Pharm Oli.
21. Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply)
Ans: skeletal muscle contraction, urination, blood pressure
Dopamine agonists have linked with which adverse effects in patients with Parkinson's disease?
Ans: sudden sleep events.
A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?
Ans. Tonic-clonic
The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction?
Ans: "Once my pain improves, I will stop taking this medication."
Which are medical applications of central nervous system drugs?
Ans: Analgesia, anesthesia, seizure control
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
Ans: Gabapentin (Neurontin)
Which medication is used to control seizures or prevent migraine headaches?
Ans: Topiramate (Topamax)
21. For which condition may carbamazepine (Tegretol) be used?
Ans: Trigeminal neuralgia pain
Which patient should receive dantrolene (Dantrium) with caution?
Ans: a 55-year-old woman with multiple sclerosis.
Which drugs are used to treat spasticity? (Select that apply)
Ans: diazepam (Valium), Dantrolene (Dantrium), Baclofen (Lioresal), Tizanidine (Flexeril)
What is the drug of choice when treating a generalized tonic clonic seizure?
Ans. Valproic acid (depakene)
The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to:
Ans: withhold the next dose and notify the physician.
Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? A.) Hypertension B.) Diabetes C.) Closed angle glaucoma D.) Infectious disease
C.) Closed angle glaucoma.
A patient has begun taking phenobarbital after experiencing several seizures and currently receiving 60 mg PO twice a daily. After two weeks of therapy, the patient has a serum drug level 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?
Ans. "I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness."
What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously?
Ans. Administer without mixing with other medications.
During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?
Ans. The drug level is at a toxic level, and the dosage needs to be reduced.
A patient has been treated with anti-Parkinson medication for 3 months. What therapeutic responses should the nurse look for when assessing this patient?
Ans. Improved ability to perform activities of daily living.
A patient who has begun taking levodopa/carbidopa (Sinemet) reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?
Ans. Increasing salt and water intake.
While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding?
Ans. Difficulty in performing voluntary movements
A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
Ans. Does not cross the blood-brain barrier.
Which neurotransmitter has an inhibitor action within the central nervous system?
Ans. Gamma-aminobutytic acid
12. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication?
Ans. Heart palpitations, hypotension, urinary retention
Patients with which conditions must be carefully assessed to determine whether they would tolerate treatment with neuromuscular -blocking agent? (Select all that apply)
Ans. Hepatic disease, renal disease, neurologic disorders.
When assessing a patient with Parkinson's disease who take a carbidopa/levodopa combination drug, you find that he now has almost constant muscle movements that look line uncoordinated dancing. What is your best action?
Ans. Hold the next drug dose and report the finding to the healthcare provider.
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?
Ans. Mic the drug with normal saline and give it as a slow IV push.
A patient with cerebral palsy who has been receiving baclofen (lioresal) via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspects to be the cause of these seizures?
Ans. Missed doses of baclofen
What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy?
Ans. Nausea, vomiting, and indigestion are common during the initiation of therapy.
When treating patients with medications for Parkinson's disease the nurse knows that the wearing-off phenomenon occurs for which reason?
Ans. The medications begin to lose effectiveness against Parkinson's disease.
A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patent reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?
Ans. The provider will withdraw the drug over a 6-to-12-week period.
. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem?
Ans. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select that apply)
Ans: vital signs, alertness, orientation, mobility
Which drug interaction may occur when an aminoglycoside or tetracycline is given in conjunction with neuromuscular-blocking agents?
Ans: Increase neuromuscular-blocking activity
A patient who has undergone a lengthy surgical procedure to breathe on his own following the procedure. Which drug will the nurse expect to be administered as an antidote to the neuromuscular-blocking agent?
Ans: Neostigmine methyl sulfate (Prostigmin)
Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?
Ans: Nystagmus
How does the drug tolcapone relieve the symptoms of Parkinson's disease?
Ans: Suppresses the activity of an enzyme that normally breaks down naturally occurring dopamine
A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine (Zanaflex) to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug?
Ans: a history of hepatitis
Which changes are most important to assess for in a patient who is taking topiramate or seizure control? (Select all that apply)
Ans: decreased seizure activity, warm flushed skin, decreased heart rate
The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for reduction in medication dosage by the health care provider?
Ans: dizziness
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?
Ans. Contact the provider to request an order for serum drug levels.
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
Ans. Diazepam (Valium)
A 20-kg child has been taking valproic acid (Depakote) for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provided will order which change in the is child's drug regimen?
