Exam #2 Question&Answer

A health care professional is caring for a patient who is about to begin taking amphetamine sulfate (Adderall). The health care professional should monitor the patient for which of the following adverse effects? 1. Tachycardia 2. Tinnitus 3. Bronchospasm 4. Hypotension

Answer 1. Rationale: Amphetamine sulfate is an amphetamine stimulant. It can cause tachycardia and dysrhythmias. Patients should notify the health care professional if they develop palpitations or chest pain. S/S of amphetamine sulfate (Adderall): hypertension, irritability, insomnia, diarrhea, and nausea.

A patient is treated for psychosis with fluphenazine. What drug will the nurse anticipate may be given to prevent the development of acute dystonia? 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan)

Answer 1. Rationale: Benztropine (Cogentin), an anticholinergic, may be given to suppress the tremor and rigidity that may be caused by fluphenazine or other phenothiazine antipsychotic drugs. Options 2, 3, and 4 are incorrect. Diazepam (Valium) and lorazepam (Ativan) are benzodiazepines and will not prevent acute dystonia. Haloperidol (Haldol) is an antipsychotic drug and may increase the risk for acute dystonia.

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 to which of the following drugs? 1. Bupropion (Wellbutrin) 2. Imiparmine (Tofranil) 3. Venlafaxine 4. Valporic acid (Depakote)

Answer 2. Rationale: Imipramine, a TCA, can result in orthostatic hypotension. Patients taking this drug should change positions slowly from sitting or lying to standing.

Planning teaching for a client who is to be discharged postoperatively with a prescription for oxycodone with acetaminophen (Percocet) should include which of the following? 1. Refer the client to a drug treatment center if addiction occurs 2. Encourage increased fluids and fiber in the diet 3. Monitor for GI bleeding 4. Teach the client to self-assess BP

Answer 2. Rationale: Opioids such as hydrocodone with acetaminophen (Percocet) slow peristalsis which can lead to constipation. Increasing fluids and fiber in the diet may help prevent this adverse effect. Option 1, 3, and 4 are incorrect. Drug treatment programs are not needed if the drug is taken as ordered for the time prescribed. The drugs should not cause GI bleeding and for most patients will not cause a significant drop in blood pressure.

For which of the following should a health care professional monitor a patient who is taking donepezil (Aricept) for Alzheimer's disease? 1. Dry mouth 2. Nausea 3. Double vision 4. Confusion

Answer 2. Rationale: The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking the drug with food can help minimize adverse effects. Donepezil, a cholinesterase inhibitor, can improve memory and thinking and reduce confusion and is more likely to cause blurred vision than double vision. The muscarinic antagonist is the one that causes dry mouth not donepezil.

A 20-year-old man is admitted to the psychiatric unit for treatment of acute-schizophrenia and is started on risperidone (Risperdal). Which patient effects should the nurse assess for to determine whether the drug is having therapeutic effects? 1. Restful sleep, elevated mood, and coping abilities. 2. Decreased delusional thinking and lessened auditory/visual hallucination. 3. Orthostatic hypotension, reflex tachycardia, and sedation. 4. Relief of anxiety and improved sleep and dietary habits.

Answer 2. Rationale: Antipsychotic drugs such as risperidone (Risperdal) treat the positive and negative effects of the underlying mental disorder. A decrease in delusional thinking, lessened hallucinations, and overall improvement in mental thought processes should be noted. Options 1, 3, and 4 are incorrect. Improvement in sleep patterns, anxiety, and nutrition may be noted as secondary effects of treatment of the underlying thought disorder. Orthostatic hypotension, reflex, tachycardia, and sedation are potential adverse effects.

A health care professional is talking to a patient about beginning sumatriptan (Imitrex) therapy to treat migraine headaches. The health care professional should advise the patient to watch for which of the following adverse effect? 1. Polyuria 2. Insomnia 3. Chest pain 4. Joint pain

Answer 3. Rationale: Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Patients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for patients who have a history of coronary artery disease. It is unlikely to cause polyuria and insomnia. It is more likely to cause chest pain than joint pain.

A health care professional is caring for a patient who is receiving thiopental (Pentothal). For which of the following should the health care professional monitor? 1. Hypotension 2. Hyperthermia 3. Respiratory depression 4. Cardiac excitability

Answer 3. Rationale: Thiopental, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for patients receiving the drug.

Which of the following medications may be used to treat partial seizures? (Select all that apply.) 1. phenytoin (Dilantin) 2. valproic acid (Depakene) 3. diazepam (Valium) 4. carbamazepine (Tegretol) 5. ethosuxamide (Zarontin)

Answers 1, 2, and 4. Rationale: The phenytoin-like drugs including phenytoin (Dilantin), vampiric acid (Depakene), and carbamazepine (Tegretol) are used to treat partial seizures. Option 3 and 5 are incorrect. Diazepam (Valium) is a benzodiazepine that is used to treat tonic-clonic seizures and status epilepticus. Ethosuximide (Zarontin) is used in the control of generalized seizures such as absence seizures.

A health care professional is collecting data from a patient who is taking bupropion hydrochloride (Wellbutrin) to treat depression. The health care 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 of which of the following? 1. Ischemic stroke 2. Drowsiness 3. Respiratory depression 4. Seizure activity

Answer 4. Rationale: Bupropion, an atypical antidepressant, can cause seizure activity when patients take high doses or have a seizure disorder, a CNS tremor, 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? 1. Stevens-Johnson syndrome 2. Serotonin syndrome 3. EPS 4. Neuroleptic malignant syndrome

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

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) 1. Take the drug at bedtime to prevent daytime drowsiness. 2. Do not stop taking the drug abruptly. 3. Change position slowly from sitting or lying to standing. 4. Increase fiber and fluid intake. 5. Wear sunscreen and protective clothing.

