Avoiding Adverse Drug Interactions, Exams of Nursing

Download Avoiding Adverse Drug Interactions and more Exams Nursing in PDF only on Docsity! NURSING FINAL EXAM WITH 300 QUESTIONS AND VERIFIED ANSWERS WITH RATIONALE/ATTACHED TO A STUDY GUIDE LATEST UPDATE 2024/2025 ALREADY GRADED A The nurse should assess a patient who is taking lorazepam (Ativan) for the development of which of these adverse effect? 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria - ANSWER>>Answer 3. Rationale: Adverse CNS effects for lorazepam (Ativan) include ataxia, amnesia, weakness, disorientation, blurred vision, diplopia, nausea, and vomiting. Option 1, 2, and 4 are incorrect. Lorazepam is not known to cause tachycardia, astigmatism, or euphoria. If these symptoms occur, the patient should be assessed for other causative factors. A patient is receiving temazepam (Restoril). Which of these responses should a nurse expert the patient to have if the medication is achieving the desired effects? 1. The patient sleeps in 3-hours intervals, awakens for a short time, and then falls back to sleep. 2. The patient reports feeling less anxiety during activities of daily living. 3. The patient reports having fewer episodes of panic attacks when stressed. 4. The patient reports sleeping 7 hours without awakening. - ANSWER>>Answer 4. Rationale: Temazepma (Restoril) is a benzodiazepine ordered for insomnia. Therefore, the patient should be experiencing relief from insomnia and reporting feeling rested when awakening. Options 1, 2, and 3 are incorrect. Sleeping 3 hours or less would indicate less than therapeutic effects. Whereas some benzodiazepines are used in the treatment of anxiety or panic disorders, temazepam's primary use is in the treatment of insomnia. A 32-year-old female patient has been taking lorazepam (Ativan) for her anxiety and is brought into the emergency department after taking 30-days' worth at one time. What antagonist for benzodiazepines may be used in this case? 1. Epinephrine 2. Atropine 3. Flumazenil 4. Naloxone - ANSWER>>Answer 3. Rationale: The competitive antagonist drug used in cases of benzodiazepine overdose is flumazenil (Romazicon). Option 1, 2, and 4 are incorrect. Epinephirne, an adrenergic agonist, is not an antagonist to the benzodiazepines. Atropine is an anticholinergic, and naloxone is a competitive antagonist to opioid (narcotic) drugs. A 17-year-old patient has been prescribed escitalopram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this patient's age, the nurse will ensure that the patient and parents are taught what important information? 1. Cigarette smoking will counteract the effects of the drug. 2. Signs of increasing depression or thoughts of suicide should be reported immediately. 3. The drug causes dizziness and alternative schooling arrangements may be needed for the first two months of use. 4. Anxiety and excitability may increase during the first two weeks of use but then will have significant improvement. - ANSWER>>Answer 2. Rationale: Escitalopram (Lexapro) is an antidepressant in the SSRI class. The drug carries a black box warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Signs of increasing depression or suicidal thoughts should be reported immediately. Options 1, 3, and 4 are incorrect. Smoking has no direct effects on escitalopram. Although dizziness may occur, it should not be significant enough to warrant a change in schooling needs. Escitalopram should not cause increased anxiety or excitability in the first few weeks of use, and other causes should be investigated should these occur. Zolpidem (Ambien) has been ordered for a client for the treatment of insomnia. What information will the nurse provide for this client? (Select all that apply.) 1. Be cautious when performing morning activities because it may cause a significant "hungover" effect with drowsiness and dizziness. 2. Take the drug with food; this enhances the absorption for quicker effects. 3. Take the drug immediately before going to bed; it has a quick onset of action. 4. If the insomnia is long-lasting, this drug may be safely used for up to a year. 5. Alcohol and other drugs that cause CNS depression should be avoided while taking this drug. - ANSWER>>Answer 3 and 5. Rationale: Zolpidem (Ambien, Intermezzo) has a rapid onset, approximately 7 to 27 minutes, and should be taken immediately before going to bed. It should not be taken with alcohol or other drugs that cause CNS depression because of increased sedation and CNS depression. Option 1, 2, and 4 are incorrect.. Taking the drug with food will significantly impair its absorption and the onset of action may be delayed. Zolpidem has a duration of action of approximately 6 to 8 hours. Depending on when the drug is taken the night before, significant "hangover" effects such as sedation are not likely to occur as with other drugs in the category. The drug is approved for short-term treatment of insomnia only. Education given to clients about the use of all drugs to treat insomnia should include an emphasis on what important issue? 