Exam 4

Question 1

A nurse is caring for 4 patients- which would she be concerned about developing a substance abuse disorder?

a) A college student who admits experimenting with marijuana in the last year.
b) An older adult patient with terminal cancer who requires twice the normal morphine dosage for pain relief.
c) A patient in moderate to severe pain following total hip replacement who requests pain meds an hour before the next dose is due.
d) A patient whose history indicates prescription narcotic analgesics for back and headache pain.

Answer 1

Answer: D - A patient whose history indicates prescription narcotic analgesics for back and headache pain.

Patient who use narcotics for minor pains are more likely to be drug seekers. Pg 256

Question 2

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

a) addiction
b) psychologic dependence
c) tolerance
d) withdrawal syndrome

Answer 2

Answer: D - withdrawal syndrome

Withdrawal symptoms occur when a patient has developed physical dependence on a drug and then often show signs the opposite of the drug effect when the drug is withdrawn. Addition is characterized by compulsive drug- seeking. Psychologic dependence is intense subjective need for a drug.

Question 3

A patient is ready for discharge after a lengthy stay following an MVA. The patient suffered multiple fractures and required high doses of morphine for several weeks. The nurse preparing the patient for discharge notices the patient requests the maximum amount of pain medicine at the exact interval prescribed. The nurse suspects what has occurred?

a) Addiction
b) Compulsive drug seeking
c) Cross- tolerance
d) Drug tolerance

Answer 3

Answer: D - Drug tolerance

Patients who use a drug regularly develop a tolerance to the drug when a dose produces a smaller response than it did initially. This patient has been on large doses of opioids for several weeks and has developed tolerance to this class of drugs. Addiction is characterized by compulsive drug seeking which has not occurred. Cross- tolerance occurs when tolerance to one drug confers tolerance to another drug.

Question 4

A patient falls off a ladder at home hanging Christmas lights on a Friday evening and is experiencing shoulder pain from bruising and cannot sleep. The on-call provider calls in an oral Schedule II analgesic to the pharmacy as the office is closed. How long does the provider have to provide a written prescription to the pharmacy?

a) 24 hours
b) 48 hours
c) 72 hours
d) 1 week

Answer 4

Answer: C - 72 hours

the provider has 72 hours to provide a written prescription for this analgesic. Call in prescriptions for schedule II drugs are only accepted in an emergency. Prescriptions for schedule II drugs cannot be refilled. However, a DEA rule allows a prescriber to write multiple prescriptions on the same day- for the same patient and same drug. Reference: Chapter 32 audio clip

Question 5

A patient asks a nurse about the effects of chronic alcohol use on the heart. What is the best response?

a) Chronic alcohol use affects the liver more adversely than the heart.
b) Drinking more than two drinks a day protects the heart from atherosclerosis.
c) Long-term alcohol use can damage the heart and cause heart failure.
d) Overtime, alcohol use can lower your blood pressure.

Answer 5

Answer: C; Long-term alcohol use can damage the heart and cause heart failure.

Chronic abuse of alcohol results in direct damage to the myocardium, increasing the risk of heart failure. Drinking fewer than 2 drinks daily can reduce risk of atherosclerosis. Alcohol consumption produces a dose-dependent elevation of blood pressure overtime.

Question 6

A patient who is an active alcoholic is admitted to the hospital for surgery. Which medication order would the nurse question?

a) Acetaminophen
b) Diazepam
c) Morphine
d) Thiamine

Answer 6

Answer: A; Acetaminophen

Acetaminophen poses a risk of fatal liver damage in alcoholics; evidence indicates even modest consumption combined with acetaminophen has this effect. Diazepam and morphine are safe in history of alcoholism but should not be given with alcohol. Could cause severe CNS depression.

Question 7

A college student who is unresponsive is brought to the ER by friends who say he drank ½ bottle of whiskey 3 hours ago. Blood alcohol level is 0.32%, b/p 88/32, RR 6, pulse 76 and weak. What would the nurse prepare to do?

a) IV fluids and stimulants
b) Administer activated charcoal
c) Gastric lavage and dialysis
d) Narcan administration

Answer 7

Answer: C; Gastric lavage and dialysis

Alcohol can be removed from the body by gastric lavage and dialysis. Gastric lavage “washes out” most of the alcohol if any is left in the gut. Dialysis is implemented to reduce the chance of renal failure and CV shock.

Question 8

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

a) Ask the patient how much she consumed and at what stage of her pregnancy.
b) Reassure the patient the risk is likely to be minimal
c) Tell the patient no amount of alcohol is considered safe during pregnancy
d) Tell the patient the full range of outcomes might not be present for years

Answer 8

Answer: A; Ask the patient how much she consumed and at what stage of her pregnancy.

Although heavy use f alcohol during pregnancy is known to cause adverse effects on the fetus, the effects of lower levels are not known. The patient should first be questioned about ho much and when. Many women consume alcohol before knowing they are pregnant without ill effects to fetus. Telling the patient no amount of alcohol is considered safe would be appropriate during pregnancy appointments for teaching but during labor is not appropriate.

Question 9

Which is NOT a benefit of moderate alcohol consumption?

a) Increases bone mineral density
b) Decreases risk of Type 2 DM
c) Increases HDL
d) Improves quality and sleep & promotes regular sleep

Answer 9

Answer: D; Improves quality and sleep & promotes regular sleep

ETOH is commonly used as a sleep aid; however, it disrupts sleep. It alters sleep cycles, decreases total sleep time, and can exacerbate snoring/ OSA. Pg 260

Question 10

Which drug for alcohol abstinence creates a negative physical reaction to alcohol consumption that can be fatal?

a) Naltrexone
b) Disulfiram
c) Acamprosate
d) Diazepam

Answer 10

Answer: B; Disulfiram

Pts who are prescribed Disulfiram must be very compliant. In its mild form, combination with alcohol creates nausea, copious vomiting, flushing, HA, palpitations, chest pain, weakness, blurred vision, and hypotension and can last minutes to hours from just 7oz of alcohol. Severe reactions can be fatal. Disulfiram is useful in treating a patient where relapse has just occurred but only slightly better than a placebo in maintaining long-term abstinence. In the absence of alcohol, disulfiram rarely causes any effects.

Question 11

A decrease in intrinsic factor leads to a deficiency in __________ leading to __________.

A. Hydrochloric acid, macrocytic anemia
B. Pepsin, microcytic anemia
C. B12, macrocytic anemia
D. Prostaglandins, microcytic anemia

Answer 11

Answer: C - B12, macrocytic anemia

Reasoning: Info from Acid Controlling Drugs video

Question 12

What is a treatment option for treating Peptic Ulcer Disease (PUD)cause by H. Pylori

A. A proton pump inhibitor + Clarithromycin + Metronidazole

B. A proton pump inhibitor + Amoxicillin + Metronidazole

C. A proton pump inhibitor + Tetracycline + Azithromycin

D. A proton pump inhibitor + Doxycycline + Amoxicillin

Answer 12

A. A proton pump inhibitor + Clarithromycin + Metronidazole

Reasoning: PUD common etiology is H pylori bacteria. General treatment is PPI plus 2 antibiotics either Amoxicillin + (Clarithromycin or Metronidazole) OR Tetracycline + Metronidazole + bismuth subsalicylate for 1-2 weeks. THEN continue with PPI for 4-8 weeks. Info from Acid Controlling Drugs Video

Question 13

What is the direction of the ph change to be less acidic? (Higher or lower ph is less acidic)?

A. Lower ph is less acidic
B. Lower ph is neutrally acidic
C. Higher ph is neutrally acidic
D Higher ph is less acidic

Answer 13

Answer: D - Higher ph is less acidic

Reasoning: Info from Acid Controlling Drugs Video

Question 14

H2 receptor antagonist work by_______________. An example of a H2 receptor antagonist is ______________.

A. Increase stimulation of gastric production; Example Calcium carbonate

B. Divert the stimulation of gastric production; Example Ranitidine

C. Block the stimulation of gastric production from parietal cells: Example Ranitidine

D. Neutralize acid; Example Calcium Carbonate

Answer 14

Answer: C-Block the stimulation of gastric production from parietal cells: Example Ranitidine

Reasoning: Antacids neutralize acid; Example=Calcium carbonate. Indications for antacids are hyperacidity, GERD, gastritis, ulcer prevention. H2 receptor antagonist end in “tidine”block the stimulation of gastric production; Example=Ranitidine. Caution with H2 receptor blockers and patients with liver and kidney disease. Elderly are at greatest risk for adverse CNS effects of H2Ras. Info from Acid Controlling Drugs Video

Question 15

Match the Drug to the Mechanism of Action (MOA)

A. Omeprazole breaks up gas
B. Sucralfate (Carafate) stops production of acid
C. Simethicone (Mylicon) neutralizes acid
D. Omeprazole stops production of acid

Answer 15

Answer: D - Omeprazole stops production of acid

Reasoning: Omeprazole is a proton pump inhibitor (PPI), they stop the production of acid. PPI end in “prazole” Are first line but not single line for gastric ulcers if H pylori is involved. They are very well tolerated and are more powerful than H2RAs due to the irreversible pump shut down. Sucralfate protects the lining and Simethicone breaks up gas. Disadvantages of Sucralfate: Give QID, can cause GI upset (constipation, nausea, dry mouth). May impair absorption of other drugs (give other drugs 2 hours before Sucralfate). Administer Sucralfate QID 1 H AC meals and HS on empty stomach

Question 16

What are risk factors for stress ulcers in critically ill patients?

A. Increase prostaglandins
B. Increase in endogenous and exogenous steroid production
C. Decrease in endogenous and exogenous steroid production
D. There are no risk factors for stress ulcers in critically ill patients

Answer 16

Answer: B - Increase in endogenous and exogenous steroid production

Reasoning: After major trauma there is an increase in endogenous and exogenous steroid production (anti-prostaglandins). Prevention drugs that can be used are H2 receptor blockers and PPIs. Info in Acid Controlling Drugs Video

Question 17

What is rebound acidity and what antacid is at greatest risk for causing it?

A. Stomach increases acid due to higher ph; calcium carbonate

B. Decreased acid production due to higher ph; calcium salts

C. Stomach increases acid due to lower ph; calcium carbonate

D. Decreased acid production due to lower ph; magnesium salts

Answer 17

Answer: A - Stomach increases acid due to higher ph; calcium carbonate

Reasoning: Long duration of calcium carbonate (TUMS) may cause increased acid secretion due to higher ph. Caution all patients that use of antacids over 2 weeks may mean something that needs work up. To avoid drug interactions like chelating (binding) to tetracycline, fluoroquinolones, iron (especially calcium) take 2 hours before other meds. Info from Acid Controlling Drugs Video

Question 18

Patients with heart failure should avoid _________ antacids. Patients with renal disease should avoid ___________ antacids. Patients with constipation should avoid _________ antacids.

A. Magnesium, Calcium, Sodium
B. Sodium, Calcium, Magnesium
C. Aluminum, Sodium, Calcium
D. Sodium, Magnesium, Calcium

Answer 18

Answer: D - Sodium, Magnesium, Calcium

Reasoning: Caution should be used with Magnesium antacids for patients with diarrhea and renal disease. Calcium antacids cause constipation. Sodium antacids should not be used in patients with heart failure. Info from Acid Controlling Drugs Video

Question 19

Which particular H2RA has the most drug interactions

A. Nizatidine (Axid)
B. Ranitidine (Zantac)
C. Cimetidine (Tagamet)
D. Famotidine (Pepcid)

Answer 19

Answer: C

Reasoning: Cemetidine (Tagamet) has the most drug interactions due to CP 450 effects. Caution with H2RA and alcohol and CNS depressants for safety reasons (falls). Info from Acid Controlling Drugs Video

Question 20

What category of ulcers are PPIs used for that Antacids and H2RA are not?

A. Gastric ulcer
B. Duodenal ulcers
C. Prevention of stress ulcers
D. Bleeding Ulcers

Answer 20

Answer: D - Bleeding Ulcers

Reasoning: PPI are used for bleeding or NSAID ulcers; Antacids and H2RB are not. PPIs should be taken before meals to prevent acid production. Potential disadvantages of PPI include increased risk of food poisoning, HAI (especially C DIFF) pneumonia. Info from Acid Controlling Drugs Video

Question 21

An established patient presents to your clinic for their annual physical. The patient recently experienced a death in the family 2 months ago. She has been experiencing loss of concentration, feelings of depressed mood “on and off” and some loss of appetite most days and a 10 pound weight loss. What is this most appropriate intervention for this patient?

