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A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What should the nurse assess?
A Creatinine clearance
B Sodium levels
C Potassium levels
D Serum creatinine
A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?
A Ask the patient to share the teaching with a neighbor or friend soon after discharge.
B Give the patient detailed written information about each drug.
C Cluster medication administration times as much as possible.
D Make sure the patient understands the actions and side effects of each drug.
A nurse is reviewing an older adult patient’s chart before giving medications. Which patient information is of most concern?
A Chronic constipation
B Increased body fat
C Low serum albumin
D Low serum creatinine
Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?
A A higher dose should be used with the same time schedule.
B The interval between doses should be increased.
C No change is necessary; metabolism will not be affected.
D The interval between doses should be reduced.
A nurse is preparing to give medications to four geriatric patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
A Obese patient
B Patient with decreased serum creatinine
C Patient with chronic diarrheaD Thin patient with a chronically low appetite
A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine (Demerol) for severe pain. What will the nurse do?
A Administer the medication as prescribed and initiate a fall risk protocol.
B Ask for a PRN order for diphenhydramine (Benadryl) for the expected side effect of itching.
C Request an order for morphine instead of meperidine (Demerol).
D Suggest to the surgeon that the patient receive diazepam (Valium) to reduce anxiety and the need for narcotics.
An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient’s renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?
A Financial concerns
B Inability to open drug containers
C Increased tolerance to the drug’s effects
A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?
A “Alteration in hepatic function requires more frequent drug dosing.”
B “Changes in GI function in older adult patients lead to lower serum drug levels.”
C “Most adverse drug reactions in older adult patients are related to altered renal function.”
D “Most nonadherence among older adult patients is intentional.”
A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together are a reason for concern?
A Acetaminophen (Tylenol) and oxycodone
B Amitriptyline (Elavil) and diphenhydramine (Benadryl)
C Fexofenadine (Allegra) and an over-the-counter laxative
D Zolpidem (Ambien) and sertraline (Zoloft)
A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?
A Ask the patient if she has difficulty swallowing pills.
B Count the pills in the prescription bottle.
C Notify the provider to request more frequent dosing.D Request an order for renal function tests
A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)
A Creatinine clearance
B Gastric pH
C Plasma drug levels
D Serum albumin
A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone (Narcan) to reverse the effects of the morphine. The nurse understands that the naloxone works at the same receptor sites as the morphine to:
A block transmitter reuptake.
B inhibit transmitter release.
C interfere with transmitter storage.
D prevent activation of receptors.
A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about peripheral nervous system (PNS) drugs indicates a need for further teaching?
A “Drugs affecting axonal conduction have a variety of uses.”
B “Drugs that alter synaptic transmission can be highly selective.”
C “Many PNS drugs act by altering synaptic transmission.”“These drugs work by influencing receptor activity.”
A nurse is teaching a group of nurses about neuropharmacology. The nurse asks which classes of drugs act by reducing axonal conduction. Which response by a participant is correct?
C Local anesthetics
A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to:
A activate axonal conduction.
B enhance transmitter storage.
C increase receptor activation.D synthesize supertransmitters
A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered?
B Positive inotropic effects
C Prolonged receptor activation
A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by:
A inhibiting its release.
B interfering with its storage.
C preventing its reuptake.D promoting its synthesis.
A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what?
A nursing student asks about drugs that interfere with the termination of transmitter action. Which statement by the nurse is correct?
A “Drugs act on this process by altering the diffusion of the transmitter away from the synaptic gap.”
B “Drugs can interfere with termination by either increasing or decreasing reuptake of the transmitter.”
C “Drugs in this category lead to decreased activation by the transmitter in the synapse.”
D “These drugs reduce either reuptake or degradation of the transmitter, causing an increase in receptor activation.”
The nurse understands that patients are given beta1 agonists to treat _____ failure.
A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching?
A “The digestive functions of the body”
B “The cardiovascular system”
C “The fight-or-flight response”
D “Body temperature”
A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect?
D Urinary retention
A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching?
A “It activates three cholinergic receptor subtypes.”
B “It has effects in the parasympathetic, sympathetic, and somatic nervous systems.”
C “It is used at most junctions of the peripheral nervous system.”“Its transmission is terminated by reuptake into the cholinergic nerve terminal.”
A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see?
A Decreased sweating
C Increased cardiac output
D Pinpoint pupils
Many medications list side effects that include dry mouth, constipation, and urinary retention. What kind of effects are these?