Ans. Increasing the dose of valproic acid to 300 mg PO twice daily.
What is the reason for paraplegic patient to receive baclofen (Lioresal)?
Ans. It interrupts reflexes at the level of the spinal cord.
The nurse is assessing the medication history of a patient with diagnosis of Parkinson's disease. Which condition is a contraindication for the patient, who will be taking entacapone (comtan)?
Ans. Liver failure
Parkinson's disease has which characteristic symptom(s)? (Select all that apply)
Ans. Muscle tremors, posture alterations, slow body movement
A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (select all that apply)
Ans. Palpitations, dizziness, orthostatic hypotension, tremors
21. A nurse is caring for a patient receiving intrathecal baclofen (Lioresal). The patient is unresponsive. After asking a co-worker to contact the provider, the nurse anticipates performing which intervention?
Ans. Preparing to support respirations
21. A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa (Sinemet). After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
Ans. Re-evaluate the diagnosis.
Which assessment is most important for the nurse to obtain when a patient is being treated with a neuromuscular-blocking agent?
Ans. Respiratory assessment for patent airway.
When assessing a patient for signs and symptoms of early respiratory depression immediately after leaving the postoperative area, the nurse will be alert for signs of what?
Ans. Restlessness, anxiety, lethargy
The nurse receives a conscious patient from the postoperative unit after administration of a neuromuscular blocker. Once the patient's vital signs are stable, the best position the nurse to assist the patient into is ___ position.
Ans. Semi-Fowler's
When reviewing the preoperative laboratory results of a patient taking oxcarbazepine for seizure control, you note all the following values. For which one will you notify the surgeon immediately?
Ans. Serum sodium level of 128 mEq/L
The nurse is preparing to administer Zonis amide (zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply)
Ans. Skin rash, allergy to Bactrim, pruritus
The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?
Ans. The drug levels for carbamazepine are lower than expected.
An employee at a factory has not been to work because of ow back muscle spasms. His wife contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Based on the medication action, what will the nurse tell her? (Select that apply)
Ans: "Sedation is an adverse effect of these medications and tends to resolve with continued therapy." "I need additional and specific information regarding the amount of your husband's sedation." "Your husband should avoid activities requiring alertness, such as driving or operating power equipment." "I will review baseline laboratory studies, discuss your husband's status with the health care provider, and call you back."
A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa (Sinemet) for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
Ans: "I may need to try a lower dose of Sinemet to reduce my tics."
A nurse counsels a patient who is to begin taking phenytoin (Dilantin) for epilepsy. Which statement by the patient indicates understanding of the teaching?
Ans: "I should brush and floss my teeth regularly."
The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching?
Ans: "I will place the tablet on my tongue before breakfast."
A patient has taken levodopa (Dopar) for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?
Ans: "It may take a several months for a response to occur.
Which laboratory values will the nurse review prior to beginning medication therapy for skeletal and muscle disorders?
Ans: C-reactive protein (CRP), huma leukocyte antigen (HLA), and liver function tests
A patient who has been taking phenobarbital for epilepsy begins taking valproic acid (Depakote) as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?
Ans: Notify the prescriber and request an order to reduce the dose of phenobarbital.
In the intensive care unit, the nurse is taking care of a patient who is on a ventilator and is receiving succinylcholine (Anectine). Which is a priority nursing diagnosis for this patient?
Ans: Pain
A child who receives valproic acid (Depakote) begins taking lamotrigine (Lamictal) because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?
Ans: Rash
A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen (lioresal) but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects?
Ans: Seizures and hallucinations
Neurotransmitter(s) include. (Select all that apply)
Ans: gamma aminobutyric acid, acetylcholine, serotonin, histamine, epinephrine
A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdoes-the correct number of pills is in the bottle. The nurse suspects that which of these may have happened?
Ans: he drank a glass of wine
The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that is interactions may occur with which drugs? (Select all that apply)
Ans: oral contraceptives, opioids, antihistamines, anticoagulants
A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority action to:
Ans: provide for resident's safety
A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet). The prescriber orders bromocriptine (Pariodel) to treat dyskinesias. The nurse notes reports having frequent nightmares. The nurse will contact the provider to discuss:
Ans: reducing the dose of bromocriptine.
A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole (Mirapex) that is less likely to occur with other dopamine agonists is:
Ans: sleep attacks.
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
Ans: the safe and the toxic plasma levels of the drug are very close to each other.
