Pharmacology exam 3

Which laboratory test should you monitor for a client who is taking interferon beta b-1 to treat multiple sclerosis? (Select all that apply)

a. serum osmolality
b. Blood glucose
c. Thyroid hormones
d. liver functions
e. CBC
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Which laboratory test should you monitor for a client who is taking interferon beta b-1 to treat multiple sclerosis? (Select all that apply)

a. serum osmolality
b. Blood glucose
c. Thyroid hormones
d. liver functions
e. CBC
c. Thyroid hormones
d. liver functions
e. CBC


ATI
While obtaining a client medical history, you find that the client is taking levodopa/carbidopa for Parkinson's disease. Which information in the client's health history lets you to take further action?

a. Bradycardia
b. Pancreatic disease
c. Glaucoma
d. impaired hearing
Glaucoma

Both Dopamine replacements can cause changes in intraocular pression

ATI
A visit to the provider' office, an older client's partner reports that client has nausea, diarrhea and loss of appetite. He has a history of Alzheimer disease and is taking donepezil. Which information will be provided by the nurse?

a. Take the drug with food
b. Stop taking the drug right away
c. Take a reduced dose of the drug
d. Undergo liver function right away
Take the drug with food

Cholinesterase inhibitors, such a donezepil, commonly cause nausea, vomiting, anorexia, and other GI problems.

ATI
You are instructing a client who has multiple sclerosis about how dantrolene will help control spasticity. With which mechanism is this drug effective in treating this manifestation?

a. Blocks acetylcholine at the neuromuscular junction
b. Interrupts nerve signal from the spinal cord to the muscle
c. Inhibits destruction of acetylcholine by acetylcholinesterase
d. Alters intracellular calcium exchange at the muscles
Alters intracellular calcium exchange at the muscles

Dantrolene, a peripheral acting muscle relaxant, acts directly on spastic muscles contraction by preventing the release of calcium in skeletal muscles.

ATI
You are caring for a client who is preoperative and is NPO. The client takes carbamazepine, 200 mg PO BID for a seizure disorder. Which action should the nurse take?

a. Give the oral of carbamazepine with a sip of water
b. Give carbamazepine IV
c. Withhold the carbamazepine
d. Administer half the usual morning dose of carbamazepine
a. Give the oral of carbamazepine with a sip of water

It is important to continue the oral carbamazepine to maintain therapeutic blood levels and to prevent seizure activity. Notify the anesthesiologist.

ATI
You are instructing a school-age child and his parent about the use of amphetamine-dextroamphetamine to manage the child's attention-deficit/hyperactivity disorder. Which clinical manifestations should the nurse instruct the parent to report? (See all that apply)

a. Weight loss
b. Insomnia
c. Hallucinations
d. Orthostatic Hypotension
e. Flu-like symptoms
a. Weight loss
b. Insomnia
c. Hallucinations

It is a central nervous system stimulant

ATI
Drag the drug classification in the column to match it within its therapeutic use in the right column.

a. Hydantoin
b. Dopamine receptor agonist
c. Cholinesterase Inhibitor
d. Immunomodulator

1. Reduces the effects of Parkinson's disease
2. Helps minimize symptoms of Alzheimer's disease
3. Controls seizures
4. Reduce symptoms of multiple sclerosis
a. 3
b. 1
c. 2
d. 4

ATI
A primary care provider prescribes sumatriptan to treat a client's migraine headaches. Which instructions should the nurse include telling the client how to take sumatriptan (select all that apply)

a. Take the drug after onset of the migraine
b. Administer one nasa spray into each nostril
c. Take it once per day to prevent migraine
d. Repeat the dose once if the headache returns
e. allow the tablet to dissolve under the tongue
Take the drug after onset of the migraine

Repeat the dose once if the headache returns

ATI
A client receives spinal anesthesia with lidocaine and epinephrine. You explain that epinephrine is used with lidocaine for which of the following reason?

a. Decreases the risk for a spinal headache
b. Reduces the risk for infection
c. Prolongs the anesthetic effects
d. Prevents respiratory depression
Prolongs the anesthetic effects

ATI
Drag the drug to match it within therapeutic use.

