PathoPharm NCLEX Questions CNS and Circulatory

The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give? (Fill in the blank)

0.25 mL

The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving? (Fill in the blank)

1100 units/hr

The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? (Fill in the blank)

1120 units/hr

The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose? (Fill in the blank)

45 mL/hr

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) a. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." b. "You may have some mild sedation. Do not drive until you know how this drug will affect you." c. "This drug may cause easy bruising. If you notice this, call the clinic immediately." d. "It is very important to have good oral hygiene and to visit your dentist regularly." e. "You may continue to have wine with your evening meals, but only in moderation."

a. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." b. "You may have some mild sedation. Do not drive until you know how this drug will affect you." d. "It is very important to have good oral hygiene and to visit your dentist regularly." Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching? a. "I volunteer at a local day care center once a week." b. "I drink grapefruit juice with breakfast each morning." c. "I enjoy walking and outdoor activities in the sun." d. "I understand this drug may cause my urine to turn blue."

a. "I volunteer at a local day care center once a week." Mitoxantrone can cause myelosuppression. Patients taking this drug should be advised to avoid contact with people who have infections, such as children in day care centers. The other statements are appropriate for patients taking this drug.

A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect? a. "Rasagiline may cause insomnia, so monitor your sleeping habits." b. "It is important to avoid tyramine-containing foods." c. "You may be at increased risk for malignant melanoma, so have regular skin checks." d. "You may experience side effects, such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."

a. "Rasagiline may cause insomnia, so monitor your sleeping habits." Unlike selegiline, rasagiline does not cause insomnia. Rasagiline may pose a risk of hypertensive crisis and hence patients should be instructed to avoid tyramine-containing foods. Rasagiline may increase the risk of malignant melanoma, a potentially deadly cancer of the skin. Periodic monitoring of the skin is recommended. Side effects are headache, arthralgia, dyspepsia, depression, and flu-like symptoms.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? a. "Take the medication with a glass of grapefruit juice each morning." b. "Notify the physician if you are gaining weight or your legs are swollen." c. "Nausea, vomiting, and indigestion are common side effects of carbamazepine." d. "Have liver function tests performed on a routine basis."

a. "Take the medication with a glass of grapefruit juice each morning." Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

The nurse is teaching a patient with severe hemophilia A about the disease. Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) a. "You will need to be vaccinated for hepatitis A and B." b. "Take aspirin [Bayer] when you have mild pain." c. "You will receive prophylactic blood transfusions to manage your disease." d. "You will learn to reconstitute powdered medication with saline." e. "It will be important to get regular testing for HIV."

a. "You will need to be vaccinated for hepatitis A and B." d. "You will learn to reconstitute powdered medication with saline." People with hemophilia need to follow the normal childhood immunization schedule. In addition, they should be vaccinated for hepatitis A and B to minimize their risk. Aspirin should not be given to patients with hemophilia, because it inhibits platelet aggregation and can promote gastrointestinal (GI) ulceration and bleeding. Prophylactic blood transfusions are not part of routine care for patients with hemophilia. Factor VIII [Bioclate] administration is the cornerstone of treatment for a patient with hemophilia A. The drug comes in powdered form and is reconstituted with sterile saline. Most patients do this at home. The risk of human viral transmission using newer generation factor VIII products is essentially zero. Transmission of the human immunodeficiency virus (HIV) has not been reported.

The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (Select all that apply.) a. A patient with variant genes that code for VKORC1 and CYP2CP b. A patient with a current INR of 2.2 treated for deep vein thrombosis c. A woman with a new onset of symptoms of a pulmonary embolus d. A patient on day 4 after hip replacement with a new order for warfarin e. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen

a. A patient with variant genes that code for VKORC1 and CYP2CP c. A woman with a new onset of symptoms of a pulmonary embolus e. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen Patients with genetic alterations in VKORC1 and CYP2CP are at increased risk of warfarin-induced bleeding. An INR of 2.2 indicates a therapeutic warfarin level. Warfarin can cause fetal hemorrhage and is listed as Pregnancy Risk Category X. Warfarin could be prescribed for the prevention of deep vein thrombosis after hip replacement surgery. The day of prescription would not likely be a day to expect a dangerous adverse effect from warfarin, because its half-life is 1.5 to 2 days. Warfarin interacts with many other agents. The greatest risk for harm is when an interacting drug is being added to or deleted from the regimen.

The nurse is administering epoetin alfa [Procrit] to a patient receiving chemotherapy. Which adverse effect is a potential risk with this drug? a. Accelerated tumor progression b. Hypotension c. Easy bruising d. Bone pain

a. Accelerated tumor progression Epoetin alfa has been shown to accelerate tumor progression and shorten life in some patients with cancer. This is more common when the hemoglobin level rises above 12 gm/dL. Other adverse effects associated with epoetin alfa include hypertension, cardiovascular events, and deep vein thrombosis when the drug is used preoperatively. Bone pain is associated with filgrastim.

The nurse is caring for a patient with depression who takes citalopram [Celexa], an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process? a. Adaptive changes in the brain b. Drug tolerance and dependence c. A wide therapeutic index d. Improved neuronal transmission

a. Adaptive changes in the brain The brain adapts to CNS agents over time. The beneficial effects of antidepressants are believed to be delayed because they result from adaptive changes.

Which nursing action should prevent an adverse effect of a liquid iron preparation? a. Administer the iron preparation through a dropper. b. Administer the liquid iron preparation along with vitamin C. c. Administer the liquid buccally to delay absorption and lessen adverse effects. d. Mix the liquid iron preparation with an antacid for patients with underlying peptic ulcer disease.

a. Administer the iron preparation through a dropper. An adverse effect of liquid iron preparations is staining of the teeth, which can be prevented by (1) diluting the liquid iron with juice or water; (2) administering the iron through a straw or dropper; and (3) rinsing the mouth after administration. Whether liquid or tablet, vitamin C promotes the absorption of iron but also increases its adverse effects. Buccal administration increases the risk for contact with the teeth, leading to staining. Antacids reduce the effects of iron. Oral preparations should not be administered to patients with peptic ulcers, because the GI effects can aggravate the ulcers.

