Week 6 Flashcards
(120 cards)
1
Q
The nurse is preparing to give a drug that stimulates the parasympathetic nervous system. Which patient response is an expected outcome of this drug?
Wheezing decreases due to bronchodilator.
Heart rate decreases to 60 beats/min.
Diarrhea stool count decreases.
Oxygenation improves because of bronchodilation.
A
Heart rate decreases to 60 beats/min.
2
Q
A patient is experiencing symptoms of the “fight-or-flight” response. Which autonomic process stimulates this response?
Sympathetic system
Predominant tone of the organs
Baroreceptor reflex
Parasympathetic system
A
Sympathetic system
3
Q
The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system?
Norepinephrine
Epinephrine
Dopamine
Acetylcholine
A
Acetylcholine
4
Q
A nurse is preparing to give a medication that stimulates the beta2 receptors. Which response will the nurse expect from this drug?
Increased peristalsis
Constriction of the pupil
Hypoglycemia
Bronchodilation
A
Bronchodilation
5
Q
A nurse gives a medication that inhibits acetylcholinesterase. How would this drug affect autonomic activity?
Parasympathetic activity would increase.
Parasympathetic signals would be depressed.
Sympathetic activity would increase.
Respiratory centers would be depressed.
A
Parasympathetic activity would increase.
6
Q
The nurse is preparing to give a drug to stimulate activation of adrenergic receptors. Which effects indicate sympathetic stimulation?
Increase in heart rate
Constriction of pupils
Atrioventricular block
Sinus bradycardia
A
Increase in heart rate
7
Q
Which organs are controlled primarily by the parasympathetic system? (Select all that apply.)
Gastrointestinal tract
Respiratory tract
Cardiovascular system
Skin
Salivary glands
A
all expect cardiovascular system
8
Q
Which receptors are considered adrenergic receptors? (Select all that apply.)
Alpha1
Beta2
Dopamine
Muscarinic1
Beta1
Alpha2
A
all expect Muscarinic1
9
Q
Which receptors mediate responses to the neurotransmitter acetylcholine? (Select all that apply.)
Alpha1
Beta2
Dopamine
Nicotinic
Muscarinic
A
Nicotinic
Muscarinic
10
Q
The nurse administers a medication to a patient that stimulates the function of the parasympathetic nervous system. The nurse should assess the patient for which intended effect?
Reduced esophageal motility
Improved bladder emptying
Dilation of the pupils
Decreased gastric secretions
A
Improved bladder emptying
11
Q
The nurse administers a medication to a patient that stimulates the sympathetic nervous system. The nurse should assess the patient for which intended effect?
Increased heart rate
Blood pressure reduction
Bronchial constriction
Decreased blood glucose level
A
Increased heart rate
12
Q
A nurse administers a medication that activates dopamine receptors. The nurse should assess the patient for which intended effect?
Uterine muscle relaxation
Contraction of skeletal muscle
Improved renal perfusion
Decreased piloerection
A
Improved renal perfusion
13
Q
The nurse teaches a patient about bethanechol [Urecholine]. Which statement by the patient requires an intervention by the nurse?
“The medication should be taken with meals.”
“Urgency may occur, so I should be near a bathroom.”
“I should plan to take the drug 3 times each day.”
“This drug may cause a drop in my blood pressure.”
A
“The medication should be taken with meals.”
14
Q
A patient is prescribed bethanechol [Urecholine] for urinary retention. If the patient exhibits signs of an overdose, such as increased salivation and sweating, bradycardia, or hypotension, which medication should the nurse administer?
Acetylcholine [Miochol-E]
Cevimeline [Evoxac]
Oxybutynin [Ditropan]
Atropine [AtroPen]
A
Atropine [AtroPen]
15
Q
A patient who takes oxybutynin [Ditropan] for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity?
