Pharm III Exam practice questions from Saunders

The nurse has completed discharge teaching for a client prescribed carbamazepine. Which statement by the client indicates that education about the main effect of the medication was effective? 1."This medication has an anticonvulsant effect." 2."This medication interferes with DNA production." 3."The main effect is a decrease in intraocular pressure." 4."The main action of this medication is prevention of cellular division."

1."This medication has an anticonvulsant effect." Rationale:Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. The remaining options are not actions or effects of this medication.

A client is scheduled to begin medication therapy with valproic acid. The nurse looks for the results of which laboratory test(s) before administering the first dose? 1.Liver function tests 2.Renal function tests 3.Pulmonary function test 4.Pancreatic enzyme studies

1.Liver function tests Rationale:Gastrointestinal effects from valproic acid are common and typically mild, but hepatotoxicity, although rare, is serious. To minimize the risk of fatal liver injury, liver function is evaluated before initiation of treatment and periodically thereafter. The other options are unrelated to the use of this medication.

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? 1.Restrict fluid intake. 2.Avoid the use of alcohol. 3.Stop the medication if diarrhea occurs. 4.Notify the health care provider (HCP) if fatigue occurs.

2. Avoid alcohol Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is a side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the HCP about fatigue.

The nurse taking a medication history for a client who has been admitted to the nursing unit notes that the client is receiving olanzapine. The nurse interprets that this client most likely has a history of which disorder? 1.Hypertension 2.Schizophrenia 3.Diabetes mellitus 4.Diabetes insipidus

2.Schizophrenia Rationale:Olanzapine is an antipsychotic medication that targets both the positive and the negative symptoms of schizophrenia. The other options listed are not indications for use of this medication.

A client has been administered cyclobenzaprine (muscle relaxant) for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. How should the nurse interpret these findings? 1.Represent an allergic reaction to the medication 2.Are related to the problem with the cervical spine 3.Are the most common side effects of this medication 4.Are dose related, so the client should cut the medication dose in half

3. Most common ss Rationale:Drowsiness, dizziness, and dry mouth are the most common side effects of cyclobenzaprine, and these side effects usually diminish with continued therapy. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm that accompanies a variety of conditions. The remaining options are incorrect.

A client has a lithium level of 2.4 mEq/L. The nurse should immediately assess the client for which sign or symptom? 1.Diarrhea 2.Weakness 3.Blurred vision 4.Cardiac dysrhythmias

3.Blurred vision Rationale:At lithium levels of 2.0 to 2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2.0 mEq/L the client experiences vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3.0 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

The nurse preparing to administer carbamazepine notices a number of items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray? 1.Carton of milk 2.Scrambled eggs 3.Grapefruit juice 4.Toast with honey

3.Grapefruit juice Rationale:Grapefruit juice can increase peak and trough levels of carbamazepine. Accordingly, clients taking the medication should be advised to avoid grapefruit juice. The other foods can be taken with this medication.

A client diagnosed with bipolar disorder is prescribed lithium carbonate. The nurse who administers the medication knows that lithium is used primarily to treat which condition? 1.Suicidal ideations 2.The manic phase of bipolar disease 3.Both depressive and manic episodes 4.The depressive phase of bipolar disease

2.The manic phase of bipolar disease Rationale:Lithium is an antimanic medication and is used to treat the manic phase of a manic-depressive disorder. The remaining options are incorrect.

The nurse is administering risperidone to a client who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? 1.Get adequate sunlight. 2.Continue driving as usual. 3.Avoid foods rich in potassium. 4.Get up slowly when changing positions.

4.Get up slowly when changing positions. Rationale:Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as with driving or other activities requiring alertness) until the individual can determine whether his or her level of alertness is affected. Food interaction is not a concern.

The nurse is providing instructions to a client beginning medication therapy with divalproex sodium for treatment of absence seizures( ALSO FOR BIPOLAR). The nurse instructs the client that which represents the most frequent side or adverse effect of this medication? 1.Tinnitus 2.Irritability 3.Blue vision 4.Nausea and vomiting

4.Nausea and vomiting Rationale:The most frequent side and adverse effects of medication therapy with divalproex sodium are gastrointestinal (GI) disturbances, such as nausea, vomiting, and indigestion. The items in the other options are incorrect.

A client has a prescription for valproic acid. To maximize the client's safety, the nurse should plan to monitor for which potential complications of this medication? Select all that apply. 1.Pancreatitis 2.Hypotension 3.Renal failure 4.Hepatotoxicity 5.Cardiotoxicity

1.Pancreatitis 4.Hepatotoxicity Rationale:Valproic (liver) acid is an anticonvulsant that causes central nervous system depression. Although rare, this medication has caused pancreatitis and hepatoxicity. The nurse should monitor for these complications. The other complications noted in the options are not specifically associated with this medication.

A client with a history of spinal cord injury is beginning medication therapy with baclofen. The nurse determines that the client understands the side/adverse effects of the medication if the client makes which statement? 1."The medication may make me drowsy." 2."The medication can cause high blood pressure." 3."The medication may cause me to have some muscle pain." 4."The medication may increase my sensitivity to bright light."

1."The medication may make me drowsy." Rationale:Baclofen is a central-acting skeletal muscle relaxant useful in treating muscle spasticity, usually in upper motor neuron injury. Side/adverse effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. The other options are incorrect.

A client with status epilepticus has been prescribed phenytoin to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate? 1.50 mg/min 2.60 mg/min 3.100 mg/min 4.750 mg/min

1.50 mg/min Rationale:IV administration of phenytoin is performed slowly (no faster than 50 mg/min) because rapid administration can cause cardiovascular collapse. It should not be added to any existing IV infusion because this is likely to produce a precipitate in the solution. Solutions are highly alkaline and can cause local venous irritation.

