Drug Therapy in Nursing 4th Edition by Diane Aschenbrenner Test Bank

Drug Therapy in Nursing  4th Edition by Diane Aschenbrenner  Test Bank
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1.
A nurse is caring for a 38-year-old female patient who just started taking lithium for bipolar disorder. Which of the following outcomes would be most appropriate for this patient?
A)
The patient will reestablish and maintain a normal pattern of bowel functioning.
B)
The patient will identify appropriate interventions to promote sleep.
C)
The patient will identify satisfying and acceptable sexual practices and some alternative ways of dealing with sexual expression.
D)
The patient will adopt strategies to maintain proper fluid balance.
Ans:
D

Feedback:

In a patient taking lithium, the nurse should try to ensure that the patient will adopt strategies to restore and maintain proper fluid balance to counter the risk of excess fluid volume related to water retention. Lithium does not significantly affect bowel function, sleep, or sexual function.

2.
Each of the following patients requires sertraline therapy. Which patient would require the closest monitoring by the nurse?
A)
A 32-year-old man who is obese
B)
A 38-year-old woman who has diabetes
C)
An 11-year-old child with no other illnesses
D)
A 45-year-old man with liver impairment
Ans:
D

Feedback:

Caution must be used when administering sertraline in patients with compromised liver function; therefore, the patient with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these patients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in patients with obesity or diabetes.

3.
A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for
A)
onset of suicidal ideation.
B)
weight loss.
C)
feelings of grandiosity.
D)
decreased sleep.
Ans:
A

Feedback:

The nurse should closely assess the patient for evidence of worsening depression or onset of suicidal ideation. The most critical time to monitor for behavioral changes is during the first few weeks of drug therapy. Although sertraline is not approved by the FDA for treating depression in children at this time, the SSRI is widely used on an unlabeled basis to treat pediatric depression. While it is important to monitor for weight loss, it is not critical. Feelings of grandiosity and decreased sleep are symptoms of mania and are not adverse effects related to this drug.

4.
A 28-year-old man has been taking sertraline for a few months. On a follow-up visit to the clinic, he reports a change in sexual functioning, dizziness, and insomnia. The most appropriate response by the nurse would be
A)
How much of the drug are you taking at one time?
B)
Have you stopped taking the drug?
C)
Do you eat a lot of fat in your diet?
D)
How much alcohol do you consume?
Ans:
B

Feedback:

These symptoms are seen with serotonin discontinuation syndrome, which occurs with abrupt discontinuation of the drug. The patient has probably stopped taking the drug after having experienced changes in sexual functioning. To help the patient minimize sexually related adverse effects, it is important for the nurse to demonstrate a willingness to discuss these matters with the patient in an open and honest manner. The symptoms do not indicate common adverse drug effects or an instance of overdose or drug interaction with alcohol.

5.
A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?
A)
Increased urination
B)
Muscle twitching
C)
Hair loss
D)
Increased thirst
Ans:
B

Feedback:

Muscle twitching is an early symptom of lithium toxicity and should be reported immediately. Muscle twitching indicates that a dosage change may be needed. Increased thirst and urination are acute effects of lithium, whereas hair loss is a chronic adverse effect.

6.
A nurse is working with a Chinese immigrant who is taking an MAOI. The most important instruction to the patient by the nurse will be to
A)
avoid use of soy sauce in the diet.
B)
adhere to combination drug therapy.
C)
discuss the cultural significance of taking an MAOI.
D)
avoid taking the drug on an empty stomach.
Ans:
A

Feedback:

The patient should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The patients willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

7.
A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be
A)
This therapy will help reduce the severity of your bipolar episodes.
B)
The drug will enable you to gain the appropriate weight.
C)
The drug will help increase your attention level.
D)
This therapy will improve your overall mood and increase your social activity.
Ans:
D

Feedback:

The effectiveness of phenelzine is demonstrated by improved mood and increased social activity in depressed patients. Reduced severity of bipolar episodes indicates success of valproates. Increased attention levels and weight gain, though desired benefits, are not a direct result of the drug therapy.

