PHARM - Neuro practice questions

What is another approved and indicated use for the antidepressant bupropion (Zyban)?

Smoking cessation Zyban is a sustained-release form of bupropion that is useful in helping patients quit smoking

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply)

- Tremors - Confusion - Nausea - Muscle weakness

The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates an adverse effect of this drug?

Muscle cramps of the head and neck Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include?

"If you have persistent headaches, let the provider know." The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction.

Which statement by the patient indicates the need for additional teaching on phenothiazine (Thorazine) drug therapy?

"It is okay to take this drug with a small glass of wine to help relax me." Drinking alcohol with phenothiazines puts the patient at risk for increased central nervous system depression.

Which drug used for the management of the patient with PD is most likely to cause postural hypotension? A) amantadine (Symmetrel) B) selegiline (Eldepryl) C) tolcapone (Tasmar) D) entacapone (Comtan)

A Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension.

A patient wants to take Orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects? A) Restrict dietary intake of fat. B) Restrict dietary intake of fiber. C) Increase intake of dairy products. D) Avoid intake of carbonated beverages

A Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of Orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and who was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse suspect?

Acute dystonia Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine.

You are instructing a patient about taking phenelzine to treat depression. Which of the following foods should you tell the patient avoid?

Aged cheese This is a tyramine-enriched food. Others include red wine.

A nurse is assessing a client who has been taking alprazolam for several days. Which of the following findings should the nurse identify as an adverse reaction caused by alprazolam?

Anxiety The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety.

Which of the following drug classifications is appropriate for initial and maintenance therapy for open-angle glaucoma?

Beta-blockers Ophthalmic beta blocker is the first line of therapy. They reduce the production of aqueous humor, thus reducing intraocular pressure.

Which of the following drugs blocks beta-adrenergic receptors and thereby decreases intraocular pressure (IOP) by reducing the amount of aqueous humor produced?

Betaxolol

Which of the following drugs used to treat open-angle glaucoma, should be used with caution for a patient who is taking propranolol?

Betaxolol This is a beta blocker that can cause bradycardia, atrioventricular heart block, & hypotension. Providers should prescribe with with caution if the patient is taking other beta blockers.

A nurse is caring for a client who has schizoaffective disorder and who has been prescribed chlorpromazine. Which of the following laboratory values should the nurse monitor during and immediately after IV administration of the drug?

Blood pressure There is a risk for hypotension during and immediately after IV administration. They should remain supine for 30 min while the nurse monitors their blood pressure. It is essential to infuse slowly and not to mix it with other drugs.

A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops. Which of the following adverse effects should the nurse include in the teaching?

Bradycardia Beta-blocker

Which laboratory test should be monitored closely to assess for a potential life-threatening adverse effect to clozapine (Clozaril)?

CBC Patients taking clozapine must be monitored for the life-threatening adverse effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity?

Furosemide for hypertension Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity.

A nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past 2 weeks. Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome?

Hallucinations SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome.

A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs?

Imipramine This tricyclic antidepressant, can result in orthostatic (postural) hypotension.

A patient is taking risperidone for schizophrenia. Recognizing the adverse effects of risperidone, you advise the patient to monitor for and report which of the following?

Tremor May cause Parkinson-like extrapyramidal effects like tremors & shuffling gait. It may also cause weight gain, new onset diabetes, dry mouth, nausea, & blurred vision.

What atypical antipsychotic medication should the nurse anticipate the health care provider prescribing for treatment of refractory schizophrenia?

risperidone (Risperdal) Risperidone is effective for schizophrenia, including negative symptoms

A nurse is caring for a client who has a prescription for alprazolam. For which of the following adverse effects should the nurse monitor? (Select all that apply)

- Tolerance - Anxiety - Sedation - Respiratory depression

A nurse should identify that timolol is contraindicated for a client who has which of the following disorders?

Asthma Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing.

Match the drug with its therapeutic use.

Betaxolol = reduces intraocular pressure Lithium carbonate = controls manic episodes Risperidone = treats schizophrenia Venlafaxine = reduces depression

When doing an admission drug history, the nurse notes that the patient has a prescription for lithium (Lithobid). The nurse suspects that this patient has been diagnosed with which condition?

