CNS BOOK

Answer: A

The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? A Anxiety disorder B Depression C Schizophrenia D Bipolar disorder

a The reduction in kidney function may lead the health care provider to choose to reduce the dosage of the medication to prevent toxicity from developing.

10. The health care provider is considering placing the patient on memantine (Namenda). The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse anticipates which adjustment in drug therapy? a The dosage of the drug will be reduced. b A different drug will be ordered instead. c The dosage of the drug will be increased. d All drug therapy will be stopped.

d The patient should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation. There is no need to restrict milk or carbohydrates or to increase the intake of fatty foods.

2. The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient? a "Do not drink milk while on this medication." b "Increase your intake of fatty foods while on this therapy." c "Do not eat carbohydrates with this medication." d "Increase your intake of fluids while on this medication."

A B C

7. A patient is taking rivastigmine (Exelon) to improve cog- nitive function. What should the nurse teach the patient/ family member to do? (Select all that apply.) a. Rise slowly to avoid dizziness. b. Remove obstacles from pathways to avoid injury. c. Closely follow the drug dosing schedule. d. Have frequent checks for hypertension. e. Receive regular liver function tests.

d Therapeutic serum drug level for phenytoin (Dilantin) is 10 to 20 mcg/mL. The nurse should continue to monitor. Since the drug is at the therapeutic level, there is no need to intervene further by calling the health care provider or performing a more in-depth assessment.

The patient receiving phenytoin (Dilantin) has a serum drug level of 12 mcg/mL. What is the nurse's best action? a Perform a neurological assessment. b Assess the patient's gums and mouth. c Call the health care provider. d Continue to monitor the patient.

A

3. A selective serotonin reuptake inhibitor (SSRI) is pre- scribed for a patient. The nurse knows that which drug is an SSRI? a. paroxetine (Paxil) b. amitriptyline (Elavil) c. divalproex sodium (Depakote) d. bupropion HCl (Wellbutrin)

B

6. The nurse should monitor the patient receiving phenytoin for which adverse effect? a. Psychosis b. Nosebleeds c. Hypertension d. Gum erosion

c Of the drugs listed, the only SRRI drug is fluvoxamine (Luvox).

8. The nurse notes that the health care provider is considering starting the patient on a selective serotonin reuptake inhibitor (SRRI) drug. The nurse recognizes that the health care provider will select which drug? a Amitriptyline (Elavil) b Doxepin (Sinequan) c Fluvoxamine (Luvox) d Imipramine (Tofranil)

Answer: A Mydriatic action causes dilated pupils, which can precipitate an acute attack of glaucoma, resulting in blindness. Although dry mouth, constipation, and urine retention are all side effects, none is not serious and all can be resolved.

A client is receiving doxepin (Sinequan). For which most dangerous side effect of tricyclic antidepressants should a nurse monitor the client? A Mydriasis B Dry mouth C Constipation D Urine retention

Answer: D Edrophonium acts systemically to increase muscle strength; a peak effect, which is seen in 30 seconds, lasts several minutes. Edrophonium does not exaggerate symptoms. Edrophonium acts systemically on all muscles rather than selectively on the eyelids. The duration of action of edrophonium is about three minutes.

A client with a tentative diagnosis of myasthenia gravis is scheduled to receive edrophonium (Enlon) to confirm the diagnosis. What response should the nurse anticipate will confirm myasthenia gravis? a Brief exaggeration of symptoms b Improvement in ptosis of the eyelids c Prolonged symptomatic improvement d Rapid but brief symptomatic improvement

Answer: A An MAOI can cause hypertensive crisis if food or beverages that are high in tyramine are ingested. Prolonged exposure to the sun is hazardous for clients taking one of the phenothiazines. Strenuous physical exercise is not contraindicated. Antihistamines are not prohibited with MAOI medications.

A monoamine oxidase inhibitor (MAOI) is prescribed, and the nurse is formulating a teaching plan. What should the nurse instruct the client to avoid while taking this drug? A Aged cheeses B Prolonged sun exposure C Strenuous physical exercise D Over-the-counter antihistamine drugs

Answer: A, B, E Rigidity, tremors, and bradykinesia may occur because of the effect of the antipsychotic on the postsynaptic dopamine receptors in the brain. Mydriasis and photophobia are side effects of anticholinergic, not antipsychotic, drugs.

Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism? Select all that apply. A Rigidity B Tremors C Mydriasis D Photophobia E Bradykinesia

b Anticholinergic drugs help to reduce the rigidity and tremors characteristic of parkinsonism. They should not result in the patient being unable to talk or increasing the heart rate. They will be unlikely to allow the patient to sit up unassisted when the patient has been previously unable to do so.

1. A patient has been taking benztropine (Cogentin). Which outcome assessment helps the nurse verify therapeutic effects of this medication? a Patient is unable to talk. b Patient has had a decrease in tremors. c Patient can sit up unassisted. d Patient has an increased heart rate.

D

1. A patient is admitted with bipolar affective disorder. The nurse acknowledges that which medication is used to treat this disorder for some patients in place of lithium? a. thiopental b. gingko biloba c. fluvoxamine (Luvox) d. divalproex (Depakote)

a A side effect of phenytoin (Dilantin) is overgrowth of gum tissue. This can be minimized by frequent oral hygiene. If oral hygiene efforts do not improve gum condition, a consult with a dentist is recommended. Since this is an expected side effect, there is no indication to notify the health care provider or to hold the next dose.

1. The nurse assesses a patient taking phenytoin (Dilantin) and finds gingival hyperplasia. What is the nurse's priority action? a Instruct the patient on oral hygiene. b Call for a consult with a dentist. c Call the health care provider. d Hold the next dose of the drug.

a Patients taking clozapine (Clozaril) must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.

1. The nurse is caring for a patient who is starting clozapine (Clozaril). Which nursing intervention is a priority for this patient? a Assess baseline white blood cell count and absolute neutrophil count. b Evaluate suicidal tendencies. c Take a baseline EEG. d Evaluate creatinine clearance.

b Lithium is the drug of choice to treat manic episodes associated with bipolar disorders. It has a narrow therapeutic range, and levels should be monitored biweekly until the therapeutic level has been obtained and then monitored monthly on the maintenance dose.