8.
A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for
A)
dizziness.
B)
diarrhea.
C)
increased secretions.
D)
facial flushing.
Ans:
A

Feedback:

The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

9.
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
A)
A 44-year-old woman with a seizure disorder
B)
A 19-year-old man with organic brain disease
C)
A 45-year-old man with angina pectoris
D)
A 20-year-old woman with renal dysfunction
Ans:
C

Feedback:

Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

10.
A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug?
A)
0.3 mEq/L
B)
0.6 mEq/L
C)
1.7 mEq/L
D)
1.2 mEq/L
Ans:
C

Feedback:

The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 0.3 mEq/L would not be in the therapeutic range and would therefore not produce a therapeutic response. Levels of 0.6 and 1.2 mEq/L would be within the therapeutic range and would not be expected to produce adverse effects. A level of 1.7 mEq/L would be a high level and place the patient at risk for adverse effects or overdose.

11.
A nurse is aware of the high incidence and prevalence of major depression in the population. Which of the following individuals possesses the clearest risk factors for depression?
A)
A man who has a history of intravenous drug use and multiple hospital admissions for subsequent infections
B)
A woman whose father had a long history of depression before he committed suicide
C)
A man who is experiencing significant lifestyle changes after losing his job
D)
A woman who has recently begun treatment for idiopathic seizure activity
Ans:
B

Feedback:

Major risk factors for depression include previous episodes of depression, family history of depression, and being female. Life changes and drug use are associated with the problem but are not noted as major risk factors. Neurological disorders are not closely associated with depression.

12.
A woman in her twenties has been accompanied to her primary care provider by her mother, who states that her daughter has been experiencing increasingly severe episodes of irritable grandiose behavior. The care provider has consequently begun a treatment regimen that includes pharmacological therapies. This patient is most likely experiencing which of the following mood disorders?
A)
Bipolar disorder
B)
Dysthymic disorder
C)
Major depression
D)
Personality disorder
Ans:
A

Feedback:

The defining characteristic of bipolar disorder is the presence of mania, which is present when a person has an elevated or irritable mood lasting at least 1 week. Depression, dysthymic disorder, and personality disorders do not have this symptom.

13.
A 33-year-old woman has been diagnosed with major depression and has recently begun treatment with citalopram (Celexa). What teaching point should the nurse emphasize when providing health education for this patient?
A)
Its important that you not take any over-the-counter medications while youre taking this drug.
B)
Most people experience significant relief of their depression within 2 to 3 days of starting this drug.
C)
Youll need to make some important changes to your diet while youre on this drug, but it will certainly be worth it.
D)
Most people dont experience severe side effects with this drug, but it may have an effect on your sexual functioning.
Ans:
D

Feedback:

SSRIs such as citalopram tend to have fewer adverse effects than many other medications for mood disorders. However, sexual functioning is often affected. OTC medications should be taken with caution but not all of these must necessarily be avoided. Symptom relief takes longer than 2 to 3 days, and significant dietary changes are not normally required with SSRIs.

14.
A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patients subsequent care, what nursing diagnosis should the nurse prioritize?
A)
Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine
B)
Risk for Constipation related to decreased gastrointestinal peristalsis
C)
Risk for Infection related to immunosuppressive effects of phenelzine
D)
Risk for Injury related to drugdrug interactions or drugnutrient interactions
Ans:
D

Feedback:

MAOIs such as phenelzine carry a significant risk of injury that results from the multiple interactions associated with these drugs. Infection, impaired tissue perfusion, and constipation are less common, and less serious, adverse effects.

15.
Following an extensive diagnostic workup, a 20-year-old man has been diagnosed with bipolar disorder and begun lithium therapy. The nurses priority assessment in the care of the patient is
A)
close monitoring of deep tendon reflexes cranial nerve function.
B)
careful monitoring of the patients serum lithium levels.
C)
assessment of the patients renal and hepatic function.
D)
assessment of the patient for signs and symptoms of hypocalcemia and hypophosphatemia.
Ans:
B

Feedback:

In order to prevent the risk of lithium toxicity, it is imperative to closely monitor the patients lithium levels, especially near the initiation of therapy. This is priority over neurological, renal, or hepatic assessments, though each may be indicated. Electrolyte deficiencies are not a common consequence of lithium therapy.

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