Neuro Pharm

In addition to hydration, parenteral lorazepam is prescribed for a client during alcohol withdrawal delirium. Which primary purpose accurately explains why this medication is given during detoxification?

To prevent injury when seizures occur To enable the client to sleep better during periods of agitation * To reduce the anxiety tremor state and prevent more serious withdrawal symptoms To calm the client and promote acceptance of the treatment plan Lorazepam potentiates the actions of gamma-aminobutyric acid, which reduces anxiety and irritability that are common during withdrawal. This medication helps reduce the risk of seizures but does not prevent physical injury if a seizure occurs. Although the medication may enable the client to sleep better during periods of agitation, this is not its primary objective. The ability of the client to accept treatment depends on readiness to accept the reality of the problem.

For which therapeutic effect will the nurse monitor the client who is prescribed alprazolam?

Pain relief *Decreased anxiety Reduction in dysrhythmias Reduced blood pressure Alprazolam, an anxiolytic, promotes muscle relaxation, reduces anxiety, and facilitates rest. Possible adverse reactions to alprazolam are anger and hostility. Although drowsiness is a side effect of alprazolam caused by depression of central nervous system activity, it is not a hypnotic. Transient hypotension is a side effect of alprazolam, but this is not why it is given to an anxious client.

During the admission process, the client reports heavy alcohol use for at least one year. What effect does the nurse anticipate the hospitalized client will experience when alcohol consumption stops?

Bradycardia Somnolence * Withdrawal Tachypnea The findings of alcohol withdrawal develop within 24 to 48 hours after people either stop or significantly reduce their alcohol consumption. Findings of withdrawal can range from "mild" (shaking or sweating, or perhaps nausea, headache, anxiety, tachycardia or hypertension) to severe (delirium tremens or DTs), which are characterized by rapid heartbeat, fever, hallucinations or seizures.

A client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. Which statement by the client indicates the medication has been effective?

"I have less pain." * "I have been sleeping better." "My blood glucose is under control." "My blood pressure is coming down." Zolpidem is a sedative-hypnotic that produces central nervous system depression in the limbic, thalamic, and hypothalamic areas of the brain. Zolpidem is not an analgesic, antidiabetic, or antihypertensive medication.

Which manifestation is an adverse effect of intravenous lorazepam? Select all that apply. One, some, or all responses may be correct.

*Amnesia *Drowsiness *Sleep driving *Blurred vision *Respiratory depression (all of them) Benzodiazepines such as lorazepam have a range of side effects, many of which are related to central nervous system depression. Anterograde amnesia, drowsiness, sleep driving, blurred vision, and respiratory depression are all potential adverse effects of lorazepam.

A client who is receiving phenytoin asks why folic acid was prescribed. Which explanation would the nurse provide?

*Phenytoin inhibits absorption of folate from foods. Folic acid potentiates the action of phenytoin. Absorption of iron from foods is improved. Neuropathy caused by phenytoin is prevented. Phenytoin inhibits folic acid absorption and potentiates the effects of folic acid antagonists. Folic acid diminishes, not potentiates, the effects of phenytoin. Absorption of iron from foods and prevention of neuropathy caused by phenytoin are not effects of folic acid.

The nurse is caring for a client who was prescribed alprazolam. When educating the client about the new medication, which intended effect should the nurse include?

*Reduce anxiety and provide a calming effect Increase coordination and the ability to concentrate Alleviate signs and symptoms of spasticity Reduce symptoms of depression Alprazolam is a benzodiazepine which is as an anxiolytic. The medication will not increase coordination and the ability to concentrate or alleviate symptoms associated with nerve damage, such as spasticity. Alprazolam will not reduce symptoms of depression.

A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given?

Decreases anxiety associated with seizures Promotes rest after the seizure episode *Depresses the central nervous system (CNS) Provides amnesia for the convulsive episode Lorazepam is used to treat status epilepticus because it depresses the CNS. It also functions as an anxiolytic and sedative and can cause anterograde amnesia; however, these are not the reasons it is prescribed for status epilepticus.

The client with a seizure disorder receives intravenous (IV) phenytoin. The nurse will monitor closely for which condition?

*Cardiac dysrhythmias Hypoglycemia Polycythemia Paradoxical excitation IV phenytoin was once used to treat dysrhythmias until better medications were developed. It depresses both atrial and ventricular conduction, and so it can cause significant dysrhythmias. It can also cause hyperglycemia (not hypoglycemia) and pancytopenia (not polycythemia). Paradoxical excitation is not a known issue; it has a depressant effect resulting in drowsiness.

Which medication would the nurse instruct a client to avoid while taking alprazolam? Select all that apply. One, some, or all responses may be correct.

*Opioids *Alcohol *Barbiturates Antidepressants First-generation antipsychotics Respiratory depression can occur if a client combines benzodiazepines with opioids, alcohol, or barbiturates. Antidepressants and first-generation antipsychotics are safe to take with benzodiazepines.

Which instruction would the nurse provide to parents of a school-age child who has been on long-term phenytoin therapy to prevent side effects?

*Provide good oral hygiene. Administer the medication between meals. Watch for a reddish-brown discoloration of urine. Supplement the diet with high-calorie foods. These procedures reduce the risk for gingival hyperplasia, a side effect of phenytoin. This medication is strongly alkaline and should be administered with meals to help prevent gastric irritation. Discoloration of the urine may occur during medication excretion; it does not cause physiological problems. Avoiding overeating and overhydration may result in better seizure control.

Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Which medication interaction complicates seizure therapy?

*Warfarin inhibits the metabolism of phenytoin. Warfarin decreases phenytoin absorption. Phenytoin competes with warfarin for receptor occupation. Warfarin promotes excretion of phenytoin. Warfarin inhibits metabolism of phenytoin, which can result in phenytoin toxicity. Warfarin does not decrease phenytoin absorption. Phenytoin and warfarin act on different receptors. Excretion of phenytoin is not increased.

Which adverse effect would the nurse continually assess for in a client receiving valproic acid?

*Yellow sclerae Motor restlessness Ringing in the ears Torsion of the neck Yellow sclerae are a sign of jaundice; pancreatitis and hepatic failure are life-threatening adverse effects of valproic acid. The client must have frequent liver function tests. Motor restlessness (akathisia) is associated with antipsychotic medications. Ringing or buzzing in the ears (tinnitus) is associated with aspirin. Torsion of the neck (torticollis) because of contracted cervical muscles is associated with antipsychotic medications.

Which advice would the nurse include in a teaching plan to reduce the side effects of diltiazem?

Lie down after meals. Avoid dairy products in diet. Take the medication with an antacid. *Change slowly from sitting to standing. Changing positions slowly will help prevent the side effect of orthostatic hypotension. Diltiazem decreases esophageal tone, so lying down after meals can lead to acid reflux. Avoiding dairy products and taking the medication with an antacid are not necessary.

The nurse is caring for a child diagnosed with seizures. While teaching the family and the child about the medication phenytoin, which concept should the nurse emphasize?

Omit the medication if the child is seizure-free Serve a diet that is high in iron A rash is normal with this medication *Maintain good oral hygiene and dental care Gingival hyperplasia may occur with this medication. It is important that good oral hygiene is maintained. The medication should never be stopped, even if the child is seizure-free. A sudden discontinuation could result in status epilepticus. A diet high in iron interferes with phenytoin absorption and will reduce the effectiveness. A blister-like rash is not normal with this medication and could indicate medication-related Stevens-Johnson syndrome, which is a serious disorder of the skin and mucous membranes.