A. Empathize with patient and reassure her that her feelings of sadness will go away.

B. Discuss counseling and prescribe Prozac.

C. Discuss counseling and prescribe Wellbutrin.

D. Tell the patient that she needs to go to counseling now and prescribe Imipramine.

Answer 21

Ans: B - Discuss counseling and prescribe Prozac.

SSRIs should be first line treatment with patient depression.

Question 22

A patient presents to the to your clinic for her annual physical exam. She has a history of hysterectomy secondary to endometriosis, hyperthyroidism, and glaucoma. She recently saw a different provider for depressant feelings and was prescribed an antidepressant. Which antidepressant would be of most concerning and would require intervention?

A. Lexapro
B. Cymbalta
C. Effexor
D. Zoloft

Answer 22

Ans: C - Effexor

Effexor can cause sustained mydriasis, which can increase IOP.

Question 23

You are discussing patient education on a new prescription of Zoloft for your patient. Which statement is an indication that your patient is in need of further teaching?

a. I can take this while pregnant.
b. I can take this while breastfeeding.
c. I may experience constipation with this medication.
d. I need to contact the office if I want to discontinue this medication.

Answer 23

Ans: C - I may experience constipation with this medication.

Patients taking Zoloft may experience harsher GI effects than other antidepressants. The antidepressant video talked about “Squirt-teraline” (for sertraline) to remember this.

Question 24

You are prescribing a SNRI to a patient who has failed treatment with an SSRI. This patient has a history of hyperlipidemia, hypertension, and history of CABG. Which medication would be inappropriate for this patient?

a. Wellbutrin
b. Effexor
c. Cymbalta
d. Imipramine

Answer 24

Ans: B - Effexor

Effexor increases HTN 50-100%, and is contraindicated in patients with established HTN.

Question 25

A 89 year old female patient presents to your clinic with feelings of depression and anxiety. She has been prescribed Zoloft, but after one month of treatment, her feelings have not improved. Her feelings have been heighted due to not seeing friends or family due to the COIVID-19 pandemic. This patient has had a significant weight loss accompanied by her feelings of worthlessness and isolation. You are discussing switching to a SNRI, which would be most appropriate for this patient? a. Remeron b. Trazadone c. Effexor d. Paxil

Answer 25

Ans: A - Remeron Remeron is frequently used in elderly patients in nursing homes and also increases appetite and decreases nausea.

Question 26

A patient comes in to your clinic for a follow up appointment to discuss her antidepressant medication. It has been 6 weeks since initiation of her Lexapro and she has noticed no difference in her depression. She refuses to seek counseling. What would be an appropriate next step in her therapy? a. Tell her to suck it up and go to counseling and continue her Lexapro. b. Discuss switching immediately to Wellbutrin. c. Discuss weaning her Lexapro (having a “wash out” period of 2 weeks) and switching to Effexor. d. Write a prescription for Amitriptyline.

Answer 26

Ans: C-Discuss weaning her Lexapro (having a “wash out” period of 2 weeks) and switching to Effexor. Weaning and tapering SSRIs are important to avoid serotonin syndrome from switching from SSRIs to TCAs.

Question 27

A patient presents to the clinic for her yearly evaluation. Her medication list includes Imipramine for depression and occasional use of aspirin for pain. She states to you, “I think I missed my dose of Imipramine a few days ago, but it’s okay because I took a few extra to stay caught up on my treatment.” Which sign would cause the most alarm and require immediate intervention? a. Widening QRS on EKG b. Bruising on her arms and legs c. Temp 103F d. BP 130/80

Answer 27

Ans: A - Widening QRS on EKG TCA’s can cause significant widening of the QRS and is indicative of a TCA overdose. The patient probably wouldn’t be talking if she was overdosed, but this is the best scenario I could think of.

Question 28

Your patient has just had a diagnosis of Obsessive Compulsive Disorder. Which of the following would the best medication for treatment? a. Trazadone b. Imipramine c. Clomipramine d. Zoloft

Answer 28

Ans: C | Clomipramine has an FDA approval for OCD.

Question 29

Your male patient with a history of depression has been taking Prozac for 4 weeks and is complaining of lack of sexual interest. His partner thinks he is cheating on him and is visibly upset in the office. Which medication would be a good alternative? a. Paxil b. Effexor c. Selegiline d. Trazadone

Answer 29

Ans: D Trazadone increases sexual drive in patients. In the antidepressant video it states “TrazaBONE” to remember trazadone is for increased sexual drive.

Question 30

You are prescribing Phenelzine to your patient with depression. Which statement indicates a need for further teaching? a. I should monitor my BP weekly at home. b. I should monitor my weight weekly at home. c. I should keep a journal of feelings of depression and anxiety throughout the beginning of treatment. d. I should make sure and eat extra cheese and aged meats to make sure I get enough protein in my diet and a glass of wine with dinner each night for cardioprotective uses.

Answer 30

Ans: D - I should make sure and eat extra cheese and aged meats to make sure I get enough protein in my diet and a glass of wine with dinner each night for cardioprotective uses. MAOIs are associated with HTN crisis with patients that ingest foods with high levels of tyramine including aged cheeses/meats and wines. The video talks about having a fine dinner with Tyra Banks (Tyramine) having cheese and wine in Maui (MAOIs). Or think about wine night would not be good for people taking MAOIs LOL!

Question 31

A patient with cerebral palsy was prescribed Dantrolene (Dantrium) 2 months ago. At this visit, the patient’s caregiver explains to the NP that the patient is still experiencing significant muscle spasms and she has not seen any improvement in patient’s dexterity. What should the NP do? a. Increase dose of dantrolene b. Increase frequency of doses c. Advise patient to continue taking dantrolene as ordered and schedule a follow up visit in 2 weeks to check patient’s status d. Discontinue Dantrolene (Dantrium)

Answer 31

Answer: D. Discontinue Dantrolene (Dantrium) P. 174: If beneficial effects do not develop within 45 days, dantrolene should be discontinued.

Question 32

Tolerance is: a. a state in which abrupt discontinuation of drug use will precipitate a withdrawal syndrome b. when a patient is finally able to tolerate a certain medications side effects c. a decreased response to a drug that occurs with prolonged drug use. d. Is seen only with CNS medications

Answer 32

Answer C: a decreased response to a drug that occurs with prolonged drug use. p. 125. Tolerance is a decreased response that occurs with prolonged drug use. Physical dependence is a state in which abrupt discontinuation of drug use will precipitate a withdrawal syndrome.

Question 33

All of the following are true about CNS drugs EXCEPT: a. When CNS drugs are taken long term, the intensity of side effects may decrease b. Most of the compounds believed to be CNS neurotransmitters have been proven to serve this function c. If certain CNS drugs are stopped abruptly, the drug-adapted brain can no longer function properly, and a withdrawal syndrome ensues. d. Certain CNS drugs must be taken for several weeks and up to 2 months before full therapeutic effects develop

Answer 33

Answer B. - Most of the compounds believed to be CNS neurotransmitters have been proven to serve this function p. None of the compounds believed to be CNS neurotransmitters has actually been proved to serve this function.

Question 34

A 45 year old female has been taking Dantrolene (Dantrium) 100 mg TID for 3 months. Her caregiver calls the NP and states that the has been acting extremely tired and has new onset of epigastric pain. What should the NP do? a. Discontinue the Dantrolene (Dantrium) and advise the caregiver to bring the patient in as soon as possible to be evaluated. b. Advise the caregiver to half the dose of Dantrolene (Dantrium) to 50 mg and only give it BID. c. Instruct the caregiver to continue the medication as ordered, but to bring the patient in to have her blood drawn in order to check her liver function d. Prescribe a proton pump inhibitor to help with the epigastric pain

Answer 34

Answer A. - Discontinue the Dantrolene (Dantrium) and advise the caregiver to bring the patient in as soon as possible to be evaluated. p. 174: Dose-related liver damage is the most serious adverse effect. The incidence is 1 in 1000. Deaths have occurred. Hepatotoxicity is most common in women older than 35 years. Inform patients about signs of liver dysfunction (e.g., jaundice, abdominal pain, malaise), and instruct them to seek medical attention if these develop.

Question 35

A patient is currently taking methocarbamol (Robaxin) for back spasms. Upon review of systems, the patient tells the NP that is urine has turned dark brown. What should the NP do? a. Advise the patient to drink more water as this can be an indication of dehydration b. Reassure the patient that this is an expected, harmless side effect of methocarbamol (Robaxin) c. Discontinue the methocarbamol (Robaxin) immediately due to the possibility of acute kidney injury d. Order a UA to assess for blood in the urine.

Answer 35

Answer B. - Reassure the patient that this is an expected, harmless side effect of methocarbamol (Robaxin) p. 176 Methocarbamol may turn urine brown, black, or dark green. Chlorzoxazone may color urine orange to purple-red. This appears to be dose related. The effect is harmless.

Question 36

All of the following statements about baclofen (Lioresal) are true EXCEPT: a. It is approved for relief of spasms related to multiple sclerosis and some spinal cord injuries b. Patients on it should avoid alcohol. c. It decreases muscles strength due to its direct effects on skeletal muscles d. It can cause drowsiness and fatigue

Answer 36

Answer C. - It decreases muscles strength due to its direct effects on skeletal muscles p. 173. Baclofen has no direct effects on skeletal muscle. Because baclofen has no direct muscle relaxant action, it does not decrease muscle strength.

Question 37

A 50 year old patient presents to the NP with complaint of back spasms and back pain associated to the back spasms. The patient has a medical history of depression. Before prescribing cyclobenzaprine (Amrix) for the back spasms, what should the NP most importantly verify? a. If the patient is allergic to sulfas b. If the patient is currently taking any medications for depression c. If the patient is taking ibuprofen for the pain d. If the patient has a history of back surgery

Answer 37

Answer B.- If the patient is currently taking any medications for depression p. 175: Cyclobenzaprine use is contraindicated for patients taking monoamine oxidase (MAO) inhibitors. For patients previously undergoing therapy with MAO inhibitors, at least 2 weeks must have passed after discontinuing the drug before starting cyclobenzaprine. Failure to do so has led to potentially fatal serotonin syndrome manifested by high fever, seizures, and rhabdomyolysis.

Question 38

All of the following statements about the blood brain barrier are true EXCEPT: a. The blood brain barrier is fully developed at birth b. Protein-bound drugs and highly ionized drugs cannot cross the blood brain barrier. c. The blood–brain barrier presents an advantage and a disadvantage; it can protects the brain from injury, but it can also be a significant obstacle to entry of therapeutic agents d. The blood–brain barrier impedes the entry of drugs into the brain

Answer 38

Answer A. The blood brain barrier is fully developed at birth p. 125: The blood–brain barrier is not fully developed at birth. Accordingly, infants are much more sensitive to CNS drugs than are older children and adults.

Question 39

An NP is prescribing metaxalone (Skelaxin) to a 48 year old truck driver for back spasms and back pain. that What should the NP make sure to include in a patient’s education? a. Alcoholic beverages should be limited to one a day when taking metaxalone (Skelaxin). b. The patient should refrain from truck driving for the first few days or longer due to the CNS depression that this medication causes. c. No baseline labs need to be drawn with Metaxalone (Skelaxin) d. This medication cannot cause physical dependence

Answer 39

Answer B. - The patient should refrain from truck driving for the first few days or longer due to the CNS depression that this medication causes. p. 176 Depressant effects (of centrally acting muscle relaxants) may include drowsiness, lightheadedness, and fatigue. These may be dangerous if the patient must engage in hazardous activities (e.g., truck-driving or construction)

Question 40

Which one of these medications could possibly cause rebound hypertension if discontinued abruptly? a. Methocarbamol (Robaxin) b. Tizanidine (Zanaflex) c. Cyclobenzaprine (Amrix, Fexmid) d. Diazepam (Diastat, Valium)

Answer 40

Answer B. Tizanidine (Zanaflex) p. 176: Tizanidine is similar to clonidine and can cause hypotension. When discontinuing this drug, it may be necessary to taper dosage to avoid rebound hypertension.

