Pharmacology Practice Questions Ch 12, 13, 15

The health care professional is about to administer a loading dose of phenytoin (Dilantin) IV. Which of the following is essential for the health care professional to do before administering phenytoin IV? ​Protect the phenytoin solution from light. ​Make sure the phenytoin solution is cloudy. ​Mix phenytoin with a dextrose solution. ​Infuse phenytoin slowly.

​Infuse phenytoin slowly. Health care professionals should administer IV phenytoin slowly, no faster than 50 milligrams per minute, because rapid infusion may cause hypotension, bradycardia, and cardiovascular collapse. Phenytoin solution is not light-sensitive and it is important to discard it if it is cloudy or discolored. Phenytoin will precipitate in dextrose solutions.

A patient receives spinal anesthesia with lidocaine (Xylocaine) and epinephrine (Adrenalin). You explain that epinephrine is used with lidocaine for which of the following reasons? ​Decreases the risk for a spinal headache ​Reduces the risk for infection ​Prolongs the anesthetic effects ​Prevents respiratory depression

​Prolongs the anesthetic effects Injecting epinephrine with lidocaine for local or regional anesthesia extends the duration of the regional anesthesia. Epinephrine will not reduce the risk for a spinal headache. Instead, positioning patients supine can reduce headache. Epinephrine has no effect on infection risk. It is essential for the anesthetist to confirm correct drug concentration and correct spinal placement to prevent drug toxicity and to monitor for paresthesia, confusion, agitation, which can lead to seizures and respiratory arrest. Injecting epinephrine into the subarachnoid space will not prevent respiratory depression. A spinal anesthetic that involves the intercostal muscles can cause respiratory depression. Should this occur, it is critical to monitor spinal level, administer supplemental oxygen, and provide respiratory support as needed.

Which of the following assessments of this patient is most important immediately following the administration of intravenous diazepam (Valium)? ​ECG ​Seizure activity ​Blood pressure ​Respiratory rate

​Respiratory rate It is important to monitor the patient's cardiac rhythm following the administration of IV diazepam, a benzodiazepine, due to the risk of cardiac arrest. However, this is not the most important assessment. It is also important to monitor seizure activity to determine the effectiveness of the diazepam, a benzodiazepine, but this is not the most important assessment. It is also important to monitor all vital signs following the administration of IV diazepam, a benzodiazepine, due to the risk of hypotension and cardiac arrest. Nonetheless, this is not the most important assessment. The greatest risk to the patient at this time is respiratory depression and apnea. Therefore, it is most important for the health care professional to assess the patient's respiratory rate. In addition, the patient may need supplemental oxygen.

At a visit to the provider's office, an older adult patient's partner reports that the patient has nausea, diarrhea, and a loss of appetite. He has a history of Alzheimer's disease and is taking donepezil (Aricept). The provider should advise which of the following? ​Take the drug with food. ​Stop taking the drug right away. ​Take a reduced dosage of the drug. ​Undergo liver function tests right away.

​Take the drug with food. Cholinesterase inhibitors such as donepezil commonly cause nausea, vomiting, anorexia, and other gastrointestinal symptoms. This is due to the increase of acetylcholine in all parts of the body, and its subsequent effect on the gastrointestinal tract and other systems of the body. The provider should explain to the patient and his caregiver that taking the drug with food and at bedtime will help minimize uncomfortable gastrointestinal effects. The provider also should instruct the partner to report vomiting, severe diarrhea, weight loss, or signs of gastrointestinal bleeding, such as dark stools or coffee-ground emesis, especially if the patient is also taking a nonsteroidal anti-inflammatory drug. At this point, it is not necessary to stop taking the drug, reduce the dosage, or undergo liver function tests.

The health care professional is talking with the patient, who is soon to be discharged to home, about the adverse effects of phenytoin (Dilantin). Which of the following instructions may help minimize the adverse effects of phenytoin? ​Use good oral hygiene. ​Take the drug on an empty stomach. ​Use sun block when outdoors. ​Decrease dietary fiber.

​Use good oral hygiene. The risk of gingival hyperplasia may be reduced with daily flossing and gum massage. Gastric upset may be reduced by taking phenytoin with food. Phenytoin is unlikely to cause photosensitivity, but it can cause photophobia. It is unlikely to cause diarrhea, but it can cause constipation, so increasing fiber intake might help minimize or prevent that effect.