1. They will be required long-term to achieve long-lasting effects. 2. They require frequent blood counts to avoid adverse effects. 3. They are among the safest drugs available and have few adverse effects. 4. Long-term use may increase the risk of adverse effects, create a "sleep debt", and cause rebound insomnia when stopped. - ANSWER>>Answer 4. Rationale: Long-term use of drugs to treat insomnia is not recommended. They have significant adverse effects, may cause a "sleep debt" due to effects on the sleep cycle, and may cause rebound insomnia when discontinued. Option 1, 2, and 3 are incorrect. Many of the drugs used for insomnia have significant adverse effects and are not used long term. Whereas some drugs in the category may require concurrent blood counts, this is not required for all drugs in the category. An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rosh foods in the diet. Rationale: An overdose of citalopram (Celexa) causes symptoms similar to serotonin syndrome including seizures, hypertension, tachycardia, and extreme anxiety. Options 2, 3, and 4 are incorrect. These are not symptoms of an SSRI overdose. A 77 year old female client is diagnosed with depression with anxiety and is started on imipramine. Because of this client's age, the nurse will take precautions for care related to which adverse effects? 1. dry mouth and photosensitivity 2. anxiety, headaches, insomnia 3. drowsiness and sedation 4. urinary frequency - ANSWER>>Answer 3. Rationale: TCAs such as imipramine (Tofranil) may cause drowsiness and sedation. Because of this patient's age, these effects may increase the risk of falls. Option 1, 2, and 4 are incorrect. Headache, insomnia, and anxiety are not common adverse effects associated with imipramine. The drug may cause photosensitivity, dry mouth, and urinary retention, but these would not be the top priority considering the fall risk. The drug does not cause urinary frequency. Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine (Nardil) for treatment of depression? 1. headaches may occur. OTC medications will usually be effective 2. hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported 3. read labels of food and OTC drugs to avoid those with substances that should be avoided as directed 4. monitor BP for hypotension and report any BP below 60/90 - ANSWER>>Answer 3. Rationale: Phenelzine (Nardil) is an MAOI. The class of drugs has many drug and food interactions that may cause a hypertensive crisis. A list of foods, beverages, and medications to avoid should also be given to the patient. Option 1, 2, and 4 are incorrect. Headaches, especially if severe, may signal the beginning of a hypertensive crisis and any severe or increasing headache should be reported immediately. MAOIs are not known to cause hyperglycemia and other causes should be investigated if it occurs. The use of CNS depressants, including narcotics, along with an MAOI may cause profound hypotension, but the risk of hypertensive crisis is much greater and would have priority for teaching. The nurse determines that the teaching plan for a client prescribed sertraline (Zoloft) has been effective when the client makes which statement? 1. I should not decrease my sodium or water intake. 2. The drug can be taken concurrently with the phenelzineu (Nardil) that I'm taking 3. It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better 4. There are no other drugs I need to worry about; Zoloft doesn't react with them - ANSWER>>Answer 3. Rationale: SSRI antidepressant drugs such as sertraline (Zoloft) may not have full effects for a month or longer, but some improvement in mood and depression should be noticeable after beginning therapy. Options 1, 2, and 4 are incorrect. Sodium and fluid intake is a concern with lithium but does not adversely affect the SSRIs. The SSRIs should not be used concurrently with MAOIs because of an increased risk of hypertensive crisis. They also have many interactions with other drugs. The patient states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. What is the nurse's primary concern at the time? 1. A hypertensive crisis may occur with such abrupt withdrawal of the drug. 2. Significant muscle twitching may occur, increasing fall risk. 3. Extrapyramidal symptoms such as secondary Parkinsonism are likely to occur. 