Pharm Test 2 - Flashcards | StudyHippo.com

Q: A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching?

\"Adaptation results in an increased sensitivity to side effects over time.\"

Q: 4. A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching?

\"These drugs are developed based on scientific knowledge of CNS transmitters and receptors.\"

Q: A patient has taken levodopa [Dopar] for Parkinson\'s disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

\"It may take several months for a response to occur.\"

Q: A nurse provides teaching for a patient who is newly diagnosed with Parkinson\'s disease. Which statement by the patient indicates understanding of the drug therapy for this disease?

\"A levodopa/carbidopa combination is used to improve motor function.\"

Q: A nurse is discussing motor symptoms with a patient with Parkinson\'s disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?

\"I may need to try a lower dose of Sinemet to reduce my tics.\"

question

A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of:

answer

changes in the brain as a result of prolonged drug exposure.

question

A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient:

answer

may need increased amounts of the drug over time.

question

A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching?

answer

"Adaptation results in an increased sensitivity to side effects over time."

question

A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier:

answer

prevents some potentially toxic substances from crossing into the central nervous system.

question

4. A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching?

answer

"These drugs are developed based on scientific knowledge of CNS transmitters and receptors."

question

An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults?

answer

Blood-brain barrier

question

A patient has taken levodopa [Dopar] for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

answer

"It may take several months for a response to occur."

question

A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease?

answer

"A levodopa/carbidopa combination is used to improve motor function."

question

A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:

answer

re-evaluate the diagnosis.

question

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:

answer

administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.

question

A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?

answer

Taking a lower dose with a low-protein snack

question

A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?

answer

"I may need to try a lower dose of Sinemet to reduce my tics."

question

A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?

answer

Increasing salt and water intake

question

A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?

answer

"Combination products cause fewer dyskinesias and decreased psychosis."

question

A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:

answer

sleep attacks.

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A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:

answer

does not cross the blood-brain barrier.

question

A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:

answer

any history of alcohol abuse or compulsive behaviors.

question

A hospitalized patient with Parkinson's disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?

answer

Trimethobenzamide [Tigan]

question

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:

answer

reducing the dose of bromocriptine.

question

A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?

answer

"While some drugs show promise, there are no studies that have proven a neuroprotective effect."

question

The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson's disease. What will the nurse include in teaching?

answer

"If you need to stop this drug, your provider will order a gradual withdrawal."

question

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?

answer

Interrupting treatment with amantadine for several weeks

question

A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?

answer

Advancing age and family history are known risk factors.

question

The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct?

answer

"Drugs to treat Alzheimer's disease may slow the progression of memory loss."

question

An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?

answer

Tell the spouse that this is an expected progression of the disease

question

An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?

answer

The dose can be increased, because the patient has been taking the drug for longer than 3 months.

question

A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?

answer

"This drug significantly slows the progression of the disease."

question

A patient has been diagnosed with multiple sclerosis (MS) for 10 years and has a history of 3 periods of neurologic dysfunction lasting several weeks separated by long periods of full recovery. In the past 6 months, the patient has had a prolonged period of neurologic dysfunction without remission. The nurse understands that the patient may have which MS subtype?

answer

Secondary progressive MS

question

The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine [Exelon] transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?

answer

"We only need to change the patch every 2 weeks."

question

A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching?

answer

"Memantine modulates the effects of glutamate to alter calcium influx into neurons."

question

A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?

answer

Slowed heart rate and lightheadedness

question

A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient?

answer

Reducing the dose of memantine

question

A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching?

answer

"If medication is begun early, permanent remission can be achieved."

question

A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptom free. The nurse will tell the patient that this indicates what?

answer

Temporary improvement

question

A patient is being treated with interferon beta-1a [Avonex] for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend?

answer

Acetaminophen or ibuprofen

question

A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do?

answer

Take oral diphenhydramine [Benadryl].

question

A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests?

answer

"After the first year of treatment, I will need once yearly blood work.""After the first year of treatment, I will need once yearly blood work."

question

A patient has received an initial dose of glatiramer acetate [Copaxone] for relapsing-remitting multiple sclerosis. The nurse notes that the patient appears flushed and anxious and has urticaria. The patient reports palpitations, chest pain, and a feeling of laryngeal constriction. What will the nurse do

answer

Stay with the patient until this self-limiting episode passes.

question

A patient who stopped taking teriflunomide [Aubagio] 1 year prior tells the nurse that she has just found out she is pregnant. Which action by the nurse is correct?

answer

Contact the provider to obtain an order for serum drug levels.

question

A patient is about to begin therapy with fingolimod [Gilenya] to treat multiple sclerosis. The nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?

answer

Obtain an order for a VZV antibody test.

question

A patient who has recently begun taking interferon beta reports feeling depressed. Which action by the nurse is correct?

answer

Notify the provider of these symptoms.

question

A nurse provides teaching for a 25-year-old patient who will receive mitoxantrone [Novantrone] for worsening relapsing-remitting multiple sclerosis. Which statement by the patient indicates a need for further teaching?

answer

"I will need an infusion of this medication once weekly."

