Test bank for pharmacology for nurses 2nd canadian edition by adams

Test Bank for Pharmacology for Nurses 2nd Canadian Edition by Adams

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Unit 5 Pharmacology of Alterations in the Central Nervous System

Unit 5 Pharmacology of Alterations in the Central Nervous System

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Chapter 15 Brief Review of the Central Nervous System Question 1 Type: MCSA A client, prescribed an antidepressant for symptoms of depression, is expressing feelings of hopelessness and thoughts of suicide. The nurse's response will be based on which conclusion?

1. There is great variability in individual responses to drugs that affect the CNS. 2. The client has not been taking the antidepressant.

3. The antidepressant needs to be taken for several months in order to eliminate suicidal ideations.

4. Drug levels should be obtained to see if the dose needs to be increased.

Correct Answer: 1 Rationale 1: There is great client variability in symptoms and disease progression with conditions such as depression. Without a complete understanding of the etiology and pathophysiology of mental disorders, pharmacotherapy of these conditions and the development of new drug therapies for CNS disorders will remain challenging.

Rationale 2: There is no indication in the stem that the client has been noncompliant in taking the medication.

Rationale 3: Suicidal clients require immediate attention.

Rationale 4: The name of the medication is not given; therefore, the need for drug levels cannot be determined from the information given.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-1 Identify disorders for which central nervous system medications are prescribed.

Question 2 Type: MCSA A client is prescribed medication to treat bipolar disorder. Which statement indicates the client understands the medication regimen?

1. "This medication is going to cure me."

2. "I will take this medication when I remember to."

3. "This medication may help my symptoms."

4. "This is the only medication that I can take for my illness."

Correct Answer: 3 Rationale 1: The medication is not a cure, but it may help treat the symptoms that the client is experiencing. This statement indicates the need for further education.

Rationale 2: The client should be instructed to take the medication as prescribed. This statement indicates the need for further education.

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Rationale 3: This statement indicates the client understands the purpose of the medication regimen.

Rationale 4: There are many different medications the client can take to treat bipolar disorder.

This statement indicates the need for further education.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify disorders for which central nervous system medications are prescribed.

Question 3 Type: MCSA A client with Parkinson disease is prescribed a medication that affects a particular central nervous system neurotransmitter. Which neurotransmitter is the medication acting on to treat the symptoms of Parkinson disease?

1. Acetylcholine 2. Norepinephrine 3. An endorphin 4. Gamma aminobutyric acid (GABA) Correct Answer: 1 Rationale 1: Cholinergic synapses utilize acetylcholine as the neurotransmitter. Cholinergic synapses are especially important in the pathophysiology of Parkinson disease and Alzheimer disease.

Rationale 2: Norepinephrine can be excitatory or inhibitory, and it plays a role in depression, memory, and panic attacks.

Rationale 3: The endorphin receptor molecule is the opioid receptor, which is involved in pain reduction.

Rationale 4: GABA is the primary inhibitory neurotransmitter in the CNS, and it plays a role in anxiety disorders and seizures.

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-3 Identify the major neurotransmitters in the central nervous system and their functions.

Question 4 Type: MCSA

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A client tells the nurse about taking a medication that affects the central nervous system but cannot recall the name of the drug. When assessing the client, it would be appropriate for the nurse to ask about which possible symptoms?

1. Weight loss despite an increase in appetite, inability to sleep, feeling fidgety, palpitations, intolerance to heat 2. Weight loss despite an increase in appetite and food consumption, extreme thirst, and increase in urination 3. Moodiness, crying, or feelings of anxiety 4. More than usual shortness of breath, or tightness in the chest with physical activity.

Correct Answer: 3 Rationale 1: Clinical manifestations of hyperthyroidism are enlarged thyroid gland; palpitations; cardiac dysrhythmias; protruding eyeballs; hypertension; heat intolerance; diaphoresis; weight loss; diarrhea; smooth, soft skin; fine tremors; and irritability. Antithyroid medications or iodine preparations may be administered for this condition.

Rationale 2: Signs of diabetes mellitus include weight loss, polyuria, polydipsia, and polyphagia.

Antidiabetic agents, such as the sulfonylureas and insulins, are prescribed for these symptoms.

Rationale 3: Moodiness, crying, or feelings of anxiety can be associated with disorders such as bipolar disorder, anxiety, and panic disorders. Some central nervous system medications would be prescribed for these symptoms.

Rationale 4: Angina is characterized by dyspnea, pallor, diaphoresis, palpitations and tachycardia, faintness, hypertension, tightness in the chest, or pain between the shoulder blades that can radiate to the arm, jaw, neck, or shoulder. Vasodilators are given for treatment of angina.

Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify disorders for which central nervous system medications are prescribed.

Question 5 Type: MCMA The nurse recognizes the action of psychotherapeutic medications is mediated by which processes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Some neurotransmitters are stimulatory.

2. The electrical impulse causes the release of an inhibitory neurotransmitter.

3. Some neurotransmitters are inhibitory.

4. The electrical impulse inhibits the neurotransmitter from being released.

5. The electrical impulse at the synapse activates a receptor.

Correct Answer: 1,2,3,4 Rationale 1: Some neurotransmitters, such as glutamate, are primarily stimulatory.

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Rationale 2: In some cases, the electrical impulse causes the release of an inhibitory neurotransmitter that suppresses neuronal conduction.

Rationale 3: Some neurotransmitters, such as gamma aminobutyric acid (GABA), inhibit neuronal activity.

Rationale 4: In some cases, the electrical impulse inhibits the neurotransmitter from being released.

Rationale 5: The electrical impulse at the synapse releases a neurotransmitter that then moves across a physical space to activate a receptor on the neuron on the opposite side (postsynaptic).

Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-3 Identify the major neurotransmitters in the central nervous system and their functions.

Question 6 Type: MCMA Which statements describe the function of the central nervous system synapse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Suppression, or inhibition, of the firing of neurons 2. Inhibition of the release of a neurotransmitter 3. Serving as the primary functioning cell within the nervous system 4. Simulation, or activation, of the firing of neurons 5. Release of an inhibitory neurotransmitter that suppresses conduction Correct Answer: 1,2,4,5 Rationale 1: In some cases, the firing of neurons is inhibited.

Rationale 2: Synapses within the CNS operate by an electrical impulse releasing a neurotransmitter to activate a receptor neuron on the opposite side. In some cases, the electrical impulse inhibits the release of the neurotransmitter.

Rationale 3:.The neuron is the primary functioning cell within the nervous system.

Rationale 4: The neuron is the primary functional cell for communicating messages through conduction of an action potential.

Rationale 5: In some cases, there is release of an inhibitory neurotransmitter that suppresses neuronal conduction Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-2 Illustrate the major components of a synapse within the central nervous system.

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Question 7 Type: MCSA A client is treated in the emergency department for an overdose of cocaine. What does the nurse monitor based on her knowledge of the effect of cocaine? 1. Cholinergic synapses 2. Adrenergic synapses 3. Dopamine receptors 4. Glutamate Correct Answer: 3 Rationale 1: Cholinergic synapses utilize acetylcholine, and play a role in Parkinson and Alzheimer diseases.

Rationale 2: Adrenergic synapses utilize norepinephrine to heighten alertness. Adrenergic neurons likely play a role in mood disorders.

Rationale 3: Cocaine and amphetamines produce their stimulatory actions by affecting dopamine receptors.

Rationale 4: Glutamate is always excitatory and can be neurotoxic at high levels.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-3 Identify the major neurotransmitters in the central nervous system and their functions.

Question 8 Type: MCSA A client newly diagnosed with depression is given a prescription for an antidepressant. Which neurotransmitter is affected by the medication ordered?

1. Glutamate 2. Serotonin 3. Dopamine 4. Acetylcholine Correct Answer: 2 Rationale 1: Glutamate is an excitatory neurotransmitter associated with memory.