Question 41

Which of following medication are controlled substances? Select all that apply. a. Diazepam (Diastat, Valium) b. Methocarbamol (Robaxin c. Carisoprodol (Soma) d. Cyclobenzaprine (Amrix, Fexmid)

Answer 41

Answer A&C A. Diazepam (Diastat, Valium) C. Carisoprodol (Soma) p. 173: Table 22.2

Question 42

What should the NP include to a patient with multiple sclerosis that was just prescribed baclofen? a. This medication will slow down the progression of your multiple sclerosis b. It is ok to drink alcohol with this medication c. This medication should not be discontinued suddenly d. This medication will decrease muscle strength

Answer 42

Answer: C - This medication should not be discontinued suddenly p. 173: Abrupt discontinuation (of baclofen) has been associated with adverse reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures. Accordingly, withdrawal should be done slowly (over 1 to 2 weeks)

Question 43

When starting a patient on an SSRI, you should educate the patient that: a. You should start to feel better in 48 hours b. You should take this medication as needed c. Initial responses can take 1-3 weeks to develop d. Treatment will typically last 1-3 months

Answer 43

Answer: C - Initial responses can take 1-3 weeks to develop pg. 215

Question 44

A patient presents with depression and insominia, which medication would be the most appropriate choice? a. Buproprion b. Isocarboxazid c. Mirtazapine d. Fluoxetine

Answer 44

Answer: C Mirtazapine pg. 216. Mirtazapine has the side effect of substantial sedation which would help with insomnia.

Question 45

Important patient education regarding the SSRI Fluoxetine includes: a. This drug may cause you to be drowsy b. This drug may suppress your appetite. c. This drug commonly causes sexual disfunction. d. This drug can be given with an MAOI.

Answer 45

Answer: C-This drug commonly causes sexual disfunction. pg. 218

Question 46

A patient who is taking citalopram presents to their PCP with symptoms of altered mental status, incoordination, excessive sweating and fever. The provider suspects that the patient is experiencing: a. An anaphylactic reaction b. Serotonin Syndrome c. Steven Johnson’s syndrome d. Normal side effects of citalopram

Answer 46

Answer: B- Serotonin Syndrome pg. 218

Question 47

Which drug may cause hypotension and requires blood pressure monitoring? a. Escitalopram b. Venlaflaxine c. Sertraline d. Amitriptyline

Answer 47

Answer: D - Amitriptyline pg. 221

Question 48

True/False: SNRI’s can cause withdrawal and should be discontinued slowly?

Answer 48

Answer: True. Pg 220

Question 49

Which is true of treatment for patients with mild to moderate depression? a. Drug therapy is superior to psychotherapy b. Psychotherapy is superior to drug therapy c. Combination therapy is superior d. Drug therapy and psychotherapy are equal

Answer 49

Answer: D - Drug therapy and psychotherapy are equal Pg. 214

Question 50

Which lab value should be monitored in an older adult taking an SSRI? a. Sodium b. Potassium c. BUN d. PT/INR

Answer 50

Answer: A - Sodium pg. 220

Question 51

Which symptoms would you monitor for in a newborn whose mother was taking Fluoxetine in the third trimester? a. Poor feeding b. Irritability and abnormal crying c. Excessive sedation d. Poor tone

Answer 51

Answer: B. Irritability and abnormal crying Pg. 218

Question 52

Which antidepressant is the preferred drug for a breastfeeding mother? a. Amitriptyline b. Sertraline c. Bupropion d. MAOI

Answer 52

Answer: B-Sertraline pg. 219

Question 53

Which class of antidepressants does not exhibit anticholinergic side effects? a. SSRI b. SNRI c. TCA d. MAOI

Answer 53

Answer: B -SNRI pg. 221

Question 54

Question: What uses is ondansetron approved for (select all that apply) A) pregnancy B) chemotherapy induced nausea and vomiting C) radiotherapy D) viral gastritis

Answer 54

Answer: B and C A and D are off label Reasoning: Ondansetron is approved for CINV, radiotherapy, and anesthesia. A and D are off label

Question 55

Question: Out of all of the Nonspecific Drugs for Irritable Bowel Syndrome, which one has good evidence that it relieves symptoms? A) Antispasmodics (hyoscyamine and dicyclomine) B) Bulk Forming Agents (psyllium and polycarbophil) C) Antidiarrheal (loperamide) D) Tricyclic Antidepressants

Answer 55

Answer: D- Tricyclic Antidepressants Reasoning: Antispasmotics - not enough evidence Bulk Forming Agents and Antidiarrheal – no better that placebo at relieving IBS symptoms Tricyclic Antidepressants – good evidence that they are effective (p. 611)

Question 56

Question: There is a Black Box Warning that which of the following are contraindications to taking Alosetron (select all that apply) A) Crohn’s or ulcerative colitis B) diverticulitis C) chronic constipation D) women

Answer 56

Answer: A, B, C Reasoning: D – Alostetron is approved ONLY for women with severe IBS- D that has lasted more than 6 months and has not responded to conventional treatment. The other answers are in the black box warning ( p 612)

Question 57

When giving a child promethazine for post-op nausea and vomiting, what adverse effects would you pay special attention to? (select all that apply) A) seizure activity B) diarrhea C) respiratory depression D) local tissue injury at site of infusion

Answer 57

Answer: C and D Reasoning: BLACK BOX WARNING: respiratory depression can be severe and is contraindicated in children under 2 and should be used with caution in children above that age. Local tissue injury is also an adverse effect

Question 58

A patient is about to go on a road trip and has a history of motion sickness. Would medication would you recommend? A) Scopolamine B) Diphenhydramine C) Loperamide D) Lorazepam

Answer 58

Answer: A-Scopolamine Reasoning: scopolamine is the most effective drug for motion sickness. Diphenhydramine can be taken but is less effective and causes drowsiness. Loperamide is an antidiarrheal. Lorazepam is an antiemetic used for CINV

Question 59

What is the first line drug used for nausea and vomiting in pregnancy? A) ondansetron B) methylprednisone C) Diclectin (combination of doxylamine and B2) D) metoclopramide

Answer 59

Answer: C Reasoning: diclectin is first line, ondansetron or metoclopramide are second line, methylprednisone can be used after 10 weeks as a last resort (p 609)

Question 60

What is Aprepitant’s relationship with CYP enzymes? (select all that apply) A) a substrate for B) inhibitor of C) does not interact D) an inducer of

Answer 60

Answer: A, B, D Reasoning: p606

Question 61

A patient that you are caring for is taking ondansetron for CINV. What type of monitoring would you do on this patient? A) QT level B) electrolytes C) CBC D) none

Answer 61

Answer: A Reasoning: Patients taking ondansetron for an extended amount of time should have QT checked regularly. Baseline data would include QT and electrolytes. (p. 606)

Question 62

``` Question: Which of the following drugs should be avoided while breastfeeding? (select all that apply) A) Metoclopramide B) Dronabinol C) Droperidol D) promethazine ```

Answer 62

Answer: A, B, C Reasoning: A, B, and C should be avoided. Promethazine appears to be safe, but the infant should be monitored for sedation.

Question 63

``` Question: What group of drugs would you most likely prescribe for a patient with mild to moderate symptoms of Crohn’s disease? A) Glucocorticoids B) Thiopurines C) Immunomodulators D) 5-aminosalicylates ```

Answer 63

Answer: D Reasoning: A) Glucocorticoids: used for the induction of remission of crohn’s B) Thiopurines: reserved for those Crohn’s patient that have no responded to traditional therapy C) Immunomodulators: generally considered second-line, but some now think that should be used earlier on D) 5-aminosalicylates: correct answer

Question 64

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? a. “Phenobarbital doses for seizures are non-sedating.” b. “This is a short-acting barbiturate, so sedation wears off quickly.” c. “Tolerance to the sedative effects will develop in a few weeks.” d. “You may actually experience paradoxical effects of euphoria.”

Answer 64

Answer: A - “Phenobarbital doses for seizures are non-sedating.” Rationale: Phenobarbital and mephobarbital are used for seizure disorders and suppress seizures at doses that are non-sedative. Phenobarbital is a long-acting barbiturate. At therapeutic doses, sedative effects do not occur. Paradoxical drug effects are associated with benzodiazepines and in older adults and debilitated patients with barbiturates. (Ch 29)

Question 65

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? a. Flurazepam b. Trazodone [Desyrel] c. Zaleplon [Sonata] d. Zolpidem [Ambien]

Answer 65

Answer: C - Zaleplon [Sonata] Rationale: Zaleplon [Sonata] works well for people who have trouble falling asleep and, because of its short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning. Zolpidem [Ambien] has a longer duration and is a good choice for patients who have difficulty maintaining sleep. Flurazepam has a long duration of action. Trazodone causes daytime grogginess (Ch. 29)

Question 66

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because: a. the alcohol does not interact with the benzodiazepine. b. the benzodiazepine potentiates alcohol withdrawal symptoms. c. the benzodiazepine relieves muscle spasms and spasticity. d. the patient has a cross-dependence to the benzodiazepine.

Answer 66

Answer: D- the patient has a cross-dependence to the benzodiazepine. Rationale: Benzodiazepines are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzodiazepine to suppress withdrawal symptoms. Alcohol and benzodiazepines can potentiate one another. The benzodiazepine does not potentiate withdrawal symptoms (Ch. 29)

Question 67

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? a. “Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia.” b. “Benzodiazepines depress neuronal functions by acting at a single site in the brain.” c. “Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system. ” d. “Benzodiazepines promote sleep through effects on the limbic system.”

Answer 67

Answer: A - “Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia.” Rationale: All beneficial and most adverse effects of benzodiazepines occur from depressant actions in the central nervous system (CNS); the various effects depend on the site of action. Anterograde amnesia is the result of effects in the hippocampus and the cerebral cortex. Benzodiazepines act at multiple sites in the CNS. Muscle relaxant effects are the result of actions on supraspinal motor areas in the CNS. Benzodiazepines promote sleep through effects on cortical areas and on the sleep-wakefulness “clock.” (Ch. 29)

Question 68

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? a. “Benzodiazepines commonly cause residual effects lasting into the day after the dose is given.” b. “The patient is having a paradoxical reaction to this medication.” c. “This patient must have developed a previous tolerance to benzodiazepines.” d. “When this drug is metabolized, the resulting compound has longer-lasting effects.”

Answer 68

Answer: D -“When this drug is metabolized, the resulting compound has longer-lasting effects.” Rationale: Flurazepam has a half-life of 2 to 3 hours; however, its metabolite has a long half-life, so giving the drug results in long-lasting effects. Barbiturates, not benzodiazepines, are commonly associated with residual, or hangover, effects. A paradoxical reaction to a sedative would manifest as insomnia, euphoria, and excitation, not drowsiness. Tolerance means that the patient would need increased amounts of a drug to get the desired effects and would not have prolonged effects of the medication. (Ch. 29)

Question 69

Which of the following is NOT one of the three therapeutic uses of benzodiazepines? a. Anxiety b. Muscle spasms c. Insomnia d. Seizures

Answer 69

Answer: B - Muscle Spasms Rationale: The three main therapeutic uses of benzodiazepines are anxiety, insomnia, and seizures. Only one benzodiazepine is approved for muscle spasms (diazepam).

Question 70

You are treating a patient with complaints of insomnia and anxiety. You know that a benzodiazepines or benzodiazepine-like drug would be contraindicated if they also take: a. PO morphine BID b. Diphenhydramine once daily c. Acetaminophen BID d. Captopril TID

Answer 70

Answer: A - PO Morphine BID Rationale: Benzodiazepines and benzodiazepine-like drugs can cause death if used with other CNS depressants, such as opioids and alcohol. Diphenhydramine would cause the provider to proceed with caution, but the most concern would be related to the PO morphine. (Ch 29 video study guide)

Question 71

A 55-year-old patient presents to your clinic. She states “I don’t have trouble falling asleep, but I can never stay asleep and its really affecting me during the day”. You prescribe her a sedative-hypnotic after attempting to assess the root cause. You prescribe: a. Triazolam (Halcion) b. Zaleplon (Sonata) c. Ramelteon (Rozerem) d. Suvorexant (Belsomra)

Answer 71

Answer: D - Suvorexant (Belsomra) Rationale: Triazolam has a short duration with rapid onset. Zaleplon has a very rapid onset and short duration of action, so it is great at helping people fall asleep but not good at helping them maintain sleep. Ramelteon is approved for treating chronic insomnia characterized by difficulty with sleep onset (has a rapid onset), but not maintaining sleep. Suvorexant approved for treating chronic insomnia characterized by difficulty with sleep onset AND/OR sleep maintenance. (Ch 29 video study guide and Table 29.2 and Table 29.3)

Question 72

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? a. Ask the patient about any alcohol consumption in conjunction with the benzodiazepine. b. Contact the prescriber to request an order for a benzodiazepine with a shorter duration. c. Reassure the patient that this is most likely caused by a paradoxical reaction to the benzodiazepine. d. Tell the patient that this is an example of anterograde amnesia, which is an expected effect of the benzodiazepine.

