Week 3 Sherpath Flashcards by Monica Galvan-Valencia

Centrally-acting muscle relaxants relieve muscle spasms and pain through which mechanism?

Increase neuron activity in the spinal cord or brain, or decrease neuronal inhibition on the skeletal muscles.

Sedate the patient so the spasms and spasticity are decreased.

Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles.

Increase the hyperactive reflex which blocks the spasms and spasticity.

Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles.

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Cyclobenzaprine exerts an effect within which time span?

30 minutes

1 hour

2 hours

6 to 8 hours

1 hour

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Cyclobenzaprine may aid in the relief of muscle spasm for which duration?

1 to 2 hours

3 to 8 hours

12 to 24 hours

36 to 48 hours

12 to 24 hours

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The nurse plans to provide patient teaching to Ms. Wilson regarding cyclobenzaprine. Which information would the nurse share with Ms. Wilson?

Avoid concomitant use with alcohol and other central nervous system (CNS) depressants.

Take cyclobenzaprine every 8 hours around the clock.

Take cyclobenzaprine every morning before driving to work to increase range of motion in her cervical spine.

Take cyclobenzaprine on an empty stomach.

Avoid concomitant use with alcohol and other central nervous system (CNS) depressants.

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Which statement made by Ms. Wilson regarding cyclobenzaprine indicates further teaching is required by the nurse?

“I should avoid taking the cyclobenzaprine and ibuprofen together.”

“I can take this medication as long as I want.”

“I should take this medication with food.”

“I need to taper this medication if I want to stop taking it.”

“I can take this medication as long as I want.”

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Which common side effects are associated with centrally-acting muscle relaxants?

Select all that apply.

Dizziness

Drowsiness

Bradycardia

Hypertension

Dyspnea

Polydipsia

Dizziness

Drowsiness

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Which products, if taken concurrently with midazolam, could result in drug interactions?

Select all that apply.

Kava kava

Erythromycin

Zolpidem

Penicillin

Fish oil

Atropine

Kava kava

Erythromycin

Zolpidem

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The nurse would withhold the prescribed midazolam for the patient reporting which condition?

Peripheral vascular disease

Muscle spasms

Acute low back pain

Hepatitis B

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The nurse would monitor which laboratory values for a patient taking cyclobenzaprine?

Liver function tests

Creatine kinase

Serum amylase and lipase

Arterial blood gases

Liver function tests

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The nurse understands that excretion of cyclobenzaprine occurs via which organ system?

Kidneys

Liver

Lungs

Skin

Kidneys

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Which nursing assessments are important for a patient prescribed cyclobenzaprine?

Select all that apply.

Level of consciousness

Breathing

Blood pressure

Blood glucose

Vision checks

Level of consciousness

Breathing

Blood pressure

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Which method would the nurse use to administer cyclobenzaprine to facilitate the greatest amount of absorption?

Administer with grapefruit juice

Administer with a full meal

Administer on an empty stomach

Administer intravenously

Administer on an empty stomach

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Use of muscle relaxants is contraindicated in patients with which condition?

Brain tumor

Diabetes

Acromegaly

Hepatic disease

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A patient who has been taking 5 mg of oral cyclobenzaprine PO tid for 6 weeks asks for a renewal of the prescription. Which information is of concern to the nurse?

Length of time patient has been on medication

Frequency that the medication is prescribed

Dose of the medication that is prescribed

Route that current medication is prescribed

Length of time patient has been on medication

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The nurse educates a patient to avoid which drugs while taking muscle relaxants?

Select all that apply.

Alcohol

Ibuprofen

Over-the-counter vitamins

Kava kava

Valerian

Alcohol

Kava kava

Valerian

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Which side effects of muscle relaxants would the nurse educate a patient about?

Select all that apply.

Coughing

Headache

Nausea

Tinnitus

Amber urine

Muscle weakness

Headache

Nausea

Muscle weakness

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Which instruction would the nurse provide a patient taking cyclobenzaprine to avoid dizziness and fainting?

Select all that apply.

