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Questions and Answers
Which instruction would a nurse provide a patient who is receiving the first dose of an antiseizure drug at home?
Which instruction would a nurse provide a patient who is receiving the first dose of an antiseizure drug at home?
Which potential complication could occur if a patient abruptly stops taking an antiseizure drug?
Which potential complication could occur if a patient abruptly stops taking an antiseizure drug?
By which mechanism do selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function?
By which mechanism do selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function?
Which finding indicates a contraindication that should be discussed by the patient with the healthcare provider regarding seizure activity in spite of taking the prescribed medication?
Which finding indicates a contraindication that should be discussed by the patient with the healthcare provider regarding seizure activity in spite of taking the prescribed medication?
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Which would be the best information for the nurse to include in medication education to promote adherence to the therapeutic regimen if a patient who has taken fluoxetine for 2 weeks reports dissatisfaction with the therapy?
Which would be the best information for the nurse to include in medication education to promote adherence to the therapeutic regimen if a patient who has taken fluoxetine for 2 weeks reports dissatisfaction with the therapy?
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Which side effect will a patient receiving phenytoin minimize with regular visits to the dentist and appropriate oral hygiene?
Which side effect will a patient receiving phenytoin minimize with regular visits to the dentist and appropriate oral hygiene?
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Which activity would the patient be cautioned to avoid while taking a monoamine oxidase inhibitor (MAOI)?
Which activity would the patient be cautioned to avoid while taking a monoamine oxidase inhibitor (MAOI)?
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Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants?
Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants?
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Which substance(s) does the nurse advise the patient to avoid if the patient has been prescribed cyclobenzaprine? (Select all that apply)
Which substance(s) does the nurse advise the patient to avoid if the patient has been prescribed cyclobenzaprine? (Select all that apply)
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Which assessment would the nurse make a priority if a patient taking an antidepressant for major depression reports feeling dizzy when getting up after sitting in a chair?
Which assessment would the nurse make a priority if a patient taking an antidepressant for major depression reports feeling dizzy when getting up after sitting in a chair?
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Which condition is the patient most likely experiencing when prescribed alprazolam?
Which condition is the patient most likely experiencing when prescribed alprazolam?
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Which substance would the nurse question a patient about using if the nurse suspects serotonin syndrome and the patient, who is currently taking duloxetine, reports restlessness, agitation, diaphoresis, and tremors?
Which substance would the nurse question a patient about using if the nurse suspects serotonin syndrome and the patient, who is currently taking duloxetine, reports restlessness, agitation, diaphoresis, and tremors?
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Which intervention(s) would the nurse implement for a patient who has been prescribed a benzodiazepine for anxiety? (Select all that apply)
Which intervention(s) would the nurse implement for a patient who has been prescribed a benzodiazepine for anxiety? (Select all that apply)
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Which medication would the nurse expect the primary health care provider to prescribe for a suspected benzodiazepine overdose?
Which medication would the nurse expect the primary health care provider to prescribe for a suspected benzodiazepine overdose?
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Which sign or symptom would the nurse observe when caring for a patient who experienced an absence seizure?
Which sign or symptom would the nurse observe when caring for a patient who experienced an absence seizure?
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Which patient finding indicates the goals were met when the nurse is evaluating the plan of care for a patient receiving phenytoin for the treatment of a seizure disorder?
Which patient finding indicates the goals were met when the nurse is evaluating the plan of care for a patient receiving phenytoin for the treatment of a seizure disorder?
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Which assessment is priority for the emergency room nurse caring for a patient who reports taking 'cold medicine' at home and is now dizzy and sweaty?
Which assessment is priority for the emergency room nurse caring for a patient who reports taking 'cold medicine' at home and is now dizzy and sweaty?
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Which statement explains why a patient would be cautioned not to drink alcohol while taking benzodiazepines?
Which statement explains why a patient would be cautioned not to drink alcohol while taking benzodiazepines?
