Elsevier 321 Pharm Unit 2 – Flashcards
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Which condition contraindicates barbiturates? 1 Drug allergy 2 Cardiac disease 3 Epileptic disease 4 Narrow-angle glaucoma
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Drug allergy
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The nurse notes that a patient has taken an excessive dose of baclofen. Which action does the nurse implement immediately? 1 Comfort measures 2 Seizure precautions 3 Airway maintenance 4 Antidote preparation
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Airway maintenance
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A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed? 1 Naloxone 2 Flumazenil 3 Ipecac syrup 4 Activated charcoal
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Activated charcoal
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Which medication is beneficial for reducing presurgery anxiety and decreasing the patient's ability to remember an uncomfortable medical procedure? 1 Ramelteon 2 Midazolam 3 Alprazolam 4 Eszopiclone
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Midazolam
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The nurse is teaching a group of nursing students about the stages of non-rapid eye movement (non-REM) sleep. Which is the third stage of sleep? 1 Dozing 2 Relaxation 3 Deep sleep 4 Sleepwalking
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Deep sleep
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A patient is scheduled for a brief surgical procedure. Which drug does the nurse expect to be used during surgery? 1 Thiopental 2 Butabarbital 3 Pentobarbital 4 Phenobarbital
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Thiopental
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Which drug is used as an antidote for overdose of oral benzodiazepine or excessive intravenous sedation? 1 Flumazenil 2 Olanzapine 3 Furosemide 4 Activated charcoal
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Flumazenil
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While assessing a patient, the nurse finds that the patient is allergic to aspirin. Which medication in the prescription does the nurse question? 1 Baclofen 2 Zaleplon 3 Diazepam 4 Pentobarbital
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Zaleplon - If a patient is allergic to aspirin, there is a possibility that the patient is allergic to nonbenzodiazepines such as zaleplon, too.
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A patient with epilepsy is prescribed barbiturates. On further assessment, the nurse finds that the patient has depression. What classes of antidepressants does the nurse expect the primary health care provider to avoid when prescribing to this patient? Select all that apply. 1 Tricyclic antidepressant 2 Monoamine oxidase inhibitor (MAOI) 3 Selective serotonin reuptake inhibitor (SSRI) 4 Reversible monoamine oxidase inhibitor (RMAOI) 5 Serotonin and noradrenaline reuptake inhibitor (SNRI)
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Tricyclic antidepressant Monoamine oxidase inhibitor (MAOI) Reversible monoamine oxidase inhibitor (RMAOI) - Tricyclic antidepressants, MAOIs, and RMAOIs interact with barbiturates. These drugs increase the activity of barbiturates and may lead to severe central nervous system depression.
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While teaching about a medication regimen, the nurse advises the patient to take the medication no later than midnight and at least 4 hours before the patient usually awakens. Which drug has been prescribed to the patient? 1 Zaleplon 2 Zolpidem 3 Diazepam 4 Midazolam
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Zaleplon
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The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) who is prescribed amphetamine aspartate. The nurse instructs the parent to give medications 5 to 6 hours before bed. Why did the nurse give this instruction? 1 To prevent insomnia 2 To prevent gastric ulcer 3 To prevent hyperglycemia 4 To prevent nutrition deficiency
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To prevent insomnia
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Which adverse effect does the nurse anticipate in a patient who uses analeptics at high doses? 1 Diarrhea 2 Reflex bradycardia 3 Decreased respiratory rate 4 Increased deep tendon reflexes
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Diarrhea
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A patient is diagnosed with attention deficit hyperactivity disorder (ADHD). Which drug is suitable for treatment of this disorder? 1 Orlistat 2 Doxapram 3 Sumatriptan 4 Atomoxetine
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Atomoxetine
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A 7-year-old child is highly impulsive and has not been attentive in school for the last 2 months. The child's parents are worried about the child's behavior. What will the nurse inform the child's parents? 1 "This is the normal behavior of a 7-year-old child." 2 "You should consult a child psychiatrist immediately." 3 "Your child has attention deficit hyperactivity disorder (ADHD)." 4 "You should continue to observe the child's behavior for 4 months."
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"You should continue to observe the child's behavior for 4 months."
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The nurse prepares to collect the health history of a patient with narcolepsy. Which strategy should be used to complete this assessment? 1 Provide a structured form for the patient to complete in writing. 2 Seek information from significant others rather than the patient. 3 Use the patient's past medical records to locate important information. 4 Use short, focused interview sessions with active participation by the patient.
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Use short, focused interview sessions with active participation by the patient.
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Which drug is used to treat attention deficit hyperactivity disorder (ADHD)? 1 Orlistat 2 Modafinil 3 Sumatriptan 4 Dextroamphetamine
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Dextroamphetamine
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While caring for a patient, the nurse learns that the patient has dysfunctional rapid eye movement (REM) sleep. This finding is a symptom of which condition? 1 Diplopia 2 Glaucoma 3 Narcolepsy 4 Migraine headache
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Narcolepsy
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A patient is diagnosed with narcolepsy. Which symptom does the nurse expect to find in the patient? 1 Hyperactivity 2 Pulsating headache 3 Skeletal muscle weakness 4 High body mass index (BMI)
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Skeletal muscle weakness
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Which is an adverse effect of orlistat therapy? 1 Mania 2 Diarrhea 3 Fecal incontinence 4 Foul taste in the mouth
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Fecal incontinence - Orlistat is a drug used in the treatment of obesity. A common adverse effect of orlistat is gastrointestinal distress, which causes fecal incontinence and oily stools.