4. Symptoms of psychosis is likely to return. - ANSWER>>Answer 4. Rationale: Antipsychotic medications treat the symptoms associated with mental illness but do not cure the underlying disorder. Without the medication, symptoms of the disorder are likely to return. Options 1, 2, and 3 are incorrect. Hypertensive crisis does not occur upon withdrawal of antipsychotic medication. EPS including muscle twitching and rigidity, and secondary Parkinsonism may occur related to the dosage of the medication and length of therapy, not withdrawal from the drug. Prior to discharge, the nurse plans for patient teaching related to side effects of phenothiazines to the patient, family, or caregiver. Which of the following should be included? 1. The patient may experience withdrawal and slowed activity. 2. Severe muscle spasms may occur early in the therapy. 3. Tardive dyskinesia is likely early in therapy. 4. Medications should be taken as prescribed to prevent adverse effects. - ANSWER>>Answer 2. Rationale: Acute dystopias, or severe muscle spasms, particularly of the back, neck, face, or tongue, may occur within hours or days of the first dose of a phenothiazine drug and should be reported immediately. Options 1, 3, and 4 are incorrect. Social withdrawal may be a symptom of the disease but is not related to the medication. Tardive dyskinesias occur late in therapy. Adverse effects are common with all antipsychotics, even when taken as prescribed. A 20-year-old man is admitted to the psychiatric unit for treatment of acute-schizophrenia and is started on risperidone (Risperdal). Which patient effects should the nurse assess for to determine whether the drug is having therapeutic effects? 1. Restful sleep, elevated mood, and coping abilities. 2. Decreased delusional thinking and lessened auditory/visual hallucination. 3. Orthostatic hypotension, reflex tachycardia, and sedation. 4. Relief of anxiety and improved sleep and dietary habits. - ANSWER>>Answer 2. Rationale: Antipsychotic drugs such as risperidone (Risperdal) treat the positive and negative effects of the underlying mental disorder. A decrease in delusional thinking, lessened hallucinations, and overall improvement in mental thought processes should be noted. Options 1, 3, and 4 are incorrect. Improvement in sleep patterns, anxiety, and nutrition may be noted as secondary effects of treatment of the underlying thought disorder. Orthostatic hypotension, reflex, tachycardia, and sedation are potential adverse effects. Nursing implementations of the administration of haloperidol (Haldol) to a patent exhibiting psychotic behavior include which of the following? (Select all that apply). 1. Take 1 hour before or 2 hours after antacids. 2. The incidence of extrapyramidal symptoms is high. 3. It is therapeutic if ordered on an as-needed (prn) basis. 4. Haldol is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush the sustained-release form for easier swallowing. - ANSWER>>Answer 1, 2, and 4. Rationale: Aluminum- and magnesium-based antacids decrease absorption of haloperidol (Haldol). Haldol also has a high incidence of EPS. It is contraindicated in Parkinson's disease, seizure disorders, alcoholism, and severe mental depression. Option 3 and 5 are incorrect. Haldol must be taken as ordered for therapeutic results to occur and should not be given prn for psychosis. The sustained-release forms must not be opened or crushed. A patient is treated for psychosis with fluphenazine. What drug will the nurse anticipate may be given to prevent the development of acute dystonia? 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan) - ANSWER>>Answer 1. Rationale: Benztropine (Cogentin), an anticholinergic, may be given to suppress the tremor and rigidity that may be caused by fluphenazine or other phenothiazine antipsychotic drugs. Options 2, 3, and 4 are incorrect. Diazepam (Valium) and lorazepam (Ativan) are benzodiazepines and will not prevent acute dystonia. Haloperidol (Haldol) is an antipsychotic drug and may increase the risk for acute dystonia. The nurse should immediately report the development of which of the following symptoms in a patient taking antipsychotic medication? 1. Fever, tachycardia, confusion, incontinence. 2. Pacing, squirming, or difficultly with gait such as bradykinesia. 3. Severe spasms of the muscles of the tongue, face, neck, or back. 4. Sexual dysfunction or gynecomastia. - ANSWER>>Answer 1. Rationale: Fever, tachycardia, confusion, and incontinence are symptoms of the development of NMS and should be immediately reported. Option 2, 3, and 4 are incorrect. Pacing and squirming are signs of akathisia, and bradykinesia and tremors are symptoms of secondary Parkinsonism. These adverse effects along with sexual dysfunction and gynecomastia, are adverse effects that may occur with therapy and may not be preventable. NMS is a medical emergency requiring immediate treatment. The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. What is the main rationale for the use of these techniques as an adjunct to analgesic medication? 