question

A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?

answer

Tonic-clonic

question

A patient has begun taking dimethyl fumarate [Tecfidera] to treat relapsing MS and calls the clinic to report flushing of the skin with itching and burning sensations. What will the nurse recommend to this patient?

answer

"Take a non-enteric-coated aspirin 30 minutes before each dose."

question

A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?

answer

Contact the provider to report symptoms of a complex partial seizure.

question

A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?

answer

Contact the provider to request an order for serum drug levels.

question

A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?

answer

"Febrile seizures are a type of generalized tonic-clonic seizure."

question

A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?

answer

"Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug."

question

A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?

answer

The provider will withdraw the drug over a 6- to 12-week period.

question

A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?

answer

She should consider a different form of birth control while taking phenytoin.

question

A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?

answer

An increased dose of phenytoin

question

A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?

answer

"I should brush and floss my teeth regularly."

question

A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?

answer

Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.

question

A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?

answer

Increasing the lamotrigine dose to 500 mg twice daily

question

A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?

answer

Notify the prescriber, and request an order to reduce the dose of phenobarbital.

question

A child is diagnosed with absence seizures, and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of:

answer

recording the number of seizures the child has each day.

question

A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine [Trileptal]. The patient also takes furosemide [Lasix] and digoxin [Lanoxin]. Which statement by the patient indicates understanding of the teaching?

answer

"I should report any nausea, drowsiness, and headache to my provider."

question

A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?

answer

Rash

question

A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects?

answer

Seizures and hallucinations

question

A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen?

answer

Increasing the dose of valproic acid to 300 mg PO twice daily

question

A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?

answer

"I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness."

question

A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention?

answer

Preparing to support respirations

question

A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug?

answer

"You may experience blurred vision, dry mouth, or constipation."

question

A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy?

answer

Baclofen [Lioresal]

question

A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine [Zanaflex] to alleviate the spasms. When obtaining the patient's health history, the nurse should be concerned about which possible reason for considering another drug?

answer

A history of hepatitis

question

5. Which patient should receive dantrolene [Dantrium] with caution?

answer

A 55-year-old woman with multiple sclerosis

question

A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching?

answer

"If my child has a seizure, I should stop giving the medication immediately."

question

A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity?

answer

Baclofen [Lioresal]

question

A patient with cerebral palsy who has been receiving baclofen [Lioresal] via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspect to be the cause of these seizures?

answer

Missed doses of baclofen

question

A nurse is teaching a patient who has a second-degree burn on one arm about the use of a topical anesthetic for pain. Which statement by the patient indicates understanding of the teaching?

answer

"I will apply a thin layer of the medication to a small area of skin."

question

A nurse is assisting the physician during a procedure in which a local anesthetic is administered. Within a few minutes of administration of the anesthetic, the patient has a pulse of 54 beats per minute, respirations of 18 breaths per minute, and a blood pressure of 90/42 mm Hg. The nurse should monitor the patient for further signs of:

answer

heart block.

question

A nurse is discussing the use of cocaine as a local anesthetic with a nursing student. Which statement by the student indicates understanding of this agent?

answer

"Vasoconstrictors should not be used as adjunct agents with this drug."

question

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to:

answer

prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine

question

A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate

answer

Lower the head of the bed to a 10- to 15-degree head-down position.

question

A patient receives an epidural anesthetic during labor and delivery. The nurse caring for the newborn in the immediate postpartum period will observe the infant for:

answer

bradycardia

question

A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?

answer

Nervousness and tachycardia

question

A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?

answer

Question the use of the epinephrine for this procedure.

question

A postoperative patient is reporting pain as a 7 on a scale from 1 to 10, with 10 being the worst pain. The nurse caring for the patient assesses vital signs of HR, 76; RR, 16; and BP, 110/70. The patient has vomited twice. Which postoperative medications will the nurse expect to administer?

answer

Morphine and ondansetron [Zofran]

question

A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching?

answer

"Local anesthetics affect motor and sensory nerves."

question

A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern?

answer

Elevated temperature

question

A nurse is teaching nursing students about inhalation anesthesia and asks, "What is balanced anesthesia?" Which response by a student is correct?

answer

"An anesthesia that combines other drugs with inhalation anesthesia to produce the desired effects."

question

A patient in the postanesthesia recovery unit received ketamine [Ketalar] for right open reduction internal fixation surgery. What drug would be beneficial as a premedication to help minimize adverse reactions?

answer

Diazepam [Valium]

question

A nurse administers atropine to a patient before induction of anesthesia for a surgical procedure. When evaluating the effects of this medication, the nurse will:

answer

monitor the patient's heart rate.

question

An anesthesiologist completes preoperative teaching for a patient the night before surgery. The patient asks the nurse to clarify the reason methohexital [Brevital] will be given as an adjunct to the anesthetic. Which statement by the patient indicates understanding?

answer

"Brevital is used to produce rapid unconsciousness before administration of the inhaled anesthetic."

question

A preoperative patient receives atropine before induction of anesthesia. The nurse caring for this patient understands that this agent is used to prevent:

answer

bradycardia.

