Exam 3 Questions
A patient is admitted for assessment because of his history of inappropriately flamboyant and extroverted behavior coupled with risk-taking behaviors. The wife states he has also had periods of major depression but refuses to seek help. From what mood disorder is the patient most likely suffering? A) Bipolar disorder type I B) Depression C) Schizophrenia D) Bipolar disorder type II
A) Bipolar disorder type I
A patient has been diagnosed with chronic obstructive pulmonary disease. The patient is to be administered tiotropium bromide (Sprivia HandiHaler). The patients creatinine level is 25. What is the patient at risk for developing? A) Drug toxicity B) Pneumonia C) Hepatotoxicity D) Central nervous system depression
A) Drug toxicity
An 8-year-old child is being seen in the clinic. The mother states he suffers from bed-wetting at least four times per week. What medication is effective in treating enuresis in children? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Duloxetine (Cymbalta) D) Amitriptyline (Elavil)
A) Imipramine (Tofranil)
A patient is administered edrophonium (Tensilon) to confirm the diagnosis of myasthenia gravis. What effect will the edrophonium (Tensilon) have 30 minutes after the medication adminstration, which will confirm the diagnosis? A) Improved breathing B) Decreased fatigue C) Decreased muscle spasms D) Increased urinary output
A) Improved breathing
A patient has been prescribed mirtazapine (Remeron). How will it decrease migraine headaches and depression? A) It blocks the presynaptic alpha2-adrenergic receptors. B) It acts on the dopamine only receptors in the brain. C) It inhibits norepinephrine and serotonin reuptake. D) It increases concentration of endogenous epinephrine.
A) It blocks the presynaptic alpha2-adrenergic receptors.
A patient has been taking lithium carbonate (Eskalith) for many years to treat bipolar disorder. Which of the following diets will require the dose of lithium carbonate (Eskalith) be reduced? A) Low sodium B) Low carbohydrate C) Low calorie D) Low residue
A) Low sodium
An elderly patient is admitted to the medical unit after a fall. At home he is taking amitriptyline (Elavil) 20 mg three times per day. What adverse effect could be related to the patient's fall? A) Orthostatic hypotension B) Urinary retention C) Urinary frequency D) Visual disturbances
A) Orthostatic hypotension
A patient is prescribed clozapine (Clozaril). The patient and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first months of the medication regime? A) Regular complete blood counts B) Daily INR C) Monthly creatinine levels D) Weekly liver enzymes
A) Regular complete blood counts
A military nurse is part of a team reviewing the appropriate response to chemical weapon attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment? A) Restore anticholinesterase function B) Restore GABA function C) Restore dopamine function D)Increase serotonin reuptake
A) Restore anticholinesterase function
Parenteral haloperidol has been ordered for a patient who is experiencing an acute psychotic episode. The nurse should recognize what primary goal of treatment? A) Decreased CNS stimulation B.) Increased sophistication of thinking C) Decreased agitation and combativeness D) Increased insight into delusional thinking
C) Decreased agitation and combativeness
A patient is diagnosed with Alzheimer's disease. The nurse should anticipate administering which of the following medications? A) Bethanechol (Urecholine) B) Neostigmine (Prostigmin) C) Donepenzil (Aricept) D)Physpstigmine salicylate (Antilirium)
C) Donepenzil (Aricept)
A patient is suffering from urinary urgency and frequency. Which of the following medications will assist in treating the patient's symptoms of urinary frequency? A) Belladonna tincture B) Homatropine hydrobromide C) Hyoscyamine (Anaspaz) D) Ipratropium (Atrovent)
C) Hyoscyamine (Anaspaz)
The physician orders benztropine mesylate (Cogentin). What disease process would contraindicate the administration of this anticholingeric medication? A) Diabetes mellitus B) Myocardial infarction C) Narrow-angle glaucoma D) Hyperparathyroidism
C) Narrow-angle glaucoma
A 22-year-old man's increasingly bizarre behavior has culminated in a diagnosis of schizophrenia. In light of current treatment modalities for schizophrenia, the nurse should anticipate that the patient is most likely to be prescribed what drug? A) Chlorpromazine (Thorazine) B) Haloperidol (Haldol) C) Olanzapine (Zyprexa) D) Prochlorperazine (Compazine)
C) Olanzapine (Zyprexa)
A person is seen wandering the streets and talking in an animated what to people who are not there. From what disorder do you suspect the person is suffering? A) Confusion B) Delusions C) Psychosis D) Depression
C) Psychosis
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenage girl who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite? A) Lower cost B) The possibility of oral administration C) Reduced adverse effects D) Absence of black box warnings
C) Reduced adverse effects
A patient has been administered chlorpromazine (Thorazine) for many years to treat his psychotic disorder. He has recently developed extra pyramidal symptoms related to long term adminstration of this drug. Which of the following medications can be adminstered to assist in relieving these symptoms? A) Diazepam (Valium) B) Darifenacin (Enablex) C) Trihexyphenidyl (Trihexy) D) Trospium chloride (Sanctura)
C) Trihexyphenidyl (Trihexy)
A patient is experiencing an episode of psychosis. He is belligerent, loud, and abusive when you enter the room. What is the best response by the nurse during future interactions? A) Respond to him in an assertive tone. B) Delegate care to the technician. C) Use a calm, soft voice. D) Place him in the quiet room.