Cool and moist skin, confusion, and bradycardia
Dry mouth, increased temperature, and blurred vision
Hallucinations, increased salivation, and diaphoresis
Hypothermia, increased respiratory rate, and pupil constriction
A
Dry mouth, increased temperature, and blurred vision
16
Q
A patient is brought to the emergency department with hallucinations related to a tricyclic antidepressant overdose. The patient has hot, flushed skin and an oral temperature of 103.8F (39.9C). Which medication should the nurse prepare to administer as an antidote?
Pyridostigmine [Mestinon]
Epinephrine [EpiPen]
Physostigmine [Antilirium]
Atropine [AtroPen]
A
Physostigmine [Antilirium]
17
Q
A nurse is preparing to give bethanechol [Urecholine]. What is the expected outcome of this drug?
Nondistended bladder
Increased heart rate and blood pressure
Improved pulse oximetry reading
Relief of cardiac rhythm problems
A
Nondistended bladder
18
Q
A nurse prepares to administer a new prescription for bethanechol [Urecholine]. Which information in the patient’s history should prompt the nurse to consult with the prescriber before giving the drug?
Constipation
Hypertension
Psoriasis
Asthma
A
Asthma
19
Q
Which symptom is the most indicative of muscarinic poisoning?
Constipation
Heart rate of 140 beats/min
Blood pressure of 180/110 mm Hg
Blurred vision
A
Blurred vision
20
Q
The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin [Ditropan] for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan?
“You may experience a slower heart rate. Call your doctor if it is below 60.”
“Ditropan is very effective. Most patients experience significant relief.”
“Sip on water and suck on hard candy to help with the problem of dry mouth.”
“Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan.
A
Sip on water and suck on hard candy to help with the problem of dry mouth.”
21
Q
Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition?
Epilepsy
Diabetic coma
Meningitis
Psychosis
A
Psychosis
22
Q
Which statement is true regarding the use of Bethanechol use in children?
Safety is well documented in adolescents.
Safety is documented in ages 6 months and older.
Safety has not been established in children of any age.
Safety has not been established in children with cardiac conditions.
A
Safety has not been established in children of any age.
23
Q
Which statement is true regarding cholinergic agonists?
Adverse effects are less pronounced in older adults.
Breastfeeding is safe in full-term infants.
The risk versus benefits should be weighed in use during pregnancy.
Bethanechol is safe for use in children older than 12 months.
A
The risk versus benefits should be weighed in use during pregnancy.
24
Q
The nurse is educating a group of hikers on how to prevent muscarinic poisoning. How should the nurse advise the hikers?
Muscarinic agonists can be found among certain mushrooms.
Muscarinic agonists can be found on certain ground covers, such as clover.
Muscarinic agonists can be found in tree bark.
Muscarinic agonists can be found in dirt.
A
Muscarinic agonists can be found among certain mushrooms.
25
The nurse is preparing to treat a patient with muscarinic poisoning. Which do they know is the drug of choice?
Beta blocker
Atropine
Bethanechol
Acetylcholine
Atropine
26
Which label most aptly describes the drug atropine [Sal-Tropine]?
Cholinergic
Parasympatholytic
Muscarinic agonist
Parasympathomimetic
Parasympatholytic
27
The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug?
Use as a preanesthesia medication.
Treatment of tachycardias.
Prevention of urinary retention.
Reduction of intraocular pressure in glaucoma.
Use as a preanesthesia medication.
28
The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated?
A 60-year-old woman with an overactive bladder (OAB)
A 72-year-old man with glaucoma
A 45-year-old woman with peptic ulcer disease (PUD)
A 26-year-old man being prepared for surgery today
A 72-year-old man with glaucoma
29
Which does the nurse know to be true of Atropine?
Atropine has no direct effect of its own.
Atropine acts directly on receptors.
Atropine is a muscarinic antagonist. Incorrect
Atropine is found in nature and not harmful.
Atropine has no direct effect of its own.
30
During assessment, which finding would alert the nurse that a patient has had a toxic level of Atropine?
