NUR 311 Exam 4 Last Exam

Question 1

When is the best time for a patient to take levothyroxine?

Answer 1

Take on an empty stomach before breakfast, 1 hour before meals.

Question 2

How long does it take to achieve a therapeutic effect of levothyroxine (Synthroid)?

Answer 2

Several weeks (4-6 weeks)

Question 3

What are the signs of overdose of thyroid replacement hormone?

Answer 3

Tachycardia, chest pain, anxiety/nervousness

Question 4

Why should hypothyroidism be treated during pregnancy?

Answer 4

It can cause a decrease in IQ and decrease in neuropsychological function of the child.

Question 5

What are the clinical symptoms (physical assessment) of hypothyroidism?

Answer 5

Pale skin, goiter, constipation, brittle hair/hair loss, low body temperature, fatigue, expressionless face.

Question 6

How do levothyroxine (Synthroid) and warfarin (Coumadin) interact?

Answer 6

Levothyroxine sensitizes you to warfarin and increases bleeding (must reduce dose warfarin).

Question 7

What is a side effect of low-dose radioactive iodine when used to treat Grave’s disease?

Answer 7

Lifelong hypothyroidism

Question 8

When is the best time to take sumitriptan (Imitrex-serotonin-selective agonist) for the management of symptoms?

Answer 8

When the headache starts

Question 9

What are the signs of acute salicylates (aspirin) poisoning?

Answer 9

Hyperventilation (respiratory alkalosis progresses to respiratory acidosis, hypothermia). Also coma, dehydration, and electrolytes imbalance.

Question 10

Why is acetaminophen (Tylenol) not effective for the treatment of rheumatoid arthritis?

Answer 10

Because it only has a weak anti-inflammatory effect.

Question 11

Think of examples of physical conditions that would be appropriate for a nonsteroidal anti-inflammatory agent.

Answer 11

Ankle sprain, arthritis, rheumatoid arthritis, tendonitis, menstrual cramps.

Question 12

When should high-dose aspirin be discontinued prior to surgery?

Answer 12

7 to 14 days

Question 13

Which medication may cause Reye’s syndrome

Answer 13

Aspirin

Question 14

Understand early sign of salicylate toxicity (aspirin overdose)

Answer 14

Tinnitus (in MI patient), sweating, headache, dizziness.

Question 15

Acetaminophen (Tylenol) should not exceed what max daily dose?

Answer 15

4 grams

Question 16

What do COX-2 inhibitors do?

Answer 16

Decreases inflammation. Also relieves pain, reduces fever, and reduces risk of colorectal cancer.

Question 17

What is the reversal agent for morphine?

Answer 17

Narcan (Naloxone)

Question 18

What are constipation treatment options for someone on chronic morphine treatment?

Answer 18

Laxatives and stool softeners (Colace or Docusate)

Question 19

What are life threatening symptoms of opioid overdose?

Answer 19

Respiratory depression (slow, shallow breathing)

Question 20

What are the serious side effects of long-term opioid use?

Answer 20

Inflammatory Bowel Disease, Cardiovascular Complications, sleep-disordered breathing.

Question 21

What are considerations when converting a morphine dose from the intravenous to the oral route?

Answer 21

Doses are different. Greater doses in PO than IV.

Question 22

What are the risks of giving a mixed opioid agonist-antagonist with an opioid agonist?

Answer 22

Withdrawal or pain (acute pain and opioid withdrawal symptoms)

Question 23

What needs to be assessed prior to administering morphine?

Answer 23

Blood pressure, respiration rate, and pulse.

Question 24

What is the reversal agent for Tylenol toxicity?

Answer 24

Acetylcysteine

Question 25

What are symptoms of normeperidine toxicity?

Answer 25

Irritability, nervousness, tremors.

Question 26

What is the reversal agent for aspirin?

Answer 26

No reversal agent counteracts the anti-platelet effect (irreversible)

Question 27

What is the ideal way for someone to wean off anti-seizure medications?

Answer 27

Adjusted dose based on the patient's history and seizure record

Question 28

When is the best time to take trazodone (Desyrel)?

Answer 28

Within 30 minutes of bedtime.

Question 29

Which drugs are appropriate to treat inflammation?

Answer 29

NSAIDs (Aspirin, Ibuprofen, Naproxen)

Question 30

What are the contraindications for acetaminophen (Tylenol)?

