NU 115 Final Past Paper PDF

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A 9-year-old child will be receiving carbamazepine suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient fo...

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A 9-year-old child will be receiving carbamazepine suspension, 200 mg twice daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose. ANS: 10 mL 100 mg:5 mL::200 mg:x mL. (100 x) = (5 200); 100x = 1000; x = 10 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 15: Antiparkinson Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. A patient has been taking selegiline for a few months, and recently the prescriber increased his dose to 20 mg/day. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and ―felt awful.‖ What did the patient most likely experience? a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset ANS: B At doses that exceed the recommended dosage of 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient has been given a prescription for carbidopa-levodopa for a new diagnosis of Parkinson‘s disease. The patient asks the nurse, ―Why are there two drugs in this pill?‖ The nurse‘s best response reflects which fact? a. b. c. Carbidopa allows for larger doses of levodopa to be given. Carbidopa prevents the breakdown of levodopa in the periphery. There are concerns about drug–food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system. ANS: B When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When a patient is taking an anticholinergic such as benztropine as part of the treatment for Parkinson‘s disease, the nurse should include which information in the teaching plan? If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. a. b. c. d. Minimize the amount of fluid taken while on this drug. Discontinue the medication if adverse effects occur. Take the medication on an empty stomach to enhance absorption. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth. ANS: D Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. Drinking water, at least 3000 mL/day unless contraindicated is important, even if the patient is not thirsty to prevent and manage the adverse effect of constipation and to prevent dehydration. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living ANS: D Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation Carbidopa-levodopa is prescribed for a patient with Parkinson‘s disease. The nurse informs the patient that which common adverse effects can occur with this medication? a. Drowsiness, headache, weight loss b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention ANS: D Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson‘s disease. Which condition is a contraindication for the patient, who will be taking entacapone? a. Glaucoma b. Seizure disorder c. Liver failure d. Benign prostatic hyperplasia If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. ANS: C Entacapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which human needs statement would be appropriate for this patient? a. Altered gastrointestinal elimination (diarrhea) b. Altered urinary elimination c. Altered safety needs, risk for infection d. Altered sleep needs ANS: B Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other human needs statements are not applicable to anticholinergic drugs. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Planning A patient who has been on levodopa therapy for a year has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson‘s disease. The nurse recognizes that which of these is an advantage of this drug class? a. b. c. d. It has a shorter duration of action. It causes less gastrointestinal distress. It has a slower onset than traditional Parkinson‘s disease drugs. It reduces the wearing-off phenomenon. ANS: D COMT inhibitors prolong the duration of action of levodopa, resulting in reduced wearing-off phenomenon. The other statements are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient taking entacapone for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation? a. b. c. d. This is a harmless effect of the drug. The patient has taken this drug along with red wine or cheese. The patient is having an allergic reaction to the drug. The ordered dose is too high for this patient. ANS: A COMT inhibitors, including entacapone, may darken a patient‘s urine and sweat. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies While a patient is receiving drug therapy for Parkinson‘s disease, the nurse monitors for dyskinesia, which is manifested by which finding? a. Rigid, tense muscles b. c. d. Difficulty in performing voluntary movements Limp extremities with weak muscle tone Confusion and altered mental status ANS: B Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson‘s disease. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When treating patients with medications for Parkinson‘s disease, the nurse knows that the wearing-off phenomenon occurs for which reason? a. b. c. d. The patient cannot tolerate the medications at times. There are rapid swings in the patient‘s response to levodopa. The medications begin to lose effectiveness against Parkinson‘s disease. The patient‘s liver is no longer able to metabolize the drug. ANS: C The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. When assessing the medication history of a patient with a new diagnosis of Parkinson‘s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.) a. Angle-closure glaucoma b. History of malignant melanoma c. Hypertension d. Benign prostatic hyperplasia e. Concurrent use of monoamine oxidase inhibitors (MAOIs) ANS: A, B, E Angle-closure glaucoma, a history of malignant melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment If you need any other Test Banks or eTextbooks contact us: [email protected] MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. The prescriber writes this order, ―Give amantadine 100 mg per PEG tube twice a day.