Which class of medication would the nurse anticipate preparing to administer to a client with alcohol dependence admitted to a detoxification unit?

Opiate Antipsychotic Antidepressant *Benzodiazepine Benzodiazepines are indicated for the treatment of alcohol withdrawal because they help prevent seizures and calm the vital signs. Opiates are not indicated for the treatment of alcohol detoxification. Antipsychotics and antidepressants are contraindicated because they can lower the seizure threshold.

A client with a seizure disorder will begin taking phenytoin. Which instructions will the nurse give to the client?

'Take the medication on an empty stomach.' *'Provide meticulous oral hygiene.' 'Taper off the medication if seizures are controlled for 3 months.' 'Stop taking the medication if you become pregnant.' Phenytoin can cause gingival overgrowth that increases the risk for periodontal disease. The medication should be taken with food or milk to decrease gastrointestinal side effects. The health care provider should oversee any dosage adjustment or discontinuation. Although it can affect the developing fetus, current evidence suggests that the effect of seizure activity on the developing fetus may cause even greater problems.

Which medication is indicated to treat shift-work sleep disorder (SWSD)?

* Modafinil Atomoxetine Methylphenidate Rationale Modafinil is a unique nonamphetamine stimulant used to treat SWSD. This medication promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this medication is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention-deficit/hyperactivity disorder (ADHD). Methylphenidate is considered a first-choice medication for the treatment of ADHD.

Two weeks after starting phenobarbital sodium, the client develops new symptoms. Which symptom is probably caused by the medication?

*Cognitive impairment Frequent urination Abdominal pain Mania Phenobarbital can cause significant lethargy, depression, and cognitive impairment. Frequent urination and abdominal pain are not typically associated with this medication. Depression, not mania, is a common adverse effect for this medication.

Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be correct.

Alcohol *Grapefruit juice Cheddar cheese Summer sausage Dark green vegetables Clients taking calcium-channel blockers such as diltiazem would be instructed to avoid drinking grapefruit juice or eating grapefruit because it can interfere with metabolism of the medication. Clients taking acetaminophen would be instructed to avoid alcohol. Aged cheese and meat, such as sausage, should be avoided in clients taking monoamine oxidase inhibitors (MAOIs). Clients taking anticoagulants, such as warfarin, should avoid dark green vegetables.

Which effect would the nurse assess for in a client with Alzheimer disease who has been taking galantamine and is newly prescribed paroxetine for depression?

Allergic Dystonic *Additive Extrapyramidal Paroxetine and galantamine potentiate each other's actions. Giving these medications concurrently will not precipitate an allergic reaction. Dystonic effects are associated with antipsychotic medications. Extrapyramidal effects occur with antipsychotic medications.

The nurse is caring for a client prescribed temazepam at bedtime. Which finding would the nurse report to the health care provider?

Anxiety Drowsiness *Sleep driving Morning headache Benzodiazepines are frequently used at bedtime for treating insomnia. However, some clients taking the medications may experience the side effect of performing tasks without remembering the events. When these side effects occur at night, dangerous sleep-related behaviors, such as sleep driving or preparing and consuming meals, can occur. If a client reports these side effects, the nurse will need to report the finding to the health care provider immediately to ensure the client's safety. Anxiety, drowsiness, and morning headaches are common findings during treatment with benzodiazepines and do not need to be reported to the health care provider.

The health care provider prescribes alprazolam 5 mg by mouth three times a day for a client with anxiety. Which intervention will the nurse take before administering this prescription?

Assess the apical pulse. Check the blood pressure. Encourage the ventilation of feelings. *Clarify the prescription with the health care provider. The prescribed dosage is excessive, and it must be questioned before its administration. Checking the apical pulse and/or blood pressure is not indicated. Encouraging the client to ventilate feelings does not affect the need to question the prescription. Therapeutic dosages of alprazolam range from 0.75 mg to 4 mg daily; the maximal daily dose for acute anxiety is 8 mg.

A school-age child with a seizure disorder has been on long-term carbamazepine therapy. Which intervention would the nurse incorporate into the plan of care?

Assessing the mouth for gingivitis Checking the pupillary reaction to light Keeping an accurate intake and output record *Monitoring the child's complete blood cell counts The side effects of carbamazepine include blood dyscrasias (e.g., thrombocytopenia, aplastic anemia, leukopenia, agranulocytosis). A side effect of long-term phenytoin, not carbamazepine, therapy is hyperplasia of the gingiva. Carbamazepine does not influence pupillary response directly. Keeping an accurate intake and output is unnecessary.

A client abruptly stops taking a barbiturate. Which withdrawal complication would the nurse anticipate that the client may experience?

Ataxia *Seizures Diarrhea Urticaria Seizures are a serious side effect that may occur with abrupt withdrawal from barbiturates. Ataxia, diarrhea, and urticaria are not associated with barbiturate withdrawal.

Which mechanism of action would the nurse identify for levodopa therapy prescribed to a client diagnosed with Parkinson disease?

Blocks the effects of acetylcholine Increases the production of dopamine *Restores the dopamine levels in the brain Promotes the production of acetylcholine Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic medications. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

A nurse is providing care to a client who takes phenytoin for seizure prevention. The latest laboratory report shows a phenytoin level of 32 mcg/mL. Which action does the nurse take next?

Examine the oral cavity Percuss the abdomen Check the skin turgor *Assess the pupillary response A phenytoin level of 32 mcg/mL is not an expected response to therapy. The therapeutic range of phenytoin is 10 to 20 mcg/mL. Signs of phenytoin toxicity include nystagmus, ataxia, and confusion. The pupillary response will assess for symmetrical movements of the eye. Examining the oral cavity, percussing the abdomen, and checking for skin turgor do not evaluate symptoms of phenytoin toxicity.

A client's phenytoin level is 16 mcg/L. Which action will the nurse take?

Hold the medication and notify the health care provider. *Administer the next dose of the medication as prescribed. Hold the next dose and then resume administration as prescribed. Call the health care provider to obtain a prescription with an increased dose. Administering the next dose of the medication as prescribed is within the therapeutic range of 10 to 20 mcg/L (40-80 mcmol/L); the nurse would administer the medication as prescribed. Holding the next dose and then resuming administration as prescribed is unsafe and will reduce the therapeutic blood level of the medication. Calling the health care provider to obtain a prescription with an increased dose is inappropriate because the blood level is within the therapeutic range.

Which medication would the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines?

Lithium *Flumazenil Methadone Chlorpromazine Flumazenil is the medication of choice in the management of overdose when a benzodiazepine is the only agent ingested by a client not at risk for seizure activity. Flumazenil competitively inhibits activity at benzodiazepine recognition sites on gamma-aminobutyric acid-benzodiazepine receptor complexes. Lithium is used in the treatment of mood disorders. Methadone is used for narcotic addiction withdrawal. Chlorpromazine is contraindicated in the presence of central nervous system depressants.

Which symptom of levodopa toxicity will a client taking levodopa be taught as a reason to contact the primary health care provider?

Nausea Dizziness *Twitching Constipation Abnormal involuntary movements (dyskinesias), such as muscle twitching, rapid eye blinking, facial grimacing, head bobbing, and an exaggerated protrusion of the tongue, are signs of toxicity; these probably result from the body's failure to readjust properly to the reduction of dopamine. Nausea is a side effect of therapy, not toxicity. Dizziness is a side effect of therapy, not toxicity. Constipation is unrelated to levodopa toxicity.

