5.pdf

Performance Exit Topic 5 Central and Peripheral Nervous Systems Due Jun 9, 2024 by 11:59 pm Final Score 30% 15 out of 50 questions answered correctly...

Performance Exit Topic 5 Central and Peripheral Nervous Systems Due Jun 9, 2024 by 11:59 pm Final Score 30% 15 out of 50 questions answered correctly Completed on Jun 9, 2024 10:53 pm Incorrect (35) Report content error Which intervention(s) would the nurse implement for a Which intervention(s) would the nurse implement for a patient who has been prescribed a benzodiazepine for anxiety? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Instruct the patient to change positions slowly. Instruct the patient not to drive during therapy. Teach the patient to avoid alcohol during therapy. Teach relaxation methods after the patient discontinues the drug. Monitor the patient’s urine output to look for urinary retention. Rationale The nurse would instruct the patient to change positions slowly in order to prevent dizziness due to orthostatic hypotension. Benzodiazepines cause sedation; therefore the nurse would instruct the patient not to drive during therapy. The drug can increase central nervous system (CNS) depression if it is taken with alcohol, so the patient would be taught to avoid alcohol during therapy. The patient may develop urinary incontinence, not urinary retention, during treatment. Generally, the nurse would teach the patient relaxation techniques before the patient begins treatment with an anxiolytic, not after the patient has discontinued the drug. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 266 Report content error Which medication would the nurse expect the primary health care provider to prescribe for a suspected benzodiazepine overdose? Oxazepam Flumazenil Lorazepam Buspirone HCl Rationale Flumazenil is a benzodiazepine antagonist. Thus the nurse would expect the primary health care provider to prescribe flumazenil for a suspected benzodiazepine overdose. Oxazepam and lorazepam are both benzodiazepines; as such, they would worsen the patient’s condition. Buspirone is also an anxiolytic but has fewer side effects than benzodiazepines. pp. 265-266  Report content error Which sign or symptom would the nurse observe when caring for a patient who experienced an absence seizure? Brief loss of consciousness Paleness, flushing, and sweating Small muscular jerks on one limb Visual and auditory hallucinations Rationale An absence seizure is manifested by a brief loss of consciousness that is less than 10 seconds. Paleness, flushing, and sweating are signs of an autonomic response. Small muscular jerks affecting one limb is a myoclonic seizure. Visual and auditory hallucinations occur with sensory seizures. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 220  Report content error 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? Drinking one drink per week Driving on weekends to the store Reporting seizure activity today  Noting a phenytoin level of 15 mcg/mL Rationale The nurse would consider goals to be met when the patient’s laboratory results indicate a therapeutic drug level that suggests the patient understood the instructions and is taking the medication as instructed. Further education is required when the patient reveals that he or she is consuming alcohol and still driving a vehicle. These are safety issues and indicate the goals were not met. New seizure activity would indicate the patient is not taking the medication as prescribed. p. 221 Report content error 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? Apical pulse Temperature Pulse oximetry Blood pressure Rationale When reviewing medications, the nurse’s attention should be on the patient’s home medications; because monoamine oxidase inhibitors (MAOIs), when taken in combination with pseudoephedrine products, may result in hypertensive crisis, which could account for the patient’s symptoms. As such, assessing the blood pressure is priority. Apical pulse, temperature, and pulse oximetry should also be assessed but blood pressure is of the greatest concern. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider prescriptions, medication administration record, and health history), physical assessment data, and nurse/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. p. 200 Report content error Which statement explains why a patient would be cautioned not to drink alcohol while taking benzodiazepines? Alcohol will increase the benzodiazepine withdrawal symptoms. Alcohol will lower the therapeutic threshold of benzodiazepines.  