C) Use a calm, soft voice.
A patient's medication administration record orders the IM administration of chlorpromazine. When administering this drug, the nurse should A) have the patient massage the injection site for 1 to 2 minutes after the injection. B) administer the drug into the deltoid muscle with a 1 1/2-inch needle. C) have the patient lie down for 30 to 60 minutes after the injection. D) observe the patient while he or she self-administers the drug.
C) have the patient lie down for 30 to 60 minutes after the injection.
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect? A) perspiration. B) appetite or thirst. C) involuntary movements. D) mobility.
C) involuntary movements.
A nurse is assessing a client prior to giving a cholinergic drug for treatment of urinary retention. Which nursing assessments should be completed prior to administration of a cholinergic? Select all that apply. A) Scan the bladder to determine if urine retention present. B) Assess blood pressure and pulse rate. C) Document pain assessment. D) Administer antiemetic medication. E) Palpate the abdomen in the pelvic area.
A) Scan the bladder to determine if urine retention present. B) Assess blood pressure and pulse rate. E) Palpate the abdomen in the pelvic area.
A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. The normal function of which neurotransmitter is most likely impaired? A) Serotonin B) Insulin C) Acetylcholine D) Epinephrine
A) Serotonin
A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect? A) The client is able to walk more briskly and stably than two weeks ago B) The client is oriented to person, place and time C) The client denies shortness of breath and adventitious lung sounds are absent on auscultation D) The client describes an increase in appetite compared with two weeks ago
A) The client is able to walk more briskly and stably than two weeks ago
A child suffers from tics and verbal outbursts in the classroom and while he is awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat? A) Tourette's syndrome B) Early-onset dementia C) Myasthenia gravis D) Muscular dystrophy
A) Tourette's syndrome
A patient suffers from insomnia secondary to temporomandibular joint pain. Which of the following selective serotonin reuptake inhibitors is most effective for treating insomnia? A) Trazodone (Desyrel) B) Citalopram hydrobromide (Celexa) C) Fluoxetine (Prozac) D) Olanzapine (Zyprexa)
A) Trazodone (Desyrel)
A client has benign prostatic hypertrophy and has been prescribed neostigmine. The nurse is aware that this client must be monitored for what adverse effect of this medication? A) Urinary retention B) Pain with urination C) Hematuria D)Pyuria
A) Urinary retention
The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to: A) inability to swallow. B) inability to make food choices. C) fatigue. D) loss of appetite.
A) inability to swallow.
An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided? A)"Avoid high environmental temperatures." B)"Anticholinergics increase mental alertness." C)"It is safe to take Sudafed for a cold." D)"You may experience urinary incontinence."
A)"Avoid high environmental temperatures."
The nurse is teaching a woman who has Parkinson's disease about the dietary implications of her upcoming treatment with levodopa/carbidopa. What should the nurse teach this patient? A)"It's important to take this medication on a full stomach so that it doesn't make you nauseous." B)"Most people find that it's best to take this medication at bedtime, provided you haven't snacked in the evening." C)"If possible, try to eat extra protein when you're taking this medication." D)"Dairy products will make this medication ineffective, so make sure you don't take them at the same time."
A)"It's important to take this medication on a full stomach so that it doesn't make you nauseous."
A patient with myasthenia gravis is administered pyridostigmine (Mestinon) for the first time. She asks the nurse the reason why she has been changed to this medication. Which of the following is the nurse's best response? A)"Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow." B)"Pyridostigmine (Mestinon) can be taken every other day." C)"Pyridostigmine (Mestinon) is a faster-release form of cholinergic agent." D)"Pyridostigmine (Mestinon) is taken one time per day for better control."
A)"Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow."