The nurse understands which antiepileptic medication would be used as the first-line treatment for absence seizures?

Phenytoin Diazepam *Valproic acid Acetazolamide Valproic acid is used as the first-line treatment for absence seizures. Phenytoin is used to treat partial, secondary, and generalized tonic-clonic seizures. Diazepam is used to treat status epilepticus. Acetazolamide is used as an adjunct medication for the treatment of absence seizures.

A client with Parkinson's disease is prescribed benztropine (Cogentin). For which of the following should the nurse call the health care provider immediately?

The client is complaining of dizziness when standing up. The client is exhibiting bradykinesia and slurred speech. The client's heart rate increased from 80 to 95 beats per minute. * The client has a history of primary angle-closure glaucoma. The nurse must be able to recognize adverse drug effects and contraindications of medications commonly prescribed for the client with Parkinson's disease. Common clinical manifestations of Parkinson's disease include bradykinesia (slow movement), dysarthria (slurred speech) and orthostatic hypotension, caused by the loss of the neurotransmitter dopamine. The goal of pharmacotherapy is to restore the functional balance of dopamine and acetylcholine. This is achieved by giving dopaminergic drugs and cholinergic blockers.

The nurse is caring for a client with Parkinson's disease. Which finding indicates that the client might be experiencing an adverse side effect from the dopamine-enhancing drugs?

Urinary retention * Hallucinations Kidney failure Hypertensive urgency Carbidopa-levodopa-entacapone is the treatment of choice for clients with Parkinson's disease. Common side effects include dyskinesia, confusion and dizziness. Serious side effects include hallucinations, paranoia and agitation. Hallucinations may be relieved by decreasing the dose of levodopa, but this may decrease the effect of the drug on the motor symptoms of Parkinson's disease.

Which medication acts as an antidote to benzodiazepine?

Zolpidem Temazepam Suvorexant *Flumazenil Flumazenil is a benzodiazepine receptor antagonist and is used to reverse conscious sedation induced by benzodiazepines. Zolpidem is a nonbenzodiapepine, sedative used to treat insomnia. Temazepam and is a benzodiazepine. Suvorexant is in a class of medications called orexin receptor antagonists that works by blocking the action of a certain natural substance in the brain that causes wakefulness.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses associated with this medication? Select all that apply. One, some, or all responses may be correct.

*Nausea Lethargy Bradycardia Polycythemia *Emotional changes Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to the toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects that may occur, not lethargy. Tachycardia and palpitations, not bradycardia, occur. Anemia and leukopenia, not polycythemia, are adverse reactions.

A client with insomnia takes a new medication to promote sleep. Two hours later, the client is wide awake and feeling more energized than before the medication was taken. Which type of response is the client demonstrating?

Allergic Synergistic *Paradoxical Idiosyncratic A paradoxical response to a medication is directly opposite to the desired therapeutic response. An allergic response is an antigen-antibody reaction. A synergistic response involves medication combinations that enhance each other. Idiosyncratic responses to a medication are unpredictable and unrelated to the medication purpose. They are commonly attributed to immune responses or genetic factors.

A client is scheduled to receive phenytoin extended release 100 mg orally at 6:00 PM but is having difficulty swallowing capsules. The unit has phenytoin suspension, suppositories, and injectable solution in stock. Which action will the nurse take?

Crush the capsule and mix into a soft food. Insert a rectal suppository containing 100 mg of phenytoin. Administer 4 mL of phenytoin suspension containing 125 mg/5 mL. *Request a prescription for phenytoin suspension. A palatable suspension is preferable, but a prescription is necessary because suspensions are immediate-release formulations that cannot be substituted for extended-release medications without a prescription. Extended-release capsules and tablets should not be crushed. The route of administration cannot be altered without the health care provider's approval.

A nurse is teaching parents of a child recently prescribed the medication phenytoin for seizure control. Which side effect will the nurse include?

Hypertension Insomnia *Gingival hyperplasia Increased appetite Gingival hyperplasia (overgrowth of the gums) is a common side effect of phenytoin. Other common side effects include ataxia, central nervous system depression, drowsiness, headache, hypotension, mental confusion, nausea, vomiting, rash and nystagmus.

A client is prescribed alprazolam. Which action must the nurse include in the client assessment during the initiation of therapy?

Measure the client's urine output. Examine the client's pupils daily. * Check the client's blood pressure. Assess the abdomen for distention. Orthostatic hypotension is a common side effect of alprazolam that occurs early in therapy, so checking the client's blood pressure is the appropriate action. An alteration in urine output is not a common side effect, but it may occur after prolonged use. Central nervous system depression is not an early side effect, but it may occur after prolonged use; examining the client's pupils daily is not appropriate at this time. Distention is not a common side effect, but distention from constipation may occur after prolonged use.

The nurse teaches a client's family about the administration of donepezil for treatment of dementia of the Alzheimer type. Which side effect identified by the caregiver indicates to the nurse that further teaching is needed?

Nausea Dizziness Headache *Constipation Donepezil, a cholinesterase inhibitor, may cause nausea, vomiting, increased salivation, diarrhea, and involuntary defecation related to the increase in gastrointestinal secretions and activity caused by parasympathetic nervous stimulation; it does not cause constipation. Common side effects of donepezil include anorexia, nausea, and vomiting that result from stimulation of the parasympathetic nervous system. Dizziness and headache are common side effects of donepezil that result from central nervous system cholinergic effects.

The nurse is educating a client with seizure disorder about newly prescribed phenytoin. Which statement should the nurse include in the teaching?

"Blood work will be required if you have a seizure while taking this medication." * "You will need to have routine visits with a dentist when taking this medication." "It is normal to have a change in your gait when you first start this medication." "Avoid grapefruit juice when taking this medication." Phenytoin is the first-line medication for the treatment of seizures. Clients should be instructed that they will need routine lab work to ensure that they are at a therapeutic level with the medication, even if they have been seizure-free. This medication can cause gingival hyperplasia, which will require routine dental visits. The client does not need to avoid grapefruit juice with this medication. Difficulty with hand and gait coordination could indicate toxicity and should be reported to the healthcare provider.

A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved?

Decreased blood pressure. **Lessening of tremors. Increased salivation. Increased attention span. Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.

An older adult client has been prescribed zolpidem for insomnia. The nurse should monitor the client for which side/adverse effect of this medication?

Tachypnea *Hypotension Tachycardia Constipation Zolpidem is classified as a non-benzodiazepine and acts as a GABA agonist which can cause central nervous system depression, including drowsiness and lightheadedness. Nurses should be aware of the sedative effects and assess for hypotension, bradycardia, and bradypnea. Diarrhea, not constipation, is more commonly associated with the administration of this medication.

A school-age child with a seizure disorder is prescribed divalproex. The nurse would include which instruction when teaching the parents about administering this medication?

'Crush the tablets and mix them with applesauce.' *'Take the child for regularly scheduled blood tests.' 'Stop the medication immediately if a rash develops.' 'Provide oral hygiene, especially gum massage and flossing.' Adverse reactions to divalproex include thrombocytopenia, leukopenia, and lymphocytosis; blood studies must be performed on a regular basis. Tablets must be swallowed whole; they should not be broken, crushed, or chewed. If the medication is stopped suddenly, a seizure may result; a rash should be reported to the health care provider. Meticulous oral hygiene is more important for a child who is taking phenytoin.

Which action would the nurse implement for a client who has overdosed on barbiturates? Select all that apply. One, some, or all responses may be correct.

