Pharm Exam 5
What beta-adrenergic antagonist is used for migraine prophylaxis?
propranolol Explanation: The most commonly administered beta-adrenergic blocking agent for migraine headaches is propranolol. Verapamil is a calcium channel blocker. Valproic acid is a carboxylic acid derivative administered to control seizures and prevention of migraine headaches. Topiramate is a sulfamate-substituted monosaccharide agent used as an antiepileptic agent and to limit migraine frequency.
A caregiver asks the nurse what the caregiver can give a 9-year-old child for a headache. What is the nurse's best response?
"Acetaminophen is appropriate." Explanation: Acetaminophen is appropriate. Acetaminophen-aspirin-caffeine is recommended for children older than 12 years of age. Ketorolac and triptans are not prescribed for children.
"Have you recently taken any other medications to treat this migraine?"
"Ask your healthcare provider what other medications you can take." Explanation: The medication should only be taken if the benefit outweighs the risk. If another medication can control the migraine, then the patient should avoid sumatriptan while pregnant because of risk to the fetus.
The patient asks how caffeine will help a migraine headache. How should the nurse respond?
"Caffeine causes constriction of blood vessels." Explanation: Caffeine constricts blood vessels. Migraines are caused by the dilation of blood vessels. Enhancing neurologic function does not help to decrease headaches. Caffeine does not block prostaglandins, nor does it help the patient cope with the pain.
An adult resident of an assisted living facility has a history of migraines and has a prescription for sumatriptan, administered PRN. Before the client takes a dose, the nurse should ask what question to ensure the client's safety?
"Have you recently taken any other medications to treat this migraine?" Explanation: It is important to ask the client about the recent administration of ergot alkaloids. The ergot alkaloids should not be given within 24 hours of the administration of triptans. The combination of ergot-containing drugs and the triptans results in cardiac ischemia. Antacids do not interfere with efficacy or pose a risk to safety. Constipation is unlikely, so the client's last bowel movement is not critical. It is important to gauge the effectiveness during the last migraine, but this is not related to safety.
What statement indicates the patient needs more teaching about administering sumatriptan subcutaneously?
"I can take this medication safely when pregnant." Explanation: The medication should not be taken if pregnant.
The nurse has been educating the client on the self-administration of phenytoin. Which statement by the client demonstrates an understanding of the medication?
"I should not change brands without checking with my health care provider." Explanation: All brands of phenytoin are not the same. If a client taking one form of phenytoin switches to another, there is a risk of serum phenytoin levels that are too high or too low, toxicity or loss of therapeutic effectiveness, and seizures. The client should not change forms except at the direction of the prescribing health care provider. If cost is a concern, the client should discuss the issue with the provider. The administration of acetylsalicylic acid is contraindicated with phenytoin.
Which statement indicates that more teaching is necessary for the patient taking ergotamine?
"I will hold off taking the medication until the pain is unbearable." Explanation: The patient should take the medication at the onset of the headache and not wait until it gets worse.
A 30-year-old female client is diagnosed with seizure disorder, and the provider is considering the use of carbamazepine. What assessment question best addresses the safety and effectiveness of the medication regimen?
"Is there any chance that you could be pregnant?" Explanation: Carbamazepine is contraindicated during pregnancy. A female client of this age should be assessed for pregnancy prior to starting to take the drug. The client's history of hepatitis vaccinations does not have a major bearing on treatment. Visual changes are unlikely and there are not known optic conditions that contraindicate use. It is appropriate to assess the client's ability to pay but this does not directly relate to client safety.
A female client calls the clinic and states she has been taking propranolol for the last week to help decrease the incidence of migraine headaches. The client states that there has been no decrease in the number of headaches yet. What is the nurse's best response?
"It may take up to 3 months to know whether this medication will be effective in preventing your migraine headaches." Explanation: Propranolol is a beta-blocker and it may take up to 3 months to be effective as a migraine preventative.
A client has been diagnosed with partial seizures and has been prescribed carbamazepine. When providing health education about the safe and effective use of this medication, what should the nurse teach the client?