A client has a prescription to receive valproic acid daily. To ensure the client's safety, when is the best time for the nurse to schedule the administration of this medication? 1.At bedtime 2.Mid-afternoon 3.Two hours after lunch 4.Two hours before breakfast

1.At bedtime Rationale:Valproic acid is an anticonvulsant that causes central nervous system (CNS) depression. For this reason, the side effects include sedation, dizziness, ataxia, and confusion. When the client is taking this medication as a single daily dose, administering it at bedtime negates the risk of injury from sedation and enhances client safety. The medication also should be administered at the same time each day.

The nurse is caring for a client who is taking a maintenance dosage of lithium carbonate. What nursing action should be included in the client's plan of care? 1.Monitoring intake and output 2.Reviewing daily serum lithium levels 3.Performing a weekly electrocardiogram 4.Observing for remission of a depressive state

1.Monitoring intake and output Rationale:This medication is very dependent on stable body fluid levels, and so monitoring daily intake and output is critical. Lithium is used to treat manic disorders, not depression. Side/adverse effects of lithium are nausea, tremors, polyuria, and polydipsia. Serum lithium concentration is assessed approximately every 2 to 4 days during initial therapy and at longer intervals thereafter. Toxic levels of lithium may induce electrocardiogram changes; however, performing weekly ECGs is unnecessary if therapeutic levels are maintained.

A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L (2.5 mmol/L). The nurse plans care based on which representation of this level? 1.Toxic 2.Normal 3.Slightly above normal 4.Excessively below normal

1.Toxic Rationale:Maintenance serum levels of lithium are 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Symptoms of toxicity begin to appear at levels of 1.5 to 2 mEq/L (1.5 to 2 mmol/L). Lithium toxicity requires immediate medical attention with lavage and possible peritoneal dialysis or hemodialysis.

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which finding, if noted during the nursing assessment, would indicate that the client is experiencing a side/adverse effect of this medication? 1.Headache 2.Drowsiness 3.Urinary retention 4.Increased salivation

2. Drowsiness Rationale: Incoordination and drowsiness are common side/adverse effects of diazepam. The remaining options are unrelated to the use of this medication.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (SSRI). Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? 1.Cardiovascular symptoms 2.Gastrointestinal dysfunctions 3.Problems with mouth dryness 4.Problems with excessive sweating

2.Gastrointestinal dysfunctions Rationale:The most common side and adverse effects related to fluoxetine include central nervous system and gastrointestinal system dysfunction. Fluoxetine affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.

A client who is receiving lithium carbonate has a serum level of 1.8 mEq/L. Which intervention will the nurse implement in response to this diagnostic result? 1.Plan rest periods into the client's daily routine. 2.Monitor the client for behaviors that suggests ataxia. 3.Document incidences that the client has begun to demonstrate mood stability. 4.Notify the client's health care provider that the medication dosage needs to be increased.

2.Monitor the client for behaviors that suggests ataxia. Rationale:A serum lithium level of 1.8 mEq/L indicates moderate toxicity. Serum lithium concentrations of 1.5 to 2.5 mEq/L may produce vomiting, diarrhea, ataxia, incoordination, muscle twitching, and slurred speech. The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level below that indicates a need for an increase in dosage. Fatigue is a common side effect of this medication.

A client diagnosed with schizophrenia has been prescribed clozapine. The nurse should monitor the client for which side/adverse effects of this medication? Select all that apply. 1.Diarrhea 2.Sedation 3.Dry mouth 4.Weight loss 5.Orthostatic hypotension 6.Presence of a fixed stare

2.Sedation 3.Dry mouth 5.Orthostatic hypotension 6.Presence of a fixed stare\ Rationale:Clozapine is an antipsychotic medication used to treat schizophrenia. Hallucinations, delusions, and altered thought processes are characteristic of this disorder and should decrease with effective treatment. Fixed stare, dry mouth, orthostatic hypotension, and sedation are side/adverse effects of therapy. The other options are unrelated to this medication.

A client prescribed chlorpromazine hydrochloride calls the mental health clinic to report urine that is much darker than usual. The client currently has no other urinary symptoms. What instructions should the nurse provide the client based on this information? 1.To seek treatment for a possible urinary tract infection 2.That this is an expected side effect of the medication 3.To increase the daily intake of acid-ash foods and liquids 4.That this symptom indicates mild chlorpromazine hydrochloride toxicity

2.That this is an expected side effect of the medication Rationale:Chlorpromazine hydrochloride is an antipsychotic medication. A side effect of this medication is that the color of urine may darken. The client should be aware that this effect is harmless. The other options are incorrect and not associated with this medication.

The nurse has a prescription to administer diazepam 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long? 1.15 seconds 2.30 seconds 3.1 minute 4.5 minutes

3.1 minute Rationale:The recommended rate of infusion of diazepam is to give each 5 mg of the medication over at least 1 minute. This will prevent adverse effects, including apnea, bradycardia, hypotension, and possibly cardiac arrest.

The nurse in the health care provider's office is reviewing the results of a client's phenytoin level determination performed that morning. The nurse identifies that a therapeutic medication level has been achieved if which result is noted? 1.3 mcg/mL (11.9 mmol/L) 2.8 mcg/mL (31.74 mmol/L) 3.15 mcg/mL (59.52 mmol/L) 4.24 mcg/mL (95.23 mmol/L)

3.15 mcg/mL Rationale:The therapeutic range for serum phenytoin levels is 10 to 20 mcg/mL (40 to 79 mmol/L) in clients with normal serum albumin levels and renal function. A level below this range indicates that the client is not receiving sufficient medication and is at risk for seizure activity. In this case, the medication dose should be adjusted upward. A level above this range indicates that the client is entering the toxic range and is at risk for toxic effects of the medication. In this case, the dose should be adjusted downward.

The nurse has a prescription to administer phenytoin 100 mg mixed in 5% dextrose in water by the intravenous (IV) route to a client. After reading this prescription, which action should the nurse take? 1.Prepare the solution for administration. 2.Contact the agency pharmacy to obtain the medication. 3.Contact the health care provider (HCP) to question the prescription. 4.Mix the medication in the prescribed solution and attach an in-line filter.