Apply ice packs. *Maintain airway. Administer naloxone. *Give intravenous fluids. *Give activated charcoal. Due to the adverse effect of respiratory depression, the nurse will administer oxygen and maintain the airway. Any unabsorbed medication can be removed by giving the client activated charcoal. To eliminate any barbiturate that has been absorbed, the nurse would administer intravenous fluids to alkalinize the urine. Naloxone is given to reverse the effects of opioid overdoses. The nurse will provide warm blankets, not ice packs, to clients who have overdosed.

A client is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals abuse of multiple medications for the past 8 months. When caring for this client, the nurse determines that the most serious life-threatening responses usually result from withdrawal from which medication?

Heroin Methadone *Barbiturates Amphetamines Withdrawal from central nervous system depressants, such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur. Withdrawal from heroin or methadone is rarely life threatening, but it does cause severe discomfort, including abdominal cramping and diarrhea. Withdrawal from amphetamines is rarely life threatening, but it causes severe exhaustion and depression.

The client wants to know why midazolam will be administered preoperatively. Which reason would the nurse provide?

It reduces pain. *It induces sedation. It prevents respiratory depression. It limits oral secretions. Midazolam, a benzodiazepine, reduces anxiety and induces sedation. Analgesics are given to reduce pain. It does not prevent respiratory depression and has been known to promote apnea. Atropine, an anticholinergic, is given to decrease oral and respiratory secretions.

A client has a tonic-clonic seizure. The nurse anticipates that the health care provider will prescribe the intravenous administration of which medication?

Naloxone *Diazepam Epinephrine HCl Atropine Parenterally administered diazepam is a benzodiazepine that has muscle relaxant and anticonvulsant effects that help limit massive muscular spasms. Naloxone does not limit seizures; it is an opioid antagonist and is used for opioid overdose. Epinephrine HCl does not limit seizures; it increases contractility of the heart. Atropine sulfate is not used for seizures. It is used for bradycardia resulting from vagal overstimulation.

The nursing is preparing to administer phenytoin IV push to a client. The client has dextrose 5% in water infusing continuously. Which action is appropriate?

Pinch the line above the infusion port during the administration Hold the medication and collaborate with the provider prior to administration *Stop the infusion and flush the port with normal saline prior to administration Ask the pharmacy to mix the medication into an IV piggyback (IVPB) infusion If giving phenytoin as an infusion, it cannot be administered with D5W because it will precipitate. The D5W should be disconnected, the port flushed with normal saline solution (NSS), medication administered, and the port flushed again with NSS before the D5W is reconnected. The provider does not need to be contacted as this is best practice and aligns with hospital protocol. Administering the medication via IVPB does not reduce the risk for precipitation.

The nurse is educating a client about newly prescribed alprazolam. Which information should the nurse include in the teaching?

Tardive dyskinesia is common early in treatment. Administration of paroxetine may be needed to prevent adverse effects. * The use of grapefruit juice should be avoided. Hyperactivity is seen with long-term use. Grapefruit or grapefruit juice is a known food-drug interaction and may increase drug levels of alprazolam to potentially toxic concentrations. Paroxetine when given with alprazolam will increase the incidence of adverse side effects. Alprazolam is used to treat tardive dyskinesia and is not an adverse side effect of this medication. In general, side effects of benzodiazepines with long-term use include drowsiness, lethargy, and weight gain but not hyperactivity.

A client receives a new prescription for sustained release levodopa/carbidopa PO BID for the treatment of Parkinson's disease. The client's previous prescription was levodopa PO TID. The client's last dose of levodopa was at 0800 hr. Which set of instructions should the nurse give to the client?

"Take the first dose of levodopa/carbidopa today, as soon as your prescription is filled." "Since you already took your levodopa, wait until tomorrow to take the levodopa/carbidopa." "Take both drugs for the first week, then switch to taking only the levodopa/carbidopa." **"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa." Carbidopa combined with the levodopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. Which instruction will the nurse include when teaching the client about this medication?

'Take this medication between meals.' 'Blood levels of the medication should be monitored weekly.' 'It can cause happy feelings followed by feelings of depression.' *'You may experience dizziness when moving from sitting to standing.' Carbidopa-levodopa is a metabolic precursor of dopamine; it reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension. Carbidopa-levodopa should be administered with food to minimize gastric irritation. Although periodic tests to evaluate hepatic, renal, and cardiovascular status are required for prolonged therapy, these tests aren't required on a weekly basis. Carbidopa-levodopa may produce either happiness or depression, but no established pattern of such responses exists.

The mother of an infant recently prescribed phenobarbital for seizures calls the pediatric clinic and states that the infant is lethargic and sleeps for long periods. Which response by the nurse is most appropriate?

'There's a medication that will prevent this problem.' 'This means that your baby's dosage needs to be adjusted.' *'This is a temporary response to the medication; it usually stops after a few weeks.' 'Many infants experience the same problem, but your baby needs the medication.' Drowsiness is frequently a side effect of barbiturate therapy because it depresses the central nervous system; the infant will adapt to this over time. Stimulants are not routinely administered because they counteract the desired effect of seizure reduction. The dosage does not need adjustment; this response demonstrates little understanding of barbiturate therapy. The mother's concern is with her own baby; the medication's side effects should be explained.

The caregiver of a client with Alzheimer's disease asks the nurse for information about different treatment options that can help with memory or behavior problems. Which of the following responses by the nurse are correct? Select all that apply.

* "Music therapy has been found to help some clients." "Ginkgo biloba may help with memory." "Acupuncture may be very relaxing." * "Donepezil (Aricept) may help slow cognitive decline." * "Garlic may help with this disease." Some complementary and integrative health therapies may help with the symptoms of Alzheimer's disease. Music, art and dance therapies can help with behavior issues. Ginkgo biloba may be used to improve memory. Acupuncture may be a frightening experience for someone with Alzheimer's disease. Garlic is not a treatment for Alzheimer's disease. Donepezil (Aricept) is used to ease the symptoms associated with Alzheimer's disease.

The nurse provides care for a client with a long history of alcohol abuse. Which medication would the nurse anticipate will be prescribed for the client to prevent symptoms of withdrawal?

* Lorazepam Phenobarbital Chlorpromazine Disulfiram Lorazepam is most effective in preventing the signs and symptoms associated with withdrawal from alcohol. It depresses the central nervous system by potentiating gamma-aminobutyric acid, an inhibitory neurotransmitter. Phenobarbital is used to prevent withdrawal symptoms associated with barbiturate use. Chlorpromazine, an antipsychotic medication, is not used for alcohol withdrawal. Disulfiram does not prevent symptoms; it is aversion therapy that causes symptoms when alcohol is ingested.

The nurse is providing discharge education to a client who is prescribed alprazolam for a panic disorder. What concept should the nurse emphasize concerning the drug action?

* Short-term relief can be expected The medication acts as a stimulant The medication works by suppressing dopamine If you you miss a dose, double the next scheduled dose Alprazolam is a short-acting benzodiazepine, which works quickly to control panic symptoms by enhancing the effects of the neurotransmitter Gamma-amino butyric acid (GABA). This produces a calming effect. The drug does not suppress dopamine like dopamine antagonists and some antipsychotic medications. Alprazolam will not be increased as tolerated, the lowest dose that controls the symptoms will be maintained.

Which statement by the nurse reflects teaching for a client recently initiated on anticonvulsants? Select all that apply. One, some, or all responses may be correct.