1. The nurse is reviewing a patient's medication history and notes that the patient recently began taking lithium (Lithibid). What intervention is a priority for this patient? a Monitoring for the recurrence of seizure activity b Assessing lithium levels every other week c Asking the patient if they have ringing in the ears d Monitoring the patient's intake and output

B

1. The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Pseudoparkinsonism

c

1. The nurse witnesses a patient's seizure involving generalized contraction of the body followed by jerkiness of the arms and legs. The nurse reports that this is which type of seizure? a. Myoclonic b. Petit mal c. Tonic clonic d. Psychomotor

B C D

1. Which of the following assessment findings could the nurse see in a patient with parkinsonism? (Select all that apply.) a. An abrupt onset of symptoms b. Muscle rigidity c. Involuntary tremors d. Bradykinesia e. Bilateral muscle weakness

B D The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

10. The nurse will hold the next dose of antipsychotic medication for which patients? (Select all that apply.) a The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing b The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips c The patient who has pill-rolling motions of the hand d The patient who has a sudden high fever

A

2. A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse under- stands that antipsychotics act in which way? a. Blocking actions of dopamine b. Blocking actions of epinephrine c. Promoting prostaglandin synthesis d. Enhancing the action of gamma-aminobutyric acid

D

2. A patient is receiving carbidopa-levodopa for parkinson- ism. What should the nurse know about this drug? a. Carbidopa-levodopa may lead to hypertension. b. Carbidopa-levodopa may lead to excessive salivation. c. Dopaminergic and anticholinergic therapy may lead to drowsiness and sedation. d. Dopaminergics and anticholinergics are contraindi- cated in patients with glaucoma.

b

2. Phenytoin has been prescribed for a patient with seizures. The nurse should include which appropriate nursing intervention in the plan of care? a. Report an abnormal phenytoin level of 18 mcg/mL. b. Monitor CBC levels for early detection of blood dyscrasias. c. Encourage the patient to brush teeth vigorously to prevent plaque buildup. d. Teach the patient to stop the drug immediately when passing pinkish-red or reddish-brown urine.

b Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.

2. The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless," as he paces the floor. What is the nurse's primary intervention? a Stop the medication immediately and notify the health care provider. b Administer the prescribed benzodiazepine. c Administer benztropine (Cogentin) as ordered. d Stay with the patient and offer reassurance.

C

2. The nurse realizes that some herbs interact with selective serotonin reuptake inhibitors. Which herb interaction may cause serotonin syndrome? a. feverfew b. ma-huang c. St. John's wort d. gingko biloba

c This medication takes between 1 to 4 weeks to be therapeutic. The patient must be encouraged to remain on the medication. This medication is given PO and does not interact with caffeine. Fluvoxamine should not be taken by those with hepatic disease.

2. What information will the nurse include on the care plan for a patient taking fluvoxamine (Luvox)? a This medication must be given IV. b This medication will interact with caffeine. c This medication might not become therapeutic for 4 weeks. d This medication is safe in those with liver disease unlike other SSRIs.

c Imipramine (Tofranil) causes urinary retention and delayed micturition, side effects that make it useful to treat nocturnal enuresis (bedwetting) in children. This is most likely the reason a young child is on this medication. For adults, the drug can treat major depressive disorders.

3. A 6-year-old child is taking imipramine (Tofranil). What will the nurse monitor as a therapeutic outcome of the administration of this medication? a The child has no tonic-clonic seizures. b The child is free of manic episodes. c The child has no more nocturnal enuresis. d The child is free of obsessive-compulsive disorder behaviors.

C

3. An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication? a. quetiapine (Seroquel) b. aripiprazole (Abilify) c. benztropine (Cogentin) d. chlorpromazine (Thorazine)

D

3. The nurse has initiated teaching for a family member of a patient with Alzheimer's disease. The nurse realizes more teaching is needed if the family member makes which statement? a. As the disease gets worse, the memory loss will get worse. b. There are several theories about the cause of the disease. c. Personality changes and hostility may occur. d. It may take several medications to cure the disease.

a 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.

3. The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa (Sinemet). What information does the nurse use as a basis for the teaching plan? a Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of 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.

b of the medications listed, flumazenil (Romazicon) is the only one that would be effective as a benzodiazepine antagonist.

3. The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? a Lorazepam (Ativan) b Flumazenil (Romazicon) c Oxazepam (Serax) d Buspirone HCl (BuSpar)

c

3. When administering phenytoin, the nurse realizes more teaching is needed if the patient makes which statement? a. "I must shake the oral suspension very well before pouring it in the dose cup." b. "I cannot drink alcoholic beverages when taking phenytoin." c. "I should take phenytoin 1 hour before meals." d. "I will need to get periodic dental checkups."

C D E

4. A patient is having absence (petit mal) seizures. Which of the following does the nurse expect to be prescribed for this type of seizures? (Select all that apply.) a. phenytoin (Dilantin) b. phenobarbital (Luminal) c. valproic acid (Depakote) d. clonazepam (Klonopin) e. ethosuximide (Zarontin)

C

4. A patient is taking rivastigmine (Exelon). The nurse should teach the patient and family which information about rivastigmine? a. That hepatotoxicity may occur b. That the initial dose is 6 mg t.i.d. c. That GI distress is a common side effect d. That weight gain may be a side effect

B

4. A patient is taking tranylcypromine sulfate (Parnate) for depression. What advice should the nurse include in the teaching plan for this medication? a. Warn the patient about severe hypotension. b. Instruct the patient to avoid beer and cheddar cheese. c. Encourage the patient to take ginseng and ephedra. d. Encourage the patient to eat fruit such as bananas.

A D E

4. An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply.) a. clozapine (Clozaril) b. fluphenazine (Prolixin) c. haloperidol (Haldol) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

b Ketazolam (Loftan) is known for being used to treat anxiety that is not associated with depression. The other medications are not first-line drugs for treatment of anxiety.

4. The nurse is working with a patient who asks for medication for anxiety related to coping with a chronic illness. Which benzodiazepine does the nurse anticipate will be ordered for the patient? a Temazepam (Restoril) b Ketazolam (Loftan) c Clonazepam (Klonopin) d Quazepam (Doral)

d This medication may inhibit monoamine oxidase (MAO)-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine, and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the patient.

