Antidepressants
The nurse is planning care for a patient taking imipramine [Tofranil], a TCA. Which finding, if present, would most likely be an adverse effect of this drug?
A. Blood pressure of 160/90 mm
B. Insomnia and diarrhea
C. Sedation and dry mouth
D. Tachypnea and wheezing
C.
Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.
The nurse knows that which neurotransmitter is most commonly found at the synapses of the peripheral nervous system?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Acetylcholine
D.
Norepinephrine, epinephrine, dopamine, and acetylcholine are neurotransmitters for the peripheral nervous system, but acetylcholine is the most abundant. It is released by all preganglionic neurons in the sympathetic and parasympathetic systems. It is also released by all postganglionic neurons of the parasympathetic nervous system.
The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
A. Resistant infection
B. Superinfection
C.Nosocomial infection
D. Allergic reaction
B.
Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.
The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug?
A. “This medication should not make me feel drowsy.”
B. “This medication should help me feel less anxious.”
C. “I will drink grapefruit juice instead of coffee with breakfast.”
D. “I will take my medication three times per day.”
C.
Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.
A nurse should give which nonmedication instruction to a patient who has peptic ulcers?
A. Reduce your intake of caffeine-containing beverages, such as coffee and colas.” Incorrect
B. “Take a nonsteroidal anti-inflammatory drug once a day to help with pain.”
C. “It would be better to eat five or six small meals a day instead of three larger ones.”
D. “An ulcer diet of bland foods with milk and cream products will speed healing.”
C.
One optimal nondrug measure, in addition to drug management, to aid patients with peptic ulcers, is changing the eating pattern to more frequent, smaller meals to avoid fluctuations in intragastric pH. No evidence indicates that beverages containing caffeine promote ulcer formation or that an “ulcer diet” improves healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins, which reduce mucosal blood flow and promote the secretion of gastric acid.
Which drugs does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.)
A. Bupropion [Wellbutrin]
B. Imipramine [Tofranil]
C. Fluoxetine [Prozac]
D. Desvenlafaxine [Pristiq]
E. Sertraline [Zoloft]
C, E
Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).
The nurse is preparing to administer a medication for acute organ rejection. Which medication will the nurse prepare to administer?
A. Methylprednisolone sodium [Solu-Medrol]
B. Diphenhydramine [Benadryl]
C. Acetaminophen [Tylenol]
D. Meperidine [Demerol]
A
Methylprednisolone sodium, a glucocorticoid, is administered intravenously to treat episodes of acute organ rejection. Diphenhydramine or acetaminophen would not be as effective as a steroid to minimize an adverse immune system reaction. Meperidine is a pain medication.
It is most important for the nurse to assess a patient taking itraconazole [Sporanox] for the development of what?
A. Hair loss
B. Skin rash
C. Pedal edema
D. Joint pain
C.
Itraconazole [Sporanox] has negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure. Pedal edema is a symptom of heart failure, and the nurse should assess for it. Skin rash, hair loss, and joint pain are unrelated to the use of itraconazole.
The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug?
A. Diarrhea
B. Risk for abuse
C. Dizziness
D. Weight gain
C.
Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
A. Omeprazole [Prilosec]
B. Famotidine [Pepcid]
C. Misoprostol [Cytotec]
D. Ranitidine [Zantac]
A.
Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.
A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid?
A. Aged cheese and sherry
B. Grapefruit and other citrus juices
C. Coffee, colas, and tea
D. Potato and corn chips
A.
Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.
The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (Select all that apply.)
A.“Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis.”
B.“The most common side effect of treatment with the drug is kidney failure.”
C.“Notify your healthcare provider if you notice that your skin or eyes are turning yellow.”
D.“Do not routinely use acetaminophen to prevent vaccine-associated fever and pain.”
E. “Use of this drug can prevent heart attack and stroke.”
C,D
Acetaminophen [Tylenol] is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.
A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B?
A.Furosemide [Lasix]
B. Insulin
C. Vitamin K
D. Potassium
D.
Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels. Furosemide, insulin, and vitamin K do not prevent any adverse effects of amphotericin B.
The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan?
A. “When it is time to discontinue this drug, you will need to taper it off slowly.”
B. “Protect your skin from the sun to prevent rash and exaggerated sunburn.”
C. “Increase your intake of fluid and high-fiber food to prevent constipation.”
D. “Take this medication on an empty stomach at least 2 hours after meals.”
A.
Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].
The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.)