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Which characteristic of amphetamines is the most likely reason that these drugs are abused? 1 They induce euphoria. 2 They increase energy. 3 They induce wakefulness. 4 They promote industriousness.
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They induce euphoria.
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Which drug is most commonly used for the treatment of a spinal headache? 1 Caffeine 2 Modafinil 3 Sumatriptan 4 Atomoxetine
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Caffeine - Caffeine is a xanthine cerebral stimulant used to treat spinal headache. It acts by antagonizing the purine receptors.
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The nurse is teaching a new nurse about medication administration for patients with attention deficit hyperactivity disorder (ADHD). Which statement by the new nurse indicates understanding of the teaching? 1 "I may dispense these medications to nursing staff if needed." 2 "I will give these drugs 30 to 45 minutes before meals to improve absorption." 3 "It is permissible to crush extended-release medications for patients who have difficulty swallowing pills." 4 "If I notice side effects of these medications, I should stop giving the drug immediately and notify the provider."
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"I will give these drugs 30 to 45 minutes before meals to improve absorption."
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The nurse is assessing a patient who is obese. After reviewing the prescription the nurse instructs the patient to take the medication in the morning and avoid taking the medication before going to bed. Which drug is this patient taking? 1 Morphine 2 Diazepam 3 Phentermine 4 Phenobarbitone
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Phentermine
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Which patients who have which conditions are contraindicated for anorexiant therapy? Select all that apply. 1 Patients who have glaucoma 2 Patients who have hypotension 3 Patients who have drug allergies 4 Patients who have hypothyroidism 5 Patients who have bulimia nervosa
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Patients who have glaucoma Patients who have drug allergies Patients who have bulimia nervosa
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What is the dose regimen of methylphenidate (Ritalin) for a 6-year-old child with attention deficit hyperactivity disorder (ADHD)? 1 20 mg after lunch 2 120 mg at each meal 3 50 mg as a single dose 4 5 mg before breakfast and lunch
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5 mg before breakfast and lunch
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Which is the primary action site for serotonin agonists? 1 Cerebral cortex 2 Medulla and brainstem 3 Cerebrovascular system 4 Hypothalamic and limbic regions
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Cerebrovascular system
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The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug? 1 Heart block 2 Constipation 3 Myelin degeneration 4 Cardiac dysrhythmias
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Cardiac dysrhythmias
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Which drug should be used with caution with the herbal drug ginseng to prevent possible drug interactions? 1 Aspirin 2 Warfarin 3 Metformin 4 Disulfiram
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Metformin
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Which class of drugs is prescribed for a patient who is obese to promote weight reduction? 1 Ergot alkaloids 2 Lipase inhibitors 3 Serotonin receptor agonists 4 Phosphodiesterase inhibitors
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Lipase inhibitors
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The patient's serum phenytoin level is 31 mcg/mL. What is the appropriate nursing action? 1 Hold the medication. 2 Increase the medication dose. 3 Administer the medication intravenously. 4 Have the patient continue the current regimen.
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Hold the medication. - A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse should hold the medication and then call the health care provider.
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A patient receiving lamotrigine therapy has started using oral contraceptives. What is essential for the nurse to teach the patient? 1 "This combination may cause liver toxicity." 2 "With oral contraceptive use, you may need more lamotrigine." 3 "This medication may stop your oral contraceptive from working." 4 "This medication, together with oral contraceptives, may cause toxicity."
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"With oral contraceptive use, you may need more lamotrigine." - When given with oral contraceptives, lamotrigine [1] [2] may need an increased dose to be effective because the oral contraceptives also compete for the CYP450 enzyme pathway.
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What is appropriate information for the nurse to give the patient who is taking an antiepileptic drug with a narrow therapeutic index? 1 Take the medication every other day. 2 Keep the medication with you at all times. 3 Make certain the drug is taken at the same time daily. 4 Crush the drug and put it in applesauce for better absorption.
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Make certain the drug is taken at the same time daily.
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What is the appropriate way for the nurse to prepare a dosage of a suspension medication for a pediatric patient? 1 Pour it into a teaspoon 2 Draw it up in an oral syringe 3 Pour it into a medication cup 4 Pour the suspension without shaking
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Draw it up in an oral syringe
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A patient is receiving carbamazepine to treat trigeminal neuralgia. What assessment indicates a therapeutic response to the medication? 1 The patient states no facial pain. 2 The patient states she is able to walk. 3 The patient has a reduction in foot pain. 4 The patient states they have no dizziness.
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The patient states no facial pain.
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A nurse is caring for a patient who has been started on antiepileptic drug therapy for seizures. What information should be included in the teaching plan for the patient? 1 Alter drug therapy based on normal meal times. 2 If there are side effects of therapy, stop the drug. 3 Take the medication at the same time each day. 4 If this medication is not effective, another drug will be added.
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Take the medication at the same time each day.
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Which intervention will best maintain therapeutic levels of an antiepileptic drug? 1 Give the medication every 8 hours. 2 Administer the medication intravenously. 3 Administer the medication only during the day. 4 Establish a drug regimen based on the half-life of the medication.
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Establish a drug regimen based on the half-life of the medication.
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Which patient should the nurse assess first? 1 The patient taking valproic acid with an increased appetite. 2 The patient taking carbamazepine who has bruises on his arms. 3 The patient taking carbamazepine who is not oriented to place or time. 4 The patient taking valproic acid who has lost 2 pounds since starting therapy.
