Week 1 Medications

A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia

A. CORRECT: Areas of loss of skin sensation are a finding in a client who has MS. B. CORRECT: Nystagmus is a finding in a client who has MS. E. CORRECT: Ataxia occurs in the client who has MS as muscle weakness develops and there is loss of coordination.

A nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Hallucinations B. Increased salivation C. Diarrhea D. Discoloration of urine

A. CORRECT: Pramipexole can cause hallucinations within 9 months of the initial dose and might require discontinuation. B. Increased salivation is an adverse effect of cholinesterase inhibitors. Dry mouth is an adverse effect of pramipexole. C. Constipation is an adverse effect of pramipexole. D. Discoloration of urine is an adverse effect of COMT inhibitors and not an adverse effect of pramipexole

A nurse is preparing to administer dantrolene to a client who has muscle spasticity. Which of the following findings from the client's medical record should the nurse identify as a contraindication to the administration of this medication? a. history of cirrhosis b. history of multiple sclerosis c. history of cerebral palsy d. history of malignant hyperthermia

Answer: A Dantrolene is contraindicated for clients who has active liver disease because it is hepatotoxic and can cause liver failure. Liver function tests are monitored for clients throughput the treatment with this medication.

Which nursing intervention is a priority for a patient with multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Answer: A Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.

A nurse is providing teaching to a client with a seizure disorder who has a new prescription for carbamazepine. Which of the following statements should the nurse include in the teaching? a. This medication will decrease the effectiveness of oral contraceptives. b. Once you are seizure-free for a month, you will be able to stop taking it. c. You can cut the dose in half if GI upset occurs. d. This medication might initially increase the frequency of your seizures.

Answer: A Take medication even if no seizure activity. Take with meals to avoid GI stress.

A nurse is caring for a client with OCD who has been taking fluoxetine for 3 months. The client states, "This medication isn't working. I want to stop taking it." Which of the following responses should the nurse make? a. It is best to discontinue medication slowly over 1-2 months. b. If the medication hasn't helped you in 3 months, it's not going to. c. You will likely gain weight if you stop taking the medication. d. This medication is the only treatment available for your condition.

Answer: A Taper off slowly to reduce withdrawal manifestations. It takes several months to peak and therapy should be continued for a year before discontinuation. Adverse effect of medication is weight gain. This is not the only form of treatment for OCD.

Stimulation of the parasympathetic nervous system results in (SATA) a. constriction of the bronchi b. dilation of skin blood vessels c. increased secretions of insulin d. increased blood glucose levels e. relaxation of the urinary sphincters

Answer: A B C E Stimulation of the parasympathetic nervous system results in pupil constriction, decreased heart rate, increased saliva secretion, and relaxation of the urinary sphincter with stimulation of urination. Stimulation of the sympathetic nervous system results in increased blood glucose levels.

A nurse is providing teaching about baclofen to the guardian of a toddler who has cerebral palsy. Which of the following adverse effects should the nurse include? a. Bradycardia b. Muscle weakness c. Diarrhea d. Dry skin

Answer: B Muscle weakness is a common side effect of baclofen, other common adverse effects include dizziness, drowsiness, and nausea.

A nurse is reviewing the medical record of a client who is requesting a prescription for sildenafil citrate. Which of the following data in the client record should the nurse identify as a contraindication to the use of this medication? a. Diabetes mellitus b. Current use of isosorbide to treat heart failure. c. Eyeglasses for presbyopia d. Osteoarthritis

Answer: B Nitrates such as isosorbide and nitroglycerin is a contraindication for sildenafil, a medication that treats erectile dysfunction. Taking it concurrently with nitrates can cause life-threatening hypotension.

The nurse observes a patient with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appopiate? a. provide the patient with diversion activities b. document the activity in the patients health record c. take the patients blood pressure sitting and standing d. ask the patient if they are feeling either anxious or depressed.

Answer: B Patients with Parkinson's disease are taught to rock from side to side to stimulate balance mechanisms and decrease akinesia.

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). What strategy would prevent a common cause of death for patients with ALS? a. Reduce fat intake. b. Reduce the risk of aspiration. c. Decrease injury related to falls. d. Decrease pain secondary to muscle weakness.

