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- 1. Open EndedA client enters the emergency department complaining of acute lower right quadrant abdominal pain. It is determined that the client has appendicitis and is scheduled to go to the operating room immediately. The nurse notes on the database that the client generally drinks 10 to 12 beers a day, although he did not drink in the past 4 days because of the pain. The nurse would expect that the: A. client's surgery would be canceled because of the threat of a withdrawal reaction. B. client's surgery would proceed with no change in the plan of care. C. client would require a greater level of anesthesia as a result of cross-tolerance. D. client would need less anesthesia because of the circulating blood alcohol.
- 2. Open EndedA client expresses the desire to quit smoking. She elects to use Nicorette gum replacement therapy. Which statement by the nurse is true regarding this smoking cessation technique? A. "You should not eat or drink for 15 minutes before or after chewing the gum." B. "You may experience a skin rash as a result of this treatment." C. "Using a nicotine replacement system will decrease the risk of cancer." D. "The gum will take away the craving to smoke."
- 3. Open EndedA client hospitalized with a fractured femur following an automobile accident develops diarrhea and vomiting with abdominal cramps, chills with goose bumps, and dilated pupils. The nurse suspects the client is experiencing which reaction? A. Opioid withdrawal B. Alcohol toxicity C. Flashbacks from psychedelic episode D. Barbiturate Withdrawal
- 4. Open EndedA client in the hospital is experiencing methamphetamine withdrawal. What does the nurse expect the symptoms and treatment to be? A. Hypertension, tachycardia, and autonomic overactivity; treated by benzodiazepines B. Hypersomnia, irritability; treated by supportive care including pushing food and fluids C. Minimal notable symptoms; no treatment D. Anxiety, insomnia, hyperactivity, and rapid, pressured speech; treated by symptom management
- 5. Open EndedA client is admitted to the emergency department with acute cocaine toxicity. Which is the most important intervention by the nurse? A. To institute cardiac monitoring and obtain frequent blood pressures B. To collect the history of substance abuse from the client and or family member C. To provide reality orientation with a calm, quiet approach D. To administer oral fluids with caffeine to prevent withdrawal symptoms
- 6. Open EndedA client is admitted to the emergency room after overdosing on a benzodiazepine. The nurse anticipates that the healthcare provider will order which antidote? A. Caffeine B. Epinephrine (Adrenalin) C. Flumazenil (Romazicon) D. Phentolamine (Regitine)
- 7. Open EndedA client is to start a new medication to help with alcohol abuse. The nurse providing medication education about the disulfiram (Antabuse) is sure to include which topics in the education plan? 1. It is important to take this medication every day. 2. If planning to drink alcohol, stop disulfiram treatment 1 day before alcohol consumption. 3. Disulfiram works by disrupting the metabolism of alcohol. 4. Use of alcohol may cause nausea, vomiting, and may even be fatal. A. 1,2,3 B. 2,3,4 C. 1,3,4 D. 1,2,3,4
- 8. Open EndedA client scheduled for elective gallbladder surgery is addicted to heroin and is in a methadone treatment program. Postoperatively, the nurse would expect the client's surgical pain to be treated with which measure? A. A saline placebo and nonpharmacologic pain relief measures. B. Increased doses of methadone C. Combination buprenorphine/naltrexone (Suboxone) D. Morphine or other opioids
- 9. Open EndedA client who has stopped smoking "cold turkey" after 2 years of smoking 1 pack per day calls for a clinic appointment. The nurse teaches the client that signs of nicotine withdrawal include: A. increased appetite and blood pressure B. restlessness and increased blood pressure C. depression and decreased blood pressure D. nausea, confusion, and seizures
- 10. Open EndedA client with congestive heart failure receives digoxin (Lanoxin) to slow and strengthen ventricular contraction. He tells a nurse during his health history that he frequently uses amphetamines to "deal with all the stress." Which assessments and diagnostics would be a priority for this client? A. Urinalysis and creatinine clearance B. Digoxin levels and palpation for edema C. Blood pressure and BUN D. Auscultation of heart rhythm and an ECG
- 11. Open EndedA nurse in the emergency department receives a call that a client is being transported to the hospital by paramedics. The client is a known heroin addict and is showing signs of potential overdose. The nurse would expect which symptoms? A. Anxiety, blurred vision, agitation B. Clammy skin, constricted pupils, decreased level of consciousness C. Fatigue, paranoia, hallucinations D. Panic behaviors, tachycardia, hypertension
- 12. Open EndedA nurse is caring for a patient admitted to the unit who is receiving dantrolene (Dantrium) for spasticity. The nurse should particularly monitor the patient's A. Liver enzymes B. Complete blood count C. Renal function tests D. Serum electrolytes
- 13. Open EndedA nurse is caring for a patient receiving succinylcholine (Anectine) IV before an abdominal surgery. During the procedure, the patient suddenly develops rigidity, and his body temperature begins to rise. Stat CMP shows: Na 140 mEq/L, K 6.0 mEq/L, CL 102 mEq/L, Glucose 85 mg/dL, Cr 1.0, and BUN 12. Based on aforementioned information, the following statements are correct EXCEPT: A. The patient has developed malignant hyperthermia, one of adverse effect caused by succinylcholine administration. B. Dantrolene (Dantrium) can be used to treat malignant hyperthermia by directly relaxing skeletal muscle to decrease fever and muscle rigidity C. The patient has high risk of developing dysrhythmia induced by hyperkalemia, one of the adverse reactions to the administration of succinylcholine. D. A second dose of succinylcholine should be given immediately.