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The patient taking carbamazepine who is not oriented to place or time. - Any patient who is not oriented has a potential risk to his safety. The patient who is not oriented and taking carbamazepine could be experiencing adverse effects of therapy. This is the patient the nurse should assess first.
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Which patient is most likely to have toxic effects of antiepileptic therapy? 1 The patient with a primidone level of 10 mcg/mL 2 The patient with a phenobarbital level of 8 mcg/mL 3 The patient with a valproic acid level of 50 mcg/mL 4 The patient with a carbamazepine level of 15 mcg/mL
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The patient with a carbamazepine level of 15 mcg/mL - The only value listed that is above therapeutic plasma levels is the carbamazepine, which has a therapeutic range of 4 to 12 mcg/mL; this patient is most likely to have toxic effects of therapy.
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A patient is receiving phenobarbital. What information is essential to include in the discharge teaching plan? Select all that apply. 1 "This medication may cause confusion." 2 "Checkups with a cardiologist are essential." 3 "Respiratory assessments should be performed daily." 4 "Good dental care is essential while on this medication." 5 "Don't drive until you determine how the medication affects you."
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"This medication may cause confusion." "Good dental care is essential while on this medication." "Don't drive until you determine how the medication affects you." - The most common adverse effects are lethargy and cognitive changes as well as gingival hyperplasia. Confusion can be a result of this therapy. Good dental care is essential because the medication can cause gingival hyperplasia. The patient should evaluate how the drug affects him before driving.
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The nurse is caring for a patient with a phenytoin level of 12 mcg/mL. What is the nurse's best action? 1 Continue to monitor the patient on this medication. 2 Assess liver function tests for clearance of the drug. 3 Call the health care provider for a decrease in the daily dose. 4 Call the health care provider for an increase in the daily dose.
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Continue to monitor the patient on this medication.
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The nurse instructs a patient receiving phenytoin to visit the dentist regularly and perform frequent oral hygiene. What side effect will these interventions assist in preventing? 1 Oral candidiasis 2 Gingival hyperplasia 3 Increased risk of dental abscesses 4 Increased incidence of dental caries
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Gingival hyperplasia
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What is the goal of antiepileptic therapy? 1 Reducing seizure occurrence to one per week. 2 Maximizing drug dosages to control seizure activity. 3 Maximally reducing seizure activity while minimizing side effects of medication therapy. 4 Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months.
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Maximally reducing seizure activity while minimizing side effects of medication therapy.
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The patient was started on an antiepileptic medication 6 weeks ago. The nurse notes that the patient's blood level of the medication is very low after 6 weeks of therapy. How will the nurse interpret this result? 1 The patient has received a toxic amount of the drug. 2 The patient should be placed on a different medication. 3 The patient may not be taking the medication as ordered. 4 The patient is experiencing an allergic reaction to the drug.
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The patient may not be taking the medication as ordered.
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The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. What statement should the nurse include? 1 "You will only need to be on therapy for a few months." 2 "Your medication is chosen based on your type of seizure." 3 "You will be started on several drugs to control your seizures." 4 "Medication therapy is not essential to treat seizure disorders."
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"Your medication is chosen based on your type of seizure."
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What is the reason for many potential drug interactions with antiepileptic drug therapy? 1 Altered urinary output 2 Altered electrolyte balances 3 Altered CYP450 enzyme metabolism 4 Alterations in blood urea nitrogen (BUN) and creatinine levels
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Altered CYP450 enzyme metabolism
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What is important to teach the patient taking valproic acid for seizure management? 1 Do not take the medication with meals. 2 Take the medication every other day only. 3 Take the medication an hour before or after other medications. 4 Do not take the medication with milk or carbonated beverages.
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Do not take the medication with milk or carbonated beverages. - Oral forms of valproic acid are not to be given with milk, because this may cause the drug to dissolve early and irritate the mucosa. Carbonated beverages must also be avoided during the time of drug administration.
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The health care provider has ordered once-daily phenytoin for an 8-year-old child who has a seizure disorder. The parents state the child cannot swallow pills. What intervention would the nurse recommend to the health care provider? 1 Suggest another medication be prescribed. 2 Suggest the phenytoin be administered intramuscularly. 3 Ask for a suspension form of the medication to be prescribed. 4 Ask for an intravenous form of the medication to be prescribed
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Ask for a suspension form of the medication to be prescribed.
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The nurse is administering intravenous diazepam. When will the nurse expect the onset of action to occur? 1 Immediately 2 Within 1 hour 3 Within 5 minutes 4 Within 15 minutes
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Immediately
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What intervention is appropriate to include in discharge teaching for a patient prescribed phenytoin therapy? 1 Perform good oral hygiene. 2 See a physical therapist for tremors. 3 Report headaches to your health care provider. 4 Report drowsiness to your health care provider.
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Perform good oral hygiene.
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The nurse is assessing a patient who is receiving antiepileptic drug therapy with phenytoin. What assessment finding requires immediate action? 1 Nystagmus 2 Weight gain 3 Heart rate 60 beats/min 4 Blood pressure 130/80 mm Hg
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Nystagmus - The patient who has nystagmus may be presenting with adverse effects to phenytoin therapy and should be assessed for other signs of toxicity.
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Which assessment is a priority for the patient starting on gabapentin therapy for a seizure disorder? 1 Cardiac assessment 2 Urologic assessment 3 Neurologic assessment 4 Respiratory assessment
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Neurologic assessment - Gabapentin requires a thorough neurologic assessment, including baseline energy levels, vision level, sensory and motor functioning, and any changes in speech.