Answer: B Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

A nurse is providing teaching to a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St.John's wort for depression. Which of the following instructions should the nurse give the client? a. Take medication and herbal supplement together. b. Stop taking the herbal supplement while on this medication. c. Take the herbal supplement and the medication at least 2hr apart. d. Take an antiacid with both.

Answer: B Taking both increases risk of serotonin syndrome.

A nurse is providing teaching to the parent of a school-aged child who has ADHD and a new prescription for methylphenidate IR. Which of the following information pieces should the nurse provide? a. "Have your child take medication once daily." b. "This medication might make your child gain weight." c. "Your child's growth might slow while using this medication." d. "Avoid giving your child food when taking this medication."

Answer: C Adverse effect of medication is growth suppression related to the appetite suppression associated with it. IR has a dosing schedule of 2-3x daily, sustained-release is taken once or twice daily.

The nurse conducts a home visit for a patient with Parkinson disease taking levodopa/carbidopa daily. The patient has stopped eating meals with his family and has lost 3 pounds since the last visit a week ago. What action will the nurse take? a. plan 6 small high-protein meals a day b. provide information on a high-fat ketogenic diet. c. evaluate their ability with eating, swallowing, and use of assistive devices d. collaborate with the HCP about every other day levodopa/carbidopa dosing

Answer: C Patients with Parkinson's disorder have trouble with the coordinated act of eating, often require assistive devices to eat, and have difficulty swallowing. Diet is of major concern as malnutrition can occur without adequate calories and nutrient intake. The uncoordinated movements and tremors and slow eating can be embarrassing for the patient who may be isolating from the family. The nurse must determine if physical difficulty with the act of eating is causing the weight loss or if depression or another organic cause is to blame. Identifying the root of the problem would start with assessing the patient's abilities. Ketogenic diets are for headaches. Protein makes levodopa less effective, so protein should be limited to the evening meal. Reducing levodopa/carbidopa dosing will increase the tremors and bradykinesia.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient would the nurse see first? a. 42 yr w/ multiple sclerosis who was admitted with sepsis b. 72 yr w/ Parkinson's disease who has aspiration pneumonia c. 38 yr w/ myasthenia gravis who declined prescribed medications d. 45 yr w/ amyotrophic lateral sclerosis who refuses enteral feedinds.

Answer: C Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will develop myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.

Which patient problem is the priority when caring for a patient with myasthenia gravis (MG)? a. acute confusion b. bowel incontinence c. activity intolerance d. disturbed sleep pattern

Answer: C The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG. Although sleep disturbance is likely, activity intolerance is of primary concern.

When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests would the nurse expect? SATA a. EEG b. ECG c. CT scan d. Carotid duplex scan e. Evoked response testing f. Cerebrospinal fluid analysis

Answer: C E F No definitive diagnostic test exists for MS. Along with history and physical examination, CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI are used to establish a diagnosis of MS. EEG, ECG, and carotid duplex scan are not used to diagnose MS.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for baclofen PO. Which of the following pieces of information should the nurse include? a. You should take this on an empty stomach to increase absorption. b. You can stop taking it once your back spasms disappear. c. You can expect to experience urinary frequency when you first start taking it. d. You should change positions slowly while on this medication.

Answer: D Dizziness and hypotension are adverse effects of this medication. Baclofen should be taken with milk or food to minimize GI stress. Stopping medication abruptly can cause withdrawal reaction like hallucinations and increased spasticity. Urinary frequency is an adverse effect of medication and should be reported to provider.

The nurse is caring for a patient with peripheral neuropathy who is scheduled for EMG studies tomorrow morning. The nurse should a. ensure the patient has an empty bladder b. instruct the patient about the risk of electric shock c. ensure the patient has no metallic jewelry or metal fragments d. teach the patient that pain may be experienced during the study

Answer: D Electromyography (EMG) is used to assess electrical activity associated with nerves and skeletal muscles. Activity is recorded by insertion of needle electrodes to detect muscle and peripheral nerve disease. The nurse should tell the patient that pain and discomfort are associated with insertion of needles. There is no risk of electric shock with this procedure.