Bipolar disorder

When providing teaching to a patient receiving an anticholinergic for the treatment of PD, the nurse will include which information? A) Take the medication first thing in the morning. B) Limit fluid intake when taking this drug. C) The tremors you experience will be reduced within 24 hours of taking this drug. D) Do not take this medication at the same time as other medications.

D When anticholinergics are used for the treatment of PD, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident.

A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle glaucoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply)

- Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops - Do not touch the tip of the dropper - Remove contact lenses prior to instilling the drops

A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. Which of the following instructions should the nurse include? (Select all that apply)

- Change positions slowly from sitting or lying to standing - Do not stop taking the drug abruptly - Take the drug at bedtime to prevent daytime drowsiness - Increase fiber and fluid intake

Early clinical manifestations of lithium toxicity include which of the following? (Select all that apply)

- nausea - muscle weakness Other early findings include thirst, vomiting, & fine muscle tremors.

A patient is taking venlafaxine to treat major depression. Which of the following information should you include when instructing the patient and family about the use of venlafaxine? (Select all that apply)

- take it with food to reduce gastric disturbances - monitor and report insomnia - have blood pressure checked regularly - check with the provider before taking any herbal supplements This may cause withdrawal symptoms when patients stop taking it regularly. Instruct to watch for & report worsening depression or/& suicidal idealization. Tapering off is recommended.

A nurse is providing teaching to a client who has a prescription for buspirone. Which of the following instructions should the nurse include?

Allow 2 to 4 weeks for full therapeutic effects.

Match the drug classification with its therapeutic use.

Antipsychotics = schizophrenia Benzodiazepines = anxiety disorders Monoamine oxidase inhibitors (MAOIs) = depression Cholinergic agonists = glaucoma

The primary care provider prescribes pilocarpine for a patient. Which of the following information should you include when instructing the patient about instilling pilocarpine eye drops?

Apply gentle pressure to the nasolacrimal duct after instillation. The provider should tell the patient to pull down the lower lid gently and place the drop in the lower eyelid in the conjunctival sac. Next, apply pressure for 1 minute after instillation to reduce systemic absorption. The patient should not rub or massage the eye.

The patient returns to the provider's office after 1 week. The patient is sweating and reports urinary urgency. The provider suspects systemic effects from the pilocarpine. Which of the following drugs can reverse systemic toxicity from pilocarpine?

Atropine sulfate Systemic effects include bradycardia, bronchospasm, hypotension, sweating, & urinary urgency. Atropine sulfate reverses it.

A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication?

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

A patient has been diagnosed with PD. Medication therapy is started for this patient. The nurse should teaching the patient and care giver that pharmacologic therapy of PD? A) The medication should be stopped when the patient's symptoms improve. B) Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. C) A common side effect of anticholinergics is drooling. D) Improvements in symptoms are expected within 5 days of medication therapy.

B Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. Emphasize the importance of taking the medication as prescribed and not quitting the medication. It is important for the patient and family or caregiver to understand that medication(s) must be taken at the dosage and time prescribed. Inability to adhere to or remain compliant may lead to exacerbation of symptoms and development of complications. Missing a dose by even 30 minutes may lead to an "off" period and last hours. With anticholinergics, warn the patient about the adverse effect of dry mouth. Use of artificial saliva drops or gum, frequent mouth care, fluids, and sucking on sugarless gum or hard candy may be helpful. The patient and family must understand that some antiparkinson drugs are often titrated to the patient's response and that it may take 3 to 4 weeks for a therapeutic response to become evident.

The "off-on phenomenon" that some patients with PD experience is best explained as the: A) need to take a drug holiday to improve response to medications. B) variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. C) alternating schedule of medications needed to control PD. D) fluctuation of emotions that often occurs with PD.

B Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?

Blocking the reuptake of neurotransmitters at nerve endings The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin.

The patient has now been ordered an oral disintegrating form of the MAO-B inhibitor drug selegiline. When administering the drug, the nurse should A) tell the patient to take the medication with liquids. B) tell the patient to take the medication with a meal. C) assess the patient for hypertension, a common side effect of this medication. D) tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted.

D The oral disintegrating dose should be placed on the tongue and should not be swallowed until it is completely melted. This dosage form is to be taken without liquids and given in the morning before breakfast. Foods and fluids are not to be consumed for 5 minutes before or after the drug is taken. Postural hypotension may be a transient problem, so the patient needs to move and change positions slowly and purposely.