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The nurse is caring for a patient who has been taking phenytoin for the past week and has developed a rash. What is the first action the nurse should take? 1 Monitor the area. 2 Assess the patient. 3 Apply a topical steroid cream. 4 Notify the prescribing health care provider.
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Assess the patient.
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A patient with a seizure disorder is taking oral phenytoin. He is nothing by mouth (NPO) for elective surgery. What is the appropriate nursing action? 1 Draw a serum phenytoin level after surgery. 2 Administer the medication immediately postoperatively. 3 Call the health care provider to clarify medication orders. 4 Administer the oral phenytoin before the patient goes to surgery.
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Call the health care provider to clarify medication orders.
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What assessment indicates the patient is having a therapeutic response to valproic acid? 1 Nystagmus 2 Absence of seizures 3 Normal liver enzymes 4 Decrease in headaches
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Absence of seizures
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A patient has been taking valproic acid and is being switched to another medication due to elevated liver function tests. What nursing action is appropriate? 1 Taper the valproic acid while starting the new medication. 2 Administer the new medication intravenously for fastest therapeutic action. 3 Stop the valproic acid and start the same dose of the new medication immediately. 4 Wait until the valproic acid is completely out of the patient's system before starting a new medication.
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Taper the valproic acid while starting the new medication.
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A patient is admitted who has reportedly stopped taking her antiepileptic medication. What is the appropriate nursing action? 1 Assess for hypotension. 2 Assess for confusion and delirium. 3 Monitor for rebound seizure activity. 4 Monitor for acute withdrawal syndrome.
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Monitor for rebound seizure activity.
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What intervention is essential before a patient starts therapy with lamotrigine? 1 Platelet count 2 Kidney function tests 3 Assessment of weight 4 Assessment of risk for Stevens-Johnson syndrome
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Assessment of risk for Stevens-Johnson syndrome
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The nurse is administering intravenous phenytoin. When will the nurse expect the onset of the drug to occur? 1 Immediately 2 Within 5 minutes 3 Within 15 minutes 4 Within 1 to 2 hours
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Within 1 to 2 hours
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What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? 1 "Do not take the medication if you have a fever." 2 "Lie in bed for at least an hour after taking your medication." 3 "Wait to see how you react to the medication before driving." 4 "Take the antiepileptic agent with milk or juice to prevent stomach upset."
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"Wait to see how you react to the medication before driving."
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The nurse is administering morning medications. Which administration technique is in error? 1 The nurse administers intravenous phenytoin with a filter. 2 The nurse administers phenobarbital elixir with fruit juice. 3 The nurse administers carbamazepine with grapefruit juice. 4 The nurse administers gabapentin without checking when the patient ate.
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The nurse administers carbamazepine with grapefruit juice.
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When administering phenytoin via intravenous (IV) push, which action will the nurse perform? 1 Monitor for hypertension. 2 Always use an infusion pump. 3 Administer through peripheral IV sites only. 4 Flush the line with normal saline before and after administration.
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Flush the line with normal saline before and after administration. - Phenytoin is very irritating to veins and incompatible with all fluids except normal saline.
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A patient reports switching from brand-name antiepileptic drug therapy to generic drug products. What is an essential nursing intervention? 1 Call the insurance company. 2 Request a decrease in the patient's dose. 3 Request an increase in the patient's dose. 4 Monitor the patient's neurologic status closely.
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Monitor the patient's neurologic status closely. - Increased monitoring of the patient's neurologic status is necessary because there is concern that generic drugs may not be as effective as brand-name medications. When the patient switches preparations, the patient may have seizures if the blood level does not remain therapeutic.
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The nurse is administering phenytoin intravenously. What interventions are essential? Select all that apply. 1 Administer using a filter. 2 Administer the medication through a large vein. 3 Administer the medication no faster than 50 mg/min. 4 Mix the medication in 5% dextrose with 0.9% saline. 5 Administer the medication through a 20-gauge or larger catheter.
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Administer using a filter. Administer the medication through a large vein. Administer the medication no faster than 50 mg/min. Administer the medication through a 20-gauge or larger catheter.
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The patient asks the nurse why she is receiving a different drug than her usual phenytoin. The patient is NPO (nothing by mouth) and is receiving intravenous fosphenytoin. Which is the nurse's most accurate response? 1 "You cannot take phenytoin orally while you are NPO." 2 "You need to ask your health care provider this question." 3 "Your serum phenytoin levels were most likely not therapeutic." 4 "This is the same class of drug, but better tolerated intravenously."
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"This is the same class of drug, but better tolerated intravenously."
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Which patient should receive her medication as ordered at 8 am? 1 The patient who is receiving phenobarbital and has a plasma level of 38 mcg/mL. 2 The patient who is scheduled to receive carbamazepine who was started on verapamil. 3 The patient who has been taking aspirin for a headache and is scheduled to receive valproic acid. 4 The patient who is scheduled to receive a barbiturate and was admitted after a night of drinking alcohol.
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The patient who is receiving phenobarbital and has a plasma level of 38 mcg/mL. - The patient who is scheduled to receive phenobarbital and has a plasma level of 38 mcg/mL is safe to receive the medication. The therapeutic range is 10 to 40 mcg/mL. Carbamazepine interacts with verapamil and can cause toxicity.
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A patient receiving phenytoin complains of "blurred vision." What is the priority nursing action? 1 Monitor for seizure activity. 2 Assess the patient's pupils. 3 Hold the patient's medication. 4 Assess serum phenytoin levels.