A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which of the following therapeutic effects should the nurse identify for the client taking this medication? a. Reduced cancer-related bone pain b. Decreased anxiety and insomnia c. Decreased inflammatory response to cancer tumors d. Reduced cramping, aching, and burning neuropathic pain.

Answer: D Gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.

A nurse is providing teaching to the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following statements by the parent indicates an understanding of the teaching? a. "I should expect my child to gain weight while on this medication." b. "I should expect this medication to decrease my child's heart rate." c. "I should crush the medication and put it in food." d. "I should give this medication to my child 30 minutes before breakfast."

Answer: D Medication should be administered on an empty stomach. Methylphenidate is a stimulant medication that can cause anorexia and weight loss. The parent should weight the child 2-3x per week to monitor for weight loss. This medication can cause tachycardia and hypertension.

A nurse is providing teaching to the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following pieces of information should the nurse include in the teaching? a. "Crush the medication and mix it in food." b. "Administer the medication 1 hour before bed time." c. "Expect your child to have cloudy urine while taking this medication." d. "Weight your child twice per week while on this medication."

Answer: D The parent should weight the child 2-3x per week to monitor for weight loss. Administer 30 min before meal on empty stomach. Common side effects include insomnia, weight loss, anorexia, and tachycardia.

A nurse is caring for several clients in an extended care facility. Which of the following clients is the highest priority to observe during meals? A. A client who has decreased vision B. A client who has Parkinson's disease C. A client who has poor dentition D. A client who has anorexia

B. CORRECT: A client who has Parkinson's disease is at risk for aspiration. Due to this safety risk, this client is the highest priority to observe during meals.

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids

B. CORRECT: Loss of cognitive function is a manifestation associated with MS. A. Fluctuations in blood pressure is a manifestation associated with amyotrophic lateral sclerosis. C. Ineffective cough is a manifestation associated with amyotrophic lateral sclerosis. D. Drooping eyelids is a manifestation associated with myasthenia gravis.

A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include? (Select all that apply.) A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Offer cold fluids such as milkshakes. E. Offer nutritional supplements between meals.

B. CORRECT: Record the client's diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration. D. CORRECT: Provide cold fluids such as milkshakes. Thick and cold fluids are tolerated easier by the client. E. CORRECT: Offer nutritional supplements between meals to maintain the client's weight.

A nurse is assessing a client for manifestations of Parkinson's disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill‑rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression

B. CORRECT: The client who has PD can manifest pill‑rolling tremors of the fingers due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. C. CORRECT: The client who has PD can manifest shuffling gait because of overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. D. CORRECT: The client who has PD can manifest drooling because of overstimulation of the basal ganglia by acetylcholine, making the controlled movement of swallowing secretions difficult. F. CORRECT: The client who has PD can manifest a lack of facial expressions due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult.

A nurse is preparing to administer a medication to a client who has absence seizures. The nurse should expect to administer which of the following medications to the client? (Select all that apply.) A. Phenytoin B. Ethosuximide C. Gabapentin D. Carbamazepine E. Valproic acid F. Lamotrigine

B. CORRECT: The only mechanism of action of ethosuximide is to treat a client who has absence seizures. E. CORRECT: Valproic acid has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures. F. CORRECT: Lamotrigine has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures.

A nurse is reviewing a new prescription for oxcarbazepine with a client who has partial seizures. Which of the following instructions should the nurse include? (Select all that apply.) A. "Use caution if given a prescription for a diuretic medication." B. "Consider using an alternate form of contraception if you are using oral contraceptives." C. "Chew gum to increase saliva production." D. "Avoid driving until you see how the medication affects you." E. "Notify your provider if you develop a skin rash."

A. CORRECT: Diuretic medications are administered with caution because of the high risk for hyponatremia when taking oxcarbazepine. B. CORRECT: An alternate form of contraception is recommended for clients taking oral contraceptives because oxcarbazepine decreases oral contraceptive levels. D. CORRECT: The client should avoid driving if CNS effects of dizziness, drowsiness, and double vision develop. E. CORRECT: The client should notify the provider if a skin rash occurs because life‑threatening skin disorders can develop.

A nurse in the post‑anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should expect a prescription for which of the following medications? A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium

A. CORRECT: Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. B. Naloxone is used to reverse the effects of opioids. C. Dantrolene acts on skeletal muscles to reduce metabolic activity and treat malignant hyperthermia. D. Vecuronium is an intermediate‑acting nondepolarizing neuromuscular blocker.