question

A patient receives a neuromuscular blocking agent as an adjunct to inhalation anesthesia. When caring for this patient, it is important for the nurse to remember that neuromuscular blocking agents:

answer

prevent contraction of the diaphragm.

question

A patient will receive intravenous midazolam [Versed] combined with fentanyl while undergoing an endoscopic procedure. The nurse is explaining the reasons for this to a nursing student before the procedure. Which statement by the student indicates understanding of the teaching?

answer

"The patient will not remember the procedure."

question

A postoperative patient complains of abdominal bloating and discomfort. The nurse caring for this patient will contact the provider to request which medication?

answer

Bethanechol

question

A nurse caring for a patient after a cesarean section learns that the patient received isoflurane [Forane] during the surgery. What will the nurse monitor most closely in this patient?

answer

Uterine tone

question

A surgical nurse is caring for a patient who is receiving isoflurane [Forane]. Which is true about this inhalation anesthetic?

answer

Propofol is used for induction to minimize cough prior to administering isoflurane.

question

A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?

answer

Fentanyl [Duragesic] transdermal patch

question

A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do?

answer

Prepare to administer naloxone and possibly ventilatory support.

question

A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:

answer

changing the medication to a continued-release preparation.

question

A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?

answer

The patient should discuss increasing the dose with the provider.

question

A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for:

answer

respiratory depression.

question

A patient who has biliary colic reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct?

answer

Request an order for meperidine [Demerol].

question

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of:

answer

worsening hypoxia.

question

A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for:

answer

yawning and sweating.

question

A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?

answer

Avoid prolonged exposure to the sun.

question

A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do?

answer

Instruct the parents not to activate the device when their child is sleeping.

question

A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes?

answer

Prolonged QT interval

question

A patient who has developed opioid tolerance will experience which effect?

answer

Decreased analgesic effect

question

A patient who has cancer reports pain as "burning" and "shooting" alternating with feelings of numbness and coldness. The nurse will contact the provider to discuss the use of which medication?

answer

Imipramine [Tofranil]

question

A patient with bone cancer has recently undergone chemotherapy and radiation therapy to reduce the size of the tumor. The patient is taking a large dose of an opioid analgesic, along with acetaminophen and an antidepressant. The nursing student caring for this patient is concerned that the patient is showing drug-seeking behaviors, because the individual requested an increased dose of the opioid. The student discusses this concern with the nurse. Which statement by the student indicates a need for further teaching?

answer

"It would probably help this patient more to give a larger antidepressant dose."

question

A patient with cancer who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:

answer

infection or metastasis.

question

An 8-year-old child with advanced cancer has an order for oxycodone [OxyContin] PO, PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain. What will the nurse do?

answer

Contact the provider to discuss using patient-controlled analgesia (PCA).

question

An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?

answer

Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.

question

A nursing student caring for a patient with cancer tells the nurse that the patient seems to be exaggerating when reporting the degree of pain. Which statement by the nurse is an appropriate response to this concern?

answer

"It is important to give pain medication as ordered for the degree of pain the patient reports."

question

A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be used initially to treat pain in this patient?

answer

Opioid analgesics

question

A patient who is taking a fixed-dose combination drug with an opioid and acetaminophen for cancer pain reports increased muscular pain. The patient asks the nurse if the pain medication dose can be increased. What will the nurse tell this patient?

answer

The provider will prescribe separate dosing of the opioid and acetaminophen.

question

A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:

answer

a fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic.

question

A patient is taking hydrocodone and ibuprofen for cancer pain and is admitted to the hospital for chemotherapy. The nurse anticipates that the prescriber will ____ ibuprofen.

answer

discontinue the

question

A nurse is teaching a group of nursing students about the differences between pure opioid agonists and agonist-antagonist opioids. Which statement by a student indicates understanding of the teaching?

answer

"Pure agonists act as agonists at both mu receptors and kappa receptors."

question

A patient newly diagnosed with cancer is admitted to the hospital, and the provider orders oxycodone [OxyContin] every 4 to 6 hours PRN pain. The patient requests pain medication whenever he reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but he tells the nurse the medication is not working well. The nurse will contact the provider to discuss:

answer

a fixed dosing schedule for the oxycodone.

question

A patient who has had cancer for 1 year uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of pain (which she rates as 8 or 9 on a scale of 1 to 10) each day, and each episode lasts 15 to 30 minutes. The nurse will contact the provider to:

answer

request a strong, short-acting opioid PRN.

question

A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?

answer

"There is increased pain relief with the combination than when either product is used alone."

question

A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What will the nurse tell this patient?

answer

"Studies to date do not clearly indicate effectiveness of acupuncture for alleviating cancer pain."

question

A patient who has occasional migraine headaches tells a nurse that the abortive medication works well, but she would like to do more to prevent the occurrence of these headaches. The nurse will suggest that the patient:

answer

keep a headache diary to help determine possible triggers.

question

A woman with moderate migraine headaches asks a nurse why the provider has ordered metoclopramide [Reglan] as an adjunct to aspirin therapy, because she does not usually experience nausea and vomiting with her migraines. The nurse will tell her that the metoclopramide is used to:

answer

improve absorption of the aspirin.

