Pharmacology - Chapters 14-16
Primary side effects of the SSRIs include which of the following symptoms? A. Rash and alopecia B. Gastritis and diarrhea C. Weight gain and sexual dysfunction D. Photosensitivity and discoloration of the skin
c.
An agitated patient is to receive an intravenous dose of diazepam (Valium). The order reads, "Give diazepam, 2 mg, IV push, now. Repeat in 15 minutes if needed." Identify how many milliliters will the nurse administer for this dose. The medication vial contains 5 mg/mL. _______
0.4 mL
A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mL daily. The medication is available in a strength of 100mg/5 mL. How many milliliters will the nruse give to the patient for each dose?
10 mL
The prescriber writes this order, "Give amantadine (Symmetrel) 100 mg per PEG tube twice a day." The medication is available in a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters will the nurse give with each dose. _______
10 mL
The medication order reads: "Atomoxetine (Strattera) 1.2 mg/kg/day in 2 divided doses." The child weighs 66 Ibs. How much will be given with each dose?
18 mg/dose
The medication order reads: "Give benztropine (Cogentin) 2.5 mg PO every morning." The medicaiton is available in 1-mg tablets. How many tablets will the nurse administer?
2.5 tablets
A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in 2 divided doses via the feeding tube. The medication is available in a 1 mg/ml solution. How many milliliters will the nurse administer for each dose?
4 mL/dose
The nurse is preparing to administer valproic acid to a child. The order reads: "Give valproic acid, 15 mg/kg/day orally in three divided doses." The child weighs 33 pounds. How milligrams will the child receive with each dose?
75 mg
What medication do you use to treat a febrile seizure?
Tylenol (acetaminophen)
A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. the lithium level is therapeutic b. the lithium level is too low c. the lithium level is too high d. lithium is not usually monitored with blood levels
a.
A patient is experiencing a seizure that has lasted for several minutes, and he has not regained consciousness. The nurse recognizes that this is a life-threatening emergency known as- A. Status epilepticus B. Tonic-clonic convulsions C. Epilepsy D. Secondary epilepsy
a.
A patient is experiencing status epilepticus (or partial and tonic-clonic seizures). The nurse prepares to give which drug of choice for the treatment of this condition? A. diazepam (Valium) B. midazolam (Versed) C. valproic acid (Depakote) D. carbamazepine (Tegretol)
a.
A patient is receiving lamotrigine as treatment for partial seizures. Which assessment finding would lead the nurse to stop the drug immediately? A. Rash B. Somnolence C. Anorexia D. Confusion
a.
A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? A. Notify the patient that this drug causes discoloration of the urine B. Limit the patient's intake of tyramine-containing foods C. Monitor the results of renal studies because this drug can seriously affect renal function D. Force fluids to prevent dehydration
a.
A patient is taking gabapentin (Neurontin), and the nurse notes that the patient has no history of seizures on his medical record. What is the best possible rationale for this medication order? A. This medication is used for treatment of neuropathic pain. B. The medication is helpful for the treatment of osteoarthritis. C. This medication is used to reduce the symptoms of Parkinson's disease. D. The medical record is missing the correct information about his history of seizures.
a.
A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also indicated for- A. Postherpetic neuralgia B. Viral infections C. Parkinson's disease D. Depression
a.
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 that what is happening in this situation? a. This is a harmless effect of the drug. b. The patient has taken this drug along with red wine or cheese. c. The patient is having an allergic reaction to the drug. d. The ordered dose is too high for this patient.
a.
A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that A. the entacapone can reduce the on-off effects B. the levodopa may be stopped in a few days C. there is less GI upset with entacapone D. it does not cause the cheese effect
a.
A patient with narcolepsy will begin treatment with Methylphenidate. The nurse expects to see what adverse effect? a. nervousness b. bradycardia c. mental clouding d. drowsiness at night
a.
During therapy for depression with a selective serotonin reuptake inhibitor (SSRI), it is most important for the nurse to instruct the family to monitor for which adverse effect? A. Suicidal thoughts B. Visual disturbances C. Tardive dyskinesia D. Bleeding tendencies
a.