A nurse is providing teaching to a client who has chronic constipation and new prescription of psyllium. Which of the following instructions should the nurse provide? a. This medication is for short-term use only. b. You should eat low-residual diet while on this medication. c. Mix with water and follow with an additional glass of liquid. d. Adverse effects include stomach cramps and nausea that go away in time.

Answer: C Take with full glass of water or juice followed by an additional glass of liquid. It can be taken for long-term use. Do not take if abdominal pain, nausea, vomiting, or a fever occurs.

A nurse is teaching about the adverse effects of baclofen with a client who has multiple sclerosis with spasms. Which of the following statements should the nurse identify as an indication that the client understands the teaching? a. Adverse effects include urinary frequency. b. I should increase my fiber intake to counteract the adverse effect of constipation. c. This medication can cause addiction. d. I should not stop taking this medication suddenly.

Answer: D Adverse effects associated with abrupt withdrawal of baclofen include visual hallucinations, paranoid ideations, and seizures.

A patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action would the health care team take to promote adequate nutrition? a. Administer multivitamins every morning and with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Give the patient with a pureed diet that is high in potassium and low in sodium. d. Provide small, frequent meals throughout the day that are easy to chew and swallow.

Answer: D Nutrition support is a priority in the care of persons with PD. Patients may benefit from smaller, more frequent meals that are easy to chew and swallow. Multivitamins are not necessary at each meal. Vitamin and protein intake must be monitored to prevent interactions with medications. Introducing a minced or pureed diet is likely premature, and a low carbohydrate diet is not indicated.

A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include? A. Rise slowly when standing. B. Expect urine to become dark‑colored. C. Avoid foods containing tyramine. D. Report any skin discoloration.

A. CORRECT: Orthostatic hypotension is a common adverse effect of bromocriptine, a dopamine receptor agonist. Therefore, rising slowly when standing up will decrease the risk of dizziness and lightheadedness.

A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include? A. Recommend a community support group. B. Integrate a daily exercise routine. C. Provide a walker for ambulation. D. Perform ADLs for the client.

C. CORRECT: The client should use a walker for ambulation in stage III of Parkinson's disease because movement slows down significantly and gait disturbances occur.

A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. "This medication will help you with your tremors." B. "This medication will help you with your bladder function." C. "This medication can cause your skin to bruise easily." D. "This medication can cause you to experience dizziness."

D. CORRECT: Baclofen is an antispasmodic medication that is given to clients who have MS to treat muscle spasms. An adverse effect of this medication is drowsiness, as well as dizziness. Instruct the client to monitor for these findings, as they can lead to impaired safety. The client should be instructed not to discontinue baclofen abruptly.

A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating. B. Complete passive range‑of‑motion exercises daily. C. Place the client on a low‑protein, low‑calorie diet. D. Give the client extra time to perform activities.

D. CORRECT: Bradykinesia is abnormally slowed movement and is seen in clients who have PD. The client should be given extra time to perform activities and should be encouraged to remain active.

A nurse is caring for a client who has multiple sclerosis and is receiving interferon beta-1a. The nurse should identify that which of the client statements indicate a potential adverse effects of this medication? a. My body aches all over b. I have abdominal cramping c. My hair seems to be thinning d. It hurts when I urinate

Answer: A Adverse effects include flu like symptoms such as general body and muscle aches.

A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. Increase intake of protein‑rich foods. B. Expect muscle twitching to occur. C. Take this medication with food. D. Anticipate relief of manifestations in 24 hr.

A. The client should avoid protein‑rich foods, which can result in decreased therapeutic effects of levodopa. B. The client should monitor and report muscle twitching which can indicate toxicity. C. CORRECT: The client should take this medication with food to reduce GI effects. D. The client should anticipate relief of manifestations to take several weeks to months.

A patient's eyes jerk while the patient looks to the left. The nurse records this finding as a. nystagmus b. CN VI palsy c. ophthalmic dyskinesia d. oculocephalic response

Answer: A Nystagmus is defined as fine, rapid jerking movements of the eyes.