PHARM Quiz 5
In a pregnant patient, medications to depress the central nervous system are administered to reduce the risk of injury from a seizure to mother and baby. Which patient teaching is mandatory to reduce the risk of complications? 1 "Avoid consuming alcohol." 2 "Take long drives if you feel depressed." 3 "Take herbs like ginkgo along with the anticonvulsant drug." 4 "Stop taking anticonvulsant drugs if there are no seizure episodes for several months."
"Avoid consuming alcohol." The nurse should instruct the patient to avoid consuming alcohol in order to prevent an increase in central nervous system depression. The patient should be instructed not to drive, because anticonvulsants may induce drowsiness. Herbs like ginkgo can reduce the effect of phenytoin; therefore, the patient should be asked to avoid taking any herbs along with the medication. The patient must follow the prescription of the primary health care provider before stopping the anticonvulsant drugs, because abrupt discontinuation may cause seizure rebound or status epilepticus.
What is the primary information the nurse should teach a patient who has just started taking mephobarbital (Mebaral)? 1 "Do not drive until you determine how you react to the medication." 2 "Take the medication on a full stomach." 3 "Do not take any over-the-counter medications with this drug." 4 "Take this medication for 1 month only and then stop."
"Do not drive until you determine how you react to the medication." This medication can cause drowsiness. The nurse must teach the patient to be safe while taking this medication. The drug does not need to be taken on a full stomach or to be taken for a limited period of time. The patient should be advised not to take any sedating medications that are available over the counter, but the patient does not need to discontinue all over-the-counter medications.
A female patient who is at risk of stroke is on aspirin therapy. A nurse provides instructions regarding the correct use of aspirin to ensure effective outcome of the treatment. Which statement made by the patient indicates effective understanding? 1 "I should take aspirin at mealtime." 2 "I should take aspirin with warfarin (Coumadin)." 3 "I should discontinue aspirin for the first 2 days of my menstrual cycle." 4 "I should avoid large doses of vitamin C during aspirin therapy."
"I should take aspirin at mealtime." Aspirin is used to prevent blood clotting. It should be administered at mealtime or with plenty of fluids to avoid gastrointestinal disturbances. This is because aspirin inhibits cyclooxygenase-1 (COX-1), which protects the stomach lining. Administration of aspirin with warfarin (Coumadin) should be strictly avoided, because aspirin increases the effect of warfarin (Coumadin). This will result in increased anticoagulant levels. Aspirin administration should be discontinued for 2 days before menstrual periods and for the first 2 days of menstrual periods because it can cause heavy menstrual bleeding. During this period, the patient can take acetaminophen. A large dose of vitamin C will not cause any effect during aspirin therapy; it should be avoided during the administration of allopurinol (Zyloprim) because it can cause kidney stones.
A nurse is teaching a patient on anticonvulsant therapy with phenytoin (Dilantin) about the necessary precautionary measures to be taken during treatment. Which statement by the patient indicates a need for further teaching? 1 "I should avoid driving and other hazardous activities during initiation of therapy." 2 "I should stay away from alcohol and other central nervous system (CNS) depressants." 3 "I should ask the primary health care provider to modify the drug dosage if I use the herb evening primrose." 4 "I should withdraw the medication gradually if my seizures stop to reduce the risk of seizure rebound and status epilepticus."
"I should withdraw the medication gradually if my seizures stop to reduce the risk of seizure rebound and status epilepticus." It is essential to withdraw anticonvulsant medications gradually to reduce the risk of seizure rebound and status epilepticus. However, the patient should do so only under proper medical supervision, not independently. The patient should avoid driving and other hazardous activities during the initiation of therapy, because the drug might cause drowsiness. Alcohol and CNS depressants should not be taken with anticonvulsants, because they might lead to added depressive effects on the patient's body. Evening primrose oil lowers the seizure threshold. The patient should consult with the primary health care provider regarding the modification of phenytoin (Dilantin) dosage.
A child is prescribed methylphenidate (Ritalin) for attention deficit/hyperactivity disorder (ADHD). Which instruction should the nurse give to the parent or caregiver as precautionary step to be followed while taking the medication?
