NU 115 Final (Part 4) PDF

which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. d. They have a higher potency than agonists. They have a lower dependency potential than agonists. ANS: D If you need any other Test Banks or eTextbooks cont...

which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. d. They have a higher potency than agonists. They have a lower dependency potential than agonists. ANS: D If you need any other Test Banks or eTextbooks contact us: [email protected] 14. 15. 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 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 ANS: C 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The radiographs 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/day.‖ ANS: D 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. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning If you need any other Test Banks or eTextbooks contact us: [email protected] 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 ANS: C Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The opioid 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 ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking opioids such as Vicodin. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies COMPLETION 1. A patient is to receive methadone 2.5 mg intramuscularly (IM) now. The medication is available in a concentration of 10 mg/mL. Identify how many milliliters of methadone will be drawn up for this dose. ANS: 0.25 mL 10 mg:1 mL::2.5 mg:x mL (10 x) = (2 2.5); 10x = 2.5; x = 0.25 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 13: Central Nervous System Stimulants and Related Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. 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 ANS: 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who started taking orlistat 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. d. The patient will need to increase her fat intake to prevent these adverse effects. The patient will need to restrict fat intake to less than 30% of total calories to help reduce these adverse effects. ANS: D 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. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride 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. ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. 7. 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. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation A 22-year-old nursing student has been taking 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 human needs statement may be appropriate for her? a. Altered oxygenation need b. Altered physical activity c. Altered need for sleep d. Altered food intake ANS: C Caffeine, is a central nervous system stimulant that can be used to increase mental alertness. It is available in OTC forms such as NoDoz. Restlessness, anxiety, and insomnia are common adverse effects. Thus, altered need for sleep is the most appropriate human needs statement of those listed. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation A 10-year-old patient will be started on methylphenidate hydrochloride 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 ANS: B Assessment of baseline height and weight is important before beginning methylphenidate therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When evaluating a patient who is taking orlistat, which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity ANS: C are incorrect. Orlistat is a nonstimulant drug that is used as part of a weight loss program. The other options DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is teaching a patient how to self-administer triptan injections for migraine If you need any other Test Banks or eTextbooks contact us: [email protected] 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. c. d. ―I will take this medication when I feel a migraine headache starting.‖ ―This medication will not reduce the number of migraines I will have.‖ ―I will keep a journal to record the headaches I have and how the injections are working.‖ ANS: 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. 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 g. Migraine headaches ANS: A, D, E, F, G Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, migraine headaches, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient has a new prescription for phentermine 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. b. c. d. e. Take this medication after meals. Take this medication in the morning. This drug is taken along with supervised exercise and suitable diet. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. Avoid foods that contain caffeine, such as coffee, tea, and colas. ANS: B, C, D, E 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 If you need any other Test Banks or eTextbooks contact us: [email protected] 3. 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has just received an injection of onabotulinumtoxin A. The nurse will monitor for which adverse effects? (Select all that apply.) a. Insomnia b. Dysphagia c. Weight gain d. GI upset e. Difficulty breathing ANS: B, E Onabotulinumtoxin A (Botox) is given by injection (by a healthcare provider) 12 weeks. Botox has a Black Box Warning regarding spread of the toxin beyond the site of injection which can result in dysphagia and breathing difficulties. The other answers are not correct. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Evaluation COMPLETION 1. The order reads, ―Give atomoxetine 0.5 mg/kg/day once daily in the morning before school.‖ The child weighs 88 pounds. Identify how many milligrams will be administered per dose. ANS: 20 mg 88 pounds ÷ 2.2 = 40 kg. 0.5 mg/kg/day 40 kg = 20 mg/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 14: Antiepileptic Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a. Levetiracetam b. Phenobarbital c. Valproic acid d. Gabapentin ANS: B Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options; therefore, it allows for once-a-day dosing. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse has given medication instructions to a patient receiving phenytoin. Which statement by the patient indicates that the patient has an adequate understanding of the instructions? a. b. c. d. ―I will need to take extra care of my teeth and gums while on this medication.‖ ―I can go out for a beer while on this medication.‖ ―I can skip doses if the side effects bother me.‖ ―I will be able to stop taking this drug once the seizures stop.‖ ANS: A Thorough 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. DIF: Cognitive Level: Analyzing (Analysis) MSC: NCLEX: Safe and Effective Care Environment: Management of Care TOP: Nursing Process: Evaluation When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. b. c. d. ―Driving is allowed after 2 weeks of therapy.‖ ―If seizures recur, take a double dose of the medication.‖ ―Antacids can be taken with the AED to reduce gastrointestinal adverse effects.‖ ―Take the drug at the same time every day.‖ ANS: D 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. The other options are not correct statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. MSC: NCLEX: Safe and Effective Care Environment: Management of Care A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin 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. b. c. d. Give the same dose intravenously. Give the morning dose with a small sip of water. Contact the prescriber for another dosage form of the medication. Notify the operating room that the medication has been withheld. ANS: C 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is monitoring a patient who has been taking carbamazepine for 2 months. Which effects would indicate that autoinduction has started to occur? a. b. c. d. The drug levels for carbamazepine are higher than expected. The drug levels for carbamazepine are lower than expected. The patient is experiencing fewer seizures. The patient is experiencing toxic effects from the drug. ANS: B 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is giving an intravenous dose of phenytoin. Which action is correct when administering this drug? a. b. c. d. Give the dose as a fast intravenous (IV) bolus. Mix the drug with normal saline, and give it as a slow IV push. Mix the drug with dextrose (D5W), and give it as a slow IV push. Mix the drug with any available solution as long as the administration rate is correct. ANS: B 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. 10. 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 ANS: A The U.S. Food and Drug Administration (FDA) has 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a. Diazepam b. Midazolam c. Valproic acid d. Carbamazepine ANS: A Diazepam and lorazepam are considered by many to be the drugs 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Phenytoin has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these? a. b. c. d. The safe and the toxic plasma levels of the drug are very close to each other. The phenytoin has a low chance of being effective. There is no difference between safe and toxic plasma levels. A very small dosage can result in the desired therapeutic effect. ANS: 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. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has been taking an AED for several years as part of his treatment for seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore. What is the nurse‘s best If you need any other Test Banks or eTextbooks contact us: [email protected] 11. 12. 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.‖ ANS: B 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 18 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. ANS: B Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect. DIF: Cognitive Level: Analyzing (Analysis) MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: Evaluation A patient is taking gabapentin, 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. b. c. d. The medication is used for the treatment of neuropathic pain. The medication is helpful for the treatment of multiple sclerosis. The medication is used to reduce the symptoms of Parkinson‘s disease. The medical record is missing the correct information about the patient‘s history of seizures. ANS: A Gabapentin is commonly used to treat neuropathic pain. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE If you need any other Test Banks or eTextbooks contact us: [email protected] 1. The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.) a. b. c. d. e. AED therapy can be stopped when seizures are stopped. AED therapy is usually lifelong. Consistent dosing is the key to controlling seizures. A dose may be skipped if the patient is experiencing adverse effects. Abruptly stopping AEDs may cause rebound seizure activity. ANS: B, C, E 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. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation