Test Bank For Lehne Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

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Test Bank For Lehne Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

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INSTANT DOWNLOAD WITH ANSWERS

 

Lehnes Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

Chapter 01: Orientation to Pharmacology

Test Bank

 

MULTIPLE CHOICE

 

  1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic?
a. Clinical pharmacology
b. Drug efficacy
c. Pharmacokinetics
d. Pharmacotherapeutics

 

 

ANS:  D

Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions. Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the study of the impact of the body on a drug.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 1

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. What is a desired outcome when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.

 

 

ANS:  C

A major benefit of drugs that are easy to administer is that patients taking them are more likely to comply with the drug regimen. Drugs that are easy to give may have the other attributes listed, but those properties are independent of ease of administration.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 2

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drugs effects by the patient, the nurse will anticipate which outcome?
a. Decreased chance of having a placebo effect
b. Decreased motivation to take the drug
c. Improved compliance with the drug regimen
d. Increased likelihood of drug overdose

 

 

ANS:  C

A drug is effective if it produces the intended effects, even if it also produces side effects. Patients who understand both the risks and benefits of taking a medication are more likely to comply with the drug regimen.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 2

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. What are the properties of an ideal drug? (Select all that apply.)
a. Irreversible action
b. Predictability
c. Ease of administration
d. Chemical stability
e. A recognizable trade name

 

 

ANS:  B, C, D

In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name, because generic names are usually complex and difficult to remember and pronounce.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 1-2

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patients response to the medication? (Select all that apply.)
a. Chemical stability of the medication
b. Ease of administration
c. Family medical history
d. Patients age
e. Patients diagnosis

 

 

ANS:  C, D, E

The family medical history can indicate genetic factors that may affect a patients response to a medication. Patients of different ages can respond differently to medications. The patients illness can affect how drugs are metabolized. The chemical stability of the medication and the ease of administration are properties of drugs.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 3-4

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 03: Drug Regulation, Development, Names, and Information

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, Which drug name gives information about the drugs pharmacologic classification? Which is the correct response?
a. Amoxicillin
b. Tylenol
c. Cipro
d. Motrin

 

 

ANS:  A

Amoxicillin is the generic name, and the suffix -cillin indicates that it belongs to the penicillin class of antibiotics. Tylenol, Cipro, and Motrin are all trade names without segments that indicate their pharmacologic class.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 18

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety?
a. Allowing pharmaceutical companies to identify off-label uses of medications approved for other uses
b. Evaluating drug safety information that emerges after a drug has been approved and is in use
c. Expediting the approval process of the U.S. Food and Drug Administration (FDA) so that needed drugs can get to market more quickly
d. Requiring manufacturers to notify patients before removing a drug from the market

 

 

ANS:  B

The FDAAA was passed to enable the Food and Drug Administration to continue oversight of a drug after granting it approval so that changes in labeling could be made as necessary and postmarketing risks could be tracked and identified. A provision of the FDA Modernization Act (FDAMA), passed in 1997, allows drug companies to promote their products for off-label uses as long as they promise to conduct studies to support their claims. Regulations to permit accelerated approval of drugs for life-threatening diseases were adopted in 1992 by the FDA. The requirement that drug companies notify patients 6 months before removing a drug from the market is a provision of the FDAMA.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 14-15

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what?
a. To ensure that differences in outcomes are the result of treatment and not differences in subjects
b. To compare the outcome caused by the treatment to the outcome caused by no treatment
c. To make sure that researchers are unaware of which subjects are in which group
d. To prevent subjects from knowing which group they are in and prevent preconception bias

 

 

ANS:  A

Randomization helps prevent allocation bias, which can occur when researchers place subjects with desired characteristics in the study group and other subjects in the control group so that differences in outcome are actually the result of differences in subjects and not treatment. Comparing treatment outcome to no treatment outcome is the definition of a controlled study. The last two options describe the use of blinding in studies; blinding ensures that researchers or subjects (or both) are unaware of which subjects are in which group so that preconceptions about benefits and risks cannot bias the results.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 15-16

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friends illness. Which statement by the nurse is correct?
a. A drug at this stage of development can be used only in patients with serious disease.
b. At this stage of drug development, the safety and usefulness of the medication is unknown.
c. Clinical trials must be completed to make sure the drug is safe to use in humans.
d. Until postmarketing surveillance data are available, the drug cannot be used.