"Monitor your child's weight twice a week." Methylphenidate (Ritalin) may cause weight loss due to its appetite-suppressant effects. Therefore, the parents of a client taking this drug should be instructed to check their child's weight twice a week. Caffeine-containing foods such as chocolate should be avoided because methylphenidate (Ritalin) may increase the effect of caffeine. Methylphenidate (Ritalin) should not be taken before sleep because it may cause insomnia. The client should not abruptly stop getting the drug as it may lead to severe withdrawal symptoms.
During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement? 1 "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." 2 "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." 3 "Most drugs produce sedation at low doses, and sleep, the hypnotic effect, at higher doses." 4 "There really is no difference; the terms are used interchangeably."
"Most drugs produce sedation at low doses, and sleep, the hypnotic effect, at higher doses." Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at higher doses. These drugs do not induce a state of hypnosis.
A nurse is teaching a patient being treated for seizures with phenytoin (Dilantin) about necessary precautions that need to be taken during the course of treatment. What is the most important instruction to reduce the risk of status epilepticus in the patient? 1 "Refrain from driving and taking up other hazardous activities." 2 "Avoid consumption of alcohol and caffeinated products like tea and coffee." 3 "Never stop taking the drug abruptly; please take each dose as scheduled." 4 "Consult your primary health care provider regarding the teratogenic effects of phenytoin (Dilantin)."
"Never stop taking the drug abruptly; please take each dose as scheduled." Stopping the drug therapy abruptly increases the risk of seizure rebound and status epilepticus. Therefore the patient should take each dose as scheduled in order to maintain drug therapeutic levels. During the initiation of anticonvulsant therapy, the patient should not drive or perform hazardous activities, because drowsiness may occur. This does not help to prevent status epilepticus. Alcohol and other central nervous system (CNS) depressants might lead to added depressive effects on the body if taken with anticonvulsants. Caffeinated products are CNS stimulants. If a female patient being treated with phenytoin (Dilantin) is contemplating pregnancy, she should consult the primary health care provider regarding the teratogenic effects of the drug. This instruction, however, is not relevant to preventing status epilepticus.
What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin (Dilantin)? 1 "Take your blood pressure daily." 2 "If your weight increases, call your health care provider." 3 "Use birth control while on this medication." 4 "Do not take this medication with grapefruit juice."
"Use birth control while on this medication." The nurse should tell the young woman to use birth control while on the medication as an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.
What information will the nurse teach the patient who is considering stopping the antiepileptic drug phenytoin? 1 "You may go into status epilepticus." 2 "You may have an acute withdrawal." 3 "You will have severe hypotension." 4 "You may become confused and delirious."
"You may go into status epilepticus." Abrupt withdrawal of antiepileptic drugs can cause the development of status epilepticus. However, stopping phenytoin should not result in acute withdrawal, severe hypotension, or confusion.
The registered nurse is teaching a group of student nurses about the pharmacodynamics of amphetamine-like drugs. Which statements by a nursing student indicate the need for further learning? Select all that apply. 1 "Amphetamine-like drugs may cause hypertensive crisis." 2 "Amphetamine-like drugs are contraindicated for treating narcolepsy." 3 "Amphetamine-like drugs have a lesser potential for abuse when compared to amphetamines." 4 "Amphetamine-like drugs are considered more effective in treating attention deficit/hyperactivity disorder (ADHD) than amphetamines." 5 "Sympathomimetics and psychostimulants taken simultaneously with amphetamine-like drugs increase stimulatory effects of irritability, nervousness, tremors, and insomnia."
1 "Amphetamine-like drugs may cause hypertensive crisis." 2 "Amphetamine-like drugs are contraindicated for treating narcolepsy." Concurrent monoamine oxidase inhibitors (MAOIs), amphetamine-like drugs, essentially cause hypertensive crisis. Amphetamine-like drugs are prescription drugs for treating narcolepsy. Amphetamines are generally avoided because they have a higher potential for abuse, habituation, and tolerance when compared to amphetamine-like drugs. Amphetamine-like drugs are essentially considered more effective in treating ADHD than amphetamines. Sympathomimetics and psychostimulants if taken simultaneously with amphetamine-like drugs increase stimulatory effects of irritability, nervousness, tremors, and insomnia.