A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? Cooked carrots 2% milk Cheddar Cheese Bananas

Bananas

A nurse is caring for a client who is receiving mydriatic eye drops. Which of the following manifestations indicates to the nurse that the client has developed a systemic anticholinergic effect? Seizures Bradycardia Hypothermia Constipation

Constipation

A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? Dilute the medication with dextrose 5% un water Hold the injection if seizure activity is present Administer the medication at 100mg/min Administer a saline solution after injection

Administer a saline solution after injection

A nurse is preparing to administer phenytoin 50 mg by intermittent IV bolus to a client who has a seizure disorder. Which of the following actions should the nurse take? Slow the injection if the medication crystalizes Dilute the medication before injecting Follow the IV injection with sterile water Administer the medication over 1 minute

Administer the medication over 1 minute

A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide? Phenytoin turns urine blue Avoid flossing the teeth to prevent gum irritation Take and antacid with medication if indigestion occurs Alcohol increases the chance of phenytoin toxicity

Alcohol increases the chance of phenytoin toxicity

A nurse is preparing to administer medications to a client who states, "I don't want to take those drugs." Which of the following actions should the nurse take? Explain the purpose for the medications Ask the client why he is refusing to take the medications Document that the client refuses the medications Tell the client the physician wants him to take the medications

Document that the client refuses the medications

A nurse is preparing a presentation about echinacea to a group of clients. Which of the following information should the nurse include in the teaching? Echinacea blocks testosterone receptors Echinacea is used to treat vertigo Echinacea increases the ability to walk further distances for clients who have PAD Echinacea boosts the immune system

Echinacea increases the ability to walk further distances for clients who have PAD

A nurse is teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor for and report which of the following adverse effects of this medication? Anxiety Skin Rash Diarrhea Metallic Taste

Skin Rash

The patient is taking oral contraceptives for birth control. Which of the following instructions should the health care professional include? ​It is safe to discontinue birth control while taking phenytoin. ​Additional birth control methods may be needed. ​Oral contraceptives may increase the risk for phenytoin toxicity. ​Oral contraceptives may reduce the effectiveness of phenytoin.

​Additional birth control methods may be needed. Phenytoin is teratogenic and can cause serious birth defects, so women taking it should prevent pregnancy. Phenytoin can reduce the effectiveness of oral contraceptives, so the dosage may have to be increased or other birth control methods used or added. Diazepam (Valium), omeprazole (Prilosec), and valproic acid (Depakote), can increase serum phenytoin levels. Carbamazepine (Tegretol) and phenobarbital can decrease phenytoin levels.

A primary care provider prescribes sumatriptan (Imitrex) to treat a patient's migraine headaches. Which of the following instructions should you include when telling the patient how to take sumatriptan? ​Take the drug after onset of the migraine. ​Administer one nasal spray into each nostril. Take it once per day to prevent migraine. Repeat the dose once if the headache is not relieved. ​Allow the tablet to dissolve under the tongue.

Take the drug after onset of the migraine. Repeat the dose once if the headache is not relieved. Patients should only take sumatriptan, a serotonin agonist, after the onset of a migraine or a cluster headache. They should spray the drug once into one nostril. They may repeat the dose once, 1 to 2 hours after the initial dose, depending on the route. They should not use sumatriptan sublingually; only oral, subcutaneous, and intranasal routes are appropriate.

Which of the following laboratory tests should you monitor for a patient who is taking interferon beta-1b (Betaseron) to treat multiple sclerosis? (Select all that apply.) ​Serum osmolality Blood glucose ​Thyroid hormones ​Liver function tests CBC

​Liver function tests CBC Interferon beta-1b, an immunosuppressant, may cause hepatotoxicity and myelosuppression. Monitor liver studies and complete blood counts. This drug is unlikely to alter serum osmolality or glucose or thyroid hormone levels, but it can elevate serum creatinine and alter serum electrolytes.

A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? "Stop taking the medication immediately for a headache" "Expect to develop diarrhea initially" "Do not take antihistamines with this medication" "Take the medication on an empty stomach"

"Do not take antihistamines with this medication"

A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? I know that I cannot switch brands of this medication" "I will notify my doctor before taking any other medications" "I have made an appointment to see my dentist next week." "I'll be glad when I can stop taking this medicine."

"I'll be glad when I can stop taking this medicine."

Match the drug classification with its therapeutic use. Dantrolene (Dantrium) amphetamine/dextroamphetamine sulfate (Adderall) Zolpidem (Ambien) Sodium thiopental (Pentothal) A. Sleep disorders B. Malignant hyperthermia C. Anesthesia induction D. Attention-deficit/hyperactivity disorder

Dantrolene B. is a peripherally acting muscle relaxant that, in its IV form, helps reverse malignant hypertension, which is a dangerous complication of general anesthesia. Amphetamine mixture D. that comprises the brand-name drug Adderall helps patients with attention-deficit/hyperactivity disorder focus and lengthen their attention span. Zolpidem A. acts similarly to benzodiazepines in promoting sedation and thus helps patients fall asleep and stay asleep. Sodium thiopental C. is a barbiturate that helps provide rapid induction of anesthesia and hypnosis for brief procedures.

You are caring for a patient who is preoperative and is NPO. The patient takes carbamazepine (Tegretol), 200 mg PO BID for a seizure disorder. Which of the following actions should you take? ​Give the oral dose of carbamazepine with a sip of water. ​Give carbamazepine IV. Withhold the carbamazepine. ​Administer half the usual morning dose of carbamazepine.