A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention?
Ans. Implementing measure to maintain the airway and support respirations.
The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which statements indicated a need for the further teaching? A.) "If I develop enlarged gums, I will stop taking the medication." B.) "It is important for me to take my medicine at the same time daily." C.) "I need to avoid or limit caffeine intake. D.) "I will check with the pharmacist before taking over the counter medication.
A.) "If I develop enlarged gums, I will stop taking the medication."
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instrcutions? A.) "Take the drug at the same time every day." B.) "If seizure recur, take a double dose of the medication." C.) Antacids can be taken with the AED to reduce gastrointestinal adverse effects." D.) Driving is allowed after 2 weeks of therapy.
A.) "Take the drug at the same time every day."
A patient with cerebral palsy has severe spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy? A.) Baclofen (Lioresal) B.) Dantrolene (Dantrium) C.) Diazepam (Valium) D.) Metaxalone (Skelaxin)
A.) Baclofen (Lioresal)
The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select that apply)
Ans: pregnancy, severe chronic obstructive pulmonary disease, severe liver disease
What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease? (Select that apply)
Ans. You may experience sleep attacks or episodes of daytime sleepiness. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). Apomorphine does not have any opioid activity. A multidose injector pen is commonly used to administer apomorphine
A nurse is discussing atrial versus generalized seizures with a group of nursing students. Which statement by a student indicated indicates understanding of the teaching?
Ans. "Febrile seizures are a type of generalized tonic-clonic seizure."
Which condition is associated with hydantoin therapy?
Ans. Gingival hyperplasia
Which common adverse effect occurs with neuromuscular-blocking agents? A.)Fever B.) flushing c.) Nausea d.) Ataxia
B.) FlusHING Rationale: Neuromuscular - blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary secretions, flushing, edema, and urticaria. Ensure that the airway is patent and that secretions are suctioned regularly to prevent obstructions. Report evidence of bronchospasm , edema, and urticaria immediately. Neuromuscular - blocking agents do not commonly cause fever, nausea, or ataxia.
Which symptoms in a patient taking levodopa for Parkinson DISEASE INDICATE THE DRUG IS "WEARING OFF" (Select all that apply.) A.) Increased appetite. B.) Increased tremors. C.) dECREASED MUSCLE TONE d.) dIFFICULTY Swallowing E.) sLOWER GAIT. F.) Dry mouth.
B, D, E: Increased tremors, difficulty swallowing and drooling. Rationale: Levodopa is a dopamine agonist that restores balance between excitatory and inhibitory input to motor responses. When it wears off, the symptoms of parkinson disease return or become worse. These include muscle movements that are heard to control and jerky with rigidity because they fail to relax sufficiently. The gait becomes slow and shuffling with short steps. Other common symptoms of PD include tremors, stooped posture, difficulty stopping motion once it has started, difficulty chewing and swallowing and drooling.
The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). based on this finding, the nurse interprets that the patient has which disorder? a.) agitation B.) A musculoskeletal injury. C.) Epilepsy D.) Insomnia
B.) A musculoskeletal injury.
Which symptoms will be the most important for the nurse to assess for early signs of respiratory distress in the patient who has been given a neuromuscular-blocking agent? A.) Pallor, stridor, and diaphoresis b.) Restlessness, Anxiety, and lethargy. c,) Nasal flaring and retraction of intercostal muscles. d.) Dyspnea, increased respiratory rate, and cyanosis.
B.) Restlessness, anxiety, and lethargy Rationale: THE SIGNS OF RESTLESSNESS ANXIETY, LETHARGY, DECREASED mental alertness, and headaches are early, subtle clues to respiratory distress. Retractions, flaring, dyspnea, hyperventilations, cyanosis, pallor, stridor, and diaphoresis are not early signs of respiratory distress.
A patient is taking gabapentin (Neurontin), and the nurse notes is no history of seizures on his medical record. What is the best possible rationale for this medication order? A.) The medication is used to reduce the symptoms of Parkinson's disease. B.) The medication is used for the treatment of neuropathic pain. C.) The medical record is missing the correct information about the patient's history of seizures. D.) The medication is helpful for the treatment of multiple sclerosis.
B.) The medication is used for the treatment of neuropathic pain.
When assessing the medication history of a patient with a new diagnosis of Parkinson's disease, which conditions are contraindications for the patient who will be taking cadbidopa-levadopa? (Select all that apply.) 1.) Concurrent use of monoamine oxidase inhibitors (MAOIs). B.) Hypertension. C.) Angle-closure glaucoma d.) History of malignant melanoma. E.) Benign prostatic hyperplasia.