Rationale 2: Low serotonin levels in the CNS are associated with anxiety and impulsive behavior, including suicidal ideation. Serotonergic receptors play an important role in the mechanism of action of antidepressant drugs.

Rationale 3: Dopamine is associated with Parkinson disease, psychoses, motivation, and pleasure.

Rationale 4: Acetylcholine is associated with myasthenia gravis and Alzheimer disease.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Copyright © 2018 Pearson Canada Inc.

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Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-3 Identify the major neurotransmitters in the central nervous system and their functions.

Question 9 Type: MCSA A client recovering from a recent stroke is having difficulty with speech, memory, and movement of the extremities on the left side of the body. The nurse explains to the family that which area of the CNS has most likely been affected by the stroke?

1. Limbic system 2. Cerebrum 3. Cerebellum 4. Thalamus Correct Answer: 2 Rationale 1: The limbic system is a group of structures deep in the brain responsible for emotional expression, learning, and memory.

Rationale 2: The cerebrum is the "thinking" part of the brain responsible for perception, speech, conscious motor movement, movement of skeletal muscles, memory, and smell. Focal abnormalities, often the result of stroke, occur in specific regions and can affect a single brain function. Generalized disorders of the cerebrum affect widespread areas or multiple regions.

Rationale 3: The cerebellum controls muscle movement, balance, posture, and tone. It is involved in learning the fine motor skills that make muscular movements smooth.

Rationale 4: The thalamus is the major relay centre in the brain and sends sensory information such as sounds, sights, pain, touch, and temperature to the cerebral cortex.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-4 Describe the major structural regions of the brain and their primary functions.

Question 10 Type: MCSA A client admitted to the hospital with a possible brain tumour has symptoms of increased thirst and hunger, despite an increase in weight, and complains of feeling cold all the time. Which region of the CNS system most likely has been affected?

1. Thalamus 2. Hypothalamus 3. Cerebellum 4. Limbic system Correct Answer: 2

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Rationale 1: The thalamus is a relay centre that sends sensory information such as sounds, sights, pain, touch, and temperature.

Rationale 2: The regulation of hunger, thirst, water balance, and body temperature is the function of the hypothalamus.

Rationale 3: The cerebellum controls muscle movement, balance, posture, and tone.

Rationale 4: The limbic system is responsible for emotional expression, learning, and memory.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 15-4 Describe the major structural regions of the brain and their primary functions.

Question 11 Type: MCSA The nurse is taking care of a client who has been in the intensive care unit (ICU) for 10 days.

Which nursing action would cause a decrease in stimulation of the reticular activating system?

1. Keeping the door closed and the lights dim 2. Assisting with bathing and activities for elimination 3. Allowing family members, including children, to visit 4. Turning on the television Correct Answer: 1 Rationale 1: Stimulation of the reticular formation causes heightened alertness and arousal of the brain as a whole. Inhibition causes general drowsiness and the induction of sleep. The RAS is responsible for sleeping and wakefulness, and it performs an alerting function for the cerebral cortex.

Rationale 2: Movement needed for bathing would increase stimulation.

Rationale 3: Allowing visitors would increase stimulation.

Rationale 4: Turning on the TV would increase stimulation.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-5 Explain the major functional systems of the brain and their primary functions.

Question 12 Type: MCSA

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The nurse is concerned that a client taking an antipsychotic medication is experiencing extrapyramidal side effects. For which effects should the nurse notify the health care provider?

1. Complaints of slight drowsiness 2. Urinary hesitancy 3. Muscular spasms of the head and neck 4. Dry mouth Correct Answer: 3 Rationale 1: Complaints of drowsiness are common with many medications.

Rationale 2: Urinary hesitancy is a common anticholinergic adverse affect.

Rationale 3: Adverse extrapyramidal symptoms include jerking motions; muscular spasms of the head, face, and neck; and akathisia. They can cause nerve damage if allowed to continue.

Rationale 4: Dry mouth is a common anticholinergic adverse effect treated by sucking on hard candy and increasing fluid intake.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-5 Explain the major functional systems of the brain and their primary functions.

Question 13 Type: MCSA The family of a client who has a tumour deep in the brain is concerned about the client’s demonstration of aggression and anger over the last few months. Which is the best response by the nurse?

1. "I will inform the health care provider about the client's anger and aggression."

2. "I will request a referral for anger management."

3. "The tumour might affect areas of the brain responsible for emotional expression."

4. "This may be a normal reaction to his diagnosis."

Correct Answer: 3 Rationale 1: The anger and aggression will remain until the tumour is treated.

Rationale 2: The root cause of the anger, the tumour, needs to be addressed.

Rationale 3: The limbic system is a group of structures deep in the brain responsible for emotional expression, learning, and memory. Emotional states associated with this system include anxiety, fear, anger, aggression, remorse, depression, sexual drive, and euphoria.

Rationale 4: While anger may be a normal response to his diagnosis, aggression would not be.

The source of his anger and aggression is most likely the location of his tumour.

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-5 Explain the major functional systems of the brain and their primary functions.

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Question 14 Type: MCMA A client with depression and a sleep disorder is prescribed a central nervous system medication.

The nurse will expect to assess which effects of this medication in the client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Improved mood 2. Improved sleep pattern 3. Activation of the fight-or-flight response 4. Onset of seizures 5. Increased pain levels Correct Answer: 1,2 Rationale 1: An improved mood is an effect of some central nervous system medications.

Rationale 2: An improvement in sleep patterns is an effect of some central nervous system medications.

Rationale 3: Activation of the fight-or-flight response is an effect of the ANS, not an effect of central nervous system medications.

Rationale 4: Some central nervous system medications control rather than cause the onset of seizures.

Rationale 5: Some central nervous system medications control, not increase, pain.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify disorders for which central nervous system medications are prescribed.

Question 15 Type: MCMA The nursing instructor is teaching students on the effects of a medication on the neurons and synapses within the nervous system. What should the instructor include about about the characteristics of a synapse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Synapses are junctions between two neurons.

2. Synapses respond only to acetylcholine and norepinephrine.

3. The function of the synapse is to communicate messages through an action potential.

4. Synapses are junctions between a neuron and a muscle.

5. Synapses stimulate an emotional response.

Correct Answer: 1,4 Copyright © 2018 Pearson Canada Inc.

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Rationale 1: Synapses are junctions between two neurons.

Rationale 2: Although acetylcholine and norepinephrine are the most abundant neurotransmitters in the autonomic nervous system, other neurotransmitters such as dopamine exist.

Rationale 3: The function of a neuron is not to communicate messages through an action potential.

Rationale 4: Synapses are junctions between a neuron and a muscle.

Rationale 5: Synapses do not stimulate an emotional response.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-2 Illustrate the major components of a synapse within the central nervous system.

Question 16 Type: MCMA A client is found to have a reduction in the amount of the neurotransmitter acetylcholine. The nurse realizes this client is prone to developing which health problems?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Myasthenia gravis 2. Alzheimer disease 3. Parkinson disease 4. Seizure disorders 5. Anxiety Correct Answer: 1,2 Rationale 1: The neurotransmitter acetylcholine plays a role in myasthenia gravis.

Rationale 2: The neurotransmitter acetylcholine plays a role in Alzheimer disease.

Rationale 3: The neurotransmitter acetylcholine is not implicated in the development of Parkinson disease.

Rationale 4: The neurotransmitter acetylcholine is not implicated in the development of seizure disorders.

Rationale 5: The neurotransmitter acetylcholine is not implicated in the development of anxiety.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-3 Identify the major neurotransmitters in the central nervous system and their functions.

Question 17 Type: MCMA Copyright © 2018 Pearson Canada Inc.

Unit 5 Pharmacology of Alterations in the Central Nervous System A client is prescribed a serotonin supplement. For which disorder(s) is this neurotransmitter replacement indicated?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Anxiety 2. Bipolar disorder 3. Depression 4. Panic attacks 5. Psychosis Correct Answer: 1,2,3 Rationale 1: One clinical use of serotonin is in the treatment of anxiety.