A. Abdominal pain
B. Diverticulitis
C. Constipation
D. Bowel obstruction
E. Pregnancy
A, B, D
Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and obstruction of the bowel. Laxatives should be used with caution during pregnancy and lactation. Laxatives are used to treat constipation.
The nurse is preparing to administer phenelzine [Nardil], an MAOI, to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression?
A. It increases the risk of suicide in the early phase.
B. It is less effective than the tricyclic antidepressants.
C. It increases the risk of psychoses and parkinsonism.
D. It has more side effects and drug interactions.
D.
Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.
The nurse is administering isoproterenol, a beta1 and beta2 agonist. The nurse understands activation of these two receptors will result in which expected drug effects? (Select all that apply.)
A.Increased heart rate
B. Excessive drowsiness
C.Increased force of heart contraction
D.Decreased cardiac output
E. Bronchial dilation
F. Decreased glucose levels
A, C, E
Activation of beta1 and beta2 receptors results in (1) increased cardiac output (by increasing the heart rate and force of contraction); (2) dilation of the bronchi; and (3) elevation of the blood glucose level.
A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.)
A. Aortic valve replacement
B. Ruptured appendix
C. Bronchitis
D. Neutropenia
E. Chickenpox
A,E
Antibiotic prophylaxis is appropriate and effective in certain situations. These include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in “dirty” surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion. Antibiotics are not prescribed preventively for bronchitis or chickenpox.
Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter?
A. Norepinephrine
B. Acetylcholine
C. Serotonin (5-HT)
D. Gamma-aminobutyric acid (GABA)
D.
Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.
The nurse expects laxatives to be ordered for which of the following patients? (Select all that apply.)
A. A patient with chronic pain
B. A patient recovering from cardiac surgery
C. A patient who recently delivered a child
D. A patient with acute food poisoning
E. A patient with no bowel sounds
A, B, C
Laxatives are used for correcting constipation associated with certain drugs, especially opioid analgesics, which would probably be used for chronic pain. By softening the stool, laxatives can reduce the painful elimination that can be associated with episiotomy and with hemorrhoids associated with child birth. In patients with cardiovascular diseases (eg, aneurysm, myocardial infarction, disease of the cerebral or cardiac vasculature), softening the stool decreases the amount of strain needed to defecate, thereby avoiding dangerous elevation of blood pressure.
The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms?
A. Depressive psychosis
B. Serotonin syndrome
C. Escitalopram overdose
D. Cholinergic crisis
B.
Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.
The nurse should be concerned about which finding in a patient on long-term, low-dose colchicine therapy to prevent gout?
A.White blood cell (WBC) count of 6500/mcL
B. Platelet count of 200,000/mcL
C. Complaints of muscle pain and weakness
D. Complaints of headache
C.
Long-term, low-dose therapy with colchicine can cause rhabdomyolysis, which is manifested by complaints of muscle tenderness, pain, and weakness. Because the drug causes myelosuppression, patients should be monitored for leukopenia and thrombocytopenia. Both the WBC count and platelet count are within normal limits. Headache is not an adverse effect of colchicine.
A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.)
A.Potassium level of 4 mEq/dL
B. Reduction of fever
C. Sterile sputum cultures
D. Oxygen saturation of 98%
E. Elastic skin turgor
B,C,D
Antimicrobial therapy is assessed by monitoring clinical and laboratory responses. Clinical indicators of success in a patient with pneumonia may include afebrile status and resolution of an infectious infiltrate, resulting in an oxygen saturation above 95%. The disappearance of infectious organisms from post-treatment cultures also indicates resolution of infection. Potassium levels and elastic skin turgor are not assessment parameters for clinical infections, including pneumonia.
The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication?
A. Dry mouth
B.Temperature of 101°F
C. BP of 104/72 mm Hg
D. Drowsiness
B.
Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.
A patient has been taking docusate sodium [Colace] daily for 1 year. Which statement by the patient would indicate a complication associated with use of this drug?
A. “My doctor says that I’ve developed colon polyps.”
B. “I only have a bowel movement when I take the medicine.”
C. “The dental hygienist said I was losing the enamel on my teeth.”
D. “I’ve noticed that I’m having tremors now in my left hand.”
B.
Docusate sodium is a surfactant laxative that softens stool by allowing water penetration. Chronic exposure to laxatives can diminish defecation reflexes, leading to further reliance on laxatives. Patient education is the key to reducing laxative abuse. Colon polyps, loss of tooth enamel, and tremors are unrelated to docusate sodium.