3.Contact the health care provider (HCP) to question the prescription. Rationale:Precipitation will occur if phenytoin is mixed with any solution other than 0.9% (normal) saline. This is especially true with solutions containing dextrose. Therefore, the nurse would contact the HCP who prescribed the medication to change the prescription. Phenytoin is very irritating to the vein wall or other tissues and an in-line filter reduces the chance of precipitants entering the bloodstream. However, the prescription needs to be questioned and changed.

Baclofen is prescribed for the client with multiple sclerosis. The nurse determines that the medication is having the intended effect if which finding is noted in the client? 1.Increased muscle tone 2.Increased range of motion 3.Decreased muscle spasms 4.Decreased local pain and tenderness

3.Decreased muscle spasms Rationale:Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and degree of muscle spasms in clients with multiple sclerosis, spinal cord injury, or other diseases. The other options are incorrect.

At what time of day does the nurse recommend that a child prescribed methylphenidate be given the last dose of the day of the medication? 1.At bedtime 2.With a bedtime snack 3.Just before the noontime meal 4.In the morning, 2 hours before breakfast

3.Just before the noontime meal Rationale:Methylphenidate is used to treat attention deficit hyperactivity disorder and has stimulant effects. Children with should take the morning dose after breakfast and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. Usually the health care provider recommends that the last dose be given just before the noontime meal. The other options are incorrect.

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result? 1.Hypotension 2.Tachycardia 3.Slurred speech 4.No abnormal finding

3.Slurred speech Rationale:The therapeutic phenytoin level is 10 to 20 mcg/mL (40 to 79 mcmol/L). At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) occur. At a level higher than 30 mcg/mL (120 mcmol/L), ataxia and slurred speech occur.

A client with muscle spasms in the lumbar area of the spine has been started on cyclobenzaprine. The nurse should monitor for which most frequent side effect of the medication? 1.Weakness 2.Confusion 3.Excitability 4.Drowsiness

4. Drowsiness Rationale:The most common side effects of cyclobenzaprine are drowsiness, dizziness, and dry mouth. This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm due to a variety of conditions. Weakness, confusion, and excitability are less frequent central nervous system effects of cyclobenzaprine.

What is the most serious risk associated with the use of benzodiazepine? 1.Headache 2.Vomiting 3.Skin rashes 4.Dependence

4.Dependence Rationale:A benzodiazepine carries with it a high risk for abuse and physical and psychological dependence. For this reason, limited amounts of these medications are given to a client at one time. The other symptoms may be side effects of some benzodiazepines but are not as serious as the risk of dependence.

Which assessment findings suggest to the nurse that the client is experiencing tardive dyskinesia? 1.Severe headache, flushing, tremors, and ataxia 2.Abnormal breathing through the nostrils, accompanied by a thrill 3.Severe hypertension, migraine headache, and "marbles in the mouth" syndrome 4.Movements of the mouth, tongue, and face that are both abnormal and involuntary

4.Movements of the mouth, tongue, and face that are both abnormal and involuntary Rationale:Tardive dyskinesia is an adverse effect associated with long-term use of antipsychotic medication. The clinical manifestations include abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue ("fly-catcher tongue"), and face. In its more severe form, tardive dyskinesia involves the fingers, arms, trunk, and respiratory muscles. None of the remaining options are manifestations associated with this adverse effect.

When providing client education on the medication alprazolam, why is it essential to include the importance of avoiding abrupt discontinuation of the medication? 1.Irreversible kidney damage is likely to occur. 2.The original symptoms will be greatly intensified. 3.The medication will be much less effective if it must be restarted. 4.Rebound central nervous system excitation could cause seizure activity.

4.Rebound central nervous system excitation could cause seizure activity Rationale:Alprazolam is a benzodiazepine used to manage anxiety disorders. The abrupt withdrawal of alprazolam could result in seizure activity from central nervous system excitation. All clients receiving this medication should be warned of this danger. The other options are incorrect.

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1.Platelet count 2.Blood glucose level 3.Liver function studies 4.White blood cell count

4.White blood cell count Rationale:A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.

The health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication will be administered intrathecally. Which medication should the nurse expect to be prescribed and administered by this route? 1. Baclofen 2. Chlorzoxazone 3. Dantrolene sodium 4. Cyclobenzaprine hydrochloride

1. Baclofen Rationale:Baclofen is the skeletal muscle relaxant that can be administered intrathecally, which means within the spinal column. Therefore, the remaining options are incorrect.

The nurse has given medication instructions to a client beginning carbamazepine. The nurse determines that the client understands the use of the medication if he makes which statement? 1."I will use sunscreen when outdoors." 2."I can drive a car as long as it is not at night." 3."I will keep tissues handy because of excess salivation." 4.I will discontinue the medication if fever or sore throat occurs."

1."I will use sunscreen when outdoors" Rationale:Carbamazepine is an anticonvulsant. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving at any time or doing other activities that require mental alertness until the effect of the medication on the client is known. The medication may cause dry mouth, and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because this could lead to return of seizures or status epilepticus. Fever and sore throat (leukopenia) should be reported to the health care provider. Testwise: nystagmus, ataxia, headache, bone marrow, edema, decreased UO, htn, birth defects, rash, Steven Johnson syndrome.

The nurse has given instructions to a client prescribed lithium carbonate. What statement by the client indicates that the client needs further information? 1."I will take the lithium with meals." 2."I will decrease fluid intake while taking the lithium." 3."Lithium blood levels must be monitored very closely." 4."I will call my health care provider if I start vomiting."

2."I will decrease fluid intake while taking the lithium." Rationale:A normal diet and normal salt and fluid intake (1500 to 3000 mL per day) should be maintained because lithium decreases sodium reabsorption by the renal tubules, leading to sodium depletion. A low sodium intake causes a relative increase in lithium retention and could lead to toxicity. Lithium is irritating to the gastric mucosa and should be taken with meals. Because therapeutic and toxic dosage ranges are narrow, lithium blood levels must be monitored closely. They are measured more frequently when the client begins the medication and then once every several months after the levels stabilize. The client should be instructed to stop taking the medication and call the health care provider if excessive diarrhea, vomiting, or diaphoresis occurs.