Answer 72

Answer: A - Ask the patient about any alcohol consumption in conjunction with the benzodiazepine. Rationale: This patient is describing complex sleep-related behavior, which occurs when patients carry out complex behaviors while taking benzodiazepines but have no memory of their actions. These actions can occur with normal doses but are more likely with excessive doses or when benzodiazepines are combined with alcohol or other CNS depressants, so the nurse is correct in evaluating this possibility. The duration of the benzodiazepine does not contribute to this phenomenon. Paradoxical effects of benzodiazepines include insomnia, excitation, euphoria, anxiety, and rage. Anterograde amnesia occurs when patients have impaired recall of events that occur after dosing.

Question 73

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/minute. The nurse will expect to administer which of the following? A. Flumazenil [Romazicon] B. Gastric lavage C. Respiratory support D. Toxicology testing

Answer 73

Answer: C - Resp support Rationale: When benzodiazepines are administered IV, severe effects, including profound hypotension, respiratory arrest, and cardiac arrest, can occur. Respiration should be monitored, and the airway must be managed if necessary. Flumazenil [Romazicon] is a competitive benzodiazepine receptor antagonist and is used to reverse the sedative effects but may not reverse respiratory depression. Gastric lavage would not be effective, because the benzodiazepine has been given IV. Without further indication of the ingestion of other drugs, toxicology testing is not a priority.

Question 74

Newer seizure medications require more frequent monitoring A) True B) False

Answer 74

Answer: False, older antiseizure meds had a very narrow therapeutic index so frequent monitoring was required to prevent toxicity or under dosing

Question 75

Which medication is the best choice for a 33 year old woman with epilepsy interested in having a baby one day but not in the next year? A) Keppra B) Phenytoin C) Valproic Acid D) Carbamazepine

Answer 75

Answer: A - Keppra | Valproic Acid, Carbamazepine, Phenytoin are all teratogenic and contraindicated in pregnancy

Question 76

Which medication is known to be effective for all seizure types? A) Keppra B) Valproic Acid C) Trileptal D) Rifaxamin

Answer 76

Answer: B - Valproic Acid Reasoning: pg 160

Question 77

Valproic Acid is contraindicated in pregnancy due to high risk for: A) Autism, decreased IQ, neural tube defects B) Gestational Diabetes, premature rupture of membranes C) Hyponatremia, hyperkalemia, oliguria D) Bone density loss and osteopenia

Answer 77

Answer: A - Autism, decreased IQ, neural tube defects Reasoning: pg 160

Question 78

These epilepsy medications carry an FDA warning of increased suicidal thoughts and behaviors. Select all that apply A) Topiramate B) Vigabatrin C) Pregabalin D) Lamotrigine

Answer 78

Answer: A, D Reasoning: pg 154

Question 79

A post-stroke patient has developed epilepsy and been prescribed Phenytoin. What education should be given to their caregiver in regards of Phenytoin dose timing? A) Phenytoin should be administered with his PEG tube feeds to prevent nausea B) Phenytoin should be administered 1-2 hours separate from tube feeds C) Phenytoin absorption is not effected by feed timing D) Patient can drink alcohol safely on Phenytoin

Answer 79

Answer: B - Phenytoin should be administered 1-2 hours separate from tube feeds Reasoning: pg 158, administering phenytoin with tube feeds can decrease phenytoin levels and lead to subtherapeutic serum levels

Question 80

Carbamazepine carries a black box warning of Stevens-Johnson Syndrome and toxic epidermal necrolysis. Which ethnicity is most at risk of this adverse skin reaction? A) Ashkenazi Jewish B) Asian C) African D) Hispanic

Answer 80

Answer: B - Asian Reasoning: pg 159, high risk for SJS or TEN reaction is associated with an HLA-B gene variant found predominately in the Asian population. All Asian patients should be screened for the HLA-B 1502 gene variant if prescribed carbamazepine

Question 81

What education should be provided to a patient with a new prescription for Oxcarbazepine? Select all that apply A) Birth Control pills are ineffective when taken concurrently with oxcarbazepine, alternative contraceptive methods must be utilized B) Rash, fever, jaundice, and joint pain should be immediately reported to your provider because these could be signs of a life-threatening reaction C) Severe thirst is a common side effect and should be watched for D) Diuretics can decrease risk of hypernatremia and should be given at the same time as oxcarbazepine

Answer 81

Answer: A & B A) Birth Control pills are ineffective when taken concurrently with oxcarbazepine, alternative contraceptive methods must be utilized B) Rash, fever, jaundice, and joint pain should be immediately reported to your provider because these could be signs of a life-threatening reaction Reasoning: pg 163 Oral contraceptives are not effective with oxcarbazepine because oxcarbazepine induces enzymes to metabolize estrogen and progestin Rash, fever, jaundice, join pain are all signs of a multiorgan hypersensitivity reaction and should be reported, oxcarbazepine should be discontinued if they occur Severe thirst is a sign of hypernatremia, oxcarbazepine puts patients at risk for hyponatremia so diuretics should be used with great caution

Question 82

Which antiepileptic is not a good fit for a patient with history of multidrug dependence? A) Keppra B) Valproic Acid C) Phenobarbital D) Ethosuximide

Answer 82

Answer: C- Phenobarbital Reasoning: pg 161, phenobarbital has a risk of misuse, patients with history of addiction are not good candidates for phenobarbital The other medications carry no risk of abuse

Question 83

Which antiepileptic should not be given to patients with a sulfa allergy? A) Rufinamide B) Vigabatrin C) Tiagabine D) Zonisamide

Answer 83

Answer: D - Zonisamide Reasoning: pg 166, Zonisamide belongs is the same chemical family as sulfa antibiotics but does not have antimicrobial activity

Question 84

What actions occur when taking Benzodiazepines? a. Reduced anxiety b. Sleep promotion and muscle relaxation c. Reduced anxiety and sleep promotion d. Reduced anxiety, sleep promotion, muscle relaxation

Answer 84

Answer: D. - Reduced anxiety, sleep promotion, muscle relaxation pg: 234

Question 85

Benzodiazepine metabolism may be reduced in patients with hepatic impairment. Some Benzodiazepines, however, undergo minimal metabolic alteration. What Benzodiazepines are they? a. Oxazepam, temazepam, lorazepam b. Oxazepam, temazepam c. Lorazepam, Oxazepam d. None of the above

Answer 85

Answer: A - Oxazepam, temazepam, lorazepam pg: 235

Question 86

What are the therapeutic uses of benzodiazepines? a. Anxiety, seizure disorders b. Anxiety, seizure disorders, insomnia c. Anxiety, insomnia d. Insomnia, seizure disorders

Answer 86

Answer: C. Anxiety, insomnia pg: 235

Question 87

Benzodiazepine-like drugs are the preferred agents for insomnia and NOT anxiety. These drugs share the same mechanism of action as benzodiazepines by acting as agonists at the benzodiazepine receptor site on the GABA receptor chloride-channel complex. What drugs are these? a. Romelteon, suvorexant b. Zolpidem, zaleplon, eszopiclone c. Temazepam, Quazepam, triazolam d. Trazodone, doxepin

Answer 87

Answer: B. - Zolpidem, zaleplon, eszopiclone pg: 237

Question 88

Barbiturates have important applications in which of the following? a. Anesthesia, seizure control b. Anxiety, seizure control c. Anesthesia, seizure control, insomnia d. anesthesia, anxiety, seizure control, insomnia

Answer 88

Answer: A - Anesthesia, seizure control pg: 239

Question 89

Which drug can directly mimic GABA? a. Benzodiazepine-like drugs b. Barbiturates c. Hypnotics d. Benzodiazepines

Answer 89

Answer: B. - Barbiturates pg: 239

Question 90

When a patient being treated for insomnia with hypnotic drugs experiences less effects than before, suggesting tolerance to the drug, the provider should… a. Increase the dose and monitor for adverse effects b. Interrupt the therapy allowing tolerance to decline, thereby restoring responsiveness to treatment c. Switch the patient to a barbiturate therapy and monitor the patient closely for adverse effects d. Start the patient on Melatonin

Answer 90

Answer: B. Interrupt the therapy allowing tolerance to decline, thereby restoring responsiveness to treatment pg: 241

Question 91

Doxepin, a strong, tricyclic antidepressant, is approved in low dose formulations for treating patients who have trouble staying asleep. What are the most common adverse effects of this medication when used in low doses for treating insomnia? a. Sedation, nausea, upper respiratory infections b. Headache, visual disturbance, nausea, vomiting, diarrhea c. Sedation, upper respiratory infections d. Hypotension, sedation, nausea

Answer 91

Answer: A. - Sedation, nausea, upper respiratory infections pg: 241

Question 92

Doxepin, a strong, tricyclic antidepressant, is approved in high dose formulations for treating patients with depression. What are the most common adverse effects of this medication when used in high doses for treating depression? a. Tachycardia, hypotension, visual disturbance b. Dysrhythmias, hypertension c. Sedation, headache, nausea d. Hypotension, dysrhythmias, anticholinergic effects

Answer 92

Answer: D. Hypotension, dysrhythmias, anticholinergic effects pg: 241

Question 93

Typically, benzodiazepines cause low physical dependency. However, one type of benzodiazepine, Alprazolam (Xanax, Xanax XR, Niravam), may create a greater dependency and benzodiazepine withdrawal syndrome may resemble an anxiety disorder. Because of this, doses should be tapered, and patients should be monitored for ______weeks for indication of withdrawal or recurrence of original symptoms. a. 2 b. 3 c. 4 d. 6

Answer 93

Answer: B. - 3 weeks pg: 237

Question 94

What are the uses for Valproic Acid? Select all that apply ``` A. Simple partial B. Complex partial C. Tonic clonic D. Absence E. Myoclonic ```

Answer 94

A, B,C,D,E The answer all of the above Valproic acid can be used to treat all types of seizures. P.160

Question 95

True or false Valproic has a black box warning for … • Fetal hepatic failure in young patient and patients with mitochondrial disease are at increased risk • Fatal and rapidly progressing pancreatitis has occurred common symptoms include nausea, vomiting, anorexia, and abdominal pain • Valproate is highly teratogenic. Neonates who survive may have major congenital malformations and decrease mental capacity

Answer 95

True there is a black box warning for Valproic acid pg. 160

Question 96

What group of patients is at high risk for taking Valproic acid? Select all that apply A. Children less than 2 years B. Patients with a preexisting liver disease C. Pregnant patients D. Patients with kidney disease

Answer 96

Answer A, B, & C pg. 160

Question 97

Which medications are on the Beer’s list for seizures medications? Select all that apply. A. Carbamazepine B. Oxcarbazepine C. Phenobarbital D. Valproic acid

Answer 97

Answer A, B, & C. PG.161

Question 98

What is Ethosuximide used for? A. Partial seizures B. Complex seizures C. Absence seizures D. All of the above

Answer 98

Answer C only for absence seizures pg.161

Question 99

What is the indication for phenobarbital? A. Partial & generalized tonic clonic seizures B. Only partial seizures C. All types of seizures D. Absence seizures

Answer 99

The answer is A phenobarbital is effective against both partial and generalized tonic clonic seizures. Pg.161

Question 100

What drugs should be avoided with phenobarbital? Select all that apply ``` A. Primidone B. Valproic acid C. Alcohol D. Benzodiazepines E. Opioids ```

Answer 100

Answer is all of the above A, B,C,D & E pg. 162

Question 101

Which of the following should be including in the patient education for antiseizure medications? Select all that apply A. It takes time to find the optimal dose B. Importance of taking anti seizures medications exactly as prescribed, a small deviation can cause either toxic or subtherapeutic levels C. It is ok to abruptly stop antiseizures medications since you don’t have seizures anymore. D. It is not importance to draw drug serum levels on medications E. It is best practice to keep a log of seizures activity and take to primary care provider to evaluate and adjust dosing accordingly F. There is no risk of suicide for patients on antiseizures medication that is only for patients on antidepressants G. To reduce risk for neural tube defects, advise women to take folic acid before and throughout pregnancy.

Answer 101

Answer A,B,E,& g P. 162 C is incorrect because you should NEVER ABRUPTLY STOP and antiseizure medications. D is incorrect because it is important to follow up in serum drug levels to ensure adequate levels F is incorrect because there is some risk of INCREASED SUICIDE WITH ANTISEUIZURE MEDICATIONS

Question 102

True of false Oxcarbazepine can be used for both monotherapy and adjunctive therapy for management of partial seizures.

Answer 102

True pg. 163 It is approved for monotherapy in children greater than 4 years old and adults & Adjunctive therapy for children less than 2 years pg. 163

Question 103

11. What are the uses of Lamotrigine (Lamictal)? Select all that apply A. Adjunctive therapy for partial seizures in adults and children older than 2 years B. Adjunctive therapy for generalized seizures associated with Lennox -Gastaut Syndrome C. Adjunctive therapy of primary generalized tonic clonic seizures in adults and children older than 2 years D. Monotherapy of partial seizures in a patient at least 16 years who is converting from another antiseizure medications.