Answer 30

Cirrhosis or heavy alcohol use

Question 31

A common drug ending for a Serotonin receptor agonist?

Answer 31

Triptan

Question 32

What labs must be monitored for Valproic Acid (Depakote)?

Answer 32

Liver enzymes for hepatotoxicity (CBC and liver function tests)

Question 33

What is a common, non-serious side effect of imipramine (Tofranil)?

Answer 33

Drowsiness (ends after a few weeks)

Question 34

How long will it take to achieve a therapeutic response from imipramine (Tofranil)?

Answer 34

3-6 weeks

Question 35

What is a common, non-serious side effect of tricyclic antidepressant that would most likely diminish over time?

Answer 35

Sedation

Question 36

Between bupropion (Wellbutrin) and serotonin selective reuptake inhibitors (SSRIs) which would have less adverse sexual side effects?

Answer 36

Wellbutrin because it doesn't cause erectile dysfunction. It works well for ED patients.

Question 37

What is the interaction between an SSRI, fluoxetine (Prozac) and St. John's Wort?

Answer 37

Do not take St. John's Wort with SSRI or Fluoxetine because it increases their effects.

Question 38

After symptoms are controlled, how long does one continue antidepressant medications?

Answer 38

At least 4-9 months

Question 39

What is the interaction of monoamine oxidase inhibitors (MAOIs) and foods containing tyramine?

Answer 39

Tyramine can reach dangerous levels causing a serious spike in blood pressure and requires emergency care.

Question 40

What are the anticholinergic effects associated with antidepressant agents?

Answer 40

urinary retention, dry mouth, constipation, blurry vision.

Question 41

What symptoms should a patient seek emergency care for when taking a monoamine oxidase inhibitor (antidepressant)?

Answer 41

Hypertensive crisis (chest pain, dizziness, headache)

Question 42

What is the general patient education regarding lithium and fluids and salt intake?

Answer 42

Drink fluids to prevent toxicity

Question 43

What drug counteracts benzodiazepine, chlordiazepoxide (Librium)?

Answer 43

Flumazenil (Romazicon)

Question 44

What are common contraindications for benzodiazepines?

Answer 44

Pregnancy, lactation, respiratory depression, obstructive sleep apnea.

Question 45

When is the best time to take trazodone (Desyrel)?

Answer 45

Take it for sleep within 30 minutes of bedtime.

Question 46

What are common side effects of benzodiazepine, diazepam (Valium)?

Answer 46

Drowsiness, dizziness, and confusion

Question 47

What is the effect of buspirone (Buspar), an anxiolytic, on the central nervous system?

Answer 47

Treats anxiety only. No sedation and does not enhance CNS depression.

Question 48

Drug endings to indicate a benzodiazepine?

Answer 48

- pam | - lam

Question 49

What side effects are classified as anticholinergic effects?

Answer 49

SLUD acronym: Decreased salivation (dry mouth), decrease lacrimation (blurry vision), urinary retention, and dry defecation (constipation)

Question 50

What antidepressant medication is contraindicated for those with a history of seizures?

Answer 50

Bupropion (Wellbutrin)

Question 51

What are signs of Steven Johnson Syndrome?

Answer 51

Blisters of mucous membranes of mouth, nose, eyes that leads to a red rash that spreads causing skin sloughing off and possible organ failure.

Question 52

What is an effect of Amitriptyline overdose?

Answer 52

Cardiotoxicity (Conduction disturbances, arrhythmia, hypotension)

Question 53

At what dose could a patient experience adverse side effects with TCA Amitriptyline overdose?

Answer 53

8x daily dose

Question 54

What are dietary considerations for those taking MAOI medication?

Answer 54

Avoid foods high in Tyramine (hot dogs, beer, wine, chocolate, caffeine, aged/fermented/pickled foods)

Question 55

What is the black box warning for SSRIs (antidepressants)?

Answer 55

Increased risk of suicidal thinking, feeling, and behavior in young people ages 15-24.

Question 56

What is general patient education for patients taking LAMOTRIGINE (LAMICTAL)?

Answer 56

Watch for Steven Johnson Syndrome (SJS): RASH

Question 57

What range of LITHIUM LEVELS indicates SEVERE TOXICITY?

Answer 57

1.5-2.0