 

 

ANS:  B

Preclinical testing must be completed before drugs can be tested in humans. In this stage, drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Some drugs can be used in patients before completion of Phase III studies, but this is after preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines defining how a new drug may be used and which patients may receive it. Postmarketing surveillance takes place after a drug is in general use.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 16

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient?
a. Testing for all side effects of a medication would be prohibitively expensive.
b. Patients in drug trials often are biased by their preconceptions of a drugs benefits.
c. Researchers tend to conduct studies that will prove the benefits of their new drugs.
d. Subjects in drug trials do not always represent the full spectrum of possible patients.

 

 

ANS:  D

All drug trials are limited by a relatively small group of subjects who may not have all the characteristics of people who will be using the drug; therefore, some side effects go undetected until the drug is in use. Although drug trials are very expensive, this is only an indirect reason they do not detect all side effects before approval. In theory, well-designed drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to prove desired results is unethical.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 17

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?
a. They are approved by the FDA and are easy to remember.
b. They are assigned by the U.S. Adopted Names Council.
c. They clearly identify the drugs pharmacologic classification.
d. They imply the efficacy of the drug and are less complex.

 

 

ANS:  B

Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which ensures that each drug has only one name. Trade names, or brand names, are approved by the FDA and are easier to remember. Some nonproprietary names contain syllables that identify the classification, although not all do. Drug names are not supposed to identify the use for the drug, although some brand names do so.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 18

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 11: Drug Therapy in Geriatric Patients

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?
a. Creatinine clearance
b. Sodium levels
c. Potassium levels
d. Serum creatinine

 

 

ANS:  A

The proper index of renal function in older adults is creatinine clearance, which indicates renal function in older patients whose organs are undergoing age-related deterioration. Sodium and potassium levels are not indicative of renal function. Serum creatinine levels do not reflect kidney function in older adults because lean muscle mass, which is the source of creatinine in serum, declines and may be low even with reduced kidney function.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 92-93

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?
a. Ask the patient to share the teaching with a neighbor or friend soon after discharge.
b. Give the patient detailed written information about each drug.
c. Cluster medication administration times as much as possible.
d. Make sure the patient understands the actions and side effects of each drug.

 

 

ANS:  C

Unintentional nonadherence often is the result of confusion and forgetfulness. Grouping medications to reduce the number of medication times per day can simplify the regimen and help the patient remember medication times. Enlisting a neighbor, relative, or friend is a good idea, but this person should be included in the teaching. Asking the patient to share what is learned may not be a reasonable expectation of a forgetful patient. Detailed written information may just be more confusing; verbal and written information should be clear and concise. Making sure the patient understands the actions and side effects of medications helps when intentional nonadherence is an issue, but in this case it may just add to the patients confusion.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 93-95

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is reviewing an older adult patients chart before giving medications. Which patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine

 

 

ANS:  C

Low serum albumin reduces protein binding of drugs and can cause levels of free drug to rise, increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a major factor in drug sensitivity in the older adult, although delayed gastric emptying can delay drug responses. Increased body fat can alter drug distribution, causing reduced responses in lipid-soluble drugs. Low serum creatinine is a function of decreased lean muscle mass and does not reflect kidney function or drug excretion.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be reduced.

 

 

ANS:  B

The interval between doses of the medication should be increased in older adult patients, because drugs that undergo the first pass effect may not be broken down as well as in an individual with full liver function. A higher dose of the medication is not indicated, because toxic effects could occur. A change in administration may be indicated in older adults, because their metabolism is affected. The interval between doses should not be reduced but increased.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 92-93

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite

 

 

ANS:  D

The patient who is thin and has a poor appetite has an increased risk of malnutrition, with significant lowering of serum albumin. This can result in increased free drug levels of protein-bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue, would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of medications through the GI tract and reduce absorption.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 92

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine [Benadryl] for the expected side effect of itching.
c. Request an order for morphine instead of meperidine [Demerol].
d. Suggest to the surgeon that the patient receive diazepam [Valium] to reduce anxiety and the need for narcotics.