The nurse is teaching a patient about the administration of methylphenidate HCl (Ritalin). Which statements show that the patien needs further teaching about the medication? Select all that apply. 1 "I should check my weight every day." 2 "I should not be taking it on a long-term basis." 3 "I should consume drinks that contain caffeine." 4 "I should take the medication after every meal." 5 "I should not stop taking the medication whenever I choose."
1 "I should check my weight every day." 3 "I should consume drinks that contain caffeine." 4 "I should take the medication after every meal." Methylphenidate HCl (Ritalin) is a central nervous system stimulant. The patient should be taught to monitor weight twice a week, not every day, and report weight loss. The patient should not consume drinks that contain caffeine when the medication is being administered. It is imperative that the medication be taken before, not after, every meal. The patient should not be advised to take the medication on a long-term basis, because the patient will develop dependency on the drug. The medication should not stopped abruptly. It has to be tapered off gradually, according to the prescription of the primary health care provider.
When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? Select all that apply. 1 Decreased peristalsis 2 Diarrhea 3 Delayed gastric emptying 4 Urinary retention 5 Nausea
1 Decreased peristalsis 3 Delayed gastric emptying 4 Urinary retention 5 Nausea Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention and nausea.
What are contraindications to the administration of barbiturates? Select all that apply. 1 Pregnancy 2 Hypotension 3 Drug allergy 4 Status epilepticus 5 Significant respiratory difficulties
1 Pregnancy 3 Drug allergy 5 Significant respiratory difficulties Use of barbiturates during pregnancy may lead to miscarriage. Barbiturates can cause hypersensitivity reactions such as urticaria, rash, and fever. Barbiturates may also cause respiratory depression. Hypotension is one of the adverse effects of barbiturates. They are used to treat status epilepticus, as they are prescribed to decrease central nervous system activity.
A patient who is an alcoholic is prescribed benzodiazepines by the health care provider. Which symptoms does the nurse anticipate in this patient? Select all that apply. 1 Somnolence 2 Hypotension 3 Confusion 4 Diminished reflexes 5 Respiratory depression
2 Hypotension 5 Respiratory depression Hypotension and respiratory depression are the most common symptoms seen when benzodiazepines are taken along with other central nervous system depressants such as alcohol or barbiturates. Somnolence, confusion, and diminished reflexes are seen in patients with an overdose of benzodiazepines.
A nurse is administering ibuprofen to a patient with arthritis. Which nursing interventions would result in an effective outcome of the treatment? Select all that apply. 1 Observing the patient for fever, nausea, and vomiting 2 Monitoring peripheral edema, especially in the morning 3 Providing the name and dosage of the medication to the patient 4 Administering a nonsteroidal antiinflammatory drug 30 minutes before mealtime 5 Informing the patient that the desired response of ibuprofen will be experienced very quickly
2 Monitoring peripheral edema, especially in the morning 3 Providing the name and dosage of the medication to the patient The nurse should monitor peripheral edema, especially in the morning, because at night, during sleep, the patient's body is in complete rest position without any movement. Therefore, there are chances of peripheral edema. The nurse should provide the name and dosage of the medication to the patient. The nurse should observe bleeding gums, petechiae, ecchymoses, or black (tarry) stools during the treatment, but not fever, nausea, or vomiting, because these are the common side effects of this medication. First-generation nonsteroidal antiinflammatory drugs increase the blood clotting time by inhibiting the action of cyclooxygenase-1 (COX-1). The nurse should administer ibuprofen to the patient at mealtime, because this drug can cause gastric disturbances. The nurse should inform the patient that it may take several weeks to experience the desired drug effect of some NSAIDs such as ibuprofen.
