Pharmacology Exam 2 Questions and Answers,100% CORRECT

Pharmacology Exam 2 Questions and Answers Ch 10-15 PPT Questions 1. A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain? a. Somatic pain ...

Pharmacology Exam 2 Questions and Answers Ch 10-15 PPT Questions 1. A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain? a. Somatic pain b. Referred pain c. Visceral pain d. Neuropathic pain 2. A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern? a. Pulse b. Blood pressure c. Temperature d. Respirations 3. A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. What do the nurse’s actions reflect? a. Appropriate concern for the patient’s best welfare b. Appropriate caution for a patient who is already on a long-term opioid c. An uncaring attitude toward the patient d. A failure to manage the patient’s pain properly 4. A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be a. 1000 mg. b. 2000 mg. c. 3000 mg. d. 4000 mg. 5. The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the a. administration of minimal doses of multiple anesthetic drugs. b. administration of inhaled anesthetics. c. intravenous (IV) administration of anesthetics. d. administration of anesthetics to cause muscle relaxation. 6. When assessing a patient under general anesthesia, which change to organ systems does the nurse expect? a. Nystagmus b. Skeletal muscle contraction c. Hypertension d. Decreased intracranial pressure 7. During surgery, the anesthetist notes that the patient’s heart rate is gradually increasing and becoming more irregular, the patient’s blood pressure is becoming unstable, and the patient is starting to sweat profusely. What other assessment should the anesthetist note immediately? a. Pupillary reactions b. Respiratory effort c. Temperature d. Urinary output 8. Which statement regarding conscious sedation does the nurse identify as being accurate? a. The IV route of drug administration is commonly used in pediatric patients to provide conscious sedation. b. Mild amnesia is a common effect of midazolam. c. Patients receiving conscious sedation must be intubated with an endotracheal tube. d. Effects of propofol include relief of anxiety and pain 9. When teaching a patient about spinal headaches, which statement will the nurse include? a. “Spinal headaches can be prevented with bed rest after the epidural procedure.” b. “Patients who have a spinal headache should have very limited fluid intake.” c. “A graft of skin from the patient’s hand can be used to seal the leaking area causing the headache.” d. “High Fowler’s positioning should be used for patients who have a spinal headache.” 10. A patient is to receive a NMBD while on mechanical ventilation. While the patient is receiving this medication, the nurse should expect the patient to be a. Sedated. b. resisting the ventilator. c. awake but unable to move. d. pain free. 11. A patient in the ICU will be receiving an NMBD. Which piece of equipment is essential to have nearby when the nurse initiates this therapy? a. Defibrillator b. Sphygmomanometer c. Mechanical ventilator d. Oxygen source 12. When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information? a. These medications have little effect on the normal sleep cycle. b. Using this medication may cause drowsiness the next day. c. It is safe to drive while taking this medication. d. These drugs are safe to use with alcohol. 13. Barbiturates have a low therapeutic index. How does the nurse interpret this? a. Low doses are not therapeutic. b. The toxic range is narrow. c. They are habit forming. d. The effective, safe dosage range is narrow. 14. An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, what should the nurse expect? a. A decrease in dosages of the other medications b. The patient will experience increased amounts of REM sleep c. To administer half of the usual dose of the barbiturate d. Total relief of anxiety 15. Which statement regarding muscle relaxants does the nurse identify as being accurate? a. Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device. b. Cyclobenzaprine (Flexeril) produces little sedation. c. Patients taking muscle relaxants are at high risk of developing hypertension. d. Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy. 16. A patient comes to the health care provider’s office with complaints of feeling anxious and having difficulty sleeping. The patient tells the nurse that he wants to start taking valerian and Kava because he heard that these work well to help the problems he is experiencing. The patient has the following questions about valerian and Kava. What is the best response by the nurse? a. The patient asks, “Is there anything I have to worry about when taking Kava?” The best response by the nurse is: i. “Kava is a natural product which has no side effects.” ii. “You need a prescription to take Kava.” iii. “No worries, Kava is recommended for patients with depression.” iv. “It is best to inform your health care provider of any additional medication or supplements you plan to take to check for interactions that may be harmful.” 17. The patient tells the nurse that his friend has been taking valerian for a long period of time and that he isn’t feeling so well. The patient asks the nurse what the adverse effects of valerian are. a. What adverse effect with valerian would the nurse discuss with the patient? i. Insomnia ii. Yellow skin iii. Bruising iv. Increased appetite 18. A teenage boy will be receiving atomoxetine (Strattera) as part of treatment for ADHD. Which statement about this drug therapy is accurate? a. Strattera is highly addictive. b. Psychotherapy is rarely helpful in cases of ADHD. c. The patient should be monitored for possible suicidal thoughts and behavior. d. Strattera is used to treat narcolepsy as well as ADHD. 19. A patient wants to take Orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects? a. Restrict dietary intake of fat. b. Restrict dietary intake of fiber. c. Increase intake of dairy products. d. Avoid intake of carbonated beverages. 20. What is important for the nurse to assess the patient’s history before administering a serotonin agonist? a. Hypertension b. Allergy to penicillin c. Chronic bronchitis d. Cataracts 21. A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching? a. “Take the medication with your evening meal.” b. “You will need to take this drug for at least 2 years.” c. “If you develop a dry mouth, stop taking the drug immediately.” d. “Avoid intake of caffeine.” 22. A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse is correct when recognizing autoinduction as which response? a. Toxic levels of carbamazepine (Tegretol) b. Lower than expected drug levels c. Gingival hyperplasia d. Cessation of seizure activity 23. The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. What does the nurse suspect? a. The patient is unaware of his own disease history. b. The patient has been taking his wife’s medication by mistake. c. The patient may be taking this drug for neuropathic pain. d. The patient is reluctant to admit to having a seizure disorder. 24. Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? a. High white blood cell count b. Low serum albumin levels c. Low platelet levels d. High hemoglobin levels 25. A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 μg/mL. Which administration technique will the nurse use? a. Administer the drug by rapid IV push. b. Infuse slowly, not exceeding 50 mg/min. c. Mix the medication with dextrose solution. d. Administer via continuous infusion. 26. Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy? a. If you feel sleepy when taking the drug, decrease the dose by half. b. Take the drug on an empty stomach. c. Call your health care provider if you experience a sore throat or fever. d. Patients with epilepsy are not able to hold a job and work, so you should apply for benefits. 27. How can the nurse best explain the “off-on phenomenon” that some patients with PD experience? a. The need to take a drug holiday to improve response to medications b. The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms c. The alternating schedule of medications needed to control PD d. The fluctuation of emotions that often occurs with PD 28. Which drug used for the management of the patient with PD is most likely to cause postural hypotension? a. Amantadine (Symmetrel) b. Selegiline (Eldepryl) c. Tolcapone (Tasmar) d. Entacapone (Comtan) 29. When providing teaching to a patient receiving an anticholinergic for the treatment of PD, the nurse will include which information? a. Take the medication first thing in the morning. b. Limit fluid intake when taking this drug. c. The tremors you experience will be reduced within 24 hours of taking this drug. d. Do not take this medication at the same time as other medications. 30. A patient has been diagnosed with PD. Medication therapy is started for this patient. a. What teaching should the nurse include to the patient and caregiver regarding pharmacologic therapy of PD? i. The medication should be stopped when the patient’s symptoms improve. ii. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. iii. A common side effect of anticholinergics is drooling. iv. Improvements in symptoms are expected within 5 days of medication therapy. 31. The patient diagnosed with PD has been started on dopaminergic replacement drug therapy with carbidopa-levodopa. a. What is a priority action for the nurse? i. Assess the patient for dizziness and syncope when the patient is walking. ii. Administer the medication first thing in the morning. iii. Administer the medication on an empty stomach. iv. Omit protein from the patient’s diet. 32. The patient has now been ordered an oral disintegrating form of the MAO-B inhibitor drug selegiline. a. What should the nurse consider when administering this drug? i. Tell the patient to take the medication with liquids. ii. Tell the patient to take the medication with a meal. iii. Assess the patient for hypertension, a common side effect of this medication. iv. Tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted. Ch 16-21 PPT Questions 1. Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value? a. Blood sugar b. Sodium c. Urine osmolality d. Hematocrit 2. When patients are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks of therapy? a. Hypertensive crisis b. Suicidal thoughts c. Convulsions d. Orthostatic hypotension 3. When providing teaching for a patient who is prescribed a selective SSRI, which statement will the nurse include? a. The SSRI will work faster than the older tricyclic antidepressants. b. The SSRI will have an immediate beneficial effect on the patient’s depression symptoms. c. The SSRI will not work well for severe cases of depression. d. The SSRI may take several weeks to have a beneficial effect. 