A patient is having seizure activity, and the physician has ordered diazepam (Valium) to be given parenterally. If this medication is administered intravenously, when will its onset of action be observed? A)1 to 5 minutes B)7 to 10 minutes C)More than 10 minutes D)Less than 1 minute
A)1 to 5 minutes
A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A)Atropine B)Pseudoephedrine C)Propranolol (Inderal) D)Bethanechol (Urecholine)
A)Atropine
A patient with Parkinson's disease is being treated with rasagiline (Azilect). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the following foods should the patient be instructed to avoid? A)Cheddar cheese and Polish sausage B)Ham and rye bread C)Roast beef and horseradish D)Dairy products
A)Cheddar cheese and Polish sausage
A patient is administered a benzodiazepine for anxiety. Which of the following will place the patient at risk for benzodiazepine toxicity? A)Decreased albumin B)Increased calcium C)Decreased potassium D)Low bicarbonate
A)Decreased albumin
A patient has developed symptoms of rigidity and bradykinesia. Which of the following medications has been linked to secondary parkinsonism?A)Haloperidol B)Furosemide (Lasix) C)Psyllium hydrophilic mucilloid (Metamucil) D)Valproic acid (Valproate)
A)Haloperidol
Which sign demonstrated by a client one anticholinergic medication therapy should the nurse treat as an adverse reaction? A)Hypohidrosis B) Rhinorrhea C) Mydriasis D) Pylorospasm
A)Hypohidrosis
A patient is administered atropine to increase the heart rate. What is the action of atropine? A)It blocks the parasympathetic vagal stimulation. B)It exacerbates the parasympathetic vagal stimulation. C)It provides long-acting antihistamine blockage. D)It blocks cell wall synthesis of gram-negative bacilli.
A)It blocks the parasympathetic vagal stimulation.
A patient is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa (Lodosyn). Why is this course of combination treatment most effective? A)Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa. B)Levodopa decreases the toxic effects of carbidopa to reduce the extrapyramidal reaction. C)Carbidopa increases the peripheral breakdown of levodopa to hasten its onset and peak. D)Levodopa and carbidopa, when combined, enhance voluntary movement to improve gait.
A)Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa.
When administering benzodiazepines, which of the following medications should be considered the drug of first choice?A)Lorazepam (Ativan) B)Estazolam (Prosom) C)Temazepam (Restoril) D)Triazolam (Halcion)
A)Lorazepam (Ativan)
An accidental overdose of neostigmine has prompted the emergency administration of atropine. When assessing the patient, the emergency department nurse should take into account that this intervention will not relieve the effects of neostigmine on A)skeletal muscle. B)smooth muscle. C)the heart. D) glands.
A)skeletal muscle.
In the 18 months following the death of his wife, a middle-aged man has been taking benzodiazepines on a daily basis. He has expressed to the nurse his desire to stop taking these medications. In order to minimize the chances of withdrawal symptoms, the nurse knows that the patient will likely be advised to A)taper down his dose of benzodiazepines over a prolonged period of time. B)replace the benzodiazepine with a herbal supplement in anticipation of stopping the medication. C)replace the immediate-acting form of the drug with a long-acting form. D)replace the benzodiazepine with an anticonvulsant
A)taper down his dose of benzodiazepines over a prolonged period of time.
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching? A) "I should avoid driving if I feel light-headed or dizzy." B) "I need to exercise frequently outside in the warm weather." C) "I should make sure that I drink plenty of fluids." D) "I should eat plenty of fiber to prevent constipation."
B) "I need to exercise frequently outside in the warm weather."
A patient has been achieving an acceptable reduction in his positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The patient has asked the nurse if it is acceptable for him to have "a few drinks from time to time." How should the nurse best respond to the patient's inquiry? A) "If you notice that your symptoms are worsening when you drink, you should stop doing it." B) "When you're taking clozapine, it's best to avoid drinking alcohol altogether." C) "That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits." D) "That shouldn't present a problem, provided you make sure that you're safe when you do it."
B) "When you're taking clozapine, it's best to avoid drinking alcohol altogether."
The nursing instructor is teaching a student about the drugs used for Alzheimer's disease. Even though cholinesterase inhibitors do not cure the disease, the instructor informs the student that they do help to slow the progression. The instructor then asks the student, "When a drug is stopped due to side effects, what happens to the client?" The student's best response would be: A) The side effects will worsen B) .The client loses any benefit they have received from the drug. C) The client will show no changes. D) The client will deteriorate at a faster rate.
B) .The client loses any benefit they have received from the drug.