The nurse teaches the wife of a client who is receiving levodopa/carbidopa to avoid pyridoxine medications. Which statement by the wife indicates an understanding of the instructions? 1."Vitamin B6 will change perspiration and urine to a dark color, which may stain clothing." 2."Vitamin B6 reverses the effectiveness of the medication, meaning a higher dose is needed." 3."The medication competes with vitamin B6 for absorption in the intestine, blocking absorption." 4."The two medications in combination will cause the blood sugar to drop, causing hypoglycemia."

2."Vitamin B6 reverses the effectiveness of the medication, meaning a higher dose is needed." Rationale:Pyridoxine (vitamin B6) reverses the therapeutic effects of levodopa. Dietary restrictions are not necessary, but ingredients of multivitamins should be assessed. Many multivitamins contain pyridoxine and should be avoided. Careful reading of over-the-counter vitamin labeling is necessary to avoid increasing pyridoxine in the diet. The statements in the remaining options are incorrect. *AVOID B6*

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication? 1.5% dextrose in water 2.0.9% sodium chloride 3.Lactated Ringer's solution 4.5% dextrose and 0.45% sodium chloride

2.0.9% sodium chloride Rationale:Intermittent IV infusion of phenytoin is administered by injection into a large vein, using normal saline solution. Dextrose solutions are avoided because the medication will precipitate in these solutions. Therefore, the options containing dextrose identify incorrect solutions for IV administration with this medication. In addition, lactated Ringer's solution contains electrolytes that can interfere with phenytoin administration

The mother of a child diagnosed with attention deficit hyperactivity disorder has been given instructions about how to administer methylphenidate (ADHD/ADD). Which response by the mother shows she understands the information about the best way to administer the medication? 1.At bedtime 2.After breakfast 3.At the evening meal 4.With a bedtime snack

2.After breakfast Rationale:Children with attention deficit hyperactivity disorder should take the morning dose after breakfast and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. The other options are incorrect.

A client who has been taking phenytoin for seizure control has a serum phenytoin level of 8 mcg/mL (35.71 mmol/L). On the basis of this finding, which note should the nurse enter in the client's health record? 1.Client is experiencing a toxic level. 2.Client has an inadequate medication level. 3.Client's result is at the low end of therapeutic range. 4.Client's result is at the high end of therapeutic range.

2.Client has an inadequate medication level Rationale:The therapeutic serum level range for phenytoin is 10 to 20 mcg/mL (40 to 79 mmol/L). A laboratory value of 8 mcg/mL is below the therapeutic range, indicating an inadequate medication level, so this should be noted in the health record and the health care provider should be notified.

A client is having the dosage of clonazepam adjusted. The nurse should plan to perform which action? 1.Weigh the client daily. 2.Institute seizure precautions. 3.Monitor blood glucose levels. 4.Observe for areas of ecchymosis.

2.Institute seizure precautions Rationale:Clonazepam is a benzodiazepine that is used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Weight, glucose levels, and ecchymosis are unrelated to this medication.

The nurse is providing instructions to an adolescent prescribed phenytoin for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication? 1."The medication may cause acne or oily skin." 2."Drinking alcohol may affect the medication." 3."If my gums become sore and swollen, I need to stop the medication." 4."Birth control pills may not be effective when I take this medication."

3."If my gums become sore and swollen, I need to stop the medication." Rationale:The adolescent should not stop taking antiseizure medications suddenly or without discussing it with a health care provider (HCP) or nurse. Acne or oily skin may be a problem for the adolescent, and the adolescent is advised to call a HCP for skin problems. Alcohol will lower the seizure threshold, and it is best to avoid its use. Birth control pills may be less effective when the client is taking antiseizure medication.

A client diagnosed with schizophrenia has a new prescription for risperidone. Which baseline laboratory result should the nurse review before administering the first dose of this medication? 1.Platelet count 2.Blood clotting tests 3.Liver function studies 4.Complete blood count

3.Liver function studies Rationale:Risperidone is an atypical antipsychotic. A baseline assessment of renal and liver function should be done before the initiation of therapy with risperidone. The medication is used with caution in clients with renal or hepatic impairment, in those with underlying cardiovascular disorders, and in geriatric or debilitated clients. These clients are started on the medication at a reduced dosage level. None of the other diagnostics are relevant to this medication.

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care? 1.History of falls 2.Use of assistive devices 3.Postural (orthostatic) vital signs 4.Degree of exhibited intention tremor

3.Postural (orthostatic) vital signs Rationale:Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem is exacerbated with the introduction of levodopa/carbidopa, which also can cause postural hypotension and increase the client's risk for falls. Although knowledge of the client's use of assistive devices and history of falls is helpful, neither of these options is the most important element of the assessment, based on the wording of this question. Clients with Parkinson's disease generally have resting tremor, not intention tremor.

A client receiving long-term therapy with lithium carbonate has a serum lithium level of 1.0 mEq/L. Which nursing intervention should the nurse be prepared to implement based on this result? 1.Monitor the client for signs of coarse hand tremors. 2.Assess the client for possible short-term memory loss. 3.Provide positive support for the client's compliance with the therapy. 4.Educate the client regarding risk for injury associated with drowsiness.

3.Provide positive support for the client's compliance with the therapy. Rationale:The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L, and the client's medication compliance should be acknowledged. Serum lithium concentrations of 1.5 to 2.0 mEq/L may produce a variety of toxicity symptoms, including vomiting, diarrhea, drowsiness, incoordination, coarse hand tremors, muscle tremors, and mental confusion.

The nurse is reading the laboratory results for a client being treated with carbamazepine for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with a side or adverse effect of this medication? 1.Sodium level, 136 mEq/L (136 mmol/L) 2.Platelet count, 350,000 mm3 (350 × 109/L) 3.White blood cell count, 3200 mm3 (3.2 × 109/L) 4.Blood urea nitrogen (BUN), 19 mg/dL (6.84 mmol/L)

3.White blood cell count, 3200 mm3 (3.2 × 109/L) Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Other adverse effects include cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects.

