitor for insomnia.

ANS: C Waist circumference baseline measurement is appropriate because of the weight gain and onset of diabetes with use of these medications. Hypoglycemia and insomnia do not occur with this medication. A low fiber diet is not appropriate.

22. Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinsons disease e. Preparation for surgery f. Stimulation of the vagus nerve

ANS: C, D, E Anticholinergic drugs are used to treat bradycardia and Parkinsons disease and are used as drying agents in preparation for surgery and anesthetic administration. Anticholinergic drugs are not used to treat glaucoma, are contraindicated in cases of prostatic hypertrophy, and block vagal stimulation.

14. What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinsons disease? (Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors is permanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

ANS: C, D, E, F Apomorphine has no opioid activity, is commonly injected by a reusable multidose pen, and may cause nausea, vomiting, or sleepiness. Apomorphine brings temporary relief from hypomobility. Apomorphine must not be administered intravenously. It may crystallize in the vein and form a thrombus or embolism.

7. Which medication will be prescribed for a patient complaining of muscle spasms resulting from a back injury? a. Acetaminophen (Tylenol) b. Morphine sulfate c. Bethanechol (Urecholine) d. Cyclobenzaprine (Flexeril)

ANS: D Cyclobenzaprine is a centrally acting skeletal muscle relaxant, which is a group of drugs used to relieve acute muscle spasms. Their exact mechanism of action is unknown, except that they depress central nervous system (CNS) function. All the centrally acting skeletal muscle relaxants produce some degree of relaxation, and health care providers maintain that the benefits from the sedative effects may exceed the benefits from actual muscle relaxation. Acetaminophen, morphine, and bethanechol do not relieve skeletal muscle spasms.

10. The nurse is assessing an older patient with Parkinsons disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the health care provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness

ANS: D Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered. Constipation is an expected adverse effect of this medication. Brownish orange urine is an expected adverse effect of this medication. Drowsiness is an expected adverse effect that occurs when therapy is initiated.

5. The nurse is teaching a patient with Parkinsons disease about levodopa. Which statement by the nurse is accurate regarding drug administration? a. Take this medication in between meals. b. Take this medication at bedtime to prevent dizziness. c. Take this medication when your tremors get worse. d. Take this medication with food or antacids to reduce GI upset.

ANS: D Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in divided doses with food or antacids to decrease gastrointestinal (GI) irritation. Levodopa should be taken with food. Levodopa must be taken on a regular schedule as prescribed to provide therapeutic results.

5. Which is true regarding psychological drug dependence? a. It is easier to treat than physiological dependence. b. It is not considered a true addiction. c. It is easily controlled by influencing the patients perceptions. d. It requires medical intervention to treat.

ANS: D Medical intervention is required to treat psychological drug dependence. Psychological addictions are often more difficult to overcome than physiological addictions. Psychological drug dependence can be very difficult to treat.

Where are they located and when stimulated, what do Beta 1 receptors do?

Beta 1 receptors are located primarily in the heart and also in the kidneys. Stimulation of the beta 1 receptors increases myocardial contractility and heart rate.

Why should beta blockers be used with caution in diabetic and hypoglycemic-susceptible patients?

Beta blockers further induce the hypoglycemic effects of insulin and reduce the release of insulin in response to hyperglycemia.

What are serious adverse effect of the cardiovascular system with respect to adrenergic blockers?

Dysrhythmias, chest pain, severe hypotension, hypertension, anginal pain. Discontinue therapy immediately. Notify HCP. Ask patient if there has been a recent change in their regiment of Rx, non Rx, or herbal meds.

Where are they located and when stimulated, what do Alpha 1 receptors do?

Located in the blood vessels, eyes, bladder and prostate. When the alpha 1 receptors in the vascular tissues (blood vessels) of muscles are stimulated, the arterioles and venules constrict, increasing peripheral resistance and blood return to the heart. Circulation is improved and blood pressure is increased. When there is too much stimulation, blood flow to the vital organs is decreased.