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Which can benefit from fluoxetine? (Select all that apply)
Which can benefit from fluoxetine? (Select all that apply)
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Which finding indicates the nurse administered an initial dose of diazepam 5 mg intravenous (IV) push to a patient experiencing status epilepticus too rapidly?
Which finding indicates the nurse administered an initial dose of diazepam 5 mg intravenous (IV) push to a patient experiencing status epilepticus too rapidly?
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Which is an adverse effect of cyclobenzaprine? (Select all that apply)
Which is an adverse effect of cyclobenzaprine? (Select all that apply)
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Which instruction will the nurse provide to a patient taking both phenytoin and an oral contraceptive?
Which instruction will the nurse provide to a patient taking both phenytoin and an oral contraceptive?
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Which information would the nurse provide to a patient taking anticonvulsants for a seizure disorder? (Select all that apply)
Which information would the nurse provide to a patient taking anticonvulsants for a seizure disorder? (Select all that apply)
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Which condition(s), if found in the patient’s medical history, would prompt the nurse to contact the health care provider for an alternative prescription if the health care provider has prescribed cyclobenzaprine to treat muscle spasms? (Select all that apply)
Which condition(s), if found in the patient’s medical history, would prompt the nurse to contact the health care provider for an alternative prescription if the health care provider has prescribed cyclobenzaprine to treat muscle spasms? (Select all that apply)
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Which reversal agent needs to be on hand when administering intravenous lorazepam?
Which reversal agent needs to be on hand when administering intravenous lorazepam?
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Which intervention is most important to ensure safety in a patient being treated with anxiolytic medications?
Which intervention is most important to ensure safety in a patient being treated with anxiolytic medications?
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Which conclusion will the nurse make when a patient states, 'When my brother had anesthesia, he developed a really high temperature,' in completing an assessment regarding general anesthesia?
Which conclusion will the nurse make when a patient states, 'When my brother had anesthesia, he developed a really high temperature,' in completing an assessment regarding general anesthesia?
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Which serum drug level is within the therapeutic range for phenytoin?
Which serum drug level is within the therapeutic range for phenytoin?
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Which cue related to central nervous system side or adverse effects in a patient taking lorazepam should the nurse be alert for? Select all that apply.
Which cue related to central nervous system side or adverse effects in a patient taking lorazepam should the nurse be alert for? Select all that apply.
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Which is an anticholinergic side effect of cyclobenzaprine? Select all that apply.
Which is an anticholinergic side effect of cyclobenzaprine? Select all that apply.
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Which assessment question will the nurse ask before administering zolpidem tartrate to an older patient with insomnia? Select all that apply.
Which assessment question will the nurse ask before administering zolpidem tartrate to an older patient with insomnia? Select all that apply.
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How does phenytoin work to control seizures?
How does phenytoin work to control seizures?
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Which statement by the patient is a characteristic finding in narcolepsy?
Which statement by the patient is a characteristic finding in narcolepsy?
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Which method is most effective when the nurse is teaching a patient about antidepressant medications?
Which method is most effective when the nurse is teaching a patient about antidepressant medications?
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Which feature of phenytoin makes it most susceptible to drug interactions?
Which feature of phenytoin makes it most susceptible to drug interactions?
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Which diagnosis would the nurse expect for a patient who has involuntary movements of the body and extremities?
Which diagnosis would the nurse expect for a patient who has involuntary movements of the body and extremities?
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Which condition is a contraindication to lorazepam therapy?
Which condition is a contraindication to lorazepam therapy?
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Which alteration would the nurse monitor for if a central nervous system stimulant is abruptly stopped?
Which alteration would the nurse monitor for if a central nervous system stimulant is abruptly stopped?
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Which symptom would the nurse recognize as a side effect of fluoxetine? Select all that apply.
Which symptom would the nurse recognize as a side effect of fluoxetine? Select all that apply.
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Which parameter would the nurse plan to monitor in a patient who is beginning treatment of major depression with a selective serotonin reuptake inhibitor (SSRI)? Select all that apply.
