Pharmacology Exam 1: NUR 2407, Exams of Nursing

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NUR 2407 PHARMACOLOGY -PHARM EXAM 1

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Pharm Exam 1 Questions What nursing intervention is appropriate for a 70-year-old female patient receiving lithium?

• Monitor Fluid and Sodium Intake A nurse is caring fora patient who is taking lithium for mania. The nurse’s assessment includes a notation of a lithium serum level of 2.4 mEq/L. The nurse anticipates seeing what?
• Clinic movements •serum levels of 2-2.5 mEq/L may produce ataxia, clinic movements, possible seizures and hypotension* The nurse administers chlorpromazine intramuscularly to the preoperative patient who is extremely anxious about surgery in the morning. What priority teaching point will the nurse provide this patient?
• *remain recumbent for at least 30 minutes after the injection decreases the risk of injury if orthostatic hypotension occurs. The nurse is presenting an in-service at a children’s unit on hyperactivity. The nurse is told that a 6-year-old on the unit is being treated with methylphenidate (Ritalin), an amphetamine. The presenting nurse talks about discharge teaching for this patient and the importance of monitoring what?
• weight and complete blood count

*drug is associated with weight loss, bone marrow suppression, and cardiac arrhythmias The nurse is caring for a patient taking an oral neuroleptic medication, haloperidol. What is the nurse’s priority assessment to monitor for?

• Tardive dyskinesia *such a common adverse effect with continued use of the drug A psychotic patient is admitted through the ED. The physician has ordered chlorpromazine (Thorazine) 25 mg intramuscularly. After administration of the medication, what is the nurse priority to evaluate?
• a decrease in psychotic symptoms (purpose of administering the drug) A patient diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has complete patient teaching regarding the use of lithium. What statement by the patient indicates an understanding of their responsibility?
• *i will increase my fluid intake to maintain a therapeutic level, patient must increase fluids. decrease can lead to toxicity A patient has just been prescribed a phenothiazine. During patient teaching about this drug, what would be important for the nurse to tell the patient?
• The urine can turn pink or reddish A patient on chlorpromazine is feeling better and decides they no longer need their medication. the nurse teaches the patient that abrupt withdrawal of a typical antipsychotic medication can result in what
• *insomnia sudden withdrawal can cause cholinergic effects

A patient’s medication has been changed to clozapine (Clozaril). The nurse evaluates this patient for which life-threatening adverse effects?

• Neuroleptic malignant syndrome Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug?
• Extrapyramidal effects The pharmacology instructor is explaining to their class the difference between the typical and the atypical groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia?
• *Clozapine (Clozaril) advantages include improvement of negatives symptoms without causing the EPS associated with older antipsychotic drugs The nurse, providing teaching about a typical antipsychotic newly prescribed for the patient, cautions against use of alcohol with the drug by explaining it will have what effect?
• increased central nervous system (CNS) depression Degeneration in neurons that release a neurotransmitter leads to Parkinson’s disease. What neurotransmitter is involved?
• Dopamine A patient is newly diagnosed with Parkinson’s disease and levodopa (Doper) has been prescribed. What patient teaching information should be considered a high

priority for this patient?

• avoid vitamin B6 intake avoid grains and bran. Speeds the conversion of levodopa to dopamine before it can cross the blood brain barrier.

A patient with Parkinsonism has been told that the levodopa prescribed is no longer controlling the disease. What drug would the nurse question if ordered as adjunctive therapy?

• Vitamin B *decreases therapeutic effects and is contraindicated The nurse provides patient teaching about use of levodopa for treatment of Parkinson’s disease. What statement by the patient would indicate a good understanding of levodopa?
• I should take this drug with meal to avoid GI upset A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with long-term use of antipsychotics, can be treated with what drug type?
• Anticholinergic Agents The nurse is presenting an educational event to a local community group on Parkinson’s disease. What will the nurse tell the attendees causes the classic Parkinson’s disease symptoms?
• degeneration of dopamine-producing nerve cells When providing patient teaching for older adults, the nurse employs what priority strategy to improve patient understanding?
• *extensive written teaching can improve effectiveness of teaching, The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby

reducing adverse effects? What is the name of this drug?

• Carbidopa

When the nurse develops a plan of care for a patient newly diagnosed with Parkinson’s disease, the nurse includes what appropriate goal for this patient?

• Symptom improvement as demonstrated by ability to ambulate the length of the hall within 24 hours of starting medication The nurse is teaching a group of student nurses about Parkinson’s disease. The nurse would determine teaching was successful if the students identified what neurotransmitters as imbalanced in Parkinson’s disease?
• *dopamine and acetylcholine important in regulating, posture, muscle tone and voluntary movement The pharmacology instructor is discussing drugs used for the treatment of partial seizures. What accurately describes the physiological action of carbamazepine?
• Increases GABA activity and blocks sodium and calcium channels to stop action potentials The nurse evaluates the patient’s serum phenytoin (Dilantin) level and determines the level is therapeutic when it is within what range?
• between 10-20 mcg/mL A nurse is teaching a patient about his or her newly prescribed drug, phenytoin (Dilantin) for a seizure disorder. What will the nurse alert the patient to as a serious adverse effect of this drug?
• *Rash serious liver, bone marrow and potentially serious dermatological adverse effects can occur

An 8-year-old child has been diagnosed with a seizure disorder and phenytoin (Dilantin) has been prescribed for him or her. What nursing diagnosis would be appropriate if the child demonstrated adverse effects to the drug?

• impaired skin integrity related to dermatological effects *can cause potentially serious dermatological effects as well as gum disease and stained teeth The nurse is providing patient education for a patient newly prescribed a hydantoin antiseizure medication. What would the nurse be sure to teach the patient regarding the dangers of abrupt withdrawal?
• Status epilepticus Richard, 15 years old, has been diagnosed with epilepsy. He is to be sent home on oral phenytoin 100 mg b.i.d. What statement by Richards’s mother leads the nurse to believe she has understood drug teaching?
• *I will make sure he has routine visits to the dentist gingival hyperplasia is common in patients, especially children The patient’s serum drug level of phenytoin is elevated and indicates a toxic level. What will the nurse assess for in this patient? (Select all that apply.)
• *liver toxicity bone marrow suppression serious dermatological reactions toxic levels increase the likelihood of adverse effects A patient has a new order for carbamazepine (Tegretol). What does the nurse know is a contraindication to administration of carbamazepine?
• Bone marrow depression

What factors contribute to determining the drug of choice for a patient with epilepsy? (Select all that apply.)

• Age Type of Epilepsy Patient characteristics A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine (Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should avoid what?
• *drinking alcohol can increase in CNS depression. Combination should be avoided due to possible injury or severe body system depression that could lead to coma or death A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed?
• Baclofen (L’Oreal) Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.)
• hypotension urinary frequency dizziness What is the physiological action of tricyclic antidepressant (TCAs)?
• *Inhibiting reuptake of norepinephrine and serotonin cause an accumulation of neurotransmitters that is thought to create the antidepressant effect

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?

• reassuring the patient that a decrease in weight is common adverse effect with this medication