What other drug agents produce interactions with adrenergic blockers that may increase therapeutic and/or toxic effects?

MAOIs (phenelzine, tranylcypromine) TCA (amitriptyline, imipramine) Atropine and halothane May increase both therapeutic and toxic effects. Many OTC meds: Cold remedies, appetite suppressants, diet pills (pseudoephedrine, ephedrine, ma huang) contain adrenergic meds that can have an additive effect when taken with the adrenergic Rx med.

What are some adverse effects of adrenergic blocking agents with respect to the cardiovascular system?

Palpitations, tachycardia, skin flushing, dizziness, tremors. These are usually mild and the nurse would encourage the patient not to discontinue therapy without first consulting the hcp. Orothostatic hypotension: generally mild/infrequent. Manifestations: dizzy/weak (especially at starting therapy). Monitor BP daily for patient in supine/standing positions. Anticipate postural hypotension: Educate patient to rise slowly from supine or sitting position and sit/lie down if feeling faint. Remember: MOST adverse effects can be solved by minor dose changes. STRONGLY encourage patient to see HCP before discontinuing therapy.

What is an advantage of using a selective beta 1 blocker vs a nonselective one?

To prevent bronchospasms that are caused from beta 2 blockers.

20. A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) a. Palpitations b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors f. Bradycardia

ANS: A, B, C, E Common adverse effects of adrenergic agents are palpitations, rapid heart rate, dizziness, orthostatic hypotension, and tremors. Adrenergic agents may cause hyperglycemia in the patient with diabetes mellitus. Adrenergic agents may cause tachycardia, not bradycardia, in the patient.

9. What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

ANS: A Nausea, vomiting, and indigestion are common during initiation of therapy. Taking the medicine with food or milk reduces the nausea and indigestion. Sedation, drowsiness, and dizziness tend to disappear with continued therapy. Gradual increases in dosage tend to decrease nausea and vomiting.

12. A patient taking a neuromuscular blocking agent is assessed to have a heart rate of 120 and blood pressure of 80/50. The nurse will anticipate the physician writing an order for: a. ABGs. b. blood glucose level. c. CBC. d. liver function tests.

ANS: A Patients taking neuromuscular-blocking agents should be monitored closely for clinical signs of hypoxia and hypercapnia (tachycardia, hypotension, cyanosis). ABG levels may be determined to confirm the clinical observations. Blood glucose levels, CBC, and liver function tests would not be indicated with these symptoms.

12. Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patients ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

ANS: A The nurse needs to review the patients history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescribers attention so that genetic testing may be completed. BP monitoring is important and hypotension is an adverse effect, but it is not as significant to monitor prior to the initiation of therapy. Lung sound assessment and smoking history assessment are important assessments, but not prior to the initiation of carbamazepine therapy.

10. The nurse is developing a teaching plan for patients prescribed buspirone (BuSpar). Which information about this medication should be included? a. There is minimal potential for abuse. b. Signs of improvement can be seen within 3 days. c. Sedation is increased compared with other antianxiety medications. d. It stimulates the action of gamma-aminobutyric acid (GABA).

ANS: A There is minimal potential for abuse with buspirone. It takes longer than 3 days to see signs of improvement. Buspirone has lower sedative properties and does not affect GABA receptors. Buspirone is an antianxiety agent that is midbrain modulator. 7-10 days for inital signs (similar to A/D) and 3-4 weeks for optimal effects (like A/D)

22. Which drug(s) interact(s) with SSRI agents? (Select all that apply.) a. Tranylcypromine (Parnate) b. Lithium (Eskalith) c. Warfarin (Coumadin) d. Furosemide (Lasix) e. Propranolol (Inderal)

ANS: A, B, C, E A 14-day lapse is recommended between MAOIs, such as Parnate, and SSRI agents. The incidence of lithium toxicity is increased with SSRI agents. The anticoagulant effects of warfarin may be enhanced with SSRIs. The SSRIs fluvoxamine and citalopram inhibit the metabolism of beta adrenergic blocking agents such as propranolol. Lasix does not interact with SSRI agents.