a. Fentanyl
b. Amphetamine/dextroamphetamine sulfate
c. Dantrolene
d. Baclofen

1. Muscle spasma
2. ADHD
3. Malignant hyperthermia
4. anesthesia for cancer pain managment
a. 4
b. 2
c. 3
d. 1

ATI
A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should instruct the the client that sumatriptan is indicated for which of the following conditions? a. Tonic-clonic seizures b. Presence of a migraine headache c. Exacerbation of multiple sclerosis d. Alzheimer's diseasePresence of a migraine headache ATIA nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these drugs? a. Hyperammonemia b. Phenytoin toxicity c. Hypertension d. Peptic ulcer diseasePhenytoin toxicity Valproic acid can cause an increase in phenytoin blood levels, resulting in phenytoin toxicity. ATIA nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor? a. Confusion b. Dry mouth c. Nausea d. Double visionNausea The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking with food can help minimize adverse effects ATIA nurse is caring for a client who has a new prescription for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects? a. Hypotension b. Tinnitus c. Tachycardia d. BronchospasmTachycardia Amphetamine sulfate is an amphetamine stimulant. It cause tachycardia and dysrhythmias. The client should notify the nurse if develop palpitations or chest pain ATIA nurse is teaching a client who is taking ledovopa/carbidopa to treat Parkinson's disease. Which of the following instructions should the nurse include? a. Change position slowly to prevent orthostatic hypotension b. Eat a high-protein to avoid daytime drowsiness. c. Take the drug a bedtime to avoid daytime drowsiness d. Expect eye watching to develop with long-term therapyChange position slowly to prevent orthostatic hypotension ATIA nurse is teaching a client who has a new diagnosis of Parkinson's disease about how ledovopa/carbidopa can help control symptoms. The nurse should identify that the drug has which of the following pharmacologic effects? a. Increase available acetylcholine in the brain b. Inhibits norepinephrine metabolism in the brain c. Inhibits serotonin metabolism in the brain Increases available dopamine in the brainInhibits serotonin metabolism in the brain Increases available dopamine in the brain Can increase dopamine in the extrapyramidal of the brain, reducing involuntary motion, or tremors, associated with Parkinson's disease ATIA nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug? a. "Premedicate with acetaminophen" b. "Take the drug with food" c. "Increase your fluid intake" d. "Take the drug in the morning""Premedicate with acetaminophen" Interferon beta drugs can cause fever, headache, and muscles aches. ATIA nurse is teaching a client who has Alzheimers disease and their caregiver about memantine. Which of the following instructions should the nurse include? a. Increase fluid intake to improve renal excretion b. Report memory loss of confusion c. Watch for signs of liver impairments, such a jaundice and abdominal pain d. Avoid taking over-the counter antacidsAvoid taking over-the counter antacids Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity ATIA nurse is caring for a client who has been taking amphetamine dextroamphetamine sulfate for the treatment of attention deficit hyperactivity disorder ADHD for 2 weeks. The nurse should report which of the following finding to the provider? a. Weight loss of 2.3 kg b. BP 110/70 mm Hg c. Apical pulse 80/min d. Respiratory rate 16/minWeight loss of 2.3 kg Can cause a decreased appetite and weight loss. ATIA nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should identify that which of the following laboratory tests requires monitoring? a. Serum potassium b. Liver function c. Serum sodium d. Thyroid functionLiver function Liver toxicity is a seriouos adverse effect of dandrolene. The nurse should monitor the client's liver function prior treatment and regular intervals and advise the client to report jaundice or abdominal pain ATIA nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include? a. Monitor constipation b. The dose will be increased weekly to provide optimum therapeutic effect c. Administering the drug first thing in the morning promotes effectiveness d. Avoid the use of NSAIDs for painAvoid the use of NSAIDs for pain Combining NSAIDS with donepezil can cause GI bleeding. ATIA nurse is taking care of a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects? a. Cardiac excitability b. Respiratory depression c. Hyperthermia d. HypertensionRespiratory depression Methohexial, a short-acting barbiture, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for clients receiving the drug. ATIA nurse is teaching a client who has new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects?Drowsiness Headache Rash ATIA nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests requires monitoring? a. C-reactive