4. The patient is currently on a treatment regimen that includes selegiline (Eldepryl) therapy. What information is most important for the nurse to teach the patient about this medication? a "This medication will cure your disease." b "This medication is used when other drugs do not work." c "This medication blocks breakdown of dopamine." d "You will need to restrict your intake of certain foods and drinks."

a Tricyclic antidepressants (TCAs) cause anticholinergic side effects, including constipation and dry mouth. The time period required to produce therapeutic effects ranges from 2 to 4 weeks. Concurrent use of MAOIs with amitriptyline may lead to cardiovascular instability and toxic psychosis. The patient does not need to avoid beer and chocolate to prevent a hypertensive crisis as the patient would need to with MAOIs, but beer would potentiate central nervous system depression when taken with TCAs.

4. When teaching a patient about the use of tricyclic antidepressants, what will the nurse emphasize? a Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. b The patient should notify the health care provider if therapeutic effects are not noted within 10 days. c The drugs are often given with monoamine oxidase inhibitors (MAOIs) for synergistic effect. d Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis.

A B

5. A patient is admitted to the emergency department with status epilepticus. Which drug should the nurse most likely prepare to administer to this patient? (Select all that apply.) a. diazepam (Valium) b. midazolam (Versed) c. gabapentin (Neurontin) d. levetiracetam (Keppra) e. topiramate (Topamax)

b Citalopram (Celexa), an SSRI, produces minimal anticholinergic and cardiovascular side effects. The patient will need to wait 14 days after stopping amitriptyline (Elavil) before starting the citalopram (Celexa). The patient does not need to limit cheese intake with citalopram.

5. A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient indicates understanding of medication instructions? a "I can stop taking my amitriptyline and start taking the citalopram as ordered." b "I can expect fewer cardiovascular side effects with the citalopram." 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 citalopram to prevent a rise in my blood pressure."

A

5. A patient is prescribed lorazepam (Ativan). What does the nurse know to be true regarding lorazepam? a. It may cause anterograde amnesia and sleep-related behaviors. b. It has a maximum adult dose of 25 mg/day. c. When combined with cimetidine, it causes plasma levels to be decreased. d. It interferes with the binding of dopamine receptors.

c The medication is known to pass into breast milk. There are not specific requirements regarding the need to take with or without food or with specific amounts of fluid.

5. The nurse is working with a patient who has recently been started on clonazepam (Klonopin). The patient is also a new mother. What is the nurse's highest priority instruction to the patient? a "Take this medication with food." b "The drug should be taken with 8 ounces of water." c "Do not breastfeed while taking the medication." d "Take this medication on an empty stomach."

a Ropinirole (Requip) is a newer antiparkinson drug that directly stimulates specific dopamine receptors. Because the drug itself is not dopamine, there are fewer side effects related to peripheral dopamine levels than are noted with carbidopa-levodopa.

5. The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's best response is based on understanding that 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.

B

5. Which is a nursing intervention for a patient taking carbidopa-levodopa for Parkinsonism? a. Encourage the patient to adhere to a high-protein diet. b. Inform the patient that perspiration may be dark and stain clothing. c. Advise the patient that glucose levels should be checked with urine testing. d. Warn the patient that it may take 4 to 5 days before symptoms are controlled.

D

5. Which statement is true concerning lithium? a. The maximum dose is 3.4 g/d. b. The therapeutic drug range is 2.5 to 3.5 mEq/L. c. Lithium increases receptor sensitivity to GABA. d. Concurrent NSAIDs may increase lithium levels.

B C D E

6. A patient is receiving aripiprazole (Abilify). Which nursing intervention(s) will the nurse include in the patient's care plan? (Select all that apply.) a. Administer before meals on an empty stomach to facili- tate absorption. b. Remain with the patient until medication is swallowed. c. Monitor vital signs to detect orthostatic hypotension. d. Assess the patient for evidence of neuroleptic malig- nant syndrome. e. Observe the patient for acute dystonia, akathisia, and tardive dyskinesia.

c Temazepam (Restoril) is used to treat insomnia. It is not recommended for treatment of anxiety, seizures, or depression.

6. The nurse is working with a patient who has recently been started on temazepam (Restoril). The nurse recognizes that the patient is most likely experiencing which condition? a Anxiety b Seizures c Insomnia d Depression

d Drowsiness at frequent intervals is known to be a side effect of the medication. Drowsiness is not indicative of an anaphylactic reaction, overdosage, or underdosage.

6. The patient has begun treatment with ropinirole (Requip) and complains to the nurse of feeling excessively drowsy. What does this symptom indicate to the nurse? a An anaphylactic reaction to the medication b An overdosage of the medication c An insufficient dosage of the medication d An expected side effect of the medication

A B C E

6. What would the nurse teach a patient who is taking anti- cholinergic therapy for parkinsonism? (Select all that apply.) a. Avoid alcohol, cigarettes, and caffeine. b. Relieve dry mouth with hard candy or ice chips. c. Use sunglasses to reduce photophobia. d. Urinate 2 hours after taking the drug. e. Receive routine eye examinations.

A B C D

6. When a patient is taking an antidepressant, what should the nurse do? (Select all that apply.) a. Monitor the patient for suicidal tendencies. b. Observe the patient for orthostatic hypotension. c. Teach the patient to take the drug with food if GI dis- tress occurs. d. Tell the patient that the drug may not have full effec- tiveness for 1 to 2 weeks. e. Advise the patient to maintain adequate fluid intake of 2 L/d.

c Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

6. Which food will the nurse teach the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? a Coffee b White bread c Aged cheese d White meat

A B C F

7. A patient appears to have had an overdose of phenothi- azines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? (Select all that apply.) a. Gastric lavage b. Adequate hydration c. Maintaining an airway d. Fluphenazine (Prolixin) e. Risperidone (Risperdal) f. Activated charcoal administration

A B E F

7. A patient is taking lithium. The nurse should be aware of the importance of which nursing intervention(s)? (Select that apply.) a. Observe the patient for motor tremors. b. Monitor the patient for orthostatic hypotension. c. Draw lithium blood levels immediately after a dose. d. Advise the patient to drink 750 mL/d of fluid in hot weather. e. Advise the patient to avoid caffeinated foods and beverages. f. Teach the patient to take lithium with meals to decrease gastric irritation.