15. The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patients: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs.

ANS: A, B, D, E Premedication assessment prior to apomorphine therapy should include baseline vital signs, patients degree of mobility, alertness, and orientation to name, place, and time. It is not necessary to assess intellectual ability prior to apomorphine therapy.

16. Barbiturates have which common adverse effect(s)? (Select all that apply.) a. Residual daytime sedation b. Headache c. Hyperactivity d. Blurred vision e. Impaired coordination

ANS: A, B, D, E The long half life of a barbiturate medication often causes residual daytime sedation. Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long acting barbiturates. Impaired coordination is an adverse effect of barbiturates. Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

17. Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)?(Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

ANS: A, B, D, F Phenytoin may cause blood dyscrasias, gingival hyperplasia, and sedation and may elevate blood glucose levels, especially if higher doses are used. Urinary retention and insomnia are not adverse effects of phenytoin.

16. The health care provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patients airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

ANS: A, D, E It is important to monitor the patient for bradycardia during administration of diazepam. During a seizure of any type, it is important to assess for airway patency continuously. Diazepam should be administered slowly by the IV route at a rate of no more than 5 mg/min. For status epilepticus, 5 to 10 mg is typical, preferably by slow IV. The dose may be repeated every 5 to 10 minutes, up to a total dosage of 30 mg. If necessary, repeat therapy in 2 to 4 hours; other drugs are preferable for long term control. Diazepam is incompatible with most other IV medications and should not be combined.

14. The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be: a. thoroughly chewed. b. taken with a full glass of water. c. taken on an empty stomach. d. taken only before bedtime.

ANS: B

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patients response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain.

ANS: B Dosage must be adjusted according to the patients response and tolerance. Entacapone may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic effects of levodopa. Entacapone does not increase the production of dopamine in the brain.

14. What information is most accurate regarding the nurses understanding of pain management? a. Older patients have difficulty describing their pain level. b. Encourage patients to report pain before the pain becomes too severe. c. Use the smallest dose of medication possible to control pain. d. Pain medication administration ordered PRN will maintain a constant blood level.

ANS: B Even though pain medicine administration may be scheduled, encourage the patient to request pain medication before the pain escalates and becomes severe. Although the smallest dose possible to control the pain is the goal of therapy, it is also important that the dose be sufficient to provide adequate relief. Older patients are able to describe pain; a variety of tools are available for a variety of patient populations. Analgesics given on a scheduled basis every 3 to 4 hours will maintain a more constant plasma level.

8. A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take? a. Advise the patient to take the medication with food. b. Assess the patients blood pressure in sitting and lying positions. c. Inform the patient to discontinue the medication once sleep improves. d. Instruct the patient to lie down before taking the medication.

ANS: B Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension. Ativan does not have to be taken with food. Rapid discontinuance of the medication after long term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. Medications should be taken sitting up.

9. Which common adverse effects occur with neuromuscular-blocking agents? a. Fever b. Flushing c. Nausea d. Ataxia

ANS: B Neuromuscular-blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary secretions, flushing, edema, and urticaria. Ensure that the airway is patent and that secretions are suctioned regularly to prevent obstruction. Report evidence of bronchospasm, edema, and urticaria immediately. Neuromuscular-blocking agents do not commonly cause fever, nausea, or ataxia.