protein b. Creatinine clearance c. Thyroid function d. CBCCreatinine clearance Pramipexole, a direct-acting dopamine receptor agonist, should used with caution for clients who have renal disease. The nurse should monitor the client's renal function ATIA nurse is administering fentanyl to a client to reduce pain. Which of the following drugs should the nurse have available to reverse the effects of fentanyl? a. Neostigmine b. Succinylcholine c. Naloxone d. DantroleneNaloxone ATIA nurse is caring for a client who has been taking selegiline to treat Parkinson disease. The provider is considering the use of analgesics for the client but should be aware that a drug interaction between selegiline and meperidine cane result in which of the following? a. Frequent urination b. Jaundice c. Cellulitis d. Muscle rigidityMuscle rigidity A drug interaction between selegiline and opiods, especially meperidine, can result in rigidity, stupor, agitation, hypertension, and fever ATIA nurse is teaching a client who has a prescription for carbamazepine. Which of the following instructions should the nurse include to help the client to avoid adverse effects of this drug?Begin taking the drug at a low dosage Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, a drug that treats seizures disorders. Dosages should be low to minimize or prevent these adverse effects ATIA nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the drug and notify the provider? a. Pancreatic cancer b. Hypotension c. Cirrhosis d. OsteoporosisCirrhosis Memantine should be used cautiously in patients who have severe impairment. ATIA nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of the following instructions should the nurse include?Take the drug in the morning Modafinil is a nonamphetamine stimulant. Taking in the morning helps improve wakefulness for clients who have narcolepsy or 1 hour before work. ATIA nurse is providing teaching for a client who had a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects? a. Hirsutism b. Depression c. Jaundice d. Gum irritationJaundice Valporic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. ATIA nurse is teaching a client who is about to genii sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects? a. Chest pain b. Polyuria c. Joint pain d. InsomniaChest pain Can cause coronary vasospasm and chest pain ATIA nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include? a. Avoid driving until the drug's effects are evident b. Stop taking the drug immediately if headache occurs c. Take the drug as needed for spasticity d. Take the drug with antacids to reduce gastric effectsAvoid driving until the drug's effects are evident Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Clients taking the drug should avoid alcohol and other CNS depressants and should not drive a vehicle until they know how the drug will affect them ATIA nurse is teaching a client who received a prescription for interferon beta 1a for the treatment of multiple sclerosis. Which of the following information should the nurse include? a. "Have kidney function tests done every month for a year" b. "Take an extra dose if muscle aches occur" c. "store the drug at room temperature after mixing it" d. Administer the drug in your thigh or upper arm"Administer the drug in your thigh or upper arm It is administered subcutaneous route ATIA nurse is caring for a client who is taking interferon beta 1b. The nurse should identify that which of the following findings indicates a potential serious adverse effect of this drug? a. Tinnitus b. Twitching eyelids c. Blue-green skin discoloration d. FatigueFatigue Also include unexplained brushing, bleeding and fatigue ATIA nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should instruct the client to report which of the following adverse effects? a. Slow heart rate b. Cough c. Diarrhea d. Hearing lossDiarrhea Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea, nausea, and vomiting are adverse effects if dantrolene ATIWhen a 12 year old child is prescribed methylphenidate, which is most important for the nurse to monitor? a. Temperature b. Respirations c. Intake and output d. Height and weightHeight and weight Chapter 17Several Children are admitted for diagnosis with possible attention-deficit/hyperactivity disorder. Which is most important for the nurse to observe? a. A girl who is lethargic b. A girl who lacks impulsivity c. A boy with smooth coordination d. A boy with inability to complete tasksA boy with inability to complete tasks Chapter 17The nurse monitoring a patient for methylphenidate withdrawal should observe the patient for which condition? a. Tremors b. Insomnia c. Weakness d. TachycardiaWeakness Chapter 17The nurse is teaching a patient to self-administer medications. The nurse knows that which drug is used to treat narcolepsy? a. Modafinal b. Atomoxetine c. Lidsdexamfetamine d. PhendimetrazineModafinal