FULL TEXT BANK LEHNES PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS 3RD EDITION BY LAURA D.ROSENTH/JACQUELINE ROSENJACK BURCHUM/LASTEST VESTION/ALL CHAPTERS WITH VERIFIED ANSWERS PRINTEND PDF/ ORIGINAL DIRECTLY FROM T. A

FULL TEXT BANK LEHNES PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS 3RD EDITION BY LAURA D.ROSENTH/JACQUELINE ROSENJACK BURCHUM/LASTEST VESTION/ALL CHAPTERS WITH VERIFIED ANSWERS PRINTEND PDF/ ORIGINAL DIRECTLY FROM T. A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest? a. Avoiding fatty and spicy foods b. Consuming extra clear fluids c. Eating three meals daily d. Taking foods later in the day - correct answer-ANS: A Nausea and vomiting of pregnancy (NVP) can be treated with nondrug measures, including avoiding fatty and spicy foods. Consuming extra fluids does not help with nausea and vomiting (N/V) but may be needed to prevent dehydration. Patients should be advised to eat small portions of food throughout the day rather than three complete meals. "Morning sickness" may actually occur all day, so delaying intake is not recommended. A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching? a. "Azathioprine [Imuran] helps induce rapid remission of IBD." b. "Cyclosporine [Sandimmune] can be used to induce remission of IBD." c. "Cyclosporine [Sandimmune] does not have serious adverse effects." d. "Methotrexate is used long term to maintain remission of IBD." - correct answer-ANS: B Cyclosporine can be given intravenously to induce rapid remission of IBD. Azathioprine has delayed onset of effects up to 6 months and is not used to induce rapid remission. Cyclosporine is a toxic compound that can cause renal impairment, neurotoxicity, and immune suppression. Methotrexate is used to promote short-term remission. A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug? a. Giving the dose as an IV push over 3 to 5 minutes b. Infusing the dose with microbore tubing and an infusion pump c. Observing the IV insertion site frequently for patency d. Telling the patient to report dry mouth and sedation - correct answer-ANS: C If IV administration must be done with this drug, it should be given through a large-bore, freely flowing line. The site should be monitored closely for local burning or pain or any sign of extravasation, which can cause abscess formation, tissue necrosis, and gangrene requiring amputation. Giving the medication as a rapid IV push or through microbore tubing does not adequately slow the infusion or dilute the drug. Dry mouth and sedation are expected side effects of this drug and are not dangerous. A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug? a. "Loperamide is used for moderate to severe symptoms only." b. "This drug is useful as prophylaxis to prevent symptoms." c. "This drug is only effective to treat certain infectious agents." d. "Use of this drug may prolong symptoms by slowing peristalsis." - correct answer-ANS: D An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which physiologic system in infants and adults? a. Blood-brain barrier b. First-pass effect c. Gastrointestinal absorption d. Renal filtration - correct answer-ANS: A The blood-brain barrier is not fully developed at birth, making infants much more sensitive to CNS drugs than older children and adults. CNS symptoms may include sedation and drowsiness. The first-pass effect and GI absorption affect metabolism and absorption of drugs, and renal filtration affects elimination of drugs, all of which may alter drug levels. Which monoamines act as neurotransmitters in the central nervous system? Select all that apply. a. Acetylcholine b. Norepinephrine c. Serotonin d. Dopamine e. Epinephrine f. Histamine - correct answer-ANS: B , C , D , E Acetylcholine and histamines are not monoamines. A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient: a. has developed a psychological dependence on the drug. b. may need increased amounts of the drug over time. c. will cause an abstinence syndrome if the drug is discontinued abruptly. d. will have increased sensitivity to drug side effects. - correct answer-ANS: B When tolerance develops, a dose increase may be needed, because a decreased response may occur with prolonged use. Psychologic dependence involves cravings for drug effects and does not define tolerance. Physical dependence occurs when the drug becomes necessary for the brain to function "normally," meaning the patient should be weaned from the drug slowly to prevent an abstinence syndrome. Patients may have a decreased sensitivity to drug side effects over time as the brain adapts to the medication. A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier: a. prevents some potentially toxic substances from crossing into the central nervous system. b. causes infants to be less sensitive to CNS drugs and thus require larger doses. c. allows only ionized or protein-bound drugs to cross into the central nervous system. d. prevents lipid-soluble drugs from entering the