NR566 FINAL 2024/2025 Examination with 100% correct and Verified Answers, Exams of Nursing

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NR566 FINAL 2024/2025 Examination with 100% correct and Verified Answers 1st line treatment for panic disorder - ✔✔The SSRIs are first-line drugs for PD fluoxetine (Prozac) Paroxetine(Paxil) and sertraline (Zoloft) 1st line treatment for performance anxiety - ✔✔Propranolol (INDERAL )and other B blockers can benefits patients with performance anxiety 1st line treatment for sleep disturbance - ✔✔Benzodiazepine Triazolam Benzodiazepine-Like Drugs Zolpidem ,Zaleplon, and eszopiclone Barbiturate :Secobarbital Melatonin Receptor Agonist :Ramelteon , melatonin Orexin Receptor Agonist: Suvorexant A patient with what type of condition should not take echinacea? - ✔✔HIV immunocompromised patients tuberculosis AUTOIMMUNE DISORDER Alprostadil benefits of various routes: for ED - ✔✔The injection needs to be done by the patient or in ER setting: rapidly leads to erection, painless Intraurethral pellet insertion: can be done by the patient, an erection occurs within 5-10 mins minimal side effects Androgen therapy appropriate vs. not needed related to puberty - ✔✔Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress Long term: if delayed puberty related to true hypogonadism Bacterial Vagionosis 1st line Treatment - ✔✔Non pregnant metronidazole 500 mg 2xdays for 7 days pregnant - vaginal metronidazole 2% for 7 days clindamycin 1% for 7 days baseline data needed to prescribe Serotonin/Norepinephrine Reuptake Inhibitors (SNRI) - ✔✔Serum sodium should be checked in older adults and patients on diuretic therapy. baseline data needed to prescribe Tricyclic antidepressant (TCA) - ✔✔ECG should be checked, especially in patients with known dysrhythmias or patients older than 40 years of age. Donepezil (Aricept) when would it be appropriate to increase the dose? - ✔✔patient are stabilized on the initial dosage for 1 to 3 months before an increased in dosage doxazosin (BPH treatment) (a1 blocker) side effect - ✔✔side effect hypotension, dizziness, nasal congestions Dutasteride (Avodart) BPH treatment (5a reductase inhibitors) patient teaching - ✔✔benefits take months to develop, must continue taking med even if improvement not readily seen may lower ejaculatory volume and libido Examples of opioid analgesics reserved for severe migraines that don't respond to first-line medications - ✔✔Butorphanol nasal spray use one spray each nostril every 60 minutes PRN First generation antipsychotics (FGA) - ✔✔All of the FGAs produce a strong blockade of dopamine in the central nervous system (CNS). As a result, they all can cause serious movement disorders, known as extrapyramidal symptoms (EPSs) and tardive dyskinesia(TD) Ginger Root Adverse Effects - ✔✔have the potential to cause CNS depression and cardiac dysrhythmias. Excessive doses may also cause GI disturbances Ginkgo Biloba adverse effects - ✔✔Mild GI Upset Headache Lightheadedness Side Effects reduced by reducing dose Taken precautious in patients at risk for seizures How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? - ✔✔accelerated OC medication and reducing OC EFFECT How long depression medication should it take to work? - ✔✔With all antidepressants, symptoms resolve slowly. Initial responses develop in 1 to 3 weeks. Maximal responses may not be seen until 12 weeks. 4-8 weeks How might this affect which OCP is prescribed Carbamazepine - ✔✔Increase the estrogen dosage of the OC Combine the OC with a second from a birth control Switch to an alternation form of birth control How to know someone would be appropriate for preventative therapy for migraine headache - ✔✔Patients who have frequent attacks 3 or more, severe attacks, or attacks that do not respond adequately to abortive therapy How to manage side effects of Bromocriptine ( dopamine agonist): - ✔✔Take medication with food to decrease GI upset or decrease dose How to monitor phenytoin for effectiveness - ✔✔Plasma drug level absence of seizure during trial period while finding right medication HSV (herpes simplex virus) 12st line treatment - ✔✔1 Clinical episode: Acyclovir 400 mg 3x days for 7-10 days 2 Clinical episode: Acyclovir 800 mg 2x days for 5 days Kava adverse effects - ✔✔sever live injury , hepatotoxicity Laws related to CAM, Current Good Manufacturing Practices (CGMP) ruling of 2007 - ✔✔regulates supplement manufacturing and labeling to ensure supplements are free of contaminants and prevent mislabeling Patient teaching Phenytoin use with OC - ✔✔Need for 2nd contraceptive or Increase PO contraceptive Patient teaching taking 1st generations antipsychotic medication - ✔✔Patients should be informed about signs of hypotension (lightheadedness, dizziness) and advised to sit or lie down if these occur. In addition, patients should be informed that hypotension can be minimized by moving slowly when assuming an erect posture. Patients should be warned against participating in hazardous activities (e.g., driving) until sedative effects diminish. Report any s/s of EPs or TD Phenytoin (Dilantin) common side effect ( treat Seizure disorder ) - ✔✔CNS, gingival hyperplasia, leathery, GI upset, blurred