A home care nurse visits a client at home. Clonazepam has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates that further teaching is necessary? 1."My drowsiness will decrease over time with continued treatment." 2."I should take my medicine with food to avoid any stomach problems." 3."I can take my medicine at bedtime if it tends to make me feel drowsy." 4."If I experience slurred speech, this problem will disappear in about 8 weeks."

4."If I experience slurred speech, this problem will disappear in about 8 weeks. Rationale:Clients who are experiencing signs and symptoms of toxicity with the administration of clonazepam exhibit slurred speech, sedation, confusion, respiratory depression, hypotension, and eventually coma. The medication may be taken with food to decrease gastrointestinal irritation. Some drowsiness may occur but will decrease with continued use.

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long? 1.1 week 2.24 hours 3.2 to 3 days 4.2 to 3 weeks

4.2 to 3 weeks Rationale:Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. The client needs to understand this concept to aid in compliance with medication therapy.

The nurse is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The nurse questions the prescription if which disorder is noted in the admission history? 1.Hypothyroidism 2.Chronic bronchitis 3.Recurrent pneumonia 4.Angle-closure glaucoma

4.Angle-closure glaucoma Rationale:Because cyclobenzaprine has anticholinergic effects, it should be used cautiously in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. It is intended for short-term (2- to 3-week) therapy. The conditions of hypothyroidism, chronic bronchitis, and recurrent pneumonia are not a concern with this medication.

A client diagnosed with schizophrenia is taking haloperidol. The nurse understands that this medication will exert its therapeutic effect through which mechanism? 1.Blocking serotonin reuptake 2.Inhibiting the breakdown of released acetylcholine 3.Blocking the uptake of norepinephrine and serotonin 4.Blocking dopamine from binding to postsynaptic receptors in the brain

4.Blocking dopamine from binding to postsynaptic receptors in the brain Rationale:Haloperidol is an antipsychotic. Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Fluoxetine hydrochloride is a potent serotonin reuptake blocker. Donepezil hydrochloride inhibits the breakdown of released acetylcholine. Imipramine hydrochloride blocks the uptake of norepinephrine and serotonin.

Which assessment finding would the nurse anticipate when monitoring a client who is at risk for developing neuroleptic malignant syndrome (NMS)? 1.Dysphagia 2.Bradycardia 3.Hypotension 4.Hyperpyrexia

4.Hyperpyrexia Rationale:Hyperpyrexia with body temperatures up to 107°F may be present in neuroleptic malignant syndrome (NMS). Manifestations develop suddenly and may include respiratory distress and muscle rigidity. As the condition progresses, evidence of tachycardia, hypertension, increasing respiratory distress, confusion, and delirium may appear. Dysphagia is not associated with this condition.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? 1.Pruritus 2.Tachycardia 3.Hypertension 4.Impaired voluntary movements

4.Impaired voluntary movements Rationale:Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

When should the nurse advise a client being prescribed fluoxetine hydrochloride (SSRI) to take the medication? 1.Just before bedtime 2.With the evening meal 3.At noon with an antacid 4.In the morning on first arising

4.In the morning on first arising Rationale:Fluoxetine hydrochloride is an antidepressant and is administered in the early morning so that the client will experience an elevated mood during the daytime hours. In addition, fluoxetine can cause insomnia so taking the medication early in the day will prevent interference with sleep. The other options are incorrect.

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation? 1.Carbamazepine and phenytoin by mouth 2.Lioresal by mouth and diazepam intravenously 3.Phenytoin intravenously, then tapered to oral route 4.Methylprednisolone and cyclophosphamide intravenously

4.Methylprednisolone and cyclophosphamide intravenously Rationale:Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity.

To determine whether the client is experiencing akathisia as an adverse effect of the medication haloperidol, what should the nurse observe the client for? 1.Lip smacking 2.Puffing of the cheeks 3.Rapid tongue movements 4.Restlessness or constant generalized movement

4.Restlessness or constant generalized movement Rationale:Akathisia is restlessness or an urge to keep moving. It may appear within 6 hours of administration of the first dose and may be difficult to distinguish from psychotic agitation. The other options describe tardive dyskinesia, which is manifested by uncontrolled rhythmic movements of the mouth, face, and extremities. These movements can include lip smacking or puckering, puffing of the cheeks, uncontrolled chewing, and the presence of rapid or undulating (wormlike) movements of the tongue.

A client who was started on clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on which understanding? 1.These symptoms probably result from interaction with another medication. 2.These symptoms usually occur when the client takes the medication with food. 3.These symptoms indicate that the client is experiencing a severe adverse reaction to the medication. 4.These symptoms are most severe during initial therapy and decrease or disappear with long-term use.

4.These symptoms are most severe during initial therapy and decrease or disappear with long-term use. Rationale:Clonazepam is classified as a benzodiazepine and is used as an anticonvulsant and antianxiety agent. Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. They are unrelated to an interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. These symptoms do not indicate that an adverse effect is occurring.

The nurse gives a dose of diazepam to an assigned client. What is the most important action to be taken by the nurse before leaving the room? 1.Instituting safety measures 2.Closing the curtains in the room 3.Lowering the volume on the television set 4.Giving the client the remote control for the television set

1. Instituting safety measures Rationale: Diazepam (Benzo) is a sedative hypnotic that also has anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to prevent injury as a result of medication side effects, which include dizziness, drowsiness, and lethargy. The other options listed are useful but not essential to the client's safety in this situation.

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions? 1. Watch for urinary retention as a side effect. 2.Stop taking the medication if diarrhea occurs. 3.Restrict fluid intake while taking this medication. 4.Notify the health care provider if fatigue occurs.

1. Watch for urinary retention as a side effect. Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention. The client should not restrict fluid intake. Constipation, rather than diarrhea, is an adverse effect of baclofen. Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary to notify the health care provider if fatigue occurs.