Answer 103

All of the above is correct pg. 163

Question 104

True of false? Lamotrigine has a black box warning for serous skin reactions such as SJS and TENS. Fatalities have been reported.

Answer 104

True pg. 164

Question 105

What are the FDA approve uses for gabapentin? Select all that apply? A. Partial seizures (adjunctive therapy) B. Partial seizure monotherapy C. Post herpetic neuralgia D. Diabetic neuropathy

Answer 105

Answer is A and C B is approved for monotherapy of partial seizures according to ANN/AES guidelines but not FDA D is off label use pg.164

Question 106

What are the approved uses for Levetiracetam (Keppra)? Select all that apply A. Adjunctive therapy of myoclonic seizures in adults and adolescents 12 years and older B. Adjunctive therapy of partial seizures in adults and children 4 years and older C. Monotherapy of generalized tonic clonic seizures in adults and children 6 years and older. D. All of the above

Answer 106

A & b are correct. Keppra is NOT approved for monotherapy only ADJUNCTIVE THERAPY pg. 165

Question 107

True or false • Topiramate is FDA approved for adjunctive treatment with adults and children 2 years and older with partial seizures, primary generalized tonic clonic seizures and seizures associated with Lennox gastaut syndrome • Monotherapy of adults and children 10 years and older with partial seizures or primary generalized tonic clonic seizures • Prophylaxis of migraine

Answer 107

True pg. 165 Black box warning pg. 167

Question 108

True of or false? Felbamate (Felbatol) has been associated with Increased risk for aplastic anemia associated with fatality rates the have been estimated by 20-30% however, rates up to 70 % have been attributed to this drug. Felbamate may cause liver failure through uncommon, 67% of reported cases were either fatal or required a liver transplant.

Answer 108

This is true and was stressed in the Audio lecture by Dr. Mello

Question 109

A patient with a new onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative effects of this drug. Which response by the nurse is correct? a. phenobarbital doses for seizures are non-sedating b. this is a short acting barbiturate, so sedation wears off quickly c. tolerance to the sedative effects will develop in a few weeks d. you may actually experience paradoxical effects of euphoria

Answer 109

Answer A- Phenobarbital is used for seizures at doses that are non-sedative. Phenobarbital is long- acting. At therapeutic doses, sedative effects do not occur. Paradoxical drug effects are associated with benzodiazepines and in older adults and debilitated patients with barbiturates

Question 110

A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the APRN that their job demands require staying up late and then getting up early for meetings. The APRN will plan to prescribe which medication? a. Flurazepam b. Trazodone (Desyrel) c. Zaleplon (Sonata) d. Zolpidem (Ambien)

Answer 110

Answer C- Zaleplon. Zaleplon works well for people who have trouble falling asleep and because it is short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning. Ambien has a longer duration and better choice for patients who have difficulty maintaining sleep. FLurazepam has a long duration of action. Trazadone causes daytime grogginess

Question 111

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The APRN understands that this drug is effective because: a. the alcohol does not interact with the benzodiazepine b. the benzodiazepine potentiates alcohol withdrawal symptoms c. the benzodiazepine relieves muscle spasms and spasticity d. the patient has a cross-dependence to the benzodiazepine

Answer 111

Answer D- Benzos are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzos to suppress withdrawal symptoms. Alcohol and benzos can potentiate one another.

Question 112

A patient has been using secobarbital for several months to treat insomnia. The APRN tells the patient that the prescription will be changed to temazepam because it is safer. The patient asks why this agent is safer. The APRN is correct in telling the patient that temazepam: a. does not depress the central nervous system b. shows no respiratory depression, even in toxic doses c. mimics the actions of a central nervous system inhibitory neurotransmitter d. potentiates endogenous gamma- aminobutyric acid (GABA) producing a finite CNS depression

Answer 112

Answer- D- Benzos potentiate the actions of GABA and because the amount of GABA in the CNS is finite, these drugs depressive effect on the CNS is limited

Question 113

A hospitalized patient who is given one dose of fluazepam 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 APRN is correct? a. Benzodiazepines commonly cause residual effects lasting into the day after the dose is given b. the patient is having a paradoxical reaction to this medication c. this patient must have developed a previous tolerance to benzodiazepines d. when this drug is metabolized, the resulting compound has longer-lasting effects

Answer 113

Answer- D. Flurazepam has a half life of 2-3 hours, however, its metabolite has a long half life so giving the drug results in long lasting effects

Question 114

A patient takes temazepam 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 APRN do? a. ask the patient about any alcohol consumption in conjunction with the benzos b. Contact the prescriber and request an order for benzo with a shorter duration c. reassure the patient that this is most likely caused by a paradoxical reaction to the benzo d. tell the patient that this is an example of anterograde amnesia which is an expected effect of benzos.

Answer 114

Answer- A- This patient is describing complex sleep- related behavior, which occurs when patients carry out complex behaviors while takin benzos but have no memory of their actions. These actions can occur with normal doses by are more likely with excessive doses or when benzos are combined with alcohol or other CNS depressants.

Question 115

An APRN is discussing the use of benzodiazepines as sedative- hypnotic agent with a group of nursing students. A student asks about the actions of these drugs in the CNS. The nurse makes which correct statement? a. benzodiazepines affect the hippocampus and cerebral cortex to cause anterograde amnesia b. benzodiazepines depress neuronal functions by acting at a single site in the brain c. benzodiazepines induce muscle relaxation by acting on sites outside the CNS d. benzodiazepines promote sleep through effects on the limbic system

Answer 115

Answer- A- all beneficial and most adverse effects of benzos occur from depressant actions in the CNS; the various effects depend on the site of action

Question 116

A paradoxical reaction to a sedative would manifest as... (select all that apply) a. insomnia b. euphoria c. excitation d. drowsiness

Answer 116

Answer- A, B, C- chapter 29 video

Question 117

Although usually well tolerated Ramelteon (Rozerem) which activated receptors for melatonin side effects such as.... (select all that apply) have been seen a. hallucinations b. angio edema c. amenorrhea d. fertility problems

Answer 117

Answer- A,B,C,D- chapter 29 video

Question 118

To minimize drug- dependency insomnia the APRN should. a. prescribe high dose for the shortest time to produce the fastest results b. prescribe the lowest effective dosage for shortest time c. prescribe the lowest effective dosage for a long period of time d. prescribe the dosage the patient always requests.

Answer 118

Answer- B- prescribe the lowest effective dosage for shortest time chapter 29 video

Question 119

A 32-year old female comes into the office stating that her anxiety is increasingly getting worse. She is diagnosed with Generalized Anxiety Disorder (GAD). She has no significant past medical history. What would you expect the prescriber to prescribe? A. Paroxetine (Paxil) B. Propranolol C. Tell the patient it will get better D. Ativan

Answer 119

Answer: A. - Paroxetine (Paxil) First line treatment for GAD is an SSRI or SNRI. Second line treatment would be a benzodiazepine.

Question 120

A patient has an important Pharmacology exam coming up. She continues to become more nervous before the test. It is determined that she has test anxiety. What medication would be helpful for this patient to help her through her tests? A. Alcohol B. Zoloft C. Propranolol D. Protonix

Answer 120

Answer: C. - Propranolol Propranolol is prescribed to help with performance anxiety. When taken 1 to 2 hours before a scheduled performance or test, beta blockers can reduce symptoms caused by autonomic hyperactivity.

Question 121

A patient who has been taking Valium to treat an anxiety disorder 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? A. Notify the Provider that the patient is having an anxiety attack B. Instruct the patient to resume taking Valium C. Give the patient 0.5 mg PO Ativan D. Ask the patient if the medication was stopped abruptly

Answer 121

Answer: D. - Ask the patient if the medication was stopped abruptly Long term use of benzodiazepines carries a risk for physical dependence. Patients can withdraw.

Question 122

A patient presents to the ED with the fear of dying, sweating, palpitations, chest pain, nausea, and states that she feels dizzy. She is currently having a panic attack. She states that she frequently has them and does not know why – they just happen. What would you anticipate the prescriber giving to this patient? A. SSRI and encourage her to go to Cognitive Behavioral Therapy B. Benzodiazepine C. SSRI D. BuSpar

Answer 122

Answer: A. -SSRI and encourage her to go to Cognitive Behavioral Therapy Combining drug therapy with CBT is more effective than either modality alone. SSRIs are the first line drugs for panic disorder

Question 123

5. Which medication order would you question for an anxious patient? A. A patient who suffers from IBS being prescribed Zoloft B. Propranolol for performance anxiety C. BuSpar for an alcoholic patient D. Paxil for social anxiety disorder

Answer 123

Answer: A. A patient who suffers from IBS being prescribed Zoloft A side effect of Zoloft is diarrhea – therefore it would be problematic if the patient received Zoloft.

Question 124

Selective serotonin reuptake inhibitors are known to be effective for which disorders? Select all that apply. ``` A. Social Anxiety Disorder B. PTSD C. Panic Disorder D. GAD E. OCD ```

Answer 124

Answer: A, C, D, E

Question 125

A patient is receiving a drug and is prescribed it for an off-label use. What should the patient be educated on? A. Do not tell the patient that the drug is being used off label B. Give them the insert to the medication C. Be upfront and tell the patient that the medication prescribed is being used for an off-label purpose D. Print off educational pamphlets

Answer 125

Answer: C. -Be upfront and tell the patient that the medication prescribed is being used for an off-label purpose The patient has the right and needs to know that the medication prescribed is being used for an off-label purpose.

Question 126

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. A. Benzodiazepines have a short half-life B. Physical dependence is not a risk when taking benzodiazepines C. Benzodiazepines are known to cure generalized anxiety D. Benzodiazepines have a rapid onset of action.

Answer 126

Answer: D - Benzodiazepines have a rapid onset of action.

Question 127

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? A. PTSD B. OCD C. GAD D. Panic Disorder

Answer 127

Answer: C.

Question 128

10. When withdrawing from an SSRI – how does the prescriber recommend withdrawing? A. Just abruptly quit taking it B. Over 24 months C. Reducing the dosage by 25% every 1 to 2 months D. Once you start taking an SSRI – you can never stop taking it

Answer 128

Answer: C. Reducing the dosage by 25% every 1 to 2 months page 246

Question 129

A patient on medication recovering from alcoholism reports feeling nauseous, blurred vision, heart palpitations, and hypotensive. Which of the following would be of greatest concern and warrants immediate attention? A) withdrawal syndrome B) acetaldehyde syndrome C) physical dependence D) psychological dependence

Answer 129

Answer: B- acetaldehyde syndrome pg. 266. Severe manifestations of acetaldehyde syndrome can be fatal when consuming alcohol while taking Disulfiram

Question 130

A provider emergently calls in a prescription for a controlled substance. Which of the following is an approved regulation for prescribing controlled substances in an emergency? A) electronic order of a scheduled I medication, followed by a 24-hour written prescription B) electronic prescription of a scheduled II medication, followed by a 48-hour written prescription C) oral prescription of a scheduled II medication, followed by a 72-hour written prescription D) oral prescription of a scheduled II medication, followed by a 48-hour written prescription

Answer 130

Answer: C- oral prescription of a scheduled II medication, followed by a 72-hour written prescription pg. 258

Question 131

The metabolism of alcohol between men and women differs by- A) decreased metabolism in men due to increase BMI B) decreased metabolism in women due to water percentage in body C) increased metabolism in women due to low gastric activity D) increased metabolism in men due to high gastric activity

Answer 131

Answer: D- increased metabolism in men due to high gastric activity pg. 262, women have a lower activity of alcohol dehydrogenase in the stomach leading to higher alcohol levels than men who consume the same amount of alcohol due to decreased metabolism; therefore, men metabolize alcohol faster

Question 132

A patient who consumes alcohol daily reports taking NSAIDs for bad headaches. Which of the following interactions would occur with this combination? A) gastric bleeding B) liver injury C) hypertension D) pancreatitis