The nurse is teaching a group of student nurses about evaluating a patient who is prescribed methylphenidate HCl (Ritalin). Which statements of a nursing student indicate a need for further learning? Select all that apply. 1 "I should check for the presence of adverse effects." 2 "I should monitor the patient for psychological status." 3 "I should check the level of hypoactivity in the patient." 4 "I should monitor the patient about the complete physiologic status regularly." 5 "I should evaluate the patient about the knowledge of methylphenidate HCl (Ritalin)."
3-"I should check the level of hypoactivity in the patient." 4-"I should monitor the patient about the complete physiologic status regularly." The nurse should check for hyperactivity, not hypoactivity, in the patient. The nurse does not have to monitor the patient about the complete physiologic status regularly, but should emphasize weight and sleep patterns. The nurse should imperatively monitor the presence of adverse effects of the medication. The nurse should definitely monitor the patient for mental or psychological status. The nurse should evaluate the patient's knowledge of methylphenidate HCl (Ritalin).
A patient who has been taking morphine for pain is assessed by the nurse. The patient's respiratory rate is 7 per minute, and pupils are 1 mm and unreactive. What is the nurse's immediate action? 1 Start rescue breathing. 2 Call anesthesia. 3 Call a code. 4 Administer naloxone (Narcan).
Administer naloxone (Narcan). Morphine overdose can be indicated by unresponsive, pinpoint pupils and respiratory depression. Rescue breathing, calling anesthesia, or calling a code might not be necessary if the patient receives Narcan.
What is the primary use of prostaglandin inhibitors? 1 Analgesic 2 Antipyretic 3 Anticoagulant 4 Antiinflammatory
Antiinflammatory Prostaglandin inhibitors are primarily used as antiinflammatory agents to relieve inflammation. These are also used as analgesics to relieve pain, antipyretics to reduce elevated body temperature, and anticoagulants to inhibit platelet aggregation. However, these effects are secondary compared to the antiinflammatory effects, and are not considered primary uses of prostaglandin inhibitors.
A client receiving phenytoin (Dilantin) complains of "blurred vision." What is the priority nursing action? 1 Assess serum phenytoin levels. 2 Monitor for seizure activity. 3 Assess the client's pupils. 4 Hold the client's medication.
Assess serum phenytoin levels. At toxic levels, phenytoin can cause nystagmus, which would cause the client to have difficulty focusing. The nurse should assess serum phenytoin levels to determine the drug level. The medication should not be held unless the client is determined to have toxic levels of the drug. The client is most likely not having a seizure at this time. Assessing pupils would not assist the nurse in determining the cause of the blurred vision.
Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics? 1 Assessing heart rate for bradycardia 2 Assessing patient for decreased mental alertness 3 Assessing blood pressure for hypotension 4 Assessing patient for nervousness
Assessing patient for nervousness Analeptics are CNS stimulants, thus causing nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension. Decreased mental alertness, hypotension and bradycardia should not result from the administration of this medication
Which assessment finding in a patient taking NSAIDs requires immediate intervention? 1 Black, tarry stools 2 Headache 3 Nonproductive cough 4 Palpitations
Black, tarry stools A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed. Headaches, cough, and palpitations should not result from the use of NSAID medications.
The nurse is caring for a patient who is taking a barbiturate. Which assessment finding requires immediate action by the nurse? 1 History of a sleep disorder 2 +1 pitting edema of the lower extremities 3 Blood pressure of 90/60 4 Complaint of headaches
Blood pressure of 90/60 A history of a sleep disorder and +1 pitting edema of the lower extremities are not significant enough to warrant calling the primary care provider, although they should be documented. Development of headaches is considered to be an expected side effect of administration of barbiturates. A blood pressure of 90/60 will require immediate treatment because it may be indicative of an overdosage of the medication.