question

A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient's history is of concern when taking this drug?

answer

Coronary artery disease

question

A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the patient:

answer

has taken ergotamine in the past 24 hours.

question

A patient arrives in the emergency department complaining of numbness in the extremities. The nurse notes that the patient's hands and feet are cool and pale. When conducting a health history, the nurse learns that the patient has a history of migraine headaches. The nurse recognizes this patient's symptoms as:

answer

ergotism.

question

A patient who has migraine headaches is prescribed sumatriptan [Imitrex] 5 mg unit-dose nasal spray. The patient has administered two sprays at 1400, 1600, and 1800 and calls to report little relief from headache pain. What will the nurse instruct the patient to do?

answer

Administer 2 sprays at 2000 and call the provider if no relief.

question

A young woman with migraine headaches who has recently begun taking sumatriptan [Imitrex] calls the nurse to report a sensation of chest and arm heaviness. The nurse questions the patient and determines that she feels pressure and not pain. What will the nurse do?

answer

Reassure the patient that this is a transient, reversible side effect of sumatriptan.

question

A patient who has a history of asthma experiences three or four migraine headaches each month. The patient uses sumatriptan [Imitrex] as an abortive medication and has developed medication overuse headaches. The patient asks the nurse what can be done to prevent migraines. The nurse will suggest that the patient discuss which preventive medication with the provider?

answer

Topiramate [Topamax]

question

Supplemental oxygen has been shown to help reduce symptoms for which type of headache?

answer

Cluster

question

A patient who has migraine headaches has been using sumatriptan [Imitrex] with good results, but reports frequent migraine recurrence 24 hours later. Which medication will the nurse expect the provider to order for this patient

answer

Naratriptan [Amerge]

question

A patient who uses ergotamine (Eergonar) to abort migraine headaches reports nausea and vomiting with the headaches. What will the nurse tell the patient?

answer

"Ask your provider about using another antimigraine medication"

question

A patient with schizophrenia has been taking an antipsychotic drug forcfrv several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do?

answer

Request an order to give diphenhydramine.

question

A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action?

answer

Giving an anticholinergic medication

question

A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to

answer

try a second-generation antipsychotic (SGA).

question

A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?

answer

"Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA."

question

A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient's tongue. The nurse recognizes which adverse effect in this patient?

answer

Tardive dyskinesia

question

A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?

answer

"Dry mouth and constipation are uncommon with this medication."

question

A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug?

answer

"If the ANC is less than 3000, the drug will be discontinued permanently."

question

A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement?

answer

"You will need to take an oral antipsychotic drug for 3 weeks."

question

A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?

answer

Some symptoms take months to improve.

question

A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?

answer

Teach the patient about drug side effects and how to manage them.

question

A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn't ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?

answer

"Olanzapine causes more metabolic side effects than thioridazine."

question

A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday?

answer

"Don't take the medication on Friday and Saturday."

question

A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect?

answer

Major depression

question

A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about:

answer

using nondrug therapies to augment the medication.

question

A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:

answer

hospitalizing the patient for closer monitoring.

question

A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient?

answer

Discuss gradual withdrawal of the medication with the provider.

question

A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?

answer

Discuss these symptoms with a dentist.

question

A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to:

answer

stop taking the MAOI 2 weeks before starting the SSRI.

question

A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for:

answer

irritability, tremor, and respiratory distress.

question

A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient?

answer

Duloxetine [Cymbalta]

question

A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?

answer

"TCAs have many side effects, but none of them are serious."

question

An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to:

answer

divide the daily dose into two equal doses 12 hours apart.

question

A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:

answer

sit or lie down when feeling lightheaded.

question

A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient?

answer

To list all foods eaten that day

question

A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug?

answer

Bupropion [Wellbutrin]

question

A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?

answer

Ask her to complete the Edinburgh Postnatal Depression Scale.

question

A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication?

answer

That sertraline is safer than other antidepressants for nursing mothers

question

A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:

answer

help control symptoms during manic episodes.

question

The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse:

answer

"During manic episodes, many patients don't see the benefit of prophylactic medications."

question

A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do?

answer

Administer the dose and tell the patient that the side effects are temporary.

question

A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?

answer

"I can continue to use ibuprofen as needed for muscle pain."

question

A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?

answer

Contact the provider to report these findings.

question

A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?

answer

Reassure the patient that these effects occur early in treatment and will resolve over time.

question

A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?

answer

"I've broken out in a rash on my chest and back."

question

A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient

answer

Administration of levothyroxine

question

A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?

answer

Lithium [Lithobid]

question

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?

answer

"Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia."

question

A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:

answer

potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression.

question

A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?

answer

"When this drug is metabolized, the resulting compound has longer-lasting effects."

question

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:

answer

the patient has a cross-dependence to the benzodiazepine.

question

A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?

answer

Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.

question

A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?

answer

Suspect a possible paradoxical reaction to the clorazepate.

question

A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following?

answer

Respiratory support

question

A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?