When instructing a patient about taking buspirone, you inform the patient to monitor and report a paradoxical reaction to buspirone. Which of the following is a paradoxical effect of buspirone?

Insomnia This is a non-benzo that reduces anxiety. A paradoxical effect is one that is the opposite of what is expected; insomnia, nervousness, & anxiety.

A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine?

Phenelzine Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever.

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason for the prescription modification?

Renal function impairment Should be decreased for these types of clients.

A nurse is caring for a client who was admitted to the emergency department with a head injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. For which of the following adverse effects is the client at increased risk?

Seizures This atypical antidepressant, can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement?

St. John's wort Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instructions should the nurse include?

Wear sunscreen when exposed to sunlight Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors.

A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching? A) "Take the medication with your evening meal." B) "You will need to take this drug for at least 2 years." C) "If you develop a dry mouth, stop taking the drug immediately." D) "Avoid intake of caffeine."

D Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped because a rebound increase in appetite may develop.

A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. Which of the following client statements indicates an understanding of the teaching?

"If i become pregnant, it is important to let my health care provider know." Diazepam increases the risk of congenital malformations and it contraindicated for clients who are pregnant.

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? (Select all that apply)

- Seasonal affective disorder - Nicotine addition - Depression

You continue to instruct the patient about using pilocarpine. You tell the patient to watch for and report which of the following adverse effects of this drug? (select all that apply)

- blurred vision - headache - visual floaters

A patient is to start taking amitriptyline. For which of the following should the health care provider instruct the patient to monitor and report? (Select all that apply)

- blurred vision - urinary hesitancy - tachycardia This is a tricyclic antidepressant that can cause anticholinergic effects.

Before administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of: A) hypertension. B) allergy to penicillin. C) chronic bronchitis. D) cataracts.

A The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs and thus the need for careful assessment and documentation.

The patient diagnosed with PD has been started on dopaminergic replacement drug therapy with carbidopa-levodopa, it is most important for the nurse to A) assess the patient for dizziness and syncope when the patient is walking. B) administer the medication first thing in the morning. C) administer the medication on an empty stomach. D) omit protein from the patient's diet.

A The patient may need assistance when walking because of the dizziness and possible syncope caused by these drugs. Doses are given several hours before bedtime to decrease the incidence of insomnia, a known adverse effect of these drugs. Oral doses are given with food to help minimize GI upset. It is important to make sure that the patient and family or caregivers understand that while taking carbidopa-levodopa, the patient may continue to eat high-protein foods (e.g., meat, fish, poultry, and dairy products) but with the following special instructions: use portion control (meat portion about the size of a deck of cards) and take the drug dose one-half hour before eating a protein-containing meal or one hour after.

A patient prescribed lorazepam (Ativan) for the treatment of anxiety states, "I feel drowsy all the time, and it's interfering with every aspect of my life." The nurse knows that a better drug therapy option for this patient is which anxiolytic medication?

Buspirone (BuSpar) Has the advantage of having fewer adverse effects such as sedation and lack of dependency potential

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include?

Avoid taking NSAIDs NSAIDs increase renal absorption of lithium & sodium.

Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value? A) Blood sugar B) Sodium C) Urine osmolality D) Hematocrit

B Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity.

A teenage boy will be receiving atomoxetine (Strattera) as part of treatment for ADHD. Which statement about this drug therapy is accurate? A) Strattera is highly addictive. B) Psychotherapy is rarely helpful in cases of ADHD. C) The patient should be monitored for possible suicidal thoughts and behavior. D) Strattera is used to treat narcolepsy as well as ADHD.

C Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient's family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse reactions?

Hypertensive crisis Manifestations include hypertension, headache, and nausea.

During an assessment of a patient taking chlorpromazine, the provider notes a slow shuffling gait, rigid facial expression, and fine tremors. The provider recognizes this as which of the following?

Parkinsonism This is an adverse effect of antipsychotic drugs.

A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. Which of the following instructions should the nurse include?

Take a missed dose as soon as you remember. Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose.

A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication?

There is a risk of toxicity when this medication is taken with alcohol

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically?

Thyroid function tests Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter.

A nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects?

Withdrawal symptoms Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.