Answer 132

Answer: A- gastric bleeding pg. 263

Question 133

``` A patient has completed detoxication of alcohol and is ready to maintain abstinence but is worried he might ‘slip’ and have another drink again. Which of the following medication would be best for this patient? A) Propranolol B) Naltrexone C) Acamprosate D) Disulfiram ```

Answer 133

Answer: B- Naltrexone pg. 265-266. Propranolol a beta blocker is not approved in the US and Acamprosate is not very effective as monotherapy. Disulfiram should only be administered to a patient with confident compliance on the medication or else will experience an adverse reaction if alcohol is consumed.

Question 134

.A patient has a lifelong history of chronic consumption of alcohol. For pain management in this patient, which of the following must you consider ensuring proper pain control? A) cross tolerance B) cross dependence C) physical tolerance D) physical dependence

Answer 134

Answer: A- cross tolerance pg. 262. “Chronic consumption of alcohol produces tolerance…tolerance to alcohol confers cross-tolerance to general anesthesia, barbiturates, and other CNS depressants.”

Question 135

When teaching a patient about Disulfiram. Which of the following statements by the patient demonstrates a need for further education? A) “I will wait 12 hours after my last alcohol beverage to take the medication.” B) “It is okay to take my medication with orange juice.” C) “I can use shaving cream instead of soap to shave my face.” D) “I will notify my provider if I feel I cannot continue abstinence from alcohol.”

Answer 135

Answer: C- “I can use shaving cream instead of soap to shave my face.” pg. 266 PATIENT EDUCATION box

Question 136

A patient subjectively feels an intense need for a drug in order to properly function. This is called- A) psychological tolerance B) substance use disorder C) physical dependence D) psychological dependence

Answer 136

Answer: D- psychological dependence pg. 256

Question 137

Which of the following is not a pharmacological effect of alcohol on the body? A) sleep disruption B) increase fasting levels of glucose and insulin C) respiration depression D) diuresis

Answer 137

Answer: B- increase fasting levels of glucose and insulin pg. 261. Alcohol decreases fasting levels of glucose and insulin

Question 138

In a patient withdrawing from alcohol, which of the following class of medications is effective as a monotherapy in reducing withdrawal symptoms in order to carry out daily activities? A) Antiepileptics B) Benzodiazepines C) Barbiturates D) Beta blockers

Answer 138

Answer: pg. 265 B- Benzodiazepine are the most effective in facilitating alcohol withdrawal and provide the greatest protection against breakthrough withdrawal symptoms. Antiepileptics, alpha2 antagonist, and beta blockers are not very effective as monotherapy.

Question 139

What is NOT a benefit of Metamucil? a) Achieves BM within 6 hours b) Stool softener c) Prebiotic d) Encourages growth of colonic bacteria

Answer 139

Answer: A - Achieves BM within 6 hours Rationale: Benefits of bulk forming laxatives are prebiotic effects, softens stool, increases fecal volume leads to growth of colonic bacteria (normal flora). Produces stool in 1-3 days. (P 600 7th edition and video lecture slide 4)

Question 140

Which of the following is a fact of Lactulose? a) Increases ammonia in patients with portal hypertension b) Osmotic laxative c) Produces stool in 24 hours d) causes less side effects than other laxatives

Answer 140

Answer: B - Osmotic laxative Rationale: Decreases ammonia in patients with portal HTN, produces stool in 1-3 days, causes more unpleasant side effects ( flatulence and cramping) (P 602)

Question 141

Which laxative has the highest risk of abuse? a) Surfactant b) Osmotic c) Bulk Forming d) Stimulants

Answer 141

Answer: D - Stimulants Rationale: P 601 7th ed " Stimulant laxatives are widely used-and abused- by the general public and are of concern for this reason."

Question 142

A 65 yr old man is scheduled to have a colonoscopy. What is NOT a drug used to prep for a colonoscopy? a) Polyethylene glycol plus electrolytes b) Sodium phosphate c) magnesium oxide/anhydrous citric acid/sodium picosulfate (Prepopik) d) Docusate sodium

Answer 142

Answer: D - Docusate sodium Rationale: all others are used for bowel cleansing for colonoscopy ( Table 65.5 p603)

Question 143

Which class of drug is the most effective for chemotherapy induced nausea and vomiting (CINV)? a) Glucocorticoids b) P/Neurokinin-1 Antagonists c) Serotonin Receptor Antagonists d) Dopamine antagonists

Answer 143

Answer: C - Serotonin Receptor Antagonists Rationale: "Serotonin Receptor antagonists are the most effective drug for suppressing nausea and vomiting caused by cisplatin and other highly emetogenic anti cancer drugs" (P 505 7th ed)

Question 144

What is the mechanism of action of Diphenoxlate plus atropine (Lomotil) a) increases intestinal flora b) acts as an adsorbent in the intestine c) decreases intestinal motility d) causes stool to bulk in colon

Answer 144

Answer: C - decreases intestinal motility Rationale: p 610 7th ed " these drugs decrease intestinal motility and thus slow down intestinal transit..."

Question 145

Which antidiarrheal is contra indicated in children? a) Bismuth subsalicylates to prevent Reyes Syndrome b) Vancomycin to prevent Red Mans Syndrome c) Tetracycline to prevent teeth discoloration d) Valaporate to prevent hepatoxicity

Answer 145

Answer: A - Bismuth subsalicylates to prevent Reyes Syndrome Rationale: Video lecture slide 41

Question 146

Antihistamines are used for anti-nausea in addition to all except: a) Nonproductive cough b) Allergy Symptoms c) Motion Sickness d) Asthma

Answer 146

Answer: D Asthma Rationale: Video Lecture slide 49

Question 147

Which is not a cause of chronic diarrhea? a) infection b) Diabetes mellitus c) IBS d) Tumors

Answer 147

Answer: A - infection Rationale: Video Lecture slide 24

Question 148

30 y/o male has completed course of Augmentin for an ear infection. He developed watery diarrhea 7x per day. How would you treat? a) Lomotil b) Pepto Diarhea c) Imodium d) Treat with Vancomycin

Answer 148

Answer: D - Treat with Vancomycin Rationale: Antibiotic induced diarrhea is not treated with antidiarrheal due to assumed C.Diff infection. C.Diff is treated with vancomycin.p 611 7th ed

Question 149

In management of anxiety disorders, the APRN knows that: A) A combination of psychotherapy and drug therapy is more effective than either modality alone B) Serotonergic reuptake inhibitors (SSRI’s) and benzodiazepines should be avoided in anxiety disorders C) Of all anxiety disorders, generalized anxiety disorder (GAD) is least likely to remit D) Mild symptoms of anxiety will need a lower dose of an antianxiety medication than a more complicated form of anxiety disorder.

Answer 149

Answer: A - A combination of psychotherapy and drug therapy is more effective than either modality alone Reasoning: Psychotherapy as well as drug treatment is more effective at treating anxiety disorders than either therapy alone. SSRI’s and benzodiazepines are drugs used to treat anxiety and GAD is most likely to remit. Mild anxiety symptoms often do not require drug therapy, as psychotherapy will suffice. (Chapter 30, page 243 and Dr. Mello’s voice thread over chapter 30)

Question 150

In treating anxiety disorders, benzodiazepines: A) are first line treatment as they immediately stabilize the patient during an anxiety attack B) are second line treatment as they are used for immediate stabilization or during hospitalization C) are preferred over nonbenzodiazepine/nonbarbiturate medications as relief is rapid D) are not likely to cause dependence and are preferred to treat anxiety disorders

Answer 150

Answer: B - are second line treatment as they are used for immediate stabilization or during hospitalization Reasoning: Since benzodiazepines are rapid-acting drugs, they are preferred for an acute anxiety attack by enhancing responses to GABA, an inhibitory transmitter in the brain. First line treatment for anxiety are SSRI’s, SSRNI’s and Buspar. They are not preferred over nonbenzodiazepine/nonbarbiturate medications (Buspar) and are more likely to cause dependence than the other drug classes. (Chapter 30, pages 243-244, Dr. Mello’s voice thread over Chapter 30)

Question 151

For treatment of anxiety, buspirone (Buspar): (select all that apply) A) is not a CNS depressant B) is as effective as the benzodiazepines C) should not be taken with grapefruit juice or erythromycin D) does not exhibit withdrawal symptoms if discontinued abruptly

Answer 151

Answer: A B C D Reasoning: All of the above are true regarding Buspar (Chapter 30, pg 244 and Dr. Mello’s voice thread on Chapter 30)

Question 152

When teaching a patient regarding a new medication prescribed for panic disorder, the APRN will teach the patient: A) To drink several cups of caffeinated beverages to provide a synergistic effect of the medication B) The medication will be needed for at least 3 months, then can discontinue the drug to assess the response to drug therapy C) The medication will take a full 6-12 weeks to develop full benefit D) Usually cognitive behavior therapy (CBT) is not useful when drugs are employed.

Answer 152

Answer: C - The medication will take a full 6-12 weeks to develop full benefit Reasoning: Antidepressants are very useful in treating Panic Disorder (PD), but take a full 6-12 weeks to develop full benefit. Combining CBT with drug therapy is more effective than either modality alone, and drug treatment should continue at least 6-9 months. Stopping sooner results in a high rate of relapse. Additional benefits of medication therapy can be increased if caffeine is avoided (as well as sleep deprivation and sympathomimetics).

Question 153

Optimal treatment of obsessive compulsive disorder (OCD) requires: A) Lifelong treatment B) At least two different medications to control both compulsions and repetitive behaviors C) Continued drug therapy for at least 6 months before weaning off slowly D) Combined behavioral and drug therapy

Answer 153

Answer: D - Combined behavioral and drug therapy Reasoning: OCD is the hardest of the anxiety disorders to treat and requires both behavioral therapy as well as drug therapy. A patient with OCD might require lifelong treatment, but is not the “most correct” answer. Treatment of the initial episode should be at least a year long before withdrawing the drug slowly- by 25% every 1-2 months. Using at least two medications is not mentioned in the book. (Chapter 30, page 246 as well as Dr. Mello’s voice thread on Ch. 30)

Question 154

Beta blockers can: A) be prescribed as an off label use for performance anxiety B) can increase autonomic hyperactivity C) cause a panic attack if not given in the correct dosage D) increase anxiety caused by social situations

Answer 154

Answer: A - be prescribed as an off label use for performance anxiety Reasoning: Beta blockers can be effective in reducing autonomic hyperactivity related to performance anxiety (tachycardia, tremors, sweating, and palpitations), and decreases anxiety caused by this. Beta blockers do not cause panic attacks. (Chapter 30, pg. 246 and Dr. Mello’s voice thread on Ch. 30)

Question 155

Central nervous system (CNS) stimulants have which two principal indications? A) Depression and anxiety B) ADHD and narcolepsy C) ADHD and OCD D) Depression and Social Anxiety Disorder

Answer 155

Answer: B - ADHD and narcolepsy Reasoning: CNS stimulants have limited clinical applications other than treatment of ADHD and narcolepsy. Depression, anxiety and social anxiety disorder are usually treated with antidepressants. (Chapter 31, page 248)

Question 156

Children are usually diagnosed with ADHD between the ages of 3-7. Stimulants are generally well tolerated in this population, but non-stimulants can cause adverse effects. Most concerning is: A) Suicidal thoughts B) Urinary retention C) Physical growth delay D) Steven-Johnson syndrome (SJS)

Answer 156

Answer: A - Suicidal Thoughts Reasoning: In the pediatric population, non-stimulant drugs for ADHD (such as atomoxetine) can cause suicidal thoughts. This generally does not happen in the adult population. Urinary retention is a side effect seen in adults, delayed growth can be “caught up” and SJS has not been associated with non-stimulant drugs for ADHD. (Chapter 31, pg 252)

Question 157

When prescribing methylphenidate (Ritalin) and dexmethylphenidate (Focalin) it is important to note that: (select all that apply) A) the pharmacology of both drugs is nearly identical to that of the amphetamines B) chronic abuse of methylphenidate (Ritalin) can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior and possible frank psychotic episodes C) both drugs promote norepinephrine (NE) and dopamine (DA) release and inhibit NE and DA reuptake D) Methylxanthines can be considered a methylphenidate

Answer 157

Answer: A, B, C Reasoning: All are true regarding methylphenidate and dexmethylphenidate. (Ch. 31, page 249) Methylxanthines are not like Ritalin and Focalin—Caffeine is the most common methylxanthine.

Question 158

Which of the following is true regarding adult ADHD: (select all that apply) A) Combining behavioral therapy with drug therapy may be more effective than drug therapy alone B) CNS stimulants are the foundation of adult ADHD treatment C) Some adults cannot tolerate the side effects of stimulant drugs, so non-stimulant drugs can be a viable option for treatment D) non-stimulant drugs such as atomoxetine (Strattera) do not cause suicidal thoughts in adults

Answer 158

Answer: A, B, C, D Reasoning: All are true regarding treatment of adult ADHD (Chapter 31, pgs. 251-253)

Question 159

Your patient is being seen in the office for treatment of atypical depression. Which type of drug would be your first treatment of choice? A. SSRI B. SNRI C. TCA D. MAOI

Answer 159

Answer: D- MAOI (pg 223) The only time MAOIs are the treatment of choice is for treatment of atypical depression.

Question 160

MAOIs are contraindicated to prescribe with which drugs? (Select all that apply) A. SSRIs B. SNRIs C. TCAs D. Antihypertensives

Answer 160

Answer: A,B,C,D- (pg 225) MAOIs can interact with many drugs. If taken with SSRIs and SNRIs the patient can develop serotonin syndrome, which usually develops 2-72 hours after initial treatment. When taken with TCAs, it can cause the patient to develop hypertensive episodes or hypertensive crisis caused by excessive adrenergic stimulation of the heart and blood vessels. If taken with antihypertensive medication, excessive lowering of blood pressure may occur.

Question 161

You are prescribing an MAOI to treat a patient with atypical depression, what would you include in your patient teaching? A. MAOIs can cause Hyperglycemia B. To avoid foods that contain tyramine C. The prescription should be taken at night due to the sedative effects D. MAOIs are the safest choice of drug to treat any type of depression

Answer 161

Answer: B (p 223) - To avoid foods that contain tyramine Although MAOIs can cause hypotension, they can cause hypertensive crisis if the patient eats food that is rich in tyramine, a substance that promotes the release of NE from sympathetic neurons. MAOIs do not effect blood sugars, they cause insomnia not sedative effects, and MAOIs are only first line treatment of choice for atypical depression.

Question 162

Your educating your patient about MAOIs and avoiding foods that contain tyramine, which food would you tell your patient to avoid? (Select all that Apply) A. Avocados B. Milk C. Figs D. Fresh Fish

Answer 162

Answer: A,C - Avocados and Figs (Table 27.5, p225)

Question 163

MAOIs can be prescribed even if the patient A. Is taking an SSRI B. Is taking Digoxin for heart failure C. Is on Insulin for diabetes D. Is taking Lisinopril for hypertension

Answer 163

Answer: C (p225) MAOIs are contraindicated in patients taking SSRIs, with heart failure, and hypertension.

Question 164

Tricyclic antidepressants and all other antidepressants can increase the risk for suicide, especially in the early phase of treatment. Which group of patients is at highest risk? A. Children/Adolescence B. Pregnant Women C. Breastfeeding Women D. Older Adults

Answer 164

Answer: A Children/Adolescence | p222, Black Box Warning

Question 165

Which type of neurotransmitters are effected by MAOIs? A. 5-HT only B. 5-HT, NE, DA C. NE and 5-HT D. NE

Answer 165

Answer: B - 5-HT, NE, DA | (p221, Table 27.4)

Question 166

Which of the following is true about Bupropion (Wellbutrin)? Select all that Apply A. It can cause weight gain B. It can improve sexual dysfunction C. It can cause sexual dysfunction D. It can cause seizures

Answer 166

Answer: B,D (p226) Bupropion does not cause weight gain and has been used to improve sexual dysfunction. Seizures are the side effect of greatest concern.

Question 167