- 14. Open EndedA nurse is providing patient education for a patient who is to gradually discontinue baclofen (Lioresal). The nurse advises the patient to avoid abrupt discontinuation of the medication to prevent which adverse effect? A. Weakness B. Seizures C. Fatigue D. Respiratory depression
- 15. Open EndedA nurse suspects that one of the patients she is caring for exhibits symptoms of baclofen (Lioresal) overdose. The patient is unresponsive. What should the nurse's initial action be? A. Prepare to support respiration's. B. Administer the antidote to baclofen C. Administer diazepam to relax the body D. Obtain an electrocardiogram
- 16. Open EndedA patient comes to the clinic with severe spastic paralysis. During the health history the patient asks a nurse which drug could be used in an attempt to provide relief from the spasms. The nurse explains that the only benzodiazepine used to treat spasticity is A. Carisoprodol (Soma) B. Orphenadrine (Norflex) C. tizanidine (Zanaflex) D. Diazepam (Valium)
- 17. Open EndedA patient has been taking neostigmine (Prostigmin) for the treatment of myasthenia gravis. What are the side effects/adverse effects of neostigmine (Prostigmin)? A. bradycardia, diaphoresis, and urinary urgency B. tachycardia, diaphoresis, and urinary retention. C. xerostomia, diaphoresis, and mydriasis. D. increased gastric motility, mydriasis, and urinary retention.
- 18. Open EndedA patient is going to take the immunosuppressant, Mitoxantrone (Novantrone), for the treatment of multiple sclerosis. What are some baseline tests need to be done prior to the drug therapy? 1. Complete blood counts and differentiation; 2. Liver function tests (LFTs) 3. The pregnancy test 4. EKG A. 1,2,3 B. 2,3,4 C. 1,2,3,4 D. 1,3,4
- 19. Open EndedA patient with multiple sclerosis began a treatment regimen with mitoxantrone (Novantrone) 2 weeks ago. Which nursing diagnosis would have the highest priority in the plan of care? A. Risk for sleep pattern disturbance related to irritability B. Risk for infection secondary to myelosuppression. C. Impaired urinary elimination related to blue-green urine D. Disturbed sensory perception, auditory, related to ototoxicity
- 20. Open EndedA patient with multiple sclerosis is admitted to the unit for an acute exacerbation and is given interferon beta-1a (Avonex). What questions related to adverse effects should the nurse include in the physical assessment? A. "Are you experiencing any constipation?" B. "Do you have a headache, chills, or muscle aches?" C. "Are you having any swelling in your legs or shortness of breath?" D. "Do you have or have you experienced any ringing in your ears?"
- 21. Open EndedA postoperative client received morphine in the recovery room. On assessment, the nurse notes that the client's respiratory rate is 6 breaths per minute and that the client has a decreased level of consciousness. The anesthesiologist orders naloxone (Narcan). The nurse administers this medication with the knowledge that this drug is a(n): A. Respiratory Stimulant B. Opioid antagonist C. Bronchodilator D. Anticonvulsant
- 22. Open EndedAtropine is used in cholinesterase inhibitor overdose. True or False
- 23. Open EndedDrugs that the nurse would anticipate administering to a client who has been admitted with acute alcohol intoxication include which drugs? 1. naloxone (Narcan) 2. thiamine 3. lorazepam (Ativan) 4. intravenous glucose solution A. 1,2,3 B. 2,3,4 C. 1,3,4 D. 1,2,3,4
- 24. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Thiamine 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 25. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Lorazepam (Ativan), Benzodiazepines 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 26. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Propranolol, β adrenergic antagonist 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 27. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Disulfiram (Antabuse) 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 28. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Naltrexone (ReVia, Depade) 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 29. Open EndedThe nurse is caring for a patient with alcohol addiction. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Acamprosate (Campral) 1. Wernicke-Korsakoff syndrome 2. The use in detoxification phase for alcohol withdrawal syndrome 3. Reduction of cravings 4. Abstinence Maintenance or aversion (behavioral) therapy 5. The use in abstinence maintenance phase to reduce unpleasant effects caused by abstinence.