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that A. the safe and the toxic plasma levels of the drug are very close to each other. B. phenytoin has a slim chance of being effective. C. there is no difference between safe and toxic plasma levels. D. a very small dosage can result in the desired therapeutic effect.
a.
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that: a. the safe and toxic plasma levels of the drug are very close to each other b. phenytoin has a low chance of being effective c. there is no difference between safe and toxic plasma levels d. a very small dosage can result in the desired therapeutic effect
a.
The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? a. increased risk of suicidal thoughts and behaviors b. signs of bone marrow depression c. indications of drug addiction and dependency d. increased risk of cardiovasular events, such as strokes
a.
The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient will lead the nurse to determine that the patient has an adequate understanding? A. "I will need to take extra care of my teeth and gums while on this medication." B. "I can go out for beer while on this medication." C. "I can skip doses if the adverse effects bother me." D. "I will be able to stop taking this drug once the seizures stop."
a.
The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene based on the knowledge that a common side effect of this drug is: A) Gingival hyperplasia. B) Oral candidiasis. C) Increased risk of dental abscesses. D) Increased incidence of dental caries.
a.
The nurse is giving medications to a patient. Which drug or drug class, when administered with lithium, increases the risk for lithium toxicity? a. Thiazides b. levofloxacin c. calcium citrate d. Beta blockers
a.
The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy? a) Cardiovascular disease b) Chronic bronchitis c) History of renal calculi d) Diabetes mellitus type 2
a.
The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. anxiety disorder b. depression c. schizophrenia d. bipolar disorder
a.
Which drug may be used early in the treatment of Parkinson's disease but eventually loses effectiveness and must be replaced by another drug? A. Amantadine (Symmetrel) B. Levodopa (Larodopa) C. Selegiline (Eldepryl) D. tolcapone (Tasmar)
a.
While completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that abruptly stopping this drug could cause: A) Rebound seizure activity. B) Acute withdrawal syndrome. C) Hypotension. D) Confusion and delirium.
a.
While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). Which condition will the nurse suspect that the patient experiences? A) Absence seizures B) Tonic-clonic seizures C) Panic attacks D) Partial seizures
a.
A nurse is developing a care plan for a client on a Tricyclic antidepressant (TCA). What should be included? (Select all that apply) A. Suck on hard candy B. Increase fluid and water C. Avoid foods high in tyramine D. Take in AM
a. b.
A patient receiving valproic acid (Depakote) should be monitored for which side effects? (Select all that apply.) A) Tremors B) Weight gain C) Hepatoxicity D) Hypoglycemia E) Insomnia
a. b. c.
Phenytoin (Dilantin) is prescribed for a patient. The nurse checks the patient's current list of medications and notes that interactions may occur with which drugs or drug classes? (Select all that apply) A. Proton pump inhibitors B. Warfarin (Coumadin) C. Sulfonamide antibiotics D. Corticosteroids E. Oral contraceptives
a. b. c.
The expected side effects of the anticholinergic drugs used to treat Parkinson's include (select all that apply) A. dry mouth and decreased salivation B. Urinary retention C. decreased GI motility and constipation D. pupillary constriction E smooth muscle relaxation
a. b. c. e.
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 carbidopa-levodopa? (Select all that apply): a. angle-closure glaucoma b. history of malignant melanoma c. benign prostatic hyperplasia d. hypertension e. concurrent use of monoamine oxidase inhibitors (MAOI's)
a. b. e.
A patient asks why a second drug is give with his drug for Parkinson's disease. The nurse notes that this drug, an anticholinergic, is given to control or minimize which symptoms? A. Drooling B. Constipation C. Muscle rigidity D. Bradykinesia E. Dry mouth
a. c.
When administering certain antipsychotic drugs, the nurse monitors for extrapyramidal effects such as- (Select all that apply) A. Tremors B. Elation and a sense of well-being C. Painful muscle spasms D. Motor restlessness E. Bradycardia
a. c. d.