The nurse is told that the result of a serum carbamazepine level for a client who is receiving the medication for the control of seizures is 13 mcg/mL (55.03 mmol/L). Based on this laboratory result, the nurse anticipates that the health care provider (HCP) will document which prescription? 1.Discontinuation of the medication 2.A decrease of the dosage of the medication 3.An increase of the dosage of the medication 4.Continuation of the presently prescribed dosage

2.A decrease of the dosage of the medication Rationale:When carbamazepine is administered, blood levels need to be monitored periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 8 to 12 mcg/mL (34 to 51). The nurse would anticipate that the HCP will decrease the dosage of the medication.

A client receiving therapy with carbidopa/levodopa is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is indicative of which condition? 1.Developing toxicity 2.A harmless side effect of the medication 3.A result of taking the medication with milk 4.A sign of interaction with another medication

2.A harmless side effect of the medication Rationale:With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. Darkened urine is not indicative of carbidopa/levodopa toxicity, the result of taking the medication with milk, or a sign of interaction with another medication.

The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief? 1.Oxycodone plus aspirin 2.Carbamazepine and gabapentin 3.Acetaminophen and codeine sulfate 4.Meperidine hydrochloride and hydroxyzine

2.Carbamazepine and gabapentin Rationale:The anticonvulsant medications carbamazepine and gabapentin help relieve the pain in many clients with trigeminal neuralgia. They act by inhibiting the reactivity of neurons in the trigeminal nerve. Opioid analgesics (oxycodone, codeine sulfate, and meperidine hydrochloride) are not very effective in controlling pain caused by trigeminal neuralgia.

The nurse is preparing an intravenous (IV) infusion of phenytoin as prescribed by the health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication? 1.Dextrose 5% 2.Normal saline solution 3.Lactated Ringer's solution 4.Dextrose 5% and half-normal saline (0.45%)

2.Normal saline solution Rationale:IV infusion of phenytoin should be administered by injection into a large vein. The medication may be diluted in normal saline solution; however, dextrose solution should be avoided because of medication precipitation. The medication is administered as intermittent doses. Continuous IV infusions should not be used. Infusion rates of more than 50 mg/minute may cause hypotension or cardiac dysrhythmias, especially in older and debilitated clients.

A client is prescribed fluphenazine daily. The nurse teaches the client to take which measure to minimize a common side/adverse effect of this medication? 1.Monitor the temperature daily. 2.Use hard sour candy or sugarless gum. 3.Eat snacks at midmorning and at bedtime. 4.Have the blood pressure checked once a week.

2.Use hard sour candy or sugarless gum. Rationale:Fluphenazine is an antipsychotic. Dry mouth is a common side effect of this medication. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Mild leukopenia may occur, but the temperature does not need to be taken daily. Weight gain is a common side effect, and frequent snacks would worsen the problem. Hypotension and hypertension are rare side effects of fluphenazine.

The nurse instructs the client to be sure to take which action while taking newly prescribed lithium carbonate? 1.Limit salt intake. 2.Limit food intake. 3.Maintain a fluid intake of 2 to 3 L/day. 4.Stop the medication if gastrointestinal disturbances occur.

3.Maintain a fluid intake of 2 to 3 L/day. Rationale:Lithium carbonate is prescribed for clients requiring mood stabilization. The client who begins taking lithium carbonate must maintain a fluid intake between 2 and 3 L/day. The client should also maintain normal salt intake. Both of these are necessary to avoid dehydration. Gastrointestinal disturbances generally disappear during continued therapy. It is not necessary to limit food intake.

A client diagnosed with anxiety is starting therapy with lorazepam. Which factor in the client's history should prompt the nurse to consult with the health care provider before administering the medication? 1.Hypothyroidism 2.Diabetes mellitus 3.Narrow-angle glaucoma 4.Coronary artery disease

3.Narrow-angle glaucoma Rationale:Lorazepam is a benzodiazepine and is contraindicated in hypersensitivity, cross-sensitivity with other benzodiazepines, comatose state, preexisting central nervous system depression, uncontrolled severe pain, and narrow-angle glaucoma. It also is contraindicated in pregnancy and in women who are breast-feeding. None of the other options are relevant to the administration of lorazepam.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1.Pregnancy must be avoided while taking phenytoin. 2.The client may stop the medication if it is causing severe gastrointestinal effects. 3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4.There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

3.There is the potential of decreased effectiveness of birth control pills while taking phenytoin. Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the health care provider should be done if pregnancy is considered. Telling a client that there is an increased risk of thrombophlebitis is incorrect and inappropriate and could cause anxiety in the client. A client should not be instructed to stop antiseizure medication.

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? 1.Sodium level, 140 mEq/L (140 mmol/L) 2.Uric acid level, 4.0 mg/dL (0.24 mmol/L) 3.White blood cell count, 3000 mm3 (3.0 × 109/L) 4.Blood urea nitrogen level, 10 mg/dL (3.6 mmol/L)

3.White blood cell count, 3000 mm3 (3.0 × 109/L) Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia; cardiovascular disturbances, including thrombophlebitis and dysrhythmias; and dermatological effects. The low white blood cell count reflects agranulocytosis. The laboratory values in options 1, 2, and 4 are normal values.

The health care provider (HCP) writes a prescription for carbamazepine for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data? 1.Hypertension 2.Tonic-clonic seizures 3.Trigeminal neuralgia 4.Bone marrow depression

4.Bone marrow depression Rationale:Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is used to treat seizure disorders, trigeminal neuralgia, and diabetic neuropathy. The medication can cause blood dyscrasias as an adverse effect and is contraindicated if the client has a history of bone marrow depression, hypersensitivity to tricyclic antidepressants, or concurrent use of monoamine oxidase inhibitors.

Carbamazepine has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication? 1.Lipase level 2.Amylase level 3.Ammonia level 4.Complete blood cell (CBC) count

4.Complete blood cell (CBC) count Rationale:Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. The medication can cause blood dyscrasias as an adverse effect, and the client should have a CBC count done before therapy and periodically during therapy. Additional laboratory tests that should be done include a serum iron determination, urinalysis, blood urea nitrogen determination, and carbamazepine level. The tests identified in the remaining options are unnecessary.