Alcohol combined with benzodiazepines may result in respiratory depression. Drinking alcohol while taking benzodiazepines will cause you to get drunk faster. Rationale Benzodiazepines and alcohol are both central nervous system (CNS) depressants. Combining alcohol with benzodiazepines may result in respiratory depression. Abruptly discontinuing benzodiazepines will result in the patient experiencing withdrawal symptoms. Alcohol does not lower the therapeutic threshold of benzodiazepines but causes an additive CNS depressant effect. Drinking alcohol while taking benzodiazepines will not cause the patient to become drunk faster, but it may depress the patient’s respiratory drive. p. 264 Report content error Which can benefit from fluoxetine? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Panic disorder Generalized anxiety disorder Obsessive-compulsive disorder  Premenstrual dysphoric disorder Attention-deficit/hyperactivity disorder (ADHD) Rationale Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression, panic disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder. Panic disorder and obsessive- compulsive disorder are anxiety disorders that occur because of an imbalance in serotonin levels. Premenstrual dysphoric disorder is a severe mood disorder that is caused by chronic changes in the levels of serotonin in the brain; therefore fluoxetine helps to balance the levels of serotonin by inhibiting its absorption in the brain nerve cells. It also helps in alleviating anxiety and enhances mood. Venlafaxine is used in the treatment of generalized anxiety disorder. Desipramine is a tricyclic antidepressant used in the treatment of ADHD. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 270 Report content error Which finding indicates the nurse administered an initial Which finding indicates the nurse administered an initial dose of diazepam 5 mg intravenous (IV) push to a patient experiencing status epilepticus too rapidly? Temperature 99.9°F Respirations seven breaths per minute Apical heart rate 60 beats per minute Oxygen saturation 90% on 2 L Rationale Diazepam must be administered slowly when given IV push to prevent respiratory depression and hypotension. The patient has a respiratory rate of seven breaths per minute. This indicates the dose was administered too fast. The patient’s temperature is elevated, but this is unrelated to the medication. The patient has a normal heart rate and acceptable oxygen saturation. These are not affected by administering phenytoin rapidly. pp. 224-225 Report content error Which is an adverse effect of cyclobenzaprine? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected  Seizures Dyspnea Angioedema Bronchospasm Myocardial infarction Rationale Cyclobenzaprine is a muscle relaxant that acts on the central nervous system (CNS). Because this medication affects the CNS, its overdose may cause seizures. Angioedema may occur as a result of the release of bradykinin upon the administration of cyclobenzaprine. Long-term administration of this medication may cause myocardial infarction because it facilitates the development of plaques in the coronary arteries. Dyspnea and bronchospasm are the adverse effects of pyridostigmine, not cyclobenzaprine. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 251 Report content error Which instruction will the nurse provide to a patient taking both phenytoin and an oral contraceptive? 'Follow up with your provider frequently, because the dosage of phenytoin will likely need to be increased.' 'Have your serum drug levels routinely checked, because the dosage of phenytoin will likely need to be decreased.' 'Use an additional form of contraception, because your oral contraceptive may not be as effective while on phenytoin.' 'Monitor your legs for warm, red, and swollen areas and for shortness of breath, which may be signs of a potential blood clot while receiving phenytoin with an oral contraceptive.' Rationale Phenytoin can decrease the effects of oral contraceptives. Therefore a nurse will advise the patient to use an additional form of birth control while receiving phenytoin. The dosage of phenytoin will not need to be increased or decreased while receiving an oral contraceptive. Although patients receiving oral contraceptives should monitor for signs and symptoms of venous and pulmonary thromboembolism, the addition of phenytoin does not increase the patient’s chance of developing these symptoms, particularly because phenytoin decreases the efficacy of the oral contraceptive. p. 221 Report content error Which information would the nurse provide to a patient taking anticonvulsants for a seizure disorder? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Wear a medical alert bracelet at all times. Obtain serum drug levels on a regular basis. Visit the dentist every 6 months for examinations. Be aware urine may turn a reddish-brown color. Take over-the-counter analgesics for headaches. Rationale Instructions to a patient taking anticonvulsants include wearing a medical alert bracelet to alert emergency medical personnel of the condition. Serum drug levels should be obtained as prescribed to determine therapeutic ranges. Many anticonvulsant medications can cause gingival hyperplasia, therefore it is important for the patient to visit a dentist every 6 months for dental examinations. The nurse would instruct the patient that urine can turn a pinkish-red or reddish-brown color, therefore the patient should not panic when this is noted. Over- the-counter medications should be cleared with the health care provider first. p. 223  Report content error 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. One, some, or all responses may be correct. Some correct answers were not selected Asthma Peptic ulcers Hyperthyroidism Hepatic impairment Narrow-angle glaucoma Rationale The administration of cyclobenzaprine may cause hypertension and tachycardia in a patient who has hyperthyroidism. This medication may also cause an increase in intraocular pressure and is therefore contraindicated in patients who have narrow-angle glaucoma. Thus a history of hyperthyroidism or narrow-angle glaucoma would prompt the nurse to contact the health care provider for an alternative prescription in this scenario. Pyridostigmine would not be administered in patients who have conditions such as asthma, peptic ulcers, and hepatic impairment, because this medication may aggravate these conditions. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 252 Report content error Which reversal agent needs to be on hand when administering intravenous lorazepam? Naloxone Zolpidem Flumazenil Phytonadione Rationale The reversal agent for benzodiazepines such as lorazepam is flumazenil. Reversal agents should be easily accessible in case reversal of sedation is required. Naloxone is the reversal agent used for opioid agents. Zolpidem is a sedative used for insomnia. Phytonadione is also known as vitamin K and is used as a reversal agent for warfarin. Test-Taking Tip: Come to your test preparation with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and studying further (implementation), and (d) answering questions (evaluation). p. 211 Report content error Which intervention is most important to ensure safety in a patient being treated with anxiolytic medications? Monitor for orthostatic hypotension. Instruct the patient not to miss doses. Teach the patient about the side effects. Monitor the patient’s response to therapy. Rationale Anxiolytic drugs tend to affect the blood pressure, causing orthostatic hypotension, which can cause dizziness in the patient and increase the risk for falls. Therefore the nurse would monitor the blood pressure of the patient to prevent falls and ensure safety. The nurse should teach the patient about the side effects of the drugs; however, this can be done only when the patient is stabilized on the anxiolytics. The nurse would tell the patient not to miss any doses to ensure the maintenance of therapeutic levels of the drug, but this would be a secondary intervention. The nurse would monitor the patient’s response to the therapy, as this helps to assess cases in which the dose needs to be adjusted, but this would not help prevent falls in the patient. p. 266 Report content error 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? The patient is confused and may need a sitter. The patient is at risk for malignant hyperthermia. The patient is anxious about the upcoming surgery. The patient’s brother had sepsis in the postoperative period. Rationale The conclusion the nurse should make regarding the patient’s statement is that malignant hyperthermia is a possible risk factor for general anesthesia. There is no indication of confusion in the patient’s statement. The patient is likely anxious for the upcoming surgery; however, malignant hyperthermia is a life-threatening consequence of general anesthesia. The fever with malignant hyperthermia is not the result of infective processes that would result in sepsis. p. 214 Report content error Which serum drug level is within the therapeutic range for phenytoin? 6 mcg/mL 8 mcg/mL 12 mcg/mL 30 mcg/mL Rationale Therapeutic serum drug levels for phenytoin are between 10 and 20 mcg/mL. Therefore a serum drug level of 12 mcg/mL is considered therapeutic. Both 6 mcg/mL and 8 mcg/mL are subtherapeutic levels. A serum drug level of 30 mcg/mL is supratherapeutic. Test-Taking Tip: Do not read too much into the question or worry that it is a 'trick.' If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. p. 221 Report content error The nurse must be alert for which cue related to central nervous system side or adverse effects in a patient taking lorazepam? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Seizures Suicidal ideation Confusion Paralysis Amnesia Rationale Seizures are an adverse reaction of lorazepam that should be monitored for and reported. Suicidal ideations are a life-threatening adverse reaction. Confusion and amnesia are also symptoms that should be monitored for because they are potential side effects of the drug. Paralysis is not a listed side effect or adverse reaction of lorazepam. p. 265  Report content error Which is an anticholinergic side effect of cyclobenzaprine? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Tachycardia Constipation Angioedema Urinary retention Myocardial infarction Rationale Cyclobenzaprine is a cholinesterase inhibitor that inhibits parasympathetic activity, thereby causing side effects such as tachycardia, constipation, and urinary retention. Angioedema and myocardial infarction are the adverse effects of cyclobenzaprine that would occur if a medication overdose is administered. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 252 Report content error Which assessment question will the nurse ask before administering zolpidem tartrate to an older patient with insomnia? Select all that apply. One, some, or all responses may be correct. 'Do you drink alcohol?' 'Do you have a history of Crohn disease?' 'Do you have any problems with your liver?' 'Do you have any problems with your kidneys?' 'Do you have a history of any thyroid conditions?' Rationale Before administering zolpidem tartrate to an older patient, the nurse will ask if the patient drinks alcohol. When giving zolpidem with alcohol, there is additive central nervous system depression. Additionally, zolpidem use is cautioned in patients with liver and kidney problems. Thus the nurse will ask the patient about these conditions. There is no need for the nurse to inquire about a history of Crohn disease or thyroid conditions, because these are not problematic when receiving zolpidem therapy. p. 212 Report content error Which answer would the nurse provide if asked how phenytoin works to control seizures? Excites the neuronal cell membranes Prevents an influx of sodium into cells Suppresses calcium movement into cells Intensifies action of gamma aminobutyric acid (GABA) Rationale Phenytoin prevents sodium from entering the neurons, thus stabilizing the cell membranes and reducing the number of neurons continually firing. Neuronal cell membranes are excited during seizure activity. Levetiracetam and gabapentin prevent calcium movement into the cells. Gabapentin intensifies the action of GABA in the cell. p. 220 Report content error Which statement by the patient is a characteristic finding in narcolepsy? 'I have difficulty falling asleep.' 'My spouse tells me I walk in my sleep.' 'According to my spouse, my legs move all night.' 'I go to sleep at dark and wake up when the sun rises.' Rationale Narcolepsy is characterized by falling asleep during normal waking activity. As such, the patient statement 'My spouse tells me I walk in my sleep' is a characteristic finding of narcolepsy. 'I have difficulty falling asleep' could be caused by a number of things such as diet, medications, or emotional distress. 'According to my spouse, my legs move all night' warrants further investigation into restless legs syndrome, not narcolepsy. 'I go to sleep at dark and wake up when the sun rises' is not indicative of a sleep disorder. p. 200 Report content error Which method is most effective when the nurse is teaching a patient about antidepressant medications? Printed instructions in the language of choice Websites and videos as determined by the patient’s education Verbal instructions and reinforcement of instructions via videos Primary health care providers, not nurses, teaching patients about psychiatric medications Rationale Verbal instructions reinforced with video visuals are most effective in teaching a patient about antidepressant medications because they provide two routes of learning for the patient. Printed instructions will be ineffective if the patient does not read them or does not understand medical terminology. Websites and videos may not be used by the patient. It is part of the nurse’s responsibility to provide patient education. p. 271 Report content error Which feature of phenytoin makes it most susceptible to drug interactions? Alkaline  Fat-soluble Water-soluble Protein-bound Rationale Drug interaction is common with phenytoin, because it is highly protein-bound and competes with other drugs for plasma protein- binding sites. Alkalinity, fat solubility, and water solubility do not increase the likelihood of drug interactions the way being protein- bound does. p. 221 Report content error Which diagnosis would the nurse expect for a patient who has involuntary movements of the body and extremities? Akathisia Acute dystonia Tardive dyskinesia Pseudoparkinsonism Rationale A patient withtardive dyskinesia has involuntary movements of the body and extremities. Thus the nurse would expect a diagnosis of tardive dyskinesia in this case. Restlessness, trouble standing still, floor pacing, and constant back-and-forth rocking motion of the feet are symptoms of akathisia. Involuntary upward eye movement, facial grimacing, and laryngeal spasms are symptoms of acute dystonia. A pill-rolling