Module 3: Pharmacology Ch. 19 - 21

A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response?

"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."

The nurse is caring for a client who has been prescribed oxazepam. What statement by the client would suggest an increased risk of CNS depression to the nurse?

"I take an over-the-counter antihistamine each day for my allergies."

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective."

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

A client is recovering from an ischemic stroke that caused a significant brain infarction and loss of neurons. The client's family member asks the nurse, "How long will it take before new brain cells replace the ones that died?" What is the nurse's best response?

"Unfortunately, the destruction of nerves is permanent and they're unable to reproduce."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth."

What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide?

"When did you have your last drink of alcohol?"

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

(4-6) Several weeks after stopping the paroxetine

What exerts its anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA)? (Select all that apply.)

- Alprazolam (Xanax) - Chlordiazepoxide (Librium) - Lorazepam (Ativan)

A client has taken a blow to the back of the head and the hindbrain is thought to have a lesion. What nursing assessments should the nurse include when monitoring for effects of a lesion in this region? (Select all that apply.)

- Blood Pressure - Swallowing Assessment - Respiratory Assessment

A nurse is caring for client experiencing pain. The client describes the pain as "9" on a scale of 1 to 10, with 10 being the worst pain. What nursing interventions would be necessary for the nurse to assess? Select all that apply.

- Count Respirations - Assess blood pressure - Evaluate Pupils

The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.

- Decreased anxiety - Interest in Physical activity - Improved sleep

The nurse is preparing a client for discharge who is taking phenelzine. The nurse instructs the client that which foods cause serious complications? (Select all that apply.)

- Deer meat - Fava Beans - Shrimp

The anatomy and physiology instructor is talking about the nervous system. What would the instructor tell the students about the cerebrum? (Select all that apply.)

- It has a frontal lobe. - It has a temporal lobe. - It has a parietal lobe. - It has an occipital lobe.

The neurotransmission system of the human body is a communication network. What is this network composed of? (Mark all that apply.)

- Neurotransmitters - Synapses - Receptors

Neurotransmission process

1.) Neurotransmitter molecules are released from synaptic vesicles. 2.) Neurotransmitter molecules cross the synapse. 3.) Neurotransmitter molecules bind to receptors in the cell membrane of the postsynaptic neuron. 4.) Neurotransmitter molecules exert their effects on postsynaptic neurons.

After studying for a test on the brain and spinal cord, the students demonstrate understanding when they identify the spinal cord as being made up of how many pairs of nerves?

31

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

The neurological nurse is caring for a diverse group of clients. For which client would the role of the blood-brain barrier be most significant during treatment?

A client who has been diagnosed with an infection of brain tissue

A client is experiencing acute anxiety and the nurse has received an order for diazepam 4 mg PO STAT. What is the nurse's best action?

Administer the medication as prescribed

A nurse is reviewing the structure and function of the blood--brain barrier . This anatomical feature would have the greatest effect on what aspect of nursing care?

Administering antibiotics to treat brain infections

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?

Asking the client to sit on the side of the bed for 1 minute before getting up

After failing to respond to treatment with SSRIs and tricyclic antidepressants, a client with major depression has been started on phenelzine. The client's current drug regimen also includes levothyroxine, metformin and simvastatin. What assessment should the nurse prioritize when monitoring for drug-drug interactions?

Assessing the client's blood glucose levels frequently

A nurse is preparing to assess a patient's cerebellar function. What would the nurse expect to test?

Balance

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client?

Benzodiazepine toxicity

The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?

Blood Pressure

A client is receiving a barbiturate intravenously. The nurse would monitor the client for:

Bradycardia

Which would a nurse identify as a component of the hindbrain?

Brain stem

The nurse is providing a continuing education program to teenagers about the nervous system. The nurse is reviewing the parts of the neuron with the students. Based on this information, the nurse asks a student to describe the axon of a neuron. Which explanation by the student best describes the axon?

Carries impulses away from the neuron cell body

What part of the brain controls and coordinates muscle movement?

Cerebellum

An elderly client arrives at a health care facility with reports of loss of sensation. The nurse understands that a change in which part of the brain is responsible for changes in the client's ability to perceive sensation?

Cerebral Cortex

The CNS structure involved in all higher order functions, including conscious processes containing both motor and sensory areas, is the:

Cerebral cortex

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells?

Chemically

What aspect of a client's health is most likely to cause insomnia?

Chronic Pain

A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse?

Client is diagnosed with hepatitis C.

An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following?

Confusion

After teaching a group of students about the functions of the nervous system, the instructor determines that the teaching was effective when the students identify that a function is:

Control of body functions

A patient has sustained an injury to the cerebellum. Which area would be the primary area for assessment?

Coordination

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

Decreased cardiac workload

A client's left adrenal medulla has been injured in a motor vehicle accident. What is a possible implication of this injury?

Disruptions in the levels of norepinephrine & epinephrine

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

Dizziness

A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?