 

 

ANS:  C

In older adults, meperidine is not effective at usual doses and causes more confusion than in younger patients. Morphine is recommended for severe pain. A fall risk protocol is appropriate, but the drug ordered is not. Diphenhydramine is not recommended for older adult patients, because it causes blurred vision. Both diphenhydramine and diazepam have central nervous system (CNS) sedative effects, which will compound the CNS effects of the narcotic. Diazepam also produces prolonged sedation in older adults.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patients renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?
a. Financial concerns
b. Inability to open drug containers
c. Increased tolerance to the drugs effects
d. Patients conviction that the drug is unnecessary

 

 

ANS:  A

Older adult patients who have financial concerns about paying for medications often take less of the drug or take it less often to make the drug last longer. A patient unable to open the drug container would not get any medication and would not have a detectable serum drug level. A patient with increased tolerance to a drugs effects would require more of the drug to get effects. A patient convinced that the drug is not needed would probably not fill the prescription.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?
a. Alteration in hepatic function requires more frequent drug dosing.
b. Changes in GI function in older adult patients lead to lower serum drug levels.
c. Most adverse drug reactions in older adult patients are related to altered renal function.
d. Most nonadherence among older adult patients is intentional.

 

 

ANS:  A

Changes in hepatic function in older adult patients lead to decreased metabolism, meaning that drugs metabolized by the liver have prolonged half-lives and should be given less frequently. Altered GI function does not have much effect in this population, but most known effects from this cause are related to poor absorption and less available drug. Alterations in renal function are the cause of most adverse drug effects in the older adult. In most cases, nonadherence to drug regimens is intentional, usually because the patient doesnt believe that the drug is needed or that the dose prescribed is not necessary.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?
a. Acetaminophen [Tylenol] and oxycodone
b. Amitriptyline [Elavil] and diphenhydramine [Benadryl]
c. Fexofenadine [Allegra] and an over-the-counter laxative
d. Zolpidem [Ambien] and sertraline [Zoloft]

 

 

ANS:  B

Both amitriptyline and diphenhydramine are on the BEERS list, amitriptyline for anticholinergic effects and diphenhydramine because it causes blurred vision. Additionally, they both have CNS effects that can compound each other when the drugs are given together. Acetaminophen and oxycodone are both acceptable and may be given together. Fexofenadine is a second-generation antihistamine with fewer side effects, and it is not contraindicated for use with a laxative. Zolpidem is a sedative that has less risk of physical dependence and less risk of confusion, falls, and cognitive impairment; sertraline is a safer antidepressant, because it has a shorter half-life than others.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?
a. Ask the patient if she has difficulty swallowing pills.
b. Count the pills in the prescription bottle.
c. Notify the provider to request more frequent dosing.
d. Request an order for renal function tests.

 

 

ANS:  B

Intentional nonadherence is common and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. Counting the pills would be an appropriate first step as the nurse determines the cause of the low serum drug level, because it provides information about adherence. If the pill count is correct and the patient has taken the drug as prescribed, other causes may have to be investigated. If it is clear that the patient has not been taking enough of the medication, asking about her ability to swallow may be a good follow-up question. The last two options would be steps to discuss with the provider if the patient is taking the medication as prescribed.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding of the teaching?
a. An inability to pay for medications contributes to most intentional nonadherence among older adults.
b. Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens.
c. Most nonadherence in older adults results in drug toxicity and adverse drug effects.
d. The majority of older patients who do not adhere to drug regimens do so intentionally.

 

 

ANS:  D

Intentional nonadherence is common. It accounts for 75% of nonadherence among older adults and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. The inability to pay for medications and complicated drug regimens result in nonintentional nonadherence. Although nonadherence may result in therapeutic failure and drug toxicity, subtherapeutic dosing is by far the most common result.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

MULTIPLE RESPONSE

 

  1. A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)
a. Creatinine clearance
b. Gastric pH
c. Plasma drug levels
d. Serum albumin
e. Serum creatinine

 

 

ANS:  A, C, D

Creatinine clearance is the best way to evaluate renal function in the older adult. Plasma drug levels are important for determining if the patient has toxic or subtherapeutic drug levels. Serum albumin may be decreased, especially in patients who are thin, are chronically undernourished, or have been vomiting, and the decreased level may result in higher levels of drugs that normally bind to proteins. Gastric pH is not important; most GI changes result in lowered absorption and less free drug. Serum creatinine levels are related to the amount of lean muscle mass, which may be low in older adult patients, and do not reflect renal function.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 21: Drugs for Parkinsons Disease

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient has taken levodopa [Dopar] for Parkinsons disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?
a. Another agent will be needed to manage your symptoms.
b. Double the dose to see whether an effect occurs.
c. It may take several months for a response to occur.
d. The prescriber may need to change your drug regimen.