Fever
Delirium
Dilated pupils
Decreased secretions
Delirium
31
The nurse is preparing to administer Atropine. Which route would be inappropriate?
Oral
IM
IV
SubQ
Oral
32
The nurse understands that xerostomia can lead to which occurrence?
Tooth decay
Cardiac conditions
Ulcers
Glaucoma
Tooth Decay
33
The nurse notes xerostomia on assessment. Which action would be appropriate?
Advise the patient to chew sugary gum.
Advise the patient to eat hard candy.
Advise the patient to floss more.
Advise the patient to drink more fluids
Advise the patient to drink more fluids
34
Which statements about the anticholinergic drug scopolamine are true? (Select all that apply.)
A side effect is sedation.
It is used for motion sickness.
A side effect is nausea and vomiting.
It is used for preanesthetic sedation.
It causes CNS excitation
A side effect is sedation.
It is used for motion sickness.
It is used for preanesthetic sedation.
35
After an intramuscular injection of penicillin, a patient develops severe difficulty breathing and a swollen tongue. Which medication should the nurse prepare to administer?
Dopamine [Inotropin]
Epinephrine [Adrenalin]
Norepinephrine [Levophed]
Pseudoephedrine [Sudafed]
Epinephrine [Adrenalin]
36
A patient is receiving dopamine [Inotropin] for the treatment of shock. What would indicate to the nurse that the medication is effective?
Decreased mean arterial pressure
Gain of 2 kg in 24 hours
Increased heart rate
Increased urine output
Increased urine output
37
A patient is started on a dobutamine infusion for the treatment of acute decompensated heart failure. The nurse should assess the patient for the major adverse effect of dobutamine therapy, which is what?
Supraventricular tachycardia
Fine hand tremors
Atrioventricular heart block
Hyperglycemia
Supraventricular tachycardia
38
The nurse cares for a patient with asthma who uses an albuterol (Ventolin) metered-dose inhaler. The nurse is most concerned if the patient makes which of the following statements?
“The medicine in the inhaler helps me to breathe.”
“I can use the inhaler as often as needed.”
“My hand starts to shake after I use the inhaler.”
“If the inhaler doesn’t work, I should dial 911.”
“I can use the inhaler as often as needed.”
39
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest?
Topical phenylephrine
Subcutaneous terbutaline
Intravenous epinephrine
Inhaled albuterol
Intravenous epinephrine
40
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug?
Cardiac rhythm
Blood urea nitrogen
Central nervous system (CNS) tremor
Lung sound
Cardiac Rhythm
41
The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug?
“I will keep my medication in the refrigerator when I’m not using it.”
“I should take this medication within 30 minutes of the onset of symptoms.”
“I must remove my pants before injecting the medication into the leg.”
“I will jab this medication firmly into my outer thigh if needed.”
“I will jab this medication firmly into my outer thigh if needed.”
42
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.)
Terbutaline must be given by a parenteral route.
The selectivity of terbutaline is dose dependent.
The patient may experience tremor with terbutaline.
Terbutaline is a sympathomimetic drug.
Bronchoconstriction is a potential adverse effect of terbutaline.
The selectivity of terbutaline is dose dependent.
The patient may experience tremor with terbutaline.
Terbutaline is a sympathomimetic drug.
43
The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.)
Check the blood urea nitrogen (BUN) and creatinine levels.
Obtain insulin from the medication cart.
Assess the patency of the IV line.
Review the allergy history.
Assess the vital signs.
Assess the patency of the IV line.
Review the allergy history.
Assess the vital signs.
44
A patient is receiving a drug that blocks alpha1-adrenergic receptors. Which adverse effect, if experienced by the patient, is of most concern to the nurse?
Nasal congestion
Orthostatic hypotension
Inhibition of ejaculation
Reflex tachycardia
Orthostatic hypotension
45
The nurse instructs a patient about doxazosin [Cardura]. Which statement by the patient to the nurse indicates an understanding of the instructions?
“It is common to have nightmares and insomnia.”