- 30. Open EndedThe nurse is caring for a patient with opioid addition. Math the treatment goal with the appropriate medications. (You can use one answer more than once) Methadone (Dolophine) 1. The reduction of withdrawal syndrome and cravings. 2. Abstinence Maintenance 3. The reduction of autonomic GI hyperactivity (diarrhea, nausea, vomiting). 4. The reversal of respiratory depression and coma. 5. The detection of other concurrent substance use
- 31. Open EndedThe nurse is caring for a patient with opioid addition. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Naltrexone (ReVia, Depade) 1. The reduction of withdrawal syndrome and cravings. 2. Abstinence Maintenance 3. The reduction of autonomic GI hyperactivity (diarrhea, nausea, vomiting). 4. The reversal of respiratory depression and coma. 5. The detection of other concurrent substance use
- 32. Open EndedThe nurse is caring for a patient with opioid addition. Math the treatment goal with the appropriate medications. (You can use one answer more than once) Clonidine (alpha2-adrenergic agonist, Catapres) 1. The reduction of withdrawal syndrome and cravings. 2. Abstinence Maintenance 3. The reduction of autonomic GI hyperactivity (diarrhea, nausea, vomiting). 4. The reversal of respiratory depression and coma. 5. The detection of other concurrent substance use
- 33. Open EndedThe nurse is caring for a patient with opioid addition. Math the treatment goal with the appropriate medications. (You can use one answer more than once) Naloxone (Narcan) 1. The reduction of withdrawal syndrome and cravings. 2. Abstinence Maintenance 3. The reduction of autonomic GI hyperactivity (diarrhea, nausea, vomiting). 4. The reversal of respiratory depression and coma. 5. The detection of other concurrent substance use
- 34. Open EndedThe nurse is caring for a patient with opioid addition. Match the treatment goal with the appropriate medications. (You can use one answer more than once) Buprenorphine (Subutex) or the combination of buprenorphine and naloxone (Suboxone) 1. The reduction of withdrawal syndrome and cravings. 2. Abstinence Maintenance 3. The reduction of autonomic GI hyperactivity (diarrhea, nausea, vomiting). 4. The reversal of respiratory depression and coma. 5. The detection of other concurrent substance use
- 35. Open EndedWhat drug is used to treat acute episode (relapse) of multiple sclerosis? A. Glucocorticoid B. Immunomodulator C. Immunosuppressant D. Central acting muscle relaxant
- 36. Open EndedWhen caring for a client recovering from an episode of opioid toxicity, the nurse determines that the client has an addiction to the drug based on which finding? A. Physical withdrawal signs B. A history of daily use C. Craving that results in drug-seeking behaviors D. Intravenous use of the drug rather than oral use
- 37. Open EndedWhich part of a neuron would be the most damaged in a patient with multiple sclerosis? A. Myelin sheath B. Cell body C. Dendrite D. Nucleus
- 38. Open EndedWhich statement is true regarding how to differentiate between a myasthenic crisis and a cholinergic crisis? A. Ask the patient about occupation and family history. B. Assess serum levels of the cholinesterase inhibitors. C. Assess the patient for muscle weakness. D. Administer edrophonium (Tensilon) and monitor the response.
- 39. Open EndedWhile teaching the parents of an adolescent who has been using marijuana, the nurse explains that the euphoria that results from the use of abused psychoactive substances is believed to be caused by which? A. Blockade of opioid receptors in the mesolimbic system of the brain B. Stimulation of the dopamine pathways in the pleasure areas of the brain C. An increased release of serotonin in all areas of the brain D. A reduction in the responsiveness of brain receptors
- 40. Open EndedA patient is prescribed zolpidem (Ambien) for insomnia. Which instructions should the nurse give to the patient? 1. "Take zolpidem immediately before going to sleep." 2. "Take zolpidem only when able to get a full night' s sleep (7 - 8 hours)." 3. "Avoid driving within 8 hours of taking this drug." 4. "It is recommended to take this drug more than 30 days." A. 1,2,3 B. 1,2,3,4 C. 2,3,4 D. 1,2,4
- 41. Open EndedA patient taking oxycodone with acetaminophen (Percocet, an opioid) for pain after fracturing an ankle. What instructions should the nurse give to the patient? 1.Take stool softener to prevent and treat constipation 2.Increase fluid intakes 3.Increase physical activity as tolerated 4.Take the drug on a regular schedule (ATC) rather PRN A. 1,2,3,4 B. 1,2,3 C. 2,3,4 D. 1,3,4
- 42. Open EndedA patient taking warfarin (Coumadin) has mild to moderate pain after exercising. Which over-the-counter pain reliever should he take? A. aspirin B. ibuprofen (Advil) C. acetaminophen (Tylenol) D. naproxen (Aleve)
- 43. Open EndedA patient with the end-stage cancer is taking an oral opioid drug for chronic and moderate-severe pain. Which side effects/adverse effects could the patient experience? 1.Respiratory depression 2.Addiction 3.Dependence 4.Tolerance A. 1,2,3,4 B. 1,2,3 C. 2,3,4 D. 1,3,4
- 44. Open EndedHow do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve a patient's pain? A. By blocking cyclooxygenase (COX) receptor and inhibiting the COX enzymes needed for synthesis of prostaglandins production. B. By binding to opioid receptors in the central nervous system and altering the perception of pain. C. By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission. D. By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts.
