Pharm module 10 prep u
A 36-year-old man has been taking extended-release carbamazepine for 1 year. He is in the clinic every 3 months for follow-up visits, which include a drug blood level. Which of the following carbamazepine blood levels would indicate a potential risk for adverse effects?
15 mcg/mL Explanation: The therapeutic blood level for the drug ranges from 4 to 12 mcg/mL for an adult. A level of 15 mcg/mL is higher than the therapeutic level and could cause increased adverse effects or possible toxic effects.
When combination therapy is ineffective, what needs to be reassessed?
Drug-drug interactions
A primary health care provider has prescribed phenytoin parenterally for a client experiencing seizures. The nurse prepares to administer this drug via which route?
Intravenously Explanation: Phenytoin can be administered orally and parenterally. If the drug is administered parenterally, the intravenous (IV) route is preferred over the intramuscular (IM) route because, with the IM route, erratic absorption of phenytoin causes pain and muscle damage at the injection site. The drug is not administered intradermally or subcutaneously.
A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen? Risk for Injury related to CNS depression Risk for Impaired Swallowing related to adverse neuromuscular effects Risk for Sexual Dysfunction related to endocrine changes Risk for Ineffective Airway Clearance rela
Risk for Injury related to CNS depression Explanation: The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.
A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?
"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Explanation: Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.
A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions? A client receiving pregabalin who is not responsive to verbal stimuli A client who will be discharged on carbamazepine and who requires education A client being treated with phenobarbital whose blood pressure is 106/69 mmHg A client who is anxious about undergoing electroencephalography to investigate a recent absence seizure
A client receiving pregabalin who is not responsive to verbal stimuli Explanation: A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice. The client with a blood pressure of 106/69 may require further monitoring and possible interventions, but this blood pressure is not so low as to be considered an emergency. Addressing clients' learning needs and anxiety is also important, but less time dependent than a client who is not rousable.
What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? status epilepticus akinetic motor febrile
status epilepticus Explanation: Status epilepticus is a life-threatening emergency characterized by generalized tonic-clonic convulsions lasting for several minutes or occurring at close intervals during which the client does not regain consciousness. None of the other options present with this described experience.
A client has been prescribed cyclobenzaprine for the treatment of muscle spasticity due to injury. The client asks if it is safe to take ibuprofen while taking cyclobenzaprine. What should the nurse teach the client? "Check with your care provider, but it's likely not a problem." "Confirm with your provider, but it would likely be quite hard on your liver." "It would probably be unsafe because both drugs are from similar families." "Ask your care provider, but the combination mig
"Check with your care provider, but it's likely not a problem." Explanation: In most cases, centrally acting skeletal muscle relaxants are not contraindicated with NSAIDs like ibuprofen. The client should be encouraged to dialogue with the provider before adding any OTC medications to the drug regimen.
A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?
"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." Explanation: Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.
A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment?
"This will likely make you drowsy, so don't take it before doing anything that would require alertness." Explanation: Cyclobenzaprine causes drowsiness because of CNS depression. There is no absolute prohibition against using the drug for more than five days; it is metabolized in the liver but is not noted to be highly hepatotoxic. Sedation is an anticipated adverse effect, not a sign of a serious drug reaction.
After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students correctly choose which drug as being used to treat osteoporosis?
Bone resorption inhibitors Explanation: Bone resorption inhibitors are used to treat osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are used to treat rheumatoid arthritis. Uric acid inhibitors are used to treat gout. Skeletal muscle relaxants are used to alleviate muscle spasms and cramping.
A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response?
Correct response: "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." Explanation: The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.
The nurse is administering phenytoin to a client who is also receiving a continuous nasogastric enteral feeding and is aware of what possible effect? Increasing absorption of the AED Decreasing the absorption of the AED Not affecting absorption of the AED Precipitating signs of overdosage
Decreasing the absorption of the AED Explanation: The use of continuous nasogastric enteral feedings may decrease the absorption of phenytoin administered through the same route, predisposing the client to the risk of seizure activity.
