N352 Exam 4

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects?

Rivastigmine (Exelon)

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified?

Secondary progressive

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug?

Sedation and dry mouth

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms?

Serotonin syndrome

The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug?

Serum creatinine level of 2.3 mg/dL

The nurse monitors a patient taking an antipsychotic agent for tradive dyskinesia. The nurse should observe the patient for what symptom?

Twisting, worm-like movements of the tongue and face.

The nurse is caring for a client with parkinson's disease and administers levodopa/carbidopa (sinement). The client states that there are times when the tremor and symptoms return but then get better. Which statement by the nurse offers the correct explanation for the client?

this reaction is called the on-off phenomenon. There are other medications that may help to diminish the effects

The nurse is working on a unit in which patients regularly receive controlled substances. Which principles guide the appropriate care of patients receiving these drugs?

-Drugs that are categorized into schedules based on their potential for abuse and dependence -A transfer must be documented every time a controlled substance is purchased or dispensed

Overdose of cholinesterase inhibitors causes which of the following?

-Excessive muscarinic stimulation -Respiratory depression -Cholinergic crisis

The nurse on an orthopedic unit routinely cares for patients receiving carisoprodol [Soma]. For which adverse effects should the nurse monitor these patients?

-Drowsiness and sedation -Risk of dependence

The nurse is preparing to administer quetiapine extended-release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer?

2

The nurse is seeing several clients in the outpatient clinic today. Which client requires the nurse's immediate attention?

A male client takes lithium and has a lithium level of 2.1 mEq/L.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention?

A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L

The nurse prepares to administer the antidote to a patient in cholinergic crisis. Which medication does the nurse anticipate the healthcare provider to order?

Atropine

Parkinsonism

Bradykinesia, mask-like face, drooling, tremor rigidity, shuffling gait and stooped posture, side effect of certain medications

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity?

Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min

The nurse is caring for a patient receiving amiodarone [Cordarone]. Which body system should the nurse assess for serious adverse effects of this medication?

Respiratory

A nurse caring for a patient with a blood alcohol level of 0.2% monitors the patient closely for which priority assessment?

Respiratory depression

The nurse is caring for a patient taking dextroamphetamine [Dexedrine]. Which symptom, if present, is most likely an adverse effect of this drug?

Restlessness

The nurse is monitoring a client with depression in the early phase of treatment with amitriptyline (Elavil), a tricyclic antidepressant. Which question is most important for the nurse to ask the client?

"Have you had any changes in your mood or anxiety level?"

The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication?

"I must make sure I swallow the pill whole."

The nurse knows that which neurologic condition can be caused by the direct actions of alcohol or the nutritional deficiencies often seen in people with chronic alcoholism?

Wernicke's encephalopathy

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium?

Aspirin (ASA) for mild headache

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse?

"I should take the medication on an empty stomach."

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug?

"I will drink grapefruit juice instead of coffee with breakfast."

The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective?

"I will rise slowly when changing from a sitting to a standing position."

The nurse is teaching a patient with attention-deficit/hyperactivity disorder (ADHD) about his prescription for methylphenidate [Ritalin LA]. Which statement by the patient indicates that the teaching was effective?

"I will take my medication once per day in the morning."

The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching?

"I will use a salt substitute to lower my sodium intake."

Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]?

"I'm glad I can still have a glass or two of wine at dinner."

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching?

"Read food labels and reduce your intake of saturated fats."

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]?

"Take the medication with a glass of grapefruit juice each morning."

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful?

"The primary treatment is therapy, but there are some medications that have been somewhat effective."

The nurse is caring for a patient recovering from alcoholism who is taking naltrexone [ReVia]. Which statement made by the patient indicates that the drug is effective?

"This drug reduces the high from drinking alcohol and also helps reduce my craving for it."

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan?

"When it is time to discontinue this drug, you will need to taper it off slowly."

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct?

"Yes, there is a medication that works with your body's melatonin and is not a controlled substance."

Psychoses

- severe emotional disorder that impairs the mental function so that the individual cannot participate in activities of daily living - Hallmark: loss of contact with reality - Ex: Schizophrenia, Depression and drug-induced psychoses

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family?