A patient treated for bipolar disorder with lithium carbonate (Eskalith) is scheduled for a lithium blood level. What is the therapeutic serum lithium level? A) 1.5 to 2.0 mEq/L B) 0.5 to 1.2 mEq/L C) 2.7 to 2.9 mEq/L D) 2.75 to 3.25 mEq/L
B) 0.5 to 1.2 mEq/L
A psychiatric nurse is providing care for a female patient with schizophrenia whose medication regimen includes oral chlorpromazine. When administering this medication, the nurse should do which of the following? A) Have the patient hold the drug under her tongue for at least 30 seconds. B) Administer the drug 1 to 2 hours before bedtime. C) Instruct the patient to avoid dairy products for 1 hour before and 2 hours after administration. D) Administer the drug on alternating days.
B) Administer the drug 1 to 2 hours before bedtime.
A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which of the following foods should the patient avoid eating? A) Tortellini in cream sauce B) Aged Swiss cheese and bratwurst C) Mashed potatoes and roast beef D) Anise cookies and milk
B) Aged Swiss cheese and bratwurst
Decreased acetylcholine levels are characteristic of: A)multiple sclerosis. B) Alzheimer's disease. C) Huntington's disease. D)Parkinson's disease.
B) Alzheimer's disease.
A 40-year-old man has been prescribed fluoxetine (Prozac). The patient states he has not continued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make? A) Assess for pain and discomfort. B) Assess for sexual dysfunction. C) Assess for hypotension. D) Assess for cardiac dysrhythmia.
B) Assess for sexual dysfunction.
A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug? A) Pyridostigmine B) Bethanechol C) Guanidine D) Ambenonium
B) Bethanechol
A women has a history of long periods of depression interspersed with hypomanic episodes. What mood disorder is the patient likely suffering from? A) Bipolar disorder type I B) Bipolar disorder type II C) Situational depression D) Coping disorder
B) Bipolar disorder type II
The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effectA) Decreased secretions B) Bronchoconstriction C) Bronchodilation D) Thickened secretions
B) Bronchoconstriction
An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A) Acetylsalicylic acid (aspirin) B) Chlorpromazine (Thorazine) C) Aminophylline (Theophylline) D) Dantrolene sodium (Dantrium)
B) Chlorpromazine (Thorazine)
A patient has atony of the smooth muscle of the gastrointestinal tract. Which type of medication may be administered to increase smooth muscle strength? A) Anticholinergic drugs B) Cholinergic drugs C) Muscle relaxants D) Selective serotonin reuptake inhibitors
B) Cholinergic drugs
A man with neurogenic bladder secondary to a spinal tumor has been taking bethanechol. The patient has illuminated his call light, and the nurse has found him anxious, diaphoretic, and visibly flushed. Following a safety assessment, what action should the nurse take? A) Prepare to administer an IV dose of epinephrine to mitigate the effects of acetylcholine. B) Contact the physician as the patient may be experiencing a cholinergic crisis. C) Insert a Foley catheter as the patient may have excessive urine in his bladder. D) Assess the volume of the patient's bladder contents using a bladder ultrasound.
B) Contact the physician as the patient may be experiencing a cholinergic crisis.
A patient is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The patient tells the nurse he is voiding three times each night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A) Hyperthyroidism B) Diabetes mellitus C) Urinary tract infection D) Renal calculi
B) Diabetes mellitus
A nurse has noted that a newly admitted patient has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this patient was experiencing what problem prior to starting this drug? A) Somnambulism (sleepwalking) B) Difficulty falling asleep at night C) Early morning waking D) Frequent nighttime awakenings
B) Difficulty falling asleep at night
Which agent would be most appropriate to administer to a client with Alzheimer's disease? A) Neostigmine B) Donepezil C) Pyridostigmine D) Ambenonium
B) Donepezil
A patient's severe familyy tragedy 1 year ago resulted in derpession and insomina. Which of the following hypnotics may be safely taken for longer-term treatmenr of insomina? A) Lorazepam (Ativan) B) Eszopiclone (Lunesta) C) Chloral hydrate D) Oxazepam (Serax)
B) Eszopiclone (Lunesta)
A patient is being treated for bipolar disorder with lithium carbonate (Eskalith). He also suffers from congestive heart failure and hypertension. The patient has an increased fluid volume and has recently had difficulty breathing. What laboratory value will most affect the action of the patient's lithium carbonate? A) Increased potassium level B) Increased sodium level C) Increased white blood cell count D) Increased hematocrit
B) Increased sodium level
A patient with a diagnosis of major depression has failed to respond to treatment with SSRIs, and the use of venlafaxine is being considered. The psychiatric nurse would recognize that this drug may have a therapeutic effect by which of the following means? A) Slowing the reuptake of acetylcholine in brain synapses B) Increasing levels of serotonin and norepinephrine C) Stimulating synthesis and potentiating the action of dopamine D) Slowing the reuptake of endorphins in the CNS
B) Increasing levels of serotonin and norepinephrine
A patient with myasthenia gravis is administered neostigmine (Prostigmin). How does this drug produce its therapeutic effect? A) It stimulates the sympathetic nervous system B) It stimulates the parasympathetic nervous system C) It stimulates the cardiac smooth muscle D) It stimulates the respiratory system
B) It stimulates the parasympathetic nervous system
A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient? A) Report signs of neuralgia. B) Maintain the medication regimen. C) Limit alcohol intake to two drinks per day. D) Stop medications if weight gain occurs.