Chapter 17A newborn patient is in respiratory distress. The nurse anticipares preparation for which medication to be given? a. Modafinil b. Armodafinil c. Theophylline d. AmphetamineTheopylline Chapter 17Which suggestion should the nurse provide to the parents of a child taking methylphenidate for attention-deficit/hyperactivity disorder to offset anticipated side effects? a. Take the medication with grapefruit juice. b. Suck on hard candy. c. Decrease fluid intake prior to bedtime. d. Increase vitamin C in the diet.Suck on hard candy. Side effects of amphetamines include dry mouth. Sucking on hard candy can help eliminate this effect. Nclex Review Q. Chapter 17What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant? a. Continuously monitor the patient's pulse rate. b. Keep the patient on bed rest. c. Obtain a bedside commode for the patient. d. Monitor the patient for seizure activity.Monitor the patient for seizure activity. Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant. Nclex Review Q. Chapter 17Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics? a. Observing patient for nervousness b. Checking blood pressure for hypotension c. Assessing for decreased mental alertness d. Ausculating heart rate for bradycardiaObserving patient for nervousness Analeptics are CNS stimulants, which cause nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension as well. Nclex Review Q. Chapter 17The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's priority action? a. Assess for over-the-counter medication use. b. Stay with the child and use relaxation techniques. c. Hold the next dose of the medication. d. Administer an antianxiety agent.Assess for over-the-counter medication use. Methylphenidate interacts with over-the-counter cold medication. Nclex Review Q. Chapter 17A patient taking methylphenidate is nauseous and vomiting. What is the nurse's best action? a. Ask the patient if he or she has been taking the medication regularly. b. Monitor the patient's vital signs. c. Assess the patient's temperature. d. Administer an antiemetic medication.Ask the patient if he or she has been taking the medication regularly. Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly. Nclex Review Q. Chapter 17The nurse expects that a newborn who is experiencing apnea is most likely to be ordered treatment with which medication? a. Caffeine citrate b. Benzphetamine HCl c. Diphenhydramine d. Diethylpropion HClCaffeine citrate Can be used as a respiratory stimulant for newborns experiencing apnea. Nclex Review Q. Chapter 17The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient? a. Phentermine-topiramate b. Diethylpropion HCl c. Benzphetamine HCl d. ModafinilModafinil Modafinil (Provigil) is indicated for treatment of narcolepsy. Nclex Review Q. Chapter 17Which of the following conditions would meet the medically approved criteria for use of CNS stimulants? (Select all that apply.) a. Promotion of wakefulness in narcolepsy b. Reversal of respiratory distress c. Severe depressive states d. Weight loss in the morbidly obese e. Attention-deficit/hyperactivity disorder in childrena. Promotion of wakefulness in narcolepsy b. Reversal of respiratory distress e. Attention-deficit/hyperactivity disorder in children Nclex Review Q. Chapter 17The patient asks the nurse if there is anything that the physician could order that would function as an appetite suppressant. The nurse anticipates that the physician may order which medications? (Select all that apply.) a. Diethylpropion HCl b. Phentermine-topiramate c. Armodafinil d. enzphetamine HCl e. Caffeine citratea. Diethylpropion HCl b. Phentermine-topiramate d. enzphetamine HCl They are appetite suppressants Nclex Review Q. Chapter 17During which phase of sleep do most recallable dreams occur? a. Stage 1 of nonrapid eye movement sleep b. Stage 2 of nonrapid eye movement sleep c. During rapid eye movement (REM) sleep d. Throughout all phases of sleepDuring rapid eye movement (REM) Nclex Review Q. Chapter 18A patient is admitted to the emergency department with an overdose of benzodiazepine. Which antidote should the nurse expect to administer? a. Naltrexone b. Naloxone c. Flumazenil d. NalmefeneFlumazenil Flumazenil is the antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are used in opioid or narcotic overdose. Flumazenil should be used with caution when the patient is known to have an addiction to one of the benzodiazepine drugs because of the possibility of withdrawal seizures that may occur. Nclex Review Q. Chapter 18The nurse is caring for a patient who is taking barbiturate. Which assessment finding requires immediate action by the nurse? a. Blood pressure of 140/95 mm Hg b. +1 pitting edema of the lower extremities c. Urinary output of 10 mL/h d. History of a sleep disorderUrinary output of 10 mL/h The patient's urinary output is insufficient and could result in