Rationale 2: One clinical use of serotonin is in the treatment of bipolar disorder.

Rationale 3: One clinical use of serotonin is in the treatment of depression.

Rationale 4: Serotonin is not indicated in the treatment of panic attacks.

Rationale 5: Serotonin is not indicated in the treatment of psychosis.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify disorders for which central nervous system medications are prescribed.

Question 18 Type: MCMA A client is admitted with a spinal cord injury. Which clinical manifestations does the nurse anticipate upon assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Paresthesia 2. Paralysis 3. Jerky body movements 4. Obsessive-compulsive disorder 5. Drowsiness Correct Answer: 1,2 Rationale 1: The spinal cord is essentially a conduction pathway to and from the brain.

Disruptions of these pathways will prevent transmission of nerve impulses and cause loss of sensory function (paresthesia).

Rationale 2: The spinal cord is essentially a conduction pathway to and from the brain.

Disruptions of these pathways will prevent transmission of nerve impulses and cause loss of motor function (paralysis).

Rationale 3: Jerky body movements are not associated with a spinal cord injury.

Rationale 4: Obsessive-compulsive disorder is not associated with a spinal cord injury.

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Rationale 5: Drowsiness is not associated with a spinal cord injury.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-4 Describe the major structural regions of the brain and their primary functions.

Question 19 Type: MCMA A client is demonstrating a disorder involving the limbic system. Which physiological findings associated with this disorder does the nurse anticipate upon assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Rapid heart rate 2. High blood pressure 3. Peptic ulcer disease 4. Increased peristalsis 5. Slow respirations Correct Answer: 1,2,3 Rationale 1: Through its connection with the hypothalamus, autonomic actions such as rapid heart rate are associated with intense emotional states.

Rationale 2: Through its connection with the hypothalamus, autonomic actions such as high blood pressure are associated with intense emotional states.

Rationale 3: Through its connection with the hypothalamus, autonomic actions such as peptic ulcers are associated with intense emotional states.

Rationale 4: Increased peristalsis is not associated with actions of the limbic system.

Rationale 5: Slow respirations are not associated with actions of the limbic system.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-5 Explain the major functional systems of the brain and their primary functions.

Question 20 Type: MCMA A client is believed to have a disorder that affects the basal ganglia. What should the nurse instruct the client about this structure?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It helps regulate skeletal muscle movement.

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2. It helps with memory.

3. It is needed for learning.

4. It is useful for being attentive.

5. Disorders can cause myasthenia gravis.

Correct Answer: 1,2,3,4 Rationale 1: The basal ganglia are a cluster of neurons in the brain that help regulate the initiation and termination of skeletal muscle movement.

Rationale 2: The basal ganglia help initiate and terminate the cognitive function of memory.

Rationale 3: The basal ganglia help initiate and terminate the cognitive function of learning.

Rationale 4: The basal ganglia help initiate and terminate the cognitive function of attention.

Rationale 5: Disorders of the basal ganglia are not implicated in the development of myasthenia gravis. .

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-5 Explain the major functional systems of the brain and their primary functions.

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Chapter 16 Pharmacotherapy of Anxiety and Sleep Disorders Question 1 Type: MCSA A client who recently returned from duty in Iraq is diagnosed with post-traumatic stress disorder (PTSD). The client’s family questions what this means. How should the nurse respond to the family?

1. “The client might experience sweating, increased heart rate, and blushing when asked to speak to an audience.”

2. “Whenever in an enclosed, small space, the client might experience an attack of sweating, racing heart, shortness of breath, and trembling.”

3. “The client might experience nightmares, hallucinations, or flashbacks, accompanied by a racing heart, sweating, shortness of breath, and trembling.”

4. “It might be common for the client to repetitively wash his hands over and over without apparent reason.”

Correct Answer: 3 Rationale 1: Social anxiety disorder is an unreasonable and persistent fear of crowds or of being ridiculed or embarrassed in public.

Rationale 2: Claustrophobia is a fear of closed places, such as elevators, where a panic attack could occur.

Rationale 3: Post-traumatic stress disorder is a type of situational anxiety that develops in response to re-experiencing a previous life event. The re-experience may take the form of nightmares, hallucinations, flashbacks, and panic attacks.

Rationale 4: Repetitive behaviours are a symptom of obsessive-compulsive disorder.

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-4 Describe the nurse’s role in the pharmacological management of clients with anxiety disorders and insomnia.

Question 2 Type: MCMA A client sees her health care provider with complaints of insomnia. After completing her physical and assessment, it is determined that she has secondary insomnia due to poor sleep hygiene. Which of the following non-pharmacological strategies does the nurse suggest to improve the client’s sleep?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Exercise in the evening to help relax.

2. Use room darkening shades over the windows.

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3. Drink cola no later than 8 pm in the evening.

4. No heavy meals past 6 pm.

5. Use ear plugs to block out extraneous noise.

Correct Answer: 2, 4,5 Rationale 1: Exercise should be avoided in the evening to promote sleep.

Rationale 2: Too much light in the room can prevent sleep, use of room darkening shades will promote optimum rest.

Rationale 3: Drinks with caffeine should be avoided in the evening.

Rationale 4:Heavy meals late in the evening can contribute to poor sleep.

Rationale 5. Use of ear plugs will help block out noise that can prevent sleep.

Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-1 Discuss factors contributing to anxiety and insomnia and explain some non-pharmacological therapies used to manage each of these disorders.

Question 3 Type: MCSA A client is taking verapamil for hypertension, Glucotrol for management of type II diabetes, and melatonin for sleep. Which question should the nurse ask about these medications?

1. "How is the melatonin helping you with sleep?"

2. "How long have you been taking the verapamil for blood pressure control?"

3. "What was the result of your last hemoglobin A1C level?"

4. "What was your blood pressure before you began taking the verapamil?"

Correct Answer: 1 Rationale 1: There is evidence that melatonin helps older adults fall sleep faster and helps insomnia related to disrupted circadian rhythm cycles.

Rationale 2: The length of time verapamil has been taken is not relevant.

Rationale 3: Even though it would be nice to know how well the diabetes has been controlled over the last 2–3 months, it is not necessary knowledge.

Rationale 4: It would be important to know the control of blood pressure after taking the verapamil.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-1 Discuss factors contributing to anxiety and insomnia and explain some non-pharmacological therapies used to manage each of these disorders.

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Question 4 Type: MCMA A client whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications. Which strategies for sleep could the nurse suggest?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "Walking 2–3 miles or engaging in some other exercise every morning can enhance sleep."

2. "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy."

3. "Eating a large meal at bedtime will help induce sleep."

4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime."

5. “Reading at nighttime sometimes may help you fall asleep."

Correct Answer: 1,2,4,5 Rationale 1: Exercise therapy (except just prior to sleeping), nutrition therapy, and deep breathing are alternative treatments for insomnia.

Rationale 2: Acupuncture, aromatherapy, yoga, prayer, massage, meditation, biofeedback therapy, hypnosis, guided imagery, and music therapy are alternative treatments for anxiety and insomnia.

Rationale 3: Eating a large meal prior to bedtime is a secondary cause of insomnia.

Rationale 4: Amphetamines, cocaine, caffeinated beverages, corticosteroids, sympathomimetics, antidepressants, alcohol use, nicotine, and tobacco use are secondary causes of insomnia.

Rationale 5: Reading can be used to bring on sleep, but not on a computer. The lights will often delay the responses of melatonin.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-1 Discuss factors contributing to anxiety and insomnia and explain some non-pharmacological therapies used to manage each of these disorders.

Question 5 Type: MCMA A client who recently experienced the loss of a spouse asks the nurse if there are any over-thecounter herbs or nonprescription medications that can be used to improve insomnia. Which response by the nurse is the most appropriate?

Standard Text: Select all that apply.

1. "Ginger root is commonly taken to improve sleep."

2. "Ginkgo is an herb commonly taken to improve sleep."

