ATI Pharm Neurological System Part 2 with rationale

A patient is admitted to the emergency department with spasms of his face and back. He has recently begun taking chlorpromazine to treat schizophrenia. Which of the following adverse reactions should the health care professional suspect?

Acute dystonia Rationale: 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.

During the immediately following IV administration of chlorpromazine to a patient who has schizoaffective disorder, a health care professional should monitor which of the following?

Blood pressure Rationale: During the immediately following IV administration of chlorpromazine to a patient who has schizoaffective disorder, a health care professional should monitor which of the following?

A health care professional should expect which of the following adverse effects for a patient who is taking betaxolol (Betoptic) eye drops to treat glaucoma?

Bradycardia Rationale: Betaxolol and timolol (Timoptic) can cause bradycardia because of the blockade of cardiac beta1 receptors. Patients should check their pulse rate regularly and report any sustained decreases.

A health care professional is caring for a patient who is about to begin taking echothiophate (Phospholine Iodide) to treat glaucoma. The health care professional should monitor the patient for the development of which of the following adverse effects?

Cataracts Rationale: Echothiophate, a cholinesterase inhibitor, can cause cataracts, or opacity of the lens of the eye. Patients should report any changes in vision, such as cloudiness or halos around lights.

A health care professional should question the use of alprazolam (Xanax) for a patient who

Drinks two 8-oz glasses of wine each evening Rationale: To prevent severe sedation and respiratory depression, patients should avoid alcohol and other CNS depressants when taking benzodiazepines.

A health care professional is obtaining a patient's drug history when he finds that the patient is taking lithium carbonate (Lithobid) for bipolar disorder. Which of the following findings in the patient's drug history should alert the health care professional to monitor the lithium toxicity?

Furosemide (Lasix) for hypertension Rationale: Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The health care professional should evaluate the patient for lithium toxicity.

When reviewing the adverse effects of drug therapy with a patient, a health care professional should explain that orthostatic hypotension is a common adverse reaction of which of the following drugs?

Imipramine (Tofranil) Rationale: Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Patients taking this drug should change positions slowly from sitting or lying to standing.

A health care professional should monitor an older adult patient who is taking alprazolam (Xanax) for which of the following adverse effects? (Select all that apply).

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

A health care professional is caring for a patient who is about to begin taking lithium carbonate (Lithobid) to treat bipolar disorder. The health care professional should caution the patient to watch for which of the following indications of lithium toxicity? (Select all that apply).

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

Which of the following instructions should a health care professional include when advising a patient about instilling pilocarpine (Isopto Carpine) for managing open-angle glaucoma? (Select all that apply).

- Apply gentle pressure to the nasolacrimal duct for one minute after instilling the drops. Rationale: 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. Rationale: Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the drug from entering the systemic circulation. - Remove contact lenses prior to instilling the drops. Rationale: Patients should remove contact lenses before instilling eye drops because they can cause further irritation if left in place.

A health care professional is caring for a patient who is about to begin amitriptyline therapy to treat major depression. The health care professional should include which of the following instructions when talking with the patient about taking the drug? (Select all that apply).

- Change position slowly from sitting or lying to standing. Rationale: Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension. Patients should move slowly from sitting or lying to standing. - Do not stop taking the drug abruptly. Rationale: 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. Rationale: Amitriptyline, a tricyclic antidepressant, can cause drowsiness. Patients 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. Rationale: Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Patients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

When reviewing the indications for various antidepressants, a health care professional should understand that bupropion hydrochloride (Wellbutrin) is an appropriate choice for patients who have which of the following? (Select all that apply)

- Seasonal affective disorder. Rationale: 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. Rationale: Bupropion, an atypical antidepressant, is an appropriate adjunct for patients who are trying to quit smoking. - Depression. Rationale: Bupropion, an atypical antidepressant, can help treat depression.

When talking to a patient about taking buspirone, the health care professional should include which of the following instructions?

Allow 2-4 weeks before expecting to feel better Rationale: It can take up to 4 weeks for patients to feel the drug's full therapeutic effects.

A health care professional should question the use of timolol (Timoptic) for a patient who has which of the following disorders?

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

A health care professional is talking to a patient who is taking lithium carbonate (Lithobid). Which of the following instructions should be included to reduce the risk of lithium toxicity?

Avoid taking NSAIDs Rationale: NSAIDs increase renal reabsorption of lithium and sodium. Patients taking lithium should not take NSAIDs.

A health care professional should advise a patient who is taking phenelzine (Nardil) to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions?

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

A health care professional is caring for a patient who is about to begin using betaxolol (Betopic) eye drops to treat open-angle glaucoma. The health care professional should advise the patient to expect which of the following reactions?

Ocular stinging Rationale: Betaxolol, a beta-adrenergic blocker, can cause short-term, mild stinging and burning of the eye. Patients should expect transient eye discomfort, but should not rub their eyes. Severe or continuous irritation should be reported.

A health care professional is caring for a patient who is taking venlafaxine to treat major depression. The health care professional should recognize that which of the following drugs can cause serotonin syndrome when patients take it concurrently with venlafaxine?

Phenelzine (Nardil) Rationale: Patients 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.

When caring for a patient who is taking risperidone (Risperdal) for schizophrenia, the health care professional should monitor for which of the following adverse effects of the drug?

Polyuria Rationale: Risperidone, an atypical antipsychotic, can cause new-onset diabetes mellitus. It is essential to monitor patients taking the drug for signs of hyperglycemia, and check their glucose levels regularly.

A health care professional is collecting data from a patient who is taking bupropion hydrochloride ( Wellbutrin) to treat depression. The health car professional notes that the patient has a recent history of a head injury. She should recognize that the drug is inappropriate for the patient because of the increased risk for which of the following?

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

Soon after beginning fluoxetine (Prozac), a patient is admitted to the emergency department with agitation and confusion. The health care professional should suspect which of the following?

Serotonin syndrome Rationale: Serotonin syndrome can begin 2 to 72 hr after beginning to take fluoxetine, a selective serotonin reuptake inhibitor. Manifestations include mental confusion, difficulty concentrating, and agitation.

A health care professional is caring for a young adult patient who is taking fluoxetine (Prozac) to treat depression. The health care professional should tell the patient and the patient's family to report which of the following?

Suicidal thoughts Rationale: Young adults taking fluoxetine, a selective serotonin reuptake inhibitor, have an increased risk for suicide, especially in the early stages of treatment. Patients who are severely depressed can have, with drug therapy, the energy for self-harm. With awareness of this risk, family members and patients can watch for indications of worsening depression.

A health care professional is caring for a patient who is taking lithium carbonate (Lithobid) to treat bipolar disorder. Which of the following diagnostic tests should the health care professional recommend periodically for the patient?

Thyroid function tests Rationale: Hypothyroidism is an adverse effect of lithium carbonate. Patients 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.

While talking with a patient about taking chlorpromazine, which of the following instructions should the health care professional include?

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

A health care professional is caring for a patient who has been taking alprazolam (Xanax) for an extended period of time to treat anxiety. The health care professional should recognize that stopping alprazolam therapy suddenly can result in which of the following?

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