Which antiinflammatory agent inhibits only cyclooxygenase-2 (COX-2), but not cyclooxygenase-1 (COX-1)? 1 Etodolac (Lodine) 2 Tolmetin (Tolectin) 3 Meloxicam (Mobic) 4 Celecoxib (Celebrex)
Celecoxib (Celebrex) Cyclooxygenase (COX) is the enzyme that helps convert arachidonic acid into prostaglandins and their products. These prostaglandins cause inflammation and pain at the tissue injury site. Celecoxib (Celebrex) is a second-generation nonsteroidal antiinflammatory drug known as a selective COX-2 inhibitor. Celecoxib (Celebrex) is a selective COX-2 inhibitor that inhibits only COX-2. Usually, all NSAIDs such as etodolac (Lodine), tolmetin (Tolectin), and meloxicam (Mobic) inhibit both COX-1 and COX-2, but celecoxib (Celebrex) is a selective COX-2 inhibitor.
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? 1 Stimulation of the immune system 2 Cough suppressant 3 Expectorant 4 Bronchodilation
Cough suppressant Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.
A postoperative craniotomy patient is received in the intensive care unit. The nurse makes sure which prescribed drug is readily available to treat acute seizure activity? 1 Gabapentin (Neurontin) 2 Diazepam (Valium) 3 Ethosuximide (Zarontin) 4 Flumazenil (Romazicon)
Diazepam (Valium) Therapy for acute seizure activity is typically diazepam (Valium), which is considered by many to be the drug of choice. Other drugs used for acute therapy include lorazepam, fosphenytoin, phenytoin, and phenobarbital.
When assessing a client for adverse effects of morphine sulfate (Roxanol), which finding would a nurse expect? 1 Increased bowel sounds 2 Diarrhea 3 Insomnia 4 Drowsiness
Drowsiness Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility, leading to constipation. Morphine sulfate can cause constipation, not increased bowel sounds. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. It is an opioid and causes drowsiness.
A patient is admitted to the emergency department with an overdose of a benzodiazepine. Which antidote will the nurse expect to administer? 1 Flumazenil (Romazicon) 2 Naloxone (Narcan) 3 Naltrexone (ReVia) 4 Nalmefene (Revex)
Flumazenil (Romazicon) is the antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are used in opioid or narcotic overdose.
The patient is being started on the first-line antiepileptic medication carbamazepine. The patient asks the nurse to assist in planning meals that will not conflict with dietary restrictions related to the medication. The nurse's response is based on the knowledge that the patient who is taking this medication should avoid which fluid? 1 Grape juice 2 Orange juice 3 Grapefruit juice 4 Apple juice
Grapefruit juice The patient who is taking carbamazepine should avoid drinking grapefruit juice because it may lead to toxicity of the medication.
In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? 1 Nausea related to gastrointestinal side effects 2 Risk for Injury related to central nervous system side effects 3 Impaired Gas Exchange related to respiratory depression 4 Constipation related to gastrointestinal side effects
Impaired Gas Exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority.
What will the nurse teach the patient to minimize gastrointestinal (GI) side effects of opioid analgesics for chronic pain? 1 Take stool softeners with each dose. 2 Eat foods high in lactobacilli. 3 Take the medication on an empty stomach. 4 Increase fluid and fiber in the diet.
Increase fluid and fiber in the diet. Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this. Eating foods high in lactobacilli and taking the medication on an empty stomach will not minimize GI side effects and may intensify them. Lomotil is used to treat diarrhea rather than the constipation that would result from use of narcotic analgesics.
The nurse assesses a patient taking phenytoin (Dilantin) and finds gingival hyperplasia. What is the nurse's priority action? 1 Instruct the patient on oral hygiene. 2 Call for a consultation with a dentist. 3 Call the health care provider. 4 Hold the next dose of the drug.
Instruct the patient on oral hygiene. A side effect of phenytoin (Dilantin) is overgrowth of gum tissue. This can be minimized by frequent oral hygiene. If oral hygiene efforts do not improve gum condition, a consultation with a dentist is recommended. Because this is an expected side effect, there is no indication to notify the health care provider or to hold the next dose.