B) Maintain the medication regimen.
A patient suffers from insomnia and is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which of the following contributes to the long half-life of this medication and other benzodiazepines? A) Metabolism by cytochrome P450 B) Presence of active metabolites C) Excretion by the renal system D) Movement of calcium in the cell
B) Presence of active metabolites
A patient in her 60s has been living with schizophrenia since she was a young woman and was treated with chlorpromazine for many years. The nurse who is meeting the patient for the first time observes that the patient continually smacks her lips and appears to be chewing. The nurse should recognize that this patient is likely experiencing what problem? A) Dystonias B) Tardive dyskinesia C) Akathisia D) Neuroleptic malignant syndrome
B) Tardive dyskinesia
A patient is to be switched from fluoxetine (Prozac) to isocarboxazid (Marplan). What patient education is most important when changing from fluoxetine (Prozac)? A) Wait 1 week before starting isocarboxazid (Marplan). B) Wait 5 weeks before starting isocarboxazid (Marplan). C) Wait 2 weeks before starting isocarboxazid (Marplan). D) Wait 5 days before starting isocarboxazid (Marplan).
B) Wait 5 weeks before starting isocarboxazid (Marplan).
A patient with a diagnosis of depression states to the nurse that she has started taking St. John's wort to help her feel better and tolerate the demands of parenting. The patient has been taking an SSRI for the past several months. The nurse should teach that patient that this combination may result in A) worsened symptoms of depression. B) dangerous drug interactions. C) blood dyscrasias. D) hemostatic instability.
B) dangerous drug interactions.
A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up? A) significant changes in mood and affect B) sudden muscle weakness C) jaundice D) migraine-type symptoms
B) sudden muscle weakness
A patient with long-standing Parkinson's disease has been prescribed entacapone (Comtan). The patient asks the nurse to describe exactly how this medication works. Which of the following responses is most appropriate? A)"Entacapone is best given parenterally to relieve symptoms." B)"Entacapone inhibits COMT so that dopamine is active for a longer time." C)"It increases the metabolism of levodopa in the bloodstream." D)"It increases the amount of dopamine that your brain creates."
B)"Entacapone inhibits COMT so that dopamine is active for a longer time."
A nurse is conducting health education with a man who has Alzheimer's disease and his daughter, who is his primary caregiver. The man has been deemed to be a good candidate for treatment with donepezil (Aricept) and will soon begin taking this medication. What teaching point should the nurse convey? A)"Aricept should be taken 1 hour before or 2 hours after any dairy products." B)"It's important to take this medication at bedtime." C)"Aricept should be taken with food to reduce the chance of stomach upset." D)"If you don't notice any cognitive improvement within 2 weeks, the drug should be discontinued.
B)"It's important to take this medication at bedtime."