A patient has an infection affecting a central nervous system (CNS) component. Which structure makes the delivery of antibiotic therapy more difficult? a. Blood-brain barrier b. Chemotherapeutic trigger zone c. Neuropeptide receptors d. Thalamic synapses

a. Blood-brain barrier The blood-brain barrier normally is protective, but it can also interfere with the delivery of some therapeutic agents. This is one reason CNS infections are critical.

A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg 3 times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities? a. By producing drowsiness, lethargy, and blurred vision b. By causing gastrointestinal distress c. By reducing sensation in the extremities d. By impairing coordinated movements

a. By producing drowsiness, lethargy, and blurred vision Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? a. Continue as planned, because the level is within normal limits. b. Tell the patient to hold today's dose and return to the clinic. d. Consult the prescriber to recommend an increased dose. e. Have the patient call 911 and meet him/her in the emergency department.

a. Continue as planned, because the level is within normal limits. The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

For which medication order should the nurse notify the healthcare provider? a. Cyanocobalamin 100 mcg intravenously (IV) every month b. Folic acid 1 mg orally daily × 2 weeks; then folic acid 400 mcg orally daily c. Iron dextran [INFeD] test dose 25 mg (IV) over 5 minutes d. Sodium-ferric gluconate complex [Ferrlecit] 125 mg in 100 mL NSS to run intravenously over 15 minutes

a. Cyanocobalamin 100 mcg intravenously (IV) every month Cyanocobalamin must never be given intravenously (IV); therefore, this order must be questioned. It may be given by the oral route, intranasally, or by subcutaneous or intramuscular injection. The dosages and routes listed in all of the other options are appropriate.

The nurse on an orthopedic unit routinely cares for patients receiving carisoprodol [Soma]. For which adverse effects should the nurse monitor these patients? (Select all that apply.) a. Drowsiness and sedation b. Decreased renal function c. Risk of dependence d. Decreased neutrophil count e. Unusual hair growth

a. Drowsiness and sedation c. Risk of dependence Carisoprodol is a centrally acting skeletal muscle relaxant and as such can produce generalized central nervous system (CNS) depression. These agents may also cause physical dependence when taken long term or in high doses.

The nurse is administering iron dextran (INFeD) by intravenous (IV) infusion to a patient with iron deficiency. Which is the priority nursing action during the administration of this drug? a. Ensure that epinephrine is available as needed. b. Assess the lung sounds and respiratory rate. c. Monitor the blood urea nitrogen and creatinine levels. d. Use Y-connector tubing to connect to the primary line.

a. Ensure that epinephrine is available as needed. An anaphylactic reaction is the most serious potential adverse reaction to iron dextran administration. Epinephrine and resuscitation equipment should be readily available.

The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? (Select all that apply.) a. Ferritin level b. Temperature trends c. Blood glucose level d. Blood pressure trends e. Hemoglobin and hematocrit

a. Ferritin level d. Blood pressure trends e. Hemoglobin and hematocrit Baseline data that should be collected and evaluated before initiation of epoetin alfa [Epogen] include blood pressure, blood chemistry (blood urea nitrogen [BUN], uric acid, creatinine, phosphorous, potassium), degree of transferrin saturation, ferritin concentration, and hemoglobin and hematocrit. The ferritin concentration should be at least 100 ng/mL for epoetin alfa therapy to be effective. In patients with CRF, epoetin alfa is associated with a rise in blood pressure. Knowledge of baseline blood pressures is essential to determine whether changes are occurring. Baseline hemoglobin/hematocrit levels serve as a measure of comparison for determining the effectiveness of therapy. It is not essential to know the temperature trends or blood glucose level before starting therapy.

The nurse is assessing a patient with hemophilia for complications of clotting factor administration. Which assessment findings would indicate an adverse effect of this treatment? (Select all that apply.) a. Hives and urticaria b. Potassium level of 3.2 mEq/L c. Creatinine level of 2.5 mg/dL d. Bethesda titer of 40 units e. Alkaline phosphatase of 303 units/L

a. Hives and urticaria d. Bethesda titer of 40 units Complications of clotting factor administration include allergic reactions, which can range from mild to anaphylactic, and the development of antibodies against the factor (known as inhibitors). Hives and urticaria indicate an allergic reaction. The Bethesda assay titers are used to detect the presence of inhibitors. Clotting factor administration is not associated with hypokalemia, renal dysfunction (elevated creatinine), or liver dysfunction (elevated alkaline phosphatase).

Which organ regulates the body's iron stores? a. Intestines b. Kidneys c. Liver d. Bloodstream

a. Intestines Most of the iron absorbed in the body stays in place and there is not a great deal of iron turnover. Some is lost through the GI tract and much more can be lost through hemorrhage. The body prevents excessive buildup of iron (hemachromatosis) by controlling the amt. of uptake in the intestines. When stores are high, only about 2-3% of dietary iron is absorbed, when they are low up to 20% is absorbed.

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block? a. Lacosamide [Vimpat] b. Felbamate [Felbatol] c. Tiagabine [Gabitril] d. Levetiracetam [Keppra]

a. Lacosamide [Vimpat] Lacosamide can prolong the PR interval and should be used with caution in patients with cardiac conduction problems and in those taking other drugs that prolong the PR interval, such as calcium channel and beta blockers. Felbamate, tiagabine, and levetiracetam do not affect the PR interval.