You are caring for a patient with Parkinson's disease. The patient takes Amantadine (Symmetrel)100 mg twice a day. During your assessment you will look for which possible adverse effects? (Select all that apply) a. nausea b. palpitation c. dizziness d. insomnia e. edema
a. c. d.
A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when started taking an over the counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (select all that apply) a. agitation b. drowsiness c. tremors d. bradycardia e. sweating f. constipation
a. c. e.
Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson's disease. The nurse will inform the patient of which possible adverse effects? A. Palpitations B. Insomnia C. Hypotension D. Urinary frequency E. GI distress
a. c. e.
The nurse is administering an antiepileptic drug and will follow which guidelines? (Select all that apply): a. monitor the patient for drowsiness b. medication may be stopped if seizure activity disappears c. give the medication at the same time every day d. give the medication on an empty stomach e. notify the prescriber if the patient is unable to take the medication
a. c. e.
A client calls the clinic 2 weeks after beginning Sinemet. She states she does not feel better and that the med is not controlling her symptoms. What is the appropriate action? A. Review her history of medication compliance. B. Remind patient that it may take 1-2 months for a therapeutic effect. C. Increase her dosage. D. Encourage a high protein diet.
b.
A patient has a new prescription for Imitrex. The nurse providing patient teaching on self-administration will include which information? a. correct technique for IM injections b. take the medication before the headache worsens c. allow atleast 30 minutes between injections d. take no more than 4 doses in a 24-hour period
b.
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact? a. Carbidopa allows for larger doses of levodopa to be given. b. Carbidopa prevents the breakdown of levodopa in the periphery. c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
b.
A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse's best response? A. "He is taking another antiepileptic drug, so he can go without the medication for a week." B. "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." C. "He should temporarily increase the dosage of his other antiseizure medications." D. "He can probably stop all medication because he has been treated for several years now."
b.
A patient has been taking carbamazepine (Tegretol) for several months and is worried because the physician has increased the dose twice since the beginning of therapy. What explanation by the nurse is correct? A. The initial dose was not sufficient to prevent seizures. B. A process known as autoinduction results in lower-than-expected drug concentrations. C. The seizures are difficult to manage, and increased doses are needed to control them. D. The patient was forgetting to take the medication as prescribed, which led to a need for increased dosage.
b.
A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. 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. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset
b.
A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. drowsiness b. palpitations and anxiety c. dry mouth d. constipation
b.
A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low carbohydrate/ high protein weight loos diet. The nurse tells the patient that this type of diet may have what effect on this drug therapy? A. There will be no problem with this diet while on this medication B. The high protein diet can slow or prevent absorption of this medication C. The high protein diet may cause increased blood levels of this medication D. The high protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6)
b.
A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? A. Teach patients to avoid foods containing tyramine. B. Monitor for dizziness C. Inform patient that this drug may cause urine discoloration D. Monitor for weight gain
b.
A patient with Parkinson's disease has difficulty preforming voluntary movements. What is the correct term for this symptom? A. Akinesia B. Dyskinesia C. Chorea D. Dystonia
b.
A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? A. Administer the drug by rapid IV push. B. Infuse slowly, not exceeding 50 mg/min. C. Mix the medication with dextrose solution. D. Administer via continuous
b.
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? A) gabapentin (Neurontin) B) diazepam (Valium) C) ethosuximide (Zarontin) D) flumazenil (Romazicon)
b.
Amantadine (Symmetrel)is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication? a. Dyskinesias, drowsiness b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention
b.
An important contraindication to carbamazepine therapy is- A. Intolerance to phenytoin B. A preexisting hematologic abnormality. C. Sedation. D. Visual disturbances.
b.
Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? A. High white blood cell count B. Low serum albumin levels C. Low platelet levels D. High hemoglobin levels
b.
Before beginning a patient's therapy with selective srotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medicaiton class? a. aspirin b. anticoagulants c. diuretics d. nonsteroidal antiinflammatory drugs
b.
Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instruction to the patient about the medication. The nurse includes which information? a. the patient needs to avoid caffeine while on this drug b. the patient needs to wear sunscreen while outside because of photosensitivity c. long-term therapy may result in nervousness and excitability d. the medication may be taken with an antacid to reduce gastrointestinal upset
b.
After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinations c. Suicidal ideation d. Difficulty with urination
c.
During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 18 mcg/mL. What concern should the nurse have, if any? A. The patient is at risk for seizures because the drug level is not at a therapeutic level. B. The patient's seizures should be under control because this is a therapeutic drug level. C. The patient's seizures should be under control if she is also taking a second antiepilepsy drug. D. The drug level is at a toxic level, and the dosage should be reduced.
b.
In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants
b.
The nurse has given medication instructions to the client receiving phenytoin (Dilantin). The nurse determines that the client has an adequate understanding if the client states that: a. "alcohol is not contraindicated while taking this medicaiton" b. "good oral hygiene is needed, including brushing and flossing" c. "the medication dose may be self-adjusted depending on side effects" d. "the morning dose of medications should be taken before a serum drug level is drawn"
b.
The nurse is caring for a patient who has been taking clozapine (Clozaril) for 2 months. Which laboratory test(s) should be performed regularly while the patient is taking this medication? a. Platelet count b. WBC count c. Liver function studies d. Renal function studies
b.
The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? a. Diarrhea b. Urinary retention c. Risk for infection d. Disturbed sleep pattern
b.
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug? a. give the dose as a fast IV bolus b. mix the drug with normal saline and give it as a slow IV push c. mix the drug with dextrose (D5W), and give it as a slow IV push d. mix the drug with any available solution as longas the administration rate is correct
b.
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action will the nurse perform to administer the drug? A. Give the dose as a fast intravenous (IV) bolus. B. Mix the drug with normal saline and give it as an IV piggyback. C. Mix the drug with dextrose (D5W) and give it as an IV piggyback. D. Mix the drug with any available solution as long as the drip rate is correct.
b.
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? a. the drug levels for carbamazepine are higher than expected b. the drug levels for carbamazepine are lower than expected c. the patient is experiencing fewer seizures d. the patient is experiencing toxic effects from the drug
b.
The nurse is preparing to give medications. Which is the most appropriate nursing action for intravenous (IV) phenytoin (Dilantin)? A. Give IV doses via rapid IV push. B. Administer in normal saline solutions. C. Administer in dextrose solutions. D. Ensure continuous infusion of the drug.
b.
The nurse is providing discharge instructions to the patient who will be taking phenytoin (Dilantin). With an understanding of the side effects of phenytoin, which instruction is most important? A. Drink plenty of fluids throughout the day. B. Perform mouth care at least twice a day. C. Limit intake of spinach. D. Use sunscreen liberally.
b.
The nurse is providing teaching on COMT inhibitors to a patient with a new prescription. The nurse will be re to educate the patient on the possibility of which adverse effect? A. Dizziness B. Urine discoloration C. Leg edema D. Visual changes
b.
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? A. tiagabine (Gabitril) B. phenobarbital (Solfoton) C. valproic acid (Depakote) D. rabapentin (Neurontin)
b.
The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? A. digoxin (Lanoxin) B. acetaminophen (Tylenol) C. diazepam (Valium) D. warfarin (Coumadin)
b.
The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "the medication may not be effective for him. He may need to try another type" b. "it may take up to 4 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does" c. "it sounds like the dose is not high enough. Ill check about increasing the dosage" d. "some patients never recover from depression. He may not repond to this therapy"
b.
When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. fewer panic attacks b. decreased paranoia and delusions c. decreased feeling of hopelessness d. improved tardive dyskinesia
b.
When administering intravenous phenytoin (Dilantin), which action will the nurse perform? A) Always use an infusion pump. B) Flush the line with 10 mL normal saline to prevent precipitation. C) Administer through peripheral intravenous sites only. D) Monitor for hypertension.
b.