``` Your patient is prescribed Bupropion (Wellbutrin), which side effect is the greatest concern? A. Hypertensive Crisis B. Weight Gain C. Seizures D. Sexual Dysfunction ```

Answer 167

Answer: C (p226) Seizures are the side effect of greatest concern at a dose greater than 450mg/day. Bupropion does not cause hypertensive crisis, weight gain, or sexual dysfunction

Question 168

Your patient presents to your clinic for treatment of peripartum depression. She has a history of depression and is currently breastfeeding. Which drug would be your first choice of drug to prescribe? A. SSRI B. Whatever antidepressant the patient has responded to before C. Fluoxetine D. TCA

Answer 168

Answer: B (p227) SSRIs are typically a first choice in a patient with no history of depression. TCAs can be prescribed and appear to be safe with breastfeeding, however the first choice of drug should be whatever antidepressant the patient responded to before. Fluoxetine appears to be unsafe with breastfeeding.

Question 169

Select all that apply: Which of the following are criteria for use of laxatives in infants and children? A. three consistent months of two or fewer defacations per week B. painful or hard bowel movements for two weeks C. one episode per week of incontinence for 6 weeks D. history of excessive stool retention

Answer 169

Answers: A, C, D (pg 599)

Question 170

Which of the following is a contraindication for laxative use? A. concomitant use with anthelmintic therapy B. appendicitis C. episiotomy with hemorrhoids D. CV aneurysm

Answer 170

Answer: B - Appendicitis | (pg 599)