D

7. The nurse is administering valproic acid (Depakote) to a patient. The nurse checks the laboratory values and finds a serum range for valproic acid of 200 mcg/ml. What should the nurse do? a. Increase the daily dose to get the patient's level to a therapeutic range. b. Hold the morning dose but give the other scheduled dosages for the day. c. Ask the patient if he is having any adverse effects from the medication. d. Hold the medication and notify the health care provider.

a Chlordiazepoxide (Librium) is the benzodiazepine that is most frequently used with patients who are experiencing alcohol withdrawal rather than the other conditions listed.

7. The nurse is caring for a patient whose medication regimen includes the benzodiazepine chlordiazepoxide (Librium). The nurse recognizes that the patient is most likely experiencing which condition? a Alcohol withdrawal b Depression c Seizures d Insomnia

d The combination of the imipramine (Tofranil) and the diazepam (Valium) will potentiate CNS depression.

7. The patient has been started on a treatment regimen that includes imipramine (Tofranil). The patient tells the nurse that he also is being treated with diazepam (Valium) for a separate condition. What is the nurse's highest priority action? a Notify the pharmacy because the dosage of the imipramine (Tofranil) will need to be increased. b Notify the health care provider because the patient may experience an anaphylactic reaction. c Notify the pharmacy because the dosage of the imipramine (Tofranil) will need to be decreased. d Notify the health care provider because central nervous system (CNS) depression may result.

a Glaucoma is known to be a contraindication to use of carbidopa-levodopa (Sinemet). Adjusting the dosage will not change this fact.

7. The patient is scheduled to begin treatment with carbidopa-levodopa (Sinemet). A family member tells the nurse that the patient has a history of undergoing treatment for narrow-angle glaucoma. What is the highest priority action on the part of the nurse? a Contact the health care provider with this information. b Reassure the family that this will not affect the patient's treatment. c Contact the pharmacist since the dosage will need to be decreased. d Contact the pharmacist since the dosage will need to be increased.

a Donepezil (Aricept) can be used in all stages of Alzheimer's disease. The symptoms noted will occur in the very mild stage of Alzheimer's disease.

8. The patient has been diagnosed with Alzheimer's disease and has been forgetting the location of objects in addition to having difficulty finding the word to use in conversation. The patient has been started on donepezil (Aricept). The patient is most likely in which stage of the disease process? a Very mild b Mild c Moderate d Moderately severe

a Alprazolam (Xanax) is known to be effective in treating anxiety that is associated with depression. It is not considered a first-line treatment for alcohol withdrawal, seizures, or insomnia.

8. The patient has been ordered to be treated with alprazolam (Xanax). The nurse recognizes that the patient is most likely experiencing which condition? a Anxiety with depression b Alcohol withdrawal c Seizures d Insomnia

d Of the drugs listed, the only drug that is a tricyclic antidepressant is doxepin (Sinequan).

9. The nurse notes in the patient's chart that the health care provider is considering adding a tricyclic antidepressant to the patient's treatment regimen. The nurse recognizes that the health care provider will select which drug? a Amoxapine (Asendin) b Maprotiline (Ludiomil) c Trazodone (Desyrel) d Doxepin (Sinequan)

A B C Loxitane (Loxapine) is known to cause sedation, hypotension, and extrapyramidal symptoms. Nausea may result as a side effect of loxitane.

9. The patient has been ordered a medication regimen that includes loxitane (Loxapine). During instructional sessions regarding the medication, the nurse should emphasize which information? (Select all that apply.) a Sedation can occur. b Hypotension is likely. c Extrapyramidal symptoms can occur. d Nausea reduction will occur.

c Donezepil (Aricept) is known to cause slow heartbeat and fainting. The health care provider should be notified because the patient may need to be taken off the medication. It is beyond the nurse's scope to take the patient off a drug.

9. The patient has been started on donepezil (Aricept). The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? a Reassure the family member that this is an expected side effect of the medication. b Instruct the family member not to administer any further doses of the drug. c Notify the health care provider; the patient may need to be taken off the drug. d Instruct the family member to call if the patient continues to exhibit fainting episodes.

d

A 62-year-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dose? a The patient has a chronic dry cough. b The patient has four loose stools in a day. c The patient develops a deep vein thrombosis. d The patient's blood pressure is 92/52 mm Hg.

d

A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information is most important for the nurse to report to the health care provider? a Shuffling gait b Tremor at rest c Cogwheel rigidity of limbs d Uncontrolled head movement

Answer: B A level 0.3 mEq/L is below the therapeutic range of 0.5 to 1.5 mEq/L; therefore the medication should be administered as prescribed to increase the serum drug level. There is no need to notify the practitioner because the level is still subtherapeutic. Adverse side effects are not expected until the level exceeds the therapeutic range of 0.5 to 1.5 mEq/L.

A client has been taking lithium carbonate (Eskalith) for 3 days. The nurse has the client's lithium level checked before administering the medication and finds it to be 0.3 mEq/L. The nurse should: A Notify the practitioner. B Administer the medication. C Watch for adverse side effects. D Withhold the next dose of the medication.

c 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 drugs. 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 client is diagnosed with Parkinson disease and receives a prescription for levodopa (l-dopa) therapy. The nurse concludes that the medication is appropriate for this client because it: a Blocks the effects of acetylcholine. b Increases the production of dopamine. c Restores the dopamine levels in the brain. d Promotes the production of acetylcholine.

Answer: B Akathisia, an extrapyramidal side effect of typical antipsychotics, is motor restlessness. The client is unable to sit or stand still and feels the need to move, pace, rock, swing the legs, or tap the feet. The condition occurs within 5 to 90 days of the initiation of therapy. Dystonia is muscle spasms of the face, tongue, head, neck, jaw, or back, usually resulting in exaggerated posturing. This extrapyramidal side effect of typical antipsychotics occurs within 1 hour to 1 week of the initiation of therapy. Tardive dyskinesia is facial, ocular, oral/buccal, lingual/masticatory, and systemic movements. This extrapyramidal side effect of typical antipsychotics may occur 6 months or more after the initiation of therapy. Pseudoparkinsonism has characteristics similar to those of Parkinson's disease (e.g., shuffling gait, tremors, rigidity, bradykinesia). This extrapyramidal side effect of typical antipsychotics may occur anytime after the initiation of therapy.