Answer 1, 2, 3, and 4. Rationale: Amitriptyline, a TCA, can cause orthostatic hypotension. Patients should move slowly from sitting or lying to standing. 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. It can also cause drowsiness; also includes anticholinergic effects, so increasing fiber and fluid can help induces bowel movement and urination.

A health care professional is caring for 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) 1. Tremors 2. Nausea 3. Muscle weakness 4. Confusion 5. Bronchospasm

Answer 1, 2, 3, and 4. Rationale: A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. Other signs and symptoms include confusion, slurred speech, ataxia, nausea, vomiting, diarrhea, and muscle weakness.

A health care professional should monitor an older adult patient who is taking alprazolam (Xanax) for which of the following? (Select all that apply) 1. Sedation 2. Tolerance 3. Anxiety 4. Constipation 5. Respiratory depression

Answer 1, 2, 3, and 5. Rationale: Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Patient should use these drugs only as needed and for short periods of time. Paradoxical reactions, such as anxiety and insomnia, can develop, especially in older adults. Adverse effects: respiratory depression and sedation.

The nurse is monitoring the client for early signs of lithium (Eskalith) toxicity. Which symptoms, if present, may indicate that toxicity is developing? (Select all that apply.) 1. persistent GI upset (N/V) 2. confusion 3. increased urination 4. convulsions 5. ataxia

Answer 1, 2, and 3. Rationale: Persistent GI upset such as nausea, vomiting, and abdominal pain; increased urination; and confusion are signs of elevated lithium levels and may signal the early stages of toxicity. Options 4 and 5 are incorrect. Convulsions and ataxia may occur later in lithium toxicity.

A health care professional is talking to a patient who is about to take a valporic acid (Depakote) for a newly diagnosed seizure disorder. He should tell the patient to watch for which of the following adverse effects? (Select all that apply) 1. Rash 2. Drowsiness 3. Headache 4. Hirsutism 5. Ataxia

Answer 1, 2, and 3. Rationale: Patients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these effects can indicate the need for a reduction in dose. Valproic acid can cause headache, along with other central nervous system adverse effects, such as sleep disturbances. Skin rash is a side effect of valproic acid and other antiepileptic drugs.

Nursing implementations of the administration of haloperidol (Haldol) to a patent exhibiting psychotic behavior include which of the following? (Select all that apply). 1. Take 1 hour before or 2 hours after antacids. 2. The incidence of extrapyramidal symptoms is high. 3. It is therapeutic if ordered on an as-needed (prn) basis. 4. Haldol is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush the sustained-release form for easier swallowing.

Answer 1, 2, and 4. Rationale: Aluminum- and magnesium-based antacids decrease absorption of haloperidol (Haldol). Haldol also has a high incidence of EPS. It is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. Option 3 and 5 are incorrect. Haldol must be taken as ordered for therapeutic results to occur and should not be given prn for psychosis. The sustained-release forms must not be opened or crushed.

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) 1. Seasonal affective disorder 2. Insomnia 3. Depression 4. Motion sickness 5. Nicotine addiction

Answer 1, 3, and 5. Rationale: Bupropion, an atypical antidepressant, can cause nausea, vomiting, constipation, insomnia, and agitation. It does not prevent motion sickness. It helps prevent and treat seasonal affective disorder and is an appropriate adjunct for patients who are trying to quit smoking.

A health care professional is caring for a patient who is about to begin taking dantrolene (Dantrium) for skeletal muscle spasms. The health care professional should tell the patient to report which of the following adverse effects? 1. Cough 2. Diarrhea 3. Slow pulse rate 4. Hearing loss

Answer 2. Rationale: Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea is an adverse effect of dantrolene, as are nausea and vomiting. Patients should report these effects so the health care professional can monitor fluid balance and intervene accordingly.

A patient is taking selegiline (Eldepryl) to treat Parkinson's disease. The provider is considering the use of analgesics for the patient but should be aware that a drug interaction between selegiline and meperidine (Demerol) can result in which of the following? 1. Muscle rigidity 2. Frequent urination 3. Cellulitis 4. Jaundice

Answer 1. Rationale: A drug interaction between selegiline and opioids, especially meperidine, can result in a serious reaction resulting in rigidity, stupor, agitation, hypertension, and fever. A drug interaction between selegiline and meperidine is unlikely to result in frequent urination, which can indicate a urinary tract infection and glucose intolerance. It is also unlikely that it can result in oral ulcers and jaundice. Skin inflammation is a serious adverse effect of some anticonvulsants, such as phenytoin (Dilantin). Liver toxicity is a serious adverse effect of dantrolene (Dantrium) and many anticonvulsants, such as valproic acid (Depakote).

A 16 year old client has taken an overdosage of citalopram (Celexa) and is brought to the emergency department. What symptoms would the nurse expect to be present? 1. seizures, hypertension, tachycardia, extreme anxiety 2. hypotension, bradycardia, hypothermia, sedation 3. miosis, respiratory depression, absent bowel sounds, hypoactive reflexes 4. manic behavior, paranoia, delusions, tremors

Answer 1. Rationale: An overdose of citalopram (Celexa) causes symptoms similar to serotonin syndrome including seizures, hypertension, tachycardia, and extreme anxiety. Options 2, 3, and 4 are incorrect. These are not symptoms of an SSRI overdose.

