Drugs

Multiple Choice

1. A patient diagnosed with migraine headache is experiencing what type of pain?

a. Acute pain b. Persistent pain c. Vascular pain d. Phantom pain

ANS: C

Vascular pain is thought to account for a large percentage of migraine headaches. It is believed to originate from vascular or perivascular tissues. It is characterized by persistent and recurring pain lasting 3 to 6 months. Acute pain is sudden and usually subsides when treated. Phantom pain occurs in the area of a body part that has been removed surgically or traumatically and is often described as burning, itching, tingling, or stabbing. It can also occur in paralyzed limbs following spinal cord injury.

DIF: Cognitive Level: Comprehension REF: p. 196 a. A synthetic opioid, such as meperidine hydrochloride b. An opium alkaloid, such as morphine sulphate c. An opioid antagonist, sucN h asRnaI loxoGne B hy . dC rochMloride (Suboxone®) d. A non-opioid analgesic, suU ch aS s traNmaT dol O

2. An 18-year-old basketball player fell and twisted his ankle during a game. Which type of analgesic is he likely to be given?

ANS: D

Pain originating from skeletal muscles, ligaments, and joints usually responds to non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). All drugs in the NSAID class are especially useful for pain associated with inflammatory conditions because these drugs have analgesic and anti-inflammatory effects.

DIF: Cognitive Level: Application REF: p. 207 a. Temperature b. Respiration rate c. Appearance of the incision d. Time of last bowel movement

3. A patient is in the recovery room following abdominal surgery. He is groggy but reports severe pain around his incision. What is the most important factor for the nurse to consider during her patient assessment before administering a dose of morphine sulphate?

ANS: B

One of the most serious side effects of opioids is respiratory depression, so respiration must be assessed prior to administering a dose of morphine.

DIF: Cognitive Level: Analysis REF: p. 220 a. Close observation for signs of opioid tolerance b. Immediate intubation and artificial ventilation c. Administration of naloxone, an opioid reversal agent d. Administration of an agonist opioid, such as fentanyl (Duragesic Mat)

4. A 78-year-old patient is in the recovery room after lengthy hip surgery. While gradually awakening, the patient requests pain medication. Within 10 minutes after receiving a dose of morphine sulphate, the patient is very lethargic; respiration is shallow, at a rate of nine respirations per minute. What necessary action may the nurse need to perform?

ANS: C

Naloxone, an opioid reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression.

DIF: Cognitive Level: Application REF: p. 206 a. How to manage diarrhea b. How to access drug addiction programs c. How to prevent constipation d. How to avoid dehydration due to polyuria

5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after his abdominal surgery. What should the nurse teach this patient in regard to this drug?

ANS: C

Gastrointestinal occurrences such as nausea, vomiting, and constipation are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. N

DIF: Cognitive Level: Application REF: p. 206| p. 219 a. Opioid toxicity b. Addiction c. Opioid tolerance d. Abstinence syndrome

6. A patient who has been treated for lung cancer for 3 years has noticed that over the past few months the opioid analgesic that is being used is not helping as much, and says that taking more medication is needed for the same pain relief. What is this patient experiencing?

ANS: C

Opioid tolerance is a common physiological result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia.

DIF: Cognitive Level: Comprehension REF: p. 200 a. Tachycardia b. Central nervous system (CNS) depression c. Hepatic necrosis d. Nephrotic necrosis

7. A 38-year-old male has arrived at the urgent care centre with severe hip pain after falling from a ladder at work. He has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol®). What is the most serious toxic effect of acute acetaminophen overdose?

ANS: C

Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. Tachycardia and CNS depression are not side effects of acute acetaminophen overdose. Long-term, not short-term, ingestion of large doses is more likely to result in nephropathy.

DIF: Cognitive Level: Comprehension REF: p. 211 a. It has minimal analgesic effects. b. It works to reverse the effects of opiates. c. Its adverse effects differ from those of the opiate narcotics. d. It has a lower addiction potential than opiate narcotics.

8. The drug pentazocine (Talwin®) is a narcotic agonist–antagonist. Which statement describes a characteristic of this type of medication?