Which parameter would the nurse plan to monitor in a patient who is beginning treatment of major depression with a selective serotonin reuptake inhibitor (SSRI)? Select all that apply.
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Which action would the nurse take to ensure the well-being of a patient taking lorazepam who reports headaches, dry mouth, and constipation?
Which action would the nurse take to ensure the well-being of a patient taking lorazepam who reports headaches, dry mouth, and constipation?
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Which intervention would the nurse include in the plan of care for a patient hospitalized with a history of convulsions?
Which intervention would the nurse include in the plan of care for a patient hospitalized with a history of convulsions?
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Which substance(s) does the nurse instruct the patient to avoid to help prevent intensification of alprazolam’s adverse effects? Select all that apply.
Which substance(s) does the nurse instruct the patient to avoid to help prevent intensification of alprazolam’s adverse effects? Select all that apply.
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Which action is appropriate for a nurse who determines a patient’s phenytoin level is 8 mcg/mL?
Which action is appropriate for a nurse who determines a patient’s phenytoin level is 8 mcg/mL?
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Which symptom(s) would the nurse expect a patient with major depression to describe when the nurse is gathering a health history? Select all that apply.
Which symptom(s) would the nurse expect a patient with major depression to describe when the nurse is gathering a health history? Select all that apply.
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Which instruction is important for a nurse to include in discharge teaching for a 25-year-old female patient who has been prescribed phenytoin for seizures?
Which instruction is important for a nurse to include in discharge teaching for a 25-year-old female patient who has been prescribed phenytoin for seizures?
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Which action will a nurse take for a patient who has a serum phenytoin level of 31 mg/mL?
Which action will a nurse take for a patient who has a serum phenytoin level of 31 mg/mL?
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Which action would the nurse take when providing care to a patient who has recently been prescribed a benzodiazepine?
Which action would the nurse take when providing care to a patient who has recently been prescribed a benzodiazepine?
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Which nonpharmacologic nursing intervention can be provided to help promote sleep in a patient who reports unusual sleep patterns and lack of sleep?
Which nonpharmacologic nursing intervention can be provided to help promote sleep in a patient who reports unusual sleep patterns and lack of sleep?
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Study Notes
Benzodiazepine Interventions
- Instruct patients to change positions slowly to prevent dizziness from orthostatic hypotension.
- Advise against driving while on benzodiazepines due to sedation effects.
- Caution patients to avoid alcohol to prevent increased CNS depression.
- Teach relaxation techniques before initiating anxiolytic treatment.
Benzodiazepine Overdose Management
- Flumazenil is the preferred medication for suspected benzodiazepine overdose.
Absence Seizures
- Characterized by brief loss of consciousness lasting less than 10 seconds.
Evaluation of Phenytoin Treatment
- Goals met if a therapeutic phenytoin level (10-20 mcg/mL) is noted; a level of 15 mcg/mL is acceptable.
- New seizure activity indicates goals are not met, warranting further education.
Emergency Room Priorities
- Blood pressure assessment is crucial for patients on 'cold medicine' who present with dizziness and sweating, due to potential hypertensive crises.
Alcohol Consumption with Benzodiazepines
- Alcohol can cause respiratory depression when combined with benzodiazepines, highlighting the need for patient education regarding safety.
Fluoxetine Applications
- Effective for panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder; does not treat ADHD.
Diazepam Administration Cautions
- Rapid IV administration of diazepam can lead to respiratory depression; monitor for a low respiratory rate (e.g., seven breaths per minute).
Adverse Effects of Cyclobenzaprine
- Possible effects include seizures, angioedema, bronchospasm, and myocardial infarction with chronic use.
Phenytoin and Contraceptive Interactions
- Patients on phenytoin should use additional contraception as it can reduce the efficacy of oral contraceptives.
Anticonvulsant Patient Instructions
- Wear medical alert bracelets, monitor serum drug levels regularly, and maintain dental check-ups every six months to manage gingival hyperplasia.
Cyclobenzaprine Contraindications
- Use caution in patients with hyperthyroidism or narrow-angle glaucoma due to potential increased intraocular pressure.