"It's safest if you avoid drinking alcohol while you're taking this drug." Explanation: Use of alcohol during treatment with carbamazepine is contraindicated due to the potential for CNS depression. Carbamazepine is taken on an ongoing basis to prevent partial seizures; it is not a treatment for impending seizure activity. It is administered orally, not by injection, and it does not necessitate significant dietary changes.
A client with myoclonic seizures has been prescribed clonazepam as an adjunctive treatment by the neurologist. What teaching should the nurse prioritize when explaining this new drug regimen to the client?
"Make sure you don't stop taking this abruptly because that might bring on a seizure." Explanation: Tolerance to the antiseizure effects of clonazepam can occur within months. Abrupt withdrawal of the drug induces seizures, including status epilepticus. Clonazepam causes drowsiness, not agitation, and it is unnecessary to monitor blood sugar closely. Administration is oral, not intravenous.
A patient with a cluster headache reports that the health care provider did not prescribe anything but "air." What is the nurse's best response to this statement?
"Oxygen therapy has been shown to help relieve cluster headaches." Explanation: The nurse should explain the rationale for the treatment, not address the patient's statement about being prescribed "air."
A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug?
"Take this drug as soon as you feel the first signs of a migraine." Explanation: Administer sumatriptan as soon as the headache begins. Sumatriptan is more efficacious when given before the headache escalates. However, it is not normally taken on a prophylactic basis.
A 50-year-old client received atropine preoperatively. The nurse explains the symptom of dry mouth to client as which effect?
"The medication temporarily decreased your salivation." Explanation: Adverse effects of atropine and other anticholinergic drugs include decreased secretions of salivary glands. Atropine does not cause a loss of body fluid or electrolyte imbalance. Even though the client would be NPO for surgery, the atropine would not cause dehydration.
After teaching the caregiver of a client prescribed transdermal rivastigmine, the nurse determines that the teaching was successful when the caregiver makes which comment?
"The patch should be placed on a hairless area." Explanation: Rivastigmine patches are changed on a daily basis and rotated to a clean, dry, and hairless area. Because the client is experiencing dementia, the site for application should be where the client is not able to pick at or remove the patch. The upper or lower portions of the back are recommended for patch administration. Because the same site should not be used more than once every 2 weeks, the caregiver should be instructed to make a chart of the back and indicate where patches have been applied during the last 14 days.
A caregiver of a client diagnosed with AD asks the nurse about galantamine. Which response by the nurse would be most appropriate?
"These drugs help to slow the progression of the disease." Explanation: The progression of memory loss associated with dementia is treated with cholinesterase inhibitors. These drugs slow progression but do not cure dementia. These drugs are given to clients with mild to moderate dementia, but they do not treat any delirium that the clients may experience. Cholinesterase inhibitors are not frequently used in late-stage AD.
A female client's seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse's best response?
"They are considered teratogenic." Explanation: Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED.
A client who has been prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, but I feel like a headache is returning. Can I take another pill?" How should the nurse respond?
"Wait at least half-an-hour before you take another pill." Explanation: Clients can take a second dose of oral sumatriptan when symptoms return but no sooner than 2 hours after the first tablet. There's no evidence that the client needs to go to the emergency department.
A female client has been prescribed ropinirole (Requip). She states, "I don't know why they are giving me this medicine. I don't have restless leg syndrome." What is the nurse's best response in teaching this client with newly diagnosed Parkinson's disease about ropinirole (Requip)?
"You are right about ropinirole, but it is also used in early Parkinson's disease." Explanation: Ropinirole (Requip) is used for restless leg syndrome and in the beginning and advanced stages of Parkinson's disease. The statement, "You are mistaken; ropinirole is not used for restless leg syndrome" is incorrect. It is used for restless leg syndrome. The statement, "Your health care provider must have written the prescription wrong" is incorrect. Ropinirole is used for restless leg syndrome, not for migraine headaches.
A client has taken sumatriptan and does not feel it is working. The client wants to know when more medication can be administered. Which response should the nurse prioritize?
"You can take a second dose 2 hours after the first." Explanation: The maximum daily dose should not exceed 100 mg/day. The client needs to wait at least 2 hours before another dose can be given. A second dose is not doubled, nor is a different medication automatically given if the first dose is not effective. .
The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage?
2 mcg/mL Explanation: Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.
