NURSING MSN 571 SYNCH SESSION 3| GRADED A

NURSING MSN 571 SYNCH SESSION 3| GRADED A Synch Session #3 1. The nurse prepares to administer a new prescription for bethanechol. Which diagnosis in the pts hx would prompt the nurse to consult with the prescriber before giving the drug? Asthma Bethanechol = muscarinic agonist. Parasympathomimetic. Decreases HR, N/V, increase salivation, opposite effects of fight or flight. Induces bronchospasm. Used for urinary retention. 2. The nurse is preparing to administer sumatriptan (Imitrex) to a pt suffering from a migraine. This medication works to relieve migraine symptoms by affecting which substance in the brain? Calcitonin gene related peptide = potent neuropeptide neurotransmitter, released from peripheral and central nerve endings during a migraine. Causes pain and vasodilation. Sumatriptan blocks the pain transmission, vasoconstriction occurs. Avoid prescribing this to patients with HTN. 3. Which medication would the nurse anticipate being prescribed for a pt with a new diagnosis of cluster headaches? Verapamil (calan) =CCB. Lithium is 2nd line for tx of cluster headaches. 4. Which of the following measurements would prompt the nurse to hold the sumatriptan dose and contact the hcp? BP of 190/100. Causes vasoconstriction, avoid giving to patients with HTN. Can cause hypertensive crisis. Toradol 5. Pt with a hx of moderate to severe h/a pain associated with n/v is diagnosed with migraines. Which medication would the nurse anticipate the pt will be prescribed initially? Sumatriptan (Imitrex)- 1st choice for mod to severe migraines. Migraine referactory= difficult to treat and failed to fix with other methods- you can use stadol/meperidine/demoral 6. The nurse is assessing a pt taking ergotamine. Which assessment result requires immediate action? Pale extremities= sign of serious toxicity-ergotism. N/V, overdose, can cause ischemia secondary to constriction of peripheral arteries. Good for acute headaches, not for long term use. Ergotamine is a naturally occurring vasoconstrictor, decreases blood blow in cerebral arteries; binds selectively to serotonin 5H21D receptors; Ergotism- ischemia of large vessels. 7. A pt has been admitted with a h/a of unknown origin. Which med will the nurse administer first while assessing for cause? Acetaminophen 8. When reviewing the pts current medication lsit, which drug does the nurse recognize as a first line drug for migraine? Propranolol= used for migraine prevention HA; 1st line for prevention of h/a; Topiramate= 2nd line choice; Metoclopramide (Reglan) for n/v associated with migraines. 9. The nurse is reviewing the meds order for a pt on sumatriptan and sertraline (Zoloft) – which possible interaction? The combined medications can cause serotonin syndrome.= sumatriptan increases BP, sertraline-SSRI- should not be combined with triptans. s/s- AMS, agitation, anxious, poor concentration, fever, tremors, profuse sweating, hallucinations, hyperreflexia, death can occur. 10. Pt is taking sumatriptan for migraines tells nurse she and her husband are attempting to conceive, what is best response? Please talk with your provider about changing your migraine medication. – sumatriptan is classified as category C. not recommended for use during pregnancy. Subq lidocaine is 2nd choice for cluster HA. No NSAIDs in 1st trimester. 11. Pt who takes ergotamine for migraines calls the clinic to report numbness in the feet, which are also cold and pale- which response? You should get to the hospital as soon as possible for treatment!- possible ergotism. 12. Pt is being treated for persistent migraines. Pt wil be treated with which adrenergic blocking dug? Propranolol- used for migraine HA. The other choices are not used for migraines. 13. Pt is be d/c home with a new script for prazosin (minipress) (HTN) which is most important to teach? You should move slowly from a sitting to a standing position.- can cause orthostatic hypotension. Move slowly to prevent falls. Even on first dose. Pts on tamsulosin will have floppy eyes during cataracts surgery and makes it difficult to perform surgery. 14. Which drug is used as an adjunct therapy with levodopa/carbidopa to treat parkinsons disease? Selegiline- MAOI-B, to decrease fluctuating symptoms. Used to increase efficacy of carbidopa levodopa. Amantadine- musce tremors and rigidity Benztropine- tremors and rigidity Entacapone is 3rd drug combo with cabi/levo (Stalvo) decreases breakdown of dopamine; manages on/off phenomenon. 15. The nurse is caring for a pt with Parkinson’s disease who has been prescribed selegiline (MAOI). The nurse instrus the pt to avoid wine and cheese. Which food/drug interaciotn is the nurse trying to prevent? Hypertension= hypertensive crisis but have to eat a lot of it 16. Which cholinesterase inhibitor has the highest incidence of adverse GI effects? Rivastigmine = highest probability of producing GI effects. Transdermal patch is given to prevent GI effects. Memantine (NMDA class) can treat AD and Parkinson’s. Antagonists for NMDA receptors Ketamine, dextromethorphan, methadone (mu receptor agonist) good to use for neuropathic pain. 17. Elderly pt with AD is prescribed Donepezil. The pt caretaker reports there is no improvement in the pt memory. What explanation should the nurse give for this lack of improvement? Donepezil does not improve memory in some patients. Use caution with someone with bradycardia, Heart block contraindicated. Can cause insomnia, N/V/D, heartburn. 18. A new mom has been prescribed fluoxetine (Prozac). What is essential for the nurse to ask prior to therapy? Are you breastfeeding your infant? Reaches therapeutic levels in breastmilk and should not be taken while breastfeeding. Use sertraline (Zoloft) instead. 19. The nurse is caring for a pt taking fluoxetine (Prozac) for depression. Which side effect is most likely associated with this drug? Sexual Dysfunction- all SSRIs and SNRIs can cause sexual dysfunction, decreases appetite. Sometimes given Wellbutrin instead- increases sexual desire and pleasure. 20. A pt takes sertraline (Zoloft, SSRI) for depression relasted to chronic pain. The nurse avoids admin which analgesic agent to help prevent serotonin syndrome? Tramadol- blocks the reuptake of norepinephrine and serotonin in the CNS. Effects of norepi can increase HR and vasoconstriction. 21. The hcp has prescribed bupropion HCL to a pt. after reviewing the pts medical hx, the nurse requestes that the hcp revise the script. What is the reason behind this nursing action? The patient has seizures- bupropion HCL is similar to the structure of amphetamines. Can cause loss if appetite, used in ADHD, smoking cessation, depression. 22. Pt asks the nurse how long it willtake for escitalopram to be completely effective. Which time frame should the nurse include in pt teaching? Several weeks-3-4 weeks to reach full therapeutic effects.