toxicity. Nclex Review Q. Chapter 18The patient has recently been prescribed a benzodiazepine and reports experiencing vivid dreams. What should the nurse suspect based on this finding? a. Allergic reaction to the medication b. Expected finding of the medication c. Overdosage of the medication d. Inadequate amount of the medicationExpected finding of the medication The benzodiazepine medications are known to delay REM sleep and thus generate vivid dreams. Such a symptom is not indicative of overdosage, an allergic reaction, or inadequate dosage. Nclex Review Q. Chapter 18The patient has recently been prescribed a sedative-hypnotic medication and reports experiencing a "hangover"-type effect upon awakening. What does this symptom indicate to the nurse? a. A need to change to a different medication b. Inadequate amount of the medication c. Allergic reaction to the medication d. Toxicity level of the medicationA need to change to a different medication Some of the sedative-hypnotic drugs can produce a hangover-type effect; if this occurs, the patient should be changed to a different drug. Nclex Review Q. Chapter 18The patient is undergoing anesthesia in preparation for surgery. The patient is starting to have difficulty speaking and is losing the sensation of pain. Which anesthesia stage is the patient most likely experiencing? a. Stage 1 b. Stage 3 c. Stage 2 d. Stage 4Stage 1 Difficulty speaking and loss of the sensation of pain both occur in stage 1 of anesthesia. Nclex Review Q. Chapter 18The nurse is assessing a patient with a history of chronic sedative use. The nurse notes the patient is exhibiting muscle twitching, tremors, and dizziness, especially on moving from sitting to standing. Which reaction is the patient experiencing? a. Underdosing of the sedative b. An allergic response to the sedative c. Tolerance to the sedative d. Dependence to the sedativeDependence to the sedative Physical dependence results in the appearance of specific withdrawal symptoms when a drug is discontinued after prolonged use. The severity of withdrawal symptoms depends on the drug and dosage. Symptoms may include muscular twitching and tremors, dizziness, orthostatic hypotension, delusions, hallucinations, delirium, and seizures. Nclex Review Q. Chapter 18The patient is receiving triazolam as part of treatment for insomnia. The patient complains of experiencing memory problems. The nurse recognizes this as a. an adverse reaction to the drug. b. evidence of an allergic response. c. evidence of drug toxicity. d. an idiosyncratic effect.an adverse reaction to the drug. Memory issues may occur as an adverse reaction to triazolam. Nclex Review Q. Chapter 18The patient is receiving anesthesia in preparation for surgery. The patient will be in which stage of anesthesia when the procedure occurs? a. Stage 2 b. Stage 4 c. Stage 3 d. Stage 1Stage 3 Once the patient is anesthetized, the procedure will actually occur while the patient is in stage 3 of anesthesia. Nclex Review Q. Chapter 18The patient is undergoing anesthesia in preparation for a procedure. The patient is experiencing hallucinations and dreams. Which anesthesia stage is the patient most likely experiencing? a. Stage 2 b. Stage 3 c. Stage 4 d. Stage 1Stage 1 During stage 1 of anesthesia, the patient may experience dreams and both auditory and visual hallucinations. Nclex Review Q. Chapter 18The nurse assesses a patient taking phenytoin and finds gingival hyperplasia. What is the nurse's priority action? a. Hold the next dose of the drug. b. Call for a consult with a dentist. c. Call the health care provider. d. Instruct the patient on oral hygiene.Instruct the patient on oral hygiene. A side effect of phenytoin (Dilantin) is overgrowth of gum tissue. This can be minimized by frequent oral hygiene. . Nclex Review Q. Chapter 19The patient receiving phenytoin (Dilantin) has a serum drug level of 12 mcg/mL. What is the nurse's best action? a. Call the health care provider. b. Assess the patient's gums and mouth. c. Perform a neurological assessment. d. Continue to monitor the patient.Continue to monitor the patient. Therapeutic serum drug level for phenytoin (Dilantin) is 10 to 20 mcg/mL. Nclex Review Q. Chapter 19While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide. What should the nurse suspect as a primary assessment? a. Absence seizures. b. Migraines. c. Panic attacks. d. Tonic-clonic seizures.Absence seizures. Ethosuximide is the first-line drug of choice to treat absence seizures. . Nclex Review Q. Chapter 19What is the primary information the nurse should teach a patient who has just started taking mephobarbital? a. "Take this medication for 1 month only and then stop." b. "Take the medication on a full stomach." c. "Do not drive until you determine how you react to the medication." d. "Do not take any over-the-counter medications with this drug."Do not drive until you determine