“I need to take the medication on an empty stomach.”
“The medication should be taken tonight before I go to bed.”
“I should stop taking the medication if I feel lightheaded.”
The medication should be taken tonight before I go to bed.”
46
A patient with type 2 diabetes mellitus is diagnosed with stable angina. Which beta blocker, if prescribed by the physician, would the nurse question?
Metoprolol [Lopressor]
Nadolol [Corgard]
Bisoprolol [Zebeta]
Atenolol [Tenormin]
Nadolol [Corgard]
47
The nurse prepares to administer metoprolol [Lopressor] to a patient with chronic stable angina. What is a priority assessment to make before the administration of this medication?
Temperature
Urinary function
Respiratory rate
Heart rate
Heart rate
48
A patient is to be discharged home with a new prescription for prazosin [Minipress]. Which statement is most important for the nurse to include in the teaching plan?
“You should increase your intake of fresh fruits and vegetables.”
“You should move slowly from a sitting to a standing position.”
“Be sure to wear a Medic Alert bracelet while taking this medication.”
“Take your first dose of this medication first thing in the morning.”
You should move slowly from a sitting to a standing position.”
49
The nurse notices significant edema surrounding and proximal to the peripheral intravenous (IV) site where epinephrine is being infused. Which action would the nurse anticipate first?
Prepare to administer phentolamine [Regitine].
Ensure that naloxone [Narcan] is available.
Institute the protocol for congestive heart failure (CHF). Incorrect
Monitor the blood urea nitrogen (BUN), creatinine, and potassium levels.
Prepare to administer phentolamine [Regitine].
50
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug?
A heart rate of 100 beats/min Incorrect
Wheezing
A glucose level of 180 mg/dL
Urinary urgency
Wheezing
51
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated?
Cardiac dysrhythmias
Hypertension
Diabetes
Angina
Diabetes
52
Why does the nurse anticipate administering metoprolol [Lopressor] rather than propranolol [Inderal] for diabetic patients who need a beta-blocking agent?
Metoprolol is less likely to cause diabetic nephropathy.
Propranolol causes both beta1 and beta2 blockade.
Metoprolol helps prevent retinopathy in individuals with diabetes.
Propranolol is associated with a higher incidence of foot ulcers.
Propranolol causes both beta1 and beta2 blockade.
53
Which statement made by the patient indicates understanding of teaching related to a new prescription for atenolol [Tenormin]?
“I will increase my fluids to prevent constipation.”
“I will not stop taking this medication abruptly.”
“I will take the first dose of this medicine at night.” Incorrect
“I will wear sunscreen and a hat when I work in the sun.”
“I will not stop taking this medication abruptly.”
54
The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse’s instruction?
“I will need to wait for 6 months and then stop this medication.”
“One missed dose will not affect my blood pressure.”
“I may experience occasional chest pain and discomfort.”
“I will not stop taking this drug without the approval of my healthcare provider.
“I will not stop taking this drug without the approval of my healthcare provider.
55
A nurse is caring for a patient prescribed doxazosin [Cardura] for hypertension. Safety is a priority because of which associated adverse effect?
Reflex tachycardia
Heart palpitations
Cardiac dysrhythmias
Orthostatic hypotension
Orthostatic Hypotension
56
The nurse is preparing to administer diltiazem and atenolol. What is the priority nursing intervention before administering these two medications to the patient?
Obtain blood glucose.
Observe for lower leg edema.
Assess the heart rate.
Apply a pulse oximeter.
Assess the heart rate.
57
Prior to discharge, the nurse provides teaching related to adverse effects of terazosin [Hytrin] to the patient and caregivers. Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.)
Headache
Hypoglycemia
Nasal congestion
Erectile dysfunction
Orthostatic hypotension
Headache
Nasal Congestion
Erectile dysfunction
Orthostatic hypotension
58
The nurse cares for a patient with depression who has been prescribed an antidepressant. When would the nurse expect the medication to reach its full therapeutic effect?