- 45. Open EndedThe nurse notes the following changes in a 72-year-old nursing home patient taking nortriptyline (Pamelor) for chronic pain. 1. Hand tremor. 2. Unable to urinate. 3. Unsteady gait due to sedation. 4. No bowel movement for 1 week. A. 1,2,3 B. 2,3,4 C. 1,2,3,4 D. 1,3,4
- 46. Open EndedWhich class of drugs is the first line drugs used to treat insomnia? A. Antihistamines B. Benzodiazepines C. Non-Benzodiazepines (Benzodiazepine receptor agonists) D. Sedating antidepressants
- 47. Open EndedWhich statement is true about anticonvulsants for pain control? 1. They are used to treat chronic pain, such as fibromyalgia and diabetic neuropathy. 2. They can potentially increase blood pressure in a patient who just discontinued MAOI within 3 days. 3. The adverse effects include CNS sedation and bone marrow suppression. 4. The grapefruit juice prolongs anticonvulsants' both expected and adverse effects. A. 1,2,3 B. 2,3,4 C. 1,2,3,4 D. 1,3,4
- 48. Open EndedWhich statement(s) is(are) true about the analgesic drugs in general 1. Acetaminophen (Tylenol) can cause permanent liver damage. 2. Opioids can cause the visual impairment (miosis) in the older patients. 3. Salicylate poisoning can be caused by all the NSAIDs. 4. Opioids act in the central nerve system, while NSAIDs act at the injured site. A. 1,2,3 B. 2,3,4 C. 1,3,4 D. 1,2,4
- 49. Open EndedThe differences between COX-1 and COX-2 inhibitors it that ibuprofen is more likely than celecoxib to cause which adverse effect? A. Fever B. Constipation C. Peptic ulcers D. Metallic taste
- 50. Open EndedWhich statement is true about gold, a disease-modifying antirheumatic drug (DMARD)? A. Gold is used to reduce inflammation by inhibiting the migration of erythrocytes. B. Gold is used in the early stages of arthritis and the first line therapy. C. When the patient is on gold therapy, his/her blood should be monitored for agranulocytosis or aplastic anemia. D. When the patient is taking both gold and another highly protein-bound drug, Warfarin (blood thinner), gold will not increase the risk of bleeding.
- 51. Open EndedA client is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout attack? A. Colchicine B. Allopurinol (Zyloprim) C. Probenecid (Benemid) D. Lasix (furosemide), a diuretic
- 52. Open EndedA client is taking aspirin for arthritis. Which adverse reaction should the nurse teach the client to report to the health care provider? A. Black stool B. Frequent urination C. Sinusitis D. Palpitations
- 53. Open EndedThe nurse is teaching a client about taking aspirin. Which are important points for the nurse to include? 1. Advising client to avoid alcohol while taking aspirin. 2. Instructing client to take aspirin before meals on an empty stomach. 3. Instructing client to inform dentist of aspirin dosage before any dental work. 4. Instructing client to inform surgeon of aspirin dosage before any surgery. 5. Suggesting that aspirin may be given to children for flu symptoms. A. 2, 3, 4, 5 B. 1, 2, 3, 4 C. all of the above D. 1, 3, 4
- 54. Open EndedA nurse is reviewing medications with a client newly diagnosed with rheumatoid arthritis. The nurse should instruct the client that which of the following medications will relieve arthritis pain and inflammation but will NOT stop the disease from progressing? A. Infliximab (Remicade) B. Abacept (Orencia) C. Indomethacin (Indocin) D. Methotrexate (Rheumatrex)
- 55. Open EndedWhich teaching does the nurse realize would have the highest priority for the client with gout who is taking colchicine? A. Increase vitamin C. B. Avoid alcohol and caffeine. C. Increase foods high in purine. D. Take colchicine 2 hours before meals.