While talking to a patient and his family about taking memantine (Namenda) for Alzheimer's disease, the health care professional should include which of the following instructions? 1. Notify the health care professional before taking over-the-counter antacids. 2. Increase fluids to improve renal excretion. 3. Report memory loss or confusion. 4. Watch for signs of liver impairment, such as jaundice or abdominal pain.

Answer 1. Rationale: Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity. It is not necessary to increase fluids. Patients excrete the drug essentially unchanged in the urine; fluid intake does not affect this process. Patients with Alzheimer's disease already have and will continue to have memory loss and confusion. The drug can help slow the progressive decline of this disorder, but will not eliminate its manifestations. Memantine should not result in liver impairment, although health care professionals should use it cautiously with patients who have severe liver impairment.

The nurse should immediately report the development of which of the following symptoms in a patient taking antipsychotic medication? 1. Fever, tachycardia, confusion, incontinence. 2. Pacing, squirming, or difficultly with gait such as bradykinesia. 3. Severe spasms of the muscles of the tongue, face, neck, or back. 4. Sexual dysfunction or gynecomastia.

Answer 1. Rationale: Fever, tachycardia, confusion, and incontinence are symptoms of the development of NMS and should be immediately reported. Option 2, 3, and 4 are incorrect. Pacing and squirming are signs of akathisia, and bradykinesia and tremors are symptoms of secondary Parkinsonism. These adverse effects along with sexual dysfunction and gynecomastia, are adverse effects that may occur with therapy and may not be preventable. NMS is a medical emergency requiring immediate treatment.

When talking a patient about taking modafinil (Provigil) to treat narcolepsy, which of the following instructions should the health care professional include? 1. Take the drug in the morning 2. Expect urinary frequency 3. Take the drug 30 min before bedtime 4. Anticipate daytime drowsiness

Answer 1. Rationale: Modafinil is a non-amphetamine stimulant. Taking it in the morning helps improve wakefulness for patients who have narcolepsy. Patients taking the drug for shift-work sleepiness should take it 1 hr before work. S/S: insomnia and diarrhea.

A health care professional is talking to a patient and her family about how methylphenidate (Ritalin) will help manage attention-deficit hyperactivity disorder (ADHD). Which of the following therapeutic effects should they expect? 1. Increased focus 2. Improved mood 3. Reduced panic 4. Decreased anxiety

Answer 1. Rationale: Stimulants, such as methylphenidate, regulate levels of dopamine and norepinephrine in the brain to produce calmness, reduce hyperactivity, and increase focus for patients who have ADHD.

The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritis or dry skin 4. Bone and joint pain

Answer 1. Rationale: Valporic acid may cause life-threatening pancreatitis, and any severe or increasing abdominal pain should be reported immediately. Options 2, 3, and 4 are incorrect. The drug is not known to cause dyspepsia (altered sense of taste) or effects on bones or joints. Although pruritus is an adverse effect associated with vampiric acid, it may be managed with simple therapies, and unless it progresses to a more serious rash, it does not need to be reported immediately.

Because of the potential for adverse effects, which of the following should a health care professional recommend for patients who began taking carbamazepine (Tegretol)? 1. Begin taking the drug at a low dosage. 2. Discontinue the drug immediately if diarrhea occurs. 3. Have serum glucose levels checked regularly. 4. Take the drug on an empty stomach.

Answer 1. Rationale: Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, an iminostilbene that treats seizure disorders. Dosages should be low to minimize or prevent these adverse effects. Since this is an antiseizure drug, it should not be stopped abruptly or else the seizure would reoccur. It does not have any effect on the glucose level. And it would cause GI upset if taken without food.

A health care profession is caring for a patient who is taking zolpidem (Ambien). The patient has a history of benzodiazepine abuse and reports insomnia. The health care professional caution the patient that the drug can cause: 1. Memory impairment 2. Hearing loss 3. Constipation 4. Joint pain

Answer 1. Rationale: Zolpidem, a non-benzodiazepine, can cause anterograde amnesia, or memory impairment, particularly an inability to recall activities patients carry out just before or during sleep.

A health care professional is talking to a patient who is to begin valporic acid (Depakote) to treat a seizure disorder. He should advise the patient to monitor for which of the following adverse effect? 1. Jaundice 2. Depression 3. Gum irritation 4. Hirsutism

Answer 1. Rationale: Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. Patients taking the drug should report these symptoms, and health care professionals should monitor liver function studies prior to treatment and periodically during therapy.

The nurse knows that which of the following are major disadvantages for the use of donepezil (Aricept) to treat the symptoms of early Alzheimer's disease? (Select all that apply) 1. It must be administered four times per day. 2. It may causes significant weight loss. 3. It may cause potentially fatal cardiac dysrhythmias. 4. It may cause serious hepatic damage. 5. It results in only modest cognitive improvement and results do not last.

Answer 2, 3, 4, and 5. Rationale: Donepezil (Aricept) may cause serious liver damage and potentially fatal dysrhythmias including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cognitive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term. Option 1 is incorrect. Donepezil is taken once per day usually at bedtime.

When talking with a patient about taking temazepam (Restoril), which of the following instructions should the health care professional include? (Select all that apply) 1. Wear sunscreen and protective clothing. 2. Take the drug 30 minute before bedtime. 3. Avoid alcohol and other depressants. 4. Taper the drug slowly to prevent withdrawal symptoms. 5. Increase fiber and fluid intake.