Question 171

``` Which of the following is considered a stimulant laxative? A. Senna B. Docusate sodium C. Psyllium D. Polyethylene glycol ```

Answer 171

Answer: A - Senna | pg 601

Question 172

What kind of stool do bulk laxatives produce? A. semifluid stool in 6-12 hours B. watery stool in 2-6 hours C. watery stool in 1-3 days D. soft stool in 1-3 days

Answer 172

Answer: D - soft stool in 1-3 days | table 65.3

Question 173

Select all that apply: Which drugs are not recommended for use in children? A. Bisacodyl B. Lubiprostone C. Plecanatide D. Lactulose

Answer 173

Answers: B, C (table 65.4)

Question 174

What is the mechanism of action for surfactant laxatives? A. similar to that of dietary fiber B. lowering surface tension, which allows for penetration of water into fever C. stimulating intestinal motility D. drawing water into the intestinal lumen

Answer 174

Answer: B - lowering surface tension, which allows for penetration of water into fever (pg 600)

Question 175

Which of the following is considered an osmotic laxative? A. Magnesium citrate B. Methylcellulose C. Docusate sodium D. Plecanatide

Answer 175

Answer: A - Magnesium citrate | table 65.2

Question 176

Which of the following drugs has similar effects on stool as dietary fiber? A. Senna B. Castor oil C. Polycarbophil D. Lactulose

Answer 176

Answer: C - Polycarbophil | (pg 600)

Question 177

Select all that apply: Which of the following laxatives are safe for use in infants? A. Docusate B. Lactulose C. Sodium phosphate D. Glycerin suppositories

Answer 177

Answers: A, B, D (pg 598)

Question 178

Which of the following should be monitored in the older adult taking laxatives? A. heart rate B. fluid and electrolyte status (dehydration) C. CBC D. bone density

Answer 178

Answer: B - fluid and electrolyte status (dehydration) | pg 598

Question 179

What are the significant drug/drug interactions with Valproic acid? Select all that apply A. Valproic acid can displace phenytoin causing phenytoin toxicity B. Combining Valproic acid with topiramate poses a risk for hyperammonemia C. Valproic acid decreases the rate at which phenobarbital is metabolism thus causing significant CNS depression D. Two carbapenems Meropenem and Imipenem/clastatin reduce plasma levels of Valproic acid cause breakthrough seizures to occur.

Answer 179

Answer A, C & D | B is incorrect because the use of Valproic acid and Topiramate would cause hyperammonemia. PG,160

Question 180

Drugs for Peptic Ulcer Disease (PUD) do which of the following to promote healing: Choose all that apply ``` A. Reduce gastric acidity B. Eradicate H. pylori C. Decrease mucosal defenses D. Enhance mucosal defenses E. Increase gastric acidity ```

Answer 180

Answer: A, B, D p. 590

Question 181

Which of the following is true regarding antibiotic treatment of H. pylori for PUD? A. H. pylori is not sensitive to amoxicillin B. H. pylori is resistant to tetracycline C. Clarithromycin promotes protein synthesis which suppresses growth of H. pylori D. Bismuth compounds act topically to disrupt the cell wall of H. pylori, thereby causing lysis and death

Answer 181

Answer: D Bismuth compounds act topically to disrupt the cell wall of H. pylori, thereby causing lysis and death p. 592

Question 182

The histamine-2 receptor antagonist, Cimetidine: A. Requires 6-8 weeks to heal duodenal ulcers B. Can cause gynocomastia and reduce libido C. Cannot promote healing in patients with Zollinger-ellison syndrome D. Requires 4-6 weeks to heal gastric ulcers

Answer 182

Answer: B - Can cause gynocomastia and reduce libido | pgs. 593-4

Question 183

True or False: A single dose of Omeprazole (Prilosec) reduces acid production by 90-97% within two hours of dose.

Answer 183

Answer: True p. 595

Question 184

The following are adverse effects of Omeprazole (Prilosec): Choose all that apply A. Pneumonia B. Constipation C. Hypermagnesemia D. Fractures

Answer 184

Answer: A & D Pneumonia and Fractures p 595

Question 185

What is a key prescribing consideration for proton pump inhibitors: A. Get magnesium level as baseline data and periodically B. When used long-term, the risk of osteoporosis decreases C. Inform patient of hypermagnesemia (muscle cramps, palpitations, tremors) D. PPIs can increase absorption of meds used to treat HIV/AIDS

Answer 185

Answer: A Get magnesium level as baseline data and periodically p. 596

Question 186

Which is true regarding Sucalfate? A. Decreases acid secretion B. Neutralizes acid C. Creates a protective barrier against acid & pepsin D. Has significant side effects and drug interactions

Answer 186

Answer: C - Creates a protective barrier against acid & pepsin p. 596

Question 187

Which of the following is true regarding PUD treatment for pregnant women? A. Misoprostol must be avoided in pregnant women B. Ranitidine should be avoided in pregnancy C. Esomeprazole should be avoided in pregnancy

Answer 187

Answer: A Misoprostol must be avoided in pregnant women p 596

Question 188

What is true regarding antacids? A. Mainstay of antiulcer therapy B. Some cause constipation and some cause diarrhea C. High urine pH can slow down the excretion of acidic drugs D. Wait four hours after taking cimetidine to take an antacid

Answer 188

Answer: B - Some cause constipation and some cause diarrhea p. 597

Question 189

Which of the following is true regarding drug treatment for ulcers? A. Prophylactic therapy is indicated for patients over 50 who have a history of ulcers B. Antibiotics are the preferred prophylactic treatment C. Antibiotics should never be prescribed for patients with NSAID induced ulcers D. For H. pylori associated ulcers antibiotics and an antisecretory agent should be given

Answer 189

Answer: D - For H. pylori associated ulcers antibiotics and an antisecretory agent should be given p.590

Question 190

True or False: | A combination of medication therapy and psychotherapy is most effective for anxiety disorders?

Answer 190

True Source: from chapter 30 audio clip

Question 191

Which of the following is not a first line treatment for Generalized Anxiety Disorder? a. Buspirone b. SRIs c. SSRIs d. SRNIs e. benzodiazepines

Answer 191

answer E, Benzos are the second choice unless a patient needs immediate stabilization Source: from chapter 30 audio clip

Question 192

Which of the following is NOT true about Buspirone/Buspar? a. It is not a benzodiazepine b. It is not a barbiturate c. It has a rapid onset and is useful for acute anxiety d. the onset is lengthy which makes it a poor choice for acute anxiety

Answer 192

answer is C. The onset is slow and may take one week to appear and then weeks to peak source: from chapter 30 audio clip

Question 193

Which of the following is NOT approved for treatment of Generalized Anxiety Disorder? a. Venlafaxine b. Paroxitine c. sertraline d. Duloxetine e. Escitalopram

Answer 193

answer is C. Sertraline/Zoloft is not approved for treatment of GAD. source: from chapter 30 audio clip

Question 194

Which of the following drug classes best treats somatic symptoms in anxiety? a. SSRIs b. MAOIs c. SNRIs d. benzodiazepines e. Tricyclics

Answer 194

answer is D. - benzodiazepines The fact that they are the only class that treat the somatic symptoms makes them highly addictive source: from chapter 30 audio clip

Question 195

Which SRNI was the first to be approved for treatment of generalized anxiety disorder?

Answer 195

Venlafaxine | source: from chapter 30 audio clip

Question 196

Which of the following make Buspirone a good choice for treating anxiety? (select all that apply) a. Busipirone does NOT effect the CNS b. There is no known abuse potential c. It does not intensify the effects of other CNS depressants d. It Is generally well tolerated e. It is great for PRN use and immediate relief f. there are no known withdrawal symptoms g. it is not known to cause depression, little to no risk of suicide

Answer 196

Answer is a,b,c,d,f, and g. Buspar should NOT be used prn or for immediate release as it is not effective. source: from chapter 30 audio clip

Question 197

True of false: | Buspirone is intended for long term use.

Answer 197

Answer is FALSE. Buspar is intended for short term use | source: from chapter 30 audio clip

Question 198

Which of the following are first line SSRI choices that are APPROVED for panic disorder? a. paroxetine d. fluvoxamine c. sertraline d. fluoxetine

Answer 198

Answer, a,c,d. Fluvoxamine (luvox) is not approved to treat panic disorder source: from chapter 30 audio clip

Question 199

Which medication is NOT approved for first line OCD treatment? a. fluoxetine b. sertraline c. fluvoxamine d. propranolol e. paroxetine

Answer 199

answer is D. while propranolol is useful for social anxiety is not approved for OCD. source: from chapter 30 audio clip

Question 200

Which of the following anxiety disorders is behavioral therapy most important in treating? a. OCD b. Social Anxiety Disorder c. PTSD d. GAD

Answer 200

answer is A - OCD | source: from chapter 30 audio clip

Question 201

Of the following, which TWO drugs are approved for treating social anxiety disorder? a. paroxetine b. escitalopram c. propranolol d. sertraline

Answer 201

answer is a and d. | source: from chapter 30 audio clip

Question 202

which of the following medications may be very effective for treating social anxiety disorder as off labeled use? a. paroxetine b. propranolol c. sertraline

Answer 202

answer is b. both a and c ARE approved source: from chapter 30 audio clip

Question 203

PTSD requires a combination of psychotherapy and medication therapy. Which medications are approved for treatment of PTSD. a. Fluoxetine b. sertraline c. mirtazapine d. paroxetine

Answer 203

answer a,c,d. Mirtazapine has shown to be beneficial but is not approved. source: from chapter 30 audio clip

Question 204

Which needs of a patient should be referred out as they are specific roles of the PMHNP? a. the need for supportive therapy b. the need for CBT c. the need for a combination of medications to control symptoms d. anytime a benzo is needed

Answer 204

answer. ALL OF THE ABOVE | source: from chapter 30 audio clip

Question 205

How long can a patient expect for these medication to take effect? a. 2 weeks b. immediately c. one week d. 10 days

Answer 205

answer is a. Medication start to take effect at about the 14 day mark source: from chapter 30 audio clip

Question 206

What time frame is the full benefit of these medication typically seen at? a. 2-4 weeks b. 3-6 months c. 6-12 weeks d. 4-8 weeks

Answer 206

answer is C - 6-12 weeks | source: from chapter 30 audio clip

Question 207

Which is NOT an advantage of the newer seizure medications as opposed to the traditional medications? a. Designed to have less adverse effects b. show improved efficacy c. Decreased need for lab monitoring d. may require few doses and result in improved compliance

Answer 207

answer b - show improved efficacy | source chapter 21 audio clip

Question 208

Which of the following is/are true about Keppra? a. does not effect birth control b. high risk for psychiatric symptoms c. not approved as first line monotherapy d. only treat absent seizures

Answer 208

answer a,b,c, Keppra is approved for monotherapy only in patients over 16 years old AND changing from another antiseizure medication. Keppra is approved to treat. It is approved as ADJUNCTIVE therapy for generalized tonic clonic and partial seizures source chapter 21 audio clip and pg 165

Question 209

Which medication is appears to be approved for ALL forms of epilepsy? a. valproic acid b. carbamazepine c. Keppra d. topiramate

Answer 209

answer is A - Valproic Acid | source chapter 21 audio clip

Question 210

True or false: | No drug should be considered ineffective until tested in sufficient dosages for a reasonable amount of time?

Answer 210

Answer is TRUE | source chapter 21 audio clip

Question 211

Which of the following is NOT one of the three main types of seizures? a. generalized tonic-clonic (grand mal) b. absence (petit mal) c. partial seizures d. psuedoseizures

Answer 211

answer d - pseudo seizures | source chapter 21 audio clip

Question 212

which of the following drugs matches the black box warning Warning- hepatic failure, fatal and rapidly progressing pancreatitis, highly teratogenic a. Topimate b. phenobarbital c. phenytoin d. valproic acid

Answer 212

answer d.- Valproic acid | source page 160

Question 213

which of the following drugs matches the black box warning Warning- aplastic anemia, serious skin reactions such as SJS and TEN, linked to variant of HLA-B gene. a. carbamazepine b. phenytoin c. lamotrigine d. Levetiracetam

Answer 213

answer is A- carbamazepine | source page 159

Question 214

The variant of the HLA-B gene that is predominantly found in people of what ancestry and is listed in the black box warning for which medication? a. African American, carbamazepine b. American Indian, valproic acid c. African American, carbamazepine d. Asian, carbamazepine

Answer 214

answer is D - Asian, carbamazepine | source page 159

Question 215

When given IV, which medication should be monitored for severe hypotension and cardiac dysthymias? (black box warning) a. carbamazepine b. valproic acid c. phenytoin d. phenobarbital

Answer 215

answer is C - phenytoin | source pg 158

Question 216

which antiseizure drug is associated with vision loss that may be permanent? a. Lamotrigine b. Oxcarbazepine c. Primidone d. Topiramate e. Levetiraetam

Answer 216

answer is D - Topiramate | source page 165

Question 217

Phenobarbital should be avoided in all of the following EXCEPT a. patients with addictive patterns b. patients with absence seizures c. patients with significant respiratory compromise d. those who are pregnant or wish to become pregnant e. patients experiencing partial and generalized seizures

Answer 217

answer is E. Phenobarbital is approved for use in partial and generalized seizures source pg 161-162

Question 218

Which of the following has the highest abuse potential and potential for causing physical and psychological dependence? a. Schedule II b. Schedule III c. Schedule IV d. Schedule V

Answer 218

Answer: A - Schedule II Ch. 32/33 study guide

Question 219

The Comprehensive Drug Abuse Prevention & Control Act of 1970 (Controlled Substance Act) sets forth regulations for handling of controlled substances by: a. Manufacturers b. Distributors c. Nurses d. All of the above

Answer 219

Answer: D - All of the above ch 32/33 study guide

Question 220

Which of the following places regulations on prescribing controlled substances? a. FDA b. DEA c. AMA d. None of the above

Answer 220

Answer: B - DEA ch 32/33 study guide

Question 221

Oral prescriptions called in for emergencies must be followed with a written prescription within how much time? a. 24 hours b. 48 hours c. 72 hours d. 1 week

Answer 221

Answer: C - 72 hours ch 32/33 study guide

Question 222

Which of the following is characterized by an intense subjective need for a particular psychoactive drug? a. Physical dependence b. Psychological dependence c. Tolerance d. Cross-tolerance

Answer 222

Answer: B - Psychological dependence Ch 32/33 study guide

Question 223

Which of the following is not an effect of alcohol on the CV system? a. Dilation of cutaneous blood vessels b. Damage to the myocardium c. Elevation of BP d. Vasodilation of vascular beds of skeletal muscle

Answer 223

Answer: d Vasodilation of vascular beds of skeletal muscle Ch 32/33 study guide

Question 224

Which of the following is an effect of alcohol on the GI system? a. Erosive gastritis b. Promotion of gastric acid secretion c. Direct injury to gastric mucosa d. All of the above

Answer 224

Answer: d All of the above Ch 32/33 study guide

Question 225

Which of the following does not have cross-tolerance to alcohol? a. General Anesthetics b. Barbiturates c. Benzodiazepines d. Opioids

Answer 225

Answer: d - Opioids Ch 32/33 study guide

Question 226

Which of the following drugs used to maintain abstinence causes an unpleasant reaction if alcohol is consumed? a. Naltrexone b. Acamprosate c. Disulfiram d. None of the above

Answer 226

Answer: d - none of the above | Ch 32/33 study guide

Question 227

Which of the following is used as a first line drug used to facilitate alcohol withdrawal? a. Carbamazepine b. Clonidine c. Atenolol d. Lorazepam

Answer 227

Answer d: Lorazepam | Ch 32/33 study guide

Question 228

1. Which of the following are true regarding antiseizure medications? (select all that apply) a. they often are associated with drug/drug interactions. b. the drugs are commonly used off label and are used for patients with anxiety, bipolar disorders, and headaches. c. it is possible for antiseizure drugs to cause seizures in some patients. d. there are specific indications for when to use the drugs as monotherapy and when they should be used as adjunct/add on therapy. e. monitoring patients on antiseizure drugs is critical and can vary depending on drug from regular vision screens, assessment of aggression and hostility, EKGs, liver function tests, and CBCs. f. screening for HLA-B allele variants is necessary for Asian patients before initiating some antiseizure drugs. g. all seizure drugs are approved for use in children.

Answer 228

All except G Review questions

Question 229

A healthcare provider is educating a patient with newly diagnosed partial complex seizure disorder who will begin taking an antiepileptic drug (AED). Which statement by the patient indicates an understanding of the teaching? a. “When the drug level is maintained at therapeutic levels, I can expect to be seizure free” b. “I may need to try several drugs before finding one that is effective” c. “Serious side effects may occur, and if they do, I should stop taking the medication right away” d. “I know that the drug is effective if I am seizure free for two months”

Answer 229

b. “I may need to try several drugs before finding one that is effective” review questions

Question 230

A patient who has been taking an antiepileptic drug for several weeks reports little change in seizure frequency. What action should be taken? a. Ask the patient to complete a seizure frequency chart for the past few weeks b. Reinforce the need to take the medication as prescribed c. Increase the dose of the antiepileptic drug d. Write an order for serum drug levels

Answer 230

a. Ask the patient to complete a seizure frequency chart for the past few weeks

Question 231

A patient who takes phenytoin (Dilantin) for seizures asks the provider for a prescription for oral contraceptives. What recommendation will the provider make to help assure the effectiveness of the contraception method? a. She should not take oral contraceptives because they reduce the effectiveness of phenytoin (Dilantin) b. She may need to increase her dose of phenytoin (Dilantin) while taking oral contraceptives c. She should adhere strictly to oral contraceptive schedules because phenytoin (Dilantin) causes birth defects d. She should consider a different form of birth control while taking phenytoin (Dilantin)

Answer 231

d. She should consider a different form of birth control while taking phenytoin (Dilantin)

Question 232

Which of the following muscle relaxants work directly on the skeletal muscle? a. Baclofen (Lioresal) b. Dantrolene (Dantrium) c. Carisoprodol (Soma) d. Diazepam (Valium)

Answer 232

b. Dantrolene (Dantrium)

Question 233

. Which of the following are true regarding drugs used for muscle relaxants? (select all that apply) a. patient age may be a relative contraindication for the use of muscle relaxants. b. muscle relaxants are effective for muscle pain due to their anti-inflammatory properties. c. muscle relaxants do not have potential for abuse. d. drug-drug interactions with muscle relaxers are uncommon.

Answer 233

a. patient age may be a relative contraindication for the use of muscle relaxants.

Question 234

A patient with cerebral palsy who has been receiving baclofen for 3 months is admitted to the hospital for evaluation of new-onset seizures. Which assessment question will the APRN ask to help identify the most likely cause of the seizures? a. “have you taken any extra doses of baclofen” b. “are you aware of the most common adverse effect of baclofen” c. “have you missed any doses of baclofen” d. “did you know that seizures are an idiopathic response to baclofen”

Answer 234

c. “have you missed any doses of baclofen”

Question 235

4. When a patient with a lower back injury begins experiencing muscle spasms, the APRN prescribes cyclobenzaprine (Flexeril) 10mg three times per day. What information about this drug should be included in the patient teaching? a. you will need to have liver function tests performed while taking this medication b. this drug carries some risk for developing hallucinations and psychotic symptoms c. you may experience blurred vision, dry mouth, or constipation d. this medication may cause your urine to turn brown, black, or dark green

Answer 235

c. you may experience blurred vision, dry mouth, or constipation

Question 236

. A patient with asthma is having difficulty at work because of anxiety and fear when making presentations at meetings three to four times each year. The patient reports that when this happens the anxiety can stimulate an anxiety attack. What medication should be ordered for PRN use? a. Albuterol b. Paroxetine (Paxil) c. Propanolol d. Alprazolam (Xanax)

Answer 236

d. Alprazolam (Xanax)

Question 237

A patient with opioid use disorder has undergone detoxification with buprenorphine. Afterward, the provider prescribes buprenorphine with naloxone. When the patient asks why the drug regimen was changed, the correct response would be? a. “this combination has a longer half-life” b. “this combination has a lower risk of abuse” c. “buprenorphine alone causes more respiratory depression” d. “the combination drug contains more buprenorphine”

Answer 237

b. “this combination has a lower risk of abuse”

Question 238

. A patient with opioid use disorder seeks treatment. When discussing the rationale for using methadone to ease opioid withdraw, the provider explains that methadone has which pharmacologic property? a. It is a nonopioid agent b. It has a shorter duration of action than other opioids c. It can prevent abstinence syndrome d. It lacks cross tolerance with other opioids

Answer 238

c. It can prevent abstinence syndrome