*'It is important to take the medication at the same time every day with meals.' *'It is important to not drink excessive amounts of caffeine-containing beverages or alcohol.' *'Avoid driving or hazardous activities until any side effects such as drowsiness can be determined.' *'Some anticonvulsants interfere with vitamin and mineral absorption, so you may need a supplement.' *'Oral hygiene, such as gum massage and tooth brushing, is important to combat the gingival hyperplasia that some anticonvulsant medication can cause.' When initiating anticonvulsant medication, it is important to maintain consistent levels of the medication, so the patient would take it at the same time every day and with meals for absorption. It is important not to drive or perform any hazardous activities as new medications can cause drowsiness. There is some evidence that caffeinated and alcoholic beverages lower seizure threshold. Adding a multivitamin supplement is recommended, especially if the anticonvulsant is the kind that interferes with absorption. Frequent dental examinations and good oral hygiene are the first line of defense against the gingival hyperplasia caused by some anticonvulsants.

A client with Parkinson disease is admitted to the hospital. Which medication is prescribed to improve the physical manifestations of Parkinson disease?

*Carbidopa-levodopa Isocarboxazid Dopamine Pyridoxine (vitamin B 6) Levodopa crosses the blood-brain barrier and converts to dopamine, a substance depleted in Parkinson disease. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of psychological symptoms associated with severe depression, not physiological symptoms of Parkinson disease. Dopamine is not prescribed for this purpose because it does not cross the blood-brain barrier. Pyridoxine can reverse the effects of some antiparkinsonian medications and is contraindicated.

The nurse is preparing to administer newly prescribed intravenous phenytoin to a client. When reviewing the client's medical record, which prescription should the nurse question?

*Continuous infusion of dextrose 5% in 0.9% saline NPH insulin 40 units before meals Labetalol 100 mg orally twice per day Ketorolac 15 mg IV push as needed for pain Phenytoin is not compatible with most IV fluids, especially those with dextrose. If the nurse observes a continuous infusion of a fluid that contains dextrose, they should understand that incompatibilities are likely and should not administer the medication as prescribed. Insulin, labetalol, and ketorolac do not have potential incompatibilities.

An 18-month-old toddler is being treated with intravenous diazepam every 4 hours for generalized tetanus. Which response to the medication would the nurse anticipate?

*Control of hypertonicity and prevention of seizures Control of laryngospasms and neck and jaw rigidity Prevention of excess oxygen and caloric expenditure Prevention of restlessness and resistance to assisted ventilation Diazepam is commonly used to manage generalized muscular spasms. Laryngospasm and nuchal rigidity are responses to the exotoxin and are treated with tetanus immune globulin. Diazepam is not administered to decrease the metabolic rate. Pancuronium bromide, an acetylcholine antagonist, is given to children who do not respond to sedatives and muscle relaxants and resist ventilatory assistance.

A primary health care provider prescribes 0.25 mg of alprazolam by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. Which side effect of this medication will the nurse monitor for in this client?

*Drowsiness Bradycardia Agranulocytosis Tardive dyskinesia Alprazolam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Alprazolam may cause tachycardia, not bradycardia. Agranulocytosis is usually a side effect of the antipsychotics in the phenothiazine group, not benzodiazepines. Tardive dyskinesia occurs after prolonged therapy with antipsychotic medications; alprazolam is an antianxiety medication, not an antipsychotic.

The nurse teaches the client about effects of carbamazepine that would be reported to the primary health care provider. Which effects would the nurse include? Select all that apply. One, some, or all responses may be correct.

*Nausea Dizziness *Unusual bleeding or bruising Sensitivity to bright light or sun Breast enlargement Nausea may be a side effect or it may signal toxicity. The client should be evaluated by the primary health care provider. Carbamazepine can cause severe bone marrow depression; the client should have weekly complete blood counts for the first 4 weeks of therapy and every 3 to 6 months thereafter. Dizziness is a common side effect of carbamazepine that does not require primary health care provider notification. The client should be cautioned not to engage in hazardous activities such as driving a car. Sensitivity to bright light or sun is not a side effect of carbamazepine. Breast enlargement is not associated with carbamazepine.

Which adverse response would a nurse assesses for when carbidopa-levodopa is prescribed for a client with Parkinson disease? Select all that apply. One, some, or all responses may be correct.

*Nausea Lethargy Bradycardia Polycythemia *Emotional changes Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to the toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects that may occur, not lethargy. Tachycardia and palpitations, not bradycardia, occur. Anemia and leukopenia, not polycythemia, are adverse reactions.

Which concern will the nurse keep in mind when a client has been taking a benzodiazepine?

*Rebound insomnia may occur if the medication is discontinued abruptly. Lifelong treatment is often required. Higher doses are needed to accommodate physiological changes during pregnancy. These medications have both analgesic and antidepressant properties. Benzodiazepine often leads to tolerance and withdrawal; therefore it can cause rebound insomnia when discontinued abruptly. Benzodiazepine is not indicated for lifelong treatment; addiction is a concern. Benzodiazepine should be discontinued if the client becomes pregnant. Benzodiazepines not have analgesic, antidepressant, or antipsychotic properties.

Diazepam is administered to the client with status epilepticus. In addition to decreasing central neuronal activity, which effect would the nurse anticipate?

*Relaxing of peripheral muscles Decreased heart rate Dilation of airways Hypertension Diazepam is a benzodiazepine indicated for treatment of anxiety, muscle spasms, and seizures. Peripheral muscles may relax as a result of the antispasmodic effects. Diazepam does not slow the heart rate. Diazepam does not dilate the bronchial airways and may cause bronchoconstriction, though this is uncommon. Diazepam may cause hypotension, not hypertension.

A newly admitted client reports taking phenytoin for several months. Which assessment should the nurse include in the admission report? Select all that apply.

*Report of unsteady gait, rash and diplopia *Report of any seizure activity *Serum phenytoin levels Report of anorexia, numbness and tingling of the extremities Serious adverse outcomes of antiseizure medications such as phenytoin are unsteady gait, slurred speech, extreme fatigue, blurred vision or feelings of suicide. Clients who are prescribed phenytoin should have their levels monitored on a routine basis. The nurse should include any seizure activity as this may demonstrate lack of a therapeutic level. Increased hunger (not anorexia), increased thirst or increased urination are additional serious side effects.

A client has completed therapy and requests to discontinue treatment with benzodiazepines. Which information would the nurse provide to prevent injury?

*Taper dose over several months. Switch to using an antidepressant. Refrain from renewing prescription. Monitor for signs of increased anxiety. Abruptly discontinuing the use of benzodiazepines can cause withdrawal symptoms including intense anxiety and worsening of panic disorders. Therefore, the dose will need to be tapered over several months. Switching to an antidepressant does not alleviate withdrawal symptoms when discontinuing benzodiazepines. Refraining from renewing the prescription would lead to abrupt discontinuation of the medication and would be discouraged. Monitoring for signs of increased anxiety would not actively prevent injury.

Which information would the nurse give to a client interested in kava and valerian supplements for the treatment of anxiety and insomnia? Select all that apply. One, some, or all responses may be correct.

*Valerian can cause restlessness and insomnia. *Both kava and valerian are contraindicated with liver disease. *Kava is contraindicated with Parkinson disease or depression. *Kava can cause temporary yellow discoloration of the skin, hair, and nails. Both kava and valerian can have adverse effects on the central nervous system. It is true that valerian can cause restlessness and insomnia. Both kava and valerian can cause liver toxicity and liver injury; both are contraindicated with liver disease. Kava is also contraindicated with Parkinson disease or depression and can worsen symptoms of both. Kava can cause temporary yellow discoloration of the skin, hair, and nails. It is not true that both kava and valerian have adverse effects on the central nervous system; only valerian does, including depression, nausea, and vomiting.