C, D, A, Angle - closure glaucoma History of malignant melanoma Concurrent use of monoamine oxidase.
A nursing student wants to know why a patient who has been taking levodopa (dopar) for years will now receive levodopa/carbidopa (Sinemet). The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education? A.) "Carbidopa increases the availability of levodopain the central nervous system" B.) Carbidopa reduces the incidence of nausea and vomiting." C.) "Combination products cause fewer dyskinesias and decreased psychosis." D.) "Combination products reduces peripheral cardiovascular side effects."
C.) "Combination products cause fewer dyskinesias and decreased psychosis."
Which instruction (s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) A.) "Suck on candy or ice chips." B.) "Take the medication with meals." C.) "Increase fluids daily." D.) "Monitor blood glucose."
C.) "Increase fluids daily." A.) "Suck on candy or ice chips."
A child is diagnosed with absence seizures, and the prescriber orders ethosuximide (Zarontin). When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of: A.) Frequent serum drug level monitoring. B.) Reporting dizziness and drowsiness to the provider. C.) Recording the number of seizures the child has each day. D.) Learning as much as possible about the disorder and its treatment.
C.) Recording the number of seizures the child has each day.
A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa (Sinemet) for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider? A.) Taking a lower dose on an empty stomach. B.) Taking dopamine in addition to levodopa/carbidopa C.) Taking a lower dose with a low-protein snack. D.) Taking an increased dose along with a high - protein snack.
C.) Taking a lower dose with a low-protein snack.
A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicated understanding of the drug therapy for this disease? A.) "There are several drugs available to treat dyskinesias." B.) "With adequate drug therapy, the disease progression may be slowed." C.) When 'off' times occur, I may need to increase my dose of levodopa." D.) "A levodopa/carbidopa combination is used to improve motor function.
D.) "A levodopa/carbidopa combination is used to improve motor function.
The U.S. food and drug administration has issued has issued a warning for users of anti-epileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? A.) Increased risk of cardiovascular events, such as strokes. B.) Signs of bone marrow depression. C.) Indications of drug addiction and dependency. D.) increased risk of suicidal thoughts and behaviors.
D.) Increased risk of suicidal thoughts and behaviors. Rationale: The U.S. food and drug administration has required black box warnings on all anti-epileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with anti-epileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect.
What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? A.) Slows the detoriation of dopaminergic nerve cells. B.) Enhances the cholinergic symptoms of Parkinson's disease. C.) Inhibits the relative excess of dopaminergic activity. D.) Reduces the destruction of dopamine in peripheral tissues.
D.) Reduces the destruction of dopamine in peripheral tissues.
Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? A.) Obtain smoking history. B.) Monitor blood pressure (BP)lying, sitting, and standing. c.) Determine patient's ancestry. D.) Auscultate lung sounds
Determine patient's ancestry
Which do monoamines act as neurotransmitters in the central nervous system? (Select all that apply) A.) Serotonin. B.) Dopamine. C.) Norepinepherine d.) Epinephrine E.) aCETYLCHOLINE F.) Histamine
a,b,c,d: Norepinephrine, serotonin, Dopamine, Epinephrine Rationale: Acetylcholine and histamines are not monoamines.
What does is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with seizure disorder? a.) 30mg/min b.) 60mg/min c.) 100mg/min d.) 5mg/min
a.) 30mg/min
A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with anti-epileptic drugs (AEDs). Which statement by the patients indicated understanding of the teaching? A.) "Serious side effects may occur, and if they do, I should stop taking the medication." B.) I will soon know that the drugs are effective by being seizure free for several months" c.) "Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug." D.) "When drug levels are maintained at therapeutic levels, I can expect to be seizure free."
c.) "Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug." Rationale: Even with an accurate diagnosis of seizures, many patients have to try more than one AED to find a drug that is effective and well tolerated. Unless patients are being treated for absence seizures, which occur frequently, monitoring of the clinical outcome is not sufficient for determining effectiveness, because patients with convulsive seizures often have long seizure free periods. Serious side effects may occur, but widthrawing a drug precipitously can induce seizures. Not all patients have seizure control with therapeutic drug levels, because not all medications work for all patients.