‖ The medication is available in a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters the nurse will give with each dose. ANS: 10 mL 50 mg:5 mL::100 mg:x mL. (50 x) = (5 100); 50x = 500; x = 10 mL. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 16: Psychotherapeutic Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The nurse reads in the patient‘s medication history that the patient is taking buspirone. The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder ANS: A bipolar disorder. Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Before beginning a patient‘s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Warfarin c. Diuretics d. Nonsteroidal anti-inflammatory drugs ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential When a patient is receiving a second-generation antipsychotic drug, such as risperidone, the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia ANS: B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect. If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation A patient has been taking haloperidol for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Involuntary motor symptoms d. Dry mouth and constipation ANS: C Extrapyramidal symptoms are manifested by involuntary motor symptoms, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine for 6 months. The patient wants to go to a party and asks the nurse, ―Will just one beer be a problem?‖ Which advice from the nurse is correct? a. b. ―You can drink beer as long as you have a designated driver.‖ ―Now that you‘ve been on the drug for 6 months, there will be no further dietary restrictions.‖ c. ―If you begin to experience a throbbing headache, rapid pulse, or nausea, you‘ll need to stop drinking.‖ d. ―You need to avoid all foods that contain tyramine, including beer, while taking this medication.‖ ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A patient has been taking lithium for 1 year, and the most recent lithium level is 0.5 mEq/L. Which statement about the laboratory result is correct? a. b. c. d. The lithium level is therapeutic. The lithium level is too low. The lithium level is too high. Lithium is not usually monitored with blood levels. ANS: B Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect. If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. DIF: Cognitive Level: Analyzing (Analysis) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Evaluation A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. b. c. d. ―I can‘t sleep at night.‖ ―I feel hungry all the time.‖ ―Look at how red my hands are.‖ ―My mouth has been so dry lately.‖ ANS: D and constipation. Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Evaluation A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John‘s wort. Which response by the nurse is appropriate? a. b. c. d. ―That should be no problem.‖ ―Good idea! Hopefully you‘ll be able to stop taking the Zoloft.‖ ―Be sure to stop taking the herb if you notice a change in side effects.‖ ―Taking St. John‘s wort with this medication may cause severe interactions and is not recommended.‖ ANS: D The herbal product St. John‘s wort must not be used with SSRIs because of the potential for serotonin syndrome (see Box. 16.1). The other responses by the nurse are inappropriate. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite ANS: B The U.S. Food and Drug Administration (FDA) has issued black box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Evaluation If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. 12. MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding ANS: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning The wife of a patient who has been diagnosed with depression calls the office and says, ―It‘s been an entire week since he started that new medicine for his depression, and there‘s no change! The medicine is not working!‖ What is the nurse‘s best response? a. b. ―The medication may not be effective for him. He may need to try another type.‖ ―It may take 4 to 6 weeks to notice any therapeutic effects. Let‘s wait a little longer to see how he does.‖ c. ―It sounds like the dose is not high enough. I‘ll check about increasing the dosage.‖ d. ―Some patients never recover from depression. He may not respond to this therapy.‖ ANS: B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Clozapine, an atypical antipsychotic, is prescribed for a patient. The nurse will monitor for which adverse effect during this drug therapy? a. Edema b. Photosensitivity c. Hypotension d. Severe neutropenia ANS: D Atypical antipsychotics may cause severe neutropenia. The other effects are adverse effects of conventional antipsychotics. 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] 13. 14. 15. The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching? a. Grapefruit juice b. Salami sandwich c. Scrambled eggs d. Pancakes and maple syrup ANS: B Cured meats such as salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. The other foods listed do not contain tyramine. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b. Palpitations and anxiety c. Dry mouth d. Constipation ANS: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug–food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants. ANS: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning MULTIPLE RESPONSE If you need any other Test Banks or eTextbooks contact us: [email protected] 1. 2. A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) states that he ―felt awful‖ when he started taking an over-the-counter St. John‘s wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating ANS: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. b. c. Avoid foods and beverages that contain tyramine. Monitor the patient for extrapyramidal symptoms. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur. ANS: C, D During SSRI therapy, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the