Quiz 3 - Pharm end of chpt practice quiz

5. The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond? A. "Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa." B. "Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease." C. "Both drugs have the same pharmacodynamic and side effect profiles." D. "Carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine."

A. "Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa." Rationale Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. It is more specific for the receptors associated with parkinsonian symptoms, the D2 family. This in turn may have more specific antiparkinsonian effects, with fewer adverse effects associated with generalized dopaminergic stimulation.

2. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? A. Blocking the reuptake of neurotransmitters at nerve endings B. Increasing alertness levels in the brain C. Decreasing levels of epinephrine and serotonin at nerve endings D. Increasing the placebo effect

A. Blocking the reuptake of neurotransmitters at nerve endings Rationale SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin.

A patient who is prescribed the drug miconazole (Monistat), a topical antifungal, has most likely been diagnosed with which condition? A. Candidiasis B. Pruritus C. Eczema D. Folliculitis

A. Candidiasis Rationale: Miconazole is used in the treatment of candidiasis, which is commonly known as a yeast infection.

2. When teaching a patient about carbidopa-levodopa (Sinemet), what information will the nurse include in the teaching? A. Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. B. Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. C. Giving both drugs together minimizes side effects. D. Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

A. Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. Rationale Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.

11. The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What is the nurse assessing for in the patient? A. Dystonia B. Orthostatic hypotension C. Dry mouth and constipation D. Neuroleptic malignant syndrome

A. Dystonia Rationale Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.

Isotretinoin (Amnesteem) and tretinoin (Retin-A) are common dermatologic drugs used to treat A. acne. B. male pattern baldness. C. keloid scarring. D. fungal infections.

A. acne. Rationale: Isotretinoin and tretinoin are effective topical treatments for acne vulgaris. Isotretinoin inhibits sebaceous gland activity, and tretinoin stimulates the turnover of epidermal cells, resulting in skin peeling.

5. A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education? A. "I can just stop taking my Elavil and start taking the Celexa as ordered." B. "I will not get as dizzy when I change positions after I switch medications." C. "The doctor is switching me to this medication because it is less expensive but just as effective." D. "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."

B. "I will not get as dizzy when I change positions after I switch medications." Rationale Citalopram, an SSRI, produces minimal anticholinergic and cardiovascular side effects.

A patient is prescribed bacitracin topical ointment. What does the nurse suspect as the possible diagnosis based on the medication prescribed? A. Fungal infection B. Bacterial infection C. Parasitic infection D. Viral infection

B. Bacterial infection Rationale: Bacitracin is a polypeptide antibiotic that is applied topically for the treatment or prevention of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms such as staphylococci, streptococci, anaerobic cocci, corynebacteria, and clostridia.

10. Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)? A. Renal panel B. Complete blood count C. Liver function tests D. Immunoglobulin levels

B. Complete blood count Rationale Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

A patient is prescribed selegiline, an MAO-B inhibitor, as adjunctive therapy in treatment of Parkinson's disease. What potential adverse effects would the nurse include in education for this patient? (Select all that apply.) A. Headache B. Insomnia C. Weight gain D. Depression E. Blood pressure changes

B. Insomnia D. Depression E. Blood pressure changes Rationale MAO-B inhibitors have many potential side effects: dizziness, insomnia, hallucinations, ataxia, agitation, depression, paresthesia, somnolence, headache, dyskinesia, nausea, diarrhea, hypotension or hypertension, chest pain, weight loss, dermatologic reactions, rhinitis, pharyngitis. Weight loss, not gain, is a known adverse effect.

7. What is another approved and indicated use for bupropion (Zyban), a second-generation antidepressant? A. Orthostatic hypotension B. Smoking cessation C. Anorexia in patients undergoing chemotherapy D. Nocturnal enuresis in children

B. Smoking cessation Rationale Zyban is a sustained-release form of bupropion that is useful in helping patients quit smoking.