ANS: D

Opioid agonist–antagonist drugs generally have lower addiction potentials than opiate narcotics.

DIF: Cognitive Level: Comprehension REF: p. 211 a. She should be given NSAIDs. b. Her current therapy shouN ld nR ot bI e chGangBed. . C M c. The baseline dose of the narcotic may need to be increased in increments. d. The narcotic route should be changed to the rectal route, to increase absorption.

9. A 57-year-old patient has been on a transdermal narcotic analgesic as part of the management of pain for end-stage breast cancer. Lately, she has experienced ―breakthrough‖ pain. How should this pain be addressed?

ANS: C

If a patient is requiring larger doses for breakthrough pain, the baseline dose of the narcotic may need to be titrated upward.

DIF: Cognitive Level: Analysis REF: p. 201 a. Muscle aches b. Headaches c. Leg cramps d. Incisional pain after surgery

10. For which situation is the herb feverfew commonly used?

ANS: B

Feverfew is commonly used to treat migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

DIF: Cognitive Level: Comprehension REF: p. 219 a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving the medication c. Disguising the flavour with a soft drink or flavoured water d. Preparing to give the medication via a nebulizer

11. A patient is to receive acetylcysteine as part of treatment for an acetaminophen overdose. Which action by the nurse is appropriate when administering this medication?

ANS: C

Acetylcysteine has the flavour of rotten eggs. It is better tolerated when the taste is disguised by mixing it with a soft drink or flavoured water to increase its palatability. Giving this medication undiluted is not recommended. The use of a straw will help minimize contact with mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not acetaminophen overdose.

DIF: Cognitive Level: Application REF: p. 220 a. Pain associated with peripheral neuropathy b. Inflammation pain c. Depression associated with chronic pain d. Prevention of possible seizures

12. A patient is receiving an anticonvulsant but has no history of seizures. What is the most likely reason the patient is receiving this drug?

ANS: A

Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. Pain from inflammation is best treated with NSAIDs. This patient is not receiving this anticonvulsant drug for depression associated with chronic pain or to prevent possible seizures.

DIF: Cognitive Level: Comprehension REF: p. 222 a. Transdermal lidocaine (EMLA®) b. Tramadol hydrochloride (Ultram®) c. Naloxone hydrochloride d. Fentanyl (Duragesic MAT®)

13. A patient has been diagnosed with shingles and is experiencing postherpetic neuralgia. What would the nurse expect to administer for pain relief?

ANS: A

Transdermal lidocaine is indicated for the treatment of postherpetic neuralgia, a painful skin condition that remains after a skin outbreak of shingles. Tramadol hydrochloride, naloxone hydrochloride, and fentanyl are not indicated for postherpetic neuralgia.

DIF: Cognitive Level: Application REF: p. 214

Multiple Response

1. Nalbuphine (Nubain®) is a partial opioid agonist. What characterizes this type of medication? (Select all that apply.)

a. Used for mild pain b. Used for moderate to severe pain c. Drug of choice for reversing the effects of opioids in cases of overdose d. Usually used for long-term conditions e. Usually used for short-term conditions f. Sometimes used in those who have a history of opioid addiction

ANS: B, E, F

Partial opioid agonists are used for moderate to severe pain in conditions requiring short-term pain control, such as after surgery and for obstetric procedures. They are sometimes chosen for patients who have a history of opioid addiction.

DIF: Cognitive Level: Comprehension REF: pp. 210-211

Chapter 12: General and Local Anaesthetics

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. After piercing a finger with a fish hook during a fishing trip, a patient is now at an emergency department to have the hook removed. What type of anaesthesia will be used for this procedure?

a. Topical benzocaine spray to the area b. Spinal anaesthesia with mepivacaine hydrochloride c. Topical prilocaine cream (EMLA®) around the site d. Infiltration of the area with tetracaine hydrochloride

ANS: D

Infiltration anaesthesia is commonly used for minor surgical procedures. It involves injecting the local anaesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anaesthetized. The local anaesthetic may be administered in a circular pattern around the operative field.