1. They are less costly 2. They may allow lower doses of drugs with fewer adverse effects 3. They can be used at home 4. They do not require self-injection - ANSWER>>Answer 2. Rationale: When used concurrently with medication, nonpharmacologic techniques may allow for lower doses and possibly fewer drug-related adverse effects. Relaxation techniques and guided imagery may also be used in the acute care setting. Options 1, 3, and 4 are incorrect. Although nonpharmalogic measures of pain control are less costly, may be used at home, and do not require injections, those are not the main rationale for using such techniques. The emergency department nurse is caring for a client with a migraine headache. Which drug would the nurse anticipate administering to abort the client's migraine attack? 1. morphine 2. propranolol (Inderal) 3. ibuprofen (Motrin) 4. sumatriptan (Imitrex) - ANSWER>>Answer 4. Rationale: Triptans such as sumatriptan (Imitrex) are used to abort a migraine attack. Options 1, 2, and 3 are incorrect. Morphine and other narcotics are not effective in aborting a migraine. Propanolol (Inderal) and ibuprofen (Motrin) may be used as adjunctive therapy in migraine therapy but will not stop a headache from occurring. A client admitted with hepatitis B is prescribed hydrocodone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take? 1. Administer the drug as ordered 2. Administer 1 tablet only 3. Recheck the order with the health care provider 5. It results in only modest cognitive improvement and results do not last. - ANSWER>>Answer 2, 3, 4, and 5. Rationale: Donepezil (Aricept) may cause serious liver damage and potentially fatal dysrhythmias including severe bradycardia and heart block. It may also cause significant weight loss, and the patient's weight should be monitored. While cognitive improvement may be observed in as few as 1 to 4 weeks, patients should receive pharmacotherapy for at least 6 months prior to assessing maximum benefits of drug therapy. Unfortunately, cognitive improvement is only modest and short-term. Option 1 is incorrect. Donepezil is taken once per day usually at bedtime. An early sign of levodopa toxicity is which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking and muscle twitching 4. N/V, diarrhea - ANSWER>>Answer 3. Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity. Options 1, 2, and 4 are incorrect. Orthostatic hypotension is a common adverse effect of both PD and many drugs used to treat the condition but is not a symptom of overdosage or toxicity. Drooling, nausea, vomiting, and diarrhea are also not symptoms of overdose or toxicity. A health care profession is caring for a patient who is taking zolpidem (Ambien). The patient has a history of benzodiazepine abuse and reports insomnia. The health care professional caution the patient that the drug can cause: 1. Memory impairment 2. Hearing loss 3. Constipation 4. Joint pain - ANSWER>>Answer 1. Rationale: Zolpidem, a non-benzodiazepine, can cause anterograde amnesia, or memory impairment, particularly an inability to recall activities patients carry out just before or during sleep. While talking to a patient and his family about taking memantine (Namenda) for Alzheimer's disease, the health care professional should include which of the following instructions? 1. Notify the health care professional before taking over-the-counter antacids. 2. Increase fluids to improve renal excretion. 3. Report memory loss or confusion. 4. Watch for signs of liver impairment, such as jaundice or abdominal pain. - ANSWER>>Answer 1. Rationale: Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity. It is not necessary to increase fluids. Patients excrete the drug essentially unchanged in the urine; fluid intake does not affect this process. Patients with Alzheimer's disease already have and will continue to have memory loss and confusion. The drug can help slow the progressive decline of this disorder, but will not eliminate its manifestations. Memantine should not result in liver impairment, although health care professionals should use it cautiously with patients who have severe liver impairment. A patient is taking selegiline (Eldepryl) to treat Parkinson's disease. The provider is considering the use of analgesics for the patient but should be aware that a drug interaction between selegiline and meperidine (Demerol) can result in which of the following? 