vision, suicidal behavior/cognitive decline Phenytoin (Dilantin) patient teaching - ✔✔this Rx causes gingival hyperplasia patients should practice good oral hygiene (flossing, massaging gums) Folic acid can help decrease occurance of hyperplasia increase calcium and vitamin D while taking this Rx avoid driving is not seizure-free for more than 1 years Pramipexole (Mirapex) adverse effect - ✔✔Nausea, dizziness, daytime sleep attacks, insomnia, constipation, weakness, and hallucinations, impulse control disorder can occur ( excessive gambling, spending etc) Preventive therapy for migraines headache - ✔✔Metoprolol/propranolol ( Beta-blockers ) are often used as preventive therapy Progesterone (progestin) When is day not safe to prescribe - ✔✔if women has had a hysterectomy/pregnant Rivastigmine (Exelon) patient teaching - ✔✔can cause bradycardia, fainting, fall, and fall-related fractures. family teaching how to prevent fall at home Side effect of progestin oral contraceptives - ✔✔it can cause irregular/ inconsistent bleeding, must be take at same time very day to be effective Side effect of testosterone replacement therapy - ✔✔hot flashes, bone fx, decrease libido, insulin resistance, erectile dysfunction, acne, HTN, sterility, aggression, and mood swings. SSRI common adverse effects - ✔✔Sexual dysfunction Weight gain Serotonin syndrome SSRIs baseline data needed to prescribe common adverse effects - ✔✔Serum sodium should be checked in older adults and patients on diuretic therapy SSRIs drug interactions - ✔✔•MAOIs-serotonin syndrome Antiplatelet drugs and anticoagulants St. John's Wort adverse effects - ✔✔Allergic skin reactions may occur, especially in people allergic to ragweed and daisies. In addition, the herb may cause CNS effects (e.g., insomnia, vivid dreams, restlessness, anxiety, agitation, and irritability), as well as GI discomfort, fatigue, dry mouth, and headache. High-dose therapy may pose a risk for phototoxicity Strategies to minimize adverse effects of SNRI - ✔✔Educate patients that abrupt cessation of these drugs is not recommended. Patients should also report thoughts of suicide or self-harm immediately Triptans contraindications - ✔✔History of ischemic heart disease, uncontrolled hypertension, cerebrovascular disease, pregnancy, basilar or hemiplegic migraine; use within 24 hours of an ergot derivative Uncomplicated gonorrhea urethritis treatment - ✔✔ceftriaxone 500 mg IM single dose with or without doxycycline 100 mg 2x days for days Use of levodopa/carbidopa in treatment/diagnosis - ✔✔Dopamine replacement, first-line drug/treatment to dopamine agent) maintain or improve pts ADLs Adverse effects: orthostatic hypotension, psychosis, dyskinesia what education needed Patients taking MAOI medication - ✔✔Patients should be informed about the symptoms of hypertensive crisis (headache, tachycardia, palpitations, nausea, vomiting, sweating) and instructed to seek immediate medical attention if these develop what education needed Patients taking TCA medication - ✔✔Patients should be informed that they can minimize orthostatic hypotension by moving slowly when assuming an upright posture. In addition, patients should be instructed to sit or lie down if symptoms (dizziness, lightheadedness) occur. What foods contain tyramine? - ✔✔- Avocados, aged meats, bean curd, bananas, cold cuts/sausages, cured fish, cheese, yeast, beers, protein supplements, soups, shrimp, soy sauce, chocolate, caffeine What is abortive therapy for migraines headache and when is it used? - ✔✔Abortive medications stop a migraine when pt feels one coming or once it has begun. NSAIDS and opioid and migraine-specific meds ( Triptans and Ergot alkaloids) used at 1st sign of attack What seizure medication reduces OC efficacy? - ✔✔Carbamazepine, eslicarbazephine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, topiramate When is Pramipexole best to prescribe in treating Parkinson's disease? - ✔✔early stage of PD When on medications for Alzheimer's Disease (AD) and symptoms increase, it is better to increase the AD medication than to add things like herbal medications, vitamins, or NSAIDs - ✔✔Adding Memantine When to use/prescribe COMT inhibitors - ✔✔COMT inhibitors can help when levodopa is not working for long enough and starts to wear off between doses. extends the half-life of levodopa Which anticonvulsant would be given for someone with epilepsy needing adjunctive therapy for partial seizures with or without secondary generalization? - ✔✔Lamotrigine Which sleep med would help patients fall asleep if they don't have trouble staying asleep? - ✔✔Melatonin Zolpidem - ✔✔Benzodiazepines like drugs · Papaverine plus phentolamine Patient Education - ✔✔Do not inject more than once in a 24 hours period, notify provide if erection duration and efficacy, consult MD before taking new medication, seek medical attention right away if erection is >3 hours 1st line treatment for acute, mid to moderate migraine without nausea or vomiting - ✔✔NASID: Naproxen and ASP 1st line treatment for General anxiety - ✔✔both SSRI AND SNRI are considered 1st line treatment GAD. SSRI: Paroxetine(Paxil)Escitalopram (Lexapro) SNRI: Venlafaxine (Effexor XR), duloxetine (Cymbalta), Buspirone