Kaizen Questions Flashcards
A NP in the ED has ordered progressive doses of flumazenil (Romazicon) for a patient who has overdoses on a benzodiazepine and alcohol. What instructions would the NP provide to the nurse caring for this patient?
A. Make sure the patient is adequately hydrated.
B. Carefully monitory the patient’s respirations.
C. Speak calmly to reduce the patient’s anxiety.
D. Carefully monitor urine output and renal functions.
B. Carefully monitory the patient’s respirations.
Flumazenil (Romazicon) is a competitive benzodiazepine receptor antagonist. The drug can reverse the sedative effects of benzodiazepines but may not reverse respiratory depression. Flumazenil is approved from benzo overdose and for reversing the effects of benzos following general anesthesia.
A 24 year old man was diagnosed with bipolar disorder several years ago. He has managed his condition well with oral medications. His significant other brings him to the ED where he is found to be in a manic state.
After review of his current meds, which drug would have contributed to his changed mental state?
A. amitriptyline
B. buspirone
C. gabapentin
D. prednisone
D. prednisone
Even if someone is well controlled on medication, steroids may precipitate a manic state in a patient with bipolar disorder.
The other drugs would provide decreased mood swings, depression, and anxiety, providing calmness rather than mania.
A cancer patient has been taking increasing doses of oxycodone (OxyContin) for pain relief. Which teaching can prevent the adverse effect that is most likely to persist with long-term use of this drug?
A. “Consume adequate fluids and fiber.”
B. “Change positions slowly.”
C. “Do not operate dangerous machinery.”
D. “Take deep breaths every hour.”
A. “Consume adequate fluids and fiber.”
Increased fluid and fiber are important. (constipation)
Tolerance can be defined as a state in which a larger dose is required to produce the same response that could formerly be produced with a smaller dose. Alternatively, tolerance can be defined as a condition in which a particular dose now produces a smaller response than it did when treatment began. Because of tolerance, dosage must be increased to have …
Which antihypertensive drug could increase the risk of hyponatremia prescribed in addition to fluoxetine?
A. candesartan
B. enalapril
C. hydrochlorothiazide
D. spironolactone
C. hydrochlorothiazide
Fluoxetine can cause hyponatremia (<135 mEq/L), probably by increasing secretion of antidiuretic hormone. Most cases involve older-adult patients taking thiazide diuretics. Accordingly, fluoxetine is used in older-adult patients, sodium should be measured at baseline and periodically thereafter.
Four days ago, a patient began benztropine, buspirone, haloperidol, and quetiapine. Today she is complaining of blurred vision.
Which medication is most likely causing the blurred vision?
A. benztropine
B. buspirone
C. haloperidol
D. quetiapine
A. benztropine
Because of its antimuscarinic activity, benztropine commonly causes blurred vision
Note: the -tropine suffix; it also commonly causes blurred vision
A NP is evaluating the lab work of a patient who uses lithium carbonate for treatment of an acute episode of bipolar disorder.
Which lab result would cause the greatest concern?
A. ALT 30 IU/L
B. Creatinine 3.4 g/dL
C. Sodium 138 mEq/L
D. Potassium 4.2 mEq/L
B. Creatinine 3.4 g/dL
Because lithium is excreted by the kidneys, it must be employed with great care in patients with renal impairment.
A. ALT 30 IU/L (NL: 7-56)
B. Creatinine 3.4 g/dL (NL: men 0.74-1.35 | women 0.59-1.04)
C. Sodium 138 mEq/L (NL: 135-145)
D. Potassium 4.2 mEq/L (NL: 3.5-5.0)
A NP is caring for a 6 year old child who receives a CNS stimulant drug for ADHD. The child presents to the office for follow-up and complains of not feeling well.
Which assessment finding would be of significant concern?
A. BP 126/84 mmHg
B. HR 100 bpm
C. RR 25 breaths/min
D. Weight gain of 2lbs since last year
A. BP 126/84 mmHg
At recommended doses, stimulants produce a small increase in heart rate and blood pressure. For most patients, these increases lack clinical significance.
In a 6yo, a BP of 124/84 mmHg is a significant increase in BP and would explain the symptoms of not feeling well.
NL: Female 86-105 / 40-58 | Male 88-106 / 42-61
A patient diagnosed with hookworm infection is prescribed mebendazole (Vermox). Which sign or symptom would suggest the most common complication of hookworm infections?
A. Bright red rectal bleeding
B. Bilious vomiting
C. Pale conjunctiva
D. Onycholysis
C. Pale conjunctiva
Hookworm infestation is most common in rural areas where hygiene is poor and people go barefoot. Adult hookworms attach to the wall of the small intestine and suck blood. As a result, infestation is associated with chronic blood loss and progressive anemia which would result in conjunctival paleness.
A 72 year old man with known benign prostatic hyperplasia (BPH) is prescribed a first-generation antipsychotic.
Which assessment would be most important?
A. abdomen for new onset pain
B. blood pressure
C. dizziness
D. intake and output
B. blood pressure
First generation antipsychotics are contraindicated for patients who are:
* comatose
* severely depressed
* Parkinson disease
* prolactin-dependent carcinoma of the breast
* bone marrow depression
* severe hypotension or hypertension.
A patient with a history of generalized anxiety disorder has been admitted with exacerbated COPD.
Which drug, if taken at home, would cause the greatest concern for this patient?
A. alprazolam
B. buspirone
C. duloxetine
D. paroxetine
A. alprazolam
Although benzodiazepines generally have minimal effects on respiration, they can be a problem for patients with respiratory disorders.
In patients with COPD, benzodiazepines may worsen hypoventilation and hypoxemia.
In patients with obstructive sleep apnea, benzodiazepines may exacerbate apneic episodes.
When switching a patient from a TCA to a MAOI, which would be of greatest concern?
A. changes in blood glucose
B. changes in blood pressure
C. changes in serum sodium
D. changes in serum potassium
B. changes in blood pressure
Although MAOIs normally produce hypotension, they can be the cause of severe hypertension if the patient eats food that is rich in tyramine.
Tyramine is a substance that promotes the release of NE from sympathetic neurons.
Hypertensive crisis is characterized by severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating - possibly leading to stroke and death.
A patient sustained a severe laceration to the right thumb and index finger that will require a local anesthetic to facilitate suturing.
Which statement should prompt further patient teaching?
A. “I have to admit I’m relieved that they’ll be freezing my hand before they stich it up”
B. “I’m feeling pretty queasy about getting stitches, so I’m glad they’ll be knocking me out”
C. “They told me that it will take a few hours before I can feel my hand again”
D. “If I understand correctly, i won’t be able to move my hand normally for a while after getting the anesthesia”
B. “I’m feeling pretty queasy about getting stitches, so I’m glad they’ll be knocking me out”
There is no loss of consciousness with local anesthesia.