- 56. Open EndedA client has been advised to take ibuprofen (Motrin). Which topic should the nurse teach the client about Motrin? 1. Tell client to avoid taking aspirin with Motrin. 2. Advise client to take with food to reduce GI upset. 3. Monitor for bleeding gums, nosebleeds, black tarry stools. 4. Encourage client to take herbs, such as ginkgo and garlic, with Motrin. 5. Advise female clients to take NSAIDs 2 days before menstruation to decrease discomfort. A. 1, 2, 3, B. 2, 3, 4, 5 C. 1, 3, 4, 5 D. 1, 2, 3, 4
- 57. Open EndedWhich of the following side effects is associated with oral steroids? A. Reduced muscle mass B. Hypotension C. Hypoglycemia D. Dehydration
- 58. Open EndedThe client has been prescribed a first generation antihistamine medication. The nurse anticipates that the client will need a teaching plan regarding management of: A. Bradycardia B. Drowsiness and dry mouth. C. Diaphoresis D. Insomnia
- 59. Open EndedThe client has been started on Zyflo. The nurse's highest priority intervention while the client is receiving this medication is to monitor: A. Calcium level. B. Serum glucose. C. Potassium level. D. Liver enzymes.
- 60. Open EndedWhich of the following seizure has NO loss of consciousness? A. Simple partial seizures B. Tonic-Clonic seizures (Grand Mal) C. Absence seizures (Petit Mal) D. Myoclonic seizures
- 61. Open EndedA nurse is providing patient education to patients who experience seizures and their families. To evaluate their understanding, the nurse asks the group several questions about medications. Which statement from the group best demonstrates an understanding of antiepileptic medication therapy? A. All seizure medications can be monitored by drug levels present in the urine. B. The monitoring period is 10 days for most patients. C. Maintenance of a seizure frequency chart is essential. D. Patients can safely drive during the monitoring period.
- 62. Open EndedA client enters the emergency department in generalized convulsive status epilepticus. The nurse anticipates the administration of: A. Phenobarbital (Luminal). B. Phenytoin (Dilantin). C. Valproic acid (Depakene). D. Diazepam (Valium).
- 63. Open EndedWhich of the following dietary restrictions is indicated with carbamazepine (Tegretol)? A. Limit foods high in vitamin K. B. Restrict acid-ash foods. C. Maintain a high-fiber diet. D. Do not drink grapefruit juice.
- 64. Open EndedA nurse is obtaining a health history from the family of a patient who has a history of seizures and is being treated with phenytoin (Dilantin). The patient was brought to the emergency department and was unresponsive to voice or touch. The family states that the patient had been drinking alcohol all afternoon. What further assessment by the nurse is indicated? A. The nurse should assess for other signs of central nervous system depression. B. The nurse should suspect that a grand mal seizure has occurred. C. The nurse should assess for gingival hyperplasia. D. The nurse should administer IV Lorazepam (Ativan) stat.
- 65. Open EndedA patient has been on carbamazepine (Tegretol) therapy for 3 weeks and comes to the clinic for a follow-up appointment. The patient complains of fatigue, headache, and vertigo. After laboratory tests are completed, which laboratory value would cause the most concern? A. Hemoglobin: 8 g/dL B. Leukocytes: 8,000 mm3 C. Platelets: 280,000 mm3 D. Potassium level: 4.5 mEq/L
- 66. Open EndedA patient with the absence seizure was brought to the clinic. The nurse anticipates that the prescriber will order which medication? A. Lorazepam (Ativan) B. Phenytoin (Dilantin) C. Valproic acid (Depakote) D. Carbamazepine (Tegretol)
- 67. Open EndedA patient has been taking valproic acid (Depakote) for seizures. During the health history, the patient tells the nurse, "I don't have good appetite as I used to. Sometimes my stomach hurts since I am on this medication." The priority nursing action would be to: A. Obtain plasma potassium level. B. Administer 10 mg morphine IM stat C. Obtain liver function tests. D. Obtain serum creatinine levels.
- 68. Open EndedA 26-year-old patient sustained a head injury at the age of 19 years. The patient has been on antiepileptic drugs and has been seizure free since 8 months after the accident. He now wants to discontinue the medications. The nurse's response would be based on which of the following rationales about antiepileptic medications? A. The patient can immediately stop the medications now and keep an accurate seizure chart to determine whether medications need to be reinstituted. B. The patient should wait a full 10 years after the last seizure; then, it is probably safe to stop the medication all in once. C. Antiepileptic drugs are needed for life. D. The dosage may be gradually reduced based on an accurate seizure record and consistent serum drug levels.