-"Be sure to call the clinic if you or your family notice increased anxiety or agitation." -You may have some mild sedation. Do not drive until you know how this drug will affect you." -"It is very important to have good oral hygiene and to visit your dentist regularly."

Which statements about zaleplon [Sonata] does the nurse identify as true?

-Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. -Zaleplon [Sonata] interacts with the neurotransmitter GABA.

The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective?

-"I will increase my intake of fluid and foods high in fiber." -"I will call my healthcare provider if I notice swelling in my ankles."

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine [Thorazine]?

-A 78-year-old man with intractable hiccups -A 48-year-old woman with schizoaffective disorder

The nurse knows that which statements about postpartum depression are true?

-About 80% of women experience depressive symptoms after giving birth. -Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. -Sertraline [Zoloft] is the drug of choice for treating postpartum depression in breast-feeding mothers.

Which of the following statements about Acamprosate [Campral] are true?

-Acamprosate reduces the unpleasant feeling brought on by abstinence -Acamprosate should not be used in patients with severe renal impairment -Acamprosate has been shown to be more effective than a placebo

Purpose of Psychotherapeutic Medications

-Affect the CNS -Symptom reduction -Not a "cure" -Successful use with other therapies -Doesn't resolve personal problems

Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders?

-Alcoholism -Bulimia -Schizophrenia -Glucocorticoid-induced psychosis

The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include?

-Avoid potassium salt substitutes. -A persistent dry cough may occur. -Report difficulty in breathing immediately.

When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true?

-Benzodiazepines have a high safety profile. -Benzodiazepines have a low ability to cause tolerance. -Benzodiazepines have a low abuse potential.

The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease?

-Beta-amyloid and neuritic plaques -Neurofibrillary tangles and tau -Neuronal degeneration and decreased acetylcholine

first generation antipsychotics

-Block a variety of receptors within and outside the CNS-dopamine, acetylcholine, histamine, and norepinephrine -Because the exact etiology of psychotic illness is unclear, the relationship of receptor blockade to improved symptoms is unclear

Which of the following statements about bupropion are true?

-Bupropion lacks the adverse effects associated with tricyclic antidepressants -Bupropion poses a risk for seizures -Bupropion is considered a second-line drug for ADHD

Which statements about caffeine does the nurse identify as true?

-Caffeine promotes constriction of cerebral blood vessels -Caffeine promotes bronchodilation -caffeine is a diuretic

The nurse identifies the mechanism of action of the amphetamines as what?

-Causing the release of dopamine -Inhibiting the reuptake of norepinephrine -Inhibiting the reuptake of dopamine

affective disorders

-Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions) -Some patients may exhibit both mania and depression: bipolar disorder

Multiple Sclerosis

-Chronic inflammatory, autoimmune disorder that damages the myelin sheath of neurons in the CNS -Myelin sheath erodes away (demyelination) resulting in delayed motor response from neurons -Exact cause is unknown -Causes a wide variety of sensory and motor deficits -most patients experience periods of acute clinical exacerbations (relapses) alternating with periods of complete or partial recovery (remissions) -Over time, symptoms usually grow progressively worse

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect?

-Complete blood count -Alkaline phosphatase

Which of the following statements about disulfiram [Antabuse] are true?

-Dasuulfirm has no applications outside the treatment of alcoholism -Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol -In the absence of alcohol, disulfiram rarely causes significant effects -acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders?

-Depression -Panic disorder -Social anxiety disorder -Obsessive-compulsive disorder

Which statements does the nurse include when teaching a patient about antipsychotic drug therapy?

-Dilute oral preparations in fruit juice to improve their palatability. -Store oral preparations in a dark area -Do not make skin contact with these drugs; flush the affected area with water if a spill occurs

A patient is prescribed hydralazine [Apresoline] for the treatment of essential hypertension. Which expected adverse effects should the nurse discuss with the patient?

-Fatigue -Dizziness -Headache

Which drugs does the nurse identify as a selective serotonin reuptake inhibitor?

-Fluoxetine [Prozac] -Sertraline [Zoloft]

The nurse is caring for client who has cardiac dysrhythmias. The nurse is providing teaching regarding long term use of amiodarone (cordarone). What should be included in the teaching?

-Have annual eye exams -have liver function tests done yearly -report changes in breathing to primary care physician

A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication?