A client is scheduled to begin therapy with carbamazepine. The nurse should assess the results of which test(s) before administering the first dose of this medication to the client? 1.Liver function tests 2.Renal function tests 3.Pancreatic enzyme studies 4.Complete blood cell count

4.Complete blood cell count Rationale:Carbamazepine may be used to treat a seizure disorder. It can cause leukopenia, anemia, thrombocytopenia, and, very rarely, fatal aplastic anemia. To reduce the risk of serious hematological effects, a complete blood cell count should be done before treatment and periodically thereafter. This medication should be avoided in clients with preexisting hematological abnormalities. The client also is told to report the occurrence of fever, sore throat, pallor, weakness, infection, easy bruising, and petechiae. The results of the remaining tests listed in the options are not associated with the use of this medication.

The nurse should assess for which toxic effect when managing the care of a client prescribed haloperidol? 1.Nausea 2.Hypotension 3.Blurred vision 4.Excessive salivation

4.Excessive salivation Rationale:Haloperidol is an antipsychotic medication. Toxic effects include marked drowsiness and lethargy, excessive salivation, a fixed stare, akathisia, acute dystonia, and tardive dyskinesia. Nausea, hypotension, and blurred vision are occasional side effects.

The nurse is speaking with a client taking phenytoin for seizure control. The client states that she has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client? 1.Oral contraceptives decrease the effectiveness of phenytoin. 2.Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together. 3.There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time. 4.Phenytoin may decrease the effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy.

4.Phenytoin may decrease the effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy. Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. The nurse should tell the client to alert the health care provider about the use of birth control pills so that counseling may be provided about alternative birth control methods. The other options are incorrect.

A client has been prescribed cyclobenzaprine for the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client has a concurrent prescription for which medication? 1.Ibuprofen 2.Furosemide 3.Valproic acid 4.Tranylcypromine

4.Tranylcypromine Rationale:The client should not receive cyclobenzaprine if the client has taken monoamine oxidase inhibitors such as tranylcypromine or phenelzine within the last 14 days. Otherwise, the client could experience hyperpyretic crisis, seizures, and possibly death. The medications in the remaining options are not contraindicated.

The nurse is collecting data from a client and notes that the client is taking carbamazepine. The nurse determines that this medication has been prescribed to treat which condition? 1.Glaucoma 2.Diabetes mellitus 3.Parkinson's disease 4.Trigeminal neuralgia

4.Trigeminal neuralgia Rationale:Carbamazepine is classified as an iminostilbene derivative and is used as an anticonvulsant, antineuralgic, antimanic, and antipsychotic. It is not used to treat any of the conditions noted in the remaining options. Testwise: nystagmus, ataxia, headache, bone marrow, edema, dec UO, htn, birth defects, rash, dermatitis, Steven Johnson syndrome

A client has been prescribed clozapine. The nurse reviews the result of which laboratory study to detect a serious adverse effect associated with this medication? 1.Platelet count 2.Liver function 3.Blood glucose level 4.White blood cell count

4.White blood cell count Rationale:Clozapine is an antipsychotic medication. The client taking clozapine may experience agranulocytosis as an adverse effect, which is monitored by obtaining weekly white blood cell counts. Treatment is withheld if the level drops below 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other options are incorrect.

A client is receiving baclofen for muscle spasms because of a spinal cord injury. Which side/adverse effect related to this medication should the nurse monitor the client for? 1.Muscle pain 2.Hypertension 3.Slurred speech 4.Photosensitivity

3.Slurred speech Rationale:Side/adverse effects of baclofen include drowsiness, dizziness, weakness, nausea. Others include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. *Test-wise*: ss fatigue, drowsiness, hepatotoxicity, n/v, physical dependence, constipation, urinary retention, muscle weakness

A client diagnosed with bipolar mood disorder has been given a prescription for carbamazepine. The nurse teaching the client about medication side and adverse effects instructs the client to notify the health care provider if which symptom develops? 1.Nausea 2.Dizziness 3.Sore throat 4.Drowsiness

3.Sore throat Rationale:Carbamazepine may be prescribed for a client with a bipolar mood disorder to provide symptomatic control of the disorder. An adverse effect of carbamazepine is blood dyscrasia. With development of a fever, sore throat, mouth ulcerations, unusual bleeding, bruising, or joint pain, the health care provider should be notified because these findings may indicate a blood dyscrasia. Nausea, dizziness, drowsiness, and vomiting are frequent side effects associated with the medication.

A client taking carbamazepine asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken? 1.Withhold until the next scheduled dose. 2.Withhold and call the health care provider (HCP). 3.Take the dose as long as it is not close to the time for the next dose. 4.Withhold until the next scheduled dose, which should then be doubled.

3.Take the dose as long as it is not close to the time for the next dose Rationale:Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not close to the time that the next dose is due. The medication should not be double-dosed. If more than 1 dose is omitted, the client should call the HCP.

After review of the client's laboratory values, the nurse notes that a phenytoin level for a client receiving phenytoin is 7 mcg/mL (27.78 mmol/L). The nurse makes which interpretation regarding this laboratory result? 1.The level is within the expected therapeutic range. 2.The level indicates the medication should be stopped. 3.The level is lower than the expected therapeutic range. 4.The level is higher than the expected therapeutic range.

3.The level is lower than the expected therapeutic range Rationale:The target range for a therapeutic serum level of phenytoin is between 10 and 20 mcg/mL (40 to 79 mmol/L). Levels below 10 mcg/mL are too low to control seizures. At levels above 20 mcg/mL (79 mmol/L), signs of toxicity begin to appear. This client has a low serum level, and the dosage is likely to be increased.

The nurse is giving medication instructions to a client who is receiving phenytoin for epilepsy. Which instruction should the nurse include to promote adherence to the medication? 1.Discuss the self-limiting nature of epilepsy. 2.Explain how nonadherence does not account for treatment failure. 3.Involve one other person only in promoting adherence to prevent confusion. 4.Monitor plasma medication levels to provide information about compliance.