The nurse is caring for a patient after total hip replacement on postoperative day 1. The nurse notes that the patient's urine is dark brown. The nurse reviews the medication administration record for which medication? a. Methocarbamol [Robaxin] b. Carisoprodol [Soma] c. Baclofen [Lioresal] d. Cyclobenzaprine [Flexeril]

a. Methocarbamol [Robaxin] Methocarbamol may turn urine brown, black, or dark green; patients should be forewarned of this harmless effect.

Which medications can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) a. Modafinil [Provigil] b. Clonazepam [Klonopin] c. Amantadine [Symmetrel] d. Carbamazepine [Tegretol] e. Dalfampridine [Ampyra]

a. Modafinil [Provigil] c. Amantadine [Symmetrel] Fatigue develops in about 90% of patients with multiple sclerosis, and the drugs most commonly used to manage this symptom include modafinil and amantadine. Clonazepam may be useful for alleviating tremor and ataxia associated with the disease. Carbamazepine, an antiepileptic drug, may be helpful for alleviating neuropathic pain. Dalfampridine may be given to improve walking.

Which neurotransmitter is active in both the peripheral and central nervous systems (CNS)? a. Norepinephrine b. Serotonin c. Substance P d. Dynorphins

a. Norepinephrine All of these agents are active in the CNS. The only known neurotransmitters in the peripheral nervous system are acetylcholine, epinephrine, and norepinephrine.

The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. b. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. c. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. d. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.

a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin.

The nurse is working with a group of patients receiving drugs that work in the central nervous system (CNS). Nursing care of these patients is based on which facts? (Select all that apply.) a. Overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. c. Animal studies in progress will greatly enhance knowledge of CNS medications. d. When CNS drugs are taken long term, their effects differ from initial use. e. The blood-brain barrier is permeable to water-soluble drugs.

a. Overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. d. When CNS drugs are taken long term, their effects differ from initial use. Even though CNS medications are widely used, much about them remains unclear. The CNS is known to have many more active neurotransmitters than the peripheral nervous system. Animal studies are not particularly helpful in studying CNS drugs, because adequate animal models of mental illness are lacking. Adaptive changes occur in the brain when CNS agents are taken over time. This can increase the therapeutic effects, decrease the side effects, and contribute to tolerance and physical dependence. The blood-brain barrier is permeable to lipid-soluble agents.

The nurse is evaluating the effectiveness of the drug oprelvekin [Neumega] in a patient undergoing cancer chemotherapy. Which finding is most indicative that this drug is having its intended effect? a. Platelet count of 150 × 10^3/mm^3 b. Hemoglobin level of 13.2 g/dL c. White blood cell count of 5500/mm3 d. Total lymphocyte count of 1000/mm3

a. Platelet count of 150 × 10^3/mm^3 Oprelvekin is a thrombopoietic growth factor that is used to stimulate the production of thrombocytes. The platelet count, which is within normal limits, would indicate that this drug is having its intended effect.

A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) a. Platelets b. Vitamin K c. Prothrombin time (PT) d. International normalized ratio (INR) e. Activated partial thromboplastin time (aPTT)

a. Platelets e. Activated partial thromboplastin time (aPTT) To reduce the risk of heparin-induced thrombocytopenia (HIT), platelet counts should be monitored. Heparin therapy is monitored by measuring the laboratory test activated partial thromboplastin time (aPTT). Warfarin therapy is monitored by measuring prothrombin time (PT) and results are expressed as an international normalized ratio (INR). Vitamin K is not monitored for a heparin infusion.

Which assessments are essential before a patient receives a second dose of mitoxantrone [Novantrone]? (Select all that apply.) a. Pregnancy test b. Echocardiogram c. Complete blood count d. T3, T4, and TSH levels e. Ophthalmic examination f. Magnetic resonance imaging (MRI)

a. Pregnancy test b. Echocardiogram c. Complete blood count Mitoxantrone [Novantrone] can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.

The nurse is caring for a patient receiving vitamin B12 because of a deficiency. What are common causes of this deficiency? (Select all that apply.) a. Regional enteritis and malabsorption b. Celiac disease c. Decreased intake of foods with vitamin B12 d. Advancing age e. Use of drugs that lower stomach acid

a. Regional enteritis and malabsorption b. Celiac disease d. Advancing age e. Use of drugs that lower stomach acid Vitamin B12 is needed in very small amounts in the diet. Dietary insufficiency is rarely the cause of a deficiency. The other options are common potential causes of this problem.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) a. Swollen, tender gums b. Measles-like rash c. Productive cough d. Unusual hair growth e. Nausea and vomiting

a. Swollen, tender gums b. Measles-like rash d. Unusual hair growth Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider. d. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. e. No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6 months.

a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider. Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. Aspirin and aspirin products should be avoided because aspirin can increase the effects of warfarin to promote bleeding and on the gastrointestinal tract to cause ulcers, thereby initiating bleeding. The INR should be determined frequently: daily during the first 5 days, twice a week for the next 1 to 2 weeks, once a week for the next 1 to 2 months, and every 2 to 4 weeks thereafter.

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? a. "The medication should not make me feel sleepy." b. "I should take the medication on an empty stomach." c. "I'll need to discuss a reliable form of birth control with my gynecologist." d. "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

b. "I should take the medication on an empty stomach." Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]? a. "If I develop any difficulty urinating, I will call my physician." b. "I'm glad I can still have a glass or two of wine at dinner." c. "I'll contact my healthcare provider when I feel I no longer need the medication." d. "I'll need to check with my healthcare provider before taking my allergy medications."

b. "I'm glad I can still have a glass or two of wine at dinner." Alcohol can intensify the CNS depressant effects of baclofen; therefore, further instruction is needed. The first statement indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.