A Alpha adrenergic
C Beta adrenergic
A nurse is explaining activation of beta2 receptors to some student nurses during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching?
A “Beta2 activation results in bronchodilation.”
B “Beta2 activation results in contraction of uterine muscle.”
C “Beta2 activation results in glycogenolysis.”
D “Beta2 activation results in vasodilation of skeletal muscles.”
A pregnant patient is in premature labor. Which class of drug will she be given?
A Alpha1 agonist
C Beta2 agonist
D Beta2 antagonist
A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse?
A Pulse oximetry reading of 88%
B Blood pressure of 100/60 mm Hg
C Respiratory rate of 28 breaths per minute
D Heart rate of 110 beats per minute
A prescriber has ordered pilocarpine (Pilocar). A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action?
A Reduce excessive secretions in a postoperative patient
B Lower intraocular pressure in patients with glaucoma
C Inhibit muscular activity in the bladderPrevent hypertensive crisis
A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication?
A Atropine (Sal-Tropine) IV
B Physostigmine (Antilirium)
C An acetylcholinesterase activator
D Pseudoephedrine (Ephedrine)
A Asthma as a child
B Gastroesophageal reflux
A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do if side effects occur. Which statement by the patient indicates the need for further teaching?
A “I can use sugar-free gum for dry mouth.”
B “I may need laxatives for constipation.”
C “I should keep the site covered to prevent other people from getting the medicine.”“I will take Benadryl for any itching caused by a local reaction to the patch.”
An older adult patient who lives alone and is somewhat forgetful has an overactive bladder and reports occasional constipation. Which treatment will the nurse anticipate for this patient?
A Behavioral therapy
B Oxybutynin (Ditropan XL) extended-release tablets
C Oxybutynin (Oxytrol) transdermal patch
D Percutaneous tibial nerve stimulation (PTNS)
A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening, has a heart rate of 96 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order:
A activated charcoal to minimize intestinal absorption of the antimuscarinic agent.
B an acetylcholinesterase inhibitor to compete with the antimuscarinic agent at receptors.
C an antipsychotic medication to treat the patient’s central nervous system symptoms.
D ipratropium bromide (Atrovent) to counter the respiratory effects of the antimuscarinic agent.
Bethanechol (Urecholine) is used to treat urinary retention but is being investigated for use in which other condition?
A Gastric ulcers
B Gastroesophageal reflux
D Intestinal obstruction
A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based on the nurse’s knowledge that muscarinic antagonists cause:
A elevation of intraocular pressure.
B miosis and ciliary muscle contraction
C paralysis of the iris sphincter.D relaxation of ciliary muscles
A nurse is caring for a patient who has myasthenia gravis. The prescriber has ordered neostigmine (Prostigmin). An important initial nursing action before administration of the medication includes assessing:
A the ability to raise the eyelids.
B level of fatigue.
C skeletal muscle strength.D swallowing ability.
A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority for treating this child?
A Administering diphenhydramine to control secretions
B Giving diazepam to control seizures
C Providing mechanical ventilation and oxygen
D Reporting the spill to the Environmental Protection Agency
A patient who has myasthenia gravis will be taking neostigmine (Prostigmin). What will the nurse emphasize when teaching this patient about the medication?
A “Stop taking the drug if you have diarrhea.”
B “Take a supplementary dose before exercise.”
C “Use atropine if you have excessive salivation.”
D “Withhold the dose if ptosis occurs.”
Two nurses are discussing the major differences between physostigmine (Antilirium) and neostigmine (Prostigmin). One nurse correctly makes which statement about physostigmine (Antilirium)?
A “It is not effective for treating poisoning by muscarinic blocking drugs.”
B “It can readily cross the blood-brain barrier.”
C “It does not cause any side effects.”
D “It can be given by all routes.”
A nurse is helping a nursing student who is administering a medication to a patient with myasthenia gravis. Which statement by the student indicates the need for further teaching?
A “I will ask the patient to sip some water before giving the medication.”
B “I will let the patient sleep after giving the medication, because rest is important.”
C “I will record muscle strength assessments before and after I give the medication.”“I will report excessive salivation to the patient’s prescriber.”
A patient with myasthenia gravis who is taking a cholinesterase inhibitor is being admitted to the intensive care unit and is on mechanical ventilation. The prescriber has ordered a challenge dose of edrophonium to distinguish between a myasthenic crisis and a medication overdose. The nurse will expect to do what?