Which finding would the nurse report to the health care provider when caring for a client prescribed temazepam at bedtime?

Anxiety Drowsiness *Sleep driving Morning headache Benzodiazepines are frequently used at bedtime for treating insomnia. However, some clients taking the medications may experience the side effect of performing tasks without remembering the events. When these side effects occur at night, dangerous sleep-related behaviors, such as sleep driving or preparing and consuming meals, can occur. If a client reports these side effects, the nurse will need to report the finding to the health care provider immediately to ensure the client's safety. Anxiety, drowsiness, and morning headaches are common findings during treatment with benzodiazepines and do not need to be reported to the health care provider.

The nurse is preparing to administer diltiazem to a client with heart disease. Which action should the nurse take first?

Assess the client's lung sounds and monitor for wheezing * Assess the client's blood pressure and apical pulse Assess the client's urine output and potassium level Auscultate the abdomen for bowel sounds Diltiazem is a calcium channel blocker that is used to treat hypertension, angina and tachyarrhythmias. The medication works by causing systemic vasodilation and lowering the client's heart rate. Common side effects of diltiazem include hypotension, orthostatic hypotension, bradycardia, edema and headaches. It is not necessary to auscultate the client's lung sounds prior to administering the medication. Wheezing is not considered a side effect of diltiazem. Because the medication can lead to hypotension and bradycardia, it is essential to assess the client's blood pressure and apical pulse prior to administration. It is not necessary to check the client's urine output or potassium level prior to administering the medication. Diltiazem does not affect a client's renal status or potassium level. It is not necessary to check the client's bowel sounds prior to administering the medication. Diltiazem does not affect a client's gastrointestinal system.

Which medication would the nurse anticipate developing a teaching plan for when a client reports becoming panicked and having an irrational fear of talking in public?

Buspirone *Alprazolam Diazepam Lorazepam Alprazolam (a benzodiazepine) is a short-acting anxiolytic medication used to treat those clients with panic disorders and the irrational fear of talking openly in public (agoraphobia). Buspirone, an anxiolytic medication that is different both chemically and pharmacologically from the benzodiazepines, is always administered on a scheduled basis (not on an as-needed basis) for the treatment of anxiety. Diazepam is an anxiolytic medication commonly prescribed for the treatment of anxiety but has generally been replaced by short-acting benzodiazepines. Lorazepam is an intermediate-acting anxiolytic medication used in the treatment of acutely agitated clients.

A client has a tonic-clonic seizure caused by an overdose of aspirin. Which action would the nurse take next?

Check reflexes every 2 hours. Insert a urinary retention catheter. *Monitor vital signs every 15 minutes. Prepare a setup for a central venous pressure (CVP) line. Because of the lethal toxicity of an aspirin overdose, hypotensive crisis and cardiac irregularities can occur. The central nervous system is not involved at the reflex level at this time. Inserting a urinary retention catheter is not the priority at this time. CVP readings are not indicated in this situation.

Donepezil is prescribed for a client who has mild dementia of the Alzheimer type. Which information would the nurse include when discussing this medication with the client and family?

Fluids should be limited to 4 large glasses per day. Constipation should be reported to the primary health care provider immediately. * Blood tests that reflect liver function will be performed routinely. The client's medication dosage may be self-adjusted according to the client's response. Donepezil may affect the liver because alanine aminotransferase (ALT) is found predominantly in the liver; most ALT increases indicate hepatocellular disease. Clients taking this medication should have regular liver function tests and report light stools and jaundice to the primary health care provider. Fluids should not be limited, because a side effect of donepezil is constipation. A side effect of constipation is expected; therefore, fluids, high-fiber foods, and exercise should be recommended to help keep the stools soft. The client should not increase or decrease the dosage abruptly; donepezil should be taken exactly as prescribed.

The nurse administers carbidopa-levodopa to a client with Parkinson's disease. Which activity describes the mechanism of action of this medication?

Increase in acetylcholine production Regeneration of injured thalamic cells Improvement in myelination of neurons *Replacement of a neurotransmitter in the brain Carbidopa-levodopa is used because levodopa is the precursor of dopamine. It is converted to dopamine in the brain cells, where it is stored until needed by axon terminals; it functions as a neurotransmitter. Regeneration of injured thalamic cells is not an action of this medication; neurons do not regenerate. Increase in acetylcholine production and improvement in myelination of neurons are not actions of this medication.

Which would the nurse include when teaching a client with Parkinson disease about carbidopa-levodopa?

Multivitamins should be taken daily. A high-protein diet should be followed. *The medication should be taken with meals. Alcohol consumption should be in moderation. Carbidopa-levodopa should be taken with meals to reduce the nausea and vomiting that commonly are caused by this medication. Multivitamins are contraindicated; vitamins may contain pyridoxine (vitamin B 6), which diminishes the effects of levodopa. A high-protein diet is contraindicated. Sinemet contains levodopa, an amino acid that may increase blood urea nitrogen levels. Also, some proteins contain pyridoxine, which increases the peripheral metabolism of levodopa, decreasing the amount of levodopa crossing the blood-brain barrier.

Which sedative-hypnotics would the nurse identify as being used to treat insomnia associated with a panic disorder? Select all that apply. One, some, or all responses may be correct.

Phenelzine Paroxetine *Alprazolam Imipramine *Clonazepam Alprazolam and clonazepam are examples of benzodiazepines, a class of sedative-hypnotics used to treat clients with insomnia associated with panic disorders. Phenelzine is a monoamine oxidase inhibitor used to treat panic disorders and promote sleep. Paroxetine is a selective serotonin reuptake inhibitor used to treat panic disorders and promote sleep. Imipramine is a tricyclic antidepressant used to treat panic disorders and promote sleep.

The nurse understands which as the primary reason oxazepam is given during detoxification?

Prevents injury when seizures occur Enables the client to sleep better during periods of agitation Encourages the client to accept treatment for alcoholism *Minimizes withdrawal symptoms the client may experience Oxazepam potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation, and thus it minimizes withdrawal symptoms. This medication helps reduce the risk for seizures but does not prevent injury during a seizure. Enabling the client to sleep better during periods of agitation is not the purpose of the medication. The ability of the client to accept treatment depends on the person's readiness to accept the reality of the problem.

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. Which action by the patient makes the nurse confident that the medication information discussed has been understood?

The client removes the pepperoni from a pizza. The client asks for an extra bottle of flavored water to drink with dinner. * The client requests a prescription for oral contraceptives before being discharged. The client states that chewable antacids may be taken to relieve heartburn. Benzodiazepines increase the risk of congenital anomalies and so should not be taken by pregnant women. Refraining from eating pepperoni is appropriate for people taking monoamine oxidase inhibitors because tyramine needs to be strictly avoided. Appropriate hydration is critical for those taking lithium. Antacids can affect both absorption and metabolism of benzodiazepines and should be avoided.

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. The nurse is confident that the medication information discussed has been understood when the client takes which action?

The client removes the pepperoni from a pizza. The client asks for an extra bottle of flavored water to drink with dinner. *The client requests a prescription for oral contraceptives before being discharged. The client states that chewable antacids may be taken to relieve heartburn. Benzodiazepines increase the risk of congenital anomalies and so should not be taken by pregnant women. Refraining from eating pepperoni is appropriate for people taking monoamine oxidase inhibitors because tyramine needs to be strictly avoided. Appropriate hydration is critical for those taking lithium. Antacids can affect both absorption and metabolism of benzodiazepines and should be avoided.

