When reviewing the client’s list of medications, the nurse notes that two anticholinergics have been prescribed. Which of the client’s recent symptoms could be caused by excessive anticholinergic therapy?
When reviewing the client’s list of medications, the nurse notes that two anticholinergics have been prescribed. Which of the client’s recent symptoms could be caused by excessive anticholinergic therapy? (Select all that apply.)
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Light sensitivity due to dilated pupils
Hyperacidity and gastric reflux
Frequent loose stools
Tachycardia
Dry mouth
Question 2 / 0.25
A nurse is taking a history from a client admitted for medication related syncope. Which of these comments from the client needs to be reported to the provider? (Select all that apply.)
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“I’m taking over the counter substitutes for the medicines I can’t affort.”
“I get my medicines from an online supplier, so I never run out of them, and refills are cheaper that way.”
“I don’t like to bother the doctor every time I need a medication refill, so sometimes I don’t.”
“My cardiologist never orders anything. He just tells my regular doctor what to order.”
“I just gave you my medication list the last time I was here!. Nothing has changed. Look it up!”
Question 3
Which teaching point is correct about the concept of “tolerance”?
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Tolerance is a state where people become used to pain, and therefore need less pain medicine.
In tolerance, smaller drug doses are needed to achieve prior effects because the body develops an increased responsiveness to the drug.
Tolerance occurs in slow metabolizers. Slow metabolism leads to prolonged sedation.
In tolerance, larger drug doses are needed to achieve prior effects because the body develops a reduced responsiveness to the drug.
Question 4 The provider is considering starting a diabetic client on valproic acid for nerve pain this week. During the health history, the client tells the nurse, “I drink a six pack of beer daily and two to three six packs on weekends.” What is the priority nursing action?
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Reassure the client that beer and valproic acid are compatible.
Obtain a lab order to assess the current level of valproic acid.
Seek an order for liver function labs to see if valproic acid would be safe for the client.
Tell the client his alcoholism is causing his nerve pain, so medicine won’t help.
Question 5The client diagnosed with a general anxiety disorder is prescribed alprazolam. Which information should the clinic nurse discuss with the client?
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Tell the client to avoid foods that are high in vitamin K.
Tell the client to expect rigidty as a side effect.
Explain to the client that this medication is intended for short-term use only.
Instruct the client to take the medication before driving to avoid transit anxiety.
Question 6How would a nurse explain the way a cholinergic would resolve related dry mouth?
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It stimulates salivation by stimulating alpha receptors in the brain
It stimulates salivation by redirecting fluid from the optic nerve
It stimulates salivation by stimulating muscarinic receptors
It stimulates salivation by blocking nicotinic receptors
Question 7What lab value will best reflect renal function in a client taking multiple medicines?
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Urinalysis
Creatinine clearance
Serum sodium
Serum potassium
Question 8A nurse is caring for a client who has been taking phenytoin for 6 weeks. Upon review of the laboratory results, the nurse notes that the client’s phenytoin level is 18 mcg/mL. What is the nurse’s best action?
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The nurse should contact the prescriber to suggest a dose increase.
This drug level is too high; the nurse should contact the prescriber about reducing the dose.
This drug level is in the therapeutic range, so the nurse can give the medicine as ordered.
Suspect that another drug is preventing phenytoin metabolism, and hold the causative medication.
Question 9A nurse is caring for a client being treated with an alpha blocker. What counseling should the client receive?
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Take a daily laxative to avoid constipation.
Void before taking the medication to avoid urine retention.
Avoid drinking more than 600 mls of fluid per day while taking this medication.
Rise slowly from lying to standing to avoid dizziness and a possible fall.
Question 10The nurse is assessing a client who has requested an adrenergic drug for dyspnea. Which sign would make the nurse hesitate to give the medication?
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Respiratory rate of 28 breaths/minute
Irregular heart rate of 122 beats/minute
Blood pressure of 130/86 mm Hg
Pulse oximetry saturation of 88%
Question 11The nurse recognizes that which of the following are actions of benzodiazepines? (Select all that apply.)
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Sleep facilitation
Suppression of seizures
Improvement of muscle coordination
Relief from tardive dyskinesia
Relief from anxiety
Question 12A 68 year old male has a history of seizures and has been taking phenytoin for years. His last seizure occurred 2 years ago, so he has decided that he no longer needs the mediation. What would be the nurse’s best response? (Select all that apply.)
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Affirm his plan to stop taking it, but tell him to restart the medication if tremors occur.
Recommend that he develop a withdrawal plan with his prescriber, as it is his right to negotiate his medicines.
Educate the client that suddenly stopping the medication could precipitate seizures.
Tell the client that once a medication for seizures is started, it can never be stopped.
Recommend that he start cutting his pills in half, then see how it goes.
Question 13A client is using a scopolamine patch for motion sickness. Since the medication has anticholinergic properties, which side effects should the client expect? (Select all that apply.)
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Blurred vision
Diarrhea
Dry mouth
Urine retention
Wheezes
Question 14 A client who has been taking an antiepileptic medication with a narrow therapeutic window for 2 weeks seems confused and forgetful. What should be the priority action of the nurse?
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Seek a plasma drug level order from the client’s prescriber.
Give an antihistamine under protocol to stop the allergic response.
Call the prescriber and have them change the seizure medication.
Set up oxygen and obtain an order for activated charcoal.
Question 15A nurse in the emergency department is caring for a client whose family reports that she had taken an overdose of diazepam. Which of the following medications should the nurse have available to reverse the central nervous system (CNS) depression caused by this drug?
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Magnesium sulfate
Protamine sulfate
Ondasteron
Flumazanil
Question 16What advice should the parents of a child needing methylphenidate receive? (Select all that apply.)
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Insomnia is a risk, so the medication should be given in the morning.
It is a gateway drug to other stimulants, and teens seek it to lose weight, so it it best for parents to keep control of it.
It is smart to order the medication from an online provider, because it it cheaper that way.
It should always be given before the meal.
It is a C2 substance, so automatic refills are not allowed.
There is no need to worry about addiction in these medications in well-adjusted children.
Question 17For which client would a beta adrenergic blocker be prescribed?
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A client with urinary retention
A client who suffers from diarrhea
A client who suffers from asthma
A hypertensive client with a heart rate of 104 beats/minute
Question 18The most common adverse effect associated with antiepileptic medications is central nervous system (CNS) depression. Knowing this, which signs and symptoms would the nurse watch for when assessing an epileptic client? (Select all that apply.)
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Confusion
Drooling
Unsteady gait
Insomnia
Hyperventilation
Question 19A client with Alzheimer’s disease has been taking a cholinesterase inhibitor for a week. What anticipated side effects of this cholinergic medication would the nurse anticipate?
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Tinnitus and hearing loss
Hypertension
Numbness and tingling in the extremities
Diarrhea, urgency, and possible bradycardia
Question 20Which statement regarding the blood-brain barrier demonstrates a need for further teaching?
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“It is not fully developed at birth.”
“It lets in therapeutic agents in but filters out everything else.”
“It can be a significant obstacle to entry of therapeutic agents.”
“It can protect the brain from potentially toxic substance injuries
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