In 7 to 10 days
In 2 to 3 weeks
In 2 to 4 months
In 5 to 6 months
In 2 to 3 weeks
59
The nurse receives a phone call from a patient who has been taking a CNS drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best?
“Nausea is not a common side effect of this drug.”
“You should stop taking the medication immediately.”
“Nausea will most likely decrease over time.”
“Try taking the medication on an empty stomach.”
Nausea will most likely decrease over time.”
60
A patient has been taking medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring?
“The medication seems to be working better than it did at first.”
“I feel really sick if I do not take the medication every day.”
“The side effects are not bothering me anymore.”
“The medication does not seem to be working as well.”
The medication does not seem to be working as well.”
61
Which characteristic improves a drug’s ability to reach the central nervous system (CNS)?
Protein binding
Lipid solubility
Electrical charge
Ionization
Lipid Solubility
62
A patient has an infection affecting a central nervous system (CNS) component. Which structure makes the delivery of antibiotic therapy more difficult?
Blood-brain barrier
Chemotherapeutic trigger zone
Neuropeptide receptors
Thalamic synapses
Blood-brain barrier
63
Which neurotransmitter is active in both the peripheral and central nervous systems (CNS)?
Norepinephrine
Serotonin
Substance P
Dynorphins
Norepinephrine
64
The nurse is caring for a patient with depression who takes citalopram [Celexa], an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process?
Adaptive changes in the brain
Drug tolerance and dependence
A wide therapeutic index
Improved neuronal transmission
Adaptive changes in the brain
65
The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures?
Nausea
Sedation
Fatigue
Dry mouth
Sedation
66
The nurse is working with a group of patients receiving drugs that work in the central nervous system (CNS). Nursing care of these patients is based on which facts? (Select all that apply.)
Overall knowledge of the workings of CNS agents is limited.
The CNS has many more neurotransmitters than the periphery.
Animal studies in progress will greatly enhance knowledge of CNS medications.
When CNS drugs are taken long term, their effects differ from initial use.
The blood-brain barrier is permeable to water-soluble drugs.
Overall knowledge of the workings of CNS agents is limited.
The CNS has many more neurotransmitters than the periphery.
When CNS drugs are taken long term, their effects differ from initial use.
67
A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching?
Teach the patient to adjust the dose according to the presence of symptoms.
Tell the patient to take the medication with meals.
Inform the patient about the prevention of gingival hyperplasia.
Teach the patient to avoid the abrupt cessation of treatment.
Teach the patient to avoid the abrupt cessation of treatment.
68
The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question?
Cimetidine [Tagamet]
Captopril [Capoten]
Pantoprazole [Protonix]
Ondansetron [Zofran]
Cimetidine [Tagamet]
69
A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food?
Tomatoes
Grapefruit juice
Spinach
Kiwi fruit
Grapefruit juice
70
The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate?
Tonic-clonic
Absence
Atonic
Myoclonic
Absence
71
The nurse is teaching a patient newly diagnosed with a seizure disorder about her disorder. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication?
“With proper treatment, we can completely eliminate your seizures.”
“Our goal is to reduce your seizures to an extent that helps you live a normal life.”
“Seizure medication does not reduce seizures in most patients.”
“These drugs will help control your seizures until you have surgery.”
“Our goal is to reduce your seizures to an extent that helps you live a normal life.”
72
A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention?
Warn her not to withdraw this drug abruptly.
Recommend that she take this medication at bedtime with meals.
Teach her family to assist by maintaining a seizure frequency chart.
Ensure that genetic testing for HLA-B1502 is performed.
Ensure that genetic testing for HLA-B1502 is performed.
73
The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug?
Increased risk of infection
Reddened, swollen gums
Nausea, vomiting, and indigestion
Central nervous system depressio
Nausea, vomiting, and indigestion
74
The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type?
Tonic-clonic
Absence
Simple partial
Complex partial
Absence
75
The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate?
