Week 3 Sherpath Flashcards
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.
Cyclobenzaprine exerts an effect within which time span?
30 minutes
1 hour
2 hours
6 to 8 hours
1 hour
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
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.
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.”
Which common side effects are associated with centrally-acting muscle relaxants?
Select all that apply.
Dizziness
Drowsiness
Bradycardia
Hypertension
Dyspnea
Polydipsia
Dizziness
Drowsiness
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
The nurse would withhold the prescribed midazolam for the patient reporting which condition?
Peripheral vascular disease
Muscle spasms
Acute low back pain
Hepatitis B
Hepatitis B
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
The nurse understands that excretion of cyclobenzaprine occurs via which organ system?
Kidneys
Liver
Lungs
Skin
Kidneys
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
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
Use of muscle relaxants is contraindicated in patients with which condition?
Brain tumor
Diabetes
Acromegaly
Hepatic disease
Hepatic disease
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
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
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
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
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
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.”
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
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
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
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.”
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
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