1. Muscle rigidity 2. Frequent urination 3. Cellulitis 4. Jaundice - ANSWER>>Answer 1. Rationale: A drug interaction between selegiline and opioids, especially meperidine, can result in a serious reaction resulting in rigidity, stupor, agitation, hypertension, and fever. A drug interaction between selegiline and meperidine is unlikely to result in frequent urination, which can indicate a urinary tract infection and glucose intolerance. It is also unlikely that it can result in oral ulcers and jaundice. Skin inflammation is a serious adverse effect of some anticonvulsants, such as phenytoin (Dilantin). Liver toxicity is a serious adverse effect of dantrolene (Dantrium) and many anticonvulsants, such as valproic acid (Depakote). A health care professional is caring for a patient who is about to be taking dantrolene (Dantrium) for skeletal spasm. The health care professional should recognize that which of the following laboratory test requires monitoring? 1. Thyroid function 2. Serum potassium 3. Serum sodium 4. Liver function - ANSWER>>Answer 4. Rationale: Liver toxicity is a serious adverse effect of dantrolene. The health care professional should monitor liver function prior to treatment and at regular intervals, and advise patients to report jaundice or abdominal pain. A health care professional is talking to a patient who is about to take a valporic acid (Depakote) for a newly diagnosed seizure disorder. He should tell the patient to watch for which of the following adverse effects? (Select all that apply) 1. Rash 2. Drowsiness 3. Headache 4. Hirsutism 5. Ataxia - ANSWER>>Answer 1, 2, and 3. Rationale: Patients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these effects can indicate the need for a reduction in dose. Valproic acid can cause headache, along with other central nervous system adverse effects, such as sleep disturbances. Skin rash is a side effect of valproic acid and other antiepileptic drugs. When talking with a patient about taking temazepam (Restoril), which of the following instructions should the health care professional include? (Select all that apply) 1. Wear sunscreen and protective clothing. 2. Take the drug 30 minute before bedtime. 3. Avoid alcohol and other depressants. 4. Taper the drug slowly to prevent withdrawal symptoms. 5. Increase fiber and fluid intake. - ANSWER>>Answer 2, 3, and 4. Rationale: . Temazepam can cause CNS depression. Combined use with alcohol or other depressants can cause severe respiratory depression. Patients should take temazepam 30 min before bedtime to improve sleep and to prevent daytime drowsiness. Abrupt discontinuation of temazepam can cause withdrawal symptoms. Patients should taper the drug slowly to prevent or minimize withdrawal. For which of the following should a health care professional monitor a patient who is taking donepezil (Aricept) for Alzheimer's disease? 1. Dry mouth 2. Nausea 3. Double vision 4. Confusion - ANSWER>>Answer 2. Rationale: The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking the drug with food can help minimize adverse effects. Donepezil, a cholinesterase inhibitor, can improve memory and thinking and reduce confusion and is more likely to cause blurred vision than double vision. The muscarinic antagonist is the one that causes dry mouth not donepezil. A health care professional is talking to a patient about beginning sumatriptan (Imitrex) therapy to treat migraine headaches. The health care professional should advise the patient to watch for which of the following adverse effect? 1. Polyuria 2. Insomnia 3. Chest pain 4. Joint pain - ANSWER>>Answer 3. Rationale: Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Patients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for patients who have a history of coronary artery disease. It is unlikely to cause polyuria and insomnia. It is more likely to cause chest pain than joint pain. A health care professional is talking to a patient who is newly diagnosed with Parkinson's disease about how levodopa/carbidopa (Sinemet) will help control her symptoms. With which of the following mechanisms is the drug effective in treating the disorder? 1. Inhibits norepinephrine metabolism in the brain 2. Inhibits serotonin metabolism in the brain 3. Increases available dopamine in the brain 4. Increases available acetylcholine in the brain - ANSWER>>Answer 3. Rationale: Levodopa/carbidopa, a dopaminergic agent, can act by increasing dopamine in the extrapyramidal center of the brain, reducing involuntary motion. A health care professional is reviewing the medical record of a patient who has been newly diagnosed seizure disorder. The patient is to begin taking both valporic acid (Depakote) and phenytoin (Dilantin). The health care professional should recognize that which of the following can occur as a result of a drug interaction between valporic acid and phenytoin? 