A client is receiving phenytoin. The nurse monitors the client's plasma drug level. Which level would alert the nurse to the possibility of toxicity?
27 µg/mL Explanation: Phenytoin plasma levels between 10 and 20 µg/mL give optimal anticonvulsant effect. However, many clients achieve seizure control at lower serum concentration levels. Levels greater than 20 µg/mL are associated with toxicity.
Which client should the nurse identify as having an absence seizure?
A client whose alterations in consciousness last a few seconds. Explanation: Absence seizures are characterized by abrupt alterations in consciousness that last only a few seconds. Characteristics of an absence seizure do not include automatic and repetitive movements, abnormal movements and bizarre behavior, or sustained contraction of skeletal muscle.
A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter?
Acetylcholine Explanation: Cholinergic drugs act like the neurotransmitter acetylcholine. Serotonin, dopamine, and norepinephrine are the neurotransmitters that affect mood.
A 75-year-old male client is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which drug would the nurse expect the health care provider to order to relieve these symptoms?
Anticholinergics Explanation: Anticholinergic medications are indicated in the relief of central nervous system symptoms of Parkinson's disease or extrapyramidal symptoms associated with some antipsychotic drugs.
What explanation should the nurse provide for why pregnancy is discouraged in women who are being treated for seizure disorders?
Antiepilepsy drugs are teratogenic. Explanation: Antiepileptic drugs such as valproic acid must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not normally genetic or familial. Antiepilepsy medications do not decrease fertility.
A client has been admitted to the emergency department with sudden nausea, diaphoresis, and shortness of breath. A thorough history has revealed that the client's signs and symptoms are attributable to an accidental overdose of neostigmine (Prostigmin). The nurse who is providing care should anticipate that the client is likely to require what drug?
Atropine Explanation: As with other cholinergic stimulants, the use of neostigmine requires the availability of an antidote in case of systemic overdose or cholinergic crisis. Atropine, as an anticholinergic, is the usual antidote. Isoflurophate, demecarium, and physostigmine are all cholinergic stimulants and would exacerbate the client's condition.
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent?
Atropine Explanation: Atropine is considered an antidote for a cholinergic drug overdose. Dopamine is a catecholamine neurotransmitter that is given to increase the contraction of the heart in shock. Epinephrine is a hormone released in the presence of stress and is given in the case of allergic reaction and norepinephrine is a neurotransmitter from the autonomic nervous system, that constricts blood vessels, raising blood pressure.
Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
Atropine Explanation: Atropine is used to counteract the severe effects of an indirect acting cholinergic agonist. Naloxone is used to reverse opioid toxicity. Edrophonium is used as the antidote for nondepolarizing NMJ blockers. Phentolamine is used as treatment for extravasation of IV norepinephrine or dopamine.
A client with dementia of Alzheimer disease is prescribed memantine. Before administering the drug to the client, which would the nurse observe while obtaining the client's health history?
Behavior patterns Explanation: When taking the health history of the client, the nurse should observe the client's behavior patterns so that they can be used as a baseline for comparison during therapy. It is not required to observe eating habits, resistance power, and sleeping patterns when taking the health history of this client.
What is a priority nursing assessment of a client prescribed oral sumatriptan?
Blood pressure Explanation: After administration of sumatriptan, the nurse should assess for adverse effects. These include increased blood pressure as well as chest pain, shock, dizziness and vertigo. Urine output and head to toe assessment are not warranted. The Glasgow comas scale is used to determine best neurological function and not migraine pain.
A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department reporting abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which situation is occurring?
Cholinergic crisis Explanation: Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing. Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing. There is no information to suggest that the client has an underlying infection.
A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what?
Decreased tremors Explanation: Decreased tremors would indicate effective antiparkinsonism therapy. Intellectual dysfunction is not a manifestation associated with Parkinson's disease. Parkinson's disease is not associated with aggression.
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?
Diazepam Explanation: IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Ethosuximide is prescribed for absence seizures, myoclonic seizures, and akinetic epilepsy. Neither meperidine nor insulin is administered for status epilepticus.
The nurse is reviewing the results of a hospital client's serum phenytoin level, which has just become available. The results indicate that the client's phenytoin level is 17.5 mcg/mL. What is the nurse's best action?