A nurse is teaching a parent of a child with spastic quadriplegia about intrathecal baclofen (Lioresal). Which statement by the parent indicated a need for further teaching? A.) "I can expect my child to be drowsier when receiving this medication." B.) I should not notice any change in my child's muscle strength." C.) "I will contact the provider if my child is constipated or cannot urinate." d.) "If my child has a seizure, I should stop giving the medication immediately."
d.) "If my child has a seizure, I should stop giving the medication immediately."
A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of 106 degrees Faren height. The admitting diagnosis is neuroleptic malignant syndrome resulting from antipsychotic medication. Which drug is indicated in treatment of this condition? A.) Baclofen (Lioresal) B.) Metaxalone (Skelaxin) C.) Edrophonium (Tessilon) D.) Dantrolene (Dantrium)
d.) Dantrolene (Dantrium)
A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? A.) "These drugs inhibit the action of acetylcholine." B.) "These drugs will decrease your eye pressure." C.) "These drugs will help you urinate." D.) "These drugs will assist in lowering your heart rate."
A.) "These drugs inhibit the action of acetylcholine."
A patient taking a neruomuscular blocking agent is assessed to have a heart rate of 120 and blood pressure of 80/50. The nurse will anticipate the physician writing an order for: A.) ABGs. B.) Liver function tests. C.) Blood glucose level D.) CBC.
A.) ABGs.
Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and uticaria? A.) Advise the patient that this adverse effect usually resolves but should be reported to the health care provider. B.) Reassure the patient that this is common adverse effect on the medication and no to worry. C.) Instruct the patient to discontinue use of the drug immediately. D.) Instruct the patient to decrease the dosage of the medication until the rash disappears.
A.) Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.
When assessing a patient before starting the first dose of a newly prescribed antiepileptic drug, what is the most important nursing action to perform? A.) Ask the patient about all their other prescribed or over the counter drugs he or she takes daily. B.) Obtain an accurate weight because most drug dosages are based on weight. c.) Determine the type of aura a patient usually has before a seizure. d.) Ensure that oxygen and suction equipment are in the patient's room and in good working order.
A.) Ask the patient about all their other prescribed or over the counter drugs he or she takes daily. Rationale: All actions are reasonable and helpful. The most important assessment information is determining all other drugs to the patients take. Anti-epileptic drugs have many drug interactions that can lead to adverse reactions.
Which adverse effect/s is are common when a patient is receiving a cholinergic agent? Select all that apply). A.) Bradycardia B.) Dizziness. C. Constipation. D.) Nausea E.) Hypertension.
A.) Bradycardia b.) Dizziness D.) Nausea
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and the experiences about 60 seconds of lip smacking and hand wringing. WAHAT SHOULD THE NURSE DO? A.) Contact the provider to report symptoms of a complex partial seizure. b.) Request an order for IV diazepam (valium) to treat status epilepticus. C.) Ask the patient about a history of absence in seizures. d.) nOTIFY THE PROVIDER THAT THE PATIENT HAS HAD A grand mal seizure.
A.) Contact the provider to report symptoms of a complex partial seizure. Rationale: This patient showed signs of a complex partial seizure, characterized by impaired consciousness beginning with a period of motionlessness with a fixed gaze, followed by a period of automatism. The entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of consciousness for a brief period (about 10 to 30 seconds) and may involve mild, symmetric motor activity or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by alternating muscle relaxation and contractions and then periods of cyanosis, all with a loss consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer.
The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? A.) Dosage is adjusted according to the patient's response. B.) This medications is not to be taken with carbidopa. C.) This medication increases the production of dopamine in the brain. D.) There will be fewer incidences of dopaminergic effects, such as confusion.
A.) Dosage is adjusted according to the patient's response. Rationale: Dosage must be adjusted according to the patient's response and tolerance. Entacapone may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic effects of levodopa. Entacapone does not increase the production of dopamine in the brain.
Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? A.) Orthostatic hypotension. B.) Anorexia and depression C.) Tachycardia and palpitations d.) Nausea and vomiting.
A.) Orthostatic hypotension.
What is included in the nursing management of the patient with generalized tonic clonic seizure activity? (Select all that apply.) A.) Placing padding around tor under the patient's head. B.) Restraining the patient's arms to avoid further injury. C.) Attempting to insert a tongue depressor into the patient's mouth. D.) Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain. E.) Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over
A.) Placing padding around tor under the patient's head. D.) Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain. E.) Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over
Which statement(s) is/are use about the efferent nerves. (Select all that apply). A.) They leave the CNS to carry impulses to the other body parts. B.) They transmit signals to the spinal cord and brain. C.) They are part of the peripheral nervous system. D.) They transmit signals that control contractions of some glandular secretions. E.) They transmit signals that control contractions of smooth and skeletal muscle.