A patient is being observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is characteristic of this problem? A)Bradycardia B)Agitation C)Lethargy D)Diaphoresis
B)Agitation
A patient is given midazolam (Versed) in combination with an opioid in the preoperative phase before a laparoscopic cholecystectomy. What does the administration of midazolam (Versed) assist in minimizing? A)Oral secretions B)Anxiety C)Hypotension D)Muscle tone
B)Anxiety
A 33-year-old female patient with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this patient's health problem is ultimately attributable to what pathophysiological process? A)Idiopathic overproduction of anticholinesterase B)Autoimmune destruction of acetylcholine receptors C)Demyelination of parasympathetic nerve pathways D)Deficient synthesis of dopamine by the substantia nigra
B)Autoimmune destruction of acetylcholine receptors
A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, he develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms?A)Myasthenic crisis B)Cholinergic overdose C)Anaphylactic reaction D)Pulmonary edema
B)Cholinergic overdose
A patient is admitted to the intensive care unit with a diagnosis of septicemia. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill patient? A)Increased diffusion and perfusion B)Decreased cardiac workload C)Increased level of consciousness D)Decreased blood pH
B)Decreased cardiac workload
An older adult patient suffers from generalized anxiety disorder. The use of benzodiazepines in this patient population creates a risk for what adverse effect? A)Seizures B)Falls C)Dysrhythmias D)Sexual dysfunction
B)Falls
A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine? A)Pallor B)Flushing C)Edema D)Incontinence
B)Flushing
A patient with myasthenia gravis is experiencing rhinorrhea. Which of the following medications should not be administered to the patient?A)Azelastine hydrochloride (Astelin) B)Ipratropium (Atrovent) C)Fexofenadine (Allegra) D)Nedocromil sodium (Tilade)
B)Ipratropium (Atrovent)
A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase? A)It will prevent tachycardia. B)It will decrease respiratory secretions. C)It will decrease gastric motility. D)It relaxes the detrusor muscle.
B)It will decrease respiratory secretions.
A patient is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A)Triazolam (Halcion) B)Midazolam (Versed) C)Oxazepam (Serax) D)Chlordiazepoxide (Librium)
B)Midazolam (Versed)
Following recent changes in memory and personality, a 72-year-old man is undergoing neurological testing to rule out Alzheimer's disease. The nurse is aware that this disease is characterized by what pathophysiological phenomena? Select all that apply. A)Meningiomas B)Neuritic plaques C)Neurofibrillary tangles D)Arteriovenous malformations (AVMs) E)Gliomas
B)Neuritic plaques C)Neurofibrillary tangles D)Arteriovenous malformations (AVMs)
A patient with a history of alcoholism is being treated in the intensive care unit for multiple trauma following a motor vehicle accident. The patient is currently being treated with lorazepam (Ativan) to treat signs of alcohol withdrawal as well as hydromorphone (Dilaudid) for the pain of injuries. The intensive care nurse should prioritize what assessments? A)Arterial blood gases B)Respiratory rate and oxygen saturation C)Deep tendon reflexes and pupillary response D)Cardiac rate and rhythm
B)Respiratory rate and oxygen saturation
77-year-old male patient with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone (Stalevo). Prior to starting this course of treatment, the nurse must ensure that A)the patient has committed to having weekly blood work drawn for the next 2 months. B)the patient has completed an anticholinergic challenge in a clinical setting. C)the patient's existing dose of levodopa has been reduced. D)the patient has a prognosis for complete recovery from Parkinson's disease.
B)the patient has completed an anticholinergic challenge in a clinical setting.
A nurse is caring for a client who has been diagnosed with Parkinson's disease. The client does not understand how the medication, carbidopa-levodopa, is going to help the condition. What is the correct response by the nurse? A) "Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months." B) "This drug will change the immune processes in your body to help decrease the tissue damage." C) "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." D) "Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation."
C) "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms."
A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The patient asks the nurse what likely prompted his care provider to change his medication. What is the nurse's best response? A)"Your doctor may have been concerned about causing depression." B)"Your doctor may have been worried about the possibility of convulsions." C)"Long-term use of benzodiazepines can result in dependency." D)"Long-term use of benzodiazepines can cause insomnia."
C)"Long-term use of benzodiazepines can result in dependency."
A patient is diagnosed with a paralytic ileus. Which of the following medications will be administered to treat a paralytic ileus? A)Neostigmine (Prostigmin) B)Donepezil (Aricept) C)Bethanechol (Urecholine) D)Ambenonium (Mytelase)
C)Bethanechol (Urecholine)
An 80-year-old man has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil (Aricept). When providing health education to the patient and his wife, the nurse should identify what goal of treatment? A)Remission of Alzheimer's disease B)Cure of Alzheimer's disease C)Improvement of cognition and function D)Resolution of memory and cognitive deficits
C)Improvement of cognition and function
A middle-aged woman has become increasingly debilitated by anxiety, to the extent that she has sought medical help. After a thorough assessment, her care provider has diagnosed her with an anxiety disorder. The etiology of anxiety involves which of the following physiological processes?A)Stimulation of the parasympathetic nervous system B)Stimulating effects of somatotropin C)Increased activation of the autonomic nervous system D)Adrenocortical suppression
C)Increased activation of the autonomic nervous system
A child with night terrors is administered a benzodiazepine agent. Why must the nurse follow the child's health status closely?A)The child is more likely to develop insomnia. B)The child is more likely to develop dependence. C)The child is more vulnerable to adverse effects. D)The child is more vulnerable to hepatotoxicity.