4. A patient is admitted to the emergency department. The patient’s heart rate is 112 beats/min. He is sweating and has muscle tremors and is agitated. The patient says, “I was depressed and took more of the pills the doctor gave me so I would feel better.” a. What does the nurse suspect is happening with this patient? 5. What treatment does the nurse expect to implement? 6. The patient was admitted to the hospital for observation and has now recovered. a. Which information will the nurse include in patient teaching about SSRIs? i. It usually takes 4 to 6 weeks until you will experience benefits from the medication. ii. The patient must avoid foods that contain tyramine. iii. If the patient develops an upset stomach when taking this medication, he should discontinue use. iv. The patient should take the medication at bedtime to enhance sleep. 7. Several months later, the patient returns to the health care provider’s office for follow-up regarding use of the SSRI. The patient tells the nurse that he is feeling better and stopped taking the SSRI yesterday. He doesn’t plan on taking the medication again. a. When talking with the patient, which knowledge should guide the nurse’s response? i. Drug dependency will develop, so it is appropriate to stop therapy after a few months. ii. Drug therapy must be stopped as soon as the patient feels better to avoid serotonin syndrome. iii. The patient is the best person to determine when the drug therapy should end. iv. A 1- to 2-month taper period is indicated to prevent adverse effects of abrupt drug discontinuation. 8. Which drug will the nurse anticipate administering to a patient experiencing benzodiazepine overdose? a. Flumazenil b. Naltrexone c. Vivitrol d. Flunitrazepam 9. A patient with a diagnosis of delirium tremens is admitted to the acute care facility. Which finding does the nurse expect upon assessment of the patient? a. Hyperthermia b. Hypotension c. Bradycardia d. Somnalence 10. Which statement does the nurse include when teaching a patient about disulfiram (Antabuse) therapy? a. “Disulfiram (Antabuse) will cure your alcoholism if you take it as directed.” b. “If you drink alcohol after taking disulfiram (Antabuse), your blood pressure will get very high.” c. “You cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse).” d. “If you miss a dose of disulfiram (Antabuse), double the dose the next time it is due.” 11. The nurse is explaining the differences between transdermal nicotine and nicotine gum programs. Which statement by the nurse is correct? a. “The nicotine patch will give you quick relief from cravings.” b. “Chewing the gum rapidly will release an immediate dose of nicotine.” c. “It seems that patients have better treatment compliance with the gum than the patch.” d. “The dose of nicotine in the gum is approximately twice the dose the average smoker receives in one cigarette.” 12. A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator; the other is a corticosteroid. Which inhaler should the patient take first? a. The bronchodilator b. The corticosteroid c. It does not matter which one is taken first. 13. A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time? a. Albuterol b. Salmeterol c. Fluticasone d. Salmeterol and fluticasone combination (Advair Diskus) 14. A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first? a. Slow the intravenous infusion. b. Stop the intravenous infusion. c. Inject the area with phentolamine. d. Notify the physician health care provider. 15. A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first? a. Check the infusion site for possible extravasation. b. Increase the infusion rate. c. Check the patient’s vital signs. d. Order an electrocardiogram. 16. A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. What is the nurse’s immediate assessment priority? a. Determine the time of the child’s last meal. b. Monitor Spo2 with a pulse oximeter. c. Monitor the child’s temperature. d. Provide education on asthma management. 17. A patient has two inhalers that are due to be taken at the same time. One is a bronchodilator; the other is a corticosteroid. Which inhaler should the patient take first? a. The bronchodilator b. The corticosteroid c. It does not matter which one is taken first. 18. A patient is experiencing bronchospasms after running half a mile. He has several inhalers with him. Which one would be appropriate for treatment at this time? a. Albuterol b. Salmeterol c. Fluticasone d. Salmeterol and fluticasone combination (Advair Diskus) 19. A patient on a dobutamine drip starts to complain that her intravenous line “hurts.” The nurse checks the insertion site and sees that the area is swollen and cool. What will the nurse do first? a. Slow the intravenous infusion. b. Stop the intravenous infusion. c. Inject the area with phentolamine. d. Notify the physician health care provider. 20. A patient on a dobutamine drip starts to complain that he feels a “tightness” in his chest that he had not felt before. What will the nurse do first? a. Check the infusion site for possible extravasation. b. Increase the infusion rate. c. Check the patient’s vital signs. d. Order an electrocardiogram. 21. A 10-year-old child is brought to the emergency department while having an asthma attack. She is given a nebulizer treatment with albuterol. What is the nurse’s immediate assessment priority? a. Determine the time of the child’s last meal. b. Monitor Spo2 with a pulse oximeter. c. Monitor the child’s temperature. d. Provide education on asthma management. 22. When phentolamine is used to diagnose the presence of pheochromocytoma, the nurse will assess for what indicative finding? a. Rapid decrease in blood pressure b. Steady increase in blood pressure c. Slower heart rate d. Reduced cardiac ectopy 23. When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development of what adverse effect? a. Renal failure b. Hypotension c. Blood dyscrasia d. Dysrhythmias 24. A 58-year-old patient is recovering in the intensive care unit after a myocardial infarction (MI). The nurse notes an order for the beta blocker metoprolol (Lopressor). What is the purpose of this drug? a. Dilate the coronary arteries. b. Inhibit stimulation of the myocardium by circulating catecholamines. c. Provide a positive inotropic effect. d. Maintain the patient’s BP. 25. The nurse knows that the adverse effects of a nonselective beta blocker are likely to be the most immediately life threatening in which patient? a. Patient with type I diabetes b. Patient with asthma c. Patient with gastroesophageal reflux disease d. Patient with hypertension 26. A patient with type 2 diabetes is taking a beta blocker as part of treatment for hypertension. Which complication is most likely to develop? a. Hypertension b. Hyperkalemia c. Hypoglycemia d. Angina 27. The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin and orthostatic blood pressure changes and is complaining of abdominal cramps and nausea. What is the patient most likely experiencing? a. Early signs of a cholinergic crisis b. Late signs of a cholinergic crisis c. An allergic reaction to the drug d. Expected adverse effects 28. A 60-year-old woman asks the nurse about taking ginkgo to help with her memory. The patient has a history of arthritis, type 2 diabetes, thyroid disease, and hypertension. She is currently taking NSAIDs for arthritis, oral antidiabetic medications, thyroid replacement hormone, and a beta blocker for blood pressure. What potential adverse effect from the gingko would be of most concern for this patient? a. Stomach upset b. Diarrhea c. Bleeding d. Drowsiness 29. A patient is scheduled to have lunch at 1200. The nurse will administer the pyridostigmine (Mestinon) at what time for optimal therapeutic effect? a. 1100 b. 1130 c. 1200 d. 1230 30. A patient with Alzheimer’s disease accidentally took 2 weeks’ worth of a cholinergic medication. He is brought to the emergency department, is going into shock, and experiencing severe hypotension and vomiting. The nurse will expect which initial treatment? a. Administration of physostigmine b. Administration of atropine c. Administration of epinephrine d. Cardiovascular support with dopamine 31. MJ is a 36 y/o female who was diagnosed with myasthenia gravis 4 years ago. She recently went through a divorce and has been under significant emotional stress the last few months. MJ presents to the ED with sudden onset of muscle weakness, drooling, and inability to articulate words. a. After the ABCs are stabilized, what history should the nurse gather from MJ? 32. To differentiate between disease exacerbation and cholinergic crisis, what medication would the nurse anticipate administering? 33. If the prescriber suspects the patient is experiencing disease exacerbation, how would the patient respond to this medication management? 34. What reversal agent should the nurse have available when giving the medication selected in question 2? 35. Which finding would the nurse anticipate when assessing a patient with an atropine overdose? a. Moist skin b. Miosis c. Bradycardia d. Urinary retention 36. Glycopyrrolate (Robinul) and an opioid are administered to a patient before surgery in the preoperative area. What is the intended effect of the glycopyrrolate (Robinul)? a. Potentiate the action of the opioid. b. Assist the patient in retaining urine during surgery. c. Control secretions during surgery. d. Prevent nausea. 37. Before administering tolterodine (Detrol), it is most important for the nurse to assess the patient for a history of which condition? a. Angle-closure glaucoma b. Cataracts c. Hypothyroidism d. Hyponatremia CH 10 Questions 1. A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain 2. An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? a. Synthetic opioid, such as meperidine (Demerol) b. Opium alkaloids, such as morphine sulfate c. Opioid antagonist, such as naloxone HCL (Narcan) d. Nonopioid analgesic, such as indomethacin (Indocin) 3. A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement 4. A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient’s pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance 5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach 6. A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome 7. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy 8. A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy 9. The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery 10. A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer 11. A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures 12. The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min 13. The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. They have a higher potency than agonists. d. They have a lower dependency potential than agonists. 