NCLEX Flashcards
What are potential side effects of administering high doses of a cholinergic-blocking medication? Select all that apply.
- Disorientation
- Decreased heart rate
- Constriction of pupils
- Decreased gastric secretions
- Constriction of internal sphincter
Disorientation
Decreased gastric secretions
Constriction of internal sphincter
Higher doses of cholinergic-blocking agents may affect the central nervous system and cause disorientation. Cholinergic blockers decrease gastric secretions by acting on the receptors present in the stomach. Cholinergic blockers affect the genitourinary system and cause constriction of the internal sphincter. Cholinergic blockers cause dilation of pupils, not constriction. Cholinergic blockers do not cause decreased heart rate.
The patient is taking a beta blocker drug. The patient tells the nurse that she has been taking antacids frequently. The nurse recognizes that the interaction of the beta blocker and the antacid may have which result?
- Increased activity of the antacid
- Decreased activity of the antacid
- Increased activity of the beta blocker
- Decreased activity of the beta blocker
Decreased activity of the beta blocker
The interaction of beta blockers and antacids is known to result in decreased beta blocker activity. It will not result in increased activity of the antacid or beta blocker or decreased activity of the antacid.
Which drug is contraindicated in patients with chronic obstructive pulmonary disease (COPD)?
- Zaleplon
- Diazepam
- Ramelteon
- Pentobarbital
Ramelteon
Ramelteon is recommended for the treatment of insomnia. This drug is contraindicated for patients with COPD or sleep apnea. Zaleplon is a nonbenzodiazepine drug used for the treatment of insomnia. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Diazepam is a benzodiazepine drug used for the treatment of sleep disorders. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Pentobarbital is a barbiturate class of drug used as hypnotic, sedative, and anticonvulsant. It is contraindicated in patients with drug allergy, pregnancy, or severe kidney or liver disease.
The primary health care provider has prescribed glycopyrrolate to a patient. Before administration, the nurse assesses the patient’s history. What conditions would be contraindications for the administration of this medication? Select all that apply.
- Glaucoma
- Bradycardia
- Osteoarthritis
- Ulcerative colitis
- Gastroesophageal reflux disease
Glaucoma
Ulcerative colitis
Gastroesophageal reflux disease
Glycopyrrolate is an anticholinergic drug that is contraindicated in patients with glaucoma, ulcerative colitis, or gastroesophageal reflux disease, because it can worsen the symptoms of these diseases. Hence, to ensure drug safety, the nurse should determine whether the patient has these conditions before administering glycopyrrolate. Anticholinergic drugs are usually prescribed to patients with sinus bradycardia to increase the heart rate. Anticholinergic drugs do not interfere with the joint structure or function and can be safely prescribed to a patient with arthritis.
The patient has been placed on an adrenergic-blocking drug and complains to the nurse of experiencing constipation. The nurse recognizes that this is indicative of which type of drug effect?
- An anaphylactic reaction to the adrenergic-blocking drug
- An interaction with another medication that she has taken
- An expected adverse effect of the adrenergic-blocking drug
- A reaction to a toxic dosage of the adrenergic-blocking drug
An expected adverse effect of the adrenergic-blocking drug
Constipation is an expected, though adverse, reaction to the adrenergic-blocking drugs. Constipation does not indicate an anaphylactic reaction, a drug interaction, or a toxic dosage of the drug.
While completing an admission assessment, the nurse assesses that a patient recently diagnosed with hypertension experiences dizziness when standing. Which question is a priority for the nurse to ask the patient?
- “How much have you had to drink today?”
- “What medications are you currently taking?”
- “Do you have air conditioning in your home?”
- “Have you been to the sauna in the past 24 hours?”
“What medications are you currently taking?”