C)The child is more vulnerable to adverse effects.
A patient's current medical status includes multiple comorbidities. In recent months, the patient has been complaining of insomnia that has begun to have a significant impact on his quality of life. What aspect of this patient's health is most likely to cause insomnia? A)The patient has hypothyroidism. B)The patient is morbidly obese. C)The patient has chronic pain. D)The patient has type 2 diabetes
C)The patient has chronic pain.
A 40-year-old woman has received a diagnosis of myasthenia gravis (MG) and is scheduled to begin treatment with oral neostigmine in her home. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on A)matching each dose of neostigmine to the severity of symptoms at that time. B)making lifestyle modifications to prioritize a healthy diet and regular activity. C)adhering strictly to the prescribed administration schedule. D)developing acceptance of the functional deficits that result from MG.
C)adhering strictly to the prescribed administration schedule.
A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience? A) Hypertension B) Central nervous system agitation C) Urinary frequency D) Extrapyramidal effects
D) Extrapyramidal effects
A 34-year-old man was diagnosed with depression several weeks ago and began taking citalopram (Celexa) 10 days ago. He has now scheduled an appointment at the clinic and has told the nurse that he intends to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the patient's statement? A) "People who take this drug often think they don't feel better because the changes in mood are incremental and subtle." B) "I'll pass that information along to your care provider; a different drug might be more appropriate for you." C) "It could be that one of the other medications or supplements you're taking is negating the effects of Celexa." D) "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."
D) "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."
A high school-aged girl has been suffering from major depression for several months, and she has begun treatment with an SSRI. In light of the black box warning accompanying SSRIs, the nurse should prioritize which of the following assessments? A) Assessment of cardiac rate and rhythm B) Assessment for hypomanic state C) Assessment for venous thromboembolism (VTE) D) Assessment for suicidal ideation
D) Assessment for suicidal ideation
A patient is admitted to the hospital for cardiac surgery and has just come up to the postsurgical unit from the recovery room. He develops unprecedented confusion and states, "I see bugs up and down the walls. They are going to get me." The nurse suspects the patient is suffering from what symptom? A) Delusions B) Schizophrenia C) Depression D) Delirium
D) Delirium
A women is admitted to the emergency department with a diagnosis of sinus badycardia. The pateint has been prescribed atropine 0.5 mg IV. How often can atropine be adminstered? A) Every 24 hours B) Every 6 hours C) Every 30 minutes D) Every 3 to 5 minutes
D) Every 3 to 5 minutes
A patient with schizophrenia has been taking haloperidol for several years. The care team and the patient have collaborated and chosen to transition the patient to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the patient's risk of extrapyramidal effects during this transition, the care team should do which of the following? A) Arrange for weekly electroconvulsive therapy during the time of transition. B) Have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic. C) Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. D) Gradually taper the dose of haloperidol.
D) Gradually taper the dose of haloperidol.
The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms? A) Improve medication absorption through the blood-brain barrier B) Cause vasodilation of the cerebral arteries C)Improve anticholinergic neurotransmission to the brain D) Improve cholinergic neurotransmission to the brain
D) Improve cholinergic neurotransmission to the brain
Duloxetine (Cymbalta) is being considered in the treatment of a patient's depression. Which of the following laboratory values would prevent the patient from being treated with this medication? A) Decreased potassium level B) Decreased hemoglobin level C) Increased erythrocyte sedimentation rate D) Increased ALT
D) Increased ALT
A patient who has a diagnosis of schizophrenia is likely to have which of the following pathophysiologic effects? A) Increased serum potassium B) Decreased numbers of glutamate receptors C) Decreased interaction with GABA D) Increased dopamine
D) Increased dopamine
When administering anticholinesterase drugs, what assessment finding would indicate the patient is experiencing a toxic effect of the medication? A)Loss of consciousness B)Abdominal distention C)Hypertension D)Muscle weakness
D) Muscle weakness
A client is prescribed benztropine. The nurse would anticipate administering this drug by which route? A) Intramuscular B) Subcutaneous C) Intravenous D) Oral
D) Oral
A teenage boy has begun to exhibit the characteristic signs and symptoms of schizophrenia. During his mother's pregnancy, during what time in development could she have experienced an intrauterine insult? A) First trimester B) Conception C) Third trimester D) Second trimester
D) Second trimester
A 77-year-old pateint is suffering from insomina. Which of the following medications can be most safelt administered to this pateint to induce sleep? A) Alprazolam (Xanax) B) Clonazepam (Klonopin) C) Diazepam (Valium) D) Temazepam (Restoril)
D) Temazepam (Restoril)
A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following goals of care is the priority? A) The patient will participate in activities of daily living. B) The patient will demonstrate independent health maintenance. C) The patient will interact therapeutically with peers. D) The patient will remain safe.