1. Hyperammonemia 2. Hypertension 3. Peptic ulcer disease 4. Phenytoin toxicity - ANSWER>>Answer 4. Rationale: Valproic acid can cause an increase in phenytoin blood levels, causing phenytoin toxicity. The primary care provider should monitor serum phenytoin levels and reduce the dosage if levels begin to exceed the therapeutic range. A health care professional is talking to a patient and her family about how methylphenidate (Ritalin) will help manage attention-deficit hyperactivity disorder (ADHD). Which of the following therapeutic effects should they expect? 1. Increased focus 2. Improved mood 3. Reduced panic 4. Decreased anxiety - ANSWER>>Answer 1. Rationale: Thiopental, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for patients receiving the drug. A health care professional is talking to a patient about the adverse effect of interferon beta-1a (Avonex). To help minimize the effects, she should tell the patient to: 1. Increase his fluid intake 2. Take the drug in the morning 3. Premedicate with acetaminophen (Tylenol) 4. Take drug with food - ANSWER>>Answer 3. Rationale: Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen or a nonsteroidal anti-inflammatory drug can help minimize these symptoms. Options 1, 2, and 4 are incorrect. The routes of administration of interferon beta drugs are parenteral (IM and SC). Evening administration of interferon beta drugs promotes tolerance of adverse reactions. Increasing fluid intake will not help relieve the adverse reactions of interferon beta drugs. Anesthetists often administer midazolam (Versed) during induction of anesthesia because of which of the following pharmacological actions? 1. Induced muscle paralysis 2. Dries secretion 3. Produces analgesics 4. Causes amnesia - ANSWER>>Answer 4. Rationale: Midazolam, a benzodiazepine, is appropriate during induction because of its antianxiety and amnesiac properties. An anesthetist is about to administer lidocaine (Xylocaine) as part of the protocol for spinal anesthesia for a pt who is undergoing a surgical procedure. potentially serious effects? 1. Hyperthermia 2. Tachycardia 3. Hypotension 4. Hemotysis - ANSWER>>Answer 3. Rationale: When systemically absorbed in sufficient amounts, lidocaine, a local anesthetic, can cause hypotension, particularly when used as spinal anesthesia. A health care professional is caring for a patient who is about to begin taking pramipexole (Mirapex) to treat Parkinson's disease. The health care professional should recognize that which of the following laboratory tests require monitoring? 1. C-reactive protein 2. Thyroid function 3. CBC 4. Creatine phosphokinase (CPK) - ANSWER>>Answer 4. Rationale: CPK is an enzyme found in the heart, brain, and skeletal muscles. Patients taking pramipexole can develop muscle weakness with a lack of energy, creating a situation that can be more problematic for patients than their original muscle dysfunction. Monitoring CPK can alert health care professionals to the possibility of skeletal muscle damage from the drug. A health care professional should include which of the following instructions when talking with a patient about levodopa/carbidopa (Sinemet) to treat Parkinson's disease? 1. Take the drug at bedtime to avoid daytime drowsiness. 2. Eat a protein snack to increase absorption. 3. Change position slowly to prevent orthostatic hypotension. 4. Expect eye twitching to develop with long-term therapy. - ANSWER>>Answer 3. Rationale: Levodopa/carbidopa can cause orthostatic hypotension. Options 1, 2, and 4 are incorrect. Patients typically take levodopa/carbidopa in divided doses during the day. High-protein foods can reduce the effectiveness of levodopa/carbidopa. Taking levodopa/carbidopa with non-protein sources of food, however, can help reduce adverse GI effects. Muscle twitching can indicate drug toxicity. This is an adverse effect patients should report. A health care professional is talking to a patient who is taking lithium carbonate (Lithobid). Which of the following instructions should be included to reduce the risk of lithium toxicity? 1. Reduce fluid intake. 2. Take the drug with food. 3. Consume a low-sodium diet. 4. Avoid taking NSAIDs. - ANSWER>>Answer 4. Rationale: NSAIDs increase renal reabsorption of lithium and sodium. Patients taking lithium should not take NSAIDs. A patient is admitted to the emergency department with spasms of his face and neck. He has recently begun taking chlorpromazine to treat schizophrenia. Which of the following adverse reactions should the health are professional suspect? 