Stand slowly from a sitting position

Take medication without food

Check blood glucose levels

Maintain adequate hydration

Stop the medication immediately

Stand slowly from a sitting position

Maintain adequate hydration

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A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. The nurse would recommend which beverage to help alleviate these symptoms?

Water

Lemonade

Milk

Tea

Milk

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A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be appropriate to include in the teaching?

“Notify your health care provider if you think you might be pregnant.”

“Finish the entire prescription, even if you feel better.”

“You may drive 4 hours after you take the medication.”

“You may take a sleeping pill, if needed, but only if you have 8 hours to sleep.”

“Notify your health care provider if you think you might be pregnant.”

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the nurse will teach the patient that cyclobenzaprine can relieve which symptoms?

Select all that apply.

Muscle stiffness

Muscle paralysis

Localized muscle spasms

Pain with range of motion

Spasticity caused by myasthenia gravis

Muscle stiffness

Localized muscle spasms

Pain with range of motion

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For which reason should a patient taking cyclobenzaprine report adverse effects to the health care provider?

To prevent respiratory depression

To decrease prescribed dose

To increase prescribed dose

To prevent hypertension

To prevent respiratory depression

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The nurse teaches a patient that a muscle relaxant should not be abruptly stopped based on which rationale?

To avoid rebound spasms

To prevent heart palpitations

To decrease chances of depression associated with chronic pain

To prevent permanent nerve damage

To avoid rebound spasms

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A patient has been prescribed a skeletal muscle relaxant and asks the nurse, “Why was I told not to drive or participate in activities that require mental alertness while taking this drug?” Which response by the nurse is appropriate?

“Sedation is a common side effect of skeletal muscle relaxants.”

“A decrease in peripheral vision is a side effect of skeletal muscle relaxants.”

“A decrease in muscle tone is a side effect of skeletal muscle relaxants.”

“Short-term memory loss is a side effect of skeletal muscle relaxants.”

“Sedation is a common side effect of skeletal muscle relaxants.”

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A patient who has received an intravenous (IV) dose of midazolam will be switched to oral (PO) formulation. Which adjustment in dosing does the nurse anticipate?

Lower PO dose

Higher PO dose

No adjustment in dose

This medication cannot be given PO

Higher PO dose

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Which medication would the nurse instruct an otherwise healthy patient to avoid while taking midazolam? Morphine Loratadine Acetaminophen Aspirin

Morphine

The nurse administered midazolam intravenously. Which assessment, if noted by the nurse, would require immediate intervention? Confusion Nausea Blurred vision Cough

Cough

Which assessment finding would require the nurse to hold the prescribed midazolam? Heart rate 110 beats/minute Respiratory rate 26/minute Oxygen saturation 93% Blood pressure 90/60 mm Hg

Blood pressure 90/60 mm Hg

Which nursing assessments, if applicable, must be completed before the administration of midazolam? Select all that apply. Allergy history Medication history Auscultation of lung sounds Blood pressure Pregnancy test

Allergy history Medication history Blood pressure Pregnancy test

Through which mechanism of action do antiseizure drugs work? They decrease the inhibitory neurotransmitter system in the brain called the gamma-aminobutyric acid (GABA) system. They increase calcium influx in the brain, causing a decrease in electrical current flow. They stabilize nerve cell membranes and suppress the abnormal electrical impulses in the cerebral cortex. They bind to opioid receptors, and molecular signaling activates the receptors to mediate certain actions.

They stabilize nerve cell membranes and suppress the abnormal electrical impulses in the cerebral cortex.