A.) They leave the CNS to carry impulses to the other body parts. C.) They are part of the peripheral nervous system. E.) They transmit signals that control contractions of smooth and skeletal muscle. D.) They transmit signals that control contractions of some glandular secretions.
The nurse is examining a patient in the emergency department whose chief complaint is a dislocated shoulder. Which assessment data are needed to evaluate the patient? (Select all that apply)
Ans. Details related to the mechanism of injury, Degree of impairment, pain level, inspection of the affected part for swelling, capillary refill, bruising, redness, localized tenderness, deformities, and paresthesia.
The health care provider orders diazepam (valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing intervention(s) associated with administration of this medication IV should the nurse perform? (Select all that apply)
Ans. Apply a cardiac monitor to the patient to assess for continuous heart rate if not already done, continuously assess the patient's airway, Obtain the correct dose (10 mg) and administer over slow IV push.
21. Which vitamin will reduce the therapeutic effects of levodopa?
Ans. B6
Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply)
Ans. Blood dyscrasias, hyperglycemia, gingival hyperplasia, sedation
Why are carbidopa and levodopa usually given together?
Ans. Carbidopa enhances the action of levodopa, and less drug is needed.
A patient has 9-year-old history of seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
Ans. Contact the prescriber for another dosage form of medication.
A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine (Trileptal). The patient also takes furosemide (Lasix) and digoxin (lanoxin). Which statement by the patient indicates understanding of the teaching?
Ans. "I should report any nausea, drowsiness, and headache to my provider."
Which precaution is most important to tell parents of young children prescribed lamotrigine for epilepsy?
Ans. "check your child daily for a rash and call your healthcare provider immediately if one develops."
A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin (Dilantin) 100mg three times daily and oxcarbazepine (Trileptal) 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?
Ans. An increase dose of phenytoin
A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet) and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:
Ans: administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of:
Ans: carbohydrates
A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply)
Ans: consult an obstetrician., carry an identification card., provide a list of seizure medications.
Why are neuromuscular-blocking agents used? (Select all that apply.) A.) Alleviation of pain. B.) Decreasing muscular activity in electroshock therapy. C.) Producing amnesia during painful procedures. D.) Reducing the use and adverse effects of general anesthetics. E.) Easing endotracheal intubation and preventing laryngospasm.
B,D,E Rationale: Neuromuscular - blocking agents are used to produce adequate muscle relaxation during anesthesia to reduce the use (and adverse effects) of general anesthesia, ease endotracheal intubation and prevent laryngospasm, and decrease muscular activity in electroshock therapy. Neuromuscular blocking agents have no effect on the pain threshold, memory, or consciousness.
A patient has been taking an AED for several years as part of his treatment for focal seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore. What is the nurse's best response? A.) "He is taking another anti-epileptic drug, so he can go without medication for a week." B.) "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." C.) "He can temporarily increase the dosage of his other antiseizure medications until you get the refill." D.) "he can stop all medications because he has been treated for several years now."
B.) "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." Rationale: Abrupt discontinuation of an antiepileptic drugs can lead to
A 25 year old patient has been newly diagnosed with parkinson's disease, and the prescriber is considering using prampexole (mirapex). Before beginning therapy with this drug, the nurse will ask the patient about: A.) difficulty falling asleep or staying asleep. B.) Any history of alcohol abuse or compulsive behaviors. c.) any previous history of hypertension. D.) Whether any family members have experienced psychoses.
B.) Any history of alcohol abuse or compulsive behaviors. Rationale: Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypertension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.
Which chonolinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? A.) Rigidity B.) Tremors and drooling C.) Cognitive impairments D.) Postural abnormalities
B.) Tremors and drooling Rationale: Anticholinergic drugs will reduce the severity of tremors and drooling in patients with parkinson's disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anti cholinergic have little effect on rigidity or a postural abnormalities.
When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan? A.) Discontinue the medication if adverse effects occur, B.) Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth. C.) Minimizes the amount of fluid taken while on this drug. D.) Take the medication on an empty stomach to enhance absorption.