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Assess serum phenytoin levels
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What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin? 1 "Take your blood pressure daily." 2 "Use birth control while on this medication." 3 "Do not take this medication with grapefruit juice." 4 "If your weight increases, call your health care provider."
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"Use birth control while on this medication." - The nurse should tell the young woman to use birth control while on the medication because an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.
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A patient receiving valproic acid should be monitored for which adverse effects? Select all that apply. 1 Dizziness 2 Pancreatitis 3 Weight gain 4 Hepatotoxicity 5 Hypoglycemia
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Dizziness Pancreatitis Weight gain Hepatotoxicity
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The nurse is monitoring a patient with a phenytoin level of 8 mcg/mL. What is an appropriate nursing action? 1 Draw another drug level within the hour. 2 Hold the medication and call the health care provider. 3 Call the health care provider for an increase in dosage. 4 Document the value and continue to monitor the patient.
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Call the health care provider for an increase in dosage.
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The parent of a child with a history of a seizure disorder calls into the clinic to report her child has a rash on his torso. What is the most appropriate assessment question for the nurse to ask? 1 "Has your child been outside today?" 2 "Does your child have seasonal allergies?" 3 "Has your child been around anyone who is ill?" 4 "Has your child started on any new medications lately?"
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"Has your child started on any new medications lately?"
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A nurse is caring for a patient who has tonic-clonic seizures and is prescribed phenytoin therapy. What assessments should the nurse make to look for potential side effects? Select all that apply. 1 Eye exams for glaucoma 2 Changes in facial appearance 3 Assessment for increased body hair 4 Assessment for changes in the gums 5 Assessment for Stevens-Johnson syndrome
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Changes in facial appearance Assessment for increased body hair Assessment for changes in the gums
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The nurse is assessing four patients who have seizures and are started on medication therapy. Which patient is receiving the correct assessment after starting medication therapy? 1 Patient starting barbiturate therapy being assessed for a rash. 2 Patient starting gabapentin therapy being assessed for anemia. 3 Patient starting iminostilbene therapy being assessed for neurologic symptoms. 4 Patient starting levetiracetam therapy being assessed for neuropsychiatric symptoms.
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Patient starting levetiracetam therapy being assessed for neuropsychiatric symptoms.
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A patient was prescribed gabapentin for neuropathic pain. What information is essential to include in the patient's discharge teaching? 1 Take the medication before meals. 2 Do not drink alcohol while on this medication. 3 Take the medication with a full glass of water. 4 Stop the medication if you develop gastric upset.
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Do not drink alcohol while on this medication. - Gabapentin is effective as a single-drug therapy for new-onset epilepsy and is most commonly used for the treatment of neuropathic pain. It is essential to teach the patient that he should not drink alcohol while on the medication, as it contributes to neurologic depression and sleepiness.
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A patient receiving phenytoin develops a measleslike rash. What is the appropriate nursing action? 1 Administer an antihistamine immediately. 2 Apply topical steroid cream for inflammation. 3 Instruct the patient to take oatmeal baths if it itches. 4 Stop the medication and notify the health care provider.
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Stop the medication and notify the health care provider. - The patient has a measleslike rash, which is an adverse effect of phenytoin. The nurse should stop administering the medication and notify the health care provider.
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A patient is being seen at the clinic for follow-up regarding treatment for seizures. The nurse notes that the patient is diaphoretic and her hands are trembling. The patient is alert. What is the priority nursing action? 1 Document the finding and perform a neurologic assessment. 2 Question the patient regarding her state of mind during the visit. 3 Call for assistance from another health care professional in the clinic. 4 Stop the appointment and notify the health care provider of the findings.
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Document the finding and perform a neurologic assessment.
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Which antiepileptic drug may cause gingival hyperplasia in patients? 1 Phenytoin 2 Gabapentin 3 Phenobarbital 4 Levetiracetam
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Phenytoin
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Which action is the highest priority for a patient who is receiving antiepileptic drug therapy for the first time? 1 Weighing the patient weekly 2 Encouraging regular check-ups 3 Assessing for suicidal tendencies 4 Teaching the patient about potential side effects
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Assessing for suicidal tendencies
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The patient taking carbamazepine should be instructed to avoid taking her dose with which beverage? 1 Grape juice 2 Apple juice 3 Orange juice 4 Grapefruit juice
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Grapefruit juice
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A 25-year-old female patient is prescribed phenobarbital therapy for seizure control. What information is essential for the nurse to assess before discharge? 1 "Have you ever had headaches? 2 "What type of insurance do you have?" 3 "What form of birth control do you use?" 4 "How often have you been having seizures?"
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"What form of birth control do you use?"
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A nurse is assessing a patient who has developed Stevens-Johnson syndrome as a result of medication therapy. What is the nurse's first intervention? 1 Hold all medications. 2 Assess for severity of rash. 3 Call the health care provider. 4 Increase the patient's fluid intake.
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Assess for severity of rash.
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What is the most appropriate nursing action for a patient in status epilepticus? 1 Apply restraints. 2 Apply restraints, start and intravenous line and administer intravenous diazepam. 3 Start an intravenous line and administer intravenous diazepam. 4 Start an intravenous line and administer intravenous pain medications.
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Apply restraints, start and intravenous line and administer intravenous diazepam.