Adrenergic-blocking agents can be prescribed for hypertension and have side effects such as dizziness and syncope. Since the patient was recently diagnosed with hypertension, the patient has most likely been prescribed new medication, such as an adrenergic-blocking agent. Assuming the patient has been drinking alcohol is not the most important and relevant question at this point. If the patient has been prescribed an adrenergic-blocking medication, the sauna or excessive heat could exacerbate the symptoms of vasodilation. The nurse should first determine exactly what medications the patient is taking.
Which drug is the only muscle relaxant that acts directly on the skeletal muscle?
- Baclofen
- Diazepam
- Dantrolene
- Cyclobenzaprine
Dantrolene
Dantrolene works directly on the skeletal muscle by suppressing the release of calcium from the sarcoplasmic reticulum to ease contractions. The remaining medications are centrally acting muscle relaxants that work by means of central nervous system depression. Baclofen is considered to be a muscle relaxant that acts in the area of the central nervous system. Diazepam is a type of barbiturate. Cyclobenzaprine falls under the category of tricyclic antidepressants.
A patient is prescribed tolterodine. What should the nurse assess to determine the therapeutic effect of this medication?
- Increased heart rate
- Decreased urination
- Increased blood pressure
- Decreased bowel movements
Decreased urination
Tolterodine is administered to treat overactive bladder. Decreased urination is a therapeutic effect. Heart rate, blood pressure, and bowel movements are not measures of the therapeutic effect of tolterodine.
Which cholinergic medication is prescribed to a patient who is unable to void after surgery?
- Donepezil
- Cevimeline
- Bethanechol
- Succinylcholine
Bethanechol
Bethanechol is a direct-acting cholinergic drug that is used to treat atony of the bladder. It is the only direct-acting cholinergic drug that is administered orally. Donepezil, cevimeline, and succinylcholine are not used to treat atony of the bladder. Donepezil is an indirect-acting cholinergic drug that is used to treat Alzheimer’s disease. Cevimeline is a direct-acting cholinergic drug used in the treatment of xerostomia (dry mouth) due to Sjögren’s syndrome. Succinylcholine is used in general anesthesia as a neuromuscular blocker.
Which medication is used in the treatment of hypertension?
- Tegretol
- Tapazole
- Topamax
- Toprol-XL
Toprol-XL
The Food and Drug Administration has reported errors in prescribing and dispensing involving a mix-up between Topamax, which is indicated for the treatment of epilepsy and prophylaxis of migraines, and Toprol-XL, which is used for the treatment of hypertension and heart failure, as well as the long-term treatment of angina pectoris. Other errors have occurred when Toprol-XL and Tegretol, a drug used for various types of seizures and trigeminal neuralgia, have been confused. Tapazole is used to treat hyperthyroidism.
During a cardiopulmonary resuscitation emergency, the nurse expects to administer which injectable, fast-acting medication?
- Salmeterol
- Epinephrine
- Naphazoline
- Oxymetazoline
Epinephrine
Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. Salmeterol is given via the respiratory tract because of its affinity for beta2 receptors that act on the lungs.
The nurse is teaching a group of nursing students about the stages of non–rapid eye movement (non-REM) sleep. Which is the third stage of sleep?
- Dozing
- Relaxation
- Deep sleep
- Sleepwalking
Deep sleep
Deep sleep is the third stage of sleep. The person finds it difficult to wake, and the respiratory rate, pulse rate, and blood pressure may decrease. Dozing is the first stage of sleep. The person has feelings of drifting off to sleep. Relaxation is the second stage of sleep. The person can easily be awakened. In the fourth stage of sleep, it is very difficult to wake the person up, and sleepwalking may occur during this stage.
What is the objective of administering phenylephrine as an adjunct to local anesthesia?
- Bradycardia
- Tachycardia
- Vasodilation
- Vasoconstriction
Vasoconstriction
Phenylephrine is an alpha1 agonist that is administered to produce vasoconstriction in regional anesthesia in order to slow absorption and prolong the effects of the anesthesia. It is not given for its effects on heart rate.
A patient reports unusual sleep patterns and lack of sleep. What is the best nonpharmacologic patient teaching the nurse can provide to reset the patient’s internal clock?
