Adrenergic
A 79-year-old male client requires a continuous infusion of dopamine for support of hypotension. Which of the following situations is a contraindication for using dopamine?
A. Poor perfusion of vital organs
B. Low urine output
C. Ventricular fibrillation
D. Septicemia
C
Select the most accurate statement:
A. Epinephrine is the primary neurotransmitter for the parasympathetic nervous system.
B. Muscarinic receptors affect skeletal muscles and help slow down the heart rate.
C. Cholinergic Agonist can result in rebound bradycardia.
D.Acetylcholine can cause increased urination, slow the heart rate, and increase peristalsis.
D
Your patient has some questions about baclofen. Which is the most appropriate and accurate answer that would fit this medication?
A.” Baclofen is used to relax the muscles but due to dilation can cause idiopathic hypertension.”
B. ”Baclofen can cause seizures so if you suspect you may be at risk, stop medication immediately.”
C. PO Baclofen is often used in order to determine the appropriate dosage for intrathecal medication.
D. If you are experiencing tachycardia, you know the medication is working properly.”
C
The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
A. "You have obviously developed resistance to your current medication after using for 2 years and will have to be switched to another drug."
B. "This is an atypical response. Unfortunately, there are no other options of drug therapy to give you."
C. "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
D. "You just need to keep taking your medication and these effects will go away."
C
Which of the patients would you need to teach further education to FIRST (All patients are taking Clonidine)?
A. 26 year old male trying to withdraw from opioids who is complaining of dry mouth after 76 hours on the medication
B. 56 year old male with neuropathic pain who went back to sleep due to drowsiness and missed their brunch date
C. 42 year old female with ADHD with dry eyes and has gain weight over the last week since starting the medication
D. 33 year old male has essential HTN forgot to pack their medicine for a 4 day vacation but says they feel fine
BONUS: explain why you choose a certain patient (50 pt) and explain how you would address the patients listed above(what would your teaching be)
D
(the major concern is the possibility of rebound hypertension)
A. Dry mouth is a common sign and frequent mouth rinses/hygiene and sugarless gum can help
B. This is not a bad thing inherently but missing important events may affect life.
C. Dry eyes occurs and weight gain is a side effect due to metabolism alteration and sodium retention.
Which patient would you question the order for bethanechol?
A. A 33 year old postpartum mother who just delivered a baby 2 hours ago
B. A 48 year old male who was diagnosed with nephrolithiasis and an UTI
C. A 27 year old woman who was in a car accident and has spinal cord injuries
D. A 56 year old male on a SSRI who is experiencing side effects from their antidepressants
B
Your patient just had botox and “states my wrinkles are gone forever by decreasing calcium transport”. She said “I‘m ready to go celebrate with my friends at the bar later”. What are some education points you can teach your patient?
Botox paralyzes the muscles. Dantrolene interferes with calcium transport. Direct acting skeletal muscle relaxants and alcohol should not be mixed together.
A physician orders a patient Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician?
A. “I take aspirin once day.”
B. “I had a PET scan last week.”’
C.“I forgot to tell the doctor I take eye drops for my glaucoma.”
D. “My hands are experiencing tremors at rest.”
C-anticholinergic
You are providing instruction on a new prescription of albuterol to a client with a new diagnosis of exercised induced asthma. Which of the following should you report to the doctor after 2 doses? SATA
A. 60 mg/dL blood glucose
B. Blood pressure of 126/84
C. K+ value: 3.1
D. Wheezing
E. Angina
C,D,E
Your patient was recently diagnosed with myasthenia gravis. The patient has muscle weakness, complains of GI cramping and ask for a emesis bag. You conducted the test to determine what crisis is occurring. While waiting for the results, the provider ask what kind of crisis do you suspect?
A. Myasthenic
B. Cholinergic
You document that the patient eyes as miosis and the patient has polyuria due to the testing. What would you use to treat this patient?
C. Atropine
D. Pyridostigmine
Bonus 50: what is the name of the test?
B
C
Edrophonium Chloride / Tensilon
What are general anesthesia intentions?
HINT: A.U.A.
Analgesia
Unconsciousness
Amnesia
What is the primary mechanism of action for Monoamine Oxidase B Inhibitors, such as selegiline?
A) It acts as a dopamine agonist, enhancing dopaminergic signaling in the central nervous system.
B) It inhibits the breakdown of dopamine, increasing dopamine availability.
C) It activates GABA-B receptors, resulting in increased neurotransmitter release and decreased muscle spasticity.
D) It blocks sodium channels in nerve cells, preventing nerve conduction and spasticity.
B
Your patient comes in and is prescribed Doxazosin. He provides the following feedback. Which parts show understanding and which shows need for reteaching?
I will start my medication tomorrow at breakfast before I drive into work. When I get out of my seat, I will rise slowly to allow my body to adjust and immediately call my doctor if I feel lightheaded tomorrow after I take my first dose. I will get regular check ups and use my BP cuff that is being sent home with me. The doctor will check my prostate size to ensure that the medication is shrinking it and working properly.
UNDERSTANDS
Rising slowly
Using BP cuff and regular check ups good
Same time everyday is good(maybe consider at bedtime tho)
RETEACH
No driving until affects known
Teach about first dose hypotension to avoid the doctor being called immediately.
Doxazosin does not shrink the prostate.
A patient is prescribed Pyridostigmine. Select all the following that is accurate with this medication.