9. Which sign or symptom displayed by a patient would be indicative of opiate withdrawal? a. Bradycardia b. Diarrhea c. Lethargy d. Hypothermia

ANS: B Symptoms of opiate withdrawal include muscular spasms; severe aches in the back, abdomen, and legs; abdominal and muscle cramps; hot and cold flashes; insomnia; nausea, vomiting, and diarrhea; severe sneezing; and increases in body temperature, blood pressure, and respiratory and heart rates. Bradycardia is not a sign of opiate withdrawal; increased heart rate is a sign of opiate withdrawal. Lethargy is not a sign of opiate withdrawal; restlessness is a sign of opiate withdrawal. Hypothermia is not a sign of opiate withdrawal; fever is a sign of opiate withdrawal.

1. What is the recommended time over which antianxiety medications must be gradually tapered before discontinuation? a. 1 week b. 1 month c. 6 months d. 1 year

ANS: B Withdrawal from medication should be done under a health care providers supervision. Withdrawal usually takes 4 weeks and requires a gradual reduction in dosage and greater intervals between medication administrations. One week is an inadequate interval for cessation of antianxiety medication therapy. Six months to 1 year is much longer than necessary for cessation of antianxiety medication therapy.

22. When performing a baseline neurologic assessment prior to the administration of an NSAID medication, the nurse will assess which patient characteristic(s)? (Select all that apply.) a. Vital signs b. Orientation to date, time, and place c. Mental alertness d. Bowel sounds e. Concurrent use of anticoagulant agents

ANS: B, C Orientation to date, time, and place as well as assessment of mental alertness are components of a baseline neurologic assessment to be completed prior to medicating with an NSAID. Vital signs, bowel sounds, and assessment of concurrent use of anticoagulant drugs are not considered components of a neurologic assessment.

17. Which statement(s) is/are true about efferent nerves? (Select all that apply.) a. They transmit signals to the spinal cord and brain. b. They leave the CNS to carry impulses to other body parts. c. They are part of the peripheral nervous system. d. They transmit signals that control contractions of smooth and skeletal muscle.

ANS: B, C, D, E Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system.

20. Clonidine (Catapres) is used in treating which opioid withdrawal symptom(s)? (Select all that apply.) a. Hypertension b. Tremors c. Agitation d. Depression e. Sweating f. Nausea

ANS: B, C, E Clonidine is useful in decreasing tremors, agitation, and sweating associated with opioid withdrawal. Clonidine does not have a hypotensive effect, treat depression, or alleviate nausea.

What is the drug of choice when treating a generalized tonic clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

ANS: C Anticonvulsant therapy should start with the use of a single agent selected from a group of first line agents based on the type of seizure. Valproic acid is indicated for generalized tonic clonic seizures. Diazepam is not the drug of choice for treatment of tonic clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

ANS: C Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects.

3. Which is the drug of choice to treat a patient with obsessive compulsive disorder (OCD)? a. Lorazepam (Ativan) b. Buspirone (BuSpar) c. Fluvoxamine (Luvox) d. Hydroxyzine (Vistaril)

ANS: C Fluvoxamine inhibits the reuptake of serotonin at the nerve endings, thus prolonging serotonin activity. Fluvoxamine is used for the treatment of OCD when the obsessions or compulsions cause marked distress or interfere substantially with social or occupational responsibilities. Fluvoxamine does not prevent the obsessions or compulsions; the therapeutic outcome of this drug is to assist the patient in their management. Lorazepam, buspirone, and hydroxyzine do not treat the symptoms of OCD.

10. Which assessment is most important for the nurse to obtain when a patient is being treated with a neuromuscular-blocking agent? a. Skin assessment for rash and urticaria b. Blood pressure assessment for orthostatic hypotension c. Respiratory assessment for patent airway d. Assessment for fluid volume overload

ANS: C Histamine release caused by these drugs may produce increased salivation. In patients who are paralyzed or who have incomplete return of control over swallowing, coughing, and deep breathing, these secretions may obstruct the airway. Histamines are not likely to produce rash or urticaria related to the administration of neuromuscular-blocking agents. Patients on neuromuscular-blocking agents are generally kept on bed rest and not subject to orthostatic hypotension. Neuromuscular-blocking agents do not cause fluid volume overload.

1. Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

ANS: D Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold.

16. A patient experiencing chronic pain as a result of metastatic cancer has a new order for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on Monday. At 8 PM on Monday, the patient reports a pain level of 8. The nurses best response is to: a. immediately contact the physician. b. reassess pain level in 30 to 45 minutes. c. remove current patch and reapply a new patch. d. provide a PRN analgesic medication as ordered.

ANS: D The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial patch of medication to reach a steady blood level, so other analgesics must be used during this time. Therefore, it is not necessary to immediately contact the physician. The patient is reporting severe pain and requires immediate intervention to help relieve this discomfort.

Where are they located and when stimulated, what do Beta 2 receptors do?

Beta 2 receptors are found mostly in the smooth muscle of the lungs, GI tract, liver, and uterine muscles. Stimulation causes (1) relaxation of the smooth muscles of the lungs, resulting in bronchodilation; (2) a decrease in gastrointestinal tone and motility; (3) activation of glycogenolysis in the liver, resulting in increase blood glucose; and (4) relaxation of the uterine muscle, resulting in a decrease in uterine contractions.

Why must nonselective beta blockers be used with extreme caution in patients with respiratory conditions (emphysema, asthma, allergic rhinitis, bronchitis)

Beta blockers may produce severe bronchoconstriction and may aggravate wheezing, especially during pollen season.

What are three indications for use of adrenergic beta blocking agents?

Hypertension, postmyocardial infarction, cardiac dysrhythmias.

What are adverse effects of the gastrointestinal system with respect to adrenergic blockers?

Nausea, vomiting. Notify HCP. Ask patient if there has been a recent change in their regiment of Rx, non Rx, or herbal meds.

21. When teaching a patient who is starting therapy with NSAIDs, the nurse must be sure to mention drug interactions with which drug(s)? (Select all that apply.) a. Warfarin (Coumadin) b. Lithium (Eskalith) c. Hydroxyzine (Vistaril) d. Insulin e. Diuretics f. Digitalis (Digoxin)

ANS: A, B, E NSAIDs may enhance the effects of warfarin, lithium, and diuretics. NSAIDs are not known to interact with hydroxyzine, insulin, or digitalis.

16. Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation

ANS: A, C, D Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase gastrointestinal (GI) motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. GI symptoms tend to be dose related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate, have a hypotensive effect, increase GI motility, and result in diarrhea and cramping.

15. In addition to the relief of mild to moderate anxiety, hydroxyzine (Vistaril) has which additional therapeutic outcome(s)? (Select all that apply.) a. Reduced need for sedation and analgesia before and after surgery b. Elimination of psychotic thinking c. Control of itching in allergic reactions d. Control of vomiting e. Control of obsessive compulsive thoughts f. Prevention of extrapyramidal adverse effects and tardive dyskinesia

ANS: A, C, D Hydroxyzine has sedative, antihistamine, and antiemetic effects in addition to antianxiety activity. Hydroxyzine does not control psychotic thinking, obsessive compulsive thinking, or movement disorders caused by other medications.

16. What does the biologic model theory of substance abuse hypothesize? (Select all that apply.) a. A predisposition to substance abuse based on a hereditary condition b. Alcoholic individuals as fixated at the oral stage of development, needing satisfaction through oral behaviors such as drinking c. Genetic aberrations that block feelings of well being, resulting in anxiety, anger, low self esteem, and other negative feelings, leaving a craving for a substance that will suppress the bad feelings d. That genes may play a role in alteration of metabolic enzyme systems in the body that enhance or detract from pleasurable responses to chemical substances e. That it is a persons choice of whether to use drugs, which drugs to use, how much to use, and to seek treatment for substance abuse

ANS: A, C, D The biologic model hypothesizes that substance abuse is caused by a persons genetic profile, making a predisposition to substance abuse a hereditary condition. Genes may play a role in altering metabolic enzyme systems in the body that enhance or detract from pleasurable responses to chemical substances. Psychoanalytic theories see alcoholics as fixated at the oral stage of development. Sociocultural factors play a role in a persons choice of whether to use drugs, which drugs to use, how much to use, and treatment for substance abuse.