motion of the hands, a stooped posture, a shuffling gait, tremors at rest, rigidity, and bradykinesia are symptoms of pseudoparkinsonism. p. 256 Report content error Which condition is a contraindication to lorazepam therapy? Alcoholism Childhood seizures Myocardial infarction Type 2 diabetes mellitus Rationale A patient with a history of alcohol use disorder is a poor candidate for therapy with lorazepam because of the potential for substance abuse and the adverse effects of therapy. The patient has an addictive personality, meaning that the patient has resorted to habitual use of a substance to manage anxiety; as a means of preventing additional substance abuse, benzodiazepines should be withheld from this patient. Moreover, benzodiazepines can cause respiratory depression. If the patient takes benzodiazepines with alcohol, the combination could result in respiratory failure. Lorazepam may be indicated for a patient with a history of convulsions because lorazepam has antiseizure properties. The use of lorazepam by a patient who has had a myocardial infarction or who has diabetes is potentially suitable. p. 265 Report content error Which alteration would the nurse monitor for if a central nervous system stimulant is abruptly stopped? Agitation Anorexia Psychosis Depression Rationale Suddenly stopping central nervous system stimulants may result in depression and withdrawal symptoms. Agitation may occur as a side effect during therapy. Anorexia is another side effect that may occur during therapy. Psychosis is not known to occur from abruptly stopping amphetamines. p. 199 Report content error Which symptom would the nurse recognize as a side effect of fluoxetine? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Nausea Bleeding Headache Dry mouth Muscle pain Rationale The nurse would recognize nausea, headache, and dry mouth as side effects of fluoxetine. Bleeding and muscle pain are not side effects of fluoxetine. p. 270  Report content error 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. One, some, or all responses may be correct. Some correct answers were not selected Mobility Fluid volume Skin integrity Temperature Suicidal ideations Rationale SSRIs can cause hyperhidrosis and peripheral edema. Therefore the nurse would monitor the patient’s fluid volume. SSRIs can cause a life- threatening rash called Stevens-Johnson syndrome, so the nurse would assess skin integrity. Many antidepressants, including SSRIs, can increase the risk for suicide. Therefore the nurse would monitor the patient for suicidal ideations. SSRIs do not affect mobility or temperature. p. 270  Report content error Which action would the nurse take to ensure the well-being of a patient taking lorazepam who reports headaches, dry mouth, and constipation? Stop administering the drug immediately. Check whether the drug dosage has been reduced gradually. Administer an emetic after consulting with the primary health care provider. Administer central nervous system (CNS) depressants after seeking approval from the primary health care provider. Rationale The nurse would check whether the drug dosage has been reduced gradually, because sudden withdrawal of the drug can increase the risk for complications. The nurse should not stop administering the drug without consulting the primary health care provider because this could lead to certain complications. In the case of a benzodiazepine overdose, the nurse would administer an emetic after consulting the primary health care provider; however, an emetic would not be required in this situation. The nurse should not administer CNS depressants with a benzodiazepine because this could cause respiratory depression in the patient. p. 264  Report content error Which intervention would the nurse include in the plan of care for a patient hospitalized with a history of convulsions? Provide a low-profile bed. Monitor serum electrolytes. Administer intravenous fluids. Implement seizure precautions. Rationale A patient with a history of having convulsions would require seizure precautions to be implemented during the hospitalization. A low-profile bed would be necessary if the patient is confused and combative and tries to get out of bed. Serum electrolytes would be monitored, and intravenous fluids would be administered in a patient who is dehydrated. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices you think are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 223  Report content error Which substance(s) does the nurse instruct the patient to avoid to help prevent intensification of alprazolam’s adverse effects? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Alcohol Opioids Tobacco Antihistamines Muscle relaxants Caffeinated drinks Rationale The nurse instructs the patient to avoid alcohol, opioids, antihistamines, and muscle relaxants because these are all central nervous system (CNS) depressants that, when taken together with alprazolam, can cause significant CNS depression, including respiratory depression. Tobacco use is likely to be harmful, but it is unlikely to intensify the adverse effects of a benzodiazepine. Caffeine, a xanthine stimulant, is likely to ameliorate CNS depression associated with benzodiazepines. p. 266  Report content error Which action is appropriate for a nurse who determines a patient’s phenytoin level is 8 mcg/mL? Contact the health care provider for an increase in dosage. Hold the medication and call the health care provider. Document the value and continue to monitor the patient. Draw another laboratory test value within the hour. Rationale Therapeutic levels for phenytoin therapy are 10 to 20 mcg/mL. A patient with a level of 8 mcg/mL may continue to have seizures. The health care provider should be contacted for an increase in dosage. Because the phenytoin level is not therapeutic, holding the medication or giving it and continuing to monitor or check laboratory values are inappropriate actions. p. 221 Report content error 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. One, some, or all responses may be correct. Some correct answers were not selected Fatigue Inability to sleep No interest in working Inability to complete tasks Sadness since a friend died Rationale The nurse would expect the patient to describe feelings of fatigue, difficulty sleeping, loss of interest in work, and the inability to complete tasks, all of which are characteristic symptoms of major depression. Having feelings of sadness since the death of a friend is a symptom of reactive depression. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 268  Report content error 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? Discuss alternate forms of birth control with the health care provider. Do not take the drug when not having seizures. Skip the dosage if headaches occur. Make certain to keep the drug out of the light. Rationale The nurse would instruct the patient that phenytoin can interfere with the efficacy of oral contraceptives, and that alternate forms of birth control should be used. The drug is taken daily to prevent seizures, and it should not be stopped if the patient has headaches. There is no concern about keeping the drug out of the light. p. 223 Report content error Which action will a nurse take for a patient who has a serum  phenytoin level of 31 mg/mL? Hold the drug. Increase the drug dosage. Administer the drug intravenously. Have the patient continue the current regimen. Rationale A therapeutic drug level for phenytoin is 10 to 20 mcg/mL, which is generally considered equivalent to 1 to 2 mcg/mL unbound or free phenytoin. Therefore a nurse would hold the drug and contact the health care provider. A dosage increase or administering the drug intravenously would not occur and are not within the scope of nursing without a prescription from the prescribing health care provider. It would be inappropriate to have the patient continue the current regimen, because the current drug level is supratherapeutic, which may result in drug toxicity. p. 221 Correct (15) Report content error Which action would the nurse take when providing care to a patient who has recently been prescribed a benzodiazepine? Assess sedation level. Auscultate bowel sounds. Check patient’s orientation. Monitor the patient’s potassium levels. Rationale Benzodiazepines are a class of anxiolytic medications that work by depressing the central nervous system (CNS). Therefore the nurse would assess the patient’s sedation level. Although these drugs are rapidly absorbed from the gastrointestinal tract, there is no evidence that they interfere with normal bowel function. Although these medications do depress the CNS, they often cause drowsiness and dizziness, not disorientation. Benzodiazepines do not affect electrolyte levels (e.g., potassium). p. 264 Report content error Which nonpharmacologic nursing intervention can be provided to help promote sleep in a patient who reports unusual sleep patterns and lack of sleep? Increase fluid intake before bedtime.  Sleep more during the day. Have an alcoholic drink before bedtime. Arise at a specific hour in the morning. Rationale Arising at a specific hour in the morning helps promote sleep. Patients should avoid drinking copious amounts of fluids before sleep to minimize nocturia, which can disrupt sleep patterns. Too much sleep may lead to fragmented sleep patterns and shallow sleep. Consuming alcohol results in fragmented sleep. Alcohol consumption within 6 hours before bedtime should be discouraged, because it can disturb sleep patterns. p. 206 Report content error Which instruction would a nurse provide a patient who is receiving the first dose of an antiseizure drug at home? 'Do not take the drug if you have a fever.' 'Wait to see how you react to the drug before driving.' 