- 69. Open EndedA patient with a history of seizures has been taking both lamotrigine (Lamictal) and valproic acid (Depakote). Upon assessment, the nurse notes that the patient has widespread rash of the skin and mucous membranes. The nurse should suspect A. A hematological reaction. B. Stevens-Johnson syndrome. C. Chickenpox D. Vasculitis
- 70. Open EndedA nurse who is assessing a nursing student's knowledge of antiepileptic medications asks, "How is ethosuximide (Zarontin) different from phenytoin (Dilantin) and carbamazepine (Tegretol)?" Which response by the nursing student best demonstrates understanding of the differences between the medications? A. "Ethosuximide cannot be used in children." B. "Ethosuximide has more significant adverse events and drug interactions." C. "Ethosuximide efficacy is readily monitored by serum levels." D. "Ethosuximide is effective against absence seizures."
- 71. Open EndedA nurse is providing patient education for a 71-year-old patient. The patient has taken levodopa (Dopar) for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. The nurse should tell the patient A. "Stop the drug. If you have not noticed any effects within 2 weeks, the prescriber may need to change your drug regimen." B. "It may take several months for a response to occur. Continue the medication as prescribed." C. "Double the dose to see whether an effect occurs. Finding the correct dose takes many adjustments." D. "Another agent will need to be added to the regimen to manage your symptoms."
- 72. Open EndedA patient with Parkinson's disease says, "I always take my other medications with my bacon and eggs each morning. Can I take the levodopa (Dopar) at this time too?" The nurse's best response would be A. "You can take the levodopa at breakfast if it helps you to remember to take it." B. "You should take all of your medications together to enhance efficacy." C. "You should take the levodopa at least 1 hour before you eat your breakfast." D. "You should never take this medication with food, because that would increase its side effects."
- 73. Open EndedA patient on levodopa (Dopar) for Parkinson's disease comes to the emergency department complaining of a severe headache. The vital signs are: temperature 98.8° F, pulse 92/minute, blood pressure 202/107 mm Hg, and respirations 18/minute. A nurse should be most concerned if which of the following drugs is on the patient's current list? A. Carbidopa B. Citalopram (Celexa) C. Phenelzine (Nardil) D. Amitriptyline
- 74. Open EndedWhich statement is true about the Dopaminergic (Levodopa) and dopamine agonist? A. "Dopamine agonists are more effective than levodopa (Dopar)." B. "The effect of dopamine agonists will be reduced by dietary proteins." C. "Dopamine agonists are more likely to cause permanent and disabling dyskinesias compared to Levadopa." D. "Postural or orthostatic hypotension is common in patients taking levodopa and pramipexole;
- 75. Open EndedA patient with Parkinson's disease who has been responding well to drug treatment suddenly develops a relapse of symptoms. Which explanation by the nurse is most appropriate? A. "You have apparently developed resistance to your current medication and will have to change to another drug." B. "This is an atypical response. Unfortunately, there are no other options for drug therapy to treat your disease." C. "This is called the 'on-off' phenomenon. Avoiding high-protein meals and adding another drug may help." D. "You should keep taking your medication at the current dose. These effects will go away with time."
- 76. Open EndedA patient has been recently diagnosed with Parkinson's disease. A nurse is providing patient education for the patient and the spouse. The nurse is correct to state that the goal with the current drug regimen is to A. Improve the patient's ability to carry out activities of daily living. B. Stimulate the growth of new neurons. C. Cure the disease. D. Prevent hypertensive crisis.
- 77. Open EndedThe spouse of a patient with advanced Alzheimer's disease confides to the nurse that the patient's wandering, pacing, and agitation seem to get worse in the evening. The nurse correctly explains this phenomenon to the spouse as A. Evening psychosis. B. Drug toxicity. C. Sundowner's syndrome. D. New onset of psychosis.
- 78. Open EndedA nurse is teaching a class on Alzheimer's disease to a group of nurses. One of the nurses asks how a cholinesterase inhibitor drug works in the Alzheimer's patient. The nurse's best response would be A. "It prevents the breakdown of acetylcholine by acetylcholinesterase, reducing symptoms, such as memory loss." B. "It promotes excretion of neurotoxins." C. "It reverses central nervous system cell degeneration." D. "It helps grow new nerve cells to replace damaged ones in the brain."