The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? a. "With proper treatment, we can completely eliminate your seizures." b. "Our goal is to reduce your seizures to an extent that helps you live a normal life." c. "Seizure medication does not reduce seizures in most patients." d. "These drugs will help control your seizures until you have surgery."

b. "Our goal is to reduce your seizures to an extent that helps you live a normal life." Seizure disorders are often treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

The nurse is teaching the parent of a young child about administering ferrous sulfate to the child at home. Which teaching point should receive the highest priority? a. "Give the liquid iron with a straw to reduce tooth staining." b. "Store the ferrous sulfate in a childproof container and keep it out of the child's reach." c. "This medicine may cause the child's stool to look dark green or black." d. "Do not give iron with any other medications or vitamins."

b. "Store the ferrous sulfate in a childproof container and keep it out of the child's reach." All these answers may be included in the parent teaching about iron. However, keeping the medication away from the child is the top priority, because death from overdose of iron-containing products is a leading cause of poisoning fatalities in the United States.

The healthcare provider orders diazepam [Valium] 5 mg IV every 8 hours. The medication available is diazepam [Valium] 5 mg/mL. How many mL will the nurse administer? a. 0.5 mL b. 1 mL c. 1.5 mL d. 2 mL

b. 1 mL

The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer? a. 1 mL b. 10 mL c. 100 mL d. 0.1 mL

b. 10 mL

The healthcare provider orders donepezil [Aricept] 10 mg PO every day. The tablets available are donepezil 5 mg. How many tablets will the patient receive? a. 0.5 b. 2 c. 5 d. 10

b. 2

The healthcare provider orders Namenda syrup 20 mg PO daily in two divided doses. The concentration available is Namenda 2 mg/mL. How many mL will the patient receive for each dose? a. 2 mL b. 5 mL c. 10 mL d. 20 mL

b. 5 mL

The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? a. 50 b. 70 c. 90 d. 110

b. 70 The therapeutic level of heparin is achieved when the aPTT reaches 1.5 to 2 times normal. Thus, a range of 60 to 80 seconds would be appropriate for this patient.

The healthcare provider prescribes hematopoietic growth factor for a patient. The nurse should notify the healthcare provider to question the prescription for which patient condition? a. A patient with chronic renal failure (CRF) b. A patient with uncontrolled hypertension c. A patient taking zidovudine for human immunodeficiency virus (HIV) d. A patient with nonmyeloid malignancy chemotherapy-induced anemia

b. A patient with uncontrolled hypertension This drug should not be given to a patient with uncontrolled hypertension because a significant adverse effect of hematopoietic growth factor is hypertension. Anemia of CRF occurs because of insufficient erythropoietin, and the hematopoietic growth factor epoetin alfa can be administered. Anemia caused by HIV-infected patients taking zidovudine can receive the hematopoietic growth factor epoetin alfa. Nonmyeloid malignancy chemotherapy-induced anemia can receive the hematopoietic growth factor epoetin alfa.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? a. Tonic-clonic b. Absence c. Simple partial d. Complex partial

b. Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? a. Tonic-clonic b. Absence c. Atonic d. Myoclonic

b. Absence This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

Which medication promotes hemostasis in hemophilia A and B by inhibition of fibrinolysis? a. Desmopressin [DDAVP] b. Aminocaproic acid [Amicar] c. Celecoxib [Celebrex] d. Diphenhydramine [Benadryl]

b. Aminocaproic acid [Amicar] Aminocaproic acid inhibits fibrinolysis by blocking the production of plasmin. Consequently, it promotes hemostasis in patients with hemophilia A or hemophilia B. Desmopressin may be useful for stopping bleeding in mild hemophilia A, because it promotes the release of stored factor VIII. Celecoxib is a cylcooxygenase-2 (COX-2) inhibitor that does not suppress platelet aggregation; however, its safety for pain management in hemophilia has not been proven. Diphenhydramine may be administered to treat symptoms of mild reaction to administration of factor VIII.

Which is the priority nursing intervention for a patient receiving parenteral iron dextran (INFeD) infusion? a. The medication must be administered by deep subcutaneous injection. b. An intravenous test dose of 25 mg over 5 minutes must be administered. c. Erythropoietin must also be given when a patient is receiving parenteral iron dextran. d. After administration of a test dose of intramuscular (IM) iron dextran, the patient must be observed for 15 minutes before the full therapeutic dose is given.

b. An intravenous test dose of 25 mg over 5 minutes must be administered. To reduce the risk of a fatal anaphylactic reaction to parenteral iron dextran, each full dose should be preceded by a small test dose of 25 mg given intravenously over 5 minutes. Iron dextran should not be administered subcutaneously. It can be administered by deep intramuscular injection using the Z-track technique to prevent leakage and surface discoloration. Sodium-ferric gluconate complex [Ferrlecit], not iron dextran, is always used in conjunction with erythropoietin. If the test dose of iron dextran is administered IM, the patient must be observed for 1 hour before the full dose is administered.

The nurse is reviewing the care of patients with AD. Which factors are associated with the pathophysiology of this disease? (Select all that apply.) a. Dilation and inflammation of cranial blood vessels b. Beta-amyloid and neuritic plaques c. Neurofibrillary tangles and tau d. Autoimmune changes in the myelin sheath e. Firing of hyperexcitable neurons throughout the brain f. Neuronal degeneration and decreased acetylcholine

b. Beta-amyloid and neuritic plaques c. Neurofibrillary tangles and tau f. Neuronal degeneration and decreased acetylcholine AD is characterized by neuronal degeneration, reduced cholinergic transmission, beta-amyloid and neuritic plaques, and neurofibrillary tangles and tau. Dilation and inflammation of cranial blood vessels are associated with migraine. Multiple sclerosis is characterized by autoimmune changes in the myelin sheath, and epilepsy is associated with hyperexcitability of neurons and firing of those neurons throughout the brain.