14. The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease 15. A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. “It would be best for you not to take anything if you are planning to drive your truck.” b. “We will discuss with your doctor about taking an opioid because that would work best for your pain.” c. “You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.” d. “You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.” 16. A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient’s medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia 17. Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching Ch 11 Questions 1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure? a. No anesthesia b. Topical benzocaine spray on the area c. Topical prilocaine (EMLA) cream around the site d. Infiltration of the puncture wound with lidocaine 2. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem? a. Tachyphylaxis b. Postoperative infection c. Malignant hypertension d. Malignant hyperthermia 3. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? a. The 21-year-old patient who has never had surgery before b. The 35-year-old patient who stopped smoking 8 years ago c. The 40-year-old patient who is to have a kidney stone removed d. The 82-year-old patient who is to have gallbladder removal 4. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient? a. Anxiety related to the use of an anesthetic b. Risk for injury related to increased sensorium from general anesthesia c. Decreased cardiac output related to systemic effects of local anesthesia d. Impaired gas exchange related to central nervous system depression produced by general anesthesia 5. When administering a neuromuscular blocking drug, the nurse needs to remember which principle? a. It is used instead of general anesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anesthetics. d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles. 6. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation? a. Local anesthesia b. Moderate sedation c. Topical anesthesia d. Spinal anesthesia 7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment? a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant c. An anticholinesterase drug, such as neostigmine d. Cardiopulmonary resuscitation (CPR) and intubation 8. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.) a. Procedural sedation b. Surgeries of short duration c. Surgeries of long duration d. Postoperative anxiety e. Sedation of mechanically ventilated patients Ch 12 Questions 1. A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam (Valium) b. Zolpidem (Ambien) c. Phenobarbital d. Cyclobenzaprine (Flexeril) 2. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that “the least little thing” bothers him now. Which is the correct explanation for this problem? a. These are adverse effects that usually subside after a few weeks. b. The drug must be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress. 3. A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. d. He developed an allergy to the drug. 4. A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels “so tired.” Which explanation by the nurse is correct? a. “Long-term use of this drug results in a sedative effect.” b. “If you take the drug every night, this hangover effect will be reduced.” c. “These drugs affect the sleep cycle, resulting in daytime sleepiness.” d. “These drugs increase the activity of the central nervous system, making you tired the next day.” 5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for injury related to decreased sensorium b. Risk for addiction related to psychologic dependency c. Decreased fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug’s interference with REM sleep 6. A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime 7. A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist 8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this medication is contraindicated in which disorder? a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia 9. The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation 10. A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital (Seconal), a barbiturate b. Diazepam (Valium), a benzodiazepine c. Midazolam (Versed), a benzodiazepine d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid 11. A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? a. “I will not drink wine with the kava tea.” b. “If I notice my skin turning yellow, I will stop taking the tea.” c. “I will not take sleeping pills if I have this tea in the evening.” d. “I will be able to drive my car after drinking this tea.” 12. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus 13. The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient’s current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin Ch 13 Questions 1. A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones 2. A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some “embarrassing” adverse effects. She tells the nurse that she has had episodes of “not being able to control my bowel movements.” Which statement is true about this situation? a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects. 3. A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be “in his system” when he goes to school the next morning. What is the nurse’s appropriate evaluation of the mother’s actions? a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia. 4. A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to “make it through” the end of the semester and exam week. She is in the university clinic today because she is “exhausted.” What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Disturbed sleep pattern d. Imbalanced nutrition: less than body requirements 5. A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? a. Eye examination b. Height and weight c. Liver function studies d. Hearing test 6. When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity 7. The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. “I will take this medication regularly to prevent a migraine headache from occurring.” b. “I will take this medication when I feel a migraine headache starting.” c. “This medication does not reduce the number of migraines I will have.” d. “I will keep a journal to record the headaches I have and how the injections are working.” 8. The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression 9. A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. Take this medication after meals. b. Take this medication in the morning. c. This drug is taken along with supervised exercise and suitable diet. d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. e. Avoid foods that contain caffeine, such as coffee, tea, and colas. Ch 14 Questions 1. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a. Levetiracetam (Keppra) b. Phenobarbital c. Valproic acid (Depakote) d. Gabapentin (Neurontin) 2. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions? a. “I will need to take extra care of my teeth and gums while on this medication.” b. “I can go out for a beer while on this medication.” c. “I can skip doses if the side effects bother me.” d. “I will be able to stop taking this drug once the seizures stop.” 3. When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. “Driving is allowed after 2 weeks of therapy.” b. “If seizures recur, take a double dose of the medication.” c. “Antacids can be taken with the AED to reduce gastrointestinal adverse effects.” d. “Regular, consistent dosing is important for successful treatment.” 4. A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin? a. Give the same dose intravenously. b. Give the morning dose with a small sip of water. c. Contact the prescriber for another dosage form of the medication. d. Notify the operating room that the medication has been withheld. 5. The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur? a. The drug levels for carbamazepine are higher than expected. b. The drug levels for carbamazepine are lower than expected. c. The patient is experiencing fewer seizures. d. The patient is experiencing toxic effects from the drug 6. The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug? a. Give the dose as a fast intravenous (IV) bolus. b. Mix the drug with normal saline, and give it as a slow IV push. c. Mix the drug with dextrose (D5W), and give it as a slow IV push. d. Mix the drug with any available solution as long as the administration rate is correct. 7. The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? a. Increased risk of suicidal thoughts and behaviors b. Signs of bone marrow depression c. Indications of drug addiction and dependency d. Increased risk of cardiovascular events, such as strokes 8. A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a. Diazepam (Valium) b. Midazolam (Versed) c. Valproic acid (Depakote) d. Carbamazepine (Tegretol) 9. Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these? a. The safe and the toxic plasma levels of the drug are very close to each other. b. The phenytoin has a low chance of being effective. c. There is no difference between safe and toxic plasma levels. d. A very small dosage can result in the desired therapeutic effect. 10. A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse’s best response? a. “He is taking another antiepileptic drug, so he can go without the medication for a week.” b. “Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.” c. “He can temporarily increase the dosage of his other antiseizure medications until you get the refill.” d. “He can stop all medications because he has been treated for several years now.” 11. During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any? a. The patient is at risk for seizures because the drug level is not at a therapeutic level. b. The patient’s seizures should be under control because this is a therapeutic drug level. c. The patient’s seizures should be under control if she is also taking a second antiepileptic drug. d. The drug level is at a toxic level, and the dosage needs to be reduced. 12. A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order? a. The medication is used for the treatment of neuropathic pain. b. The medication is helpful for the treatment of multiple sclerosis. c. The medication is used to reduce the symptoms of Parkinson’s disease. d. The medical record is missing the correct information about the patient’s history of seizures. 