Continue as planned, because the level is within normal limits.
Tell the patient to hold today’s dose and return to the clinic.
Consult the prescriber to recommend an increased dose.
Have the patient call 911 and meet him/her in the emergency department.
Continue as planned, because the level is within normal limits.
76
Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse?
“The medication should not make me feel sleepy.”
“I should take the medication on an empty stomach.”
“I’ll need to discuss a reliable form of birth control with my gynecologist.”
“I’ll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored.”
“I should take the medication on an empty stomach.
77
Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]?
“Take the medication with a glass of grapefruit juice each morning.”
“Notify the physician if you are gaining weight or your legs are swollen.”
“Nausea, vomiting, and indigestion are common side effects of carbamazepine.”
“Have liver function tests performed on a routine basis.”
Take the medication with a glass of grapefruit juice each morning.”
78
Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity?
Phenytoin [Dilantin] 200 mg IV over 4 minutes
Phenobarbital 30 mg IM
Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min
Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes
Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min
79
Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20?
Primidone [Mysoline]
Lamotrigine [Lamictal]
Lacosamide [Vimpat]
Topiramate [Topamax]
Topiramate [Topamax]
80
Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block?
Lacosamide [Vimpat]
Felbamate [Felbatol]
Tiagabine [Gabitril]
Levetiracetam [Keppra]
Lacosamide [Vimpat]
81
The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.)
Swollen, tender gums
Measles-like rash
Productive cough
Unusual hair growth
Nausea and vomiting
Swollen, tender gums
Measles-like rash
unusual hair growth
82
The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.)
“Be sure to call the clinic if you or your family notice increased anxiety or agitation.”
“You may have some mild sedation. Do not drive until you know how this drug will affect you.”
“This drug may cause easy bruising. If you notice this, call the clinic immediately.”
“It is very important to have good oral hygiene and to visit your dentist regularly.”
“You may continue to have wine with your evening meals, but only in moderation.”
“Be sure to call the clinic if you or your family notice increased anxiety or agitation.”
“You may have some mild sedation. Do not drive until you know how this drug will affect you.”
It is very important to have good oral hygiene and to visit your dentist regularly.”
83
The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.)
The patient complains of excessive facial hair growth.
The patient is walking with a staggering gait.
The patient’s gums are swollen, tender, and bleed easily.
The patient complains of double vision.
The nurse observes rapid back-and-forth movement of the patient’s eyes.
The patient is walking with a staggering gait.
The patient complains of double vision.
The nurse observes rapid back-and-forth movement of the patient’s eyes.
84
After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment?
Respiratory rate
Heart rate
Pain level
Constipation
Respiratory rate
85
A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient?
Methadone [Dolophine]
Nalbuphine [Nubain]
Tramadol [Ultram]
Naloxone [Narcan]
Naloxone [Narcan]
86
A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question?
Promethazine [Phenergan]
Pentazocine [Talwin]
Methylnaltrexone [Relistor]
Dextromethorphan [Delsym]
Pentazocine [Talwin]
87
A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient’s respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering?
Naloxone [Narcan]
Acetylcysteine [Mucomyst]
Methylprednisolone [Solu-Medrol]
Protamine sulfate
Naloxone [Narcan]
88
The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug?
Administering a cough suppressant
Inserting a Foley catheter
Administering an antidiarrheal
Monitoring liver function tests
Inserting a Foley catheter
89
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, “Why am I receiving codeine? I don’t have any pain.” The nurse’s response is based on the knowledge that codeine also has which effect?
Immunostimulant
Antitussive
Expectorant
Decongestant
Antitussive
90
A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects?
The patient should take an antacid with each dose.
The patient should eat foods high in lactobacilli.
The patient should take the medication on an empty stomach.
The patient should increase fluid and fiber in the diet.
The patient should increase fluid and fiber in the diet.
91
The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan?
“You will need to change this patch every day, regardless of your pain level.”