answer

Maintaining adequate oxygenation to the brain

question

A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?

answer

Zaleplon [Sonata]

question

A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?

answer

"Phenobarbital doses for seizures are nonsedating."

question

A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from the hospital will:

answer

request an order to change to trazodone [Desyrel] for sleep.

question

A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be:

answer

improved sleep hygiene.

question

A patient complains of chronic insomnia and reports being tired of being tired all the time. The patient is reluctant to try pharmacologic remedies and asks the nurse what to do. What will the nurse suggest?

answer

"Get out of bed for a while if you can't fall asleep."

question

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?

answer

Benzodiazepines have a rapid onset of action.

question

A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for "nerves." The nurse knows that this patient is most likely being treated for which condition?

answer

Generalized anxiety disorder

question

A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching?

answer

"I should stop taking the Ativan when I start taking the Buspar."

question

A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class?

answer

Selective serotonin reuptake inhibitors

question

A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment?

answer

Alprazolam [Xanax] as needed

question

During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior?

answer

It helps the patient reduce anxiety about causing a fire.

question

A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient?

answer

Buspirone [Buspar]

question

A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct?

answer

Ask the patient if the medication was stopped abruptly.

question

A patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient?

answer

Fluoxetine [Paxil]

question

A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching?

answer

"This drug will make him less impulsive while he's at school."

question

A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of:

answer

dyspnea.

question

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include:

answer

height and weight.

question

A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?

answer

Ask the prescriber whether this child could be given methylphenidate [Concerta].

question

A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching?

answer

"The tablet needs to be swallowed whole, not crushed or chewed."

question

An adult patient will begin taking atomoxetine [Strattera] for attention-deficit/hyperactivity disorder. What will the nurse teach this patient?

answer

Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy.

question

A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct?

answer

"It will not interfere with my normal sleep."

question

A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient?

answer

Seizures

question

A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine?

answer

"Avoid consuming alcohol while taking this medication."

question

A nurse is teaching a group of nursing students about drug abuse. Which statement by a student indicates a need for further teaching?

answer

"Patients who experience physical dependence will show compulsive drug-seeking behavior."

question

A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect that what has occurred?

answer

Drug tolerance

question

A patient who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The patient reports feeling anxious and jittery. The nurse understands that this response is due to:

answer

withdrawal syndrome.

question

A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder?

answer

A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain

question

A nursing student is caring for a patient who is addicted to several drugs. The student tells the nurse that the patient "got this way on purpose." Which response by the nurse is most appropriate?

answer

"Some individuals are more vulnerable to drug abuse than others."

question

A nurse is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching?

answer

"Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits."

question

A psychiatric nurse is caring for a drug-addicted patient. The nurse knows that the ideal goal of drug rehabilitation for this patient is:

answer

abstinence from the drug.

question

The nurse is teaching a nursing student about management of controlled substances in medication administration. Which statement by the nursing student indicates understanding of the teaching?

answer

"Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills."

question

A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement?

answer

"Long-term alcohol use can damage the heart and cause heart failure."

question

An alcoholic patient's spouse asks a nurse about recovery from chronic alcoholism. The patient is confused and has abnormal eye movements and nystagmus. Which statement by the nurse is correct?

answer

"These symptoms can be reversed with vitamin therapy and good nutrition."

question

A nurse is discussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that, in moderate amounts, alcohol:

answer

improves sexual responsiveness.

question

A patient tells a nurse that she drinks wine for its cardioprotective effects. She wants to know how much is safe. The nurse is correct in telling her that:

answer

"Cardioprotective effects are greatest in people who live an unhealthy lifestyle."

question

A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient?

answer

Acetaminophen

question

A nurse is screening a patient being admitted to the hospital. The patient reports being fired for drinking at work. On further questioning, the patient reveals a history of daily alcohol consumption of more than a six-pack of beer each day, regular morning drinking, and several unsuccessful attempts to stop drinking. The nurse detects alcohol on the patient's breath. The nurse will inform the provider of these findings and request an order for which medication?

answer

Chlordiazepoxide [Librium]

question

A nurse is providing education to a group of college students about the long-term effects of alcohol. Which statement by a student indicates understanding of the teaching?

answer

"Even small amounts of alcohol are related to the development of certain cancers."

question

A college student who is unresponsive is brought to the emergency department by friends, who say that their friend drank more than half of a large bottle of whiskey 3 hours ago. Assessment reveals a blood alcohol level of 0.32%. The vital signs are BP, 88/32 mm Hg; R, 6/min; T, 96.8°F; and P, 76/min and weak and thready. The nurse should prepare the patient for which intervention?

answer

Gastric lavage and dialysis

question

A male patient tells a nurse that he drinks a six-pack of beer a day. When the nurse begins to question him further about his alcohol consumption, he says, "You sound like my wife. She's always nagging me to quit. It's only beer!" Which response by the nurse is most appropriate?

answer

"The amount you drink is equivalent to six shots of whiskey each day."

question

During a health history, the nurse asks a male patient about alcohol use. The patient tells the nurse that he and his wife are trying to conceive a pregnancy and he is using alcohol to lower his inhibitions. What will the nurse counsel this patient?