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan?
Falls prevention measures Explanation: The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.
Signs and symptoms of what would necessitate discontinuation of dantrolene therapy? Intermittent gastrointestinal upset Visual disturbances Urinary retention Hepatic dysfunction
Hepatic dysfunction Explanation: Dantrolene therapy must be discontinued at any sign of liver dysfunction. Intermittent GI upset, visual disturbances, and urinary retention are associated adverse effects of the drug and, although problematic, do not necessitate discontinuing the drug.
A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do?
Reduce the dose Explanation: The skeletal muscle relaxants should be used cautiously in clients with renal impairment. Dosage of baclofen must be reduced.
The nurse is teaching a client about the medication they are receiving as treatment for gout. The nurse determines the session is successful when the client correctly chooses which instruction as most important?
Reporting any skin rash Explanation: The nurse should instruct the client to report any skin rash. A rash should be monitored carefully because it may precede a serious adverse reaction, such as Stevens-Johnson syndrome. The nurse need not instruct the client to take the drug on an empty stomach, use protection against sunlight, or wear a brace to get out of bed. Clients with osteoporosis are asked to wear a brace to get out of bed. Clients taking medications for gout are asked to take it with food. These clients are also instructed to avoid driving or performing other hazardous tasks.
An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? Respiratory rate and depth Blood glucose levels Swallowing ability Speech quality
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.
When does a client with spinal cord injury-associated spasticity require treatment for this condition? Ambulation is possible only with an assistive device. Safety, mobility, and activities of daily living are impaired. Pain is present in all affected extremities. Orthopedic procedures are indicated.
Safety, mobility, and activities of daily living are impaired. Explanation: In clients with spinal cord injury, spasticity requires treatment when it impairs safety, mobility, and the ability to perform activities of daily living (e.g., self-care in hygiene, eating, dressing, and work or recreational activities). The treatment should be implemented before the other options occur.
A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action?
Tell the client to take no further doses and come be assessed at the clinic immediately. Explanation: The nurse should inform the client to discontinue the drug and return to the clinic. Rashes associated with the use of lamotrigine can be life-threatening. The client needs to return to the clinic to be evaluated and will need a change of medication. Recommending another medication is insufficient, and is also beyond the nurse's scope. High-fat foods are of no benefit.
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? abusing drugs and/or alcohol abruptly stopping the antiseizure medications hypoxia-inducing experience experiencing a brain injury
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 nurse is working with the interdisciplinary team to plan the care of a client who has been newly diagnosed with epilepsy. What factor(s) should the team consider when determining the drug of choice for the client? Select all that apply.
age type of epilepsy culture and ethnicity Explanation: The drug of choice for any given situation depends on the type of epilepsy, client age, specific client characteristics such as cultural variations, and client tolerance for associated adverse effects as opposed to preferred adverse effect. Gender and cognition do not play a role in determining drug of choice.
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to:
avoid drinking alcohol for the duration of treatment. Explanation: The CNS depressant effects of baclofen can be dangerously exacerbated by alcohol, which should be avoided. Grapefruit is not contraindicated and there is no reason to increase potassium or fluid intake while taking baclofen.
A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug?
carbamazepine Explanation: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? metaxalone methocarbamol dantrolene carisoprodol
dantrolene Explanation: Dantrolene acts directly on skeletal muscle to inhibit muscle contraction. It is used to relieve spasticity in neurologic disorders (e.g., MS, spinal cord injury) and to prevent or treat malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis. None of the other medications are prescribed for this emergency.
The nurse is reviewing new medication orders for a client with severe muscle spasms. For which condition would the nurse question providing the client with a dose of baclofen?
seizure disorder Explanation: Baclofen is a centrally acting skeletal muscle relaxant that is contraindicated for specific conditions. It should be used cautiously in clients with a history of epilepsy because the central nervous system depression and imbalance caused by the drug may exacerbate the seizure disorder. Baclofen is not contraindicated in a client with gout, peripheral vascular disease, or chronic obstructive pulmonary disease (COPD).