“This type of pain medication is not as likely to cause breathing problems.”
“With the first patch, it will take about 24 hours before you feel the full effects.”
“Use your heating pad for the back pain. It will also improve the patch’s effectiveness.”
“With the first patch, it will take about 24 hours before you feel the full effects.”
92
Which agent is most likely to cause serious respiratory depression as a potential adverse reaction?
Morphine [Duramorph]
Pentazocine [Talwin]
Hydrocodone [Norco]
Nalmefene [Revex]
Morphine [Duramorph]
93
The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting?
At least 30% of the U.S. population is prone to drug addiction and abuse.
The development of opioid dependence is rare when opioids are used for acute pain.
Morphine is a common drug of abuse in the general population.
The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.
The development of opioid dependence is rare when opioids are used for acute pain.
94
A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?
Drowsiness
Tics and tremors
Increased pain
Nausea and vomiting
Increased pain
95
The patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct?
“Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release.”
“Your arm probably hurts because of the fentanyl patch.”
“I can remove your patch and reapply it after you are done with the warm pack.”
“The fentanyl patch is heat resistant, so I will get you a warm pack.”
“Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release.”
96
The nurse teaches a patient about eszopiclone [Lunesta]. Which statement by the patient indicates that the teaching has been effective?
“I should take the drug 1 hour before bedtime.”
“The drug may leave a bitter taste in my mouth.”
“I may experience amnesia with prolonged use.”
“My body may build up a tolerance to this drug.”
“The drug may leave a bitter taste in my mouth.”
97
The nurse instructs a young adult patient about triazolam [Halcion] for the short-term management of insomnia. Which statement, if made by the patient, indicates an understanding of the instructions?
“The medication will not affect my breathing.”
“I can safely drink wine while taking this drug.”
“My chance of addiction to this drug is high.”
“This drug is safe to use if I am pregnant.”
“The medication will not affect my breathing.”
98
A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient?
Protamine sulfate
Acetylcysteine [Acetadote]
Naloxone [Narcan]
Flumazenil [Romazicon]
Flumazenil [Romazicon]
99
Before administering ramelteon [Rozerem] to a patient on the medical unit, which action by the nurse is best?
Assess the patient’s lipid profile.
Administer the medication with a high-fat snack at bedtime.
Observe the patient for physical dependence and abuse.
Consult the prescriber if the patient has chronic hepatitis.
Consult the prescriber if the patient has chronic hepatitis.
100
The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential?
Diazepam [Valium]
Triazolam [Halcion]
Zolpidem [Ambien]
Phenobarbital [Luminal Sodium]
Phenobarbital [Luminal Sodium]
101
The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan?
“When it is time to discontinue this drug, you will need to taper it off slowly.”
“Protect your skin from the sun to prevent rash and exaggerated sunburn.”
“Increase your intake of fluid and high-fiber food to prevent constipation.”
“Take this medication on an empty stomach at least 2 hours after meals
“When it is time to discontinue this drug, you will need to taper it off slowly.”
102
lprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter?
Norepinephrine
Acetylcholine
Serotonin (5-HT)
Gamma-aminobutyric acid (GABA)
GABA
103
Which agent is most likely to be prescribed today for short-term management of insomnia?
Secobarbital [Seconal Sodium]
Meprobamate [Miltown]
Zolpidem [Ambien]
Flumazenil [Romazicon]
Zolpidem [Ambien]
104
The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug?
Morning sedation
A respiratory rate of 30 breaths per minute
Constipation
A blood pressure of 160/88 mm Hg
Morning sedation
105
The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam?
Naloxone [Narcan]
Flumazenil [Romazicon]
Acetylcysteine [Mucomyst]
Vitamin K
Flumazenil [Romazicon]
106
The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct?
“Yes, there is a medication that works with your body’s melatonin and is not a controlled substance.”
“No, all of the sleep medications are controlled substances.”
“There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider.”
“Yes, but it is not for chronic insomnia.”