13. The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.) a. AED therapy can be stopped when seizures are stopped. b. AED therapy is usually lifelong. c. Consistent dosing is the key to controlling seizures. d. A dose may be skipped if the patient is experiencing adverse effects. e. Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity. Ch 15 Questions 1. A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did the patient most likely experience? a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset 2. A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact? a. Carbidopa allows for larger doses of levodopa to be given. b. Carbidopa prevents the breakdown of levodopa in the periphery. c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system. 3. When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the nurse should include which information in the teaching plan? a. Minimize the amount of fluid taken while on this drug. b. Discontinue the medication if adverse effects occur. c. Take the medication on an empty stomach to enhance absorption. d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth. 4. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living 5. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication? a. Drowsiness, headache, weight loss b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention 6. The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)? a. Glaucoma b. Seizure disorder c. Liver failure d. Benign prostatic hyperplasia 7. The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient? a. Diarrhea b. Urinary retention c. Risk for infection d. Disturbed sleep pattern 8. A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class? a. It has a shorter duration of action. b. It causes less gastrointestinal distress. c. It has a slower onset than traditional Parkinson’s disease drugs. d. It is associated with fewer wearing-off effects. 9. A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation? a. This is a harmless effect of the drug. b. The patient has taken this drug along with red wine or cheese. c. The patient is having an allergic reaction to the drug. d. The ordered dose is too high for this patient 10. While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which finding? a. Rigid, tense muscles b. Difficulty in performing voluntary movements c. Limp extremities with weak muscle tone d. Confusion and altered mental status 11. When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason? a. There are rapid swings in the patient’s response to levodopa. b. The patient cannot tolerate the medications at times. c. The medications begin to lose effectiveness against Parkinson’s disease. d. The patient’s liver is no longer able to metabolize the drug. 12. When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.) a. Angle-closure glaucoma b. History of malignant melanoma c. Hypertension d. Benign prostatic hyperplasia e. Concurrent use of monoamine oxidase inhibitors (MAOIs) Ch 16 Questions 1. The nurse reads in the patient’s medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder 2. Before beginning a patient’s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs 3. When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia 4. A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation 5. A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem?” Which advice from the nurse is correct? a. “You can drink beer as long as you have a designated driver.” b. “Now that you’ve had the last dose of that medication, there will be no further dietary restrictions.” c. “If you begin to experience a throbbing headache, rapid pulse, or nausea, you’ll need to stop drinking.” d. “You need to avoid all foods that contain tyramine, including beer, while taking this medication.” 6. A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels. 7. A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. “I can’t sleep at night.” b. “I feel hungry all the time.” c. “Look at how red my hands are.” d. “My mouth has been so dry lately.” 8. A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John’s wort. Which response by the nurse is appropriate? a. “That should be no problem.” b. “Good idea! Hopefully you’ll be able to stop taking the Zoloft.” c. “Be sure to stop taking the herb if you notice a change in side effects.” d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.” 9. While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite 10. A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding 11. The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started that new medicine for his depression, and there’s no change! What’s wrong with him?” What is the nurse’s best response? a. “The medication may not be effective for him. He may need to try another type.” b. “It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.” c. “It sounds like the dose is not high enough. I’ll check about increasing the dosage.” d. “Some patients never recover from depression. He may not respond to this therapy.” 12. Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a. The patient needs to avoid caffeine while on this drug. b. The patient needs to wear sunscreen while outside because of photosensitivity. c. Long-term therapy may result in nervousness and excitability. d. The medication may be taken with an antacid to reduce gastrointestinal upset. 13. The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey 14. A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b. Palpitations and anxiety c. Dry mouth d. Constipation 15. The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants. 16. A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of “feeling so badly” when he started taking an over-the-counter St. John’s wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation 17. Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur. Ch 17 Questions 1. A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct? a. “It’s possible that these cravings will never stop.” b. “These cravings may persist for several months.” c. “The cravings tell us that you are still using nicotine.” d. “The cravings show that you are about to experience nicotine withdrawal.” 2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? a. Diazepam (Valium) b. Methadone c. Disulfiram (Antabuse) d. Bupropion (Zyban) 3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? a. Naltrexone prevents the cravings for opioid drugs. b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost. 4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is the slang term for which substance? a. Cocaine b. Flunitrazepam c. Secobarbital d. Methamphetamine 5. A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance? a. Opioids b. Alcohol c. Stimulants d. Depressants 6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition? a. Renal failure b. Cerebrovascular accident c. Korsakoff’s psychosis d. Alzheimer’s disease 7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy? a. He should not smoke cigarettes while on this drug. b. He needs to know about the common over-the-counter substances that contain alcohol. c. This drug will cause the same effects as the alcohol did, without the euphoric effects. d. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts. 8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true? a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b. Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c. Compliance with treatment is higher with use of the gum rather than the transdermal patch. d. The nicotine gum can be used only up to six times per day. 9. A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.) a. This drug is available as a chewing gum that can be taken to reduce cravings. b. Use caution when driving because drowsiness may be a problem. c. There have been very few adverse effects reported for this drug. d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur. e. Avoid caffeine while on this drug 10. A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.) a. Euphoria b. Severe vomiting c. Diarrhea d. Pulsating headache e. Difficulty breathing f. Sweating 11. The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Systolic blood pressure higher than 200 mm Hg e. Temperature over 100° F (37.7° C) f. Pulse rate 110 beats/min Ch 18 Questions 1. The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system 2. When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic 3. When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis 4. An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety 5. The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia 6. A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse’s immediate concern for this patient? a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better. 7. A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? a. “It takes time for a therapeutic response to develop.” b. “She is too young for this particular medication; it will be changed.” c. “She needs to take up to two puffs every 4 hours to ensure adequate blood levels.” d. “This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms.” 8. A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition? a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine 9. The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta1 adrenergic c. Beta2 adrenergic d. Alpha1 adrenergic 10. The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump 11. The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis Ch 19 Questions 1. During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring? a. The patient is experiencing an allergic reaction. b. The patient may be developing heart failure. c. More time is needed for the patient to see a therapeutic response to the drug. d. The patient is experiencing expected adverse effects of the drug. 2. A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug? a. Never stop taking this medication abruptly. b. The medication will be stopped once symptoms subside. c. If adverse effects occur, stop taking the drug for 24 hours, and then resume. d. Be watchful for first-dose hypotension. 3. During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation? a. It neutralizes the extravasated dobutamine immediately. b. It causes arterial vasoconstriction and reduced pain and swelling at the site. c. It increases peripheral vascular resistance and reduces arterial pressure at the site. d. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage. 4. A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. “I don’t have high blood pressure—why did my doctor give me this medicine?” Which explanation by the nurse is correct? a. “This medication will prevent blood clots that may lead to another heart attack.” b. “Beta blockers will improve blood flow to the kidneys.” c. “This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack.” d. “Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack.” 5. The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these? a. Fluids need to be restricted while on this medication. b. Take the medication with breakfast to promote the maximum effects of the drug. c. Get up slowly from a sitting or lying position. d. Blood pressure must be monitored because the medication may cause hypertension. 6. The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication? a. Angina b. Hypertension c. Glaucoma d. Asthma 7. A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient? a. Atenolol (Tenormin) b. Carvedilol (Coreg) c. Acebutolol (Sectral) d. Esmolol (Brevibloc) 8. During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to: a. notify his prescriber. b. reduce the dose of his beta blocker by half. c. continue the medication because this is an expected effect. d. skip the medication dose that day, and check his pulse again the next day. 9. A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an “embarrassing problem.” What problem did the patient most likely experience with this medication that caused him to stop taking it? a. Urge incontinence b. Dizziness when standing up c. Excessive flatus d. Impotence 10. A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug? a. Levothyroxine (Synthroid) for hypothyroidism b. Sildenafil (Viagra), an erectile dysfunction medication c. Omeprazole (Prilosec), a proton pump inhibitor d. Low-dose aspirin for stroke prevention 11. A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect? a. Orthostatic hypotension b. Increased blood pressure c. Decreased urine flow d. Discolored urine 12. A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? (Select all that apply.) a. Diuretics b. Anticholinergics c. Penicillins d. Oral hypoglycemics e. Alcohol f. Anticoagulants Ch 20 Questions 1. When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect? a. Bradycardia b. Tachycardia c. Vasoconstriction d. Palpitations 2. The nurse notes in a patient’s medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder? a. Anticholinergic poisoning b. Glaucoma c. Bladder atony d. Myasthenia gravis 3. A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote? a. Atenolol (Tenormin) b. Bethanechol (Urecholine) c. Dobutamine d. Atropine sulfate 4. A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect? a. Decreased pulse rate b. Abdominal cramping c. Passage of flatus d. Decreased urge to void 5. A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching? a. Take the medication with meals to avoid gastrointestinal distress. b. Give daytime doses close together for maximal therapeutic effect. c. Take the medication 30 minutes before eating to improve swallowing and chewing. d. Take the medication only if difficulty swallowing occurs during a meal. 6. A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug? a. Pilocarpine (Salagen) b. Bethanechol (Urecholine) c. Physostigmine (Antilirium) d. Tacrine (Cognex) 7. The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug’s expected action? a. Prevents memory loss in later stages b. Reverses the course of Alzheimer’s disease c. Provides sedation to prevent agitation and restlessness d. May help to improve the mood and decrease confusion 8. A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer’s disease. Her daughter calls the prescriber’s office and is upset because “Mother has not improved one bit!” Which response by the nurse is appropriate? a. “Increase the dosage to twice daily.” b. “It takes time for the cure to take effect.” c. “It may take up to 6 weeks to see an improvement.” d. “Take the medication on an empty stomach for improved absorption.” 9. A patient who has been diagnosed with Sjögren’s syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect? a. Reduction of salivation b. Stimulation of salivation c. Reduction of gastrointestinal peristalsis d. Improvement of fine-motor control 10. The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors? a. Muscarinic b. Nicotinic c. Cholinergic d. Ganglionic 11. A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo (Ginkgo biloba) to “help my memory.” He states that he has read much information about the herbal product. Which statement by the patient indicates a need for further education? a. “I know the FDA has not approved this herbal product, but I’d like to try it to see if it helps my memory.” b. “I need to watch for possible side effects, such as headaches, or stomach or intestinal upset.” c. “I will take aspirin or ibuprofen (Motrin) if I have a headache.” d. “Ginkgo may cause increased bleeding, so I’ll have to be careful when doing yard work.” 12. A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease? a. Parkinson’s disease b. Multiple sclerosis c. Myasthenia gravis d. Alzheimer’s disease 13. A cholinergic drug is prescribed for a patient. The nurse checks the patient’s medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.) a. Bladder atony b. Gastrointestinal obstruction c. Bradycardia d. Alzheimer’s disease e. Hypotension f. Chronic obstructive pulmonary disease Ch 21 Questions 1. The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect? a. Tachycardia b. Bradycardia c. Ectopic beats d. Cardiac standstill 2. A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient’s medical history, which condition, if present, would be considered a contraindication to therapy with this drug? a. Diarrhea b. Hypertension c. Neurogenic bladder d. Uncontrolled angle-closure glaucoma 3. The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system 4. A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer? a. Atenolol (Tenormin) b. Bethanechol (Urecholine) c. Dicyclomine (Bentyl) d. Physostigmine (Antilirium) 5. A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy? a. Drowsiness may interfere with his outdoor activities. b. Increased salivation may occur during exercise and outside activities. c. Fluid volume deficits may occur as a result of an increased incidence of diarrhea. d. He will need to take measures to reduce the occurrence of heat stroke during his activities. 6. The nurse will monitor for which adverse effect when administering an anticholinergic drug? a. Excessive urination b. Diaphoresis c. Dry mouth d. Pupillary constriction 7. The nurse is reviewing a patient’s medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication? a. Irritable bowel disease b. Induction of mydriasis c. Urge incontinence d. Reduction of secretions preoperatively 8. A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine? a. The newer cholinergic-blocker drugs are more effective. b. It helps reduce urinary retention. c. It can be used in patients with narrow-angle glaucoma. d. The incidence of dry mouth is much lower with darifenacin. 9. The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is the purpose of this drug in the preoperative setting? a. Control the heart rate b. Relax the patient c. Reduce urinary frequency d. Reduce oral and gastrointestinal secretions 10. In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication? a. Miosis b. Mydriasis c. Increased intraocular fluid production d. Enhanced tear production 11. A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used for which condition? a. Angina b. Chronic pain c. Hypertension d. Motion sickness 12. The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.) a. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min b. A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/min c. A patient with severe narrow-angle glaucoma d. A patient who is about to have surgery e. A patient newly diagnosed with myasthenia gravis f. A patient with anticholinesterase inhibitor poisoning Ch 10-15 PPT Answers 1. ANS: A a. Somatic pain, which includes bone pain, originates from the skeletal muscles, ligaments, and joints. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Visceral pain originates from organs and smooth muscles. Neuropathic pain usually results from damage to peripheral or CNS nerve fibers or injury, but may also be idiopathic. 2. ANS: D a. This patient has a history of asthma and allergies, and she will be receiving a drug that can depress respirations. 3. ANS: D a. Patients with severe pain, including metastatic pain or bone pain, may need higher and higher doses of analgesics. The nurse is responsible for ensuring that the patient experiences adequate pain relief. 4. ANS: B a. Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive acetaminophen use. For this reason, a maximum daily dose of 2000 mg is generally recommended for these persons. 5. ANS: A a. The use of a combination of drugs allows less of each drug to be used and a more balanced, controlled state of anesthesia to be achieved. 6. ANS: A a. Nystagmus can occur as a result of the use of general anesthesia. Other findings include skeletal muscle relaxation, hypotension, and increased intracranial pressure. 7. ANS: C a. These are indications of malignant hyperthermia, which can progress rapidly. 8. ANS: B a. Midazolam allows the patient to relax and have markedly reduced or no anxiety yet still maintain his or her open airway and response to verbal commands while producing mild amnesia. The oral route of drug administration for conscious sedation is preferred for pediatric patients; patients receiving conscious sedation are able to maintain their own airway. Propofol will relieve anxiety; however, pain medications must be used along with propofol therapy for situations that can cause a pain response. 9. ANS: A a. Adequate hydration using IV fluids is often used to increase cerebrospinal fluid pressure. A “blood patch” is often used to help close up or seal the leak. A small amount of blood is taken from the patient and injected into the epidural space. The patient should be positioned flat to prevent spinal headache, and if a patient has a spinal headache, relief is often obtained by lying flat. 10. ANS: C a. NMBDs make the patient unable to move, but they do not cause sedation or relieve pain. 11. ANS: C a. NMBDs paralyze the respiratory muscles; it is essential to have sufficient ventilator support nearby in case the medication causes the patient to lose the ability to breathe. Oxygen alone is not sufficient. 12. ANS: B a. Benzodiazepines interfere with REM sleep and may cause a “hangover” effect or next-day drowsiness. They should not be used with alcohol, and persons taking these drugs should not drive. 13. ANS: D a. Drugs with a low therapeutic index have only a narrow dosage range within which the drug is effective; above that range, they are rapidly toxic. Barbiturates are habit forming, but this is not related to the therapeutic index. 