4. A patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A. ibuprofen B. St. John's wort C. vitamin E supplements D. glucosamine chondroitin

B. St. John's wort Rationale Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as ginseng and St. John's wort.

A teenage female patient is going to be prescribed isotretinoin (Amnesteem) for acne. Which information is most important for the nurse to include in the education of the patient? A. The drug is supplied in oral form. B. The patient must use at least two forms of contraception while taking this medication. C. The drug is used in treatment of severe acne. D. Providers who prescribe this medication must be registered with the FDA.

B. The patient must use at least two forms of contraception while taking this medication. Rationale: The most important and mandatory teaching by the Food and Drug Administration is the requirement to use two different forms of contraception if the patient is female and of childbearing age.

7. A patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use? A. On-off phenomenon B. Wearing-off phenomenon C. Chorea D. Dystonia

B. Wearing-off phenomenon Rationale The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The symptoms return and continue on a constant basis despite treatment and medications.

8. A patient diagnosed with an anxiety disorder has been using lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient? A. alprazolam (Xanax) B. buspirone (BuSpar) C. chlordiazepoxide (Librium) D. hydroxyzine hydrochloride salt (Vistaril)

B. buspirone (BuSpar) Rationale Buspirone (BuSpar) is a third-generation anxiolytic that has the advantage of being both nonsedating and non-habit-forming. All the other options are sedatives as well as anxiolytics.

9. Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy? A. "I need to change positions slowly to prevent dizziness." B. "I will need to wear sunscreen and protective clothing when outdoors." C. "It is okay to take this drug with a small glass of wine to help relax me." D. "I should call my doctor if I notice any uncontrollable movements of my tongue."

C. "It is okay to take this drug with a small glass of wine to help relax me." Rationale Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

1. The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? A. "You have obviously developed resistance to your current medication and will have to be switched to another drug." B. "This is an atypical response. Unfortunately, there are no other options of drug therapy to give you." C. "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect." D. "You just need to keep taking your medication and these effects will go away."

C. "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect." Rationale Patients who have been taking levodopa for a period of time may experience periods of symptom return. Changing to Sinemet CR or adding another medication can help reduce the on-off phenomenon.

1. The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? A. Obsessive-compulsive disorder B. Absence seizures C. Bipolar disorder D. Paranoid schizophrenia

C. Bipolar disorder Rationale Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorders.

8. The nurse is providing care for a patient who has been diagnosed with Parkinson's disease. The patient is also in early stage liver failure. What class of medications, if prescribed, would the nurse question? A. Dopamine modulator B. Anticholinergics C. COMT inhibitors D. Ergot derivative

C. COMT inhibitors Rationale COMT inhibitors are contraindicated in patients with liver failure or liver disease. Potential liver failure is also a known side effect.

4. What is the goal of pharmacologic therapy in treating Parkinson's disease? A. To increase the amount of acetylcholine at the presynaptic neurons B. To decrease the amount of dopamine available in the substantia nigra C. To balance cholinergic and dopaminergic activity in the brain D. To block dopamine receptors in both presynaptic and postsynaptic neurons

C. To balance cholinergic and dopaminergic activity in the brain Rationale Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. By increasing dopamine, the neurotransmitter activity becomes more balanced and symptoms become controlled.

3. Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications? A. levodopa B. carbidopa C. selegiline D. diphenhydramine

C. selegiline Rationale Selegiline is an MAO-B inhibitor that has been shown to cause an increase in the levels of dopaminergic stimulation in the central nervous system and thus allow the dose of levodopa to be decreased.

6. Which activity should the patient be cautioned to avoid while taking an MAO inhibitor? A. Participating in a bowling league B. Sunbathing at the pool C.Eating aged cheese D. Smoking a low-nicotine cigarette

C.Eating aged cheese Rationale Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.

3. A patient diagnosed with depression is started on a TCA after failure to improve symptoms on an SSRI. The nurse should include which teaching point when educating the patient about the new medication? A. There are no contraindications to this medication. B. The medication is safe; it has been used longer than many others. C. This class of medications has no other use and is only for depression. D. There is a risk of toxicity when this medication is taken with alcohol.