Answer 2, 3, and 4. Rationale: . Temazepam can cause CNS depression. Combined use with alcohol or other depressants can cause severe respiratory depression. Patients should take temazepam 30 min before bedtime to improve sleep and to prevent daytime drowsiness. Abrupt discontinuation of temazepam can cause withdrawal symptoms. Patients should taper the drug slowly to prevent or minimize withdrawal.

Prior to discharge, the nurse plans for patient teaching related to side effects of phenothiazines to the patient, family, or caregiver. Which of the following should be included? 1. The patient may experience withdrawal and slowed activity. 2. Severe muscle spasms may occur early in the therapy. 3. Tardive dyskinesia is likely early in therapy. 4. Medications should be taken as prescribed to prevent adverse effects.

Answer 2. Rationale: Acute dystopias, or severe muscle spasms, particularly of the back, neck, face, or tongue, may occur within hours or days of the first dose of a phenothiazine drug and should be reported immediately. Options 1, 3, and 4 are incorrect. Social withdrawal may be a symptom of the disease but is not related to the medication. Tardive dyskinesias occur late in therapy. Adverse effects are common with all antipsychotics, even when taken as prescribed.

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rosh foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

Answer 2. Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child's height and weight to assess whether nutritional intake is sufficient for normal growth and development. Options 1, 3, and 4 are incorrect. Physical activity does not increase the risk of seizure activity or need to be curtailed, and the drug does not affect bone growth or require extra vitamin D or calcium in the diet. Dehydration is a condition to be avoided in all clients, although increasing fluid intake is not necessarily related to the use of ethosuximide.

While talking with a patient about taking chlorpromazine, which of the following instructions should the health care professional include? 1. Take the drug in the morning to prevent nocturia. 2. Wear sunscreen when exposed to sunlight. 3. Take the drug with food to reduce GI distress. 4. Stop taking the drug immediately with the first sign of sore throat

Answer 2. 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 17-year-old patient has been prescribed escitalopram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this patient's age, the nurse will ensure that the patient and parents are taught what important information? 1. Cigarette smoking will counteract the effects of the drug. 2. Signs of increasing depression or thoughts of suicide should be reported immediately. 3. The drug causes dizziness and alternative schooling arrangements may be needed for the first two months of use. 4. Anxiety and excitability may increase during the first two weeks of use but then will have significant improvement.

Answer 2. Rationale: Escitalopram (Lexapro) is an antidepressant in the SSRI class. The drug carries a black box warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Signs of increasing depression or suicidal thoughts should be reported immediately. Options 1, 3, and 4 are incorrect. Smoking has no direct effects on escitalopram. Although dizziness may occur, it should not be significant enough to warrant a change in schooling needs. Escitalopram should not cause increased anxiety or excitability in the first few weeks of use, and other causes should be investigated should these occur.

A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased 2. The dosage will be decreased 3. The dosage will remain unchanged; these are symptoms unrelated to phenytoin 4. The dosage will remain unchanged but an additional anti seizure medication may be added

Answer 2. Rationale: Nystagmus, confusion, and ataxia may occur with phenytoin particularly with higher dosages. The dosage is likely to be decreased. Options 1, 3, and 4 are incorrect. The dosage would not remain the same or be increased because these are adverse effects of phenytoin that are related to overdosage.

The client asks what can be expected from the levodopa/carbidopa he is taking for treatment of Parkinson's. What is the best response by the nurse? 1. A cure can be expected within 6 months 2. Symptoms can be reduced and the ability to perform ADLs will be improved 3. Disease progression will be stopped 4. EPS will be prevented

Answer 2. Rationale: Phamarcotherapy does not cure or stop the disease process but does improve the patient's ability to perform ADLs such as eating, bathing, and walking. Options 1, 3, and 4 are incorrect. Drug therapy for PD does not cure or halt progression of the disease.

A health care professional should question the use of alprazolam (Xanax) for a patient who 1. has a history of thromboembolism. 2. drinks 8-oz glasses of wine each evening. 3. takes prednisone (Prelone) for rheumatoid arthritis. 4. takes vampiric acid (Depakote) for seizure disorder.

Answer 2. Rationale: To prevent severe sedation and respiratory depression, patients should avoid alcohol and other CNS depressants when taking benzodiazepines.

The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. What is the main rationale for the use of these techniques as an adjunct to analgesic medication? 1. They are less costly 2. They may allow lower doses of drugs with fewer adverse effects 3. They can be used at home 4. They do not require self-injection

Answer 2. Rationale: When used concurrently with medication, nonpharmacologic techniques may allow for lower doses and possibly fewer drug-related adverse effects. Relaxation techniques and guided imagery may also be used in the acute care setting. Options 1, 3, and 4 are incorrect. Although nonpharmalogic measures of pain control are less costly, may be used at home, and do not require injections, those are not the main rationale for using such techniques.

The nurse discusses the disease process of MS with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included? 1. drink extra fluids while this drug is given 2. local injection site irritation is a common effect 3. take the drug with plenty of water and remain in an upright position for at least 30 minutes 4. the drug causes a loss of vitamin C so include extra in the diet

Answer 2. Rationale: Glatiramer (Copaxone) is given by injection and often causes injection site irrigation. Options 1, 3, and 4 are incorrect. Extra fluids do not need to be included and the drug is not given orally. It does not deplete vitamin C from the body.

When caring for a patient who is taking risperidone (Risperdal) for schizophrenia, the health care professional should monitor which of the following adverse effects of the drug? 1. Chest pain 2. Polyuria 3. Paresthesias 4. Seizures

Answer 2. 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.