'Lie in bed for at least an hour after taking the antiseizure drug.' 'Take the antiseizure drug with vitamin B complex, because the antiseizure drug reduces these vitamin levels.' Rationale Antiseizure drugs suppress the central nervous system and can cause drowsiness. The patient should know how he or she responds to the drug before attempting tasks such as driving. A fever is not a contraindication to taking an antiseizure drug. The patient does not have to lie in bed for an hour after taking an antiseizure drug. An antiseizure drug does not deplete vitamin B levels. Phenytoin reduces folic acid, calcium, and vitamin D absorption but not serum levels of vitamin B. p. 223 Report content error Which potential complication could occur if a patient abruptly stops taking an antiseizure drug? Rebound seizure activity Drug dependence Hypotension Confusion and delirium Rationale Abrupt withdrawal of antiseizure drugs can cause rebound seizure activity and status epilepticus. Abrupt cessation is not likely to cause drug dependence, hypotension, confusion, or delirium. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three quarters finished with the test. Look at the clock only every 10 minutes or so. p. 223 Report content error By which mechanism do selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function? Increasing the placebo effect Increasing alertness levels in the brain Blocking the reuptake of neurotransmitters at nerve endings Decreasing levels of epinephrine and serotonin at nerve endings Rationale Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by blocking the reuptake of neurotransmitters at nerve endings. SSRIs block the reuptake of serotonin; TCAs block the reuptake of norepinephrine and serotonin. They have real effects, not just an increased placebo effect. They do not increase alertness levels in the brain. Norepinephrine, not epinephrine, is the neurotransmitter affected by antidepressants. Also, these medications increase, not decrease, levels of norepinephrine and serotonin at nerve endings. p. 269 Report content error 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?  Aspirin Lisinopril Furosemide Gingko biloba Rationale Many anticonvulsants including phenytoin are contraindicated for use with herbal supplements. Therefore the nurse would suggest that the patient discuss the use of gingko biloba with the health care provider. Aspirin, lisinopril, and furosemide do not interact with phenytoin. Test-Taking Tip: Many times the correct answer is the longest alternative given but do not count on it. Item writers (those who write the questions) are also aware of this and attempt to avoid offering you such 'helpful hints.' p. 222 Report content error 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 to treat an anxiety disorder reports dissatisfaction with the therapy? “The adverse effects can be managed well.” “This medication usually requires titration.” “Relaxation exercises can offer some relief.” “A therapeutic effect can be expected in another 2 to 4 weeks.” Rationale The full therapeutic effects of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), may take 4 to 6 weeks to occur, so the best information to impart in medication education would be an explanation to the patient that the patient could anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowledge of the time frame would offer the patient realistic hope and provide a justification for adherence to therapy. Adverse effects can usually be managed well, and relaxation exercises may provide some relief from anxiety. However, the patient must fulfill these tasks to get the full therapeutic effect of the medication, and this can be difficult for a patient with depression to do. SSRIs can require considerable titration, but, because of the nature of the patient’s illness, this information would be unlikely to promote adherence to therapy. p. 270 Report content error Which side effect will a patient receiving phenytoin minimize with regular visits to the dentist and appropriate oral hygiene? Oral candidiasis Gingival hyperplasia Increased risk for dental abscesses Increased incidence of dental caries Rationale A side effect of phenytoin is overgrowth of gum tissue or reddened gums that bleed easily, known as gingival hyperplasia. This can be minimized by frequent oral hygiene and routine dental visits. Phenytoin is not expected to cause oral candidiasis, increase the risk for dental abscesses, or increase the incidence of dental caries. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none. If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as 'When assessing for pain, you should not,' the false option is the correct choice. p. 221 Report content error Which activity would the patient be cautioned to avoid while taking a monoamine oxidase inhibitor (MAOI)? Eating aged cheese Sunbathing at the pool Smoking a low-nicotine cigarette Participating in a bowling league Rationale Eating foods high in tyramine, including aged cheese, can cause hypertensive crisis in a patient taking an MAOI. Thus the patient would be cautioned to avoid eating tyramine-rich foods. This medication does not cause photosensitivity, so sunbathing would be appropriate. Although all patients should be cautioned to avoid smoking, this is not specific to MAOIs. Bowling is not contraindicated in the use of MAOIs. p. 271 Report content error The health care provider orders 2 mg of lorazepam to be given IV for a patient who is anxious and restless following a laparoscopic procedure. Based on the patient's vital signs posttreatment with lorazepam, which action would the nurse take first when the patient does not respond to names or light shaking? Vital Signs Post Blood pressure: 72/40 mm Hg Lorazepam Heart rate: 120 beats per minute Respiration: 8 shallow breaths per minute Continue to monitor vitals every 5 minutes. Administer 0.2 mg of flumazenil IV. Notify the health care provider. Update the patient's family member in the waiting room. Rationale The patient is experiencing oversedation from the lorazepam. Flumazenil is the reversal agent and is needed immediately to counteract the medication. The nurse should continue to monitor vitals and notify the health care provider, but these are not the first actions that are needed for this patient. Once the patient is stable or more people have arrived to help in this situation, the family member should be updated on the patient's status. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. pp. 262-265,266 Report content error Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants? 'CNS stimulants block the activity of inhibitory neurons.' 'CNS stimulants decrease the production of excitatory neurotransmitters.' 'CNS stimulants increase release of and block reuptake of neurotransmitters.'  'CNS stimulants enhance the effects of phosphodiesterase and the subsequent breakdown of cyclic adenosine monophosphate (cAMP).' Rationale CNS stimulation occurs when the number of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased. CNS stimulants do not block the activity of inhibitory neurons. CNS stimulants do not decrease the production of excitatory neurotransmitters or enhance the effects of phosphodiesterase. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 200 Report content error Which substance(s) does the nurse advise the patient to avoid if the patient has been prescribed cyclobenzaprine? Select all that apply. One, some, or all responses may be correct. Alcohol  Anesthetics Barbiturates Aminoglycosides Tricyclic antidepressants Rationale Cyclobenzaprine is a medication that acts as a central nervous system (CNS) depressant. The nurse would advise a patient who has been prescribed cyclobenzaprine to avoid alcohol consumption, barbiturates, and tricyclic antidepressants, as the consumption of alcohol or the use of tricyclic antidepressants along withcyclobenzaprine could cause severe CNS depression, and concomitant administration of barbiturates and cyclobenzaprine could result in coma. Anesthetics and aminoglycosides do not interact with cyclobenzaprine and can be safely prescribed together. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation or patient, but only one or some of the options may relate directly to the situation or patient. p. 251 Report content error 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? Potassium level Pulse oximeter Blood pressure Respiratory rate Rationale Antidepressants can cause orthostatic hypotension, which can be described as dizziness with position changes; thus the nurse would make a blood pressure measurement the priority. The potassium level, oxygen saturation level (as measured by the pulse oximeter), and respiratory rate are not affected by antidepressants. p. 272 Report content error Which condition is the patient most likely experiencing when prescribed alprazolam? Seizures Insomnia  Alcohol withdrawal Anxiety with depression Rationale The patient is most likely experiencing anxiety with depression, asalprazolam is known to be effective in treating anxiety associated with depression. It is not considered a first-line treatment for seizures, insomnia, or alcohol withdrawal. p. 264 Report content error 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? Ginkgo Ibuprofen St. John’s wort Glucosamine chondroitin Rationale Serotonin syndrome may occur with selective serotonin reuptake inhibitors (SSRIs), such as duloxetine, when they are combined with certain herbal products, such as ginseng and St. John’s wort. Thus the nurse would question the patient about concurrent use of St. John’s wort. Because ginkgo, ibuprofen, and glucosamine chondroitin do not cause serotonin syndrome when combined with SSRIs, the nurse would not question the patient regarding the use of these. p. 269