The nurse is caring for a patient undergoing cancer chemotherapy who presents with rash, bone pain, hypertension, and pedal edema. Which symptom is most likely an adverse reaction to the filgrastim [Neupogen] the patient is receiving? a. Rash b. Bone pain c. Headache d. Swelling in feet

b. Bone pain Bone pain occurs in about 25% of patients receiving filgrastim. The other symptoms are not adverse effects associated with filgrastim.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? a. Take the medication on a full stomach. b. Change positions slowly. c. The drug may cause the urine to be very dilute. d. Carbidopa has many adverse effects.

b. Change positions slowly. Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

The nurse is caring for a patient with anemia. What is a common cause of iron deficiency in the United States? a. Decreased intestinal uptake of iron b. Chronic blood loss through the GI tract c. Vegetarian eating patterns d. Rapid growth during adolescence

b. Chronic blood loss through the GI tract the most common cause of anemia in the US are changes in blood volume during pregnancy, infancy, early childhood, and chronic blood loss, usually of GI or uterine origin. In rare cases, decreased iron uptake is a cause of anemia.

The nurse is monitoring therapy for a patient with hemophilia B. Which evaluation criterion is most important to determine whether the medication dosage is effective? a. Clotting factor VIII levels b. Clinical response c. Clotting factor IX levels d. PT and INR

b. Clinical response Clotting factor IX levels are monitored in patients with hemophilia B. However, the dosage ultimately is determined by the clinical response.

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) a. Blood urea nitrogen b. Complete blood count c. Hemoglobin A1c d. Alkaline phosphatase e. Immunoglobulin G levels

b. Complete blood count d. Alkaline phosphatase When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.

Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia? a. Baclofen [Lioresal] b. Dantrolene [Dantrium] c. Diazepam [Valium] d. Tizanidine [Zanaflex]

b. Dantrolene [Dantrium] Dantrolene, a direct-acting skeletal muscle relaxant, is the preferred treatment for malignant hyperthermia. Malignant hyperthermia is a life-threatening syndrome that usually occurs when a general anesthetic is used with a neuromuscular blocking agent. It presents with muscle rigidity and profound temperature elevation.

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? a. Diarrhea b. Dyskinesia c. Wheezing d. Headache

b. Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.

b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? a. An imbalance of dopamine and acetylcholine in the central nervous system b. Inflammation and myelin destruction in the central nervous system c. An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone d. High-frequency discharge of neurons from a specific focus area of the brain

b. Inflammation and myelin destruction in the central nervous system The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.

Which characteristic improves a drug's ability to reach the central nervous system (CNS)? a. Protein binding b. Lipid solubility c. Electrical charge d. Ionization

b. Lipid solubility Because drugs must cross the blood-brain barrier to enter the CNS, only lipid-soluble agents and those that have a specialized transport system are able to cross. Protein binding and ionization (electrical charge) reduce a drug's ability to cross the blood-brain barrier.

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? a. Interferon beta-1a [Avonex] IM b. Methylprednisolone [Solu-Medrol] IV c. Glatiramer acetate [Copaxone] subQ d. Natalizumab [Tysabri] IV infusion

b. Methylprednisolone [Solu-Medrol] IV During an acute relapse episode of MS, the treatment of choice is a high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. The other agents are disease-modifying drugs that are used in the long-term management of MS.

Which medication used for the management of multiple sclerosis cannot be self-administered? a. Fingolimod [Gilenya] b. Natalizumab [Tysabri] c. Glatiramer acetate [Copaxone] d. Interferon beta-1b [Betaseron]

b. Natalizumab [Tysabri] Natalizumab [Tysabri] is administered by intravenous infusion over 1 hour. The patient must be observed during the infusion and also must be monitored for 1 hour after the infusion is complete. Before this medication can be prescribed and administered, everyone involved with the drug—patients, physicians, pharmacists, infusion nurses, and infusion centers—must be registered with the TOUCH Prescribing Program. The other medications can be self-administered: fingolimod (oral), glatiramer acetate, and interferon beta-1b (subcutaneous injection).

The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? a. Aspirin [Bayer] b. Omeprazole [Prilosec] c. Acetaminophen [Tylenol] d. Warfarin [Coumadin]

b. Omeprazole [Prilosec] Omeprazole and other proton pump inhibitors may reduce the antiplatelet effects of clopidogrel. Patients sometimes take them to reduce gastric acidity and the risk of gastrointestinal (GI) bleeding.

Which cholinesterase inhibitor has the highest incidence of adverse gastrointestinal (GI) effects? a. Donepezil [Aricept] b. Rivastigmine [Exelon] c. Galantamine [Reminyl] d. Memantine [NMDA]

b. Rivastigmine [Exelon] All these drugs have the potential to cause GI distress, including nausea, vomiting, anorexia, and weight loss. Rivastigmine is thought to have the highest probability of producing these effects. Memantine (NMDA) is not a cholinesterase inhibitor.

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? a. Relapsing-remitting b. Secondary progressive c. Primary progressive d. Progressive-relapsing

b. Secondary progressive Relapse-remitting MS is marked by defined episodes of neurologic dysfunction separated by periods of partial or full recovery. In secondary progressive MS, the patient with the relapse-remitting subtype experiences declining function with or without occasional recovery of function. Primary progressive MS presents with progressive decline of function from the onset. Progressive-relapsing MS is rare and is similar to primary progressive, but has acute episodes in addition to the progressively worsening dysfunction.

The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures? a. Nausea b. Sedation c. Fatigue d. Dry mouth

b. Sedation Side effects of phenobarbital include sedation during the initial phase of therapy; however, with continued treatment, sedation declines while full protection from seizures is retained. This is thought to be related to adaptive change within the brain during prolonged phenobarbital drug exposure.

Which finding indicates a positive outcome from treatment with filgrastim [Neupogen]? a. Bone pain is eliminated. b. The neutrophil count increases. c. Cancer goes into remission. d. The red blood cell count increases.

b. The neutrophil count increases. Filgrastim is a granulocyte colony-stimulating factor that is used to promote neutrophil recovery in cancer patients after myelosuppressive chemotherapy or bone marrow transplantation. It also is used to treat severe chronic neutropenia. Bone pain is a side effect of the drug. The drug is not a treatment for the cancer itself. Red blood cells are not increased.