6. Which laboratory values will the nurse review prior to beginning medication therapy for skeletal and muscle disorders? a. Sodium, magnesium, and chloride b. C-reactive protein (CRP), human leukocyte antigen (HLA), and liver function tests c. Arterial blood gases (ABGs), complete blood count (CBC), and electrolytes d. Glucose, high density lipoproteins (HDL), and prothrombin time (PT)

ANS: B Examine laboratory reports associated with the disease process present (e.g., calcium, phosphorus, lupus testing, rheumatoid factor, uric acid level, CRP, HLA, aldolase, aspartate, creatine kinase). Electrolytes, trace minerals, ABGs, CBC, electrolytes, glucose, HDL, and PT are not associated with this disease process.

2. The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experience? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

ANS: B Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects.

The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antidepressants?(Select all that apply.) a. Diarrhea b. Dryness of mouth, nose, and throat c. Constipation d. Nocturia e. Urinary retention f. Blurred vision

ANS: B, C, E, F The patient may experience difficulty with dryness of the mouth, nose, and throat as well as smooth muscle contraction (resulting in constipation, urinary retention, and blurred vision). Diarrhea and nocturia are not adverse effects of tricyclic antidepressants.

18. The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages e. Full therapeutic response may require 6 to 8 weeks to be achieved.

ANS: B, D, E Rapid increases in dosages of antipsychotic medication will not reduce the antipsychotic response time but will increase the frequency of adverse effects. Tardive dyskinesia may be reversible in early stages, but it becomes irreversible with continued use of the antipsychotic medication. Reduction in hallucinations, delusions, and thought disorders often requires 6 to 8 weeks for a full therapeutic response to be achieved. Older patients should be observed for hypotension.

11. Which drug interaction may occur when an aminoglycoside or tetracycline is given in conjunction with neuromuscular-blocking agents? a. Deep sedation b. Decreased effectiveness of antibiotics c. Increased neuromuscular-blocking activity d. Sensitivity to antibiotics and possible allergic reaction

ANS: C Question antibiotic orders that prescribe aminoglycosides or tetracycline when neuromuscular blockers have been used. These drugs may potentiate the neuromuscular blocking activity. This combination of medications would not cause deep sedation. Neuromuscular-blocking agents do not decrease the effectiveness of antibiotics or increase sensitivity to antibiotics.

6. Dopamine agonists have been linked with which adverse effects in patients with Parkinsons disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

ANS: C Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as sleep attacks, including daytime sleep. Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines.

7. What will the nurse caution a patient about when providing information about the prescribed azaspirone antidepressant? a. Risk for addiction b. Adverse effect of nausea c. Risk of injury when using machinery d. Additive effects of central nervous system (CNS) depression with alcohol

ANS: C The most common adverse effects of azaspirone therapy include dizziness, nervousness, drowsiness, and lightheadedness. Azaspirones do not have a risk for abuse or addiction. Nausea and vomiting are not common adverse effects of treatment with azaspirones. Azaspirones do not have CNS depression, but it is recommended that they not be combined with alcohol or sedatives.

6. Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.

ANS: D The nurse is not authorized to recommend dosage changes to the patient. The nurse should not trivialize the patients concern about the adverse effect; it is common only in 10% of patients who take lamotrigine and can lead to more serious adverse effects. The nurse should not recommend discontinuing the medication without orders from the health care provider. This is not a common adverse effect and should be monitored. Approximately 10% of patients receiving lamotrigine develop a skin rash in the first 4 to 6 months of therapy. The health care provider should be notified promptly because the rash could be an indicator of a more serious condition.