DIF: Cognitive Level: Application REF: p. 234, Box 12-2 a. Epinephrine prevents an anaphylactic reaction from occurring. b. The anaesthetic enhances the effect of the epinephrine. c. Epinephrine contributes to a balanced anaesthetic state. d. Vasoconstrictive effects keUep tShe aNnaeTsthetic a O t its local site of action.

2. A patient is to receive local anaesthesia for removal of a lymph node from the groin. Why does the physician add epinephrine to the local anaesthetic during the preparation?

ANS: D

Vasoconstrictors such as epinephrine are coadministered with local anaesthetics to keep the anaesthetic at its local site of action and to prevent systemic absorption.

DIF: Cognitive Level: Application REF: p. 236 a. Pupil responses b. Return to sensation c. Level of consciousness d. Airway, breathing, and circulation

3. During the postoperative recovery period, what should be the nurse‘s immediate main concern?

ANS: D

After surgery and the termination of general anaesthesia, the nurse‘s main concern should be assessing the patient‘s airway, breathing, and circulation status.

DIF: Cognitive Level: Application REF: p. 244 a. Tachyphylaxis b. Postoperative infection c. Malignant hypothermia d. Malignant hyperthermia

4. While monitoring a patient who had surgery under general anaesthesia 2 hours earlier, the nurse notes a sudden elevation in body temperature. What does this sudden elevation in body temperature indicate?

ANS: D

A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency.

DIF: Cognitive Level: Application REF: p. 242 a. A 30-year-old male who has never had surgery before b. A 45-year-old female who stopped smoking 10 years ago c. A 20-year-old male who is to have a lymph node removed d. A 78-year-old female who is to have her gallbladder removed

5. Which individual is at high risk for an altered response to anaesthesia?

ANS: D

The older adult patient is more affected by anaesthesia because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. Young or middle-aged adult patients are not at high risk for an altered response to anaesthesia.

DIF: Cognitive Level: Analysis REF: p. 231 a. Anxiety related to the use of an anaesthetic b. Risk for injury related toNincrReasI ed sGensoB r. iuC m frMom general anaesthesia c. Decreased cardiac output related to systemic effects of local anaesthesia d. Impaired gas exchange related to central nervous system (CNS) depression produced by general anaesthesia

6. A patient is undergoing abdominal surgery and has been anaesthetized for 3 hours. Which nursing diagnosis is appropriate for him?

ANS: D

Impaired gas exchange related to CNS depression produced by general anaesthesia is the appropriate nursing diagnosis for this patient. Because the patient is under anaesthesia, the nurse is unable to assess the patient for anxiety. Risk for injury is related to decreased sensorium, not increased sensorium from general anaesthesia. ―Decreased cardiac output related to systemic effects of local anaesthesia‖ is incorrect because local anaesthesia should have very little systemic effect.

DIF: Cognitive Level: Application REF: p. 243 a. It can be used instead of general anaesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anaesthetics. d. Patients will require artificial mechanical ventilation because of paralyzed respiratory muscles.

7. When administering a neuromuscular drug such as pancuronium, what does the nurse need to remember?

ANS: D

Patients receiving neuromuscular blocking agents (NMBAs) will require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. NMBAs do not cause sedation or pain relief and cannot be used in place of general anaesthesia during surgery. Respiratory muscles are paralyzed by this drug.

DIF: Cognitive Level: Application REF: p. 237 a. diazepam (Valium®) b. caffeine c. neostigmine methylsulphate d. vecuronium bromide (Norcuron®)

8. A patient has been given succinylcholine (Quelicin®) after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine?

ANS: C

The antidote for NMBAs such as succinylcholine is neostigmine methylsulphate. It reverses the effects of the NMBAs.

DIF: Cognitive Level: Application REF: p. 239 a. Twilight sleep b. Procedural sedation c. Adjunctiveanaesthesia d. Spinal anaesthesia

9. A patient is being prepared for an oral endoscopy, and the nurse reminds him that he will be awake during the procedure but probably will not remember it. What type of anaesthetic technique is used in this situation?

ANS: B

Procedural sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves the patient‘s ability to maintain his or her own airway and to respond to verbal commands.