Which condition is a contraindication for the administration of acetaminophen (Tylenol)? 1 Anemia 2 Asthma 3 Joint pain 4 Liver disease
Liver disease The patient who has liver disease is unsuitable for the administration of acetaminophen (Tylenol). Hepatotoxicity is an adverse effect of acetaminophen (Tylenol). If it is administered in the patient who has liver disease, then it increases the risk of liver failure. Therefore, acetaminophen (Tylenol) should not be administered to the patient who has liver disease. Acetaminophen (Tylenol) is safe for a patient who has anemia, asthma, or joint pain.
While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication? 1 Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months 2 Reducing seizure occurrence to one per week 3 Maximally reducing seizure activity while minimizing side effects of medication therapy 4 Maximizing drug dosages to control seizure activity
Maximally reducing seizure activity while minimizing side effects of medication therapy Anticonvulsant medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects.
A nurse is taking necessary safety measures for a pregnant woman who has been prescribed an anticonvulsant drug. What special precaution is the nurse required to take to prevent frequent seizures? 1 Monitor serum phenytoin levels closely during anticonvulsant drug therapy 2 Provide folic acid supplements on a daily basis during anticonvulsant drug therapy 3 Contact the primary health care provider if the patient is prescribed phenytoin and carbamazepine 4 Instruct the patient on anticonvulsant drugs to take oral vitamin K during the last week of pregnancy
Monitor serum phenytoin levels closely during anticonvulsant drug therapy Due to increased metabolic rates during pregnancy, frequent seizures may occur; therefore, serum phenytoin levels should be monitored closely. The daily intake of anticonvulsants can lead to increased loss of folate during pregnancy. Therefore, folic acid supplements are taken on daily basis. However, the nurse should not provide the medication without the primary health care provider's permission. Additionally, this measure does not prevent frequent seizures. A combination of phenytoin and carbamazepine can lead to fetal anomalies. Therefore, the primary health care provider must be contacted. This action does not prevent frequent seizures. Anticonvulsant drugs act as an inhibitor of vitamin K; thus oral vitamin K is prescribed during the last week of pregnancy. However, the nurse does not provide this instruction.
What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant? 1 Keep the patient on bed rest. 2 Monitor the patient for seizure activity. 3 Continuously monitor the patient's pulse rate. 4 Obtain a bedside commode for the patient.
Monitor the patient for seizure activity. Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant. There is no need to keep a patient on bed rest. Although the patients' pulse rate may increase, continuous monitoring is not necessary. There is no rationale for obtaining a bedside commode for the patient.
A nurse is monitoring a patient in the anesthetic unit who was administered droperidol and fentanyl (Innovar). Which nursing intervention would be priority for this patient? 1 Assessing for blurred vision 2 Monitoring for skin reactions 3 Monitoring blood pressure 4 Monitoring respiratory rate regularly
Monitoring respiratory rate regularly Droperidol and fentanyl (Innovar) are neuroleptic analgesics, which are used as a preanesthetic medication. Monitoring blood pressure and respiratory rate is beneficial because this drug can cause hypotension and respiratory depression as side effects. Ensuring a patent airway and monitoring respiratory rate is the priority action of the nurse. One of the side effects of alprazolam is blurred vision. Therefore, assessing for blurred vision is important in a client who is given alprazolam. Monitoring for skin reactions would be beneficial in a patient who is on benzodiazepines. The nurse should encourage a patient on spinal anesthesia to lie flat. This intervention helps decrease the spinal fluid leakage from the injection site.
The patient has recently been prescribed a sedative-hypnotic medication and reports experiencing a "hangover"-type effect upon awakening. What does this symptom indicate? 1 Need for primary provider to assess the drug 2 Toxic level of the medication 3 Allergic reaction to the medication 4 Inadequate amount of the medication
Need for primary provider to assess the drug Some of the sedative-hypnotic drugs can produce a hangover-type effect; if this occurs, the provider should assess the medication to determine if there is another that would be more effective for the patient with fewer side effects. Such a symptom is not indicative of overdosage, an allergic reaction, or inadequate dosage.