14. ANS: C a. Barbiturates are associated with an increased incidence of falls when used in older adults; therefore, the usual dose is reduced by half whenever possible. Because barbiturates stimulate the action of enzymes in the liver, drugs are usually broken down more quickly, sometimes requiring the dose to be increased. Patients taking barbiturates have decreased amounts of REM sleep and often experience paradoxical restlessness or excitement. 15. ANS: A a. Baclofen (Lioresal) is sometimes used in an injectable form. Cyclobenzaprine (Flexeril) often results in deep sedation and sleepiness. Patients taking muscle relaxants are at risk to develop hypotension; therefore, they should be taught safety measures to prevent falls. Sedation and sleepiness are common side effects of muscle relaxants; however, a patient should not abruptly discontinue use of the medication. Safety procedures should be followed to prevent accidents and falls. 16. ANS: D/IV a. Even natural products have side effects. Side effects of Kava include skin discoloration, possible accommodative disturbances and pupillary enlargement, and scaly skin (with long-term use). Kava and other supplements are available without a prescription. Kava is contraindicated in patients with Parkinson’s disease, liver disease, depression, or alcoholism; in those operating heavy machinery; and in pregnant and breastfeeding women. As with all medications and supplements, it is best to inform the health care provider to evaluate possible interactions among drugs and supplements taken. 17. ANS: A a. Adverse effects of valerian include CNS depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, and insomnia. 18. ANS: C a. Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient’s family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy. 19. ANS: A a. Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of Orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients. 20. ANS: A a. The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs and thus the need for careful assessment and documentation. In fact, these drugs are generally not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed. 21. ANS: D a. Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped because a rebound increase in appetite may develop. 22. ANS: B a. Carbamazepine (Tegretol) is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations. 23. ANS: C a. Gabapentin is commonly used to treat neuropathic pain. 24. ANS: B a. Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur. 25. ANS: B a. Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion). 26. ANS: C a. To prevent complications, patients should be taught to call the health care provider if they experience fever, sore throat, excessive bleeding or bruising, and new onset of nosebleeds. Drowsiness is a common side effect of these drugs; the dose should never be altered without consulting the prescriber. These medications should be taken with food to decrease GI upset. Most patients with seizure disorders are able to work and are protected by the Americans with Disabilities Act. 27. ANS: B a. Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled. 28. ANS: A a. Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension. 29. ANS: D a. When anticholinergics are used for the treatment of PD, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident. 30. ANS: B/II a. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. Emphasize the importance of taking the medication as prescribed and not quitting the medication. It is important for the patient and family or caregiver to understand that medication(s) must be taken at the dosage and time prescribed. Inability to adhere to or remain compliant may lead to exacerbation of symptoms and development of complications. Missing a dose by even 30 minutes may lead to an “off” period and last hours. With anticholinergics, warn the patient about the adverse effect of dry mouth. Use of artificial saliva drops or gum, frequent mouth care, fluids, and sucking on sugarless gum or hard candy may be helpful. The patient and family must understand that some antiparkinson drugs are often titrated to the patient’s response and that it may take 3 to 4 weeks for a therapeutic response to become evident. 31. ANS: A/I a. The patient may need assistance when walking because of the dizziness and possible syncope caused by these drugs. Doses are given several hours before bedtime to decrease the incidence of insomnia, a known adverse effect of these drugs. Oral doses are given with food to help minimize GI upset. It is important to make sure that the patient and family or caregivers understand that while taking carbidopa-levodopa, the patient may continue to eat high-protein foods (e.g., meat, fish, poultry, and dairy products) but with the following special instructions: use portion control (meat portion about the size of a deck of cards) and take the drug dose one-half hour before eating a protein-containing meal or 1 hour after. 32. ANS: D/IV a. The oral disintegrating dose should be placed on the tongue and should not be swallowed until it is completely melted. This dosage form is to be taken without liquids and given in the morning before breakfast. Foods and fluids are not to be consumed for 5 minutes before or after the drug is taken. Postural hypotension may be a transient problem, so the patient needs to move and change positions slowly and purposely. Ch 16-21 PPT Answers 1. ANS: B a. Lithium may become toxic if the patient has hyponatremia. The sodium level should be assessed in patients receiving lithium therapy to prevent toxicity. 2. ANS: B a. Some studies have indicated a higher risk for suicide during the first few weeks of antidepressant therapy. 3. ANS: D a. It may take several weeks to see the therapeutic effects of SSRIs. 4. Along with completing a full assessment, the nurse would need to ask the patient what medication he was prescribed, how long he has been taking the medication, and how much of the medication he currently has taken. Based on the presenting signs and symptoms, the nurse would include serotonin syndrome as a highly possible reason for the patient’s presenting symptoms. 5. . The treatment for serotonin syndrome includes discontinuation of all SSRIs and supporting the patient to maintain homeostasis. 6. ANS: A/I a. Patients should be taught that the time period for SSRIs to take effect is 4 to 6 weeks. These medications can cause GI upset, and taking them with food is recommended. SSRIs should be taken in the morning to prevent any sleep disturbances. 7. ANS: D/IV a. A taper period of 1 to 2 months is needed to prevent the development of adverse effects of withdrawal from the medication, which include dizziness, diarrhea, and a worsening of the depressive mood disorder. Serotonin syndrome is a result of taking too much of the medication. The patient and the provider should determine together when is the optimal time for drug discontinuation. There is no evidence of drug dependency associated with use of SSRIs. 8. ANS: A a. Flumazenil is a benzodiazepine reversal agent. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the benzodiazepine receptor in the CNS and thus reversing sedation. For opioid abuse or dependence, naltrexone, an opioid antagonist, is administered. Naltrexone, which is also available as an injection called Vivitrol, works by blocking the opioid receptors so that use of opioid drugs does not produce euphoria. Flunitrazepam is a benzodiazepine. 9. ANS: A a. Delirium tremens are characterized by hypertensive crisis, tachycardia, agitation, and hyperthermia and may be life threatening. 10. ANS: C a. The rationale for the use of disulfiram (Antabuse) is that patients know that if they are to avoid the devastating experience of acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram. Disulfiram (Antabuse) does not cure alcoholism; blood pressure gets very low if alcohol is consumed with disulfiram (Antabuse), and patients should follow the prescribed dosing schedule and not double a dose. 11. ANS: B a. The patch system uses a stepwise reduction in subcutaneous delivery to gradually decrease the nicotine dose, and patient treatment compliance seems higher than with the gum. Acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing releases an immediate dose of nicotine. The dose is approximately half the dose the average smoker receives in one cigarette, however. 12. ANS: A a. Taking the bronchodilator first will result in a more open airway and thus allow for better penetration by the inhaled corticosteroid. 13. ANS: A a. Albuterol is a beta2 agonist that is used for acute bronchospasms. Salmeterol is appropriate for prevention of bronchospasms. Fluticasone is a corticosteroid that is not effective for acute bronchospasms. Advair Diskus is used for daily maintenance, not acute exacerbations. 14. ANS: B a. Infiltration of an intravenous solution containing an adrenergic drug may lead to tissue necrosis from excessive vasoconstriction around the intravenous site. Phentolamine is often used for the treatment of infiltration, but the first thing the nurse must do is to stop the infusion of the adrenergic drug. Slowing the medication will not stop further tissue damage. The physician should be notified, but the infusion should be stopped first. 15. ANS: C a. Before anything else is done, the patient’s vital signs should be checked for alterations. The dopamine rate should not be increased. Extravasation rarely causes chest tightness. Although an electrocardiogram would be prudent, it's not the priority until after the vital signs demonstrate that the patient is stable. 16. ANS: B a. During administration of albuterol, a fast-acting beta2 agonist, the nurse should monitor the patient’s respiratory status, including Spo2 (with a pulse oximeter), respiratory rate, and breath sounds, to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable. 17. ANS: A a. Taking the bronchodilator first will result in a more open airway and thus allow for better penetration by the inhaled corticosteroid. 18. ANS: A a. Albuterol is a beta2 agonist that is used for acute bronchospasms. Salmeterol is appropriate for prevention of bronchospasms. Fluticasone is a corticosteroid that is not effective for acute bronchospasms. Advair Diskus is used for daily maintenance, not acute exacerbations. 19. ANS: B a. Infiltration of an intravenous solution containing an adrenergic drug may lead to tissue necrosis from excessive vasoconstriction around the intravenous site. Phentolamine is often used for the treatment of infiltration, but the first thing the nurse must do is to stop the infusion of the adrenergic drug. Slowing the medication will not stop further tissue damage. The physician should be notified, but the infusion should be stopped first. 