DIF: Cognitive Level: Comprehension REF: p. 231 a. Decreased blood pressure b. Increased risk of bleeding c. Increased risk of stroke d. Migraine headaches

10. Which symptom may occur if a patient is taking ginger and requires an anaesthetic?

ANS: B

A patient who has been taking the natural health product ginger and requires anaesthesia is at an increased risk of bleeding, especially if acetylsalicylic acid (Aspirin) or ginkgo is also being taken. Decreased blood pressure, increased risk of stroke, and migraine headaches are risks associated with the combination of anaesthesia with some natural health products, but not with ginger.

DIF: Cognitive Level: Comprehension REF: p. 243 a. Cessation of respirations due to paralysis of diaphragm and intercostal muscles b. Total flaccid paralysis c. Weakness

1. When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the following drug effects in the proper order of occurrence, using the choices A through C listed below. Express your answer with small letters followed by a comma and a space (e.g. a, b, c).

ANS: c, b, a

The first sensation typically experienced is muscle weakness. This is usually followed by a total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. The patient can no longer breathe independently.

DIF: Cognitive Level: Application REF: p. 238

Chapter 13: Central Nervous System Depressants and Muscle Relaxants

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. Which is a true statement about sedatives and hypnotics?

a. The two terms mean the same thing.

b. A hypnotic causes sleep.

c. Low doses of sedatives will cause sleep.

d. Compared with sedatives, hypnotics have a less potent effect on the central nervous system.

ANS: B

A sedative reduces nervousness, excitability, and irritability without causing sleep, whereas a hypnotic causes sleep.

DIF: Cognitive Level: Knowledge REF: p. 251 a. These adverse effects will often subside after a few weeks. b. The drug should be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivaN tionRof RIEMGsleBe . p CandMmay cause the patient‘s inability to deal with normal stress.

2. A patient who has been taking phenobarbital for 2 weeks as part of therapy for epilepsy reports feeling tense and that the ―least little thing‖ is a bother now. What is the nurse‘s best explanation to the patient?

U S N T O

ANS: D

Barbiturates deprive people of REM sleep, which can result in agitation and an inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped, and the proportion of REM sleep increases, sometimes resulting in nightmares.

DIF: Cognitive Level: Application REF: p. 251| p. 253 a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of Aspirin. d. He developed an allergy to the drug.

3. A 50-year-old male who has been taking a benzodiazepine for 1 week is found unresponsive. His wife states that he takes no other prescription drugs and that he did not take an overdose the correct number of pills is in the bottle. What might have happened?

ANS: B

Potential drug interactions with the benzodiazepines are significant because of their intensity, particularly when they involve other central nervous system (CNS) depressants (e.g., alcohol, opioids, muscle relaxants).

DIF: Cognitive Level: Analysis REF: p. 253 a. Long-term use results in a sedative effect. b. She should take the drug every night to reduce this hangover effect. c. Benzodiazepines affect the sleep cycle, thus causing a hangover effect. d. Benzodiazepines increase CNS activity, thus causing tiredness the next day.

4. A patient has been taking temazepam (Restoril®) for intermittent insomnia. She tells the nurse that when she takes it, she sleeps well, but the next day she feels ―so tired.‖ What is the nurse‘s best explanation to the patient?

ANS: C

Benzodiazepines suppress rapid eye movement REM sleep to a degree (though not as much as barbiturates) and thus result in a hangover effect.

DIF: Cognitive Level: Application REF: p. 253 a. Risk for falls related to decreased sensorium b. Risk for addiction related to psychological dependency c. Excess fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug‘s interference with REM sleep

5. A patient who is recovering from a minor automobile accident that occurred 1 week ago is taking cyclobenzaprine (Novo-Cycloprine®) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?

ANS: A

Musculoskeletal relaxants have a depressant effect on the CNS; lightheadedness, dizziness, drowsiness, and fatigue can occur, thus putting the patient at risk for falls. The patient should be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium.

N R I G B.C M

DIF: Cognitive Level: Analysis REF: p. 258| p. 261 a. Trying to establish set sleep patterns b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking warm beverages, such as tea or coffee, just before bedtime

6. A patient is taking flurazepam (Apo-Flurazepam®) 3 to 4 nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What measures are appropriate for this patient?