 

 

ANS:  C

A full therapeutic response with levodopa may take several months to develop. Until the true effect of the dose is seen, it is not necessary to change to another drug, increase the dose, or change the drug regimen.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse provides teaching for a patient who is newly diagnosed with Parkinsons disease. Which statement by the patient indicates understanding of the drug therapy for this disease?
a. A levodopa/carbidopa combination is used to improve motor function.
b. There are several drugs available to treat dyskinesias.
c. When off times occur, I may need to increase my dose of levodopa.
d. With adequate drug therapy, the disease progression may be slowed.

 

 

ANS:  A

Levodopa combined with carbidopa is the initial drug of choice to treat motor symptoms. Amantadine is the only drug recommended to treat dyskinesias. Entacapone and rasagiline are used to treat abrupt loss of effect, or off times. Drug therapy does not slow the progression of the disease.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 177-178

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient has been diagnosed with Parkinsons disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
a. add a dopamine agonist.
b. discuss the on-off phenomenon.
c. increase the dose of Sinemet.
d. re-evaluate the diagnosis.

 

 

ANS:  D

Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The on-off phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinsons disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:
a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
b. adding the DA-releasing agent amantadine to the regimen.
c. giving a direct-acting dopamine agonist.
d. shortening the dosing interval of levodopa/carbidopa.

 

 

ANS:  A

This patient is describing abrupt loss of effect, or the off phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient newly diagnosed with Parkinsons disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?
a. Taking a lower dose on an empty stomach
b. Taking an increased dose along with a high-protein snack
c. Taking a lower dose with a low-protein snack
d. Taking dopamine in addition to levodopa/carbidopa

 

 

ANS:  C

Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is discussing motor symptoms with a patient with Parkinsons disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
a. I may need to try a lower dose of Sinemet to reduce my tics.
b. My provider may order clozapine to treat these tics.
c. These tics are an indication that my dose of Sinemet is too low.
d. This means I will have to have surgery to stop the symptoms.

 

 

ANS:  A

Levodopa can cause movement disorders, generally within the first year of therapy. If they occur, a lower dose of levodopa may be required to alleviate them. Clozapine is an antipsychotic used to treat levodopa-induced psychoses. Movement disorders generally occur as the dose of levodopa increases. Surgery is a last option for treating movement disorders, after amantadine fails.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?
a. An alpha-adrenergic antagonist medication
b. Discussing amantadine with the prescriber
c. Increasing salt and water intake
d. Taking a drug holiday

 

 

ANS:  C

Postural hypotension is common early in treatment and can be reduced by increasing the intake of salt and water. An alpha-adrenergic agonist, not an antagonist, can help. Amantadine is used to treat levodopa-induced dyskinesias. Drug holidays are used when adverse effects increase with long-term use of levodopa; the drug holiday allows beneficial effects to be achieved with lower doses, which reduces the incidence of side effects.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 179-180

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
a. Carbidopa increases the availability of levodopa in the central nervous system.
b. Carbidopa reduces the incidence of nausea and vomiting.
c. Combination products reduce peripheral cardiovascular side effects.
d. Combination products cause fewer dyskinesias and decreased psychosis.

 

 

ANS:  D

Adding carbidopa to levodopa does not reduce the incidence of dyskinesias or psychosis. In fact, carbidopa can increase the intensity and the speed of onset of these effects. Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Peripheral side effects are reduced, including nausea, vomiting, and cardiovascular effects.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 182-183

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching a group of nurses about Parkinsons medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:
a. sleep attacks.
b. dizziness.
c. hallucinations.
d. dyskinesias.

