PHARM Quiz 5 x 2
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?
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.
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." 00:00:08 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
"Avoid consuming alcohol."
What is the primary information the nurse should teach a patient who has just started taking mephobarbital (Mebaral)?
"Do not drive until you determine how you react to the medication."
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?
"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?
"I should withdraw the medication gradually if my seizures stop to reduce the risk of seizure rebound and status epilepticus."
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?
"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?
"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)?
"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?
"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." 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." 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 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 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 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.
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.
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.
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.
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).
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?
Grapefruit juice
What is the primary use of prostaglandin inhibitors?
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?
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?
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 Analeptics (restorative drug: caffeine or amphetamine)
Which assessment finding in a patient taking NSAIDs requires immediate intervention?
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?
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)?
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?
Cough suppressant
A patient is admitted to the emergency department with an overdose of a benzodiazepine. Which antidote will the nurse expect to administer?
Flumazenil (Romazicon) is the antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are used in opioid or narcotic overdose.
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?
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?
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.
In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?
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?
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?
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)?
Liver disease
While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication?
Maximally reducing seizure activity while minimizing side effects of medication therapy
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?
Monitor serum phenytoin levels closely during anticonvulsant drug therapy
What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant?
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?
Monitoring respiratory rate regularly
The patient has recently been prescribed a sedative-hypnotic medication and reports experiencing a "hangover"-type effect upon awakening. What does this symptom indicate?
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?
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?
Pinpoint pupils
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?
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. Edema is a condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells (interstitial spaces)
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?
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?
Requesting an interpreter to help the nurse to complete the assessments
Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic?
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?
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?
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?
To avoid drug tolerance
What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home?
Wait to see how you react to the medication before driving.
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?
dentist