ANS: A

Nonpharmacological approaches to induce sleep include establishing set sleep patterns. The patient should avoid heavy exercise before bedtime, avoid heavy meals late in the evening, and should drink warm decaffeinated drinks, such as warm milk, before bedtime.

DIF: Cognitive Level: Application REF: p. 260 a. Infusion with diluted bicarbonate solution b. Administration of medications to decrease blood pressure c. Administration of flumazenil d. Administration of nalbuphine as an antagonist

7. Which is the best treatment of an acute overdose of diazepam?

ANS: C

Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the receptors. Flumazenil is used in cases of oral overdose or excessive intravenous sedation. Infusion with diluted bicarbonate solution and the administration of medications to decrease blood pressure are not appropriate treatments. There are no antagonists for barbiturates.

DIF: Cognitive Level: Analysis REF: p. 253 a. Creatinine b. Sedimentation rate c. Liver function studies d. Hemoglobin and hematocrit

8. A 45-year-old female has been taking dantrolene as part of the treatment for multiple sclerosis. Which laboratory value should the nurse monitor while the patient receives dantrolene?

ANS: C

Dantrolene can cause liver damage; therefore, liver function studies should be performed during therapy.

DIF: Cognitive Level: Comprehension REF: p. 259 a. Vasoconstriction b. Thrombocytopenia c. Hypertension d. Excitement

9. What is an adverse effect of barbiturate administration?

ANS: B

An adverse effect of barbiturate use is thrombocytopenia. Some other effects include hypotension, vasodilation, and drowsiness and lethargy.

DIF: Cognitive Level: Comprehension REF: p. 256 a. Kava b. Garlic c. Ginger d. Ginkgo

10. Which natural health product is used by some people to promote sleep and to relieve anxiety and restlessness?

ANS: A

Kava may be used to promote sleep and for relief of anxiety and restlessness.

DIF: Cognitive Level: Comprehension REF: p. 254

Multiple Response

1. The nurse is preparing to administer a barbiturate. Which condition(s) or disorder(s) are contraindications to the use of these drugs? (Select all that apply.)

a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Peripheral vascular disease f. Advanced liver disease g. Current use of an opioid analgesic

ANS: B, D, F, G

Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. In addition, coadministration of barbiturates with alcohol, opioids, benzodiazepines, and some medications from other drug groups can result in additive CNS depression.

DIF: Cognitive Level: Analysis REF: p. 256

Chapter 14: Central Nervous System Stimulants and Related Drugs

Lilley: Pharmacology for Canadian Health Care Practice, 3rd Canadian Edition

Multiple Choice

1. Which condition is an indication for a central nervous system (CNS) stimulant drug?

a. Insomnia b. Depression c. Appetite enhancement d. Appetite suppression

ANS: D

CNS stimulant drugs can be used as appetite suppressants (anorexiants) for appetite control.

DIF: Cognitive Level: Knowledge REF: p. 271 a. A male with a history of peptic ulcers b. A female with a history of migraine headaches c. A teenager with a history of asthma d. A male with a history of kidney stones

2. Caffeine should be used with caution in which patient?

ANS: A

Caffeine should be used with caution in patients who have a history of peptic ulcers or cardiac dysrhythmias or who have recently had a myocardial infarction.

DIF: Cognitive Level: ComprNeh a. This medication is a CNS stimulant. b. This medication reduces fat absorption by about 30%. c. This drug is used for obese patients with a body mass index (BMI) of 25 or higher. d. This drug is most effective for individuals with Crohn‘s disease.

3. A patient has a new prescription for orlistat as part of his treatment for weight loss. What important information should the nurse include when providing patient education about orlistat?

ANS: B

Orlistat (Xenical®) works by binding to gastric and pancreatic enzymes called lipases Blocking these enzymes reduces fat absorption by approximately 30%. Orlistat is not a CNS stimulant. It is used for patients with a BMI greater than 30. It is contraindicated in individuals with Crohn‘s disease.