D) The patient will remain safe.
An elderly woman tells the nurse that she was successfully treated with phenelzine (Nardil) during a bout of severe depression in the 1970s. Her mood has been worsening in recent years as she has dealt with the death of her husband and functional declines. As a result, she has asked the nurse if her care provider is likely to prescribe this same drug. What fact should underlie the nurse's response to the patient? A) In most situations, MAO inhibitors have been largely superseded by tricyclic antidepressants. B) Cognitive behavioral therapy has been found to be more effective than MAO inhibitors, so they are rarely prescribed. C) MAO inhibitors are rarely used because serum levels must be monitored with blood work every 2 weeks. D) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used.
D) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used.
A client is taking rivastigmine for Alzheimer disease. The nurse will evaluate the client regularly for: A) decreased blood pressure. B) weight gain. C) increased blood pressure. D) weight loss.
D) weight loss
Which of the following medications is administered for ingestion of clitocybe mushrooms? A)Pyridostigmine (Mestinon) B)Donepezil (Aricept) C)Rivastigmine (Exelon) D)Atropine sulfate
D)Atropine sulfate
A middle-aged female patient has been admitted to the outpatient treatment unit of the hospital for an edrophonium (Tensilon) test. Shortly after the administration of the medication, the patient reports that her muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is suggestive of what diagnosis? A)Alzheimer's disease B)Anticholinergic crisis C)Myasthenia gravis D)Cholinergic crisis
D)Cholinergic crisis
A patient has developed excessive sedation and respiratory depression. The patient has been taking a benzodiazepine and has diminished liver function. Which of the following medications will reduce the effects of sedation and respiratory depression in this patient? A)Olmesartan medoxomil (Benicar) B)Pancrelipase (Pancrease) C)Pamidronate disodium (Aredia) D)Flumazenil (Romazicon)
D)Flumazenil (Romazicon)
A patient who suffers from Parkinson's disease is being treated with levodopa/carbidopa. Which of the following disorders will result in the discontinuation of this drug based on a disease-related contraindication?A)Human immune deficiency virus B)Human papillomavirus C)Transient ischemic attacks D)Narrow-angle glaucoma
D)Narrow-angle glaucoma
A 60-year-old male patient has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from? A)Seizure disorder B)Degenerative joint disease C)Amyotrophic lateral sclerosis D)Parkinson's disease
D)Parkinson's disease
A patient has been taking a selective serotonin reuptake inhibitor for the treatment of depression. Which of the following represents the action of the medication? A) Selective serotonin reuptake inhibitors increase the number of serotonin binding sites. B) Selective serotonin reuptake inhibitors block GABA. C) Selective serotonin reuptake inhibitors increase serotonin synthesis. D)Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed.
D)Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed.
A patient with Parkinson's disease has been prescribed rasagiline. When educating this patient on this medication, which herbal supplement has the potential to produce hyperpyrexia and death with rasagiline? A)Ginger B)Dextromethorphan C)Garlic D)St. John's wort
D)St. John's wort
An older adult patient with a diagnosis of moderate Alzheimer's disease will soon return home with her husband. How can the nurse best facilitate the safe and effective administration of donepezil in the home setting? A)Have the patient explain the rationale for drug therapy repeatedly before discharge. B)Provide a detailed drug monograph to the patient and her husband and offer to answer any questions. C)Assess the patient's need for home care. D)Teach the patient's husband to administer the medication in a timely and safe manner.
D)Teach the patient's husband to administer the medication in a timely and safe manner.
A 77-year-old woman who experiences significant anxiety has been taking diazepam for several months. She was brought to the clinical earlier this week by her daughter, who stated that her mother had been behaving in an uncharacteristically confused manner. The clinician discontinued the patient's diazepam. Three days later, the daughter states that her mother has still been having problems with impaired memory and confusion. The nurse should consider what possible explanation for the patient's current status?A)Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B)The patient may have decreased liver function. C)The patient may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D)The adverse effects of benzodiazepines can persist for several days after stopping the drug.
D)The adverse effects of benzodiazepines can persist for several days after stopping the drug.