Lorazepam Safety Measures
- The reversal agent flumazenil should be readily available during lorazepam administration for potential rapid sedation reversal.
Anxiolytics Safety Monitoring
- Monitor for orthostatic hypotension as a significant safety issue when treating patients with anxiolytics.
Malignant Hyperthermia Risk
- Family history of high fever post-anesthesia suggests potential risk for malignant hyperthermia in the patient.
Therapeutic Levels for Phenytoin
- Therapeutic serum levels for phenytoin: 10-20 mcg/mL; levels below 10 mcg/mL are subtherapeutic, above 20 mcg/mL are supratherapeutic.
CNS Effects of Lorazepam
- Watch for seizures, suicidal ideation, confusion, and amnesia in patients taking lorazepam.
Anticholinergic Effects of Cyclobenzaprine
- Common effects include tachycardia, constipation, and urinary retention; monitor for these symptoms as part of patient assessment.### Zolpidem Tartrate Administration
- Ask older patients about alcohol consumption to prevent additive CNS depression when administering zolpidem.
- Inquire about liver and kidney issues as zolpidem is cautioned in patients with these conditions.
- Crohn disease and thyroid conditions are not relevant to zolpidem therapy.
Phenytoin and Seizure Control
- Phenytoin works by preventing sodium influx into neurons, stabilizing cell membranes and reducing neuron firing.
- Unlike phenytoin, levetiracetam and gabapentin suppress calcium movement while gabapentin enhances GABA action.
Narcolepsy Characteristic Findings
- "My spouse tells me I walk in my sleep" indicates narcolepsy, characterized by excessive daytime sleepiness.
- Other statements may indicate different conditions: difficulty falling asleep relates to insomnia, while leg movement at night suggests restless legs syndrome.
Teaching about Antidepressants
- Verbal instructions paired with video reinforcement are the best teaching methods for patient understanding of antidepressants.
- Printed instructions may be ineffective if the patient cannot read or understand them, and online resources may not be accessible.
Phenytoin Drug Interactions
- Phenytoin is highly protein-bound, making it susceptible to drug interactions by competing for plasma protein-binding sites.
- Alkalinity, fat solubility, and water solubility do not significantly increase drug interaction risk.
Involuntary Movements and Diagnoses
- Tardive dyskinesia is diagnosed for involuntary body and extremity movements, while akathisia involves restlessness and pacing.
Lorazepam Contraindications
- History of alcoholism is a contraindication for lorazepam therapy due to potential for further substance abuse.
- Lorazepam can be suitable for patients with convulsions or myocardial infarctions.
Withdrawal from CNS Stimulants
- Abrupt cessation of CNS stimulants may lead to depression and withdrawal symptoms.
- Agitation, anorexia, and psychosis are not typical outcomes of stopping stimulants suddenly.
Fluoxetine Side Effects
- Common side effects of fluoxetine include nausea, headache, and dry mouth.
- Bleeding and muscle pain are not recognized side effects of this medication.
Monitoring Patients on SSRIs
- Monitor fluid volume and skin integrity in patients starting SSRIs due to risks of edema and possible Stevens-Johnson syndrome.
- Assess for suicidal ideations since SSRIs may increase suicide risk.
Lorazepam Patient Management
- Ensure gradual reduction of lorazepam dosage to prevent complications; sudden withdrawal can heighten risks.
- Do not administer CNS depressants concurrently due to the risk of respiratory depression.
Seizure Precautions
- Implement seizure precautions for patients with a history of convulsions during hospitalization.
- Monitor serum electrolytes if dehydration is suspected.
Avoiding Alprazolam Interactions
- Advise patients to avoid alcohol, opioids, antihistamines, and muscle relaxants while taking alprazolam due to increased CNS depression risk.
- Tobacco is harmful but does not intensify alprazolam effects; caffeine may counteract depression effects.
Phenytoin Therapeutic Levels
- Therapeutic phenytoin levels range from 10 to 20 mcg/mL. A level of 8 mcg/mL may necessitate dosage adjustment.