1. Cholinergic crisis 2. Stevens-Johnson syndrome 3. Acute dystonia 4. Serotonin syndrome - ANSWER>>Answer 3. Rationale: Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine. When caring for a patient who is taking risperidone (Risperdal) for schizophrenia, the health care professional should monitor which of the following adverse effects of the drug? 1. Chest pain 2. Polyuria 3. Paresthesias 4. Seizures - ANSWER>>Answer 2. Rationale: Risperidone, an atypical antipsychotic, can cause new-onset diabetes mellitus. It is essential to monitor patients taking the drug for signs of hyperglycemia, and check their glucose levels regularly. Soon after beginning fluoxetine (Prozac), a patient is admitted to the emergency department with agitation and confusion. The health care professional should suspect which of the following? 1. Stevens-Johnson syndrome 2. Serotonin syndrome 3. EPS 4. Neuroleptic malignant syndrome - ANSWER>>Answer 2. Rationale: Serotonin syndrome can begin 2 to 72 hours after beginning to take fluoxetine, a selective serotonin inhibitor. Manifestations include mental confusion, difficulty concentrating, and agitation. During and immediately following IV administration of chlorpromazine to a patient who has schizoaffective disorder, the health care professional should monitor which of the following? 1. Oxygen saturation 2. Urine specific gravity 3. Blood pressure 4. Cardiac output - ANSWER>>Answer 3. Rationale: Patients receiving chlorpromazine are at risk for hypotension during and immediately after IV administration. They should remain supine for 30 min while the health care professional monitors their BP. It is essential to infuse the chlorpromazine solution slowly and not to mix it with other drugs. A health care professional is caring for a patient who has been taking alprazolam (Xanax) for an extended period of time to treat anxiety. The health care professional should recognize that stopping alprazolam therapy suddenly can result in which of the following? 1. Respiratory depression 2. Anterograde amnesia 3. Paradoxical reaction 4. Withdrawal symptoms - ANSWER>>Answer 4. Rationale: Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, patients should taper the dose slowly over several weeks. A health care professional should advise a patient who is taking phenelzineu (Nardil) to avoid tyramine- enriched foods because of an increase risk of which of the following adverse reaction? 1. Serotonin syndrome 2. Neuroleptic malignant syndrome 3. Hypertensive crisis 4. Respiratory depression - ANSWER>>Answer 3. Rationale: Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in patients who are taking phenelzine. Manifestations include hypertension, headache, and nausea. When talking to a patient about taking buspirone, the health care professional should include which of the following instructions? 1. Take the drug with grapefruit juice to increase absorption 2. Use the drug only as needed for anxiety 3. Take the drug on an empty stomach 4. Allow 2 to 4 weeks before expected to feel better - ANSWER>>Answer 4. Rationale: It can take up to 4 weeks for patients to feel the drug's full therapeutic effects especially because it is an anxiolytic which should not be taken as needed or on an empty stomach. A health care professional should question the use of alprazolam (Xanax) for a patient who 1. has a history of thromboembolism. 2. drinks 8-oz glasses of wine each evening. 3. takes prednisone (Prelone) for rheumatoid arthritis. 4. takes vampiric acid (Depakote) for seizure disorder. - ANSWER>>Answer 2. Rationale: To prevent severe sedation and respiratory depression, patients should avoid alcohol and other CNS depressants when taking benzodiazepines. While talking with a patient about taking chlorpromazine, which of the following instructions should the health care professional include? 1. Take the drug in the morning to prevent nocturia. 2. Wear sunscreen when exposed to sunlight. 3. Take the drug with food to reduce GI distress. A health care professional is collecting data from a patient who is taking bupropion hydrochloride (Wellbutrin) to treat depression. The health care professional notes that the patient has a recent history of a head injury. She should recognize that the drug is inappropriate for the patient because of the increased risk of which of the following? 1. Ischemic stroke 2. Drowsiness 3. Respiratory depression 4. Seizure activity - ANSWER>>Answer 4. Rationale: Bupropion, an atypical antidepressant, can cause seizure activity when patients take high doses or have a seizure disorder, a CNS tremor, or a history of head trauma. A health care professional should monitor an older adult patient who is taking alprazolam (Xanax) for which of the following? (Select all that apply) 1. Sedation 2. Tolerance 3. Anxiety 4. Constipation 5. Respiratory depression - ANSWER>>Answer 1, 2, 3, and 5. Rationale: Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Patient should use these drugs only as needed and for short periods of time. Paradoxical reactions, such as anxiety and insomnia, can develop, especially