While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding? a. Rigid, tense muscles b. Difficulty in performing voluntary movements c. Limp extremities with weak muscle tone d. Confusion and altered mental status
b.
While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. hypertensive crisis b. self-injury or suicidal tendencies c. extrapyramidal symptoms d. loss of appetite
b.
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which guidelines will the nurse follow for administration? (Select all that apply) A. Inject phenytoin quickly. B. Inject phenytoin slowly. C. The injection of phenytoin is followed by an injection of sterile saline. D. Do not infuse phenytoin continuously. E. Mix the phenytoin with D5W (5% dextrose and water) for the infusion.
b. c. d.
A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply): a. take this medicaiton after meals b. take this medication in the morning c. this drug is taken along with supervised exercise and a suitable diet d. use mouth rinses, sugarless gum, or hard candies to minimize dry mouth e. avoid foods that contain caffeine, such as coffee, tea, and colas
b. c. d. e.
The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.
b. c. d. f.
An 8 year old has been prescribed Concerta for treatment of ADHD. The patient has been taking the medication for a month. Which of the following are indications of a therapeutic response? (Select all that apply). a. weight loss b. decreased behaviors c. increased attention span d. change in sleep patterns e. improved concentration
b. c. e.
The nurse is administering the antipsychotic drug clozapine (Clozaril) and should monitor the patient for what long-term problem(s) associated with this drug? (Select all that apply) A. Mood swings B. Agranulocytosis C. Weight gain D. Photosensitivity E. Increased appetite
b. c. e.
Which statements about antiepileptic drug (AED) therapy are accurate? Select all that apply. A. AED therapy can be stopped when seizures are under control. B. AED therapy is usually lifelong. C. Consistent dosing is key to controlling seizures. D. A dose may be skipped if the patient is experiencing adverse effects. E. AED therapy should never be abruptly discontinued because doing so may precipitate rebound seizure activity
b. c. e.
A patient is taking lithium carbonate and is experiencing the following symptoms: nausea, vomiting, diarrhea, and hand tremor. What is your assessment? (Select all that apply) A. Not to worry, these are expected. B. Might be early toxicity. Check lithium level. C. Give a diuretic to eliminate from the body. D. Assess for dehydration and treat.
b. d.
A patient with a history of epilepsy has consecutive seizures lasting more than 20 minutes. Which interventions are appropriate? (Select all that apply) A. Administer dexamethasone (Decadron) IV. B. Administer oxygen. C. Prepare for immediate defibrillation. D. Continue to protect patient from injury. E. Administer lorazepam (Ativan)
b. d. e.
A Patient who is newly diagnosed with Parkinson's disease and beginning medication therapy with tacapone (Comtan), a COMT inhibitor, asks the nurse, "How soon will improvement occur?" What is the nurse's best response? A. "That varies from patient to patient." B. "You should discuss that with your physician. C. "You should notice a difference within a few days." D. "It may take several weeks before you notice any degree of improvement."
c.
A client has been taken off paroxetine (Paxil) that she has used for several years. She states I think I may be experiencing "discontinuation symptoms." What symptoms may she be expending? A. Tachycardia and fever B. Shuffling gait and stiffness C. Hypotension and weakness D. Agranulocytosis and itching
c.
A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth for surgery in the morning. What will the nurse do about his morning dose of phenytoin? A. Give the same dose intravenously. B. Give him the morning dose with a small sip of water. C. Contact the prescriber for another dosage form of the medication. D. Notify the operating room that the medication has been withheld.
c.
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. hypertension b. renal failure c. cardiac dysrhythmias d. gastrointestinal bleeding
c.
A patient has been taking antipsychotic medication for years, and his wife has noticed that he has had some new physical symptoms. She describes him as having odd facial movements, sticking out his tongue, and having movements of his arms that he cannot seem to control. The nurse suspects that the patient is exhibiting signs of which condition? A. Hypomania B. Serotonin syndrome C. Tardive dyskinesia D. Neuroleptic malignant syndrome
c.