-Headache -Edema of ankles and feet -Overgrowth of gum tissue

Which instructions does the nurse include when teaching a patient about phenelzine [Nardil] therapy?

-If you experience a severe headache, inform your healthcare provider -Avoid eating avocados when taking this drug

Which of the following statements about Pralidoxime are true?

-It is an antidote to organophosphate poisoning -It cannot ross the blood-brain barrier -Doses should be infused slowly

When teaching the patient and family about clozapine therapy, which statements should the nurse include?

-It is important for you to obtain ordered blood tests when taking this medication -If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider -Inform your healthcare provider if you are taking any medications to control seizures

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder?

-Lithium -Divalproex Sodium (Depakote) -Carbamazepine

The nurse is teaching a patient about malnutrition related to alcohol use. Which of the following statements should the nurse include in the teaching plan?

-Malabsorption results from alcohol-induced damage to the GI mucosa -B vitamins (thiamin, folic acid, and cyanocobalamin) are especially needed -Fluid replacement may be necessary because of vomiting or gastritis

Which medications can be used to manage fatigue associated with multiple sclerosis?

-Modafinil (Provigil) -Amantadine (Symmetrel)

Which statements about the treatment of bipolar disorder does the nurse identify as true?

-Mood stabilizers are used to prevent recurrent manic-depressive episodes. -Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. -Lithium and valproate are the preferred mood stabilizers for BPD.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient?

-Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. -The lipid levels of patients receiving second-generation antipsychotics should be monitored. -Schizophrenia is characterized by disordered thinking and loss of touch with reality.

Antidepressant Class general information

-Norepinephrine and serotonin indicated in mood regulation -Takes time for medications to work

A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. Which interventions are essential before the nurse administers nitroprusside [Nipride]?

-Obtain a baseline weight and weigh daily -Prepare for arterial line insertion -Cover the solution with an opaque bag

Which assessments are essential before a patient receives a second dose of mitoxantrone [Novantrone]?

-Pregnancy test -Echocardiogram -Complete blood count

Antiparkinsonian Drugs

-Selective MAOI -Dopaminergic drugs -Anticholinergic drugs

hypertensive crisis

-Sudden high Blood pressure -Explosive headache -Face flushes -Palpitations -Chest pain -Daphoresis -Fever -Nausea, vomiting -Photophobia

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug?

-Swollen, tender gums -Measles-like rash -Unusual hair growth

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted?

-The patient is walking with a staggering gait -The patient complains of double vision -The nurse observes rapid back and forth movement of the patient's eyes

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statements are appropriate to include in the teaching plan?

-This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs -When you stop taking this medication, you should not withdraw it abruptly. -Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety

Antidepressant classes

-Tricyclic Antidepressants (TCA) -Selective Serotonin Re-Uptake Inhibitor (SSRI) -Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) -Monoamine Oxidase Inhibitor (MAOI) -Atypical Antidepressants

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)?

-Venlafaxine (Effexor XR) -Paroxetine (Paxil) -Escitalopram (Lexapro) -Duloxetine (Cymbalta)

The nurse is preparing to apply a nitro patch. Which precautions should be included with administration of this medication?

-Wear gloves when applying the patch -Check vital signs prior to applying the patch -Alternate sites daily -Date the patch with application

What should the nurse include in the discharge teaching for a patient prescribed amiodarone [Cordarone]?

-Wear sunblock and protective clothing when you are outdoors. -Check your pulse daily and report excessive slowing to your healthcare provider immediately. -"Immediately notify your healthcare provider of shortness of breath, cough, or chest pain."

Myasthenia Gravis

-autoimmune disease of the neuromuscular junction characterized by fluctuating weakness of certain muscle groups -strength is generally restored with rest -strength best in the am after night's rest muscles involved: eyes and eye lids, chewing, swallowing, speaking, breathing -affected by stress -No sensory loss, therefore reflexes are normal and muscle atrophy is rare

Neuroleptic Malignant Syndrome Treatment

-bromocriptine (Parlodel) -dantrolene (Dantrium) -Cooling blankets/ice bath -IV fluid rehydration

The nurse is administering a dose of beta blocker. What does the RN understand the common suffix of beta blocker generic medications?