- A level of 31 mg/mL indicates toxicity, requiring the nurse to hold the drug and consult a healthcare provider.
Benzodiazepine Monitoring
- Assess sedation levels in patients prescribed benzodiazepines due to CNS depressant effects.
- Benzodiazepines do not typically impact bowel sounds, orientation, or potassium levels.
Nonpharmacologic Sleep Promotion
- Encouraging patients to arise at a specific time each morning aids sleep regulation.
- Advise against fluid intake before bedtime to minimize nocturia, and avoid alcohol close to bedtime due to sleep disturbance risks.
Antiseizure Medication Instructions
- Patients should understand their reaction to antiseizure medication prior to activities like driving.
- Fever does not contraindicate taking antiseizure medication, and patients do not need to lie down after dosing.
Complications of Antiseizure Withdrawal
- Stopping antiseizure medications abruptly may lead to rebound seizures and status epilepticus.
- Other complications like drug dependence or confusion are unlikely from abrupt withdrawal.
Mechanism of SSRIs and TCAs
- Both SSRIs and TCAs block neurotransmitter reuptake at nerve endings, enhancing serotonin and norepinephrine levels.
- They do not increase alertness and do not contribute solely to placebo effects.
Herbal Interactions with Anticonvulsants
- Patients should discuss the use of gingko biloba with healthcare providers as it may interact adversely with anticonvulsants.
- Medications like aspirin, lisinopril, and furosemide do not pose significant risks with phenytoin.### Medication Education for Fluoxetine
- Fluoxetine, an SSRI, may take 4 to 6 weeks to show full therapeutic effects.
- Patients should be informed they can expect therapeutic effects in another 2 to 4 weeks to support adherence.
- Adverse effects can be managed, but patients may struggle with compliance due to depression.
Phenytoin Side Effects
- Common side effect of phenytoin is gingival hyperplasia, characterized by gum overgrowth and bleeding.
- Regular dental visits and good oral hygiene can minimize this side effect.
- Phenytoin is not associated with oral candidiasis, dental abscess risk, or dental caries increase.
Cautions for Monoamine Oxidase Inhibitors (MAOIs)
- Patients on MAOIs must avoid tyramine-rich foods like aged cheese to prevent hypertensive crises.
- Sunbathing, smoking low-nicotine cigarettes, and participating in activities like bowling are not contraindicated with MAOIs.
Lorazepam Administration and Response
- Lorazepam can cause oversedation; if a patient is unresponsive with shallow breathing, immediate administration of flumazenil is crucial.
- Monitor vital signs but prioritize administering the reversal agent first.
CNS Stimulants Pharmacodynamics
- CNS stimulants increase the release and alter the reuptake of excitatory neurotransmitters.
- They do not inhibit neurons nor reduce the production of excitatory neurotransmitters.
Cyclobenzaprine Advisories
- Cyclobenzaprine, a CNS depressant, requires avoidance of alcohol, barbiturates, and tricyclic antidepressants to prevent excessive CNS depression.
- Anesthetics and aminoglycosides can be safely used with cyclobenzaprine.
Priority Assessments for Antidepressants
- Patients on antidepressants experiencing dizziness upon standing need a blood pressure measurement due to potential orthostatic hypotension.
- Other measures like potassium levels, pulse oximetry, and respiratory rate are less immediately critical.
Alprazolam Use
- Alprazolam primarily treats anxiety associated with depression; it's not first-line for insomnia, seizures, or alcohol withdrawal.
Serotonin Syndrome and Duloxetine
- Caution is warranted with St. John’s wort use alongside duloxetine, as it increases the risk of serotonin syndrome.
- Ginkgo, ibuprofen, and glucosamine chondroitin do not pose such risks with SSRIs.
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Test your knowledge on the Central and Peripheral Nervous Systems with this quiz. It covers various interventions and concepts vital for understanding the nervous system's function. Ideal for nursing students and those studying neuroscience.