answer

"Alcohol may cause testicular atrophy and sterility."

question

A pregnant patient in labor tells the nurse that she is afraid she may have harmed her fetus by consuming alcohol. What is an appropriate response by the nurse?

answer

Ask the patient how much alcohol she consumed, and at which stage of her pregnancy.

question

A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood alcohol level is 0.4%. The nurse will expect to:

answer

provide mechanical ventilation and oxygen.

question

A nursing student asks a nurse to discuss alcoholism and alcohol use disorder. Which statement by the nurse is correct?

answer

"Alcohol use disorder can occur without the development of tolerance or physical dependence."

question

A nurse is obtaining an admission history on a patient who reports daily drinking for several years. When the nurse questions the patient further, the patient reports drinking up to five or six drinks each day. The patient expresses worry about liver damage. What will the nurse do?

answer

Contact the patient's provider to request liver function studies.

question

A patient who has undergone treatment for alcoholism several times, with relapse occurring shortly after each treatment, has just completed detoxification. The patient requests a medication to help maintain abstinence. Which drug will the nurse expect the provider to prescribe?

answer

Naltrexone [ReVia]

question

A patient who is an alcoholic is prescribed disulfiram [Antabuse] to help prevent relapse and the nurse provides teaching about the use of this drug. Which statement by the patient indicates understanding of the teaching?

answer

"I should avoid shaving lotion and mouthwashes that contain even small amounts of alcohol."

question

A patient who has just found out she is pregnant tells the nurse she wants to quit smoking. She asks about pharmacologic aids to help her quit. The nurse is correct to tell her what?

answer

"Nicotine replacement therapy is harmful, but it is safer than smoking, so it can be used."

question

The spouse of a patient who smokes wonders why anyone would want to engage in "such a disgusting habit." What will the nurse tell the spouse?

answer

Nicotine increases alertness and promotes dopamine release.

question

A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting and a weak, thready pulse of 120 beats per minute after ingesting several cigarettes at home. The nurse caring for this child will expect to provide which treatment?

answer

Respiratory support

question

A patient reports a desire to stop smoking and asks what is available without a prescription to help with smoking cessation. The nurse tells the patient that which method is best?

answer

Nicotine replacement and 1-800-QUITNOW

question

A patient with a desire to stop smoking asks a nurse about nicotine chewing gum [Nicorette]. The patient currently smokes 30 cigarettes per day. Which statement by the nurse is correct?

answer

"Use the 4-mg strength gum and chew one piece every 2 to 3 hours."

question

A patient asks about nicotine patches for smoking cessation and wants to know the difference between the 24-hour patch and the 16-hour patch. Which response by the nurse is correct?

answer

"The 16-hour patch simulates usual nicotine ingestion patterns."

question

A prescriber has ordered nicotine nasal spray for a patient to assist with smoking cessation. Which statement will the nurse include when teaching the patient about the medication?

answer

"You should use 1 spray in each nostril per dose up to 5 times per hour."

question

A patient who wants to quit smoking has a prescription for varenicline [Chantix], which will be used with a nicotine patch. The patient asks the nurse why the varenicline is necessary. Which statement by the nurse is correct?

answer

"The drug blocks nicotine's access to 'pleasure' receptors."

question

A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient?

answer

"You should notify your provider of these symptoms immediately."

question

A nurse is teaching a drug prevention class to a group of parents of adolescents. Which statement by a parent indicates understanding of the teaching?

answer

"LSD does not cause an abstinence syndrome when it is withdrawn."

question

A provider orders clonidine [Catapres] for a patient withdrawing from opioids. When explaining the rationale for this drug choice, the nurse will tell this patient that clonidine [Catapres] is used to:

answer

relieve symptoms of nausea, vomiting, and diarrhea.

question

What is the primary reason for opioid abuse?

answer

Prolonged sense of euphoria

question

A nurse is discussing the differences between OxyContin OC and OxyContin OP with a group of nursing students. Which statement by a student indicates understanding of the teaching?

answer

"OxyContin OP is not easily crushed into a powder."

question

A patient arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The patient's friends tell the nurse that they were experimenting with "poppers." The nurse will expect to administer which medication?

answer

Methylene blue and supplemental oxygen

question

A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate:

answer

observing pinpoint pupils, respiratory depression, and possibly coma in this patient.

question

A patient who is a heroin addict is admitted to a methadone substitution program. After administering the first dose of methadone, the nurse notes that the patient shows signs of euphoria and complains of nausea. What will the nurse do?

answer

Suspect that the patient exaggerated the amount of heroin used.

question

A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient asks the nurse why the drug was changed. Which response by the nurse is correct?

answer

"Suboxone has a lower risk of abuse."

question

A nurse is caring for a patient who is addicted to barbiturates and who will begin receiving phenobarbital. The nurse discusses the care of this patient with a nursing student. Which statement by the student indicates understanding of the teaching?

answer

"Phenobarbital has a long half-life and can be tapered gradually to minimize abstinence symptoms."