-olol

The nurse is administering a dose of angiotensin converting enzyme (ACE) inhibitor. What does the nurse understand the common suffix is of ACE generic medications?

-pril

The nurse is administering a dose of angiotensin receptor blockers (ARBs). What dose the nurse understand the common suffix of ARBs generic medication?

-sartan

Anti-cholinergic management

-sips of water, ice chips -sugarless candy/gum -stool softener -monitor voiding -Increase fiber intake -Eye drops -Sunglasses

Anxiety

-unpleasant emotional state of mind, characterized by a sense of dread and fear -May be based on actual anticipated experiences or past experiences -May be exaggerated responses to imaginary negative situations -Includes PTSD, OCD, phobias, panic disorders

The healthcare provider orders clonidine [Kapvay] 0.1 mg bid for a patient with ADHD. What will the total dose be for a 24-hour period?

0.2 mg

The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer?

0.25

The healthcare provider orders diazepam [Valium] 5 mg IV every 8 hours. The medication available is diazepam [Valium] 5 mg/mL. How many mL will the nurse administer?

1 mL

The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer?

10 mL

The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount?

1600 mg

The healthcare provider orders donepezil [Aricept] 10 mg PO every day. The tablets available are donepezil 5 mg. How many tablets will the patient receive?

2

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate?

Absence

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type?

Absence

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose?

5 mL

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours?

750 mg C

Which patient would the nurse anticipate being prescribed atomoxetine [Strattera] for ADHD?

A 24-year-old male with a history of stimulant abuse

Administration of dantrolene [Dantrium] for the treatment of muscle spasticity is contraindicated in which patient?

A patient with multiple sclerosis and underlying cirrhosis

tardive dyskinesia

A side effect of long-term use of traditional antipsychotic drugs causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue. Worm-like movements of the tongue and face

In which part of the conduction pathway in a healthy heart is the electrical impulse delayed to provide time for the blood to fill the ventricles?

AV node

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD?

Acetylcholine

A patient develops supraventricular tachycardia (SVT) and is hypotensive. Which medication should the nurse anticipate will be administered?

Adenosine [Adenocard]

The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment?

Adjust the intravenous infusion rate to the blood pressure response.

The nurse is caring for a patient taking captopril (capoten). The patient complains of tongue swelling and shortness of breath with wheezing. What is the priority action by the nurse?

Administer SQ epinephrine

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid?

Aged cheese and sherry

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings?

Akathisia

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization?

Alprazolam [Xanax]

A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine?

Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications

The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure?

Angiotensin II

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta?

Applying a warm compress before giving the injection will reduce the risk of pain at the site

An elderly patient with skin cancer and hypertension is prescribed levodopa/caribidopa (Sinement) to treat parkinson's disease. Which action by the nurse is best?

Ask the patient about the type of skin cancer.

Extrapyramidal Symptom treatment

Anti-parkinsonism drugs: Benztropine mesylate (Cogentin) Relaxes smooth muscle and diminishes tremors Cation: Glaucoma, hypertension, BPH

The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine [Prostigmin], 75 mg PO twice daily. What is the most important initial nursing action?

Assess the patient's ability to swallow

The nurse is caring for a client taking phenytoin (dilantin). Which would the nurse expect to find in a Dilantin toxicity?

Ataxia

Which statement will the nurse include when teaching a patient about atomoxetine [Strattera]?

Atomoxetine has no potential for abuse.

The nurse is caring for client with atherosclerosis. Which agent is in the category of drugs considered most effective for lowering LDL cholesterol?

Atorvastatin (Lipitor)

The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate?

Atrial fibrillation

What is the most common sustained dysrhythmia among the U.S. population?

Atrial fibrillation

The nurse has just administered the first dose of haloperidol (Haldol) to a client with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider prior to the next dose?

BP 88/52.

A patient is prescribed isocarborazid (marplan) for treatment of depression. Which foods should the patient be taught to avoid?

Bananas, smoked fish and cheese. Foods high in tyramine.

Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors?

Beta1

The nurse prepares to administer metoprolol (lopressor) to a patient with chronic stable angina. What are the priority assessments to make before administration of this medication?

Blood pressure

Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]?

Blood pressure

Atypical Antidepresents

Bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel or Oleptro)

A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg 3 times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities?