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) a. The patient complains of excessive facial hair growth. b. The patient is walking with a staggering gait. c. The patient's gums are swollen, tender, and bleed easily. d. The patient complains of double vision. e. The nurse observes rapid back-and-forth movement of the patient's eyes.

b. The patient is walking with a staggering gait. d. The patient complains of double vision. e. The nurse observes rapid back-and-forth movement of the patient's eyes. Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) a. aPTT of 65 seconds b. aPTT of 40 seconds c. Nosebleeds d. aPTT of 100 seconds e. Platelet count of 300,000/mcL

b. aPTT of 40 seconds c. Nosebleeds d. aPTT of 100 seconds Measurement of the aPTT is essential to determine whether the heparin infusion is having the desired effect. If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for bleeding), the physician requires notification for adjustment of the infusion rate. Evidence of bleeding, such as nosebleeds, hematuria, and red or tarry stools, warrant a call to the physician. An aPTT of 65 seconds indicates that a therapeutic effect has been achieved, and a platelet count of 300,000/mcL is within normal limits, indicating no evidence of thrombocytopenia.

Which needle length and gauge should the nurse choose to administer subcutaneous heparin? a. ½ inch; 20 gauge b. ⅝ inch; 25 gauge c. 1½ inch; 18 gauge d. 1 inch; 26 gauge

b. ⅝ inch; 25 gauge Heparin should be administered subcutaneously into the fatty layer of the abdomen with a ½- to ⅝-inch needle, 25 or 26 gauge. The only appropriate option for injection in the list shown is the ⅝-inch, 25-gauge needle.

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? a. "I need to rotate my injection sites, so I'll need to keep a record of them." b. "I will apply hydrocortisone ointment to the injection site if it is itchy." c. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." d. "I can take over-the-counter Benadryl if the injection site itches and is red."

c. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." Brief application of ice rather than warm compress application is indicated prior to injection. Warm compresses may be helpful following the injection. Injection sites should be rotated to decrease discomfort. Itching and erythema can be reduced by topical application of hydrocortisone or oral diphenhydramine.

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? a. "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." b. "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." c. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." d. "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

c. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpesvirus 6, and Chlamydia pneumonia.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? a. "You have apparently developed resistance to your current medication and will have to change to another drug." b. "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." c. "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." d. "You should try to keep taking your medication at the current dose. These effects will go away with time."

c. "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

The nurse is teaching a patient with vitamin B12 deficiency caused by a previous gastrectomy and lack of intrinsic factor. Which statement by the nurse is the most appropriate to include in the teaching plan? a. "Because your body does not have intrinsic factor, vitamin B12 injections will be required." b. "If you increase your intake of animal protein foods, you may be able to avoid injections." c. "You may be prescribed a high dose of oral vitamin B12." d. "You will need to return to the clinic each month for your vitamin B12 injections."

c. "You may be prescribed a high dose of oral vitamin B12." In the past, people with intrinsic factor deficiency were treated only with injections. However, it is now understood that they can be treated successfully with high oral doses of vitamin B12. Oral therapy is preferred, because it is more comfortable and more convenient. Therapeutic oral doses range from 1000 to 10,000 mcg/day.

After 3 weeks of therapy with oral ferrous sulfate, a patient calls the clinic nurse, complaining of continuous nausea and vomiting with this drug. Which is the most appropriate response to this patient? a. "This may indicate a serious adverse effect of this drug. You need to come into the clinic." b. "Try to take your medication with meals. This should reduce your nausea and vomiting." c. "You may need a lower dose, I will contact your primary healthcare provider and call you back." d. "Try taking an antacid just before taking your medication. This can help reduce stomach acid, which causes nausea."

c. "You may need a lower dose, I will contact your primary healthcare provider and call you back." Nausea and vomiting are common adverse effects of ferrous sulfate. Early in treatment, patients may take the medication with food to reduce nausea; however, this significantly reduces absorption. If nausea persists, patients may need a decreased dosage to help mitigate GI effects. Nausea and vomiting are not considered serious adverse effects of the drug. The drug should not be taken with antacids, which reduce iron absorption.

The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? a. 800 mg b. 1400 mg c. 1600 mg d. 3200 mg

c. 1600 mg

A patient with an acute myocardial infarction is prescribed an intravenous (IV) bolus of tenecteplase [TNKase]. The patient weighs 160 lb. The nurse will administer what dosage? a. 30 mg b. 35 mg c. 40 mg d. 45 mg

c. 40 mg 160 lb is 72.72 kg. Body weight of 70 to 79.9 kg is prescribed 40 mg of tenecteplase as a single IV bolus.

Administration of dantrolene [Dantrium] for the treatment of muscle spasticity is contraindicated in which patient? a. A patient with a C6 spinal cord injury b. A patient with cerebral palsy c. A patient with multiple sclerosis and underlying cirrhosis d. A patient experiencing malignant hyperthermia

c. A patient with multiple sclerosis and underlying cirrhosis Although dantrolene is effective for treating spasticity in multiple sclerosis, it is contraindicated in this patient because of the underlying liver disease. Dantrolene is useful for relieving muscle spasticity associated with cerebral palsy and spinal cord injury and, in intravenous form, for managing life-threatening malignant hyperthermia.

The nurse is caring for a group of patients diagnosed with Alzheimer's disease (AD). Which neurotransmitter level is decreased by as much as 90% in patients with severe AD? a. Norepinephrine b. Serotonin c. Acetylcholine d. Dopamine

c. Acetylcholine Acetylcholine (ACh) levels naturally decline by a small percentage with age. Patients with severe AD may have ACh levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD.

A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? a. Urticaria, itching, and flushing b. Blood pressure of 90/50 mm Hg c. Decreasing level of consciousness d. Potassium level of 5.5 mEq/L

c. Decreasing level of consciousness The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level.

