NM
___________ can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect
Acute dystonia
________ __________is characterized by generalized, severe muscle weakness
Myasthenic crisis is characterized by generalized, severe muscle weakness
You are taking care of a patient who is taking chlorpromazine (Thorazine) 75mgs twice a day to treat schizophrenia. The family reports that the patient's agitation, hallucinations, and delusions have improved with use of this drug, but the patient continues to withdraw from social interactions and will not bathe unless reminded to do so. The nurse tells the family member that:
A. all symptoms will eventually resolve over time with this medication
B. the patient may need an increased dose of this medication
C. these results may indicate that the patient may not have schizophrenia
D. they should consider discussing changing the chlorpromazine (Thorazine) to an atypical antipsychotic
D. they should consider discussing changing the chlorpromazine (Thorazine) to an atypical antipsychotic
- Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely that the negative symptoms will improve over time with this medication. Atypical antipsychotics can help with both positive and negative symptoms, so it would be worthwhile discussing a change in medication to see if the patient's negative symptoms could be improved. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.
The nurse provide teaching for a patient who will begin taking montelukast (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching?
A. "I will need to have periodic lab tests while taking this medication."
B. "I will not take ibuprofen for pain or fever while taking this medication."
C. "I will take one tablet daily at bedtime."
D. "I will use this as needed for acute symptoms."
D. "I will use this as needed for acute symptoms.“
- Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.
What are signs of NMS? How would the patient present? (i.e. in the ER?)
Rigid muscles, altered mental status, Elevated body temperature
__________ is characterized by restlessness, pacing, and difficulty standing still
Akathisia
You are caring for a patient who has myasthenia gravis and notice that a dose of neostigmine due one hour ago has not been given. You anticipate the patient to exhibit which symptoms?
A. Excess salivation
B. Muscle spasms
C. Muscle weakness
D. Respiratory paralysis
C. Muscle weakness
- Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness
- The other symptoms are characteristic of cholinergic crisis, caused by too much medication
The nurse is administering 0900 medications to a patient diagnosed with peptic ulcer disease. The patient indicates they had breakfast at 0730. Which medication should the nurse question?
A. Metronidazole (Flagyl)
B. Bismuth salicylate
C. Lansoprazole (Prevacid)
D. Sucralfate
D. Sucralfate
- The nurse should question sucralfate because it must be given on an empty stomach. The nurse should reschedule this medication during a time when the patient has not yet eaten so that the medication can coat the intestinal lining before a meal. The other medications are all appropriate.
A PATIENT WITH seasonal allergies with a runny nose during the daytime reports symptoms of coughing and sneezing that are interfering with sleep. The provider recommends diphenhydramine (Benadryl) at bedtime. What SHOULD THE nurse include when teaching the patient about this medication?
A. "Avoid fluids at bedtime to prevent urinary retention."
B. "This will clear your daytime symptoms too."
C. "You should be able to sleep better when you take this medication."
D. "You should take this medication on an empty stomach."
C. "You should be able to sleep better when you take this medication."
- A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will not last through the next day. There is no need to take the medication on an empty stomach.
_________________ is an anxiolytic that treats anxiety
___________________ is an antidepressant that treats depression
• Buspirone (BuSpar) is an anxiolytic that treats anxiety
• Bupropion (Wellbutrin) is an antidepressant that treats depression
_______ is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest
Pseudo-parkinsonism
While caring for a patient who has recurrent muscle spasms, you noticed on the patient’s chart that The provider has ordered Carisoprodol to treat the spasms, and that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching the patient to which medication?
a. Edrophonium
b. Dantrolene
c. Cyclobenzaprine
D. Succinylcholine
C. Cyclobenzaprine
- Cyclobenzaprine is the only other medication choice that treats muscle spas
- Edrophonium is used to diagnose myasthenia gravis
A patient who has Parkinson disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect?
A. Helping the patient to walk faster
B. Improving mental function
C. Minimizing symptoms of bradykinesia
D. Reducing some of the tremors
D. Reducing some of the tremors
- Benztropine is given to reduce rigidity and some of the tremors. It does not enhance walking, reduce bradykinesia, or improve mental function.
Which of the following medications would be questionable for a Child 7 years of age ?
a. Azithromycin
b. Cephalexin
c. Tetracycline
d. Augmentin
C. Tetracycline
- Tetracyclines should not be given to children younger than 8 years of age because they irreversibly discolor the permanent teeth.