By producing drowsiness, lethargy, and blurred vision

A patient taking levodopa/carbidopa (Sinement) for parkinsons disease experiences frequent "on-off" episodes. Which action by the nurse is best?

Instruct the patient to avoid high-protein foods

A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites?

Candesartan [Atacand]

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease?

Change positions slowly

The nurse anticipates that which medication is likely to be prescribed to reduce the symptoms of alcohol withdrawal?

Chlordiazepoxide [Librium]

Parkinson's disease

Chronic, progressive, degenerative disorder affecting the dopamine producing neurons of the brain. Treatment goals: Improve patient's ability to carry out activities of daily living, medications are aimed at balancing the dopamine and acetylcholine in the brain

In which situation is dronedarone [Multaq] contraindicated?

Concomitant administration of amitriptyline [Elavil]

The nurse receives a laboratory report indicating that the phenytoin (Dilantin) level for a client seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate?

Continue as planned, because the level is within normal limits.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate?

Continue as planned, because the level is within normal limits.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam?

Flumazenil [Romazicon]

A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug?

Crackles in the lungs are no longer heard

Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia?

Dantrolene [Dantrium]

A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor?

Decrease in blood pressure

The nurse should recognize which acute effects of alcohol on the brain?

Depression of the central nervous system (CNS) and activation of the reward center

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what?

Developed lithium toxicity

The nurse is caring for a patient prescribed quinidine [Quinaglute] for a supraventricular dysrhythmia. What is a common adverse effect of this drug?

Diarrhea

Which medication is most likely to cause the side effect of constipation?

Diltiazem [Cardizem]

Which medication is not associated with prolongation of the QT interval?

Diltiazem [Cardizem]

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug?

Dizziness

Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber?

Dizziness and fatigue

What is the major neurotransmitter in the reward circuit of the brain related to addiction?

Dopamine

The process in which the brain decreases the amount of dopamine produced and the number of dopamine receptors is known as what?

Down-regulation

The nurse knows that which government agency is responsible for carrying out the mandates of the Controlled Substances Act of 1970?

Drug Enforcement Agency

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together?

Dyskinesia

The nurse is planning care for a patient at risk for dysrhythmias. The nurse understands that the Cardiac Arrhythmia Suppression Trial (CAST) confirmed which finding?

Dysrhythmias should be treated only when they are symptomatically significant

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention?

Ensure that genetic testing for HLA-B1502 is performed.

A patient is brought to the ED for treatment of an overdose of alprazolam (xanax). Which medication should the nurse prepare to administer to this patient?

Flumazenil

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter?

Gamma-aminobutyric acid (GABA)

The nurse is caring for a patient receiving dantrolene [Dantrium] for spasticity associated with MS. Which laboratory test will be important in monitoring for a potential adverse effect of this drug?

Gamma-glutamyltransferase (GGTP)

The nurse is caring for a client starting phenytonin (Dilantin). The nurse encourages the client to see the dentist regularly because of what side effect?

Gingival hyperplasia

The nurse is caring for a postictal seizure patient and administers valproic acid (Depakote). What side effects below should the nurse monitor for?

Hair loss, hepatotoxicity, tremor

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient?

Have you had any changes in your mood or anxiety level?

The nurse best describes the schedule class of heroin as what, according to the Controlled Substances Act?

Having a high potential for abuse and not being approved for medical use in the United States

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what?

Help control symptoms during the severe manic episode.

A patient receives an IV infusion of amiodarone to prevent recurrent episodes of V-fib. The nurse should assess the patient of what adverse effect?

Hypotension

A patient with angina pectoris is prescribed sublingual nitro. Which statement made by the patient indicates understanding of medication teaching?

I may experience a headache as a side effect

The nurse is teaching a patient about the use of disulfiram [Antabuse]. Which statement by the patient indicates that the teaching has been effective?

I need to avoid all forms of alcohol, including cough syrups and aftershave.

The nurse instructs a patient with myasthenia gravis who is taking neostigmine (prostigmin). Which statement if made by the patient to the nurse indicates understanding about the instructions?

I should take this medication in the morning after I wake up

The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching?

I volunteer at a local day care center once a week

A patient with bipolar disorder is prescribed lithium. Which statement if made by the patient indicates a need for further teaching?