Zolpidem (Ambien) has been ordered for a client for the treatment of insomnia. What information will the nurse provide for this client? (Select all that apply.) 1. Be cautious when performing morning activities because it may cause a significant "hungover" effect with drowsiness and dizziness. 2. Take the drug with food; this enhances the absorption for quicker effects. 3. Take the drug immediately before going to bed; it has a quick onset of action. 4. If the insomnia is long-lasting, this drug may be safely used for up to a year. 5. Alcohol and other drugs that cause CNS depression should be avoided while taking this drug.

Answer 3 and 5. Rationale: Zolpidem (Ambien, Intermezzo) has a rapid onset, approximately 7 to 27 minutes, and should be taken immediately before going to bed. It should not be taken with alcohol or other drugs that cause CNS depression because of increased sedation and CNS depression. Option 1, 2, and 4 are incorrect.. Taking the drug with food will significantly impair its absorption and the onset of action may be delayed. Zolpidem has a duration of action of approximately 6 to 8 hours. Depending on when the drug is taken the night before, significant "hangover" effects such as sedation are not likely to occur as with other drugs in the category. The drug is approved for short-term treatment of insomnia only.

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments require immediate nursing interventions? (Select all that apply.) 1. BP of 110/70 2. Drowsiness 3. Pain is unrelieved in 15 minutes 4. RR of 10 breaths per minute 5. The client becomes unresponsive

Answer 3, 4, and 5. Rationale: Opioids may cause respiratory depression, particularly with the first dose given. The patient's respiratory rate should remain above 12 breaths per minute. although the patient may also become drowsy, he or she should not become unresponsive after administration of morphine sulfate. Because of the rapid onset of drugs when given IV, the provider should be notified if the patient's pain is unrelieved in 15 minutes. Option 1 and 2 are incorrect. Drowsiness is a common adverse effect of opioids, and 110/70 mmHg is within normal range for blood pressure.

A patient is admitted to the emergency department with spasms of his face and neck. He has recently begun taking chlorpromazine to treat schizophrenia. Which of the following adverse reactions should the health are professional suspect? 1. Cholinergic crisis 2. Stevens-Johnson syndrome 3. Acute dystonia 4. Serotonin syndrome

Answer 3. 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.

Which of the following client statements indicates that the levodopa/carbidopa (Sinemet) is effective? 1. "I'm sleeping a lot more, especially during the day" 2. "My appetite has improved" 3. "I'm able to shower by myself" 4. "My skin doesn't itch anymore"

Answer 3. Rationale: Becoming more independent in ADLs shows an improvement in physical abilities. Options 1, 2, and 4 are incorrect. Drowsiness is a common adverse effect of medications of PD. Anorexia or loss of appetite is also a common adverse effect and skin itching is not related to medication use.

An early sign of levodopa toxicity is which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking and muscle twitching 4. N/V, diarrhea

Answer 3. Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity. Options 1, 2, and 4 are incorrect. Orthostatic hypotension is a common adverse effect of both PD and many drugs used to treat the condition but is not a symptom of overdosage or toxicity. Drooling, nausea, vomiting, and diarrhea are also not symptoms of overdose or toxicity.

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? 1. Reduce fluid intake. 2. Take the drug with food. 3. Consume a low-sodium diet. 4. Avoid taking NSAIDs.

Answer 4. Rationale: NSAIDs increase renal reabsorption of lithium and sodium. Patients taking lithium should not take NSAIDs.

A client admitted with hepatitis B is prescribed hydrocodone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take? 1. Administer the drug as ordered 2. Administer 1 tablet only 3. Recheck the order with the health care provider 4. Hold the drug until the health care provider arrives

Answer 3. Rationale: Hydrocodone with acetaminophen (Vicodin) contains acetaminophen which can be hepatotoxic. This patient has hepatitis B, a chronic liver infection with inflammation, which may affect the metabolism of the drug. Option 1, 2, and 4 are incorrect. The drug should not be given as ordered and the patient may require pain relief before the health care provider arrives. It is not within the scope of practice for a nurse to determine the dosage of medications unless the nurse has received advanced specialty practice certification with prescriptive authority.

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? 1. Chest X-ray 2. Tonometry 3. Thyroid function tests 4. Endoscopic retrograde cholangiopancreatography

Answer 3. Rationale: Hypothyroidism is an adverse effect of lithium carbonate. Patients should report neck enlargement, weight fain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter.

A health care professional is talking to a patient who is newly diagnosed with Parkinson's disease about how levodopa/carbidopa (Sinemet) will help control her symptoms. With which of the following mechanisms is the drug effective in treating the disorder? 1. Inhibits norepinephrine metabolism in the brain 2. Inhibits serotonin metabolism in the brain 3. Increases available dopamine in the brain 4. Increases available acetylcholine in the brain

Answer 3. Rationale: Levodopa/carbidopa, a dopaminergic agent, can act by increasing dopamine in the extrapyramidal center of the brain, reducing involuntary motion.

The parents of a young client receiving methylphenidate (Ritalin) express concern that the health care provider has suggested the child have a "holiday" from the drug. What is the purpose of a drug-free period? 1. to reduce or eliminate the risk of drug toxicity 2. to allow the child's normal behavior to return 3. to decrease drug dependence and assess the client's status 4. to prevent the occurrence of a hypertensive crisis

Answer 3. Rationale: Methylphenidate (Ritalin) is a Scheduled II drug with potential to cause drug dependence when used over an extended period. The drug holiday helps to decrease the risk of dependence. It is also useful to evaluate current behavior; it improvement is noted, the drug dosage may be lowered or the drug stopped. Options 1, 2, and 4 are incorrect. Brief holidays off the medication will not eliminate the risk of toxicity. Toxicity may still occur while the patient takes the medication. The child's "normal" behavior may have been the reason for medication therapy. Hypertension may occur from methylphenidate but, except in the case of an overdose, should not reach a crisis level.