Status epilepticus develops in an adolescent with a seizure disorder who is taking antiseizure medication. Which reason would the nurse identify as the most common reason for the development of status epilepticus?

The provider failed to account for a growth spurt. The amount prescribed is insufficient to cover activities. *The prescribed antiseizure medication probably is not taken consistently. The client is prescribed a medication that is ineffective in preventing seizures. Skipping doses of the medication is a form of denial that an adolescent client may engage in once the seizures are controlled; also, adolescents tend to feel invincible. The dosage is based not on activity but on the type of seizure. Medications are prescribed according to the type of seizure and are effective if taken consistently. The dosage of antiepileptic medications is based on many factors, including age, type of medication, and presence of infection, as well as on changes in height and weight.

Which statement about benzodiazepines requires correction?

They are indicated for ethanol withdrawal. * These medications increase the activity of gamma-aminobutyric acid. Benzodiazepines are the first-line medications used in chronic anxiety disorders. These medications depress activity in the brainstem. Benzodiazepines act by decreasing the activity of gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Apart from their indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the first-line medications of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and the limbic system.

Which ophthalmic solution is contraindicated for clients with glaucoma?

Timolol *Atropine Pilocarpine Epinephrine Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure.

A nurse is providing education on the use of pregabalin to a client with a seizure disorder. Which client statement indicates further teaching is required?

"I will record the number of seizures I experience." * "I will hold the dose if my seizures are controlled." "I will notify my healthcare provider if I have significant mood changes." "I will report any weight gain to my healthcare provider." Pregabalin is an anticonvulsant medication used to manage seizure disorders. The client should take the medication as prescribed as abrupt discontinuation can lead to seizure activity. Recording the number of seizures helps to evaluate the effectiveness of the medication. Pregabalin can cause suicidal thoughts and behaviors. The client should promptly report significant mood changes. Pregabalin can cause weight gain and peripheral edema. These side effects should be reported to the healthcare provider.

The daughter of a client with Alzheimer's disease asks the nurse, "Will the medication my mother is taking cure her dementia?" What is the best response by the nurse?

"It will help your mother live independently again." "It is used to halt the progression of Alzheimer's disease." * "It will not improve dementia but can help control emotional responses." D"It will provide a steady improvement in memory." Drug therapy for Alzheimer's disease such as memantine and donepezil produce modest improvements in cognition, behavior, and function, and slightly delayed disease progression. They do not reverse the dementia or halt the progression of Alzheimer's disease. At best, drugs currently in use may slow loss of memory and improve cognitive functions (e.g., memory, thought, reasoning) and emotional lability. However, these improvements are modest and last a short time and for many clients, even these modest goals are elusive.

A nurse is providing education on the use of carbidopa/levodopa to a client with Parkinson's disease. What will the nurse include in the teaching?

"This medication will stop the progression of your condition." "Notify your healthcare provider if your urine appears dark." "Eat plenty of whole-grain foods when taking this medication." * "Avoid eating meals that are high in protein." Carbidopa/levodopa is a combination medication used in the management of Parkinson's disease. Consuming high-protein meals can impair the effects of levodopa. The nurse should instruct the client to eat protein in small portions. Carbidopa/levodopa does not halt the progression of Parkinson's disease. The medication is intended to reduce the symptoms associated with the condition. Darkening of bodily fluids can occur when taking the medication. However, the client should be informed this is not a harmful side effect. Whole grains contain pyridoxine, a vitamin that interferes with the effects of levodopa.

A client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. When interviewing the client, the nurse identifies that the medication has been effective when the client makes which statement?

'I have less pain.' *'I have been sleeping better.' 'My blood glucose is under control.' 'My blood pressure is coming down.' Zolpidem is a sedative-hypnotic that produces central nervous system depression in the limbic, thalamic, and hypothalamic areas of the brain. Zolpidem is not an analgesic, antidiabetic, or antihypertensive medication.

A client with a seizure disorder is receiving phenytoin and phenobarbital. Which client statement indicates that the instructions regarding the medications are understood?

'I will not have any seizures with these medications.' 'These medicines must be continued to prevent falls and injury.' *'Stopping the medications can cause continuous seizures and I may die.' 'By my staying on the medicines I will prevent postseizure confusion.' Combination therapy suggests that this client has seizures that are difficult to control. Sudden withdrawal of any antiepileptic medication can cause onset of frequent seizures or even status epilepticus. Death can occur if seizures are continuous due to lack of adequate oxygenation and cardiac irregularities. It is important to take medication as prescribed to lessen the frequency of seizures; there is no guarantee that seizures will stop. Medication may or may not eliminate the seizures; stress may precipitate a seizure. Antiepileptic medications are not prescribed to prevent falls and injury and the added central nervous system (CNS) depression increases fall risk. Although seizures may occur while the client is taking the medications, the medications do not stop postseizure confusion.

A 7-year-old child who is taking medication to prevent seizures has been seizure free for 2 years. The child's parents ask the nurse, 'How much longer will my child need to take the medication?' Which answer will the nurse provide?

'Medications are continued for 3 years after the last seizure.' *'This is usually attempted after 2 years, but medications must be gradually decreased.' 'Children are usually able to stop seizure medication after puberty.' 'Seizure disorders are lifelong problems that require ongoing medications.' A predesigned protocol is used to wean a child off anticonvulsants gradually because abrupt removal of the drug can result in a seizure. Anticonvulsants are discontinued gradually after a child is seizure free for 2, not 3, years and has an EEG within expected limits. Anticonvulsants cannot be stopped abruptly at the 2-year follow-up visit, but the discontinuation process may be started. The statement that seizure disorders are lifelong problems that require ongoing medications may or may not be true; this is determined on an individual basis.

An antianxiety medication is prescribed for an extremely anxious client. The client states, 'I'm afraid to take this medication because I heard it's addictive.' Which response by the nurse is most appropriate?

'This medication rarely causes dependence when the dosage is controlled.' 'You may require increases in your dosage; however, it rarely causes dependence.' 'It usually results in psychological but not physiological dependence.' * 'The medication has the potential for physiological and psychological dependence.' Antianxiety medications have the potential for physiological and psychological dependence; the nurse would teach the client about both the advantages and disadvantages of taking this medication. Physiological or psychological dependence may develop even when the dosage is controlled. Tolerance does develop and can lead to dependence.

The nurse teaches the parents of a child prescribed long-term phenytoin therapy about care. Which statement indicates the teaching has been effective?

'We give the medication between meals.' 'We'll call the clinic if her urine turns pink.' 'She's eating high-calorie foods, and we encourage fluids, too.' *'We'll have her massage her gums and floss her teeth frequently.' A common side effect of phenytoin is gingival hyperplasia. Meticulous oral hygiene may reduce the risk of this side effect. Phenytoin is strongly alkaline and should be administered with meals to help prevent gastric irritation. Pink urine may be observed during medication excretion; it is expected and does not require treatment. Avoidance of overeating and overhydration may result in better seizure control.

Which instruction about phenytoin will the nurse provide during discharge teaching to a client with epilepsy who is prescribed phenytoin for seizure control?

* "Antiseizure medications will probably be continued for life." "Phenytoin prevents any further occurrence of seizures." "This medication needs to be taken during periods of emotional stress." "Your antiseizure medication usually can be stopped after a year's absence of seizures." Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite medication therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the medication irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiological condition.