A Administer neostigmine if muscle strength decreases.
B Be prepared to administer atropine if muscle weakness increases.
C Give a second dose of edrophonium if no improvement is seen.Give pralidoxime (Protopam) if cholinergic symptoms worsen
A nurse is teaching a new emergency department nurse about emergency medications. When asked to describe the uses of pralidoxime (Protopam), the new nurse makes which correct statement?
A “It exerts its greatest effects at muscarinic and ganglionic sites.”
B “It is used to treat poisoning by reversible cholinesterase inhibitors.”
C “It may not be effective if not given immediately.”
D “It reverses the effects of organophosphate insecticides in the central nervous system.”
A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer?
A Donepezil (Aricept)
B Edrophonium (Reversol)
C Neostigmine (Prostigmin)
A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors. Which statement by a student indicates understanding of the teaching?
A “Diazepam is given to reverse inhibition of cholinesterase when overdose occurs.”
B “Irreversible cholinesterase inhibitors are rapidly absorbed by all routes.”
C “These agents are often used to treat glaucoma.”
D “Toxic doses of these agents produce an anticholinergic crisis.”
A nurse is caring for an intubated patient who is receiving pancuronium for neuromuscular blockade. The patient’s eyes are closed, and the patient is not moving any extremities. The heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what?
A Request an order for an antihistamine to prevent a further drop in blood pressure.
B Request an order for serum electrolytes to evaluate for hyperkalemia.
C Review the patient’s chart for a history of myasthenia gravis (MG).
D Talk to the patient while giving care and explain all procedures.
While preparing a patient for a procedure in which a neuromuscular blocking agent will be used, the nurse reviews the patient’s preprocedure laboratory values. Which abnormality would cause the most concern?
C HypomagnesemiaD Hypokalemia
Which of the following areas of the body shows the effects of tubocurarine last?
A Levator muscle of the eyelids and the muscles of mastication
B Muscles in the lower extremities
C Muscles controlling the glottisD Muscles of respiration and the diaphragm
A patient will receive atracurium (Tracrium) during surgery for neuromuscular blockade. The nurse caring for this patient will correctly perform which of the following actions?
A Assess the patient for signs of CNS depression.
B Ensure that dantrolene is available in case of a serious adverse reaction.
C Monitor the patient’s blood pressure closely.D Review the preprocedure laboratory values related to renal and hepatic function.
While preparing a patient for a second esophageal dilation procedure, the nurse explains that succinylcholine (Anectine) will be used for muscle relaxation. The patient is anxious and reports not being able to swallow for several hours after the previous procedure. What will the nurse do?
A Be prepared to provide mechanical ventilation after the procedure.
B Have dantrolene available, because this patient is at increased risk for side effects.
C Reassure the patient that this is expected after neuromuscular blockade.D Request an order for a pseudocholinesterase level
A nurse is reviewing nursing actions for emergency treatment of malignant hyperthermia with a group of nursing students. Which statement by a student indicates a need for further teaching?
A “Analgesics should be given to help with muscle pain.”
B “Dantrolene helps to slow the metabolic activity in skeletal muscles.”
C “If malignant hyperthermia occurs, the succinylcholine must be stopped immediately.”
D “The patient may need an intravenous infusion of cold saline.”
A patient receives a neuromuscular blocking agent before a procedure. The patient’s eyes close. The nurse knows this is a sign that the patient:
A has fallen asleep.
B has received a toxic dose of the medication.
C is beginning to feel the drug’s effects.
D may need mechanical ventilation.
Small doses of tubocurarine are administered when patients are suspected of having a myasthenia gravis crisis. If the patient develops increased muscle weakness in response to the tubocurarine, the nurse should prepare to administer what kind of drug?
A Cholinesterase inhibitor
B Dopamine agonist
C Ganglionic blocker
D Neuromuscular blocking agent
A patient with hepatitis requires endotracheal intubation. Which agent does the nurse expect to be administered to facilitate this procedure?
B Cisatracurium (Nimbex)
C Rocuronium (Zemuron)
D Vecuronium (Norcuron)
A nurse is teaching a group of nursing students about neuromuscular blocking agents. For what may these agents be used? (Select all that apply.)
B Electroshock therapy
C Malignant hyperthermia
D Mechanical ventilation
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