B.) Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
A patient who is taking oral contraceptives begins taking valporic acid (depakote) for seizures. After a week of therapy with valporic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do? A.) Suspect that hepatotoxicity has occurred, because this is a common adverse effect of valporic acid. B.) Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valporic acid therapy. C.) Ask the patient if she is taking the valporic acid with food, because taking the drug on an empty stomach can cause GI side effects. D.) Suggest that the patient can perform a home pregnancy test, because valporic acid can reduce the efficiency of oral contraceptives.
C.) Ask the patient if she is taking the valporic acid with food, because taking the drug on an empty stomach can cause GI side effects. Rationale: GI effects, including nausea, vomiting, and indigestions are common with valporic acid and can be minimized by taking the drug with food or using enetric - coated product. Hyperammonemia can occur when valporic acid is combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare adverse effect,
Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply) A.) Preparation for surgery. B.) Benign prostatic hypertrophy C.) Bradycardia D.) Glaucoma E.) Stimulation of the vagus nerve. F.) Parkinson's disease.
C.) Bradycardia F.) Parkinson's disease. A.) Preparation for surgery.
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for a new diagnosis of Parkinson's disease. The patient asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact? A.) There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. B.) Carbidopa allows the breakdown of levodopa to be given. C.) Carbidopa prevents the breakdown of levodopa in the periphery. D.) Carbidopa is the biological precursor of dopamine and can penetrate into the central nervous system.
C.) Carbidopa prevents the breakdown of levodopa in the periphery.
A patient who has been on levodopa therapy for a year has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that which there is an advantage of this drug class? A.) It has a slower onset than traditional Parkinson's disease drugs. B.) It has a shorter duration of action. C.) It reduces the wearing off phenomenon. D.) It causes less gastrointestinal distress.
C.) It reduces the wearing off phenomenon.
The nurse has given medication instructions to a patient receiving phenytoin (Dilantin) which statement by the patient indicates that the patient has an adequate understanding of the instructions? A.) "I will be able to stop taking this drug once the seizures stop." B.) I can go out for a beer while on this medication." C.) I can skip doses if the side effects bother me." D.) "I will need to take extra care of my teeth and gums while on this medication."
D.) "I will need to take extra care of my teeth and gums while on this medication."
A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercise to improve walking ability. The nurse anticipates that which medication will be ordered for spacity. A.) Dantrolene (Dantrium) B.) Diazepam (Valium) C.) Metaxalone (Skelaxin) D.) Baclofen (Lioresal)
D.) Baclofen (Lioresal)
Which medication will be prescribed for a patient complaining of muscle spasms resulting from a back injury? A.) Bethanechol (urecholine) B.) Acetaminophen (Tylenol) C.) Morphine sulfate D.) Cyclobenzaprine (Flexeril)
D.) Cyclobenzaprine (Flexeril)
What is the rational for adminitering levodopa instead of dopamine for treatment of Parkinson's disease? A.) Dopamine has too many reactions with other medications. B.) The half of dopamine is too short. C.) Levodopa is much less expensive. D.) Dopamine does not cross the blood brain barrier when administered orally.
D.) Dopamine does not cross the blood brain barrier when administered orally.
When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove:
Ans. Cheese
The nurse is teaching a patient with Parkinson's disease about levodopa. Which statement by the nurse is accurate regarding drug administration?
Ans. "Take this medication with food or antacids to reduce GI upset."
A patient newly diagnosed with Parkinson's disease is prescribed an oral dopamine agonist. Which precaution is most important to teach the patient and family about the timing for taking this drug? A.) "Take the drug 30-60 minutes after eating a high protein meal." B.) "Take the drug 30 - 60 minutes before meals on an empty stomach. C.) "Take the drug first thing in the morning before getting out of bed." D.) "Take the drug when your symptoms are at their worst."
B.) "Take the drug 30 - 60 minutes before meals on an empty stomach. Rationale: Dopamine agonist should be taken 30 to 60 minutes before a meal, so patients have an easier time swallowing. An empty stomach is best to enhance absorption. Patients must be taught to avoid taking the drug or shortly after eating protein because protein reduces the effectiveness of these drugs.
A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine (Tegretol) 100mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine (lamictal) 375 mg twice daily. The nurse will contact the provider to discuss which action. A.) Increasing the lamotrigine dose to 500mg twice daily B.) Reducing the lamotrigine dose to 225 mg twice daily C.) Increasing the carbamazepine dose to 200mg twice daily D.) Reducing the carbamazepine dose to 50mg twice daily.