D. There is a risk of toxicity when this medication is taken with alcohol. Rationale There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.

6. The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide? A. The patient may be developing renal failure. B. The patient may be developing hepatic failure. C. Brown-orange urine signifies a lack of fluid intake. D. This is a normal occurrence related to entacapone (Comtan).

D. This is a normal occurrence related to entacapone (Comtan). Rationale Patients should be instructed that entacapone (Comtan) can turn urine a brown-orange color so that the patient will not be alarmed when this side effect occurs.

A male patient has been ordered clotrimazole (Lotrimin, Mycelex-G) after a diagnosis of jock itch. What is the technical name the nurse would use to document the diagnosis on the chart and the reason the patient has been prescribed this medication? A. Tinea corporis B. Tinea capitis C. Tinea pedis D. Tinea cruris

D. Tinea cruris Rationale: Infections caused by dermatophytes are called tinea, or ringworm, infections. Tinea infections are identified by the body location where they occur: tinea pedis (foot), tinea cruris (groin), tinea corporis (body), and tinea capitis (scalp). Tinea infections of the foot are also known as athlete's foot and those of the groin as jock itch.

12. What atypical antipsychotic medication would the nurse anticipate a provider prescribing for treatment of refractory schizophrenia? A. trazodone (Desyrel) B. phenelzine (Nardil) C. amoxapine (Asendin) D. risperidone (Risperdal)

D. risperidone (Risperdal) Rationale Risperidone is effective for refractory schizophrenia, including negative symptoms. The other medications listed are antidepressants.

When planning care for a burn patient, the nurse would anticipate applying which topical medication? A. erythromycin (E-Mycin) B. lindane C. minoxidil (Rogaine) D. silver sulfadiazine (Sulfadine)

D. silver sulfadiazine (Sulfadine) Rationale Silver sulfadiazine is a topical antiinfective drug used to treat and prevent infection in second- and third-degree burns.

The nurse is instructing a parent on the use of lindane (Kwell) shampoo for treatment of a child's head lice. Which statement by the parent indicates a need for further education? a. "I will wash his hair, then rinse out the shampoo immediately." b. "I will leave the shampoo on his hair for 4 minutes before rinsing." c. "After shampooing, I will rinse and dry his hair." d. "When the hair is dry, I will comb the hair to remove the nits."

a. "I will wash his hair, then rinse out the shampoo immediately."

When the nurse is providing wound care with Dakin's solution for a patient who has a stage III pressure ulcer, the patient exclaims, "I smell bleach! Why are you putting bleach on me?" The nurse's best explanation is: a. "This is a very dilute solution and acts to reduce the bacteria in the wound so that it can heal." b. "This solution is used instead of medication to promote wound healing." c. "This solution is used to dissolve the dead tissue in your wound." d. "Don't worry; we would never use bleach on a patient!"

a. "This is a very dilute solution and acts to reduce the bacteria in the wound so that it can heal."

6 The nurse is assessing a patient who has begun therapy with amantadine (Symmetrel) for Parkinson's disease. The nurse will look for which possible adverse effects? (Select all that apply.) a. Nausea b. Palpitations c. Dizziness d. Insomnia e. Edema

a. Nausea c. Dizziness d. Insomnia

2 A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-cterm-39ontaining foods. c. Monitor results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration.

a. Notify the patient that this drug causes discoloration of the urine.

The nurse is giving medications to a patient. Which drug or drug class, when administered with lithium, increases the risk for lithium toxicity? a. Thiazides b. levofloxacin c. calcium citrate d. Beta blockers

a. Thiazides

5 A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. the entacapone can reduce on-off effects. b. the levodopa may be stopped in a few days. c. there is less GI upset with entacapone. d. it does not cause the cheese effect.

a. the entacapone can reduce on-off effects.

When the nurse is teaching a patient about the mechanism of action of tretinoin, which statement by the nurse is correct? a. "This medication acts by killing the bacteria that cause acne." b. "This medication actually causes skin peeling." c. "This medication acts by protecting your skin from UV sunlight." d. "This medication has antiinflammatory actions."

b. "This medication actually causes skin peeling."

