A
Which medication can be used to prevent and treat seizures?
Levetiracetam (Keppra)
Whenever you read that a drug has an anticholinergic effect, what would you anticipate for side effects?
Blurred Vision
Urinary Retention
Dry Mouth (Xerostomia)
Constipation
Anhidrosis (No sweating)
Tachycardia
Which patient statement requires IMMEDIATE follow-up?
A. “I know to avoid stopping this medication suddenly.”
B. “I’ll take the medication at the same time each day.”
C. “I sometimes take it with antacids if my stomach feels upset.”
D. “I will schedule regular dental visits.”
C. “I sometimes take it with antacids if my stomach feels upset.”
Antacids reduce phenytoin absorption, risking seizures. This needs intervention quickly.
Anticholinergic
A patient prescribed alprazolam for anxiety reports taking “an extra dose whenever I feel stressed.” What should the nurse be MOST concerned about?
A. The patient is developing tolerance
B. The patient may be experiencing serotonin syndrome
C. The patient will have reduced medication absorption
D. The medication may cause paradoxical anxiety
A. The patient is developing tolerance
Extra doses → tolerance + dependence, especially with benzodiazepines.
A client is on Bethanechol (Urecholine) for neurogenic bladder. The nurse would monitor for the therapeutic effects of this med as well as other parasympathetic effects, including which of the following?
A. Bronchodilation
B. Constipation
C. Diarrhea
D. Blurred vision
E. Urination
F. Miosis
C. Diarrhea
E. Urination
F. Miosis
When evaluation responses of a client who has being given a cholinergic medication, the nurse should observe for the therapeutic effect of this medication. Which would include which of the following:
A. Mydriasis
B. Increased motility and tone of GI track
C. Anhidrosis
D. Increased heart rate
B. Increased motility and tone of GI track
What are the adverse effects of Phenytoin (Dilantin)?
•Nystagmus (continuous back & forth movement of eyes)
•Sedation
•Ataxia
•Diplopia (double vision)
•Cognitive impairment
•Suicidal thoughts
A patient with myasthenia gravis receives a scheduled dose of neostigmine. Thirty minutes later, they develop increased salivation, sweating, abdominal cramping, and bradycardia. Muscle strength has not improved. Which interpretation is MOST accurate?
A. The patient is experiencing cholinergic toxicity
B. The dose was too low
C. Symptoms represent expected onset of action
D. The patient is entering a myasthenic crisis
A. The patient is experiencing cholinergic toxicity
Neostigmine overdose → SLUD symptoms + weakness = cholinergic crisis, not improvement.
If strength improved, it would be therapeutic. If weakness worsened without SLUD, think myasthenic crisis.
A prescriber has ordered a beta1-agonist medication for a patient. The nurse understands that the patient who would most likely benefit from a beta1 agonist would be a patient with which of the following health alterations?
a. Heart failure
b. Hypertension
c. Asthma
d. Glaucoma
a. Heart failure
A patient receiving ketamine for a brief procedure becomes agitated, hallucinating, and disoriented in recovery. What is the BEST explanation?
A. The patient is hypoxic
B. Ketamine can cause emergence reactions during recovery
C. The patient is experiencing alcohol withdrawal
D. The patient was under-sedated during the procedure
B. Ketamine can cause emergence reactions during recovery
Ketamine is known for emergence delirium, including hallucinations and agitation.
What patient demographic must be screened for a certain gene that can cause Steven Johnson Syndrome and toxic epidermal necrolysis if given Tegretol?
Asian
The nurse should be prepared to administer which of the following drugs as an antidote to cholinergic overdose?
A. epinephrine (Adrenalin)
B. propranolol (Inderal)
C. atropine sulfate
D. diphenhydramine (Benadryl)
C. atropine sulfate
A client taking an anticholinergic med is concerned about the adverse effects of this medication. Which statement by the client informs the nurse that the client understands the adverse effects of this medication?