A health care professional administers fentanyl (Sublimaze) to a patient to reduce pain. Which of the following drugs should she have available to reverse the effect of fentanyl? 1. Neostigmine (Bloxiverz) 2. Dantrolene (Dantrium) 3. Naxolone 4. Succinylcholine (Anectine)

Answer 3. Rationale: Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an opioid agonist, can cause severe respiratory depression. Health care professionals administering fentanyl should also have resuscitation equipment available. Neostigmine, a cholinesterase inhibitor, reverses the effects of pancuronium, a nondepolarizing neuromuscular blocking agent. Dantrolene is a skeletal muscle relaxant that treats malignant hyperthermia and spasticity. Succinylcholine is a depolarizing neuromuscular blocking agent that will cause increased muscle relaxation.

What is the most appropriate method to ensure adequate pain relief in the immediate postoperative period from an opioid drug? 1. Give the drug only when the family members report that the patient is in pain 2. Give the drug every time the patient complains of acute pain 3. Give the drug as consistently as possible for the first 24-48 hours 4. Give the drug only when the nurse observes signs and symptoms of pain

Answer 3. Rationale: Opioid pain relievers should be given as consistently as possible and before the onset of acute pain in the immediate postoperative period unless the patient's condition does not allow the consistent dosing (e.g. vital signs do not support regular doses). Options 1, 2, and 4 are incorrect. These methods of drug administration would potentially allow pain to become severe before being adequately treated. Patients or family members may not always report pain or may downplay the severity. Cultural norms may also influence the patient's way of exhibiting pain.

During and immediately following IV administration of chlorpromazine to a patient who has schizoaffective disorder, the health care professional should monitor which of the following? 1. Oxygen saturation 2. Urine specific gravity 3. Blood pressure 4. Cardiac output

Answer 3. Rationale: Patients receiving chlorpromazine are at risk for hypotension during and immediately after IV administration. They should remain supine for 30 min while the health care professional monitors their BP. It is essential to infuse the chlorpromazine solution slowly and not to mix it with other drugs.

A health care professional is caring for a patient who is taking venlataxine 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? 1. Alprazolam (Xanax) 2. Phenytoin (Dilantin) 3. Phenelzine (Nardil) 4. Pilocarpine (Isopto Carpine)

Answer 3. Rationale: Patients should not take venlafaxine, a SSRI, within 14 days of taking phenezine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucination, and fever.

The nurse determines that the teaching plan for a client prescribed sertraline (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 phenelzineu (Nardil) that I'm taking 3. It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better 4. There are no other drugs I need to worry about; Zoloft doesn't react with them

Answer 3. Rationale: 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 SSRIs. The SSRIs should not be used concurrently with MAOIs because of an increased risk of hypertensive crisis. They also have many interactions with other drugs.

A 77 year old female client is diagnosed with depression with anxiety and is started on imipramine. Because of this client's age, the nurse will take precautions for care related to which adverse effects? 1. dry mouth and photosensitivity 2. anxiety, headaches, insomnia 3. drowsiness and sedation 4. urinary frequency

Answer 3. Rationale: TCAs such as imipramine (Tofranil) may cause drowsiness and sedation. Because of this patient's age, these effects may increase the risk of falls. Option 1, 2, and 4 are incorrect. Headache, insomnia, and anxiety are not common adverse effects associated with imipramine. The drug may cause photosensitivity, dry mouth, and urinary retention, but these would not be the top priority considering the fall risk. The drug does not cause urinary frequency.

A 32-year-old female patient has been taking lorazepam (Ativan) for her anxiety and is brought into the emergency department after taking 30-days' worth at one time. What antagonist for benzodiazepines may be used in this case? 1. Epinephrine 2. Atropine 3. Flumazenil 4. Naloxone

Answer 3. Rationale: The competitive antagonist drug used in cases of benzodiazepine overdose is flumazenil (Romazicon). Option 1, 2, and 4 are incorrect. Epinephirne, an adrenergic agonist, is not an antagonist to the benzodiazepines. Atropine is an anticholinergic, and naloxone is a competitive antagonist to opioid (narcotic) drugs.

A health care professional should advise a patient who is taking phenelzineu (Nardil) to avoid tyramine-enriched foods because of an increase risk of which of the following adverse reaction? 1. Serotonin syndrome 2. Neuroleptic malignant syndrome 3. Hypertensive crisis 4. Respiratory depression

Answer 3. 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.

An anesthetist is about to administer lidocaine (Xylocaine) as part of the protocol for spinal anesthesia for a pt who is undergoing a surgical procedure. potentially serious effects? 1. Hyperthermia 2. Tachycardia 3. Hypotension 4. Hemotysis

Answer 3. Rationale: When systemically absorbed in sufficient amounts, lidocaine, a local anesthetic, can cause hypotension, particularly when used as spinal anesthesia.

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? 1. Double vision 2. Excessvie salivation 3. Suicidal thoughts 4. Fever

Answer 3. Rationale: Young adults taking fluoxetine, an SSRI, 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 wait for indications of worsening depression.

The nurse should assess a patient who is taking lorazepam (Ativan) for the development of which of these adverse effect? 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

Answer 3. Rationale: Adverse CNS effects for lorazepam (Ativan) include ataxia, amnesia, weakness, disorientation, blurred vision, diplopia, nausea, and vomiting. Option 1, 2, and 4 are incorrect. Lorazepam is not known to cause tachycardia, astigmatism, or euphoria. If these symptoms occur, the patient should be assessed for other causative factors.