The nurse in the neurology office is reviewing information about levetiracetam with a 30-year-old female client with a history of seizures. Which instruction about the medication should the nurse make sure to include?

* "Call the office immediately if you feel like hurting or killing yourself." "You should avoid becoming pregnant while taking this medication." "You should stay away from large crowds and sick children." "You might experience irregular menses and intermittent bleeding." Rationale: Levetiracetam is an anti-convulsant medication used to prevent seizures. One of the significant side effects is behavioral changes and suicidal ideations. It is important to notify the provider's office immediately if the client experiences these thoughts. The other instructions do not apply to this particular medication.

A client has been taking alprazolam for three days. For which expected effect of the medication should the nurse evaluate the client?

* The client reports sleeping through the night. The client reports feeling less depressed. The client denies having auditory hallucinations. The client denies having suicide ideation. Antianxiety medications or anxiolytics, such as alprazolam, a benzodiazepine, work quickly. They produce sedative effects and reduce anxiety through effects on the limbic system, a neuronal network associated with emotionality. They also promote sleep through effects on cortical areas and on the brain's sleep-wakefulness "clock." Alprazolam is not used to treat depression or hallucinations.

Which administration guidelines would the nurse follow when administering midazolam to an older client?

*The increments should be smaller, and the rate of injection should be slower. The medication should be given as a rapid intravenous push. It is important to monitor for spikes in blood pressure elevation during administration. During the procedure, the medication should be given as needed for pain management. In an older client, the peak effect may be delayed; increments should be smaller, and the rate of injection should be slower. When used for sedation/anxiolysis/amnesia for a procedure, the dosage must be individualized and titrated. Midazolam should always be titrated slowly; administer over at least 2 minutes, and allow an additional 2 or more minutes to fully evaluate the sedative effect. Titration to effect with multiple small doses is essential for safe administration. Central nervous system depression is the most serious side effect. A sudden rise in blood pressure shortly after administration has not been evidenced. Midazolam is given to induce sedation/anxiolysis/amnesia for a procedure.

A client is taking hydromorphone (Dilaudid) PO every 4 hours at home. Following surgery, Dilaudid IV every 4 hours PRN and butorphanol tartrate (Stadol) IV every 4 hours PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. Which intervention should the nurse implement?

Alternate the two medications every 4 hours PRN for pain. Alternate the two medications every 2 hours PRN for pain. *Administer only the Dilaudid every 4 hours PRN for pain. Administer only the Stadol every 4 hours PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.

A client is admitted to the emergency department after experiencing a seizure. Which action would the nurse take first?

Ask the emergency provider for a prophylactic anticonvulsant. *Obtain a history of seizure type and incidence. Ask the client to remove any dentures and eyeglasses. Observe the client for increased restlessness and agitation. Data collection is an essential first step for a client with a seizure disorder; it should always include a history of the seizures (e.g., type and incidence). Because different seizure medicines are used to control different seizure types, it is important to determine the type before treating. Although dentures and eyeglasses may be removed during a seizure, the client's normal routines should be respected. Increased restlessness may be evidence of the prodromal phase of a seizure in some individuals, but signs and symptoms vary so widely that the client's history should be obtained.

The nurse is reviewing the medical record of a client who received a new prescription for benztropine. For which condition in the client's record should the nurse clarify the prescription with the health care provider?

Cataracts Schizophrenia Glaucoma* Parkinson's disease Benztropine is an anticholinergic medication used to treat extrapyramidal disorders caused by antipsychotic medications or Parkinson's disease. Use of benztropine or other anticholinergics is contraindicated for individuals diagnosed with glaucoma, ileus and prostatic hypertrophy. Adverse effects include tachycardia, urinary retention and increased intraocular pressure.

Which medications would the nurse identify as commonly used as an adjunct during conscious sedation for minor surgeries?

Diazepam *Midazolam Lorazepam Clonazepam When used in conjunction with an opioid analgesic, midazolam causes conscious sedation, which is a semiconscious state suitable for minor surgeries and endoscopic procedures. Diazepam and lorazepam are used for anesthetic induction, preanesthetic medication, and the production of conscious sedation when used in conjunction with opioid analgesics. Clonazepam is used to treat seizures and anxiety.

A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client's partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. Which advice would the nurse give the partner?

Give the medication with food. Administer the medication at bedtime. Omit 1 dose today and start with a lower dose tomorrow. * Bring the partner to the clinic for testing and a physical examination. Many people with dementia experience physical problems such as urinary tract infections but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems probably are not being caused by the medication. The client should be brought in for an evaluation. Taking the medication with meals is recommended to decrease gastrointestinal side effects, but this client is experiencing more than this. Donepezil can cause insomnia. The client is already restless and agitated. Taking the medication at bedtime will not help. The nurse would not advise a modification of the dosage without consulting the health care provider.

Which primary reason identifies why oxazepam is given during detoxification?

Prevents injury when seizures occur Enables the client to sleep better during periods of agitation Encourages the client to accept treatment for alcoholism *Minimizes withdrawal symptoms the client may experience Oxazepam potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation, and thus it minimizes withdrawal symptoms. This medication helps reduce the risk for seizures but does not prevent injury during a seizure. Enabling the client to sleep better during periods of agitation is not the purpose of the medication. The ability of the client to accept treatment depends on the person's readiness to accept the reality of the problem.

Which primary anxiolytic medication would the nurse anticipate developing a teaching plan for when a client with social anxiety disorder has a history of exhibiting an intense, irrational fear of being scrutinized by others? Select all that apply. One, some, or all responses may be correct.

Sertraline Paroxetine *Alprazolam Venlafaxine *Clonazepam Manifestations of social anxiety disorder include stuttering, sweating, palpitations, dry throat, and muscle tension. Clients with this disorder exhibit an intense, irrational fear of being scrutinized by others. Alprazolam and clonazepam are benzodiazepines that are well tolerated in clients, and the benefits are immediate. Sertraline and paroxetine are selective serotonin reuptake inhibitors that are also used in the treatment of social anxiety disorder, but they do not act quickly. Venlafaxine is used to treat posttraumatic stress disorder.

A client has been robbed, beaten, and sexually assaulted. The primary health care provider prescribes 0.25 mg of alprazolam for agitation. Which event would alert the nurse to administer this medication?

The client's crying increases. * The client requests something to calm her. The nurse determines a need to reduce her anxiety. The primary health care provider is getting ready to perform a vaginal examination. Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible. Crying is a typical way to express emotions; the client should be told that medication is available if desired. The nurse determining a need to reduce the client's anxiety or administering the medication when the primary health care provider is getting ready to do a vaginal examination takes control away from the client. She may view these actions as an additional assault on the body, which increases feelings of vulnerability and anxiety and does not restore control.

Which rationale explains why the nurse would question a benzodiazepine prescription for an individual experiencing acute grief?

The depression is magnified, and the risk of suicide increases. Brain activity is suppressed, and the risk of depression increases. Lethargy results, and it prevents a return to interpersonal activity. * The period of denial is extended, and the grieving process is suppressed. With this sedating medication, the individual does not face the reality of the loss and merely delays the onset of the pain associated with it. Because most support is available at the time of the death and the funeral, a benzodiazepine at this time denies the individual the opportunity to use this assistance. This class of medications does not magnify the risk of suicide or cause or prevent depression. Although sedation and muscle relaxation initially may occur with these medications, they are not reasons for the medications not to be ordered.