What is diphenoxylate (Lomotil) used for?
Used for the treatment of diarrhea
______________ manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities
Tardive dyskinesia
A patient is taking methocarbamol (Robaxin) to treat acute muscle spasms. The patient says that his urine has turned greenish-black recently. What will the nurse do?
A. Administer the next dose of methocarbamol since this is a harmless side effect
B. Contact the provider to discuss changing to cyclobenzaprine
C. Obtain an order for BUN and Creatinine levels to evaluate renal function
D. Obtain an order for liver function studies since this indicates hepatotoxicity
A. Administer the next dose of methocarbamol since this is a harmless side effect
- Urine discoloration can occur in patients taking methocarbamol (Robaxin), and this is a harmless side effect
- There is no need to change medications or order lab tests
For patients that are receiving valproic acid to treat epilepsy, what part of their health history would be of concern?
A. Chronic obstructive pulmonary disease
B. Gastrointestinal disease
C. Liver disease
D. Renal disease
C. Liver disease
- Valproic acid can elevate liver enzymes. Patients with a history of liver disease should be monitored closely while taking this drug.
Which of the following medication is likely to cause Extrapyramidal symptoms?
a. ipecac
b. metoclopramide (Reglan)
c. Phenergan
d. Lithium
b. metoclopramide (Reglan)
- Metoclopramide can cause extrapyramidal symptoms, and these effects are even more likely to occur in children and are avoided as an option to treat vomiting
Why would diphenoxylate (Lomotil) have atropine added?
Atropine is added to decrease abdominal cramping and slow intestinal motility through its anticholinergic effects
- It does not affect nausea and vomiting or pain
_____ must be given on time to prevent myasthenic crisis
Neostigmine
_____ is used to treat malignant hyperthermia or NMS
Succinylcholine is a ___
- Dantrolene is used to treat malignant hyperthermia or NMS
- Succinylcholine is a paralytic
You are teaching a family member about a medication that is new to them, Donepezil (Aricept) to treat Alzheimer disease. They ask you “what should we expect from this drug”? What is your best response? The patient will
A. demonstrate improved ambulation
B. have reversal of symptoms
C. have decreased deterioration of cognition
D. show improved communication ability
C. have decreased deterioration of cognition
- Donepezil can help to increase cognitive function for patients with mild to moderate AD. For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress.
If a patient is being given Dantrolene, they likely have what condition?
Neuroleptic malignant syndrome (NMS)
Muscle relaxants, such as dantrolene, are usually given go treat
66-year-old female client with a history of gastroesophageal reflux disease and penicillin allergy is diagnosed with Helicobacter pylori infection. Her Primary Health care provider prescribes clarithromycin-based triple therapy for 14 days her new drugs include:
Clarithromycin 500 mg orally BID
Metronidazole 500 mg orally BID
Pantoprazole 40 mg orally QD
• What health teaching would the nurse include for the client related to her drug therapy? Select all that apply
A. Take all of the drugs that are prescribed for the full 14 days
B. Report new onset prolonged diarrhea to your primary care provider new line
C. Report any feelings of fluttering or palpitations while on these drugs
D. Take all of these drugs on an empty stomach before breakfast
E. Be sure to get a bone scan before and after the drug therapy
F. Have the magnesium level checked in your blood before and after taking these drugs
G. Be aware of an episode may take you more likely to develop pneumonia
H. Avoid alcohol while you are taking these drugs prevent interaction
A. Take all of the drugs that are prescribed for the full 14 days
B. Report new onset prolonged diarrhea to your primary care provider new line
E. Be sure to get a bone scan before and after the drug therapy
F. Have the magnesium level checked in your blood before and after taking these drugs
H. Avoid alcohol while you are taking these drugs prevent interaction
- The nurse would teach the client the need to take all medication doses because two of the drugs are antibiotics to treat the infection. However, many antibiotics can cause GI distress especially nausea and diarrhea, which can cause dehydration in a client's over 65 years of age. Pantoprazole is a protein pump inhibitor that can cause magnesium and bone loss period therefore the client should have a baseline serum magnesium and bone density scan for comparison after the drug regimen is discontinued. Alcohol can cause a severe interaction with metaphyseal including possible vomiting, severe headache, and seizures. The nurse would teach the importance of avoiding alcohol while the client is taking this drug.