3. "Diphenhydramine (Benadryl) is an OTC drug sometimes taken to produce drowsiness."

4. "Valerian and melatonin are natural health products commonly taken to improve sleep."

5. "Kava is an herb taken to improve sleep."

Correct Answer: 3,4 Copyright © 2018 Pearson Canada Inc.

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Rationale 1: Ginger root is not used to improve sleep.

Rationale 2: Ginkgo is not used to improve sleep.

Rationale 3: Diphenhydramine is an antihistamines frequently used to produce drowsiness.

Rationale 4: An herbal product with demonstrated efficacy in promoting relaxation is valerian root. Supplemental melatonin, 0.5–3.0 mg at bedtime, is alleged to decrease the time required to fall asleep and to produce a deep and restful sleep.

Rationale 5: High doses of kava can damage the liver and should not be used unless recommended by a health care provider.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-1 Discuss factors contributing to anxiety and insomnia and explain some non-pharmacological therapies used to manage each of these disorders.

Question 6 Type: MCSA The nurse distinguishes medications used in general surgery as either hypnotic or sedative, or sedative–hypnotic. The nurse can anticipate the anesthesiologist using which sedative–hypnotic for induction of anesthesia?

1. Lorazepam (Ativan) 2. Oxazepam (Serax) 3. Phenobarbital (Phenobarb) 4. Temazepam (Restoril) Correct Answer: 3 Rationale 1: Lorazepam is a benzodiazepine used primarily for anxiety disorders.

Rationale 2: Oxazepam is a benzodiazepine used primarily for management of generalized anxiety disorder.

Rationale 3: Pentobarbital is a sedative–hypnotic that produces anesthesia at high doses.

Rationale 4: Restoril is a benzodiazepine approved for short-term therapy of insomnia.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-2 Identify drug classes used for treating anxiety and sleep disorders.

Question 7 Type: MCSA

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A client Is ordered temazepam ( Restoril) 7.5 mg at hs. The nurse completes her teaching with the client on the recommended use of this drug. Which of the following statements by the client indicates that more teaching is necessary?

1. “I will take this medication immediately before bedtime."

2. “I will not take this medication with alcohol."

3. "I can take this with a cup of chamomile tea."

4. “ I should taper this medication slowly once my sleep improves.”

Correct Answer: 3 Rationale 1: Taking before bedtime is recommended Rationale 2: This is a correct statement, alcohol may potentiate the drug’s sedative effect.

Rationale 3: Taking this drug with Chamomile may increase the sedative effect and is not recommended.

Rationale 4: This drug should be tapered slowly to reduce rebound insomnia.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 16-7 Use the nursing process to care for clients who are receiving drug therapy for anxiety and insomnia.

Question 8 Type: MCSA A nursing instructor asks her student why benzodiazepines are more commonly used for anxiety and insomnia. Which statement by the student indicates the need for clarification?

1. “ Withdrawal from barbiturates is severe and can be fatal.”

2.”They have less severe side effects when given orally.”

3. “They produce less physical dependance than other drugs in their class.”

4. “Larger doses can be used for anaesthesia.”

Correct Answer: 4 Rationale 1: This is a true statement and does not require clarification.

Rationale 2: This is a true statement and does not require clarification.

Rationale 3: This is a true statement and does not require clarification.

Rationale 4: This is true of barbiturates and not benzodiazepines.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-2 . Identify drug classes used for treating anxiety and sleep disorders.

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Question 9 Type: MCSA A client has asked the nurse about taking Melatonin for occasional insomnia. Which of the following reasons that the client discusses during her history would preclude her from using this drug?

1. Corticosteroid use for polymyalgia rheumatica 2. Migraine headaches 3. Peptic ulcer disease 4. Asthma Correct Answer: 1 Rationale 1: Melatonin should not betaken by those clients taking corticosteroids because of the chance it may interfere with the intended actions of the steroids.

Rationale 2: Migraines are not a contraindication to the use of Melatonin.

Rationale 3: Peptic ulcer disease is not a contraindication to the use of Melatonin.

Rationale 4: Asthma is not a contraindication to the use of Melatonin.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-7 Use the nursing process to care for clients who are receiving drug therapy for anxiety and insomnia.

Question 10 Type: MCSA The nurse is preparing to administer intravenous lorazepam (Ativan) to a client. Which nursing intervention is a priority following the parenteral administration of this medication?

1. Assess for drug interactions with other medications.

2. Instruct client to change positions slowly, especially from lying to standing.

3. Monitor for changes in respirations.

4. Assess for seizure activity.

Correct Answer: 3 Rationale 1: Assessing for drug interactions with other medications should be completed prior to administering the medication.

Rationale 2: Changing position slowly, especially from lying down to standing, helps to prevent dizziness and possible falls, especially in the older adult. However, this is not the priority intervention in this situation.

Rationale 3: When providing this medication through the parenteral route, the client should be monitored for respiratory depression.

Rationale 4: Ativan is used for several off-label indications, including seizures. However, this is not the priority intervention when administering the medication.

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Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 Describe and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with anxiety disorders and insomnia.

Question 11 Type: MCSA Lorazepam (Ativan) is ordered to be given through the intravenous route for a client with status epilepticus. The client currently has an intravenous infusion of dextrose 5% and 0.9% normal saline at the rate of 125 mL/hr. Which action demonstrates the correct administration of this medication by the nurse?

1. Administering Ativan by slow IV injection over a 2- to 4-minute period.

2. Injecting the Ativan quickly via IV push.

3. Discontinuing the intravenous infusion prior to administering the medication.

4. Mixing the Ativan in a 50cc bag of NS and administering piggyback over 30 minutes.

Correct Answer: 1 Rationale 1: Ativan should be administered over a 2- to 4-minute period when given via IV push.

Rationale 2: Rapid IV administration can result in apnea, hypotension, bradycardia, or cardiac arrest.

Rationale 3: The intravenous infusion does not need to be discontinued prior to administering the medication.

Rationale 4: Giving Ativan over 30 minutes would not benefit the client who needs immediate treatment for status epilepticus.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 Describe and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with anxiety disorders and insomnia.

Question 12 Type: MCMA Nursing students have completed their pharmacological module on sleep disorders. Which of the following medical conditions did they learn contribute to secondary insomnia?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Diabetes 2. Hyperthyroidism 3. Coronary Artery Disease Copyright © 2018 Pearson Canada Inc.

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4. Sleep apnea 5. Renal Failure Correct Answer: 2, 4 Rationale 1: There is no evidence to support that clients with Diabetes have secondary insomnia..

Rationale 2: Client’s with hyperthyroid can experience secondary insomnia due to night sweats Rationale 3: There is no evidence to support that clients with coronary artery disease have secondary insomnia Rationale 4: Sleep apnea may cause secondary insomnia. With sleep apnea, the client stops breathing at intervals during the night and often awakens several times a night.

Rationale 5. There is no evidence to suggest that renal failure is a cause of secondary insomnia.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 16-1 Discuss factors contributing to anxiety and insomnia and explain some non-pharmacological therapies used to manage each of these disorders.

Question 13 Type: MCMA A client is prescribed a medication for anxiety that will affect the limbic system. When instructing the client, the nurse explains that this medication will affect which areas?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Emotions 2. Behaviour 3. Long-term memory 4. Secretion of corticotropin-releasing factor 5. Production of melatonin Correct Answer: 1,2,3 Rationale 1: The limbic system is responsible for emotions.

Rationale 2: The limbic system is responsible for behaviour.

Rationale 3: The limbic system is responsible for long-term memory.

Rationale 4: The limbic system is not responsible for the secretion of corticotropin-releasing factor.

Rationale 5: The limbic system is not responsible for the production of melatonin.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-3 Explain the therapeutic action of drugs used to treat anxiety disorders and insomnia.

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Question 14 Type: MCMA A client is prescribed a medication that will inhibit the function of the reticular activating system.