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? a. Heart rate of 60 beats/min b. Blood pressure of 160/88 mm Hg c. Discolored urine d. Inspiratory wheezing

c. Discolored urine The primary and most serious adverse effect of heparin is bleeding. Bleeding can occur from any site and may be manifested in various ways, including reduced blood pressure, increased heart rate, bruises, petechiae, hematomas, red or black stools, cloudy or discolored urine, pelvic pain, headache, and lumbar pain.

Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? a. Hair loss b. Backache c. Dizziness and fatigue d. Blue-green tint to the skin

c. Dizziness and fatigue Fingolimod slows the heart rate and can cause bradycardia. Dizziness and fatigue may be consequences of bradycardia. Backache is an adverse effect that occurs in 12% of patients taking the medication, but it does not require prompt attention. Reversible hair loss and a blue-green tint to the skin are adverse effects of mitoxantrone [Novantrone].

A patient with nonmyeloid cancer is receiving oprelvekin [Neumega]. Which adverse effects are most likely associated with this drug? (Select all that apply.) a. Hypertension b. Accelerated tumor progression c. Fluid retention d. Atrial fibrillation e. Anaphylactic reactions

c. Fluid retention d. Atrial fibrillation e. Anaphylactic reactions The primary adverse effects associated with oprelvekin are fluid retention, cardiac dysrhythmias (tachycardia, atrial fibrillation, and atrial flutter), and severe allergic reactions. Hypertension and accelerated tumor progression are associated with epoetin alfa.

The nurse is caring for a patient receiving dantrolene [Dantrium] for spasticity associated with MS. Which laboratory test will be important in monitoring for a potential adverse effect of this drug? a. Blood urea nitrogen (BUN) b. Albumin level c. Gamma-glutamyltransferase (GGTP) d. Complete blood count (CBC)

c. Gamma-glutamyltransferase (GGTP) In large doses dantrolene has been associated with fatal liver failure. Liver function tests, such as gamma-glutamyltransferase (GGTP), should be performed at baseline and periodically thereafter.

The nurse knows that which statement is accurate for enoxaparin [Lovenox]? a. It equally reduces the activity of thrombin and factor Xa. b. It has selective inhibition of factor Xa and no effect on thrombin. c. It reduces the activity of factor Xa more than the activity of thrombin. d. It has a lower bioavailability and shorter half-life than unfractionated heparin.

c. It reduces the activity of factor Xa more than the activity of thrombin. Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Fondaparinux [Arixtra] causes selective inhibition of factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.

What condition increases the patient's risk for the development of myocardial infarction (MI) and disseminated intravascular coagulation (DIC) when receiving anti-inhibitor coagulant complex (AICC)? a. Diabetes b. Chronic renal disease c. Liver disease d. Hypothyroidism

c. Liver disease Because AICC contains multiple coagulation factors, it poses a risk of thrombotic complications, specifically MI and DIC. Although rare, the risk is increased in patients who have liver disease and those who have received repeated dosing.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? a. Phenytoin [Dilantin] 200 mg IV over 4 minutes b. Phenobarbital 30 mg IM c. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min d. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

c. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

Hemophilia is a genetically based bleeding disorder seen almost exclusively in which patients? a. Caucasian b. Hispanic c. Male d. Female

c. Male Hemophilia is a genetically based bleeding disorder seen almost exclusively in males. Because males have only one X chromosome, a male with a defective gene has hemophilia. In contrast, a female with a defective gene on just one X chromosome is an asymptomatic carrier.

Which statement about memantine [Namenda] is false? a. Memantine is indicated for moderate or severe AD. b. Memantine modulates the effects of glutamate. c. Memantine does not slow the decline in function. d. The most common side effects are dizziness, headache, confusion, and constipation.

c. Memantine does not slow the decline in function. For many patients, the drug can slow the decline in function, and, in some cases, it may actually cause symptoms to improve. The other statements are true.

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? a. Decaffeinated tea, gelatin cubes, and ginger ale when alert b. Docusate 100 mg orally daily c. Meperidine 50 mg IM every 4 hours as needed for pain d. Acetaminophen 650 mg every 6 hours as needed for temperature

c. Meperidine 50 mg IM every Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? a. Increased risk of infection b. Reddened, swollen gums c. Nausea, vomiting, and indigestion d. Central nervous system depression

c. Nausea, vomiting, and indigestion Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? a. To increase the amount of acetylcholine at the presynaptic neurons b. To reduce the amount of dopamine available in the substantia nigra c. To balance cholinergic and dopaminergic activity in the brain d. To block dopamine receptors in presynaptic and postsynaptic neurons

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

A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? a. "Amantadine was developed as an antiviral agent but is now used for treatment of PD." b. "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." c. "Amantadine works rapidly and does not lose its effectiveness." d. "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."

d. "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications." Amantadine was developed as an antiviral agent, but this response is not helpful to explain the use of the medication to the family member. Medication effects develop rapidly—often within 2 to 3 days—but are much less profound than with levodopa or the dopamine agonists. Furthermore, effects may begin to diminish within 3 to 6 months. Amantadine is not considered a first-line agent. However, the drug may be helpful for managing dyskinesias caused by levodopa.

A patient received desmopressin preoperatively to maintain hemostasis during a surgical procedure. Which postoperative assessment finding indicates the patient has experienced an adverse effect of the drug? a. Serum sodium level of 150 mEq/L b. Blood glucose level of 220 mg/dL c. Serum potassium level of 5.5 mEq/L d. +2 edema of the extremities

d. +2 edema of the extremities Principal adverse effects of desmopressin are fluid retention and hyponatremia. Edema of the extremities is a sign of fluid retention. A sodium level below 135 mEq/L is considered low.