in older adults. Adverse effects: respiratory depression and sedation. During a physical assessment, the nurse closes and door and provides drape to promote privacy. The nurse is performing her role as a/an: A. Advocate B. Communicator C. Change agent D. Caregiver - ANSWER>>D. Caregiver The role of a nurse as caregiver helps client promote, restore and maintain dignity, health and wellness by viewing a person holistically. As an advocate the nurse intercedes or works on behalf of the client. Identifying the need and problems of the client and communicating it to other members of the health team is doing the role of a communicator. As a change agent, the nurse assists the client to MODIFY their BEHAVIOR. Formulating a nursing diagnosis is a joint function of: A. Patient and relatives B. Nurse and patient C. Doctor and family D. Nurse and doctor - ANSWER>>B. Nurse and patient Although diagnosing is basically the nurse's responsibility, input from the patient is essential to formulate the correct nursing diagnosis. The nurse listens to Mrs. Sullen's lungs and notes a hissing sound or musical sound. The nurse documents this as: A. Wheezes B. Rhonchi C. Gurgles D. Vesicular - ANSWER>>A. Wheezes Wheezes are indicated by continuous, lengthy, musical; heard during inspiration or expiration. Rhonchi are usually coarse breath sounds. Gurgles are loud gurgling, bubbling sound. Vesicular breath sounds are low pitch, soft intensity on expiration. When performing an abdominal examination, the patient should be in a supine position with the head of the bed at what position? A. 30 degrees B. 90 degrees C. 45 degrees D. 0 degree - ANSWER>>D. 0 degree The patient should be positioned with the head of the bed completely flattened to perform an abdominal examination. If the head of the bed is elevated, the abdominal muscles and organs can be bunched up, altering the findings. Kussmaul's breathing is: A. Shallow breaths interrupted by apnea B. Prolonged gasping inspiration followed by a very short, usually inefficient expiration C. Marked rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnea D. Increased rate and depth of respiration - ANSWER>>D. Increased rate and depth of respiration Kussmaul breathing is also called as hyperventilation. Seen in metabolic acidosis and renal failure. Option A refers to Biot's breathing. Option B is apneustic breathing and option C is the Cheyne-stokes breathing. When performing an admission assessment on a newly admitted patient, the nurse percusses resonance. The nurse knows that resonance heard on percussion is most commonly heard over which organ? A. Thigh B. Liver C. Intestine D. Lung - ANSWER>>D. Lung Resonance is loud, low-pitched and long duration that's heard most commonly over an air-filled tissue such as a normal lung. To assess the adequacy of food intake, which of the following assessment parameters is best used? A. Food preferences B. Regularity of meal times C. 3-day diet recall D. Eating style and habits - ANSWER>>C. 3-day diet recall 3-day diet recall is an example of dietary history. This is used to indicate the adequacy of food intake of the client. Claire is admitted with a diagnosis of chronic shoulder pain. By definition, the nurse understands that the patient has had pain for more than: A. 3 months B. 6 months C. 9 months D. 1 year - ANSWER>>B. 6 months Chronic pain is usually defined as pain lasting longer than 6 months. Prolonged deficiency of Vitamin B9 leads to: A. Scurvy B. Pellagra C. Megaloblastic anemia D. Pernicious anemia - ANSWER>>C. Megaloblastic Prolonged Vitamin B9 deficiency will lead to megaloblastic anemia while pernicious anemia results in deficiency in Vitamin B12. Prolonged deficiency of Vitamin C leads to scurvy and Pellagra results in deficiency in Vitamin B3. When assessing a patient's level of consciousness, which type of nursing intervention is the nurse performing? A. Independent B. Dependent C. Collaborative D. Professional - ANSWER>>A. Independent Independent nursing interventions involve actions that nurses initiate based on their own knowledge and skills without the direction or supervision of another member of the health care team. Which of the following is a nursing diagnosis? A. Hypothermia B. Diabetes Mellitus C. Angina D. Chronic Renal Failure - ANSWER>>A. Hypothermia Hyperthermia is a NANDA-approved nursing diagnosis. Diabetes Mellitus, Angina and Chronic Renal Failure are medical diagnoses. A skin lesion which is fluid-filled, less than 1 cm in size is called: A. Papule B. Vesicle C. Bulla D. Macule - ANSWER>>B. Vesicle Vesicle is a circumscribed circulation containing serous fluid or blood and less than 1 cm (ex. Blister, chicken pox). S1 is heard best at the: A. 5th left intercostal space along the midclavicular line