A.) Increasing the lamotrigine dose to 500mg twice daily Rationale: Carbamazepine induces hepatic drug-metabolizing enzymes and can increase the rate at which lamotrigine and other drugs are metabolized; therefore, patients taking any of these drugs would need an increased dose. Reducing the dose of either drug is not indicated. Increasing the dose of carbamazepine may be necessary but only after serum drug levels have been created.
A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa (Dopar). The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?
Ans. "While some drugs show promise, there are no studies that have proven a neuroprotective effect."
The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which human needs statement would be appropriate for this patient?
Ans. Altered urinary elimination
A patient who has a lower back injury exhibits muscle spasm. The provider orders cyclobenzaprine (Flexeril) 10 mg three times/day. What will the nurse include when teaching this patient about this drug? A.) "This drug carries some risk of developing hallucinations and psychotic symptoms.: B.) "You may experience blurred visions, dry mouth, or constipation." C.) "You will need to have liver function tests performed while taking this medication." D.) "This medication may cause your urine to turn brown, black, or dark green"
B.) "You may experience blurred visions, dry mouth, or constipation." Rationale: Cyclobenzaprine has significant anticholinergic effects and patients should be warned about dry mouth, blurred visions, and constipation. Tizanidine can cause hallucinations and psychotic symptoms,. methocarbamol may turn urine brown, black, or green, which is a harmless side effects. Tizanidine and metaxalone can cause liver toxicity and require monitoring.
A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decided to hold the next dose of: a.) dextromethorphan. B.) Ciprofloxacin. C.) Levodopa. D.) Valium.
B.) Ciprofloxacin.
The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experience? A.) Diarrhea B.) Pupil dilation C.) Hyperglycemia D. Hunger
C.) Hyperglycemia
A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet) along with amantadine (Symmetrel) 400mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action. A.) Increasing the dose of amantadine (Symmetrel). B.) Ordering renal function tests. C.) Interrupting treatment with amantadine for several weeks. D.) Ordering another anticholinergic medication.
C.) Interrupting treatment with amantadine for several weeks.
A patient has been taking selegiline (edepryl) for a few months, and recently the prescriber increased his dose to 20mg/day. Today during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful". What did the patient most likely experience? A.) GI upset. B.) Hypotension C.) Urinary discomfort. D.) Hypertension
D.) Hypertension Rationale: At doses that exceed the recommended dosage of 10mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red, wine, beet, and yogurt) and can cause severe hypertension.
A patient is to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse the patient? A.) She should remain on oral contraceptives, because phenytoin causes birth defects. b.) She may need to increase her dose of phenytoin while taking oral contraceptives. C.) She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. D.) She should consider a different form of birth control while taking phenytoin.
D.) She should consider a different form of birth control while taking phenytoin.
Why is intramuscular (IM) injection of phenytoin avoided? A.) Gum hyperplasia is worsened by IM injection. B.) The drug is a known teratogen that can induce birth defects. C.) Rapid absorption can cause bradycardia. D.) The drug is very irritating to the tissues.
D.) The drug is very irritating to the tissues. Rationale: Giving phenytoin by IM route results in pain and discomfort (and sometimes damaged tissues) because it is a severe tissue irritant. The best routes are oral and intravenous. All routes of this drug can cause bradycardia, gum hyperplasia, and birth defects.
The patient's family asks why neuromuscular blocking agents are used before electroconvulsive therapy. Which explanation by the nurse is most accurate? A.) "They decrease intracranial resulting therapy." B.) "They stimulate respirations while therapy is delivered." C.) "They prevent aspiration of respiratory secretions during the therapy." D.) They reduce the risk of injury during therapy
D.) They reduce the risk of injury during therapy
A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes what is happening in this situation. A.) The patient has taken this drug with red wine or cheese. B.) The ordered doses Are too high for this patient. C.) The patient is having an allergic reaction to the drug. D.) the harmless effect of the drug.
D.) the harmless effect of the drug. Rationale: COMT inhibitors, including entacapone, may darken a patient's urine and sweat.
The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select that apply) A.) A dose may be skipped if the patient is experiencing adverse effects. b.) Abruptly stopping AEDs may cause rebound seizure activity. C.) Consistent dosing is the key to controlling seizures. D.) AED therapy can be stopped when seizures are stopped. E.) AED therapy is usually lifelong.
E.) AED therapy is usually lifelong. C.) Consistent dosing is the key to controlling seizures. b.) Abruptly stopping AEDs may cause rebound seizure activity.