how you react to the medication." This medication can cause drowsiness. The nurse must teach the patient to be safe while taking this medication. Nclex Review Q. Chapter 19The nurse is caring for several patients, each of whom is being treated with anticonvulsants. Which patient will the nurse assess first? a. A patient taking tiagabine who has partial seizures b. A patient taking levetiracetam and is on multiple drug therapy c. A patient started on pregabalin who has partial seizures d. A patient started on valproic acid with a creatinine level of 3A patient started on valproic acid with a creatinine level of 3 As valproic acid is excreted by the kidneys, this level is cause for concern because the drug could become toxic. Nclex Review Q. Chapter 19What information will the nurse teach the patient who is considering stopping the antiepileptic drug phenytoin? a. You will have severe hypotension. b. You may become confused and delirious. c. You may have an acute withdrawal. d. You may go into status epilepticus.You may go into status epilepticus. Abrupt withdrawal of antiepileptic drugs can cause the development of status epilepticus. Nclex Review Q. Chapter 19The nurse is caring for several patients, each of whom has a history of seizure activity. Which patient will the nurse assess first? a. A patient who has absence seizures b. A patient who has sensory seizures c. A patient who is taking diazepam d. A patient who is postictalA patient who is postictal The patient who is postseizure may be disoriented and not fully conscious. As safety is a primary concern, the nurse should assess this patient first. Nclex Review Q. Chapter 19The nurse is monitoring phenytoin being infused intravenously at 55 mg/min. What priority action will the nurse take? a. Have the drug changed to PO. b. Continue to monitor the infusion. c. Decrease the infusion and assess blood pressure. d. Increase the infusion.Decrease the infusion and assess blood pressure. Infusing phenytoin at rates >50 mg/min can cause severe hypotension or cardiac dysrhythmias. The infusion should not be increased or discontinued. Nclex Review Q. Chapter 19A patient asks the nurse why she is receiving a different drug than her usual phenytoin. The patient is to have nothing by mouth and is receiving intravenous fosphenytoin. What is the nurse's best response? a. "Phenytoin is not effective while you are to have nothing by mouth, so your health care provider has changed your medication to a more effective drug." b. "Since you are not taking medication by mouth, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will resume phenytoin after you recover from this illness." c. "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are not taking anything by mouth, IV fosphenytoin is easier on your veins than phenytoin." d. "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug.""Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are not taking anything by mouth, IV fosphenytoin is easier on your veins than phenytoin." Fosphenytoin is a prodrug of phenytoin developed to minimize the irritating effects of phenytoin on blood vessels. Nclex Review Q. Chapter 19The patient is noted to experience isolated clonic contractions lasting 3 to 10 seconds and limited to one limb. The nurse identifies this activity as which type of seizure? a. Massive myoclonic seizure b. Grand mal seizure c. Focal myoclonic seizure d. Jacksonian seizureFocal myoclonic seizure Focal myoclonic activity consists of isolated clonic contractions that last 3 to 10 seconds that are limited to one limb. Nclex Review Q. Chapter 19The patient has been taking phenobarbital to control seizures. The patient complains to the nurse of experiencing occasional stomach upset when taking the medication. What is the nurse's best response? a. "You should call your health care provider because the drug may need to be stopped." b. "You can take the medication with food or milk." c. "You should call your health care provider because the dose may need to be adjusted." d. "You should take the medication on an empty stomach."You can take the medication with food or milk." to minimize gastric distress, which is an expected side effect of the medication. Nclex Review Q. Chapter 19Which lab finding should alert the nurse to hold the administration of phenytoin and notify the health care provider? a. Respiration rate of 14 b. Albumin level of 2.9 g/dL c. Pulse rate of 92 d. White cell count of 7000 per mcLAlbumin level of 2.9 g/dL Phenytoin is a highly protein-bound (90% to 95%) drug; therefore a decrease in serum protein or albumin can increase the free phenytoin serum level. Nclex Review Q. Chapter 19The nurse administered donepezil to a patient. Which finding indicates that the medication is having a therapeutic effect? a. The patient is awake. b. The patient has urinated. c. The patient has increased cognition. d. The patient is relaxed.