Document the fact that the nurse checked the client's phenytoin levels Explanation: The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation.
A 70-year-old female patient has just been diagnosed with Alzheimer's disease. What cholinergic drug is used for the treatment of Alzheimer's disease?
Donepezil (Aricept) Explanation: Currently, there are four reversible indirect-acting cholinergic agonists available to slow the progression of this disease. These include tacrin (Cognex), galantamine (Razadyne), rivastigmine (Exelon), and donepezil (Aricept). Tensilon is used to diagnose myasthenia gravis; Prostigmine is used for the diagnosis and management of myasthenia gravis; and Duvoid is used infrequently today because of its widespread parasympathetic activity.
A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request?
Evaluate the client for adverse reactions from the centrally acting anticholinergics Explanation: When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.
The pharmacology instructor is discussing the differences between monotherapy and therapy that includes AEDs. What would the instructor cite as an advantage of monotherapy?
Fewer drug-drug interactions Explanation: If effective in controlling seizures, monotherapy has the advantages of fewer adverse drug effects, fewer drug-drug interactions, lower cost, and usually greater patient compliance.
The caregiver of a client diagnosed with AD asks the nurse about the prescribed therapy with rivastigmine and about how the drug works. The nurse would integrate knowledge of which action in the response to the caregiver?
Increases the level of acetylcholine in the CNS Explanation: Administration of cholinesterase inhibitors results in an increase in the level of acetylcholine in the CNS by inhibiting its breakdown and slowing neural destruction. This will also result in a decrease of cholinesterase in the blood. Administration of cholinesterase inhibitors does not decrease the neurotoxins in the brain or increase the level of adenosine triphosphate in the blood. Cholinesterase inhibitors inhibit and do not increase the level of cholinesterase in the blood.
Ergotamine tartrate is a drug used in the treatment of migraines. Cafergot is a mix of ergotamine tartrate and caffeine. What effect of caffeine aids in the treatment of migraines?
It increases vasoconstriction. Explanation: By itself, ergotamine may be poorly absorbed. Caffeine reportedly aids in the treatment of migraines by increasing the absorption and vasoconstrictive effects of ergotamine. Since caffeine is a stimulant, it does not promote relaxation or decrease blood pressure. Caffeine may increase urinary output in some people.
The most effective drug to treat major symptoms associated with Parkinson's is:
Levodopa. Explanation: Levodopa is the most effective drug available for the treatment of Parkinson's disease. It relieves all major symptoms, especially bradykinesia and rigidity. Levodopa does not alter the underlying disease process, but it may improve a client's quality of life.
What should the nurse include as a possible adverse effect when teaching a client about phenytoin?
Liver toxicity Explanation: Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.
A patient who is the administrator of a large healthcare agency reports constant stress on the job, causing "tension headaches." What therapy will the nurse teach the patient to use?
Nonsteroidal anti-inflammatory agents Explanation: The patient with tension headaches is treated with NSAIDs, rest, relaxation, and stress reduction techniques. IV medication is not used. Running hands under cold water is used for migraine headaches. Oxygen therapy is used for cluster headaches.
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?
Observe respirations frequently. Explanation: When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently. The nurse need not monitor blood glucose levels or body temperature. The nurse need not record fluid input and output. The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant.
A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?
Pain scale Explanation: The method the nurse should prioritize in this situation is using the pain scale. Following the administration of the acetaminophen-aspirin-caffeine combination, the client should exhibit diminished pain. The nurse assesses for pain using the pain scale. A subjective assessment would involve more than just the pain scale. Assesing vital signs would be an objective assessment and not necessarily confirm therapeutic effects The Glasgow coma scale would not be indicated for migraine headache.
A client with Alzheimer's disease is being treated with the medication Exelon. The nurse knows that this drug is also used to treat which disorder?
Parkinson's disease Explanation: Exelon is used to treat mild to moderate dementia of Alzheimer's disease and Parkinson's disease. All cholinesterase inhibitors are used cautiously in clients with renal or hepatic disease, bladder obstruction, seizure disorders, sick sinus syndrome, gastrointestinal bleeding, and asthma.
After teaching an in-service program about nervous system conditions, the nurse determines that the teaching was successful when the group identifies which condition or disease as a group of symptoms involving motor movement characterized by tremors, rigidity, and bradykinesia?