“Yes, there is a medication that works with your body’s melatonin and is not a controlled substance
107
The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer?
0.25
0.5
1
4
0.25
108
Which statements about zaleplon [Sonata] does the nurse identify as true? (Select all that apply.)
Zaleplon [Sonata] is a benzodiazepine.
Zaleplon [Sonata] is indicated for long-term management of insomnia.
Zaleplon [Sonata] is used to maintain sleep throughout the night.
Zaleplon [Sonata] should not be administered with cimetidine [Tagamet].
Zaleplon [Sonata] interacts with the neurotransmitter GABA.
Zaleplon [Sonata] should not be administered with cimetidine [Tagamet].
Zaleplon [Sonata] interacts with the neurotransmitter GABA
109
When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.)
Benzodiazepines have a high safety profile.
Benzodiazepines have a significant ability to depress central nervous system (CNS) function.
Benzodiazepines are associated with a high suicide potential.
Benzodiazepines have a low ability to cause tolerance.
Benzodiazepines have a low abuse potential.
Benzodiazepines have a high safety profile.
Benzodiazepines have a low ability to cause tolerance.
Benzodiazepines have a low abuse potential.
110
A patient is prescribed venlafaxine [Effexor XR] and requests information about the medication. Which response by the nurse is most appropriate?
“You will need to talk with the doctor about that.”
“Call your pharmacist, because he or she will know the most about this drug.”
“Venlafaxine [Effexor XR] is used to treat anxiety and depression.”
“I will get you a pamphlet so that you can read about the drug.”
“Venlafaxine [Effexor XR] is used to treat anxiety and depression.”
111
The nurse provides teaching for a patient with obsessive-compulsive disorder who has been prescribed Sertraline [Zoloft]. Which statement by the patient indicates that more teaching is necessary?
“I may develop headaches and trouble sleeping.”
“I will feel better in 3 weeks.”
“I need to take this medication for at least a year.”
“I should watch my diet so that I don’t gain weight.”
“I will feel better in 3 weeks.”
112
The nurse is caring for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety?
Fluvoxamine [Luvox]
Paroxetine [Paxil]
Sertraline [Zoloft]
Clonazepam [Klonopin]
Clonazepam [Klonopin]
113
he nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization?
Venlafaxine [Effexor]
Buspirone [BuSpar]
Paroxetine [Paxil]
Alprazolam [Xanax]
Alprazolam [Xanax]
114
The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug?
Diarrhea
Risk for abuse Incorrect
Dizziness
Weight gain
Dizziness
115
A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely?
Panic disorder
Bipolar disorder
Generalized anxiety disorder
Clinical depression
Panic Disorder
116
The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug?
“This medication should not make me feel drowsy.”
“This medication should help me feel less anxious.”
“I will drink grapefruit juice instead of coffee with breakfast.”
“I will take my medication three times per day.”
I will drink grapefruit juice instead of coffee with breakfast.”
117
A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder?
Clonazepam [Klonopin]
Alprazolam [Xanax]
Propranolol [Inderal]
Sertraline [Zoloft]
Propranolol [Inderal]
118
A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful?
“The primary treatment is therapy, but there are some medications that have been somewhat effective.”
“The primary treatment is monotherapy with an SSRI.”
“The primary treatment is a combination of multiple medications.”
“The primary treatment is benzodiazepine for anxiety.”
“The primary treatment is therapy, but there are some medications that have been somewhat effective.”
119
The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? (Select all that apply.)
Depression
Panic disorder
Social anxiety disorder
Post-traumatic stress disorder
Obsessive-compulsive disorder
Depression
Panic disorder
Social anxiety disorder
Obsessive-compulsive disorder
120
The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? (Select all that apply.)
Fluoxetine [Prozac]
Venlafaxine [Effexor XR]
Paroxetine [Paxil]
Escitalopram [Lexapro]
Duloxetine [Cymbalta]
All expect Fluoxetine