central nervous system. - correct answer-ANS: A The blood-brain barrier can prevent some drugs and some toxic substances from entering the CNS. The blood-brain barrier in infants is not fully developed, so infants are more sensitive to CNS drugs and often require lower doses. The blood-brain barrier prevents highly ionized and protein- bound drugs from crossing into the CNS and allows lipid-soluble drugs and those that can cross via specific transport systems to enter. A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching? a. "Central nervous system drug development relies on observations of their effects on human behavior." b. "Studies of new central nervous system drugs in healthy subjects can produce paradoxical effects." c. "Our knowledge of the neurochemical and physiologic changes that underlie mental illness is incomplete." d. "These drugs are developed based on scientific knowledge of CNS transmitters and receptors." - correct answer-ANS: D The deficiencies in knowledge about how CNS transmitters and receptors work make systematic development of CNS drugs difficult. Testing in healthy subjects often leads either to no effect or to paradoxical effects. Medical knowledge of the neurochemical and physiologic changes underlying mental illness is incomplete. The development of CNS drugs depends less on knowledge of how the CNS functions and how these drugs affect that process and more on how administering one of these agents leads to changes in behavior. A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? a. "Adaptation can lead to tolerance of these drugs with prolonged use." b. "Adaptation helps explain how physical dependence occurs." c. "Adaptation often must occur before therapeutic effects develop." d. "Adaptation results in an increased sensitivity to side effects over time." - correct answer-ANS: D With adaptation of the central nervous system to prolonged exposure to CNS drugs, many adverse effects diminish and therapeutic effects remain. Adaptation helps explain how tolerance and physical dependence occur, as the brain adapts to the presence of the drug. Therapeutic effects can take several weeks to manifest, because they appear to work by initiating adaptive changes in the brain. A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: a. changes in the brain as a result of prolonged drug exposure. b. direct actions of the drug on specific synaptic functions in the brain. c. slowed drug absorption across the blood-brain barrier. d. tolerance to exposure to the drug over time. - correct answer-ANS: A It is thought that beneficial responses to central nervous system (CNS) drugs are delayed because they result from adaptive changes as the CNS modifies itself in response to prolonged drug exposure, and that the responses are not the result of the direct effects of the drugs on synaptic functions. The blood-brain barrier prevents protein-bound and highly ionized drugs from crossing into the CNS, but it does not slow the effects of drugs that can cross the barrier. Tolerance is a decreased response to a drug after prolonged use. Which are medical applications of central nervous system drugs? Select all that apply. a. Analgesia b. Anesthesia c. Depression d. Euphoria e. Seizure control - correct answer-ANS: A, B, E CNS drugs have medical uses for pain management, anesthesia, and seizure control. Depression and euphoria are side effects that can contribute to abuse of these drugs. A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do? a. Ask the patient about a history of absence seizures. b. Contact the provider to report symptoms of a complex partial seizure. c. Notify the provider that the patient has had a grand mal seizure. d. Request an order for intravenous diazepam [Valium] to treat status epilepticus. - correct answer-ANS: B This patient showed signs of a complex partial seizure, characterized by impaired consciousness beginning with a period of motionlessness with a fixed gaze, followed by a period of automatism. The entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of consciousness for a brief period (about 10 to 30seconds) and may involve mild, symmetric motor activity or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by alternating muscle relaxation and contraction and then periods of cyanosis, all with a loss of consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer. A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching? a. "I should brush and floss my teeth regularly." b. "Once therapeutic blood levels are reached, they are easy to maintain." c. "I can consume alcohol in moderation while taking this drug." d. "Rashes are a common side effect but are not serious." - correct answer-ANS: A Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized with good oral hygiene, so patients should be encouraged to brush and floss regularly. Because small fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes can be serious and should be reported immediately.