What will the nurse assess as effects of this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Drowsiness 2. Sleeping 3. Alertness 4. Dilated pupils 5. Elevated blood pressure Correct Answer: 1,2 Rationale 1: Drugs that inhibit the reticular activating system will cause general drowsiness.

Rationale 2: Drugs that inhibit the reticular activating system will cause sleep.

Rationale 3: Drugs that inhibit the reticular activating system will not cause alertness.

Rationale 4: Drugs that inhibit the reticular activating system will not cause dilated pupils.

Rationale 5: Drugs that inhibit the reticular activating system will not cause elevated blood pressure.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-3 Explain the therapeutic action of drugs used to treat anxiety disorders and insomnia..

Question 15 Type: MCMA A hospitalized client who is not prescribed medication for sleep tells the nurse about using a sedative to sleep “for years.” What will the nurse most likely assess in this client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Sleeplessness 2. Anxiety 3. Daytime drowsiness 4. Dizziness 5. Blurred vision Correct Answer: 1,2,3 Rationale 1: Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is sleeplessness.

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Rationale 2: Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is anxiety.

Rationale 3: Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is daytime drowsiness.

Rationale 4: Dizziness is not a symptom of rebound insomnia.

Rationale 5: Blurred vision is not a symptom of rebound insomnia.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-6 and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with anxiety disorders and insomnia.

Question 16 Type: MCMA A client being treated for an anxiety disorder is prescribed medication for sleep. She asks the nurse how that will help her anxiety. What is the nurse’s best response?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. There is a link between anxiety and sleep.

2. Improving sleep will help with the anxiety disorder.

3. Less anti-anxiety medication will be needed during the day.

4. It will prevent rebound insomnia.

5. It will stop the client from worrying about not getting enough sleep.

Correct Answer: 1,2,5 Rationale 1: There is a pathophysiological link between sleep and anxiety.

Rationale 2: Insomnia therapy is more than just a nighttime problem. Anxiety and insomnia need to be treated together.

Rationale 3: There is no evidence to support that improving sleep will reduce the need for antianxiety medication during the day.

Rationale 4: Rebound insomnia occurs when a sedative drug is abruptly discontinued after it has been taken for several months or longer. Providing a medication for sleep may or may not prevent rebound insomnia in the client.

Rationale 5: Providing a sleeping medication may prevent the client from worrying about getting enough sleep and reduce the anxiety associated with sleeplessness.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-3 Explain the therapeutic action of drugs used to treat anxiety disorders and insomnia.

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Question 17 Type: MCSA A student nurse, under the supervision of her instructor is preparing to give IV lorazepam (Ativan) for a client undergoing a endoscopy. The instructor asks the student to tell her the mechanism of action before she gives the drug. What information does the student share with her instructor?

1. Potentiates the synthesis of tryptophan to serotonin.

2. It has an agonist effect on presynaptic dopamine receptors.

3. Potentiates the effect of GABA, a neurotransmitter in the CNS 4. It has an agonist effect on the neurotransmitter norepinephrine.

Correct Answer 3 Rationale 1: This is the method by which melatonin is formed.

Rationale 2: This is thought to be the action of non benzodiazepine and non barbiturate drugs used for anxiety and sleep.

Rationale 3: This is the correct action of a benzodiazepine.

Rationale 4: An agonist effect on norepinephrine would stimulate mental activity, not produce sedation or sleep Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-5 For each of the drug classes listed in Prototype Drugs, identify a representative drug and explain its mechanism of action, therapeutic effects, and important adverse effects.

Question 18 Type: MCMA Which of the following assessment findings would cause the nurse to withhold a scheduled dose of secobarbital?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Respiratory rate of 8 breaths per minute 2. Heart rate of 98 beats per minute 3. Blood pressure 95/62 mmHg 4. Temperature 99.8ºF 5. Pain level 5 on numeric pain scale Correct Answer: 1,3 Rationale 1: Respiratory depression is a serious adverse effect of this medication.

Rationale 2: This heart rate is within normal limits.

Rationale 3: Hypotension is a side effect of barbiturate therapy Rationale 4: Temperature elevation is not an adverse effect of this medication.

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Rationale 5: Pain is not an adverse effect of this medication.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-4 Describe the nurse’s role in the pharmacologic management of clients with anxiety disorders and insomnia.

Question 19 Type: MCMA The nurse notes that a client is prescribed oxazepam (Serax) at a dose smaller than is recommended. What would the nurse review to determine the reason for the reduced dose?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Client’s age 2. Blood-urea-nitrogen level 3. Increased HbA1C 4. Liver function studies 5. White blood cell count Correct Answer: 1,2,3,4 Rationale 1: This medication should be used cautiously in older clients.

Rationale 2: The dose may be lower because of impaired kidney function, which can increase serum drug levels.

Rationale 3: An increase in HbA1C would not be a reason for a decreased dose of this medication.

Rationale 4: The dose may be lower because of impaired liver function, which can increase serum drug levels.

Rationale 5: White blood cell count is not a precaution for this medication.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-5 . For each of the drug classes listed in Prototype Drugs, identify a representative drug and explain its mechanism of action, therapeutic effects, and important adverse effects.

Question 20 Type: MCMA The nurse’s client is prescribed medication for sleep, and the nurse is providing instruction on lifestyle changes that may influence the drug’s effectiveness. What would be included in this teaching?

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Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Avoid caffeine.

2. Reading on computer screens may help induce sleep.

3. Limit alcohol intake.

4. Exercise before bedtime.

5. Limit the intake of green leafy vegetables.

Correct Answer: 1,3 Rationale 1: Caffeine may decrease the effectiveness of prescribed medications.

Rationale 2: Computer screens may suppress the body’s release of Melatonin which may delay sleep.

Rationale 3: Alcohol may increase the adverse effects of prescribed medications.

Rationale 4: Exercise should be increased during the day but not before bedtime.

Rationale 5: Green leafy vegetables do not need to be limited with these medications.

Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 16-6 Describe and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with anxiety disorders and insomnia.

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Chapter 17 Pharmacotherapy of Emotional and Mood Disorders Question 1 Type: MCSA The client tells the nurse, “I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?” Which response by the nurse is the most appropriate?

1. “Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter.”

2. “Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania.”

3. “Bipolar disorder is just another type of depression, except your depression occurs in cycles.”

4. “Bipolar disorder is a type of depression that includes attention deficit disorder symptoms.”

Correct Answer: 2 Rationale 1: A mood change that becomes worse in the winter is called seasonal affective disorder.

Rationale 2: Clients with bipolar disorder can shift from emotions of extreme depression to extreme rage and agitation. Mania can include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions.

Rationale 3: Bipolar disorder must include either mania or hypomania, not just depression.

Rationale 4: Bipolar disorder must include depression with either mania or hypomania, not attention deficit disorder.

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-1 Compare and contrast the major categories of mood disorders and their symptoms.

Question 2 Type: MCSA Mood disorders are emotional disorders characterized by changes in mood, and they range from mania to depression. Which symptoms characterize major depressive disorder?

1. Fatigue and decreased appetite 2. Anxiety and elevated mood 3. Low mood and increased activity 4. Psychosis and euphoria Correct Answer: 1 Rationale 1: Major depressive disorder can be associated with fatigue and decreased appetite.

Rationale 2: Bipolar disorder is characterized by elevated mood (mania).

Rationale 3: Low mood and increased activity are hallmarks of bipolar disorder.

Rationale 4: Psychosis and euphoria are symptoms of bipolar disorder.

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Cognitive Level: Remembering Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-1 Compare and contrast the major categories of mood disorders and their symptoms.

Question 3 Type: MCSA Mood disorders are closely associated with which part of the brain?

1. Limbic 2. Hippocampus 3. Hypothalamus 4. Brainstem Correct Answer: 1 Rationale 1: The limbic system is associated with mood disorders.

Rationale 2: The hippocampus is not associated with mood disorders.

Rationale 3: The hypothalamus is not associated with mood disorders.

Rationale 4: The brainstem is not associated with mood disorders.

Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-2 Explain the pathophysiology of major depression and bipolar disorder.:

Question 4 Type: MCSA A client with depression is to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask?

1. “Are you allergic to any medications?”

2. “How long have you been depressed?”

3. “Have you had any thoughts about killing yourself?”

4. “How much alcohol do you consume during the week?”

Correct Answer: 3 Rationale 1: Asking about allergies is a good safety question but is not the priority with a depressed client, and there are very few allergies to antidepressant medication. This question can be asked later.

Rationale 2: The length of the client’s depression is important but is not the most important question to ask.

Rationale 3: The nurse should always assess for suicidal ideation in any depressed client who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue.

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Rationale 4: Assessing for alcohol intake is important but is not the most important question. .

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-6 Discuss the nurse’s role in the pharmacological management of clients with depression or bipolar disorder.

Question 5 Type: MCSA A client with bipolar disorder in the manic phase is started on lithium (Carbolith). The client’s current lithium level is 0.4 mEq/L. What will the nurse expect to assess in this client?

1. A return to baseline behaviour: calm and rational 2. Signs and symptoms of depression 3. Hyperactivity and pressured speech 4. A decrease in manic behaviour Correct Answer: 3 Rationale 1: The client will not return to baseline behaviour but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 2: The client will not exhibit signs and symptoms of depression but will continue in the manic phase.

Rationale 3: At the start of therapy, the lithium level should be maintained within the range of 0.8 to 1.4 mEq/L. Since this client’s level is low, behaviours will indicate mania—i.e., hyperactivity and pressured speech.

Rationale 4: There will be no decrease in manic behaviour, because the lithium level is too low. not exhibit signs and symptoms of depression but will continue in the manic phase. There will be no decrease in manic behaviour, because the lithium level is too low.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-7 Describe and explain, based on pharmacological principles , the rationale for nursing assessment, planning , and interventions for clients with mood disorders.

Question 6 Type: MCSA The client asks the nurse why she needs to continue using table salt, because her prescribed lithium (Carbolith) is a salt. What is the best response by the nurse?

1. “You must continue to use salt to avoid lithium (Carbolith) toxicity. If you use sea salt, you don’t need as much.”

2. “You must use table salt or your kidneys will retain lithium (Carbolith), and you will become toxic.”

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3. “Salt is very important to avoid lithium (Carbolith) toxicity, but not as important as drinking 1 to 1.5 L of water per day.”

4. “The amount is not important; just increase your table salt if you notice signs of lithium (Carbolith) toxicity.”

Correct Answer: 2 Rationale 1: There is no evidence to support the claim that sea salt is more effective than any other kind of salt.

Rationale 2: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt—in this case, lithium (Carbolith). This will lead to lithium (Carbolith) toxicity.

Rationale 3: Drinking 1 to 1.5 L of water per day of water is important, but does not substitute for adequate sodium chloride intake.

Rationale 4: Instructing a client to increase salt if toxicity occurs is inappropriate because the client must try to avoid toxicity, not treat it after it occurs.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-7 Describe and explain, based on pharmacological principles, the rationale for nursing assessment, planning, and interventions for clients with mood disorders.

Question 7 Type: MCSA The nurse is caring for a client receiving electroconvulsive therapy (ECT). What is the priority assessment for this client?

1. Orientation 2. Level of consciousness 3. Airway 4. Vital signs Correct Answer: 3 Rationale 1: Orientation would be the last priority.

Rationale 2: Level of consciousness would be the third priority.

Rationale 3: The client who undergoes ECT receives general anesthesia for this treatment. It is essential to monitor for respiratory depression following anaesthesia.

Rationale 4: Vital signs would be the second priority.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-6 Discuss the nurse’s role in the pharmacological management of clients with depression or bipolar disorder.

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A client, prescribed fluoxetine (Prozac) for anxiety and depression, reports experiencing delayed ejaculation since being on this medication. Which response by the nurse is the most appropriate?

1. “I am concerned that you will become suicidal if you stop the medication.”

2. “Keep taking the medicine, as this usually goes away after a few months.”

3. “ We should discuss this with your physician.”

4. “This does happen, but treating your depression is a bigger priority.”

Correct Answer: 3 Rationale 1: The client could become suicidal if he stops the medication, but this response does not address the client’s concern.

Rationale 2: This is an untrue statement.

Rationale 3: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% of men and women experience this. In men, delayed ejaculation and impotence can occur.

Rationale 4: It is inappropriate to tell a client that his depression is a higher priority. Sexual functioning is important to clients.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-5 For each of the drug classes listed in Prototype Drugs, identify a representative drug and explain its mechanism of action, primary actions, and important adverse effects.

Question 9 Type: MCSA A client diagnosed with depression has been placed on imipramine ( Impril). What would the nurse most likely assess if the client experiences adverse effects of this medication?

1. Various anemias accompanied by bradycardia 2. Hypertension with severe emesis 3. Dizziness accompanied by possible photosensitivity 4. Polyuria with gross proteinuria Correct Answer: 3 Rationale 1: Anemia and bradycardia are not adverse effects of this drug.

Rationale 2: Hypertension is not an adverse effect of this medication.

Rationale 3: The most common adverse effects of imipramine include dizziness and, to a lesser extent, photosensitivity.

Rationale 4: Polyuria is not an adverse effect of this medication.

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Learning Outcome: 17-5 For each of the drug classes listed in Prototype Drugs, identify a representative drug and explain its mechanism of action, primary actions, and important adverse effects.

Question 10 Type: MCSA Which medication, when administered with lithium, increases the risk of toxicity?

1. Ciprofloxacin 2. Sodium bicarbonate 3. Calcium iodine 4. Furosemide Correct Answer: 4 Rationale 1: Ciprofloxacin does not increase the risk of toxicity if taken with lithium.

Rationale 2: Sodium bicarbonate does not increase the risk of toxicity if taken with lithium.

Rationale 3: Calcium iodine does not increase the risk of toxicity if taken with lithium.

Rationale 4: Lithium, when combined with a diuretic such as furosemide, increases the potential for sodium depletion, thereby increasing therapeutic blood levels of lithium to the toxic range.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-5 For each of the drug classes listed in Prototype Drugs, identify a representative drug and explain its mechanism of action, primary actions, and important adverse effects.

Question 11 Type: MCMA The nurse educator is conducting class on depression. Which of the following statements by a student indicates an understanding of the pathophysiology?

1. “May involve an excess of excitatory neurotransmitters .”

2. “Low level of neurotransmitters in the limbic region are a possible cause of depression.”

3. “ Low serum cortisol levels may be responsible for depression” 4. “ The re-uptake of neurotransmitters are inhibited” Correct Answer: 2 Rationale 1: This would be true of mania.

Rationale 2: Major depression has been associated with abnormally low levels of neurotransmitters such as norepinephrine, serotonin, and dopamine in this region..

Rationale 3: About half of persons who are depressed have abnormally high serum cortisol levels. Cortisol mobilizes the body for stress situations and is thought to reduce serotonin levels in the brain, bringing about symptoms of depression. .

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Rationale 4: This is the action of many anti-depressants, not the pathophysiology behind depression.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17-2 Explain the pathophysiology of major depression and bipolar disorder.

Question 12 Type: MCSA A client taking amitriptyline (Elavil) for two weeks tells the nurse that the medication “isn’t working” because feelings of depression continue. Which response by the nurse is the most appropriate?

1. “This might not be the best medicine for you; I’ll call your doctor.”

2. “You might still feel depressed, but you are looking much better.”

3. “It is working, but it can take several months to have an effect.”

4. “It is working, but it can take several weeks to have an effect.”

Correct Answer: 4 Rationale 1: It is inappropriate for the nurse to call the health care provider; tricyclic antidepressants need time to work.

Rationale 2: Telling depressed clients they look better negates their feelings and is inappropriate.

Rationale 3: The time frame for efficacy is several weeks, not several months.