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In administering barbiturate therapy for seizure disorders, what safety measures are essential for the nurse to perform? Select all that apply. 1 Assess the room for safety measures 2 A neurologic assessment before administration 3 Assess drug levels before each dose of medication 4 Assess vital signs before medication administration 5 Attach patient to electroencephalogram (EEG) monitoring before each dose of medication
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Assess the room for safety measures A neurologic assessment before administration Assess vital signs before medication administration
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Which is the priority action when administering intravenous phenytoin therapy? 1 Monitor for side effects. 2 Monitor serum drug levels. 3 Flush the tubing after administration. 4 Administer by slow intravenous (IV) push.
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Administer by slow intravenous (IV) push. - The priority is to administer phenytoin slowly to prevent irritation to veins.
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A patient is in status epilepticus. Which are essential nursing actions? Select all that apply. 1 Call a code. 2 Assess oxygenation. 3 Administer diazepam. 4 Sit the patient in high Fowler. 5 Turn the patient's head to the side.
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Assess oxygenation. Administer diazepam. Turn the patient's head to the side.
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A patient who is postoperative neurosurgery is admitted to the intensive care unit and begins to have seizures. What is the nurse's priority action? 1 Reassure the patient. 2 Notify the family members. 3 Call the health care provider. 4 Assess for a patent intravenous line.
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Assess for a patent intravenous line.
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Which phenomena does the nurse recognize as positive symptoms of schizophrenia? Select all that apply. 1 Catatonia 2 Delusions 3 Hallucinations 4 Poverty of speech 5 Social withdrawal 6 Conceptual disorganization
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Delusions Hallucinations Conceptual disorganization
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Which activity should the patient be cautioned to avoid while taking a monoamine oxidase (MAO) inhibitor? 1 Eating aged cheese 2 Sunbathing at the pool 3 Participating in a bowling league 4 Smoking a low-nicotine cigarette
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Eating aged cheese - Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.
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Which patient is a poor candidate for therapy with diazepam to treat generalized anxiety disorder? 1 One with a history of alcoholism 2 One with type 2 diabetes mellitus 3 One who had convulsions as a child 4 One who has had a myocardial infarction
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One with a history of alcoholism - A patient with a history of alcoholism is a poor candidate for therapy with diazepam because of the potential for substance abuse and the adverse effects of therapy.
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The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? 1 Bipolar disorder 2 Absence seizures 3 Paranoid schizophrenia 4 Obsessive-compulsive disorder
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Bipolar disorder
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Which theory states that depression and mania are caused by alterations in the concentration of dopamine and norepinephrine and serotonin and histamine in the brain? 1 Dopamine hypothesis 2 Permissive hypothesis 3 Dysregulation hypothesis 4 Biogenic amine hypothesis
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Biogenic amine hypothesis
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Which medication increases the rate of urinary elimination of tricyclic antidepressants (TCAs) in the event of an overdose? 1 Diazepam 2 Antidysrhythmic 3 Activated charcoal 4 Sodium bicarbonate
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Sodium bicarbonate
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The nurse is assessing a patient with depression who has been prescribed nortriptyline. Following the assessment, the nurse finds that the patient has constipation and urinary retention due to interaction between the prescribed medications. Which class of medication found in the patient's prescription is responsible for these effects? 1 Diuretics 2 Anxiolytics 3 Anticholinergics 4 Antihypertensives
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Anticholinergics
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Which are common symptoms of serotonin syndrome? Select all that apply. 1 Delirium 2 Myoclonus 3 Drowsiness 4 Coarse tremors 5 Suicidal thoughts
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Delirium Myoclonus Coarse tremors
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The nurse is assessing a patient who has been prescribed alprazolam to treat panic disorder. Which adverse effects does the nurse monitor for in the patient? Select all that apply. 1 Ataxia 2 Dizziness 3 Confusion 4 Blurred vision 5 Paradoxical anxiety
answer
Ataxia Dizziness Confusion
question
Which adverse effects result from antipsychotic drugs' action on alpha-adrenergic receptors? Select all that apply. 1 Weight gain 2 Lightheadedness 3 Reflex tachycardia 4 Tardive dyskinesia 5 Postural hypotension
answer
Lightheadedness Reflex tachycardia Postural hypotension
question
What is another approved and indicated use for bupropion, a second-generation antidepressant? 1 Smoking cessation 2 Orthostatic hypotension 3 Nocturnal enuresis in children 4 Anorexia in patients undergoing chemotherapy
answer
Smoking cessation
question
Which mood-stabilizing drugs are used to treat bipolar disorder? Select all that apply. 1 Bupropion 2 Imipramine 3 Isocarboxazid 4 Oxcarbazepine 5 Lithium carbonate
answer
Oxcarbazepine Lithium carbonate
question
Which anxiolytic drug promotes antagonistic activity at both the serotonin and dopamine receptors? 1 Buspirone 2 Alprazolam 3 Lorazepam 4 Amitriptyline
answer
Buspirone
question
Which instruction does a nurse provide to a patient who is taking a selective serotonin reuptake inhibitor (SSRI)? 1 "Change positions frequently." 2 "Avoid foods or beverages rich in tyramine." 3 "Avoid hot baths, saunas, and hot climates." 4 "Increase the intake of dietary fiber supplements."
answer
"Increase the intake of dietary fiber supplements."
question
A patient is detoxifying from alcohol abuse. Which type of medication is indicated to help the patient manage withdrawal symptoms? 1 Phenothiazine 2 Dibenzazepine 3 Benzisoxazole 4 Benzodiazepine
answer
Benzodiazepine
question
The nurse notes that the patient has an increased blood glucose level, increased blood pressure (BP), and abnormal cholesterol levels. What does the nurse infer from these observations? 1 The patient has mania. 2 The patient has dystonia. 3 The patient has dyskinesia. 4 The patient has metabolic syndrome.