- 79. Open EndedAn Alzheimer's patient has been taking a cholinesterase inhibitor for a week. What anticipated side effects (signs and symptoms) related to the medication would the nurse anticipate in the patient? A. Numbness and tingling in the extremities B. Hypertension C. Urinary incontinent, excessive sweating, and diarrhea D. Tinnitus and hearing loss
- 80. Open EndedA patient with a history of Alzheimer's disease has been taking tacrine (Cognex) for 18 months. Based on the side effects of the medication, the nurse should monitor which laboratory finding? A. Blood urea nitrogen B. 24-hour creatinine clearance studies C. Serum alanine transaminase (ALT) D. Complete blood count with differential
- 81. Open EndedA patient with advanced Parkinson's disease who takes levodopa (Dopar) has been taking Pramipexole (Mirapex) for several weeks. Which of the following findings should most concern the nurse? A. Increased urine output. B. Increased blood pressure C. Orthostatic hypotension D. Dry cough
- 82. Open EndedAn elderly woman with Alzheimer's disease is admitted to the hospital. Her daughter tells the nurse that her mother has been taking a cholinesterase inhibitor. But she does not remember the name of the medication. It could be the following drugs EXCEPT: A. Memantine (Namenda) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. Rivastigmine (Exelon)
- 83. Open EndedA nurse checks on a patient with Parkinson's disease who recently began taking levodopa (Dopar). The patient tells the nurse that every time she gets out of bed, she gets dizzy and light-headed. The nurse should instruct the patient to A. Maintain bed rest for at least 2 weeks. B. Sleep on her left side to improve her circulation. C. Take extra pill to reduce blood pressure. D. Push the call light to get help before she gets out of bed.
- 84. Open EndedA nurse is completing a discharge plan for a 24-year-old woman who has been prescribed an antiepileptic drug. What is the priority for teaching the patient about this drug? A. "Let's talk about what kind of contraception you plan to use while you are taking this medication." B. "I know it's depressing to have to take a drug for the rest of your life, but you absolutely may not ever stop taking it." C. "If you stop taking the medication all of a sudden, the withdrawal syndrome is less likely to occur." D. "You may stop taking this drug when you have had no seizures for 1 full year."
- 85. Open EndedA client is placed on antidepressant therapy with Zoloft (sertraline). What type of information should be included in the client's medication teaching plan? A. This medication can potentially cause acetylcholine syndrome. B. This medication can cause sexual dysfunction, weight change, and GI problems. C. It is safe to give this medication with monoamine oxidase inhibitors. D. This medication typically produces a symptom called "punding", one of the symptoms classified under dopamine dysregulation syndrome (DDS).
- 86. Open EndedA nurse is teaching a patient who starts taking fluoxetine (Prozac) about possible adverse reactions of treatment. For which of the following manifestations should the nurse teach instruct the patient to stop the medication and notify the provider immediately? A. Weight loss and increased appetite B. Hallucinations, high fever, and tremor C. drowsiness, dizziness, feeling nervous D. stuffy nose, sneezing, dry mouth
- 87. Open EndedA patient is taking Isocarboxazid (Marplan), a non-selective monoamine Oxidase Inhibitors (MAOIs). What diet would be appropriate for him? A. Avocado salad, ham, creamed potatoes, asparagus and pickle. B. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad and soy milk. C. Potatoes, ground beef patty, corn, and green beans D. Macaroni and cheese, hot dogs, banana bread and caffeinated coffee.
- 88. Fill in the Blank______________ produce the therapeutic effects by enhancing the inhibitory neurotransmitter, Gamma-amino-butyric acid (GABA). 1. Anticonvulsants 2. Lithium 3. SSRI 4. Benzodiazepine A. 1,3 B. 2,4 C. 2,3 D. 1,4
- 89. Open EndedWhich one of the following medications is most likely to be ordered for a client to assist in controlling the occurrence of panic disorder? A. Paxil (paroxetine), SSRI B. Depakote (divalproex sodium), anticonvulsant C. Seroquel (quetiapine), atypical antipsychotic D. Parnate (tranylcypromine), MAOI
- 90. Open EndedA patient was admitted to hospital for overnight observation for acute onset anxiety related to unexpected life events. What classification of medication would the nurse anticipate will be ordered first? A. tricyclic antidepressants. B. antimanic medications. C. Selective serotonin reuptake inhibitor (SSRI) D. benzodiazepines.
- 91. Open EndedA nurse is providing teaching to a patient who is starting amitriptyline (Elavil) for treatment of depression. Which of the following should be included? (Select all that apply.) 1.Therapeutic effects should be experienced immediately. 2.Stop taking the medication after a week of improved mood. 3.Change positions slowly to minimize dizziness. 4.Chew sugarless gum to prevent dry mouth. 5.Call your doctor immediately if you experience the symptoms such as, heavy chest, pounding heartbeats or fluttering in your chest. A. 1,2,3, and 4 B. 3,4,5 C. 1,2,4 D. 3 and 4
- 92. Open EndedWhen interviewing and caring for a university students with test anxiety, the nurse must be aware that test anxiety is often treatable with: A. Neuroleptics B. Beta Blockers C. tricyclic antidepressants D. monoamine oxidase inhibitors
- 93. Open EndedThe nurse observes a schizophrenia patient taking traditional or conventional or typical antipsychotic drug is rotating his head to one side in a stiffly fixed position, thrusting his lower jaw forward and drooling. Which intervention is most warranted? A. Administering benztropine (Cogentin) 2 mg intramuscularly. B. Administering trihexyphenidyl (Artane) 5 mg orally. C. Administering Nitroglycerin 0.4 mg sublingually. D. Teaching the client progressive muscle relaxation.