The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? a. Administer intravenous (IV) push protamine sulfate. b. Continue with the current prescription. c. Prepare to administer vitamin K. d. Call the healthcare provider to increase the dose.

d. Call the healthcare provider to increase the dose. An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose.

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention? a. Warn her not to withdraw this drug abruptly. b. Recommend that she take this medication at bedtime with meals. c. Teach her family to assist by maintaining a seizure frequency chart. d. Ensure that genetic testing for HLA-B1502 is performed.

d. Ensure that genetic testing for HLA-B1502 is performed. Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B1502. The FDA now recommends that before taking carbamazepine, patients of Asian descent undergo genetic testing.

The nurse is caring for a patient with anemia related to chronic renal failure. Which agent might be used to treat the anemia? a. Filgrastim [Neupogen] b. Sargramostim [Leukine] c. Oprelvekin [Neumega] d. Epoetin alfa [Procrit]

d. Epoetin alfa [Procrit] Epoetin alfa is used to increase red blood cell counts in patients with anemia from several causes, including chronic renal failure. Filgrastim is used to elevate neutrophil counts in cancer patients and for the treatment of severe chronic neutropenia. Sargramostim is used to accelerate recovery from bone marrow transplantation. Oprelvekin is given to stimulate platelet production during chemotherapy.

The nurse knows that which statement is most accurate? a. Individuals with severe hemophilia A have less of a risk of developing inhibitors than those with the mild form. b. The risk of inhibitor development is higher in Caucasians than in Hispanics. c. Antibodies to factor VIII develop after 20 to 30 treatments. d. Immune tolerance therapy is more successful in eliminating inhibitor production in hemophilia A than in hemophilia B.

d. Immune tolerance therapy is more successful in eliminating inhibitor production in hemophilia A than in hemophilia B. The success rate of immune tolerance therapy in eliminating inhibitor production in patients with hemophilia A is high (63% to 83%), but it is very low for those with hemophilia B. Individuals with mild hemophilia A have a 3% to 13% risk of developing antibodies to factor VIII, whereas those with the severe form have a 20% to 30% risk. The risk for inhibitor (antibody) development is unusually high in African Americans and Hispanics. Antibodies to treatment with factor VIII or factor IX typically develop after only 9 to 12 courses of treatment.

The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? a. Flu-like symptoms with fever b. Decreased neutrophil count c. Jaundice and elevated bilirubin d. Injection site pain and redness

d. Injection site pain and redness Injection site reactions, such as pain, erythema, pruritus, and induration, are the most common adverse effects of glatiramer. Unlike interferon, glatiramer does not cause flu-like symptoms, myelosuppression, or hepatotoxicity, which would be indicated in the other responses.

A patient has vitamin B12 deficiency following a subtotal gastrectomy. The nurse understands the patient has which type of anemia? a. Microcytic b. Iron deficiency c. Hemolytic d. Megaloblastic

d. Megaloblastic Inadequate absorption of vitamin B12 often is caused by a lack of intrinsic factor in the stomach. A deficiency of vitamin B12 leads to megaloblastic anemia.

On-demand therapy is indicated for which type of patient? a. Patient with mild hemophilia b. Patient with severe hemophilia c. Patient who is allergic to factor VIII (Bioclate) d. Patient who is bleeding or about to undergo surgery

d. Patient who is bleeding or about to undergo surgery On-demand therapy is indicated for patients who are bleeding or about to undergo surgery. The dosage depends primarily on the site and severity of the bleeding.

A patient is receiving cyanocobalamin for the treatment of pernicious anemia. Which electrolyte should the nurse monitor as a result of this treatment? a. Sodium b. Calcium c. Chloride d. Potassium

d. Potassium Potassium depletion (hypokalemia) may occur as a natural consequence of erythrocyte production. Because erythrocytes incorporate significant amounts of potassium and a large number of erythrocytes are being produced, potassium levels may fall. The other electrolytes are not affected.

Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? a. Increased risk of sudden cardiac death b. Documented reports of necrotizing colitis c. Increased risk of Stevens-Johnson syndrome d. Rare cases of dangerous brain infections

d. Rare cases of dangerous brain infections Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug is now available only through a specialized, carefully controlled prescribing program.

A patient being treated for pernicious anemia with cyanocobalamin reports new onset of muscle weakness and states, "My heart is skipping beats." Which laboratory value most likely is contributing to these new symptoms? a. Serum chloride level of 98 mEq/L b. Serum sodium level of 133 mEq/L c. Serum glucose level of 185 mg/dL d. Serum potassium level of 2.3 mEq/L

d. Serum potassium level of 2.3 mEq/L Potassium depletion (hypokalemia) may occur as a natural consequence of erythrocyte production. Because erythrocytes incorporate significant amounts of potassium and a large number of erythrocytes are being produced, potassium levels may fall. A serum potassium level of 2.3 mEq/L indicates hypokalemia. The sodium, chloride, and blood glucose levels are not affected.

Which medication acts as an agonist at the presynaptic alpha-2 receptor site? a. Baclofen [Lioresal] b. Dantrolene [Dantrium] c. Diazepam [Valium] d. Tizanidine [Zanaflex]

d. Tizanidine [Zanaflex] Tizanidine promotes inhibition by acting as an agonist at presynaptic alpha2 receptors. Dantrolene relieves spasm by suppressing release of calcium from the sarcoplasmic reticulum. Baclofen and diazepam promote inhibition by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20? a. Primidone [Mysoline] b. Lamotrigine [Lamictal] c. Lacosamide [Vimpat] d. Topiramate [Topamax]

d. Topiramate [Topamax] The arterial blood gas results reflect metabolic acidosis with partial respiratory compensation. Topiramate can cause metabolic acidosis, because it inhibits carbonic anhydrase; this increases renal excretion of bicarbonate, causing the plasma pH to fall. Hyperventilation is the most characteristic symptom. Primidone, lamotrigine, and lacosamide do not cause metabolic acidosis.