A. High dosage Pyridostigmine has a side effect of bradycardia.
B. Pyridostigmine inhibits acetylcholinesterase which allows acetylcholine to act on the receptor.
C. Pyridostigmine is reversible.
D. Oliguria is a side effect of Pyridostigmine.
E. Respiratory assessment is vital when taking pyridostigmine.
B, C, E
DOUBLE JEOPARDY!!!
Match the following for balanced anesthesia :
A. Atropine
B. Midazolam
C. Promethazine ( Phenergan) / Metoclopramide ( Reglan)
D. Cyclizine
E. Morphine
1. Used to relieve queasiness
2. Provide pain management and muscle relaxation
3. Slow down GI peristalsis and vasoconstiction for BP control
4. Dry secretions and reduce allergic reactions (can help N/V)
5. Anxiolysis and relaxation
A-3
B-5
C-1
D-4
E-2
A patient was prescribed Entacapone, a COMT inhibitor, and has begun experiencing confusion. Besides this side effect, what lab do you suspect the doctor may order?
A. HbA1c
B. BNP
C. AST
D. eGFR
C
Which action should you take when administering the initial dose of Labetalol to a patient with hypertension?
A. Encourage the use of hard candy to prevent dry mouth.
B. Instruct the patient to use glucagon to treat tachycardia.
C. Ask the patient to request assistance when getting out of bed.
D. Teach the patient that peripheral edema and weight gain should be expected with no need to report.
C.
Your patient has Alzheimer’ and is prescribed Donepezil. Which of the following are expected with this medication.
Sialorrhea(Excessive Drooling)
Xerostomia (Absence of Drool)
Mydriasis
Miosis
Bradycardia
Tachycardia
Drowsiness
Hyperactivity
Dyspnea
Light Constipation
Light Diarrhea
Sialorrhea
miosis (constricted eyes)
Bradycardia
Drowsiness
Dyspnea
Diarrhea
After reviewing the patient’s past medical and surgical history, you get the following information: SX on 09/22/24. Use of Methohexital caused severe tachycardia and low respiratory reponse.
After talking with the patient, the patient request no use of Methohexital because they are concerned with addiction due to prior lifestyle.
After relaying this message to the provider, the decision to use Benzodiazepine was made alongside additional non-barbiturate anesthetics. Which statement would be the most accurate?
A. Nonbarbiturate medication block the receptors for GABA, which is an excitatory neurotransmitter. This closes the chloride channel increasing depolarization of the CNS.
B. Benzodiazepine has the same antidote as Methohexital; due to the neurological attachment, the antidote works faster for Benzodiazepine.
C. Nonbarbiturate medication do not cause cardiac arrhythmias unlike Methohexital.
D. Benzodiazepine has a higher therapeutic window than Methohexital and a shallow dose response curve; however, respiratory drive can be be decreased when using Benzodiazepine.
D
A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?
A. Assess the patient for a rash
B. Initiate seizure precautions
C. Hold the next dose of phenytoin
D. Continue to monitor the patient
Which statement by the patient requires you to re-educate the patient about this medication?
E. "I know it is important to have my drug levels checked regularly."
F. “If my urine turns brown, I will report it to my doctor.”
G. "This medication can lower my body's ability to clot and fight infection."
H. "This medication can cause double vision."
B , F
Which of the following could you potentially see with a patient who is on Sotalol? SATA
A. Tall peaked T Waves
B. Shallow T waves
C. Torsades de pointes
D. Absent DTR
E. Polyuria
B, C
What are some reason a parasympatholytic would be administered? SATA
A. Eye Inflammation
B. Photophobia
C. Increase secretions to excrete foreign materials out of lungs
D. Tachycardia
E. Dilation of the pupils
F. Urinary retention
Bonus 50: what is one gas that this medication can be used as an antidote for?
A,E
Serin Gas
What is wrong with the following discharge education for phenobarbital:
This medication is not only for seizures but for meningitis too.The recommended use is 2 months; note that this medication has addiction risk. Some side effects are CNS (such as nightmares) and respiratory depression. Can depress motor coordination. Testing serum levels is recommended.
The recommended use is not 2 months.
DOUBLE JEOPARDY!!!! Partial Credit can be given
Match the following:
A. Labetalol
B. Doxazosin
C. Sotalol
D. Dopamine
E. Clonidine
F. Albuterol
1. Decreases HR, cardiac workload and 02 needs and attaches to Beta receptors
2. Relaxes smooth muscles through vasodilation via Alpha 1 receptors
3. Non selective Beta Adrenergic Agonist
4. Blocks alpha 1 and beta 2 receptors
5. Agonist for the beta receptors that are in the blood vessels, GI, liver and pancreas
6. Central Acting Agonist for Rest and Digest Receptors (which inhibit release of epi/norepi)
A-4
B-2
C-1
D-3
E-6
F-5
Double Jeopardy!!!!
Your patient is planning on leaving for a long car ride. The doctor prescribes Scopolamine. She asks the following?
When should I apply for the best benefits?
How long can I wear it?
Muscarinic or Nicotinic?
What are some complications I may need to watch out for?(4, must get 2/4 for credit)
Where should I place it?
Well ahead of departure, 3-4 hours ahead of time.
3 day patch
Agitation or Hallucinations or Confusion or Distrust
Typically transdermally behind the ear
Muscarinic
Elmo was diagnosed with epilepsy. He often has hallucinations and Big Bird says Elmo seems to have act like two different people. You go in to assess Elmo and start to talk to him by asking his name. Elmo is twiddling his hands but doesn’t respond to you. This happens for 3 minutes. Elmo ask “where am I?” What type of seizure is this?
A. Absence
B. Atonic
C. Focal Impaired Awareness
D. Tonic - clonic
E. Grand mal
C