Parkinsonism Explanation: Parkinsonism is a general term that refers to a group of symptoms involving motor movement. Myasthenia gravis is a neuromuscular condition characterized by weakness and fatigability of the muscles. Seizure disorder involves a cluster of symptoms resulting from abnormal electrical activity in the brain. Anxiety refers to a feeling of apprehension, worry, or uneasiness.
A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours?
Phenytoin Explanation: Due to the short effects of lorazepam, a longer-acting anticonvulsant, such as phenytoin, is given to continue control of seizure activity. Ethotoin is a hydantoin that is used to treat tonic-clonic seizures. Ethosuximide is a succinimide that is used to treat focal seizures. Zonisamide is a nonspecified preparation and used to treat focal seizures as well.
The client newly diagnosed with epilepsy begins to show signs of seizure activity. What is the nurse's priority action?
Protect the client's safety. Explanation: As in any nursing situation, safety is paramount. The client's safety is prioritized over documentation or gathering vital signs. Seizure activity cannot be influenced by calming a client.
An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize?
Respiratory rate and depth Explanation: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill clients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. If the client is prescribed diazepam and antidiabetic medications, there may be an increase in the blood glucose level. The nurse should test the client's swallowing ability by offering sips of water before giving the drug. If there is difficulty swallowing, hold the drug and contact the health care provider as soon as possible. Slurred speech is an adverse reaction of hydantoins. It is also a potential sign of toxicity; however, the most important would be to determine the respiratory status and if that is functioning within reasonable parameters, then address the toxicity issue, if present.
A client taking carbidopa-levodopa for the treatment of Parkinson's disease reports blurred vision and the nurse observes that the client has worsening ataxia. Which nursing diagnosis should the nurse prioritize?
Risk for injury Explanation: The client has blurred vision and ataxia (muscular incoordination), placing the client at risk for falls and injury. Impaired verbal communication would be appropriate if the client was experiencing difficulty with speech. Disturbed body image would be appropriate if the client was voicing issues related to appearance or effect of the disease or drug therapy on appearance or body. Ineffective role performance would be appropriate if the client verbalized problems in fulfilling his role due to the changes in vision and the motor problems.
A client prescribed phenytoin for a seizure disorder has recently run out of medication and has not obtained a refill. What is the client at risk for developing?
Status epilepticus Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping antiepileptic drugs. Abruptly stopping phenytoin will not cause hypotension, migraine headaches, or depression.
A female client's health care provider orders an ergot preparation for her migraine headaches. The nurse is responsible for the education plan. What would be the nurse's teaching regarding how the client is to take her medication?
Take it at the onset of a headache, and lie down in a quiet, darkened room. Explanation: If an ergot preparation is used, it should be given at the onset of headache, and the client should lie down in a quiet, darkened room.
A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client's history should prompt the nurse to discourage the client from taking the drug?
The client has a diagnosis of liver cirrhosis. Explanation: Clients diagnosed with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.
A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect?
The client is able to walk more briskly and stably than two weeks ago Explanation: Gait is affected by Parkinson's disease and an improvement in health status can often be seen in the pace and character of the client's gait. Cognition is not affected, so orientation cannot gauge the course of the disease or the effectiveness of treatment. Maintenance of respiratory status indicates that the client has not aspirated, but this does not necessarily mean that the client's health status has improved. A change in appetite may or may not be attributable to drug therapy.
What is essential for the nurse to assess prior to the patient taking sumatriptan-naproxen sodium (Treximet)?
The patient's cardiac history Explanation: The patient who takes Treximet has an increased risk of myocardial infarction. The medication is taken orally. Being nauseous is not a contraindication to taking this medication. The patient does not have to eat with the medication.
A female client has been taking Aricept for several months. The family feels that she is better and wants to stop the medication. What would be an important teaching point?
This medication is a treatment, not a cure. If you stop it, she will lose any benefits that she has gained. Explanation: Cholinesterase inhibitors treat AD, they do not cure it. If the medication is stopped, the benefits seen previously will be lost. Nausea and vomiting are common side effects but not a reason to stop the medication. The cost of a medication should not determine if a client receives it or not. Cholinesterase inhibitors are not placebos; much research has been done on their effectiveness.