1. In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants

b. Benzodiazepines

The nurse is assessing the skin of a teenage patient who has been using a benzoyl peroxide product for 2 weeks as part of treatment for acne. Which assessment findings indicate that the patient is having an allergic reaction and will need to stop treatment? a. Reddened skin over the treatment area b. Blistering skin over the treatment area c. Peeling skin over the treatment area d. Sensation of warmth when the product is applied

b. Blistering skin over the treatment area

The nurse is performing wound care on a burned area using silver sulfadiazine cream in a patient with an arm wound. Which actions by the nurse are correct? (Select all that apply.) a. Applying the cream over the previous layer to avoid disturbing the wound bed b. Gently cleansing the wound to remove the previous layer of cream and wound debris c. Using clean gloves to apply the ointment d. Using sterile gloves to apply the ointment e. Always covering the wound with a dressing after applying the cream f. Washing hands before and after the procedure

b. Gently cleansing the wound to remove the previous layer of cream and wound debris d. Using sterile gloves to apply the ointment f. Washing hands before and after the procedure

4. A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? a. Teach the patient to avoid foods containing tyramine. b. Monitor for dizziness. c. Inform the patient that this drug may cause urine discoloration. d. Monitor for tachycardia and palpitations.

b. Monitor for dizziness.

6 The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.

b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly.

The nurse is caring for a patient who has been taking clozapine (Clozaril) for 2 months. Which laboratory test(s) should be performed regularly while the patient is taking this medication? a. Platelet count b. WBC count c. Liver function studies d. Renal function studies

b. WBC count

1. Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease? a. Diarrhea b. Tremors c. Angle-closure glaucoma d. Unstable gait

c. Angle-closure glaucoma

After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinations c. Suicidal ideations d. Difficulty with urination

c. Suicidal ideations

The nurse is monitoring for an allergic reaction to topical bacitracin, which would be evident by presence of a. petechia. b. thickened skin. c. itching and burning. d. purulent drainage.

c. itching and burning.

3. During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a. "The drug will be stopped when tremors and weakness are relieved." b. "If a dose is missed, take two doses to avoid significant decreases in blood levels." c. "Be sure to notify your physician if your urine turns brownish-orange in color." d. "Take care to change positions slowly to prevent falling due to a drop in blood pressure."

d. "Take care to change positions slowly to prevent falling due to a drop in blood pressure."

When considering the variety of OTC topical corticosteroid products, the nurse is aware that which type of preparation is generally most penetrating and effective? a. Gel b. Lotion c. Spray d. Ointment

d. Ointment

Patient teaching for a patient receiving an MAOI would include instructions to the patient to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese

d. Swiss cheese

A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa? A. Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease. B. Use of benzodiazepines increases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease. C. Use of benzodiazepines decreases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease. D. Use of benzodiazepines increase the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.

A. Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease. Rationale Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson's disease.

A patient is being seen for acne issues. The nurse is discussing use of various topical drugs. Which drugs are used in the treatment of acne? (Select all that apply.) A. benzoyl peroxide B. clindamycin C. isotretinoin D. vitamin A acid E. norethindrone and ethinyl estradiol

A. benzoyl peroxide B. clindamycin D. vitamin A acid Rationale: Benzoyl peroxide, clindamycin, and vitamin A acid are available in topical treatment options for acne. Isotrentinoin is only an oral option. Acne vulgaris is an off-label use for the oral contraceptive norethindrone and ethinyl estrdiol (Ortho-Novum).

The nurse will anticipate application of which medication to treat a patient diagnosed with impetigo? A. mupirocin (Bactroban) B. benzoyl peroxide C. isotretinoin (Amnesteem) D. retinoic acid (Renova)

A. mupirocin (Bactroban) Rationale: Impetigo is a skin disorder caused by bacteria and is treated with a topical antibacterial agent, mupirocin.