A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. increased paranoia b. drowsiness and dizziness c. tremors and muscle twitching d. dry mouth and constipation
c.
A patient who is experiencing neuropathic pain tells the nurse that the physician is going to start him on a new medication that is generally used to treat seizures. The nurse anticipates that which drug will be ordered? A. Phenobarbital (Luminal) B. Phenytoin (Dilantin) C. Gabapentin (Neurontin) D. Tiagabine (Gabitril)
c.
A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness? a) phentermine (Ionamin) b) almotriptan (Axert) c) modafinil (Provigil) d) methylphenidate (Ritalin)
c.
A patient with schizophrenia has been prescribed Clozaril 12.5 mg orally twice a day. As you are preparing to discharge the patient what instructions must be included about Clozaril? a. only take your medication with meals b. stop taking the drug when you start to feel better c. you must have a WBC count checked weekly for the first 6 months of therapy d. clozaril has no side effects
c.
Antiepileptic drugs work by: A) Decreasing seizure threshold. B) Enhancing transmission of impulses from one nerve to another. C) Decreasing nerve conduction. D) Correcting electrolyte imbalances.
c.
The client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin level study reveal a level of 25- 35 mcg/mL. Which of the following symptoms would be expected as a result of this laboratory result? a. hypotension b. tachycardia c. slurred speech (ataxia) d. no symptoms, because this is a normal therapeutic level
c.
The nurse administers phenytoin (Dilantin) intravenously at a rate no greater than: A) 10 mg/min. B) 25 mg/min. C) 50 mg/min. D) 100 mg/min.
c.
The nurse is administering phenobarbital (Luminal) and will monitor the patient for which possible adverse effect? A. Constipation B. Gingival hyperplasia C. Drowsiness D. Dysrhythmias
c.
The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson's disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)? a. Glaucoma b. Seizure disorder c. Liver failure d. Benign prostatic hyperplasia
c.
The nurse is reveiwing medicaitons used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects b. unlike tricyclic antidepressants, SSRIs do not have drug-food interactions c. tricyclic antidepressants casue serious cardiac dysrhythmias if an overdose occurs d. SSRIs cause a therapeutic response faster than tricyclic antidepressants
c.
The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor MAOI. Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey
c.
The patient asks the nurse why she is receiving a different drug than her usual phenytoin (Dilantin). The patient is NPO (nothing by mouth) secondary to illness and is receiving intravenous fosphenytoin (Cerebyx). Which is the nurse's most accurate response? A) "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug." B) " Phenytoin is not effective while you are NPO, so your health care provider has changed your medication to a more effective drug." C) " Fosphenytoin is a prodrug of phenytoin—it is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin." D) " Since you are NPO, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will be transferred back to phenytoin after you recover from this illness."
c.
The patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic? A) 8 mcg/mL B) 30 mcg/mL C) 12 mcg/mL D) 6 mcg/mL
c.
The regular-release capsule dosage form of topiramate (Topamax) is prescribed for a patient, and the nurse provides information to the patient about the medication. What does the nurse instruct the patient? A. "Do not chew, crush, or break the capsule." B. "Take the medication on an empty stomach." C. "The capsule may be opened and sprinkled on a teaspoon of soft food." D. "If adverse effects are too severe, a dose may be skipped."
c.
The wife of a patient who has started taking antidepressant therapy asks, "How long will it take for him to feel better?" What is the nurse's best response? A. "Well, depression rarely respond to medication therapy." B. "He should be feeling better in a few days." C. "It may take 4 to 6 weeks before you see an improvement." D. "You may not see any effects for several months."
c.
What is the goal of pharmacologic therapy with Parkinson's disease? A. Increase the amount of acetylcholine at presynaptic neurons. B. Decrease the amount of dopamine in the brain. C. Balance cholinergic and dopamine activity in the brain. D. Block dopamine receptors.
c.