Through which action does phenytoin exert its effects? By eliminating the underlying causes of seizure disorders By increasing the action of gamma-aminobutyric acid (GABA), which inhibits neurotransmitters throughout the brain By suppressing sodium influx and prolonging the channel inactivation to prevent neuron firing By suppressing the calcium influx to prevent the electric current generated by the calcium ions to the T-type calcium channel

By suppressing sodium influx and prolonging the channel inactivation to prevent neuron firing

Through which mechanisms can antiseizure drugs decrease seizure activities? Select all that apply. Diminishing calcium influx Suppressing sodium influx Increasing sodium channel activation Increasing the action of gamma-aminobutyric acid (GABA) Increasing the calcium ion current through the T-type channel

Diminishing calcium influx Suppressing sodium influx Increasing the action of gamma-aminobutyric acid (GABA)

After Mr. Briggs recovers from the postictal state, the nurse provides phenytoin education. Which statement indicates Mr. Briggs understands the phenytoin education? Select all that apply. “I need to avoid drinking alcohol.” “I will need to check in frequently with my health care provider to have my blood levels - monitored.” “I will try to improve my oral hygiene so my gums don’t bleed.” “I can take this medication whenever I have a seizure.” “I am going to receive this medication via a shot in my muscle.”

“I need to avoid drinking alcohol.” “I will need to check in frequently with my health care provider to have my blood levels - monitored.” “I will try to improve my oral hygiene so my gums don’t bleed.”

The nurse understands that phenytoin should be used with caution in patients with which comorbid conditions? Select all that apply. Hirsutism Gingival hyperplasia Porphyria Hypothyroidism Cardiac disease

Porphyria Hypothyroidism Cardiac disease

Which patient laboratory values will the nurse review before initiating therapy with phenytoin? Select all that apply. Arterial blood gases Serum electrolytes Liver function tests (LFTs) Blood urea nitrogen (BUN) and serum creatinine Complete blood count (CBC)

Liver function tests (LFTs) Blood urea nitrogen (BUN) and serum creatinine Complete blood count (CBC)

Which substances interact with phenytoin to cause increased central nervous system (CNS) depression? Select all that apply. Alcohol Evening primrose Cimetidine Oral contraceptive drugs Calcium-containing antacids

Alcohol Cimetidine

A patient asks the nurse about ways to prevent gingival symptoms while taking phenytoin. Which activity will the nurse recommend? Use a soft-bristled toothbrush. Floss the teeth three times daily. Brush the teeth and gums vigorously. Use toothpicks to clean under the gums.

Use a soft-bristled toothbrush.

A patient with complex partial seizures is prescribed phenytoin to control recurrent seizures, but the patient reports being reluctant to take the drug long term because of its side effects. Which information would the nurse provide this patient? “Tolerance to most phenytoin side effects will develop over time.” “Ask your health care provider about reducing your phenytoin dosage to minimize side effects.” “Ask your health care provider about stopping your phenytoin if the side effects become troublesome.” “Ask your health care provider about the possibility of using a different class of antiseizure medication.”

“Ask your health care provider about the possibility of using a different class of antiseizure medication.”

The nurse is caring for a patient who is experiencing excessive drowsiness caused by phenytoin. The health care provider withholds the drug and prescribes a serum drug level test. For which length of time will the nurse monitor the patient for drowsiness? 30 to 60 minutes 12 hours 24 to 42 hours 10 days

24 to 42 hours

Which condition is most likely to require lower dosing and closer monitoring to prevent drug toxicity in a patient taking phenytoin? Hepatitis Pneumonia Anemia Gastroesophageal reflux

Hepatitis

A patient who has a seizure disorder has begun taking phenytoin. To ensure effectiveness of the drug, which laboratory value will the nurse monitor? Serum drug levels Liver function tests Renal function tests Complete blood count (CBC)

Serum drug levels

The nurse is performing an admission assessment on a patient who will receive intravenous phenytoin. The patient reports a history of a “slow heart rate.” Which action by the nurse is appropriate? Administer the medication as prescribed. Request an electrocardiogram (ECG). Count the apical pulse for 1 minute before giving the drug. Request an oral form of the drug to minimize cardiovascular side effects.

Request an electrocardiogram (ECG).

A patient prescribed phenytoin reports using over-the-counter medications to treat acid reflux. Which response by the nurse is correct? “You should take a lower dose of phenytoin while using antacids.” “Use an antacid that does not contain calcium.” “Stop taking the phenytoin immediately if increased acid reflux occurs.” “This combination may lead to increased central nervous system depression.”