A. Will I become dizzy when my heart rate goes low?
B. I can suck on dry candies for my dry mouth.
C. I should carry a tissue for when my eyes tear up.
D. I am not looking forward to having frequent bowel movements.
B. I can suck on dry candies for my dry mouth.
What medication can cause purple glove syndrome?
Phenytoin (Dilantin)
A patient newly prescribed alprazolam for anxiety reports taking their first dose with a glass of wine and now feels “unusually sleepy and confused.” What is the nurse’s BEST interpretation?
A. CNS depression is intensified when benzodiazepines are combined with alcohol
B. The patient is developing a benzodiazepine allergy
C. The dose was too low for therapeutic effect
D. The patient is experiencing withdrawal symptoms
A. CNS depression is intensified when benzodiazepines are combined with alcohol
Alcohol + benzos → dangerous respiratory/CNS depression.
Not allergy, not withdrawal, and dose wasn't “too low” (symptoms show the opposite).
What are some major adverse effects of Levetiracetam (Keppra)?
1. KEPPRA Rage
2. Steven Johnson syndrome
3. Suicidal thoughts (mood changes, new anxiety, new agitation)
A patient receives IV atropine for symptomatic bradycardia. After administration, the patient becomes restless, complains of blurred vision, and HR is now 134/min. What best explains this response?
A. Anticholinergic effects are occurring as expected
B. The patient is having a paradoxical slowing of the heart
C. The dose was insufficient
D. The patient is experiencing early shock
A. Anticholinergic effects are occurring as expected
Atropine blocks acetylcholine → tachycardia + blurred vision + restlessness are expected.
Nothing indicates shock or paradoxical bradycardia.
A patient on valproate for seizure prevention reports persistent vomiting, abdominal pain, and yellowing of the eyes. What condition is most concerning?
A. Hepatic toxicity
B. Dehydration
C. Viral gastritis
D. Nonadherence to medication
A. Hepatic toxicity
Valproate carries a serious liver toxicity risk, especially early in treatment.
Jaundice + vomiting + RUQ abdominal pain = red flag.
Which patient statement indicates the most accurate understanding of phenytoin therapy?
A. “I need to have regular blood tests because the dose is based on my levels.”
B. “I can stop taking this medication if I’m seizure-free for a week.”
C. “I should take this medication with antacids to protect my stomach.”
D. “If I miss a dose, I should double the next one.”
A. “I need to have regular blood tests because the dose is based on my levels.”
Phenytoin has a narrow therapeutic range, so levels guide dosing.
Never stop abruptly, avoid antacids (they ↓ absorption), and never double doses.
What is the antidote for too much atropine?
Physostigmine salicylate
What is the antidote for too much anticholinergic drugs?
Physostigmine salicylate
A patient taking carbamazepine for seizures reports fever, sore throat, and easy bruising. Which complication must the nurse suspect first?
A. Bone marrow suppression
B. Dehydration
C. Electrolyte imbalance
D. Viral infection
A. Bone marrow suppression
Carbamazepine can cause leukopenia + thrombocytopenia → infections + bruising.
These symptoms aren’t explained by simple viral illness.
A patient taking zolpidem (Ambien) for insomnia reports waking up to find dishes washed, laundry folded, and texts sent—without remembering any of it. Which interpretation is MOST accurate?
A. Natural deep sleep cycle
B. Complex sleep behaviors associated with zolpidem
C. New-onset delirium
D. Expected therapeutic drowsiness
B. Complex sleep behaviors associated with zolpidem
Zolpidem can cause sleep-driving, sleep-eating, and amnesia.
This is a known, uncommon but serious side effect.
A patient receives IV diazepam for an active seizure. Afterward, the patient is sleepy but arousable and RR is 12/min. Which interpretation is MOST appropriate?
A. The dose caused inadequate seizure control
B. The patient is experiencing a paradoxical reaction
C. Mild respiratory depression is expected after benzodiazepine rescue therapy
D. The patient requires immediate intubation
C. Mild respiratory depression is expected after benzodiazepine rescue therapy
Diazepam → sedation + mild respiratory depression that is expected but must be monitored.