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 for lithium toxicity? 1. Ciprofloxacin (Cipro) for a urinary infeciton 2. Montelukast (Singulair) for asthma 3. Furosemide (Lasix) for hypertension 4. Acetaminophen (Tylenol) for headaches

Answer 3. 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.

A health care professional is talking to a patient about the adverse effect of interferon beta-1a (Avonex). To help minimize the effects, she should tell the patient to: 1. Increase his fluid intake 2. Take the drug in the morning 3. Premedicate with acetaminophen (Tylenol) 4. Take drug with food

Answer 3. Rationale: Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen or a nonsteroidal anti-inflammatory drug can help minimize these symptoms. Options 1, 2, and 4 are incorrect. The routes of administration of interferon beta drugs are parenteral (IM and SC). Evening administration of interferon beta drugs promotes tolerance of adverse reactions. Increasing fluid intake will not help relieve the adverse reactions of interferon beta drugs.

A health care professional should include which of the following instructions when talking with a patient about levodopa/carbidopa (Sinemet) to treat Parkinson's disease? 1. Take the drug at bedtime to avoid daytime drowsiness. 2. Eat a protein snack to increase absorption. 3. Change position slowly to prevent orthostatic hypotension. 4. Expect eye twitching to develop with long-term therapy.

Answer 3. Rationale: Levodopa/carbidopa can cause orthostatic hypotension. Options 1, 2, and 4 are incorrect. Patients typically take levodopa/carbidopa in divided doses during the day. High-protein foods can reduce the effectiveness of levodopa/carbidopa. Taking levodopa/carbidopa with non-protein sources of food, however, can help reduce adverse GI effects. Muscle twitching can indicate drug toxicity. This is an adverse effect patients should report.

Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine (Nardil) for treatment of depression? 1. headaches may occur. OTC medications will usually be effective 2. hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported 3. read labels of food and OTC drugs to avoid those with substances that should be avoided as directed 4. monitor BP for hypotension and report any BP below 60/90

Answer 3. Rationale: Phenelzine (Nardil) is an MAOI. The class of drugs has many drug and food interactions that may cause a hypertensive crisis. A list of foods, beverages, and medications to avoid should also be given to the patient. Option 1, 2, and 4 are incorrect. Headaches, especially if severe, may signal the beginning of a hypertensive crisis and any severe or increasing headache should be reported immediately. MAOIs are not known to cause hyperglycemia and other causes should be investigated if it occurs. The use of CNS depressants, including narcotics, along with an MAOI may cause profound hypotension, but the risk of hypertensive crisis is much greater and would have priority for teaching.

Levodopa (Larodopa) is prescribed for a client with Parkinson's disease. At discharge, which of the following teaching points should the nurse include? 1. Monitor BP every 2 hours for the first 2 weeks 2. Report the development of diarrhea 3. Take the pill on an empty stomach or 2 hours after a meal containing protein 4. If tremors seem to worsen, take a double dose for two doses and call the provider

Answer 3. Rationale: Taking dopamine replacement drugs such as levodopa with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach on 2 or more hours after a meal containing protein. Options 1, 2, and 4 are incorrect. Although the patient should be taught to rise gradually from lying or sitting to standing, the patient does not need to monitor blood pressure every 2 hours. Diarrhea should be reported but is unrelated to the effects of levodopa, and other causes should be explored. An increase in tremors should be evaluated, and the dose of the drug should not be independently increased.

The patient states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. What is the nurse's primary concern at the time? 1. A hypertensive crisis may occur with such abrupt withdrawal of the drug. 2. Significant muscle twitching may occur, increasing fall risk. 3. Extrapyramidal symptoms such as secondary Parkinsonism are likely to occur. 4. Symptoms of psychosis is likely to return.

Answer 4. Rationale: Antipsychotic medications treat the symptoms associated with mental illness but do not cure the underlying disorder. Without the medication, symptoms of the disorder are likely to return. Options 1, 2, and 3 are incorrect. Hypertensive crisis does not occur upon withdrawal of antipsychotic medication. EPS including muscle twitching and rigidity, and secondary Parkinsonism may occur related to the dosage of the medication and length of therapy, not withdrawal from the drug.

Which of the following information should a health care professional include when talking to a patient about baclofen (Lioseral)? 1. Stop taking the drug immediately if headache occurs. 2. Take the drug as needed for spasticity. 3. Take the drug with antacids to reduce gastric effects. 4. Avoid driving until the drug's effect is evident.

Answer 4. Rationale: Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Patients taking the drug should avoid alcohol and other CNS depressants and should not drive a vehicle until they know how the drug will affect them.

The nurse is caring for a 72 year old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client's age, the nurse would establish which nursing diagnosis related to the drug's common adverse effects? 1. Risk for deficient fluid volume 2. Risk for impaired verbal communication 3. Risk for constipation 4. Risk for falls

Answer 4. Rationale: CNS depression including dizziness and drowsiness is a common adverse effect of gabapentine (Gralise, Horizant, Neurontin). Because of this patient's age, these effects may increase the risk of falls. Options 1, 2, and 3 are incorrect. The drug is not known to cause dehydration (fluid volume deficit) or constipation or impair the ability to communicate.