“Use an antacid that does not contain calcium.”

A patient who has type 2 diabetes mellitus (DM) will begin taking phenytoin to treat seizures. Which ongoing assessment will the nurse complete on this patient? Close monitoring of serum glucose Close monitoring for adverse central nervous system (CNS) effects More frequent assessment of oxygen saturation levels Monitor for subtherapeutic serum drug levels

Close monitoring of serum glucose

The nurse is preparing to administer a dose of intravenous phenytoin to a patient and notes that the patient’s serum phenytoin level is 25 mcg/mL. Which action would the nurse take? Request a prescription for oral phenytoin. Hold the dose and notify the health care provider. Give the dose and observe closely for central nervous system (CNS) side effects. Notify the health care provider to discuss increasing the phenytoin dose.

Hold the dose and notify the health care provider.

At the beginning of a shift, the nurse assesses a 65-year-old patient who is receiving intravenous (IV) phenytoin and notes that the pump is programmed to deliver 50 mg/minute. Which action would the nurse take? Select all that apply. Stop the IV. Notify the health care provider. Increase the rate to 60 mg/minute. Request a prescription for an antihypertensive drug. Assess the patient’s blood pressure and heart rate.

Stop the IV. Notify the health care provider. Assess the patient’s blood pressure and heart rate.

An older adult patient who weighs 70 kg is in status epilepticus. Which dose is an appropriate loading dose of phenytoin for this patient? 700 mg 467 mg 4900 mg 1400 mg

1400 mg

A patient who has been taking phenytoin for several years reports stopping the drug the day before admission to the hospital. Which condition is most important for the nurse to monitor for in this patient? Fever or bruising Status epilepticus Ataxia and nystagmus Increased serum glucose

Status epilepticus

A patient who is taking oral phenytoin reports experiencing heartburn and gastrointestinal (GI) upset. Which recommendation will the nurse provide to the patient? Take the medication with food. Take with a calcium-containing antacid. Take the medication on an empty stomach. Stop taking the medication and notify the health care provider.

Take the medication with food.

A patient calls the clinic 1 week after beginning therapy with phenytoin to report urine that is pinkish red. How would the nurse respond? Have the patient come to the clinic for a dipstick urinalysis. Reassure the patient that this is a harmless side effect of phenytoin. Contact the health care provider and request a prescription for a blood urea nitrogen (BUN) and creatinine. Tell the patient to stop the drug immediately and contact the health care provider.

Reassure the patient that this is a harmless side effect of phenytoin.

The nurse would teach a patient with diabetes who is taking phenytoin to monitor for which condition? Hypoglycemia Hyperglycemia Increased drug effects Decreased drug effects

Hyperglycemia

The nurse is teaching a patient about the administration of phenytoin and instructs the patient to perform which action in case of a rash? “Contact your health care provider immediately.” “Apply a topical corticosteroid to the rash.” “Take diphenhydramine to minimize itching.” “Contact the health care provider to discuss an antibiotic.”

“Contact your health care provider immediately.”

A nurse would instruct patients taking phenytoin to report which side effects? Select all that apply. Fever Gastrointestinal (GI) upset Dizziness Bleeding gums Reddish-brown urine

Fever Dizziness Bleeding gums

Which statement explains the action of carbidopa-levodopa? Carbidopa decreases symptoms of parkinsonism. Carbidopa inhibits the breakdown of dopamine at the synapses in the brain. Carbidopa inhibits the catechol-o-methyltransferase (COMT) enzyme, increasing the concentration of levodopa. Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain.

Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain.