I will reduce my salt intake while taking this medication.

The nurse is caring for a client receiving carbamezepine (tegretol). The nurse explains the purpose of tegretol to the client. What statement below indicates an understanding of the medication purpose?

I will take this medication to decrease nerve conduction

Acute Loss of Effect

Includes gradual loss "wearing off" near end of therapeutic dose and abrupt loss "on-off" which occurs at any time and may last from minutes to hours

The nurse is caring for a client receiving amiodarone (Cordarone). What is the the most serious potential adverse effect of amiodarone?

Increased respiratory effort.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms?

Inflammation and myelin destruction in the central nervous system

The nurse is caring for a client receiving glatiramer acetate (Copaxone) for a diagnosis of Multiple Sclerosis. Which finding, if present could be considered a potential adverse effect of this drug?

Injection site pain and redness

The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug?

Injection site pain and redness

What is the pathophysiology for a myasthenic crisis?

Insufficient ACh at the NMJ

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression?

It has more side effects and drug interactions

Which best describes the rationale for using neostigmine [Prostigmin] in the treatment of myasthenia gravis?

It increases the force of skeletal muscle contraction

The nurse is caring for a patient prescribed aliskiren [Tekturna]. How does this medication lower blood pressure?

It inhibits the conversion of angiotensinogen into angiotensin I.

Which statement about aripiprazole would the nurse identify as true?

It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers.

A patient with depression is prescribed fluoxetine (prozac). Which statement made by the patient indicates an understanding of the medication teaching?

It may take 3 to 4 weeks before my mood is elevated.

The nurse is preparing to give neostigmine [Prostigmin]. Which best describes the action of this drug?

It prevents inactivation of acetylcholine

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block?

Lacosamide [Vimpat]

The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important?

Lithium level

The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept?

Many vasodilators cause retention of sodium and water.

Which statement about memantine [Namenda] is false?

Memantine does not slow the decline in function

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question?

Meperidine 50 mg IM every 4 hours as needed for pain

The nurse is caring for a patient after total hip replacement on postoperative day 1. The nurse notes that the patient's urine is dark brown. The nurse reviews the medication administration record for which medication?

Methocarbamol [Robaxin]

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse?

Methylprednisolone (Solu-Medrol) IV

The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours?

Monitor blood pressure.

The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention?

Monitor electrocardiogram.

The nurse is administering intravenous lidocaine [Xylocaine] to a patient with a ventricular dysrhythmia. What is the priority nursing intervention to prevent a potential complication with this drug?

Monitor the electrocardiogram (ECG)

The physician prescribes a calcium channel blocker to an 82-year-old patient who take digoxin (Lanoxin) daily. Which action by the nurse is best?

Monitor the patient's cardiac rhythm continuously

The nurse is preparing to administer the aripiprazole extended-release 400-mg injection. The nurse is aware that this medication is scheduled to be given how often?

Monthly

The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug?

Morning sedation

Which medication used for the management of multiple sclerosis cannot be self-administered?

Natalizumab (Tysabril)

The nurse is assessing a client receiving valproic acid (Depakote) for potential adverse effects associated with this drug. What is the most common problem with this drug?

Nausea, vomiting, and indigestion

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug?

Nausea, vomiting, and indigestion

The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent?

Neostigmine (Prostigmin)

What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]?

Notify the healthcare provider of nausea, vomiting, and visual changes.

Amiodarone [Cordarone] is prescribed for a patient with atrial fibrillation. What is the most important nursing intervention before administering this medication?

Obtain baseline serum thyroid and liver function studies.

The nurse prepares to administer the first dose of antipsychotic agent to a patient. It is most important for the nurse to asses what 1 hour after administration of medication?

Orthostatic blood pressure

The nurse identifies which most common serious adverse effect of TCA therapy?

Orthostatic hypotension

The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication?

Our goal is to reduce your seizures to an extent that helps you live a normal life

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely?

Panic disorder

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential?

Phenobarbital [Luminal Sodium]

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder?

Propranolol [Inderal]

A client verbalizes an intense need for psychoactive drugs. The nurse recognizes this behavior as what?

Psychologic dependence

The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles?

QRS complex

Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent?

Rare cases of dangerous brain infections

A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect?