A client is found to have paranoid schizophrenia, and the practitioner prescribes a typical antipsychotic medication. After a 1-month hospitalization the client is discharged home with instructions to continue the antipsychotic and a referral for weekly mental health counseling. This picture illustrates the client's physical status as observed by the nurse on the client's first visit to the community mental health clinic. What extrapyramidal side effect has developed? A Dystonia B Akathisia C Tardive dyskinesia D Pseudoparkinsonism

Answer: D MAOIs interact with many other medications to produce harmful side effects. Clients must be taught to check with the prescribing health care provider before taking any new medications. Photosensitivity has not been reported in clients who are taking MAOIs. Drowsiness is not an expected side effect, but it may occur as an adverse reaction. The therapeutic and toxic levels of the drug are not close for these medications.

A client is receiving a monoamine oxidase inhibitor (MAOI). What should the nurse teach the client? A It is necessary to avoid the sun. B Drowsiness is an expected side effect of this medication. C The therapeutic and toxic levels of the drug are very close. D Many prescribed and over-the-counter drugs cannot be taken with this medication

Answer: A Because of the severity of side effects and the stress lithium places on the renal and cardiovascular systems, its administration is contraindicated in clients with renal or cardiovascular disease. Baseline renal studies can be used for comparison in the future. Liver enzyme studies are not necessary; lithium does not alter liver function. Adrenal function studies are not necessary; lithium does not alter adrenal gland functions. Pulmonary function studies are not necessary; lithium does not cause alterations in pulmonary function.

A client is to begin lithium carbonate therapy. The nurse should ensure that before the drug's administration the client has baseline: A Renal studies B Liver enzyme studies C Adrenal function studies D Pulmonary function studies

Answer: D Donepezil (Aricept), 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.

A client is to receive donepezil (Aricept) for treatment of dementia of the Alzheimer type. The nurse sits down with the primary caregiver and the client and reviews the purpose of the drug, its dosage, and the usual side effects. What side effect identified by the caregiver leads the nurse to conclude that further teaching is needed? a Nausea b Dizziness c Headache d Constipation

Answer: C Antipsychotic drugs tend to make the client listless or drowsy and can interfere with the ability to participate in the therapeutic regimen. Antipsychotic drugs do not induce rapid eye movement sleep, which is when most dreams occur. Antipsychotic drugs do not appreciably affect diurnal rhythms. Assaultiveness is associated with increased anxiety and is unrelated to the time of day.

A client is to take an antipsychotic drug twice a day. Two thirds of the daily dose is given in the evening and one third in the morning. What should the nurse tell the client is the rationale for this schedule? A To facilitate dreaming B To maintain the daily sleep rhythm C To reduce sedation during the daytime D To decrease assaultiveness in the evening

Answer: B Because this drug inhibits the destruction of acetylcholine, parasympathetic activity may be increased. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary; they continue as long as the drug is continued. The dosage may be adjusted or an anticholinergic given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration.Content Area: Neuromusculoskeletal System

A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine (Mestinon), a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. The nurse concludes that these signs are: a Indicative of a myasthenic crisis b Cholinergic effects c A temporary response d Toxic effects of the medication

Answer: A Torticollis is an acute dystonia that involves muscle spasms of the head and neck. Torticollis develops within 1 to 5 days after beginning therapy with a conventional antipsychotic. Tardive dyskinesia is involuntary repetitious tonic muscular spasms that involve the face, tongue, lips, limbs, and trunk. Tardive dyskinesia takes several months to years to develop after the start of therapy with a conventional antipsychotic. Pseudoparkinsonism is an extrapyramidal tract response that includes masklike facies, shuffling gait, pill-rolling tremors, stooped posture, and drooling. Pseudoparkinsonism develops within several days to 1 month after the start of therapy with a conventional antipsychotic. Neuroleptic malignant syndrome is a severe, potentially fatal (10%) response to conventional antipsychotics. It is believed to be caused by an acute reduction in brain dopamine activity, precipitating hyperthermia, tachycardia, tachypnea, unstable blood pressure, hypertonicity, dyskinesia, incontinence, decreased level of consciousness, and pulmonary congestion. Neuroleptic malignant syndrome can occur during the first week of therapy but often occurs later during therapy.

A client who has been taking a conventional antipsychotic for several days comes to the clinic complaining of neck spasms. The figure illustrates the client's physical status observed by the nurse. What extrapyramidal side effect has the client developed? A Torticollis B Tardive dyskinesia C Pseudoparkinsonism D Neuroleptic malignant syndrome

Answer: D Symptoms of infection are suggestive of agranulocytosis, an adverse effect that can occur with clozapine therapy and can cause death. Remaining in bed, drinking fluids, taking aspirin, and asking the health care provider to decrease the dose of clozapine is unsafe because agranulocytosis may be developing, and this life-threatening side effect requires immediate treatment. Also, prescribing medications is outside the legal role of the nurse. Only a certified nurse practitioner can prescribe medications. Although discontinuing the medication is acceptable advice, delaying a health care provider's evaluation is unsafe. Continuing the medication, drinking fluids, taking aspirin, and seeing the health care provider in a few days if the condition does not improve is unsafe because agranulocytosis may be developing.

A client who is taking clozapine (Clozaril) calls the nurse in the psychiatric clinic to report the sudden development of a sore throat and a high fever. What should the nurse instruct the client to do? A Stay in bed, drink fluids, take a dose of aspirin, and ask the health care provider to reduce the dosage of clozapine. B Discontinue the medication immediately and see the health care provider as soon as an appointment becomes available. C Continue the medication, drink fluids, take aspirin, and see the health care provider in a few days if the symptoms do not improve. D Discontinue the medication and, if the health care provider is unavailable today, go to the emergency department for evaluation.