Through which route is carbidopa-levodopa excreted? Liver Urine Bile Saliva

Urine

Match the class of drugs used to treat Parkinson’s disease with its mechanism of action. Affect dopamine content of the brain Stimulate dopamine receptors of nerve cells in the brain Inhibit activity of acetylcholine Inhibit activity of monoamine oxidase (MAO) Answer choices Anticholinergics MAO-B inhibitors Dopamine agonists Dopaminergics COMT inhibitors

Affect dopamine content of the brain Dopaminergics Stimulate dopamine receptors of nerve cells in the brain Dopamine agonists Inhibit activity of acetylcholine Anticholinergics Inhibit activity of monoamine oxidase (MAO) MAO-B inhibitors

Which statement correctly explains the action of rivastigmine? Interferes with the breakdown of dopamine Breaks down acetylcholine in the neuron receptors Increases availability of acetylcholine in the neuron receptors Reverses clinical manifestations of Alzheimer’s disease

Increases availability of acetylcholine in the neuron receptors

Which route of administration for rivastigmine results in a peak concentration between 8 and 16 hours? Oral Intravenous Transdermal Subcutaneous

Transdermal

Which side effects would the nurse teach Mrs. Hill to expect while taking rivastigmine? Select all that apply. Nausea Diarrhea Anorexia Headache Tachycardia Hypertension

Nausea Diarrhea Anorexia Headache

Which information related to rivastigmine would the nurse provide Mrs. Hill? “Weight gain can occur.” “Avoid grapefruit products.” “Take ibuprofen 30 minutes before a meal to prevent GI upset.” “Rise slowly from sitting or lying positions, because orthostatic hypotension can occur.”

“Rise slowly from sitting or lying positions, because orthostatic hypotension can occur.”

Which baseline laboratory tests would be obtained for a female patient who has been prescribed carbidopa-levodopa? Select all that apply. Complete blood count (CBC) Liver function tests (LFTs) Serum electrolytes Kidney profile Prolactin level Pregnancy test

Complete blood count (CBC) Liver function tests (LFTs) Prolactin level Pregnancy test

Which adverse effect of carbidopa-levodopa would the nurse teach the patient and family to report to the health care provider? Gastrointestinal (GI) upset Seizures Dyskinesia Elevated temperature

Dyskinesia

Which instructions would the nurse include in patient teaching for a patient taking extended-release carbidopa-levodopa? Select all that apply. “Report tremors to your health care provider.” “Do not abruptly stop taking this medication.” “You may continue to have symptoms for several weeks or months “ “If this medication causes gastrointestinal upset, you can crush the tablets and mix them with food.” “You may experience discolored urine or dark perspiration while taking this medication.”

“Do not abruptly stop taking this medication.” “You may continue to have symptoms for several weeks or months “ “You may experience discolored urine or dark perspiration while taking this medication.”

Which phrase describes a correct therapeutic goal for treatment of Parkinson’s disease? Cure Parkinson’s disease Delay the progression of Parkinson’s disease Improve the patient’s ability to carry out activities of daily living Return the patient’s ability to carry out activities of daily living to baseline

Improve the patient’s ability to carry out activities of daily living

Which statement about carbidopa-levodopa is accurate? Carbidopa-levodopa should not be taken with food. Carbidopa-levodopa should not be stopped abruptly. High-protein foods should be consumed with every meal. A decrease in the symptoms of Parkinson’s disease occurs within a week of starting medication treatment.

Carbidopa-levodopa should not be stopped abruptly.

Which statement about the mechanism of action of carbidopa is accurate? Carbidopa has no therapeutic effect on its own. Carbidopa works by crossing the blood-brain barrier. Carbidopa aids in the breakdown of levodopa in the peripheral tissues. Because of periphery loss of the medication, only 2% of carbidopa taken is available to the brain.

Carbidopa has no therapeutic effect on its own.

A nurse administers oral carbidopa-levodopa to a patient who has tremors caused by Parkinson’s disease. The nurse would expect to see the medication effect in which time frame? 1 hour 3 hours 5 hours 8 hours

5 hours

Which statement is accurate about the pharmacodynamics of topical rivastigmine? The patch should be applied three times daily. Peak action is 24 hours. Onset of action is 2 to 4 hours. Onset of action is 0.5 to 1 hour.

Onset of action is 0.5 to 1 hour.