answer
The patient has metabolic syndrome.
question
What are the current indications for tricyclic antidepressants (TCAs)? Select all that apply. 1 Seizures 2 Insomnia 3 Depression 4 Childhood enuresis 5 Neuropathic pain syndrome
answer
Insomnia Childhood enuresis Neuropathic pain syndrome
question
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? 1 Increasing the placebo effect 2 Increasing alertness levels in the brain 3 Blocking the reuptake of neurotransmitters at nerve endings 4 Decreasing levels of epinephrine and serotonin at nerve endings
answer
Blocking the reuptake of neurotransmitters at nerve endings
question
What atypical antipsychotic medication would the nurse anticipate a health care provider prescribing for treatment of refractory schizophrenia? 1 Trazodone 2 Phenelzine 3 Amoxapine 4 Risperidone
answer
Risperidone
question
A patient with bipolar disorder has involuntary wavelike movements of the legs. Which drug is responsible for this adverse effect in the patient? 1 Diazepam 2 Buspirone 3 Alprazolam 4 Lithium citrate
answer
Lithium citrate
question
The nurse is caring for a patient who is experiencing respiratory depression due to long-term use of diazepam in high doses. The patient has been prescribed flumazenil by the primary health care provider. What does the nurse monitor while caring for the patient? 1 Presence of seizures 2 Presence of impaired vision 3 Presence of increased pulse rate 4 Presence of reduced blood glucose
answer
Presence of seizures
question
A patient who has depression is prescribed duloxetine. Which tests will the nurse suggest to the provider before the therapy is started? 1 Renal function test 2 Liver function test 3 Complete blood count 4 Complete urine examination
answer
Liver function test
question
A patient diagnosed with depression is started on a tricyclic antidepressant (TCA) after failure to improve symptoms on a selective serotonin reuptake inhibitor. The nurse should include which teaching point when educating the patient about the new medication? 1 There are no contraindications to this medication. 2 The medication is safe; it has been used longer than many others. 3 There is a risk of toxicity when this medication is taken with alcohol. 4 This class of medications has no other use and is only for depression.
answer
There is a risk of toxicity when this medication is taken with alcohol.
question
What is the main receptor in the central nervous system (CNS) that is blocked by conventional antipsychotic drugs? 1 Serotonin 2 Dopamine 3 Acetylcholine 4 Norepinephrine
answer
Dopamine
question
The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this result? 1 The patient will have persistent manic symptoms. 2 The patient may have cardiac dysrhythmia and tremors. 3 The patient may have impaired liver and renal functioning. 4 The patient should have effective relief from the manic symptoms.
answer
The patient should have effective relief from the manic symptoms. - There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.5 mEq/L is optimum for the treatment of acute mania. Therefore a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity, which is characterized by impaired liver and renal functioning.
question
A female patient who takes lorazepam for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? 1 Eat a well-balanced diet that includes milk. 2 Stop taking the drug and form another plan to manage anxiety. 3 Discuss tapering the drug with the health care provider before conception. 4 Visit an obstetrician to determine the correct dose of lorazepam during pregnancy.
answer
Discuss tapering the drug with the health care provider before conception.
question
Clozapine, an atypical antipsychotic medication, is prescribed for a patient with a schizophreniform disorder. Which information would be most important to include in the teaching plan for this patient? 1 The importance of promptly reporting flulike symptoms 2 Strategies to manage breast enlargement and nipple discharge 3 Contraceptive measures and expected changes in menstruation 4 The meaning of various components of a white blood cell count
answer
The importance of promptly reporting flulike symptoms
question
A patient asks the nurse how long it will take for escitalopram to be completely effective. Which time frame should the nurse include in patient teaching? 1 1 week 2 2 or 3 days 3 2 or 3 months 4 Several weeks
answer
Several weeks
question
A patient is admitted to the emergency department after an overdose of oxazepam. Which antagonist may be used to treat this patient? 1 Naloxone 2 Naltrexone 3 Nalmefene 4 Flumazenil
answer
Flumazenil
question
A patient diagnosed with an anxiety disorder has been using lorazepam but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient? 1 Buspirone 2 Alprazolam 3 Chlordiazepoxide 4 Hydroxyzine hydrochloride salt
answer
Buspirone
question
The primary health care provider reviews the medical history of a patient who is receiving buspirone. The health care provider instructs the nurse to continuously monitor the patient's blood pressure to prevent hypertension due to a drug interaction. Which other medication is the patient taking? 1 Iron supplement 2 Oral contraceptives 3 Nonsteroidal antiinflammatory drugs 4 Monoamine oxidase inhibitor (MAOI)
answer
Monoamine oxidase inhibitor (MAOI)
question
A patient with psychosis is experiencing adverse effects of conventional antipsychotic pharmacotherapy, including dystonia, akathisia, and abnormal limb movements. The nurse collaborates with the psychiatrist to enact a change in therapy. Which medication is best suited to this patient? 1 Molindone 2 Haloperidol 3 Risperidone 4 Chlorpromazine
answer
Risperidone
question
The nurse is caring for a patient who has bipolar disorder who has been administered lithium citrate. The primary health care provider asks the nurse to constantly monitor the patient's blood sodium levels. What is the reason for giving such an instruction? 1 To ensure proper nourishment in the patient 2 To prevent renal toxicity caused by the drug 3 To maintain therapeutic concentration of lithium 4 To maintain normal cholesterol levels in the body
answer
To maintain therapeutic concentration of lithium
question
The nurse prepares a patient who is taking sertraline for discharge. Which instruction should the nurse include in patient education? 1 Report any increase in mania. 2 Expect to feel better in 4 to 6 days. 3 Take sertraline at the same time each day. 4 Avoid overheating and direct sun exposure.