- 94. Open EndedA client comes to the medication clinic on Tuesday. The client's regular weekly appointment is Friday. The client complains to the nurse that he has a terrible sore throat. The nurse reviews the client's record and finds that the client is receiving Clozaril (clozapine). The client's temperature is 100 degrees fahrenheit. The nurse should make arrangements: A. for a prescription of an antibiotic. B. for administration of an anticholinergic. C. to have a blood draw and white blood cell (WBC) count checked. D. for admission to the in-patient unit.
- 95. Open EndedThe nurse is doing discharge teaching with a patient with the diagnosis of schizophrenia on the medication, risperidone (Risperdal). Which of the following statements accurately reflects information the nurse must provide? 1. "You should avoid eating foods high in tyramine, such as aged cheeses and pickled fish." 2. "The most common problem with this medication is the extrapyramidal symptom, such as tardive dyskinesia." 3. "You will need to have your blood drawn regularly in order to check the levels of cholesterol and triglyceride." 4. "If you experience increased thirst, urination and appetite, you need to contact your health care provider." A. 1, 2, 4 B. 3 C. 3, 4 D. 1,2,3,4
- 96. Open EndedWhich of the following symptoms are associated with Haloperidol (Haldol), the typical/traditional/conventional antipsychotic drug? 1.Facial muscle spasm 2.Shuffling gait 3.Involuntary movements of the tongue and face, such as lip-smacking 4.C. difficile induced diarrhea A. 1,2 B. 3 C. 1,2,3 D. 1,2,3 and 4
- 97. Open EndedA patient with schizophrenia has difficulty in holding a normal conversation. He replies the questions sparsely, and his speech lacks spontaneous content. In addition, he frequently fails to provide the answers. These symptoms are categorized under: A. Negative symptom B. Positive symptom C. Mood symptom D. Paranoiac symptom
- 98. Open EndedBuspirone (BuSpar) is different from other antianxiety medications in which of the following ways? A. Buspirone has anticonvulsant effects. B. Buspirone has muscle relaxant effects. C. Buspirone will depress the central nervous system. D. Buspirone does not cause physical or psychological dependence.
- 99. Open EndedA client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the provider about abruptly discontinuing the drug. Which response from the care provider is most likely appropriate? A. The dosage must be tapered to avoid withdrawal. B. The client must be evaluated for hypernatremia. C. Hypersomnia is the most common withdrawal symptom. D. The drug can be discontinued immediately since the patient has the situational anxiety.
- 100. Open EndedThe patient has been started on Citalopram (Celexa) for depression. He tells the nurse that he does not take any other medication except for St. John's wort, which he has found to be mildly therapeutic. What should be the nurse's highest priority response to this information A. The combination of Celexa and St. John's wort can be particularly safe and therapeutic. B. Co-administration of St. John's wort and Celexa can reduce their therapeutic effects. C. The combination of Celexa and St. John's Wort can reduce both drugs' SEs/ADEs. D. The combination of St. John's wort and Celexa can increase the risk of serotonin syndrome.
- 101. Open EndedWhich statement is true about mood stabilizers? A. The SEs/ADEs of Lithium include: GI discomfort, hand tremors, renal dysfunction and weight gain. B. If the patient does not respond to lithium, (s)he can switch to calcium channel blockers. C. Propranolol (Inderal ), the Beta adrenergic blocker (or beta blocker) is approved to treat Bipolar disroders. D. The anticonvulsant stabilize mood by increasing serotonin effects in CNS.
- 102. Open EndedWhich statement is true about antidepressant agents? 1. Tricyclic antidepressants (TCA) are associated with cardiac dysrhythmias 2. Tranzadone (Desyrel) can cause hyperactivity and insomnia 3. It is more effective and safer to use SSRI and MAOI together. 4. Bupropion can be used to help smoking cessation. A. 1,3 B. 2,4 C. 1,4 D. 1,3,4
- 103. Open EndedThe nurse is teaching a patient with a new prescription of lithium for her bipolar disorder. When teaching her about ways to prevent lithium toxicity, the nurse should advise her to do which of the following? A. Stops take the medication if the plasma lithium level is less than 0.1 mEq/L. B. Maintains a low sodium diet. C. Complies with fluid restriction of 800 mL daily. D. Avoid vigorous exercise in hot weather to prevent dehydration.
- 104. Open EndedThe client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered? A. Buspirone (BuSpar) B. Hydroxyzine (Vistaril) C. Flumazenil (Romazicon) D. Naloxone (Narcan)
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