Term
The nurse reads in the patient’s medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? |
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Definition
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Term
| Before beginning a patient’s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? |
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Definition
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Term
| When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? |
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Definition
Decreased paranoia and delusions
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Term
| A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? |
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Definition
Tremors and muscle twitching
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Term
| A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem?” Which advice from the nurse is correct? |
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Definition
“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
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Term
| A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? |
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Definition
The lithium level is therapeutic.
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Term
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? |
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Definition
“My mouth has been so dry lately.”
Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation |
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Term
| A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John’s wort. Which response by the nurse is appropriate? |
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Definition
“Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.”
The herbal product St. John’s wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate. |
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Term
While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? |
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Definition
Self-injury or suicidal tendencies
In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect. |
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Term
| A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? |
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Definition
Cardiac dysrhythmias
Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias. |
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Term
| The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started that new medicine for his depression, and there’s no change! What’s wrong with him?” What is the nurse’s best response? |
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Definition
“It may take up to 4 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. |
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Term
| Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? |
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Definition
The patient needs to wear sunscreen while outside because of photosensitivity
Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats. |
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Term
| The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching? |
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Definition
Salami and Swiss cheese sandwich
Aged cheeses, such a Swiss or cheddar cheese, and salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine. |
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Term
| A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? |
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Definition
Palpitations and anxiety
Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng. |
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Term
| The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? |
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Definition
Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. |
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Term
| Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) |
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Definition
Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. |
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Term
| A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of “feeling so badly” when he started taking an over-the-counter St. John’s wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) |
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Definition
Agitation
Tremors
Sweating
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Term
| A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct? |
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Definition
“These cravings may persist for several months.”
Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false. |
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Term
| A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment? |
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Definition
methadone
Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation. |
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Term
| A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next? |
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Definition
The somatropin dosage may be adjusted.
Somatropin is to be used with caution in acute or chronic illnesses, such as migraine headaches, epilepsy, and asthma. It will not have to be immediately discontinued but will require close monitoring. The patient’s growth will be measured and documented throughout therapy with somatropin. |
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Term
| When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? |
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Definition
Decreased urinary output
Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. |
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Term
| Which action is most appropriate regarding the nurse’s administration of a rapid-acting insulin to a hospitalized patient? |
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Definition
Give it within 15 minutes of mealtime.
Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient’s mealtime. |
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Term
| After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient’s adherence to the antidiabetic therapy over the past few months? |
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Definition
Hemoglobin A1C level
The hemoglobin A1C level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. |
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Term
| A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse’s next action? |
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Definition
Administer intravenous glucose (50% dextrose).
Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. |
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Term
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? |
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Definition
Only regular insulin can be administered intravenously.
Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes. |
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Term
A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? |
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Definition
The corticosteroids may cause an increase in glucose levels.
Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. |
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Term
| The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? |
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Definition
With the first bite of each main meal
When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented. |
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Term
| A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? |
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Definition
To decrease insulin resistance
Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. |
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Term
| When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? |
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Definition
Hold the drug, and check the order with the prescriber.
There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified. |
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Term
| The nurse is reviewing a patient’s medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? |
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Definition
insulin
Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin. |
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Term
| The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? |
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Definition
“Insulin therapy is possible during pregnancy if managed carefully.”
Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses. |
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Term
| The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? |
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Definition
“Basal dosing delivers a constant dose of insulin.”
Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented. |
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Term
| When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? |
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Definition
“Take the medication with food to reduce gastrointestinal (GI) effects.”
The GI adverse effects of metformin can be reduced by administering it with meals. |
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Term
| The insulin order reads, “Give 10 units of NPH insulin and 5 units of regular insulin, subcut, every morning before breakfast.” Choose the proper syringe for this injection. |
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Definition
The proper syringe for insulin injection is the insulin syringe, which is marked in units. The other syringes listed are not correct for use with insulin because they are not marked in units. |
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Term
| A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) |
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Definition
Hypoglycemia
Nausea
Weight gain |
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Term
The nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4).
Glargine insulin
Aspart insulin
Regular insulin
NPH insulin |
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Definition
| Aspart insulin, a rapid-acting insulin, has a duration of action of 3 to 5 hours; regular insulin, a short-acting insulin, has a duration of 6 to 10 hours; NPH insulin, an intermediate-acting insulin, has a duration of 10 to 18 hours; glargine insulin, a long-acting insulin, has a duration of 24 hours. |
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Term
| The nurse is administering adrenal drugs to a patient. Which action by the nurse is appropriate for this patient? |
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Definition
Rinsing the oral cavity after using corticosteroid inhalers
After the patient has used the corticosteroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs need be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they need to be discontinued by weaning, not abruptly. |
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Term
| A patient will be starting therapy with a corticosteroid. The nurse reviews the patient’s orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes? |
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Definition
Nonsteroidal antiinflammatory drugs
The use of corticosteroids with aspirin, other nonsteroidal antiinflammatory drugs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. |
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