Answer: B Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine (ACh), thus prolonging neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex. Neostigmine prevents neurotransmitter breakdown but is not a neurotransmitter. Neostigmine's action is at the myoneural junction, not the sheath.

A client with myasthenia gravis has been receiving neostigmine (Prostigmin) and asks about its action. What information about its action should the nurse consider when formulating a response? a Stimulates the cerebral cortex b Blocks the action of cholinesterase c Replaces deficient neurotransmitters d Accelerates transmission along neural sheaths

Answer: A The anticholinergic activity of each drug is magnified, and adverse effects such as paralytic ileus may occur. Hypotension, not hypertension, occurs with anticholinergic medications. Dryness of the mouth, not increased salivation, occurs with anticholinergic medications. Decreased, not increased, perspiration occurs with anticholinergic medications

A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The practitioner prescribes the anticholinergic medication benztropine (Cogentin) 2 mg daily. What should the nurse assess the client for daily when administering these medications together? A Constipation B Hypertension C Increased salivation D Excessive perspiration

Answer: A A common side effect of selegiline is dizziness. Safety precautions are necessary to prevent falls caused by orthostatic hypotension. Taking the medication with food or milk limits gastrointestinal irritation. Monitoring blood glucose levels is not necessary. Nausea is a common side effect of selegiline; the medication should not be withheld without the health care provider's supervision. Abrupt withdrawal may precipitate a Parkinsonian crisis.

A client, residing in an assisted living facility, is diagnosed with Parkinson disease and the health care provider prescribes selegiline (Eldepryl). What precaution should the nurse teach the client? a Change positions slowly. b Take the medication between meals. c Perform self-blood glucose monitoring. d Withhold the next dose if nausea occurs.

Answer: D Ototoxicity is not a side effect of antipsychotics; this side effect occurs with aspirin. Signs of pseudoparkinsonism (e.g., tremors, rigidity, and bradykinesia) are common side effects of antipsychotics. The anticholinergic effect of antipsychotic medications can cause constipation, and it is a common gastrointestinal side effect. Vision changes and photosensitivity are common side effects of antipsychotic medications.

A health care provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when he states that he should call the clinic if he experiences: A Tremors B Constipation C Blurred vision D Ringing in the ears

Answer: D Tolterodine, a urinary tract antispasmotic, may cause dizziness and blurred vision, placing the client at risk for injury. Although it is important to know if the client is experiencing anuria or overflow incontinence, which may indicate urinary retention, a detailed intake and output record is unnecessary. An extended release capsule should be swallowed whole and should not to be opened or chewed. If chewed or opened, the client will receive a surge of action and the long term action of the medication is gone. Tolterodine is classified as an anticholinergic and adverse reactions include constipation and dry mouth; diarrhea and an increase in respiratory secretions are associated with drugs classified as cholinergics.

A health care provider prescribes tolterodine (Detrol) for a client with an overactive bladder. What is most important for the nurse to teach the client to do? a Maintain a strict record of fluid intake and urinary output. b Chew the extended release capsule thoroughly before swallowing. c Report episodes of diarrhea or any increase in respiratory secretions. d Avoid activities requiring alertness until the response to medication is known.

Answer: A A regular diet maintains sodium balance; lithium decreases sodium resorption by the renal tubules. Initially, weight-reducing diets deplete body fluids; this can result in lithium retention and toxicity. Lithium is excreted in urine; decreased fluid intake and a consequent decreased urine output can result in lithium retention and toxicity. Limitation of daily salt intake to 2,000 g is unsafe because lithium decreases sodium resorption, resulting in sodium excretion; sodium intake should not be decreased.

A nurse discusses the implications of diet and fluid intake with a client who is receiving lithium therapy. What should the nurse teach the client and family about nutrition? A A regular diet should be maintained. B Daily fluid intake should be limited to 1 L. C Daily salt intake should be limited to 2,000 g. D A weight-reducing diet should be implemented.

Answer: D Restlessness, tachycardia, fever, diarrhea, and altered mental status are related to serotonin syndrome, an excessive accumulation of serotonin that can lead to death if not identified and treated quickly. Continuous involuntary movement of the tongue and jaw is related to tardive dyskinesia, which results from long-term use of an antipsychotic medication. Extremely high blood pressure with headache and flushing indicate a possible hypertensive crisis from the intake of tyramine-containing foods by a client receiving a monoamine oxidase inhibitor antidepressant. Blurred vision, urine retention, dry mouth, and constipation are common anticholinergic side effects of tricyclic antidepressants and some antipsychotic medications.

A nurse is caring for a group of clients on the psychiatric unit. What clinical findings should alert the nurse that serotonin syndrome has developed in one of the clients? A Continuous involuntary movement of the tongue and jaw B Extremely high blood pressure with headache and flushing C Blurred vision, urine retention, dry mouth, and constipation D Restlessness, tachycardia, fever, diarrhea, and altered mental status

Answer: D Antipsychotics are used to decrease positive signs and symptoms associated with psychoses, including hallucinations, delusions, paranoia, and disorganized speech. These drugs are used to minimize psychotic, not neurotic, signs and symptoms. Improved judgment and social skills are not prime reasons that antipsychotic drugs are used.

A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a health care provider prescribes an antipsychotic medication for these clients? A To improve judgment B To promote social skills C To diminish neurotic behavior D To reduce the positive symptoms of psychosis

Answer: C Clozapine (Clozaril) may cause agranulocytosis, which can result in the development of infection. Risk for falls is more common with typical antipsychotic medications because they may cause orthostatic hypotension and extrapyramidal side effects. Inability to sit still (akathisia) and dizziness upon standing (orthostatic hypotension) are more common with typical antipsychotics because they may cause extrapyramidal side effects.

A nurse is educating a client who is taking clozapine (Clozaril) for paranoid schizophrenia. What should the nurse emphasize about the side effects of clozapine? A Risk for falls B Inability to sit still C Increase in temperature D Dizziness upon standing

Answer: D The tongue's moving by itself is characteristic of tardive dyskinesia, an irreversible, antipsychotic, drug-induced neurological disorder. Dry mouth is an anticholinergic-type side effect that is not considered serious. This drug will cause sedation, not insomnia. Lack of an appetite is unrelated to antipsychotic medications.