DIF: Cognitive Level: Application REF: pp. 271-272 a. The medication dosage is being given appropriately. b. The medication should not be taken until the boy is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish the insomnia it causes.

4. A 6-year-old boy has been started on methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). His mother tells the nurse that she has been giving the medication at bedtime so that it will be ―in his system‖ when he goes to school the next morning.

Which is the nurse‘s best response to the patient‘s mother?

ANS: D

CNS stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia.

DIF: Cognitive Level: Application REF: p. 279 a. Nonadherence b. Impaired physical mobility c. Disturbed sleep pattern d. Imbalanced nutrition (less than body requirements)

5. A 22-year-old nursing student has been taking Excedrin Extra-Strength tablets for the past few weeks to ―make it through‖ the end of the semester and examination week. The feeling of being ―exhausted‖ has brought the patient to the clinic today. Which nursing diagnosis is appropriate?

ANS: C

Excedrin Extra-Strength is acetaminophen 500 mg with caffeine 65 mg, which is a CNS stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects.

DIF: Cognitive Level: Analysis REF: p. 277| p. 279 a. zolmitriptan (Zomig®) b. Amphetamines c. modafinil (Alertec®) d. methylphenidate hydrochloride (Ritalin®)

6. Which CNS stimulant drug is used to treat acute migraines?

ANS: A

Zolmitriptan is a CNS stimulant that can be used to treat migraines.

DIF: Cognitive Level: Knowledge REF: p. 272 a. Growth will occur with the onset of puberty. b. Growth can be promoted with a high-protein diet. c. Growth in 10-year-old children tends to be slower. d. Temporary slowing of growth is expected with Ritalin therapy.

7. A 10-year-old boy has been on methylphenidate hydrochloride (Ritalin) for almost 6 months. His mother reports that he seems to have stopped growing. Which is the nurse‘s best answer to the patient‘s mother?

ANS: D

Methylphenidate hydrochloride may cause a temporary slowing of growth in prepubescent children.

DIF: Cognitive Level: Application REF: p. 279 a. Eye examination b. Height and weight c. Liver studies d. Cognitive function

8. A 10-year-old will be started on methylphenidate hydrochloride (Ritalin) therapy. What important baseline assessment should be done before therapy with this drug is started?

ANS: B

Assessment of baseline height and weight is important before beginning methylphenidate hydrochloride therapy because this drug may cause a temporary slowing of growth in prepubescent children.

DIF: Cognitive Level: Application REF: p. 278 a. Hypotension b. Renal disease c. Liver damage d. Coronary artery disease

9. Before administering sumatriptan (Imitrex®) to a patient for the treatment of a migraine headache, the nurse should assess for the presence of which condition?

ANS: D

Antimigraine medication is contraindicated in patients with peripheral vascular disease, coronary artery disease, sepsis, impaired renal or hepatic function, or severe hypertension.

DIF: Cognitive Level: Comprehension REF: p. 272 a. Increased wakefulness b. Increased appetite c. Suppressed appetite d. Decreased hyperactivity

10. The nurse is evaluating a patN ientRwhoIis GtakiBng.mCodMafinil (Alertec). Which is an intended therapeutic effect?

ANS: A

Modafinil is given to treat narcolepsy. Therefore, an intended therapeutic effect is increased wakefulness.

DIF: Cognitive Level: Analysis REF: p. 268| p. 274 a. Improving memory b. Suppressing appetite c. Treating ADHD d. Stimulating appetite

11. Ginkgo biloba is a natural health product that is used for treatment of which condition what purpose?

ANS: A

Ginkgo biloba is a natural health product used for improving memory.

DIF: Cognitive Level: Knowledge REF: p. 278 a. theophylline b. amphetamine c. benzphetamine d. methylphenidate hydrochloride (Ritalin)

12. Which CNS stimulant is commonly used in conjunction with supportive measures to treat the respiratory depression that may occur in postoperative recovery?

ANS: A

Theophylline is an analeptic commonly used with supportive measures to hasten arousal and to treat respiratory depression associated with postoperative recovery, among other causes.

DIF: Cognitive Level: Knowledge REF: p. 275