The nurse is caring for a pediatric patient who has been taking phenytoin (Dilantin) for the past week. The patient develops a rash. What is the nurse's highest priority action? 1 Advise the parent to apply ointment and a bandage on the area. 2 Notify the prescribing health care provider of this development. 3 Monitor the area; this is an expected side effect of the drug. 4 Monitor the patient for evidence of additional side effects.
Notify the prescribing health care provider of this development. Development of a rash is evidence of a reaction to the drug. The drug should be discontinued and the prescribing healthcare provider should be notified.
The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's highest priority action?
Notify the primary healthcare provider. Methylphenidate interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.
The nurse is assessing a patient taking morphine sulfate. Which assessment requires immediate action? 1 Decreased bowel sounds 2 Nausea 3 Delayed gastric emptying 4 Pinpoint pupils
Pinpoint pupils might be a sign of morphine overdose or toxicity. The nurse needs to act on this finding immediately. Decreased bowel sounds, nausea and delayed gastric emptying are expected side effects of morphine sulfate and do not require immediate action.
During a history assessment and physical examination, a primary health care provider determines that a patient is at risk of heart stroke. Which action performed by the primary health care provider may reduce the risk of heart stroke? 1 Providing multivitamin tablets 2 Providing aspirin therapy 3 Prescribing celecoxib (Celebrex) therapy 4 Prescribing allopurinol (Zyloprim) therapy
Providing aspirin therapy Aspirin helps reduce the risk of stroke. It thins the blood and dissolves blood clots. Therefore, a low dose of aspirin should be given to the patient. Multivitamin tablets will not help reduce the risk of heart stroke. Multivitamin tablets provide nutritional support. Celecoxib (Celebrex) therapy will not help reduce the risk of heart stroke; instead it will lead to adverse drug reactions such as peripheral edema. Allopurinol (Zyloprim) therapy is an antigout drug and is not effective for preventing stroke.
While completing discharge teaching for a patient prescribed an antiepileptic drug, the nurse instructs the patient that what potential complication could occur if he or she abruptly stopped taking the antiepileptic drug? 1 Rebound seizure activity 2 Acute withdrawal syndrome 3 Hypotension 4 Confusion and delirium
Rebound seizure activity Abrupt withdrawal of antiepileptic drugs can cause rebound seizure activity.
A nurse is assessing a patient with status epilepticus. The patient belongs to a culture that believes that medications should not be continued for life. The client also does not understand the nurse's language well. What essential nursing activity enables the patient's compliance with the prescribed regimen? 1 Instructing the patient to attend follow-up visits 2 Showing videos and pictures involving the patient's cultural group 3 Providing a written drug schedule to ensure adherence to the drug regimen 4 Requesting an interpreter to help the nurse to complete the assessments
Requesting an interpreter to help the nurse to complete the assessments The nurse must be able to perform the necessary assessments in order to better understand the patient's problems. In this case, an interpreter is required help the patient understand the nurse's questions and instructions. The nurse should instruct the patient to attend follow-up visits. Because language barriers exist, the nurse may require the services of an interpreter and a community nurse. If language barriers are present, the nurse may show videos and pictures involving the patient's cultural group to encourage compliance with the prescribed drug regimen. However, this should be done after completing the necessary assessments. To encourage compliance to the drug regimen, the nurse should provide a written drug schedule in the patient's preferred language.
Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? 1 Blood pressure 2 Heart rate 3 Mental status 4 Respiratory rate
Respiratory rate The most serious side effect of narcotic analgesics is respiratory depression. This is the priority for the nurse to monitor. The other assessments should also be made; however, a decrease in respiratory rate is the highest priority for the nurse to address.
Which symptom indicates blood dyscrasia due to the use of anticonvulsant drugs? 1 Gum irritation and bleeding 2 Sore throat, bruising, and nosebleeds 3 Slurred speech, rash, and dizziness 4 Harmless pinkish-red or reddish-brown urine
Sore throat, bruising, and nosebleeds Sore throat, bruising, and nosebleeds may indicate blood dyscrasia due to the use of anticonvulsant drugs. Side effects such as gum irritation and bleeding may be caused by the intake of an anticonvulsant drug; these effects do not indicate blood dyscrasia. Side effects like slurred speech, rash, and dizziness are indicative of Stevens-Johnson syndrome. These symptoms do not indicate blood dyscrasia. Side effects like harmless pinkish-red or reddish-brown urine are caused by the intake of an anticonvulsant drug. This symptom does not indicate blood dyscrasia.