4.Monitor plasma medication levels to provide information about compliance. Rationale:Epilepsy is a chronic disease that requires regular and continuous therapy. It is not self-limiting, and nonadherence to the medication regimen results in treatment failure. Family and friends should be involved in the treatment regimen to help promote compliance. Monitoring plasma medication levels helps to provide information about adherence and can promote coaching and enhance compliance.

Over the course of a few hours, a client receiving lithium carbonate reports being nauseous, then drowsy and "achy." What action should the nurse take when considering the client's next scheduled dose of lithium? 1.Give the next scheduled dose and document the client's complaints. 2.Give the next scheduled dose and notify the health care provider of the client's complaints. 3.Withhold the next scheduled dose and restart the typical schedule with the next morning's dose. 4.Withhold the next scheduled dose and notify the health care provider of the client's complaints.

4.Withhold the next scheduled dose and notify the health care provider of the client's complaints. Rationale:The side/adverse effects of lithium include fine hand tremors, polyuria, mild thirst, and mild nausea. Diarrhea, vomiting, nausea, drowsiness, muscle weakness, and lack of coordination may be early signs of toxicity. The medication needs to be withheld and the health care provider notified so that the client can be further evaluated to determine the presence of toxicity. The remaining options are inappropriate actions.

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? 1."Alcohol is not contraindicated while taking this medication." 2."Good oral hygiene is needed, including brushing and flossing." 3."The medication dose may be self-adjusted, depending on side effects." 4."The morning dose of the medication should be taken before a serum medication level is drawn."

2."Good oral hygiene is needed, including brushing and flossing." Rationale:Typical antiseizure medication instructions include taking the prescribed daily dosage to keep the blood level of the medication constant and having a sample drawn for serum medication level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a MedicAlert bracelet.

A client is receiving phenytoin. To monitor for side and adverse effects of this medication, the nurse assesses the results of which laboratory test? 1.Serum sodium 2.Serum potassium 3.Blood urea nitrogen 4.Complete blood count (CBC)

4.Complete blood count (CBC) Rationale:Phenytoin is an anticonvulsant used to treat seizure disorders. The nurse monitors the CBC because hematological effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other test results that warrant monitoring include serum calcium levels, urinalysis, and hepatic and thyroid function tests. Electrolyte results and renal function tests are not a concern with this medication

The nurse is reviewing the results of a test on a sample drawn from a child who is receiving carbamazepine for the control of seizures. The results indicate a serum carbamazepine level of 10 mcg/mL (42.33 mmol/L). The nurse analyzes the results and anticipates that the health care provider (HCP) will note which prescription? 1.Discontinuation of the medication 2.An increased dose of the medication 3.A decreased dose of the medication 4.Continuation of the presently prescribed dosage

4.Continuation of the presently prescribed dosage Rationale:When carbamazepine is administered, blood levels need to be tested periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. Carbamazepine's therapeutic serum range is 6 to 12 mcg/mL (34 to 51 mmol/L). Therefore, the nurse anticipates that the HCP will continue the presently prescribed dosage.

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication? 1.Glaucoma 2.Emphysema 3.Hypothyroidism 4.Diabetes mellitus

1. Glaucoma Because cyclobenzaprine has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short time (2 to 3 weeks). The conditions in options 2, 3, and 4 are not a concern with this medication.

A client with a diagnosis of trigeminal neuralgia is started on a regimen of carbamazepine. The nurse provides instructions to the client about the side and adverse effects of the medication. Which client statement indicates an understanding of the side and adverse effects of the medication? 1."I will report a fever or sore throat to my health care provider." 2."I must brush my teeth frequently to avoid damage to my gums." 3."If I notice ringing in my ears that doesn't stop, I'll seek medical attention." 4."If I notice a pink color to my urine, I will stop the medication and call my health care provider."

1."I will report a fever or sore throat to my health care provider." Rationale:Agranulocytosis is an adverse effect of carbamazepine and places the client at risk for infection. If a fever or a sore throat develops, the health care provider should be notified. Gum damage, ringing in the ears, and pink-colored urine are not effects associated with this medication.

Phenytoin 100 mg to be given orally 3 times daily has been prescribed to a client. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions? 1."I will use a soft toothbrush to brush my teeth." 2."It's okay to break the capsules to make it easier for me to swallow them." 3."If I forget to take my medication, I can wait until the next dose and eliminate that dose." 4."If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."

1."I will use a soft toothbrush to brush my teeth. Rationale:Phenytoin is an anticonvulsant used to treat seizure disorders. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. Capsules should not be chewed or broken. The client should not skip medication doses because inadequate blood levels could precipitate a seizure. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because such findings may indicate hematological toxicity.

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1.Parkinsonism 2.Tardive dyskinesia 3.Hypertensive crisis 4.Neuroleptic malignant syndrome

2.Tardive dyskinesia Rationale:Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, masklike facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

The nurse is assisting in the care of a client being discharged on phenytoin 100 mg three times daily. When providing client teaching about this medication, the nurse should be sure to include which points? Select all that apply. 1.Break the capsules so they are easier to swallow. 2.Use a soft toothbrush while taking this medication. 3.If a dose is missed, just wait until the next one is due. 4.The medication may turn the urine pink, red, or brown. 5.Alcohol should be avoided while taking this medication. 6.Sore throat is a common side effect of the medication and is nothing to worry abou

2.Use a soft toothbrush while taking this medication. 4.The medication may turn the urine pink, red, or brown. 5.Alcohol should be avoided while taking this medication. Rationale:Phenytoin is an anticonvulsant that can cause gingival hyperplasia, as well as bleeding, swelling, and tenderness of the gums. The client should use good oral hygiene and gum massage and have regular dental checkups. Alcohol interferes with the absorption of phenytoin, so it should be avoided. Change in the color of the urine is a normal reaction. A sore throat, fever, glandular swelling, or any skin reaction indicates hematological toxicity and needs to be reported.