20. ANS: C a. Before anything else is done, the patient’s vital signs should be checked for alterations. The dopamine rate should not be increased. Extravasation rarely causes chest tightness. Although an electrocardiogram would be prudent, it's not the priority until after the vital signs demonstrate that the patient is stable. 21. ANS: B a. During administration of albuterol, a fast-acting beta2 agonist, the nurse should monitor the patient’s respiratory status, including Spo2 (with a pulse oximeter), respiratory rate, and breath sounds, to ensure that the medication is having a therapeutic effect. The other items can be handled after her respiratory status is stable. 22. ANS: A a. To help establish a diagnosis of pheochromocytoma, a single intravenous dose of phentolamine is given to the hypertensive patient who is suspected of having the tumor. If the blood pressure declines rapidly, it is highly likely that the patient has a pheochromocytoma. 23. ANS: B a. The primary adverse effects of alpha blockers are those related to their effects on the vasculature. First-dose phenomenon, which is a severe and sudden drop in blood pressure after the administration of the first dose of an alpha-adrenergic blocker, can cause patients to fall or pass out. All patients must be warned about this adverse effect before they take their first dose of an alpha blocker. Orthostatic hypotension can occur with any dose of an alpha blocker, and patients must be warned to get up slowly from a supine position. 24. ANS: B a. Studies have shown increased survival in patients given metoprolol after experiencing an MI. Metoprolol has a cardioprotective effect by decreasing the heart’s response to circulating catecholamines resulting from the MI. 25. ANS: B a. Although beta blockers may mask signs and symptoms of hypoglycemia, nonselective beta blockers may cause bronchoconstriction, which would be detrimental to the patient with asthma. 26. ANS: C a. Beta blockers may mask the signs and symptoms of hypoglycemia. 27. ANS: A a. The items listed are early signs of a cholinergic crisis, which can become more severe and lead to hypotension, circulatory collapse, bloody diarrhea, shock, and cardiac arrest. 28. ANS: C a. Potential adverse effects of gingko include stomach or intestinal upset, headache, bleeding, and allergic skin reaction. Potential drug interactions include aspirin, NSAIDs, anticoagulants, and other drugs. The ginkgo may interact with the NSAID medication and cause increased bleeding. 29. ANS: B a. The drug should be taken 30 minutes before a meal for maximal therapeutic effect. 30. ANS: B a. Atropine can be given to reverse the effects of an overdose of a cholinergic drug. 31. It is important for the nurse to gather information that may aid in differentiating cholinergic crisis from disease exacerbation. 32. Pyridostigmine (Tensilon) may be given to differentiate between disease exacerbation and cholinergic crisis. 33. . If the patient is experiencing a disease exacerbation, the symptoms would improve following the administration of Tensilon. 34. The reversal agent for Tensilon is Atropine. 35. ANS: D a. Atropine overdose is manifested by flushing, dry skin and mucous membranes, mydriasis, altered mental status, and fever. Other serious effects include sinus tachycardia, urinary retention, hypertension, hallucinations, and cardiovascular collapse. Activated charcoal is usually given along with supportive therapy. 36. ANS: C a. Anticholinergics such as glycopyrrolate and atropine are given preoperatively to reduce or control secretions before and during surgery. 37. ANS: A a. Tolterodine (Detrol) may worsen pre-existing angle-closure glaucoma and urinary retention, so its use should be avoided in patients with these conditions. Ch 10 Answers 1. ANS: B a. Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient’s symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain. 2. ANS: D a. Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain. 3. ANS: B a. One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient’s respiratory rate before administering an opioid. The other options are incorrect. 4. ANS: C a. Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient’s level of pain 5. ANS: C a. Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset. 6. ANS: B a. Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal) 7. ANS: C a. Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect. 8. ANS: B a. If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions. 9. ANS: B a. Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain. 10. ANS: C a. Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose. 11. ANS: B a. Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct. 12. ANS: C a. The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose. 13. ANS: D a. Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists. 14. ANS: C a. Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication. 15. ANS: D a. Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect. 16. ANS: C a. Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties. 17. ANS: B, C, E, F a. Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin. Ch 11 Answers 1. ANS: D a. Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of “no anesthesia” is incorrect. 2. ANS: D a. A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed. 3. ANS: D a. The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. 4. ANS: D a. The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia. 5. ANS: D a. Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery. 6. ANS: B a. Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patient’s ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect. 7. ANS: B a. Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation. 8. ANS: A, B, E a. Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect. Ch 12 Answers 1. ANS: A a. Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety. 2. ANS: D a. Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect. 3. ANS: B a. Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction. 4. ANS: C a. Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect 5. ANS: A a. Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. “Risk for addiction” is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation. 6. ANS: A a. Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime. 7. ANS: C a. There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate. 8. ANS: C a. Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications. 9. ANS: A a. Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation. 10. ANS: D a. Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation. 11. ANS: D a. Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs. 12. ANS: B, D, E a. Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications. 13. ANS: A, B, D, E a. The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin. Ch 13 Answers 1. ANS: A a. Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine. 2. ANS: D a. Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect. 3. ANS: D a. Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school. 4. ANS: C a. The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, disturbed sleep pattern is the most appropriate nursing diagnosis of those listed. 5. ANS: B a. Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time. 6. ANS: C a. Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect. 7. ANS: A a. Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient’s responses to the medication are helpful. 8. ANS: A a. Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient’s responses to the medication are helpful. 9. ANS: B, C, D, E a. This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect. Ch 14 Answers 1. ANS: B a. Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options, so it allows for once-a-day dosing. 2. ANS: A a. Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop. 3. ANS: D a. Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure. 4. ANS: C a. If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber’s order. There is an increased risk of seizure activity if one or more doses of the AED are missed. 5. ANS: B a. With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect. 6. ANS: B a. Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure. 7. ANS: A a. In December 2008, the U.S. Food and Drug Administration (FDA) required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect. 8. ANS: A a. Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options. 9. ANS: A a. Having a “narrow therapeutic index” means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect. 10. ANS: B a. Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber’s order. 11. ANS: D a. Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect. 12. ANS: A a. Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect. 13. ANS: B, C, E a. Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity. Ch 15 Answers 1. ANS: B a. At doses that exceed 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension. 2. ANS: B a. When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS. 3. ANS: D a. Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. The patient must drink at least 3000 mL/day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation. 4. ANS: D a. Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations. 5. ANS: D a. Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs. 6. ANS: C a. Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications. 7. ANS: B a. Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs. 8. ANS: D a. COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa. 9. ANS: A a. COMT inhibitors, including entacapone, may darken a patient’s urine and sweat. 10. ANS: B a. Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson’s disease. The other options are incorrect. 11. ANS: C a. The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect. 12. ANS: A, B, E a. Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect. Ch 16 Answers 1. ANS: A a. Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder. 2. ANS: B a. Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs. 3. ANS: B a. The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect. 4. ANS: C a. Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect. 5. ANS: D a. Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect. 6. ANS: A a. Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect. 7. ANS: D a. Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation 8. ANS: D a. The herbal product St. John’s wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate. 9. ANS: B a. In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect. 10. ANS: C a. Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias. 11. ANS: B a. Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect. 12. ANS: B a. Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats. 13. ANS: C a. Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine. 14. ANS: B a. Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng. 15. ANS: C a. Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect. 16. ANS: A, C, E a. Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms. 17. ANS: C, D a. During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs. Ch 17 Answers 1. ANS: B a. Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false. 2. ANS: B a. Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation 3. ANS: D a. Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost. 4. ANS: B a. Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the “date-rape” drug). The other drugs are not known as roofies. 5. ANS: C a. The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects 6. ANS: C a. A variety of serious neurologic and mental disorders, such as Korsakoff’s psychosis and Wernicke’s encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer’s disease are not associated directly with chronic use of alcohol. 7. ANS: B a. The use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicit severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol. 8. ANS: A a. Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke. 9. ANS: B, D a. Patients taking varenicline have reported drowsiness, which has prompted the U.S. Food and Drug Administration (FDA) to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug. 10. ANS: B, D, E, F a. Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy. Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness, weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not adverse effects associated with acetaldehyde syndrome. 11. ANS: A, C, D a. Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal. Ch 18 Answers 1. ANS: C a. Adrenergic drugs mimic the effects of the sympathetic nervous system. 2. ANS: A a. An increased force of contraction is known as a positive inotropic effect. 3. ANS: A a. Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated. 4. ANS: B a. For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase cardiac output. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety. 5. ANS: C a. Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine 6. ANS: C a. Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a pre-existing cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect. 7. ANS: D a. Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect. 8. ANS: B a. Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices. 9. ANS: C a. Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect. 10. ANS: D a. Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect. 11. ANS: A, D, E, G a. Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system. Ch 19 Answers 1. ANS: B a. Even though some beta blockers may be used for the treatment of some types of heart failure, the patient needs to be assessed often for the development of heart failure, a potential adverse effect of the drugs. These symptoms do not indicate expected adverse effects, an allergic reaction, or a therapeutic response. 2. ANS: A a. Patients need to be weaned off these medications slowly because rebound hypertension and chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly nor doses skipped. First-dose hypotension occurs with alpha blockers. 3. ANS: D a. Phentolamine is an alpha blocker that reduces peripheral vascular resistance when given systemically, but local subcutaneous injection around the site of extravasated vasoconstrictive drugs, such as dobutamine, causes an alpha-adrenergic receptor blockade and vasodilation. This allows for increased blood flow to the ischemic tissue and may prevent permanent tissue damage. 4. ANS: D a. Beta blockers are frequently given to patients after they have suffered an MI because of their cardioprotective properties. The other responses are incorrect 5. ANS: C a. This medication is used to relieve impaired urinary flow in men with benign prostatic hyperplasia, but it also can cause orthostatic hypotension when changing positions from sitting or lying positions. Because of these effects, the blood pressure may become dramatically lowered, and lightheadedness may occur, increasing the risk of falling. 6. ANS: D a. Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension, heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore, any pre-existing respiratory conditions such as asthma might be worsened by the concurrent use of any of these medications. 7. ANS: B a. Not all beta blockers are used for the treatment of heart failure. Carvedilol and metoprolol are currently used in the treatment of heart failure. The other options are not indicated for the treatment of heart failure 8. ANS: A a. Cardiac depression can occur with beta blockers; instruct the patient to contact his prescriber if his pulse rate decreases to less than 60 per minute. The medication dose may need to be changed, but it is not appropriate for the nurse to change the dosage. The other options are incorrect. 9. ANS: D a. Impotence is a potential adverse effect of beta blockers and may cause patients to stop taking the medication. The other options are not adverse effects of beta blockers. 10. ANS: B a. Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs; additive hypotensive effects may occur. The other drugs do not interact with tamsulosin. 11. ANS: A a. Orthostatic hypotension can occur with any dose of an alpha blocker, and patients must be warned to get up slowly from a supine position. The other responses are not drug effects of alpha blockers. 12. ANS: A, B, D, E a. When taken with beta blockers, diuretics and alcohol may cause additive hypotensive effects; oral hypoglycemic medications may cause the blood glucose to decrease; and anticholinergics may cause decreased beta-blocker effects. Penicillins and anticoagulants are not known to interact with beta blockers. Ch 20 Answers 1. ANS: A a. The cardiovascular effects of low doses of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs. 2. ANS: B a. Pilocarpine is a direct-acting drug that is used topically to reduce intraocular pressure in patients with glaucoma. The other disorders are not indications for pilocarpine. 3. ANS: D a. Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity. 4. ANS: C a. In patients suffering a decrease in GI peristalsis postoperatively, taking a cholinergic drug should result in an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements that indicate increased GI peristalsis. 5. ANS: C a. Taking the medication 30 minutes before meals allows time for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication. The other options are incorrect. 6. ANS: C a. Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase, thus reversing the neuromuscular blockade produced by anticholinergic poisoning as well as poisoning by irreversible cholinesterase inhibitors such as the organophosphates and carbamates, common classes of insecticides. The other drugs listed are not appropriate antidotes. 7. ANS: D a. Donepezil is used to treat mild-to-moderate dementia occurring in Alzheimer’s disease and may improve the symptoms of the disease. 8. ANS: C a. Donepezil therapy is not a cure for Alzheimer’s disease, but it may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals, and the medication should not be abruptly stopped or the dosage increased without the physician’s approval because of the possibility of serious complications 9. ANS: B a. Cevimeline is a direct-acting cholinergic drug that is used to stimulate salivation in patients who have xerostomia (dry mouth), one of the manifestations of Sjögren’s syndrome. The other options are incorrect. 10. ANS: B a. Many of the undesirable adverse effects are due to nicotinic receptor stimulation. The desired effects come from muscarinic receptor stimulation. The other options are incorrect. 11. ANS: C a. Drug interactions may occur between the taking of aspirin and nonsteroidal anti-inflammatory drugs and the taking of ginkgo. The other options are incorrect. 12. ANS: C a. Edrophonium, another indirect-acting cholinergic drug, is commonly used to diagnose myasthenia gravis. Edrophonium is not used in diagnosing Parkinson’s disease, multiple sclerosis, or Alzheimer’s disease. 13. ANS: B, C, E, F a. Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs. Ch 21 Answers 1. ANS: A a. Cardiovascular effects of cholinergic blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are incorrect. 2. ANS: D a. Contraindications include drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma. Neurogenic bladder is an indication for oxybutynin. The other options are incorrect. 3. ANS: D a. Anticholinergic drugs block or inhibit the actions of acetylcholine in the parasympathetic nervous system. The other options are incorrect. 4. ANS: D a. Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial, however. The other options are incorrect choices. 5. ANS: D a. Elderly patients who take an anticholinergic drug need to be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms. 6. ANS: C a. Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention. They also cause mydriasis (pupillary dilation). 7. ANS: C a. Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications 8. ANS: D a. The incidence of dry mouth is much lower with use of the newer cholinergic-blocker drugs, such as darifenacin, because the actions of these drugs are more specific for the bladder as opposed to the salivary glands. These drugs are contraindicated if narrow-angle glaucoma or urinary retention is present. The newer cholinergic-blocker drugs are not necessarily more effective. 9. ANS: D a. Anticholinergic drugs are given preoperatively to control oral and gastrointestinal secretions during surgery. The other options are incorrect. 10. ANS: B a. Cholinergic-blocking eyedrops cause dilation of the pupil (mydriasis) and paralysis of the ocular lens (cycloplegia), both of which are important for eye surgery. The other options are incorrect. 11. ANS: D a. Transdermal scopolamine (Transderm-Scop) is a patch that can be applied just behind the ear 4 to 5 hours before travel for the prevention of motion sickness. The other options are incorrect. 12. ANS: A, D, F a. Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and is used as an antidote for anticholinesterase inhibitor poisoning. The other options are contraindications to the use of atropine.