Rationale 4: The therapeutic effects of tricyclic antidepressants can take 2–6 weeks to appear.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-3 Identify drug classes used for treating emotional and mood disorders.

Question 13 Type: MCMA The nurse has completed medication education for a client about to begin therapy with phenelzine (Nardil). The nurse evaluates the education as effective when the client makes which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I can’t eat fried chicken and gravy.”

2. “I’ll have to give up my beer at the football games.”

3. “I really shouldn’t eat at a restaurant; too many foods are on my restricted list.”

4. “I am not supposed to have processed meats or cheese.”

5. “I am really going to miss my morning coffee and sweet roll.”

Correct Answer: 2,4

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Rationale 1: Fried chicken and gravy are not high in tyramine and are considered safe for a client taking a monoamine oxidase inhibitor (MAOI).

Rationale 2: Beer is high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis.

Rationale 3: There are many foods that are safe to eat; the client can safely eat at a restaurant.

Rationale 4: Processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis.

Rationale 5: Coffee and sweet rolls are not high in tyramine and are considered safe for a client taking a monoamine oxidase inhibitor (MAOI).

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-8 Use the nursing process to care for clients who are receiving drug therapy for emotional and mood disorders Question 14 Type: MCMA Which of the following symptoms would be assessed in a client in a manic phase of bipolar disorder?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Not sleeping 2. Losing weight 3. Sluggish activity 4. Complaints of muscle pain 5. Constant talking Correct Answer: 1,2,5 Rationale 1: Decreased need for sleep is a symptom of the manic phase of bipolar disorder.

Rationale 2: Decreased need for food is a symptom of the manic phase of bipolar disorder.

Rationale 3: Sluggish activity is not a symptom of the manic phase of bipolar disorder.

Rationale 4: Complaints of muscle pain are not a symptom of the manic phase of bipolar disorder.

Rationale 5: Increased talkativeness is a symptom of the manic phase of bipolar disorder.

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-1 Compare and contrast the major categories of mood disorders and their symptoms.

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Type: MCMA The nurse is instructing a client on the cause of bipolar disorder. Which neurotransmitters will the nurse describe as contributing to the manic phase of this disorder?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Excessive glutamate 2. Excessive norepinephrine 3. Deficiency of gamma-aminobutyric acid 4. Deficiency of dopamine 5. Excessive serotonin Correct Answer: 1,2,3 Rationale 1: Mania may involve an excess of excitatory neurotransmitters such as glutamate.

Rationale 2: Mania may involve an excess of excitatory neurotransmitters such as norepinephrine.

Rationale 3: Mania may involve a deficiency of inhibitory neurotransmitters such as gammaaminobutyric acid (GABA).

Rationale 4: Dopamine is not associated with the manic phase of bipolar disorder.

Rationale 5: Serotonin is not associated with the manic phase of bipolar disorder.

Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-2 Explain the pathophysiology of major depression and bipolar disorder.

Question16 Type: MCSA Students are learning about the classifications of medications used to treat depression. Which of the following classifications do they learn is considered the classification of choice due to more tolerable side effects?

1. Tricyclic antidepressants (TCAs) 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Monoamine oxidase (MAO) inhibitors 4. Norepinephrine re-uptake inhibitors Correct answer 2 Rationale 1: TCAs produce fewer side effects and are less dangerous than MAO inhibitors.

However, TCAs have some unpleasant and serious side effects, including a potential to accumulate in cardiac tissue causing cardiac dysrhythmias.

Rationale 2: SSRIs are drugs of choice in the pharmacotherapy of depression due to their more tolerable side effects.

Rationale 3. MAO inhibitors are usually prescribed in cases where other antidepressants have not been successful. They have more serious side effects than other antidepressants.

Rationale 4: Norepinephrine re-uptake inhibitors have specific symptoms that they are used for and is currently only available through Health Canada’s Special Access program.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Copyright © 2018 Pearson Canada Inc.

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Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17-3 Identify drug classes used for treating emotional and mood disorders.

Question 17 MCSA A student is about to administer an MAO inhibitor to her client. Her instructor asks her to identify it’s mechanism of action. What is the correct response of the student ?

1. “It inhibits norepinephrine re-uptake.”

2. “ It Inhibit norepinephrine, serotonin, and dopamine reuptake.”

3. “ It’s the enzyme that terminates the actions of neurotransmitters.”

4. “ It inhibits the amino acid tyranine.

Correct Answer: 3 Rationale 1: This would be the action of an atypical antidepressant i.e. a Norepinephrine (NE ) Reuptake Inhibitor Rationale 2: This is the action of a tricyclic antidepressant (TSA) Rationale 3. Monoamine oxidase (MAO) inhibitors inhibit monoamine oxidase, the enzyme that terminates the actions of neurotransmitters such as dopamine, norepinephrine, epinephrine, and serotonin.

Rationale 4 Tyranine is a substance in many foods that can cause a serious interaction with MAO inhibitors Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17-4 Explain the therapeutic action of antidepressant drugs in relation to physiological aspects of neurotransmission.

Question 18 MCSA A nurse is conducting a health history and physical on a client who has been ordered phenelzine (Nardil) an MAO inhibitor. She has tried other antidepressants in the past but they have not been effective in treating her symptoms. What does the nurse uncover during her history that should be reported to the health care provider?

1. Client has a history of heart failure 2. Client has had colon cancer 3. Client has osteoporosis 4. Client has an eating disorder Correct Answer 1 Rationale 1 Phenelzine (Nardil) is contraindicated in cardiovascular disease, heart failure, cerebrovascular accident, and hepatic or renal dysfunction, Rationale 2. There is no evidence to support that clients with a history of colon cancer should not take this drug Copyright © 2018 Pearson Canada Inc.

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Rationale 3. There is no evidence to support that clients with a history of osteoporosis should not take this drug.

Rationale 4. There is no evidence to support that clients with a history of an eating disorder should not take this drug.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17-8 Use the nursing process to care for clients who are receiving drug therapy for emotional and mood disorders.

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Chapter 18 Central Nervous System Stimulants and Pharmacotherapy of Attention Deficit and Hyperactive Disorders Question 1 Type: MCSA The mother of a school-age client tells the school nurse, “My son is so hyperactive. I can’t see any harm in putting him on medication, especially since the stimulants have so few side effects.”

Which response by the nurse is the most appropriate?

1. "Stimulants can cause the side effect of excessive excitation."

2. "Have you made an appointment for your son to see the health care provider?"

3. "Stimulants can be helpful in hyperactivity disorders."

4. "What actions lead you to think your son is hyperactive?"

Correct Answer: 1 Rationale 1: A side effect of stimulants is excessive excitation.

Rationale 2: The misunderstanding is regarding whether stimulants have side effects, not obtaining an appointment with the health care provider.

Rationale 3: The mother already perceives that stimulants would help her son's behaviour.

Rationale 4: In order to be prescribed a stimulant, the son would need to see a health care provider to determine symptoms of hyperactivity, but the misunderstanding here is regarding stimulants having side effects. .

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-1 Describe the general actions and pharmacotherapeutic applications of central nervous system stimulants.

Question 2 Type: MCSA A mother expresses concern that her school-age child may need to be started on medication for ADHD. Which statements by the mother does the nurse interpret as a potential indicator of ADHD? 1. “When I ask him to do his chores, he finishes his game before he starts.”

2. “His teacher says that he isn’t able to complete assignments that require him to sit and write for 5 to10 minutes at a time. He doodles on his paper or badgers others in the classroom instead of working on his assignment.”

3. “In the last month, he has twice forgotten to ask me to give him his lunch money for the day.”

4. “When I tell him to clean his room, he doesn’t clean under furniture or dust his furniture.

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Correct Answer: 2 Rationale 1: Clients with ADHD either forget to perform the chore or fail to finish the chore.

Rationale 2: Clients with ADHD avoid tasks that require mental effort for a long period of time and fail to finish schoolwork; they have trouble keeping attention on a task.

Rationale 3: Clients with ADHD often forget things needed for daily activities, not just occasionally.