The nurse administers ergotamine tartrate (Ergot). What is the expected pharmacologic effect?
Vasoconstriction Explanation: Ergotamine cases stimulation of cranial and peripheral vascular smooth muscles and constricts blood vessels to help abort a migraine. The expected effect is not drowsiness or diuresis. It does not mask or suppress pain. It should get rid of the cause of the migraine.
A client, newly diagnosed with a seizure disorder, asks the nurse why the client is receiving a specific drug. What would be the best answer by the nurse?
When prescribing an AED, the health care provider takes into account the type of seizure the client is having. Explanation: Type of seizure is a major factor in drug selection. Age and gender are not factors that impact the choice of AED.
A client diagnosed with Parkinson's disease and hepatic disease is to begin tolcapone therapy. What intervention should be included in the client's plan of care?
a baseline liver function test Explanation: The FDA has issued a black box warning stating that clients who take tolcapone risk potentially fatal acute fulminant liver failure. It is important to monitor liver function tests before therapy begins and every 2 weeks thereafter. Tolcapone is not associated with health risks that would require any of the other proposed interventions.
What is typically the first observable symptom of Parkinson's disease?
a resting tremor that begins in one hand, involving the fingers and thumb of one hand. Explanation: The first symptom of Parkinson's disease is often a resting tremor that begins in the fingers and thumb of one hand (pill-rolling movements), eventually spreading over one side of the body and progressing to the contralateral limbs. Other common symptoms include slow movement (bradykinesia), inability to move (akinesia), rigid limbs, shuffling gait, stooped posture, masklike facial expression, and a soft speaking voice. Head tremor, impaired mobility, and eventual dementia will typically develop after hand tremor.
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus?
abruptly stopping the antiseizure medications Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline).
The nursing student correctly identifies the transmitter in the cholinergic neuropathways that appears insufficient in clients with Alzheimer's disease is which?
acetylcholine. Explanation: Acetylcholine is the transmitter in the cholinergic neuropathways. Clients with early-stage Alzheimer's disease demonstrate a degeneration of these pathways. Epinephrine is a hormone and neurotransmitter; it acts on all body tissues and is responsible for such things as contraction of smooth muscles in the airways and that line the arterioles. Norepinephrine is also both a hormone and neurotransmitter; it works with epinephrine to give the body energy in times of stress. Memantine is a drug used to treat clients in late-stage Alzheimer's disease.
An adult client with a history of migraines has been prescribed sumatriptan 50 mg PO PRN. When should the nurse instruct the client to take the medication?
as soon as migraine symptoms are sensed Explanation: It is important to administer sumatriptan at the onset of migraine symptoms. As an abortive therapy, the medication is not taken on a daily basis, at the same time each day.
A 78-year-old man is admitted to the emergency department (ED) with bradycardia resulting from overdose of donepezil. The nurse knows that the ED is likely to order which medication?
atropine Explanation: Atropine is a specific antidote to cholinergic drugs and may be used to treat overdose. The other medications are not the antidote.
Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
decrease salivation, spasticity, and tremors. Explanation: Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. They are used primarily in people who have minimal symptoms or who cannot tolerate levodopa, or in combination with other antiparkinson drugs.
What is a common risk for epileptic seizures during late infancy to early childhood?
fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.
A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?
take the medication with food. Explanation: The nurse should advise the client to take the medication with food to minimize the GI adverse effects. Administering rivastigmine with food delays drug absorption but does not impair it. The nurse should not tell a client to stop a medication. Only the prescriber can start or stop a medication. If a client is having an adverse effect and it can be minimized, then the nurse should advise the client on what to do. This client does not needlessly have to suffer from the GI adverse effects.
A client is prescribed phenytoin and reports gastrointestinal (GI) upset. The nurse should tell the client to:
take the medication with meals. Explanation: When phenytoin is taken orally, the drug should be taken with meals to avoid GI upset, rather than two hours after dairy products. Phenytoin by injection is a more invasive route. First, the client can be instructed to take the medication with meals. Taking the medication at bedtime is not as effective in preventing GI upset than taking the drug with meals.
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which?
use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects.