When treating patients with medications for Parkinson's disease, the nurse knows that the wearing-off phenomenon occurs for which reason? a. There are rapid swings in the patient's response to levodopa. b. The patient cannot tolerate the medications at times. c. The medications begin to lose effectiveness against Parkinson's disease. d. The patient's liver is no longer able to metabolize the drug.
c.
Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for the treatment of mild Parkinson's disease? A. Diarrhea B. Tremors C. Angle-closure glaucoma D. Unstable gait
c.
Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy? A. If you feel sleepy when taking the drug, decrease the dose by half. B. Take the drug on an empty stomach. C. Call your health care provider if you experience a sore throat or fever. D. Patients with epilepsy are not able to hold a job and work, so you should apply for benefits.
c.
While teaching a patient newly diagnosed with a seizure disorder, the nurse correctly states the goal of pharmacologic therapy as: A) Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months. B) Reducing seizure occurrence to one per week. C) Maximally reducing seizure activity while minimizing side effects of medication therapy. D) Maximizing drug dosages to control seizure activity.
c.
Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (select all that apply) a. avoid foods and beverages that contain tyramine b. monitor the patient for extrapyramidal symptoms c. therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started d. if the patient has been on an MAOI, a 2 to 5 week or longer time span is required before beginning an SSRI medication e. these drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision f. cogentin is often also prescribed to reduce the adverse effects that may occur
c. d.
The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (Select all that apply.) a) "Be sure to have your child blow his nose before administering the nasal spray." b) "This medication is used only when symptoms of ADHD are severe." c) "The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep." d) "Be sure to contact the physician right away if you notice expression of suicidal thoughts." e) "We will need to check your child's height and weight periodically to monitor physical growth." f) "If adverse effects become severe, stop the medication for 3 to 4 days."
c. d. e.
A client is receiving multiple medications for his Parkinson's disease. Which of the following are adverse effects of carbidopa-levodopa? A. Edema and restless leg syndrome B. Bradykinesia and agitation C. Muscle rigidity and heart failure D. Orthostatic hypotension and dyskinesias
d.
A client with epilepsy is prescribed phenytoin (Dilantin) 100mg TID as AED therapy. The most precise method for a nurse to determine if this is the proper dose for the client is- A. Observation of the client for seizures. B. Observation of the client for adverse effects. C. Determining whether the client is able to o ADLs. D. Monitor phenytoin level.
d.
A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that which of these is an advantage of this drug class? a. It has a shorter duration of action. b. It causes less gastrointestinal distress. c. It has a slower onset than traditional Parkinson's disease drugs. d. It is associated with fewer wearing-off effects.
d.
A patient has been taking antiepileptic drugs for 1 year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time? A. Loss of appetite B. Jaundice C. Weight loss D. Suicidal thoughts or behavior
d.
A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "you can drink beer as long as you have a designated driver" b. "now that you have had the last dose of that medication, there will be no further dietary restrictions" c. "if you begin to experience a throbbing headache, rapid pulse, or nausea, you will need to stop drinking" d. "you need to avoid all foods that contrain tyramine, including beer, while taking this medication"
d.
A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's Wort. Which response by the nurse is most appropriate? a. "that should be no problem" b. "good idea! hopefully you will be able to stop taking zoloft" c. "be sure to stop taking the herb if you notice a change in side effects" d. "taking St. John's wort with Zoloft may cuase severe interactions and is not recommended"
d.
A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living
d.
A patient was prescribed Orlistat (Xenical) for weight loss. The patient calls the nurse complaining of a "horrible side effect". The nurse suspects that the patient is referring to which problem? a. nausea b. sexual dysfunction c. urinary incontinence d. fecal incontinence
d.
A patient who has been taking lithium for 6 months has had severe vomiting and diarrhea from gastrointestinal flu. The nurse will assess for which potential problem at this time? a. Anxiety b. Chest pain c. Agitation d. Dehydration
d.
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. "I cant sleep at night" b. "I feel hungry all the time" c. "Look at how red my hands are" d. "my mouth has been so dry lately"
d.