Dry mouth

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness

An older adult client diagnosed with generalized anxiety disorder is prescribed a benzodiazepine. The nurse caring for the client knows to include what intervention in the client's care plan?

Fall risk assessment

Dendrites route information away from the nerve cell while axons bring information to the nerve.

False

Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client?

Having the client walk to the bathroom

After teaching a group of students about major divisions of the brain, the instructor determines that additional teaching is needed when the students identify what as part of the hindbrain?The anatomy and physiology instructor is talking about the nervous system. What would the instructor tell the students about the cerebrum? (Select all that apply.)

Hypothalamus

The nurse is planning the care of a client who has been diagnosed with a cerebellar disorder. What should the nurse prioritize in this client's plan of care?

Implement falls precautions.

A patient admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. Why should the nurse suggest the patient stop consuming alcohol while therapy is ongoing?

Increased risk for central nervous system depression

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about?

Increased sedative effect

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics?

Less central nervous system depression

A 10-year-old child has been playing soccer and sustains a closed head injury in a collision with another player. The parent states that the child was unconscious for 5 minutes. Upon admission to the emergency department, the child has difficulty breathing. What area of the brain will have developed cerebral edema?

Medulla Oblongata

The CNS structure containing groups of neurons responsible for vital cardiac, respiratory, and vasomotor functions is the:

Medulla Oblongata

A nurse is reviewing the structure and function of the nervous system in preparation for working on a neurological floor. What characteristic of neurons should the nUrse identify?

Neurons convey action potentials to other neurons without being in physical contact.

Which is an important function of serotonin?

Prevent depression

The cell body of one of a client's nerves is intact but communication with the muscle which it normally innervates has been severed by a laceration. The nurse teaches the client that normal resumption of nerve function will depend on:

Regeneration of the nerve's axon

A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving Halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?

Risk for injury

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

SSRIs prevent serotonin from being reabsorbed.

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Salami

Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?

Selective serotonin reuptake inhibitor

A client is diagnosed with a sleep disorder. Which neurotransmitter is most likely to be dysfunctional for this client?

Serotonin

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?

Serotonin

A nurse is reading an article about sleep and arousal that includes a discussion of a neurotransmitter. Which neurotransmitter would most likely be discussed?

Serotonin

The nursing instructor is talking with their clinical group about the central nervous system. What should the instructor tell the students about the function of the spinal cord?

Serves as a conduit for impulses to and from the brain

When levels of serotonin are high in the RAS, the system shuts off and what occurs?

Sleep

What areas are mainly responsible for coordinating internal and external responses?

Thalamus and hypothalamus

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

A client is acutely ill with a brain abscess and the family has questioned why the client is not receiving intravenous antibiotics. When providing education to the family, the nurse should explain:

The structure and function of the blood-brain barrier

The nurse is working with a client who has been diagnosed with depression and the nurse has described the role that selective serotonin reuptake inhibitors (SSRIs) play in depression. The nurse should describe what effect on this neurotransmitter?

There are increased levels of serotonin in the synapses

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs.

The circle of Willis distributes blood to the brain as needed.

True

A male client is admitted to the emergency department via ambulance. He is attempting to pull out his IV line, exhibiting symptoms of agitation, and thrashing about. The physician orders a benzodiazepine-type sedative. What information is needed prior to administration of the drug?

Whether the client is experiencing drug intoxication or withdrawal

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

Yogurt

The psychiatric-mental health nurse is providing care for several clients. Which client should the nurse monitor most closely for adverse medication effects?

a client who has depression and who began taking phenelzine 15 mg PO t.i.d. last month

A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:

a dose adjustment should be made if these symptoms persist.

The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose?

antihistamines

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?

avoid driving until he is aware of the adverse effects.

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet.

A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

dangerous drug interactions Explanation:Combining St. John's wort with antidepressants can cause serious drug-to-drug interactions. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.

A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?

eszopiclone (Lunesta)

A client presented with signs and symptoms of hypothyroidism and subsequent diagnostic testing revealed low levels of thyrotropin-releasing hormone (TRH) and thyroid stimulating hormone. The care team should focus assessments and interventions on the client's:

hypothalamus

A 46-year-old male client sustained a closed head injury four hours ago. He now presents to the emergency department because he is having difficulty breathing. This is a result of swelling around the:

medulla oblongata

A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?

onset of suicidal ideation.

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?

orthostatic hypotension

One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication?

paradoxical excitement

The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?

paradoxical excitement, which is the opposite reaction than what was expected

A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction?

respiratory depression

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:

respiratory disturbances and partial airway obstruction.

The nurse is preparing to a neurologic assessment of a new pt. What principle should guide the nurse's care of pts w/ neurologic disorders?

some of the functions of the nervous system are not well understood

Characteristics that allow neurons to communicate with other body cells include:

the ability to be stimulated and to convey electrical impulses.