Rationale 4: Cleaning the house without accuracy in details would be normal for a school-age child. Clients with ADHD would be more apt to start and not finish, or to forget to clean at all.

Cognitive Level: Evaluating Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-2 Identify the signs and symptoms of attention deficit/hyperactivity disorder.

Question 3 Type: MCSA Methylphenidate (Ritalin) has been prescribed for a school-age client newly diagnosed with ADHD. Which comment by the mother would indicate that the nurse should provide more teaching about this medication?

1. "I will give this medication in the evening after meals to decrease stomach upsets.”

2. "I will monitor my child's appetite and watch for excessive weight loss."

3. "I will give him a drug free holiday in the summertime."

4. "I will give this medication early in the day in order to reduce chances of insomnia."

Correct Answer: 1 Rationale 1: The last dose of the drug should be given approximately 6 hours before bedtime for multiple daily doses, and 10-12 hours before bedtime for once daily dosing due to the insomnia it may cause.

Rationale 2: Weight loss and anorexia have been reported with Ritalin use.

Rationale 3: Periodic drug-free “holidays” are recommended to reduce drug dependence and to assess the client’s condition Rationale 4: One of the side effects of Ritalin is insomnia.

Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome:18-4 Describe the nurse’s role in the management of attention deficit/hyperactivity

Question 4 Type: MCSA Copyright © 2018 Pearson Canada Inc.

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A school-age client comes to the clinic for routine follow-up after being placed on Methylphenidate (Ritalin) 2 weeks ago for a diagnosis of ADHD. The client weighed 15 pounds over normal for height prior to the start of the Ritalin. The mother states concern that the client is no longer snacking, barely finishes meals, and “will lose too much weight.” What is the nurse’s best response to this concern?

1. ”Make an appointment each week for us to monitor against too much weight loss."

2. "It is normal for clients to lose weight when taking Ritalin."

3. "The diminished appetite may reduce. Begin by offering small, frequent meals, continue to monitor weight loss."

4. "The Ritalin will help the client to return to normal weight for his height."

Correct Answer: 3 Rationale 1: There is no reason to bring the client in for weighing each week. The mother can monitor for weight loss and call the health care provider for concerns.

Rationale 2: Weight loss is a side effect of amphetamines, but this does not directly address the concern.

Rationale 3: Offering small, frequent meals and monitoring for weight loss are the most appropriate actions.

Rationale 4: Stating that the Ritalin will help the client return to normal weight is not an appropriate comment.

Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18–5 For each class of drugs listed in the Chapter Outline, identify the prototype and representative drugs and explain the mechanisms of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

Question 5 Type: MCMA A school-age client who is taking methylphenidate (Ritalin) for treatment of ADHD is seen in the clinic for routine follow-up. The nurse will automatically perform which functions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Measure the client's height and weight.

2. Assess vital signs, especially heart rate and BP. 3. Obtain labs to assess cardiovascular status.

4. Obtain a fasting blood glucose.

5. Obtain a 24-hour urine collection for proteinuria.

Correct Answer: 1,2 Rationale 1: Placing children on amphetamines for ADHD can affect their weight. Height and weight should be checked regularly.

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Rationale 2: Amphetamines can increase BP and heart rate. Both should be monitored.

Rationale 3: A cardiovascular workup is to be performed prior to starting amphetamines. There is nothing in the stem to indicate further workup is necessary at this time.

Rationale 4: There is no evidence that the client is having symptoms of blood glucose imbalance.

Rationale 5: There is no reason to perform a 24-hour urine, as there is no indication that the client is experiencing renal problems.

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-4 Describe the nurse’s role in the pharmacologic management of attention deficit/hyperactivity disorder and narcolepsy.

Question 6 Type: MCSA An adult client who is seen by the primary care provider for complaints of inability to focus and concentrate on college studies is prescribed methylphenidate (Ritalin). Which client comment indicates that the nurse should provide additional information about the drug?

1. "I'll wait until I've taken the medication a few days before driving."

2. "I'll call the doctor immediately if I become jaundiced."

3. "It would be nice if my appetite were decreased with this medication, as I've been wanting to shed a few pounds."

4. "I'll take the drug in the evening before bedtime."

Correct Answer: 4 Rationale 1: Clients should not drive until the effects of the medication are known.

Rationale 2: The health care provider should be notified immediately for jaundice, as incidences of liver injury have been noted.

Rationale 3: Ritalin might cause weight loss.

Rationale 4: It is recommended that the client take the drug early in the day to decrease incidence of insomnia.

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18–4 Describe the nurse’s role in the pharmacological management of attention deficit/hyperactivity disorder.

Question 7 Type: MCMA A client recently prescribed methylphenidate (Ritalin) for treatment of ADHD complains of an inability to go to sleep at night. Which nursing actions are indicated?

Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.

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Standard Text: Select all that apply.

1. Assess for caffeine intake, especially late in the afternoon or evening hours.

2. Assess for time of day that Ritalin is taken.

3. Assess for nonpharmacologic measures taken to induce sleep.

4. Inform the health care provider that the client is unable to fall asleep while taking Ritalin.

5. Suggest taking melatonin to assist in nighttime drowsiness.

Correct Answer: 1,2,3 Rationale 1: Caffeine intake will cause additive CNS stimulant effects when taken concurrently with Ritalin.

Rationale 2: Ritalin should be taken no later than 6 p.m., and should be taken earlier if interference with sleep occurs.

Rationale 3: An assessment should be made of what measures the client has tried to help with sleep before contacting the health care provider (for example, meditation, quiet activities at bedtime, reduced lighting, etc.).

Rationale 4: Before informing the health care provider that the client is having difficulty falling asleep while taking Ritalin, find out what other measures could be causative factors.

Rationale 5: Melatonin should not be taken with amphetamines, as CNS stimulation can be enhanced.

Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-5 Apply the nursing process to care for clients receiving pharmacotherapy with central nervous system stimulants.

Question 8 Type: MCMA The nurse provides information regarding methylphenidate (Concerta) to the parents of a schoolage client. Which statements indicate that the parents have good understanding of the information?

Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I will talk with the school nurse about administering a dose at about noon each day.”

2. “We should fold the patch with the medication side facing in before it is thrown in the garbage.”

3. “We should not expect physical dependence at the low dose given for ADHD.” 4. “We can expect that the health care provider will occasionally tell us to stop giving the medication for a few days.”

5. “If our child experiences loss of appetite, we should immediately contact the health care provider.”

Correct Answer: 3,4

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Rationale 1: Concerta is a long duration form of methylphenidate. Midday dosing is not necessary.

Rationale 2: Concerta is not available in a patch form.

Rationale 3: Physical dependence is uncommon at therapeutic dosages.

Rationale 4: The use of drug-free periods is common when therapy with Concerta is prolonged.

Rationale 5: Loss of appetite is a common adverse effect of Concerta. Notifying the health care provider is not necessary.

Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18–6 Apply the nursing process to care for clients who are receiving pharmacotherapy with central nervous system stimulants.

Question 9 Type: MCMA The mother of a paediatric client prescribed Clonidine (Catapres) for treatment of ADHD makes these remarks. Which statements indicate that the nurse should provide additional information about the drug?

Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I’m so glad that the doctor chose a medication that won’t make my child sleepy.”

2. “I think my dad takes that for his high blood pressure.”

3. “I can expect that the doctor will take my child off this medication for a few days every 6 months or so.”

4. “I must warn my parents that Dad’s clonidine cannot be substituted for the Catapres.”

5. “At least my child will not become addicted to this medication.”

Correct Answer: 1,3 Rationale 1: Catapres can cause sedation and fatigue.

Rationale 2: The original indication for clonidine was hypertension.

Rationale 3: Drug holidays are not used with Catapres. If the medication is discontinued abruptly, rebound hypotension can occur.

Rationale 4: Catapres is not interchangeable with other forms of clonidine.

Rationale 5: There is no risk of physical dependence with Catapres.

Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18-5 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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