Give the oral dose of carbamazepine with a sip of water. It is important to continue the oral carbamazepine to maintain therapeutic blood levels and to prevent seizure activity. You should notify the anesthesiologist and should give the patient the carbamazepine with a sip of water. Carbamazepine is not available IV. Withholding the carbamazepine may reduce the therapeutic blood level and cause seizure activity. Administering a reduced dose of carbamazepine may reduce the therapeutic blood level and cause seizure activity.

The health care professional is now assessing the patient. Which of the following findings can be an early indication of phenytoin (Dilantin) toxicity? Nystagmus ​Tachycardia ​Tachypnea ​Jaundice

Nystagmus Phenytoin toxicity can develop with serum phenytoin levels greater than 20 mcg/mL, causing nystagmus, ataxia, sedation, and blurred or double vision. Rapid infusion of phenytoin can cause cardiac dysrhythmias, bradycardia, and hypotension. Toxic levels of phenobarbital, whose brand name is Luminal, sometimes given with phenytoin, also can cause bradycardia. Respiratory depression can be a sign of phenytoin or phenobarbital toxicity. Valproic acid (Depakote) can cause hepatotoxicity, which often manifests as jaundice.

Match the drug classification with its therapeutic use. Hydantoin Immunomodulator Cholinesterase inhibitor Dopamine receptor agonist A. Helps minimize symptoms of Alzheimer's disease B. Reduces symptoms of multiple sclerosis C. Reduces the effects of Parkinson's disease D. Controls seizures

hydantoins D. control tonic-clonic seizures as well as partial seizures. They act by decreasing the neuronal activity of seizure-generating cells in the brain by inhibiting the influx of sodium through sodium channels. Immunomodulators B. help reduce the symptoms of multiple sclerosis. They seem to inhibit the movement of leukocytes, which are produced as a part of the body's defective autoimmune response, and thus protect the myelin sheath of neurons from their damaging effects. Cholinesterase inhibitors A. help improve cognitive function in patients with mild to moderate Alzheimer's disease, thus minimizing symptoms. They increase the amount of acetylcholine available and thus counteract the acetylcholine depletion that characterizes Alzheimer's disease. Dopamine receptor agonists, also known as monoamine oxidase or MAO inhibitors C. are one of the types of drugs used to control the symptoms of Parkinson's disease. Dopamine-replacement drugs are another drug classification that that comprises pharmacologic therapy for Parkinson's disease. These drugs either mimic the action of dopamine or make more of it available and thus counteract the dopamine depletion that characterizes Parkinson's disease.

You are instructing a school-age child and his parent about the use of amphetamine-dextroamphetamine (Adderall) to manage the child's attention-deficit hyperactivity disorder. You should tell the child and parent to watch for which of the following? (Select all that apply.) ​Weight loss ​Insomnia ​Hallucinations ​Orthostatic hypotension ​Flu-like symptoms

​Weight loss ​Insomnia ​Hallucinations Amphetamine-dextroamphetamine, a central nervous system stimulant, can lead to weight loss. Patients should take drug right before meals and maintain healthful eating habits. Amphetamine-dextroamphetamine can cause insomnia and restlessness, so patients should take the drug in the morning. It can cause paranoid psychosis, thus patients should report delusions, hallucinations, and changes in mood. Risperidone (Risperdal), an atypical antipsychotic drug, is likely to cause orthostatic hypotension. Atomoxetine (Strattera) may cause liver injury. Patients taking atomoxetine should report signs of liver injury such as flu-like symptoms, yellowing skin, and abdominal pain.

You are instructing a patient who has multiple sclerosis about how dantrolene (Dantrium) will help control spasticity. Through which of the following pharmacologic actions is this drug effective in treating this manifestation? ​Blocks acetylcholine at the neuromuscular junction ​Interrupts nerve signals from the spinal cord to the muscles ​Inhibits destruction of acetylcholine by acetylcholinesterase ​Alters intracellular calcium exchange at the muscles

​Alters intracellular calcium exchange at the muscles Dantrolene, a peripherally acting muscle relaxant, acts directly on spastic muscles and inhibits muscle contraction by preventing the release of calcium in skeletal muscles. Anticholinergic drugs or muscarinic antagonists block acetylcholine at the neuromuscular junction. Baclofen (Lioresal), a centrally acting muscle relaxant, relieves spasticity by interrupting nerve signals from the spinal cord. Most drugs used to treat myasthenia gravis act by preventing the destruction of acetylcholine at the neuromuscular junction.

While obtaining a patient's medical history, you find that the patient is taking levodopa/carbidopa (Sinemet) for Parkinson's disease. Which of the following information in the patient's health history alerts you to take further action? ​Bradycardia ​Pancreatic disease​ ​Glaucoma ​Impaired hearing

​Glaucoma The combination of levodopa and carbidopa, both dopamine-replacement drugs, can cause changes in intraocular pressure. Providers should not prescribe this drug combination for patients who have glaucoma, and in this case, the patient's drug therapy requires adjustment. Pancreatic disorders are not a contraindication for levodopa/carbidopa; instead, caution is required when using it with patients who have peptic ulcer disease. Hearing impairment is not a contraindication for levodopa/carbidopa; instead, it can cause a variety of vision disturbances.