question

A patient arrives in the emergency department acutely intoxicated and difficult to arouse. The patient's friends tell the nurse that the patient took a handful of diazepam [Valium] pills while at a party several hours ago. The nurse will expect to administer which drug?

answer

Flumazenil [Romazicon]

question

A patient who is agitated and profoundly anxious is brought to the emergency department. The patient acts paranoid and keeps describing things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the nurse expect to administer?

answer

Diazepam [Valium]

question

A young adult patient is admitted to the hospital for evaluation of severe weight loss. The nurse admitting this patient notes that the patient has missing teeth and severe tooth decay. The patient's blood pressure is 160/98 mm Hg. The patient has difficulty answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance?

answer

Methamphetamine

question

A school nurse is teaching a high school health class about the effects of marijuana use. Which statement by a student indicates a need for further teaching?

answer

"Higher doses of marijuana are likely to produce increased euphoria."

question

A pregnant patient reports using marijuana during her pregnancy. She asks the nurse whether this will affect the fetus. What should the nurse tell her?

answer

School-aged children born to patients who use marijuana often have difficulty with memory.

question

A college student admits frequent use of LSD to a nurse and reports plans to stop using it. What will the nurse tell this student?

answer

Tolerance to the effects of LSD will fade quickly once use of the drug has stopped.

question

A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The patient has a temperature of 105°F and shows jaw clenching and confusion. The nurse will expect to administer which medication?

answer

Dantrolene [Dantrium]

question

In discussing the rationale for using methadone to ease opioid withdrawal, the nurse would explain that it has which pharmacologic properties or characteristics?

answer

Methadone can prevent abstinence syndrome.

question

A college student tells the nurse that several friends have been using synthetic marijuana to get high. What will the nurse tell this patient about this type of substance?

answer

"They can cause hypertension, nausea, vomiting, and hallucinations."

question

Alcohol overdose

answer

gastric lavage and dialysis

question

Antipsychotic that causes less weight gain

answer

ziprasidone (Geodon)

question

Seizures with LOC, jaw clenching, contraction and relaxation

answer

tonic-clonic (grand-mal)

question

Difficulty waking up

answer

respiratory status and type of anesthetics

question

Last area of the body to achieve anesthesia equilibrium

answer

adipose tissue

question

MS treatment with mitoxantrone (noveantrone)

answer

ND risk for infection r/t depressed neutrophils

question

Benzodiazepines exhibits drowsiness + confusion s/s of overdose

answer

dminister Flumaenil (romazicon)

question

Reduce craving for ETOH

answer

disulfiram (antabuse) + Naltrexone (ReVia)

question

Buspirone (BuSpar) -

answer

- 4 to 6 weeks to notice

question

Donepenzil (Aricept) better than tacrine (cognex) b/c

answer

better tolerated and once a day

question

Hx of seizures and Dilantin with alcohol =

answer

central nervous system depression

question

Tolerance

answer

decreased response to prolonged use

question

Aspirin and other cyclooxygenase inhibitors =

answer

aspirin irreversibly inhibits cyclooxygenase

question

Dopamine agonists in Parkinson's

answer

non-ergot derivatives cause fewer side effects than ergot derivatives such as bromocriptine (Parlodel)

question

Severe spastic paralysis only benzodiazepine =

answer

diazepam (valium)

question

Intraspinal injection of opioid

answer

intractable pain that can't be controlled

question

MS damaged neuron

answer

myelin sheath

question

Post op delirium and hallucination =

answer

adverse effects of Ketamine (Ketalar)

question

Migraine

answer

alar) Migraine =

question

Antipsychotic + begins to drool + tremors + unsteady gait

answer

= extrapyradimal effects of Haloperidol + has parkinsonism

question

Parkinson's experiences relapse of sx

answer

on+off phenomenon + avoid high protein meals + levodopa

question

Elavil with blurred vision and dry mouth =

answer

anticholinergic effects (give antagonist Atropine)

question

MS with acute exacerbation is givin interferon beta 1a (avonex) ?s for adverse effects

answer

swelling in legs or SOB? Ringing in ears? GI upset or diarrhea? Headache chills or aches?

question

Chronic pain for months =

answer

Fentnyl (duragesic) transdermal patch (most potent opioid)

question

busprione

answer

not a central nervous system depressant/benzodiazepines are

question

Elderly cancer pain may be undertreated

answer

true

question

Physical dependence on drugs =

answer

an abstinence syndrome will occur if the drug is abruptly discontinued

question

Prolonged central nervous system drug exposure on the CNS =

answer

side effects and adverse effects increase over time + act immediately to produce profound structural changes in the nervous system.