- Avoiding alcohol at bedtime
- Avoiding tobacco at bedtime
- Sleeping more during the day
- Establishing a set sleep pattern
Establishing a set sleep pattern
Establishing a set sleep pattern with a time to go to bed at night and a regular time to get up in the morning helps reset the internal clock. Consuming alcohol results in fragmented sleep. Using tobacco at bedtime disturbs the sleep pattern. Too much sleep may lead to fragmented sleep patterns and shallow sleep.
The patient is currently taking carvedilol. The patient tells the nurse, “Can you double-check the dosage of my medication for me? The doctor has doubled the dose of my medication, and this must be a mistake.” The nurse frames the response to the patient based on which knowledge?
- The dose of the drug can be increased in increments weekly as tolerated.
- The dose of the drug should never be changed from the initial starting dose.
- The dose of the drug can be doubled every 2 weeks to the highest dose tolerated.
- The dose of the drug can be changed slightly from the starting dose, but very seldom.
The dose of the drug can be doubled every 2 weeks to the highest dose tolerated.
The dose of the medication can be doubled every 2 weeks until the highest tolerated dose is reached for a maximum of 50 mg/day. This can be increased to 100 mg/day if the patient has heart failure and weighs over 85 kg.
The patient has been ordered two drugs of the same class to be used for treatment of asthma. The patient asks the nurse, “Why do I have to use more than one medication to treat this? Isn’t one enough?” What is the nurse’s most appropriate response?
- “You need to ask your health care provider questions like that.”
- “I will arrange for the pharmacist to do a presentation for you.”
- “No, in this case, one drug is not enough to do what’s needed for you.”
- “Sometimes use of more than one drug will give a combined therapeutic effect.”
“Sometimes use of more than one drug will give a combined therapeutic effect.”
Although the patient can gain information from both the health care provider and the pharmacist, the nurse should explain that a better therapeutic response can be gained from use of more than one drug.
Which drug is used as an antidote for overdose of oral benzodiazepine or excessive intravenous sedation?
- Flumazenil
- Olanzapine
- Furosemide
- Activated charcoal
Flumazenil
An antidote is a medication given to reduce the symptoms of drug overdose or toxicity. Flumazenil slightly reverses the adverse effects of benzodiazepines. Olanzapine may interact with benzodiazepines when administered simultaneously. However, olanzapine is not an antidote for benzodiazepines. Furosemide is commonly used to eliminate barbiturates by promoting diuresis. Activated charcoal is administered for an overdose of barbiturates. It prevents liver damage by quickly eliminating the barbiturates from the body.
What are the uses of cholinesterase inhibitors? Select all that apply.
- To diagnose and treat myasthenia gravis
- To be used as an antidote in biochemical warfare
- To relieve severe constriction of the bronchioles
- To be used as an antidote to tricyclic antidepressant toxicity
- To treat a patient with a prolonged history of sleep deprivation
To diagnose and treat myasthenia gravis
To be used as an antidote in biochemical warfare
To be used as an antidote to tricyclic antidepressant toxicity
When used therapeutically, cholinesterase inhibitors, such as physostigmine, affect the muscarinic receptors and nicotinic receptors of the neuromuscular junction, thereby helping restore acetylcholine to the level needed for nerve impulse transmission. Because patients with myasthenia gravis lack sufficient release of acetylcholine at the neuromuscular junction, administration of physostigmine helps improve muscle strength by decreasing the destruction of acetylcholine. Due to its capacity to restore the acetylcholine level, this medication is useful as an antidote to biochemical warfare involving anticholinergic agents, as well as in tricyclic antidepressant toxicity. Physostigmine therapy is contraindicated in patients with insomnia or bronchoconstriction.
Which medication is a noncholinergic drug used in the treatment of Alzheimer’s disease?