 

 

ANS:  A

A few patients taking pramipexole have experienced sleep attacks, or an overwhelming and irresistible sleepiness that comes on without warning. Dizziness, hallucinations, and dyskinesias are listed as side effects of pramipexole and other dopamine agonists.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student wants to know how carbidopa can be effective for treating Parkinsons disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
a. can be taken with high-protein meals.
b. does not cross the blood-brain barrier.
c. has dopamine-like effects of its own.
d. reduces abrupt loss of effect.

 

 

ANS:  B

Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Carbidopa is not given with high-protein meals. Carbidopa does not have dopamine-like effects. Carbidopa does not affect abrupt loss of effect.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 182-183

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A 25-year-old patient has been newly diagnosed with Parkinsons disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:
a. any history of alcohol abuse or compulsive behaviors.
b. any previous history of hypertension.
c. difficulty falling asleep or staying asleep.
d. whether any family members have experienced psychoses.

 

 

ANS:  A

Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A hospitalized patient with Parkinsons disease who is receiving apomorphine to treat off episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patients provider?
a. Levodopa [Dopar]
b. Ondansetron [Zofran]
c. Prochlorperazine [Compazine]
d. Trimethobenzamide [Tigan]

 

 

ANS:  D

Trimethobenzamide can be used as an antiemetic in patients treated with apomorphine. Serotonin receptor agonists (eg, ondansetron) and dopamine receptor antagonists (eg, prochlorperazine) cannot be used, because they increase the risk of serious postural hypotension. Levodopa only increases nausea and vomiting.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinsons disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:
a. adding an antipsychotic medication.
b. changing from bromocriptine to cabergoline [Dostinex].
c. reducing the dose of bromocriptine.
d. reducing the dose of levodopa/carbidopa.

 

 

ANS:  C

Bromocriptine is used to treat levodopa-induced dyskinesias and has dose-dependent psychologic side effects. The nurse should suggest reducing the dose of this drug to minimize these side effects. Adding an antipsychotic medication is not indicated. Cabergoline is not approved for this use. Reducing the dose of levodopa/carbidopa is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 184-185

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is newly diagnosed with Parkinsons disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?
a. Levodopa may prevent disease progression in higher doses and is safe to use for this purpose.
b. MAO-B inhibitors and dopamine agonists have both shown neuroprotective effects in human studies.
c. Vitamin E has been shown to delay neuron degeneration and may be used as adjunctive therapy.
d. While some drugs show promise, there are no studies that have proven a neuroprotective effect.

 

 

ANS:  D

To date, there is no definitive proof that any drug can protect dopaminergic neurons from progressive degeneration. Levodopa has shown neuroprotective effects, but studies have demonstrated toxic effects in the doses required for this purpose. MAO-B inhibitors have shown benefits, but only in animal studies. Vitamin E was once theorized to offer this protection, but recent studies have provided good evidence that this is not the case.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 178

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinsons disease. What will the nurse include in teaching?
a. If you develop nausea and vomiting, you should stop taking the medication.
b. If you need to stop this drug, your provider will order a gradual withdrawal.
c. You will start this drug regimen with a higher than usual loading dose.
d. You will take this medication by mouth with food.

 

 

ANS:  B

Rotigotine is a nonergot dopamine agonist, which is given by starting with a 2-mg dose that is increased by 2 mg each week until the lowest effective dose is reached. It should not be stopped abruptly but should be decreased by 2 mg per week until tapered off. It undergoes extensive first-pass metabolism, so it is not given orally and is currently available as a transdermal patch.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 184

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinsons disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?
a. Increasing the dose of amantadine [Symmetrel]
b. Interrupting treatment with amantadine for several weeks
c. Ordering renal function tests
d. Ordering another anticholinergic medication

 

 

ANS:  B

When amantadine is added to therapy to treat dyskinesias associated with levodopa, it often loses effectiveness after several months. If the effects diminish, they can be restored by either increasing the dosage or by interrupting treatment for several weeks. The maximum dosage of amantadine is 400 mg/day, so it is incorrect to increase the dose. Altered renal function would result in drug toxicity, not ineffectiveness of the drug. It is not necessary to order another drug until determining whether the effectiveness can be restored.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 187

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Chapter 31: Antipsychotic Agents and Their Use in Schizophrenia

Test Bank

 

MULTIPLE CHOICE<

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