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? a. Drowsiness, headache, weight loss b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention
d.
Carbidopa-levodopa (Sinemet) is prescribed for the client with Parkinson's disease. The nurse monitors the client for side effects of the medication. Which of the following would indicate that the client is experiencing a side effect? a. pruritus b. tachycardia c. hypertension d. impaired voluntary movements
d.
During a patient teaching session about antiparkinson drugs, the nurse will include which statement? A. "The drug will be stopped when tremors and weakness are relieved" B. "If a dose is missed, take two doses to avoid significant decrease in blood levels" C. "Be sure to notify your physician if your urine turns brownish orange in color" D. "Take care to change positions slowly to prevent falling due to drop in blood pressure"
d.
The nurse instructs a patient who is undergoing therapy with monoamine oxidase inhibitors (MAOIs) to avoid tyramine-containing foods. What medical emergency may occur if the patient eats these foods while taking MAOIs? A. Gastric hemorrhage B. Toxic shock C. Cardiac arrest D. Hypertensive crisis
d.
The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition? A. valproic acid (Depakote) B. neurontin (Gabapentin) C. carbamazepine (Tegretol) D. diazepam (Valium)
d.
The nurse is developing a plan of care for a patient receiving Phentermine. Which nursing diagnosis is most appropriate? a. sleep deprivation b. deficient fluid volume c. impaired memory d. imbalanced nutrition, less than body requirements
d.
The nurse is providing education for a patient who will be taking an antiepileptic drug for the first time. Which statement by the patient indicates that further teaching is indicated? A. "I will take the medicine at the same time every day." B. "I will check with my doctor before taking any over-the-counter drugs." C. "I will keep the appointments to check my blood work." D. "I can drive to work again once my drug levels are normal."
d.
The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? a. Lanoxin b. Valium c. Coumadin d. Tylenol
d.
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. Minimize the amount of fluid taken while on this drug. b. Discontinue the medication if adverse effects occur. c. Take the medication on an empty stomach to enhance absorption. d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
d.
When teaching a patient about taking a newly prescribed AED at home, the nurse should include which instruction? A. Driving will be allowed after 2 weeks of therapy. B. If seizures recur, take a double dose of the medication. C. Antacids can be taken with the AED to reduce gastrointestinal adverse effects. D. Regular, consistent dosing is important for successful treatment.
d.
Which drug may be used as monotherapy or in conjunction with levodopa to treat Parkinson's disease? A. Bromocriptine (Parlodel) B. Benstropine (Cogentin) C. Carbidopa (Lodsyn) D. Selegiline (Eldepryl)
d.
Which outcome represents the most serious adverse effect of lithium? A. Renal failure B. Hyponatremia C. Respiratory depression D. Cardiac dysrhythmia
d.
Which statement describes the rationale for combining carbidopa with levodopa in the treatment of Parkinson's disease? A. The combination eliminates the side effects of both medications B. The combination decreases the liver's first pass effect on dopamine. C. The combination decreases the level of acetylcholine at the synapse D. The combination allows lower levels of dopamine to be used with the same effect on alleviation of symptoms.
d.
You are caring for an 85 year old dementia patient. The daughter is interested in trying an herbal remedy, such as Gingko biloba to help improve memory. The patient is currently prescribed ASA 81 mg daily, Lisinopril 5 mg daily, Multivitamin daily, and Tylenol 500 mg TID. In reviewing the medication list, would the patient be at risk for potential drug interactions if the daughter started giving Gingko biloba? a. no, there are no possible interactions b. yes, there is a potential interaction with tylenol c. yes, there is a potential interaction with Lisinopril d. yes, there is a potential interaction with ASA
d.
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? A. The patient is at risk for seizures because the drug level is not at a therapeutic level. B. The patient's seizures should be under control because this is a therapeutic drug level. C. The patient's seizures should be under control if she is also taking a second antiepilepsy drug. D. The drug level is at a toxic level, and the dosage should be reduced.
d. (therapeutic levels of phenytoin is 10-20 mcg/mL)