Rasagiline may cause insomnia, so monitor your sleeping habits

A patient is prescribed a nitro transdermal patch. The nurse should include which statement when teaching the patient how to use this medication?

Remove the patch at bedtime

The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication?

Severe hypertension

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug?

Sexual dysfunction

A patient is prescribed sustained-released oral nitro capsules for chronic stable angina. The nurse should include which instruction?

Sit or lie down if dizziness or lightheadedness occurs

A patient is started on a trial of dextroamphetamine/amphetamine [Adderall] for ADHD. What is the most likely nursing diagnosis for inclusion in the plan of care?

Sleep pattern disturbance

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium?

Sodium level of 128 mEq/L

A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient?

Sodium nitroprusside [Nipride]

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule?

Starting at a low dose and titrating up

A patient goes to the emergency department after using organophosphate insecticides improperly. Which assessment finding would the nurse expect?

Stool incontinence

The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose?

To protect against reflex tachycardia

The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity?

Sudden confusion

A patient with multiple sclerosis is prescribed baclofen. The nurse will observe the patient for which intended effect?

Suppression of spasticity

Serotonin Syndrome

Symptoms include sweating, decrease level of consciousness, tachycardia, hyperthermia, hyperreflexia onset: 2 hours to 3 days of medication start

Which statement about tricyclic antidepressants for ADHD is true?

TCA drugs decrease hyperactivity.

Client teaching for antiparkinson medications should include which statement?

Take care to change positions slowly to prevent falling due to drop in blood pressure

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication?

Temperature of 101°F

A nurse is caring for a patient receiving dronedarone [Multaq] for treatment of atrial fibrillation. What electrocardiogram (ECG) change indicates an adverse effect of this medication?

The QT-interval measurement changes from 400 to 520 msec.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA?

To reduce the risk of suicide with overdose

Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20?

Topiramate [Topamax]

A patient is to receive a sechedule dose of diltiazem (cardizem). The nurse should hold the medication and contact the prescriber if what occurs?

The patient's heart rate is 48

The nurse identifies which appropriate principle of drug addiction treatment based on the guidelines from the National Institute on Drug Abuse (1999)?

The treatment plan must be reassessed continually and modified as indicated.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate?

This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?

This is called the on-off phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect

Which medication acts as an agonist at the presynaptic alpha-2 receptor site?

Tizanidine [Zanaflex]

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease?

To balance cholinergic and dopaminergic activity in the brain

A patient who is diagnosed with bipolar disorder is prescribed lithium (lithoid). To monitor lithium toxicity, the nurse should observe the patient for which signs and symptom?

Unsteady gait, hyperactive reflexes and hypotension

Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation?

Weigh yourself daily at the same time each day. -Notify the healthcare provider if a skin rash develops -Rise slowly from a lying to a sitting position

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug?

White blood cell (WBC) count of 2000/mm3

The nurse is caring for a client receiving clozapine (Clozaril). Which assessment finding is most indicative of an adverse effect of this drug?

White blood cell (WBC) count of 2000/mm3.

Which agent is most likely to be prescribed today for short-term management of insomnia?

Zolpidem [Ambien]

Neuroleptic Malignant Syndrome

a potentially fatal hyperpyrexia with temp of over 103, severe muscle rigidity, severe hypertension, tachycardia, delirium, stupor, coma Onset 2-3 days

The nurse is preparing to administer a daily dose of digoxin (Lanoxin) to a client in heart failure. Which assessment receives priority at this time?

assessing apical pulse for one minute

The patient is prescribed atorvastatin (Lipitor). The nurse will teach the patient to take the medication at what time?

at bedtime

Foods high in tyramine

avocados; bananas; eggplants; figs; overripe fruit; papaya; raisins; anything pickled; organ meats; smoked meats; aged cheese; caffeine; red wine; beer; sherry; sour cream; soy sauce; yogurt

Dystonia

manifests as a severe spasm of the muscles of the tongue, face, neck or back and may include upward elevation of the eyes, severe cramping and impaired respiration

Akathisia

motor restlessness

extrapyramidal symptoms

side effects of antipsychotic medications that affect a person's gait, movement, or posture Symptoms include: Akathisia, Dystonia, Parkinsonism, Tardive dyskinesia