Which description of the therapeutic effect of rivastigmine is accurate? Improves memory Restores damaged neurons Improves oxygenation in the brain Increases antioxidants in the brain

Improves memory

Rivastigmine must be used with caution in patients with which condition? Diabetes mellitus Peripheral vascular disease Asthma Hypothyroidism

Asthma

A nurse is evaluating the effectiveness of a patient’s drug regimen for Alzheimer’s disease. Which assessment finding by the nurse would indicate that the drug is effective? Absence of dizziness Decrease in blood pressure from baseline Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at baseline Improvement in mental status

improvement in mental status

A patient has been taking carbidopa-levodopa for many years. During assessment, the nurse finds that the patient presents with hand tremors, drooling, and a mask-like facial expression. Which action would the nurse anticipate incorporating into the plan of care? Increase in medication dosage Decrease in medication dosage Discontinuation of the medication Discussion of medication adherence

Increase in medication dosage

Which foods would the nurse instruct a patient who is taking selegiline to avoid? Select all that apply. Honey, beer, and apples Boiled peanuts and hot dogs Grapefruit juice and tomatoes Aged cheeses Red wine Bananas

Aged cheeses Red wine Bananas

The nurse is providing education to a patient taking carbidopa-levodopa. Which statement by the nurse correctly explains why the patient should take this medication with low-protein foods? "A high-protein diet will increase renal excretion of carbidopa-levodopa." "Low-protein foods accelerate the transportation of this medication to the central nervous system." "A low-protein diet will help prevent gastrointestinal distress from the medication." "High-protein foods interfere with transportation of this medication to the central nervous system."

"High-protein foods interfere with transportation of this medication to the central nervous system."

A patient taking an antihypertensive drug and carbidopa-levodopa tells the nurse that he or she is applying for a job that involves operating heavy machinery. Which information would the nurse share with the patient? "Perform exercises for lumbar support while sitting." "Your tremors will stop, so you will be able to operate machinery.” "These medications stimulate your central nervous system, so you will be able to operate heavy machinery." "These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery."

"These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery."

Which instruction is most important for the nurse to include when teaching a patient who has been prescribed sustained-released carbidopa-levodopa? "Take this medication with food." "Take this medication with low-protein foods." "Watch for adverse effects like dizziness and drowsiness." "Inform the health care provider if your symptoms do not improve."

"Watch for adverse effects like dizziness and drowsiness."

Which statement related to carbidopa-levodopa and symptoms of dyskinesia would the nurse include in patient teaching? "Your dyskinesia will be cured by this medication." "Your dyskinesia will worsen with this medication." "It will take 3 to 5 days for your symptoms to be controlled." "It may take weeks or months before your symptoms are controlled."

"It may take weeks or months before your symptoms are controlled."

The nurse is preparing to administer rivastigmine to a patient. The prescription states to administer 8 mg b.i.d. The pharmacy sends four 2-mg tablets for the morning dose. Which action would the nurse take? Administer the medication. Call the pharmacy to ask for one 8-mg tablet. Call the health care provider for a prescription change. Ask a family member what dosage the patient takes at home.

Call the health care provider for a prescription change.

Which effect may occur when theophylline and rivastigmine are administered together? Increased potassium levels Decreased blood glucose levels Increased risk for theophylline toxicity Increased risk for rivastigmine toxicity

Increased risk for theophylline toxicity

Which factor in a patient’s health history is most important for the nurse to consider with regard to treatment for Alzheimer’s disease using rivastigmine? Acid reflux Liver disease Prostate cancer Basal cell carcinoma

Liver disease

A family member states, “My father complains of an upset stomach after taking rivastigmine.” Which response by the nurse is appropriate? “We may need to decrease his dose.” “Make sure he takes the medication with food.” “Make sure he takes the medication without food.” “We may need to reduce the frequency of his dosing to once daily.”

“Make sure he takes the medication with food.”

To evaluate the effectiveness of dopaminergic agents, the nurse would assess for which condition? Weight loss Correction of shuffling gait Improved memory and thinking Improvement in balance

Improvement in balance