A nurse is interviewing a client in the mental health clinic. Which statement by the client indicates an irreversible adverse response to long-term therapy with an antipsychotic medication? A "My mouth is always dry." B "I can't seem to sleep at night." C "I don't have much of an appetite." D "My tongue seems to move by itself."

Answer: A Occipital headaches are the beginning of a hypertensive crisis resulting from an excess of tyramine. Generalized urticaria is unrelated to the ingestion of tyramine. Severe muscle spasms are unrelated to the ingestion of tyramine. Excessive tyramine causes an increase, not a decrease, in blood pressure.

A nurse is teaching clients about dietary restrictions during monoamine oxidase inhibitor (MAOI) therapy. What response does the nurse tell them to anticipate if they do not follow these restrictions? A Occipital headaches B Generalized urticaria C Severe muscle spasms D Sudden drop in blood pressure

A B C D

A nurse working on a detoxification unit has clients who are in active withdrawal from alcohol, opiates, benzodiazepines, cocaine, and marijuana. Place these clients in order, from the one with the highest risk for life-threatening physiological withdrawal to the one with the lowest risk: A An adolescent who is withdrawing from cocaine B An older adult who is withdrawing from alcohol C A middle-aged adult who is withdrawing from marijuana D A young adult who is withdrawing from a long-acting benzodiazepine

c Fosphenytoin is a prodrug of phenytoin developed to minimize the irritating effects of phenytoin on blood vessels. Compared to phenytoin, the pH of fosphenytoin is less alkaline and easier on the veins. Once administered, it is converted in the body to phenytoin.

A patient asks the nurse why she is receiving a different drug than her usual phenytoin. The patient is to have nothing by mouth and is receiving intravenous fosphenytoin. What is the nurse's best response? a "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug." b "Phenytoin is not effective while you are to have nothing by mouth, so your health care provider has changed your medication to a more effective drug." c "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are not taking anything by mouth, IV fosphenytoin is easier on your veins than phenytoin." d "Since you are not taking medication by mouth, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will resume phenytoin after you recover from this illness."

Answer: C A change in behavior that seems positive may actually indicate that the client has worked out a plan for suicide; the potential for suicide increases when physical energy returns. Increased supervision is needed. Complimenting the client's appearance may increase the client's feelings of inadequacy because it implies that the client did not look good before. It is inappropriate to consider discharge simply because of a change in behavior. Many factors should be considered in the decision to discharge a client. The addition of privileges is not indicated at this time.

A practitioner prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? A Complimenting the client's appearance B Starting preparations for the client's discharge C Arranging for constant supervision of the client D Adding privileges to the client's plan of care as a reward

Answer: D Lithium absorption and excretion occur 8 to 12 hours after the last dose. Concentrations may be falsely higher at 2 to 4, 4 to 6, or 6 to 8 hours after administration, affecting the reliability of the readings.

A practitioner prescribes routine checks of the client's lithium level to be performed. How many hours after the last dose of lithium should the nurse plan to obtain the blood specimen? A 2 to 4 B 4 to 6 C 6 to 8 D 8 to 12

Answer: A The effects of antidepressants are cumulative; it may take 3 to 4 weeks before improvement is identified. Antidepressants do not become more effective as a client's physical condition improves. It is too early to come to this conclusion. Antidepressants become effective after 3 or 4 weeks, regardless of the duration of the depression.

An antidepressant is prescribed for a depressed older client. After 1 week the client's son expresses concern that there does not seem to be much improvement. How should the nurse respond? A "Antidepressant therapy requires several weeks before it becomes effective." B "Antidepressant therapy will be more effective as the physical condition improves." C "Additional medications may be required before behavioral changes will be observed." D "Additional time is needed for the medication to become effective because of the prolonged depression."

Answer: A The client is displaying signs and symptoms of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld. Although antiepileptics are effective in 25% to 50% of clients with treatment-resistant bipolar disorder, this is not the appropriate treatment for lithium toxicity.

An older adult living in a long-term care facility has been receiving lithium 600 mg twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. What is the most appropriate nursing intervention? A Withholding the next dose of lithium and drawing blood to test it for toxicity B Obtaining a prescription for the antidote to lithium and administering it immediately C Suggesting that the practitioner replace the lithium for an antiepileptic that will control the mania D Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water

A B D Nausea and vomiting may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of nausea and vomiting. Changes in affect, mood, and behavior are related to toxic effects of the drug. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? Select all that apply. a Vomiting b Anorexia c Slow heart rate d Changes in mood e Peripheral edema

Answer: C Fine hand tremor or slurred speech in a person taking lithium may signal the development of toxicity; signs of toxicity include marked tremors, lack of coordination, sluggishness, and confusion. Lithium carbonate can cause polyuria and incontinence, not urine retention. Sensitivity to bright light or sun is a side effect of the phenothiazine group of medications. Neither sexual dysfunction nor breast enlargement is associated with lithium carbonate intake.

Lithium carbonate 600 mg by mouth three times a day is prescribed for a client. The nurse concludes that the teaching about its side effects is understood when the client says that she will call her primary health care provider immediately if she notices any: A Difficulty urinating B Sensitivity to bright light or sun C Fine hand tremor or slurred speech D Sexual dysfunction or breast enlargement

Answer: B, C, D Diaphoresis, hyperrigidity, and hyperthermia occur with neuroleptic malignant syndrome as a result of dopamine blockade in the hypothalamus. Jaundice and photosensitivity are not associated with neuroleptic malignant syndrome.

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? Select all that apply. A Jaundice B Diaphoresis C Hyperrigidity D Hyperthermia E Photosensitivity

Answer: B Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation; usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs 45 to 75 minutes after administration; the duration of its action is 2½ to 4 hours.

The health care provider prescribes neostigmine (Prostigmin) for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client says, "I should: a Keep the drug in a container in the refrigerator." b Take the drug at the exact time that is listed on the prescription." c Plan to take the drug between meals to promote absorption." d Expect that the onset of the action of the drug will occur several hours after I take it."

Answer: D Edrophonium, an anticholinesterase, causes temporary relief of symptoms of myasthenia gravis in clients who have the disease and is therefore an effective diagnostic aid. Symptoms will decrease. Level of consciousness is not affected. Hypotension may occur.