A patient with attention deficit/hyperactivity disorder (ADHD) has been prescribed methylphenidate HCl (Ritalin). The patient has a history of hypertension as well and is taking an antihypertensive medication. What drug interaction can be identified in the patient?
The patient will receive a reduced effect of antihypertensive. The patient will have a tendency to receive a reduced effect of the antihypertensive medication he or she is taking. The effect of antihypertensive medications is reduced as a result of drug interaction with methylphenidate HCl (Ritalin). Methylphenidate HCl (Ritalin) increases the effects of oral anticoagulants, barbiturates, and anticonvulsants, but not antihypertensive drugs. Taking caffeine along with methylphenidate increases the effect of methylphenidates in a patient. Methylphenidate HCl (Ritalin) increases the stimulatory effects of sympathomimetics and psychostimulants, not antihypertensives
What is the advantage of COX-2 inhibitors over nonspecific nonsteroidal anti-inflammatory (NSAID) drugs? 1 They do not cause gastrointestinal ulceration. 2 They are effective against pain and inflammation. 3 They block the chemical activity of cyclooxygenase. 4 They inhibit leukotriene and prostaglandin pathway.
They do not cause gastrointestinal ulceration. COX-2 inhibitors specifically inhibit cyclooxygenase-2, so they are not associated with adverse effects such as gastrointestinal ulcers. Both COX-2 inhibitors and nonspecific NSAIDs are effective against pain and inflammation, and block the chemical activity of the enzyme cyclooxygenase. Both COX-2 inhibitors and NSAIDs inhibit leukotriene and prostaglandin pathways to prevent inflammation.
An elderly patient who complains of sleeplessness is prescribed triazolam (Halcion). The primary health care provider advises the patient to take the medication for no more than 7 to 10 days. Why would the primary health care provider give this advice? 1 To avoid drug tolerance 2 To avoid suicidal ideation 3 To avoid paradoxical reactions 4 To avoid withdrawal symptoms
To avoid drug tolerance Triazolam (Halcion) is used for the treatment of insomnia. It should not be used continuously for more than 7 to 10 days because it may cause tolerance upon prolonged use. Barbiturates such as pentobarbital sodium (Nembutal sodium) and secobarbital sodium (Seconal sodium) may cause suicidal ideation. Triazolam (Halcion) is not associated with suicidal ideation. Paradoxical reactions are one of the side effects of alprazolam (Xanax), not triazolam (Halcion). Abrupt cessation of any benzodiazepine drug may result in withdrawal symptoms. To avoid withdrawal symptoms, the primary health care provider would advise the patient to stop the drug gradually.
What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? 1 Wait to see how you react to the medication before driving. 2 Lie in bed for at least an hour after taking any antiepileptic agent. 3 Take the antiepileptic agent with milk or juice to prevent stomach upset. 4 Do not take the medication if you have a fever.
Wait to see how you react to the medication before driving. Antiepileptic medications suppress the central nervous system. The patient should know how they respond to the medication before attempting tasks such as driving. The patient does not have to lie in bed for an hour after taking an antiepileptic. Several medications cannot be taken with milk or fruit juice, and the nurse should not instruct the patient to administer medication in this manner. A fever is not a contraindication to taking an antiepileptic agent.
The patient is being treated with phenytoin (Dilantin) for seizures. The nurse is instructing the patient on follow-up appointments that will be needed to maintain the patient's level of health. The nurse instructs the patient that appointments should be made on a regular basis with which health care professional? 1 Physical therapist 2 Dentist 3 Psychologist 4 Chiropractor
dentist The patient should see his or her dentist frequently to avoid the possibility of gingival hyperplasia developing as a side effect of the medication.