A health care professional is caring for a patient who is about to begin taking pramipexole (Mirapex) to treat Parkinson's disease. The health care professional should recognize that which of the following laboratory tests require monitoring? 1. C-reactive protein 2. Thyroid function 3. CBC 4. Creatine phosphokinase (CPK)

Answer 4. Rationale: CPK is an enzyme found in the heart, brain, and skeletal muscles. Patients taking pramipexole can develop muscle weakness with a lack of energy, creating a situation that can be more problematic for patients than their original muscle dysfunction. Monitoring CPK can alert health care professionals to the possibility of skeletal muscle damage from the drug.

Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom? 1. leg cramping 2. blurred vision 3. lethargy 4. blister-like rash

Answer 4. Rationale: Carbamazepine (Tegretol) is associated with Stevens-Johnson syndrome and exfoliate dermatitis. A blister-like skin rash may indicate that these conditions are developing. Option 1, 2, and 3 are incorrect. Blurred vision, leg cramping, and drowsiness or lethargy are adverse effects of carbamazepine but do not require immediate reporting and may diminish over time.

When talking to a patient about taking buspirone, the health care professional should include which of the following instructions? 1. Take the drug with grapefruit juice to increase absorption 2. Use the drug only as needed for anxiety 3. Take the drug on an empty stomach 4. Allow 2 to 4 weeks before expected to feel better

Answer 4. Rationale: It can take up to 4 weeks for patients to feel the drug's full therapeutic effects especially because it is an anxiolytic which should not be taken as needed or on an empty stomach.

A health care professional is caring for a patient who is about to be taking dantrolene (Dantrium) for skeletal spasm. The health care professional should recognize that which of the following laboratory test requires monitoring? 1. Thyroid function 2. Serum potassium 3. Serum sodium 4. Liver function

Answer 4. Rationale: Liver toxicity is a serious adverse effect of dantrolene. The health care professional should monitor liver function prior to treatment and at regular intervals, and advise patients to report jaundice or abdominal pain.

Education given to clients about the use of all drugs to treat insomnia should include an emphasis on what important issue? 1. They will be required long-term to achieve long-lasting effects. 2. They require frequent blood counts to avoid adverse effects. 3. They are among the safest drugs available and have few adverse effects. 4. Long-term use may increase the risk of adverse effects, create a "sleep debt", and cause rebound insomnia when stopped.

Answer 4. Rationale: Long-term use of drugs to treat insomnia is not recommended. They have significant adverse effects, may cause a "sleep debt" due to effects on the sleep cycle, and may cause rebound insomnia when discontinued. Option 1, 2, and 3 are incorrect. Many of the drugs used for insomnia have significant adverse effects and are not used long term. Whereas some drugs in the category may require concurrent blood counts, this is not required for all drugs in the category.

Anesthetists often administer midazolam (Versed) during induction of anesthesia because of which of the following pharmacological actions? 1. Induced muscle paralysis 2. Dries secretion 3. Produces analgesics 4. Causes amnesia

Answer 4. Rationale: Midazolam, a benzodiazepine, is appropriate during induction because of its antianxiety and amnesiac properties.

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? 1. Respiratory depression 2. Anterograde amnesia 3. Paradoxical reaction 4. Withdrawal symptoms

Answer 4. 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.

The emergency department nurse is caring for a client with a migraine headache. Which drug would the nurse anticipate administering to abort the client's migraine attack? 1. morphine 2. propranolol (Inderal) 3. ibuprofen (Motrin) 4. sumatriptan (Imitrex)

Answer 4. Rationale: Triptans such as sumatriptan (Imitrex) are used to abort a migraine attack. Options 1, 2, and 3 are incorrect. Morphine and other narcotics are not effective in aborting a migraine. Propanolol (Inderal) and ibuprofen (Motrin) may be used as adjunctive therapy in migraine therapy but will not stop a headache from occurring.

A health care professional is reviewing the medical record of a patient who has been newly diagnosed seizure disorder. The patient is to begin taking both valporic acid (Depakote) and phenytoin (Dilantin). The health care professional should recognize that which of the following can occur as a result of a drug interaction between valporic acid and phenytoin? 1. Hyperammonemia 2. Hypertension 3. Peptic ulcer disease 4. Phenytoin toxicity

Answer 4. Rationale: Valproic acid can cause an increase in phenytoin blood levels, causing phenytoin toxicity. The primary care provider should monitor serum phenytoin levels and reduce the dosage if levels begin to exceed the therapeutic range.

Which of the following findings should alert a health care professional that a patient is developing a potentially serious adverse reaction to interferon beta-1b (Betaseron)? 1. Blue-green skin discoloration 2. Twitching eyelids 3. Tinnitus 4. Fatigue

Answer 4. Rationale: ​Because of the potential for bone marrow suppression and decreased platelet count, patients should report unexplained bruising, bleeding, or fatigue. Interferon beta-1b can cause skin, sclerae, and urine to turn a blue-green color.

A patient is receiving temazepam (Restoril). Which of these responses should a nurse expert the patient to have if the medication is achieving the desired effects? 1. The patient sleeps in 3-hours intervals, awakens for a short time, and then falls back to sleep. 2. The patient reports feeling less anxiety during activities of daily living. 3. The patient reports having fewer episodes of panic attacks when stressed. 4. The patient reports sleeping 7 hours without awakening.

Answer 4. Rationale: Temazepma (Restoril) is a benzodiazepine ordered for insomnia. Therefore, the patient should be experiencing relief from insomnia and reporting feeling rested when awakening. Options 1, 2, and 3 are incorrect. Sleeping 3 hours or less would indicate less than therapeutic effects. Whereas some benzodiazepines are used in the treatment of anxiety or panic disorders, temazepam's primary use is in the treatment of insomnia.