question

Mitoxantrone 24yoF with MS

answer

managing contraception (category X)

question

Antidepressants:

answer

monoamine oxidase inhibitor antidepressants are used for a pt who has not responded to selective serotonin reuptake inhibitors and trycyclic antidepressants (1-SSRI 2-trycyclic 3-MAOI)

question

CNS stimulant for narcolepsy b/c

answer

constantly falling asleep

question

Anxious unable to sleep wants medication without "hangover"

answer

Zaleplon (sonata) + Zolpidem (ambien) = treat insomnia, short term management

question

Amphetamines increase HR

answer

(increase mood, decrease appetite, stimulant for heart)

question

Confused, fever, "lead-pipe" rigidity + antipsychotic drug

answer

neuroleptic malignant syndrome

question

Alzheimer's worse night wandering. Pacing, and agitation =

answer

sundowners

question

Abstinence syndrome =

answer

physical dependence signs and sx

question

Nitrous oxide differs from volatile liquid needs further teaching if:

answer

nitrous oxide can be used as a primary anesthetic for surgery (no, analgesia/has high MAC=low potency)

question

Monoamines that act as neurotransmitters in CNS except

answer

Acetylcholine bc peripheral nervous system

question

Cholinesterase inhibitor side effects -

answer

nausea, vomiting, diarrhea (SLUDGE)

question

Epidural infusion of morphine sulfate (opioid agonist) decrease RR and LOC =

answer

administer Narcan (opioid antagonist)

question

Parkinson's goal of treatment =

answer

improve ability to do ADL (balance cholinergic and dopaminergic activity in the brain)

question

Benzodiazepines have limited CNS depression effects compared to barbiturates (more adverse effects, not used anymore)

answer

true

question

Fluoxetine (Prozac) by

answer

selectively inhibiting serotonin receptors reuptake (SSRI)

question

Lamotrigine (lamictal) and Valroic acid (Depakote) with lesions on the skin and membranes + temp 102F + malaise =

answer

steven-johnsons syndrome

question

Endoscopic Midazolam (Versed) used with opioid analgesic to produce

answer

conscious sedation

question

Huffing

answer

pouring solvent in a rag and inhaling the vapor

question

Lidocaine + epinephrine =

answer

epinephrine prolongs anesthesia and reduces risks of toxicity (don't give epi with cocaine)

question

Antidepressants take

answer

several weeks before therapeutic effects are seen

question

Atypical antipsychotics =

answer

risk of weight gain and DM (dyslipidemia)

question

Ethosuximide (Zarontin) vs. phenytoin (Dilatin) and carbamazepine (Tegretol) =

answer

ethosuximide (does block calcium channels) does not block sodium channels or enhance gamma-amniobutyric acid

question

High levels of marijuana =

answer

reddened eyes

question

(Bipolar on lithium for 3 years now HTN), diuretics with lithium =

answer

adverse drug interaction

question

Mechanically ventilated + anxious =

answer

IV anesthetic Propofol (Diprivan)

question

Heroin (opioid agonist) needs

answer

methadone (antidote)

question

MS takes Baclofen (lioresal) (suppresses resistance to passive movement + decrease flex and extension) for spasm + rehab =

answer

drowsiness and lethargy

question

Liodcaine and irregular pulse =

answer

absorbed lidocaine and have have cardiac toxicity

question

Busprione (Buspar) - don't take with

answer

grapefruit juice

question

Extreme state of anxiety =

answer

benzodiazepine has a rapid onset of action (insomnia and anxiety)

question

Ergotamine + caffeine enhances

answer

vasoconstriction and the ergotamine absorption

question

Dopamine activates

answer

reward circuit response

question

Alcohol dependence and abuse

answer

withdrawal and tolerance

question

Atomoxetine (Strattera) (only non CNS stimulant) can cause

answer

suicidal thinking + liver damage

question

Alzheimer's with cholinesterase inhibitor + adverse GI affects =

answer

= Rivastigmine (Exelon)

question

Catapres alpha2 agonist =

answer

dry mouth

question

Entacapone with Parkinson's is to inhibit COMT and prolong the 1/2life of levodopa in the blood

answer

true

question

Absence seizures =

answer

ethosuximide (Zarontin)

question

Tx of Alz by blocking NMDA receptors for glutamate =

answer

memantine (Namenda)

question

Tx almost all forms of epilepsy

answer

Valproic acid (Depakote)

question

Levodopa/carbidopa ask if

answer

are you having any vivid dreams or hallucinations

question

Alcohol use can increase ....

answer

risk for breast cancer

question

Haloperiodol

answer

high potency antipsychotic drug

question

Skeletal muscle relaxant that doesn't affect CNS =

answer

Dantrolene

question

Hallucinations, CNS depression, CNS excitation =

answer

PCP

question

Remifentanil

answer

rapid onset and brief duration of action

question

Natalizumab

answer

rare cases of dangerous brain infections (leukoencephalopathy)

question

Synthetic derivation of major active substances of marijuana =

answer

dronabinol (Marinol)

question

Minoxidil + girl hair on face =

answer

hypertrichosis is a side effect

question

Drug treatment program =

answer

complete cessation of drug use

question

Zaleplon (Sonata) -

answer

need or want to fall asleep quickly (insomnia)

question

1-30sec LOC and eye blinking = absence seizure -

answer

ethosuximide

question

Schedule 1 drugs are

answer

not approve for any medical use

question

Migraines and prevent attacks -

answer

- propranolol (Inderal)

question

Tricyclic with weak antichoinergic properties =

answer

desipramine (norpramin)

question

Ester-type v. aminde-type =

answer

site of metabolism

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