The nurse explains to the family of a client suspected of having myasthenia gravis that edrophonium (Enlon) is used to establish the diagnosis. An increase in which factor will confirm the diagnosis? a Symptoms b Consciousness c Blood pressure d Muscle strength

Answer: B The Tensilon test is used in the client with myasthenia gravis to distinguish between a myasthenic crisis and a cholinergic crisis. In this test, edrophonium chloride (Tensilon), a short-acting anticholinesterase agent, is administered via the intravenous route. Symptoms of flaccid paralysis improve if the cause is myasthenic crisis and worsen if the cause is cholinergic crisis. To avoid respiratory arrest, in the event the symptoms are the result of a cholinergic crisis, the anticholinergic medication atropine must be readily available at the bedside. CBC, lumbar puncture, and MRI tests will offer no insight for differentiating myasthenic and cholinergic crises.

The nurse is caring for a client with myasthenia gravis. The nurse expects which test to be ordered to differentiate a myasthenic crisis from a cholinergic crisis? a CBC b Tensilon c Lumbar puncture d Magnetic resonance imaging (MRI)

c The patient who is post-seizure may be disoriented and not fully conscious. As safety is a primary concern, the nurse should assess this patient first. The patient with absence seizures, patient with sensory seizures, and patient who is taking Valium do not have the safety issues experienced by the postictal patient.

The nurse is caring for several patients, each of whom has a history of seizure activity. Which patient will the nurse assess first? a A patient who has absence seizures b A patient who has sensory seizures c A patient who is postictal d A patient who is taking diazepam (Valium)

a As valproic acid is excreted by the kidneys, this level is cause for concern because the drug could become toxic. The other patients do not demonstrate any areas outside of the therapeutic range.

The nurse is caring for several patients, each of whom is being treated with anticonvulsants. Which patient will the nurse assess first? a A patient started on valproic acid (Depakene) with a creatinine level of 3 b A patient started on pregabalin (Lyrica) who has partial seizures c A patient taking tiagabine (Gabitril) who has partial seizures d A patient taking levetiracetam (Keppra) and is on multiple drug therapy

c Infusing phenytoin (Dilantin) at rates >50 mg/min can cause severe hypotension or cardiac dysrhythmias. The infusion should not be increased nor discontinued.

The nurse is monitoring phenytoin (Dilantin) being infused intravenously at 55 mg/min. What action will the nurse take next? a Continue to monitor the infusion. b Have the drug changed to PO. c Decrease the infusion and assess blood pressure. d Increase the infusion.

a The medication can be taken with food or milk to minimize gastric distress, which is an expected side effect of the medication.

The patient has been taking phenobarbital to control seizures. The patient complains to the nurse of experiencing occasional stomach upset when taking the medication. What is the nurse's best response? a "You can take the medication with food or milk." b "You should take the medication on an empty stomach." c "You should call your health care provider because the dose may need to be adjusted." d "You should call your health care provider because the drug may need to be stopped."

d Focal myoclonic activity consists of isolated clonic contractions that last 3 to 10 seconds that are limited to one limb. The patient's type of seizure is not indicative of massive myoclonic, jacksonian, or grand mal seizures.

The patient is noted to experience isolated clonic contractions lasting 3 to 10 seconds and limited to one limb. The nurse identifies this activity as which type of seizure? a Massive myoclonic seizure b Jacksonian seizure c Grand mal seizure d Focal myoclonic seizure

a Abrupt withdrawal of antiepileptic drugs can cause the development of status epilepticus. However, stopping phenytoin should not result in acute withdrawal, severe hypotension, or confusion.

What information will the nurse teach the patient who is considering stopping the antiepileptic drug phenytoin? a "You may go into status epilepticus." b "You may have an acute withdrawal." c "You will have severe hypotension." d "You may become confused and delirious."

a This medication can cause drowsiness. The nurse must teach the patient to be safe while taking this medication. The drug does not need to be taken on a full stomach or to be taken for a limited period of time. The patient should be advised not to take any sedating medications that are available over the counter, but the patient does not need to discontinue all over-the-counter medications.

What is the primary information the nurse should teach a patient who has just started taking mephobarbital (Mebaral)? a "Do not drive until you determine how you react to the medication." b "Take the medication on a full stomach." c "Do not take any over-the-counter medications with this drug." d "Take this medication for 1 month only and then stop."

Answer: B Flumazenil (Romazicon) is the drug 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 medication competitively inhibits activity at benzodiazepine recognition sites on γ-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.

What medication should the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? A Lithium B Flumazenil C Methadone D Chlorpromazine

Answer: C Carbidopa-levodopa should be taken with meals to reduce the nausea and vomiting that commonly are caused by this drug. Multivitamins are contraindicated; vitamins may contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. Moderate amounts of alcohol will antagonize the drug's effects; a rare, occasional drink is not harmful. A high-protein diet is contraindicated. Sinemet contains levodopa, an amino acid that may increase blood urea nitrogen (BUN) levels. Also, some proteins contain pyridoxine, which increases peripheral metabolism of levodopa, decreasing the amount of levodopa crossing the blood-brain barrier.

What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa (Sinemet)? a Multivitamins should be taken daily b Alcohol consumption should be in moderation c The medication should be taken with meals d A high-protein diet should be followed

Answer: D Selective serotonin reuptake inhibitors have better safety profiles and do not carry the risk of substance abuse and tolerance. Anticholinergics are administered concurrently with antipsychotics to minimize extrapyramidal side effects. Lithium carbonate is a drug used to treat bipolar disorder. Antipsychotics are administered to clients with thought disorders

When reviewing the medications for a group of clients on a psychiatric unit, the nurse concludes that the pharmacotherapy for anxiety disorders is moving away from benzodiazepines and moving toward: A Anticholinergics B Lithium carbonate C Antipsychotic medications D Selective serotonin reuptake inhibitors

a Ethosuximide (Zarontin) is the first-line drug of choice to treat absence seizures. It does not treat panic attacks, migraines, or tonic-clonic seizures.

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). What is the nurse's primary assessment? a Assess patient for absence seizures. b Assess patient for panic attacks. c Assess patient for migraines. d Assess patient for tonic-clonic seizures.