- Atropine
- Memantine
- Donepezil
- Rivastigmine
Memantine
Memantine is a noncholinergic drug that is used in the treatment of Alzheimer’s disease. It helps by blocking the stimulation of the N-methyl-D-aspartate receptors. Atropine, donepezil, and rivastigmine are all cholinergic drugs. Atropine is a competitive antagonist to the acetylcholine receptor; it is used as the treatment for cholinergic overdose. Donepezil is usually prescribed for Alzheimer’s patients. It inhibits acetylcholinesterase and increases the levels of acetylcholine. Rivastigmine is also a cholinesterase inhibitor that causes an increase in acetylcholine levels.
A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen to help manage muscle spasticity. How will the baclofen interfere with the patient’s rehabilitation activities?
- By causing gastrointestinal distress
- By impairing coordinated movements
- By increasing pain associated with activities
- By producing drowsiness, lethargy, and blurred vision
By producing drowsiness, lethargy, and blurred vision
Baclofen falls under the barbiturates category, and drowsiness, lethargy, and blurred vision are adverse effects of baclofen, which will make it difficult for this patient to participate actively in rehabilitation activities. Gastrointestinal distress is one of the adverse effects of niacin, which is an antilipemic drug. Another adverse effect of antilipemic drugs is increased muscle pain associated with activity. Impaired physical mobility is an adverse effect related to antiemetic and antinausea drugs.
Which are contraindications for administration of cholinergic-blocking medications? Select all that apply.
- Renal failure
- Peptic ulcers
- Down syndrome
- Bronchial asthma
- Recent heart surgery
Renal failure
Down syndrome
Recent heart surgery
Cholinergic-blocking medications are contraindicated in patients with renal failure, Down syndrome, or recent heart surgery. They may increase urinary retention and may further worsen renal failure. Cholinergic-blocking drugs act on the muscarinic receptors and cause delusions and decreased muscle rigidity. This may further worsen the symptoms of Down syndrome. In patients with a recent heart surgery, anticholinergics alter the heart rate, which in turn increases the workload on the heart. Anticholinergics are beneficial for patients with peptic ulcers and bronchial asthma, because they decrease the gastric secretions and dilate the bronchioles.
Why is diazepam used for the treatment and prevention of alcohol withdrawal symptoms?
- Because of its amnesic properties
- Because of its inhibition of nerve impulse transmission
- Because of its suppression of gamma-aminobutyric acid (GABA) receptors
- Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction
Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction
Benzodiazepine receptors in the central nervous system (CNS) are present in the same area as the receptors responsible for alcohol addiction. Diazepam blocks the receptors responsible for alcohol addiction and helps treat and prevent alcohol withdrawal symptoms. Benzodiazepines, not diazepam, have amnesic properties that are used for moderate sedation. Barbiturates such as pentobarbital inhibit the transmission of nerve impulses. Diazepam does not to inhibit nerve impulse transmission. Benzodiazepines, not diazepam, suppress the activity of GABA receptors to facilitate sleep during the treatment of insomnia.
The nurse recognizes that which condition is an indication for the use of norepinephrine?
- Asthma
- Anaphylaxis
- Hypertension
- Cardiogenic shock
Cardiogenic shock
Norepinephrine is directly metabolized to dopamine and is used primarily in the treatment of hypotension and shock. The beta2 agonists are helpful in treating conditions such as asthma. Hypertension is a contraindication to the use of norepinephrine. Epinephrine is used in the treatment of anaphylaxis.
Which assessment finding should the nurse interpret as a therapeutic effect of atropine?
- Lethargy
- Hypertension
- Increased heart rate
- Constriction of pupils
Increased heart rate
Atropine, a muscarinic antagonist, works primarily on the heart, exocrine glands, smooth muscle, and eyes; it produces an increased heart rate. Atropine is likely to cause mydriasis. Lethargy is not a therapeutic effect of atropine. Because there is no parasympathetic innervation to muscarinic receptors in blood vessels, atropine has no effect on vascular smooth muscle tone and therefore no effect on blood pressure.