answer
Take sertraline at the same time each day.
question
The nurse is assessing a patient with depression who has been prescribed isocarboxazid. The nurse advises the patient to use steam inhalation for a cold rather than taking cetirizine. What is the reason for giving such advice to the patient? 1 To prevent the increased risk of bleeding 2 To prevent the increased risk of infection 3 To prevent impaired cardiovascular function 4 To prevent central nervous system depression
answer
To prevent central nervous system depression
question
The nurse is caring for a patient diagnosed with depression who has been prescribed isocarboxazid. Due to a slight increase in blood pressure and agitation, the primary health care provider prescribed buspirone for the patient. What does the nurse do to prevent adverse effects in the patient? 1 Administer buspirone at night and isocarboxazid after lunch. 2 Administer buspirone intravenously and isocarboxazid orally. 3 Administer buspirone and isocarboxazid by dissolving in water. 4 Administer buspirone 14 days after discontinuing isocarboxazid.
answer
Administer buspirone 14 days after discontinuing isocarboxazid. - Buspirone is prescribed for the treatment of agitation. It should not be coadministered with monoamine oxidase inhibitors such as isocarboxazid because the drugs interact and increase blood pressure. In order to prevent such adverse effects, the drug must be administered after a sufficient washout period. Therefore the nurse should administer buspirone 14 days after discontinuing isocarboxazid. On the other hand, continuing the administration of isocarboxazid by changing the administration time, by changing the dosage forms, or by diluting the drugs in water may not be helpful in preventing adverse effects. Therefore in order to prevent the drug interaction, the nurse should not simply administer isocarboxazid after lunch, dissolve the drug in water, or give it orally.
question
A patient taking risperidone has a necrotic foot ulcer that started as a minor scratch. Which patient data should the nurse check to help prevent complications of the pharmacotherapy? 1 Leukocyte count 2 Liver function studies 3 Fasting blood glucose 4 Kidney function studies
answer
Fasting blood glucose
question
A male patient tells the nurse that he wants to stop taking citalopram because of the sexual side effects. Which instruction should the nurse provide while educating the patient to help relieve the patient's sexual dysfunction? Select all that apply. 1 Avoid alcoholic beverages. 2 Discontinue the medication. 3 Decrease the regular dosage. 4 Take infrequent "drug holidays." 5 Report complaints to the psychiatrist. 6 Maintain the current pharmacotherapy.
answer
Avoid alcoholic beverages. Take infrequent "drug holidays." Report complaints to the psychiatrist. Maintain the current pharmacotherapy.
question
A patient currently prescribed duloxetine comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? 1 Gingko 2 Ibuprofen 3 St. John's wort 4 Glucosamine chondroitin
answer
St. John's wort
question
Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine? 1 Renal panel 2 Liver function tests 3 Complete blood count 4 Immunoglobulin levels
answer
Complete blood count
question
A patient with schizophrenia presents to a clinic with a poorly healing leg ulcer and hyperglycemia. Which atypical antipsychotic agent is the best medication for this patient? 1 Olanzapine 2 Quetiapine 3 Ziprasidone 4 Risperidone
answer
Ziprasidone
question
Which food can be included in the diet of a patient who is taking monoamine oxidase inhibitors? 1 Red wine 2 Fava beans 3 Corned beef 4 Cottage cheese
answer
Cottage cheese
question
The nurse obtains a medication history from a patient diagnosed with primary hypertension. The nurse recognizes that teaching is needed when the patient states that he takes which over-the-counter medication and/or supplement? 1 Garlic 2 Ginseng 3 Valerian root 4 St. John's wort
answer
Ginseng
question
The nurse is assessing a patient diagnosed with bipolar disorder who has been prescribed lithium carbonate. On reviewing the laboratory reports of the patient, the nurse suspects that the drug has a risk of causing cardiac dysrhythmia. What is the reason for reaching such a conclusion? 1 The sodium level of the patient was 142 mEq/L. 2 The sodium level of the patient was 160 mEq/L. 3 The sodium level of the patient was 140 mEq/L. 4 The sodium level of the patient was 138 mEq/L.
answer
The sodium level of the patient was 160 mEq/L.
question
Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy? 1 "I need to change positions slowly to prevent dizziness." 2 "I will need to wear sunscreen and protective clothing when outdoors." 3 "It is okay to take this drug with a small glass of wine to help me relax." 4 "I should call my doctor if I notice any uncontrollable movements of my tongue."
answer
"It is okay to take this drug with a small glass of wine to help me relax."
question
Which piece of objective data contraindicates the use of clozapine? 1 Allergy to phenothiazines 2 Self-destructive behavior 3 Failed antipsychotic therapy 4 Acute lymphocytic leukemia
answer
Acute lymphocytic leukemia
question
The nurse finds that a patient who has been prescribed tricyclic antidepressant (TCA) therapy consumes alcohol regularly. What intervention will the nurse expect to perform to promote drug safety? 1 Refer the patient for regular hemodialysis. 2 Perform urine acidification until the pH is 5. 3 Administer hypotensive drugs as prescribed. 4 Administer multiple doses of activated charcoal.
answer
Administer multiple doses of activated charcoal.
