1. A client with myasthenia gravis has become frequently complaining of weakness and fatigue. The physician plans to identify whether the client is responding to an overdose of the medication or a worsening of the disease. A tensilon test is performed. Which of the following would indicate that the client is experiencing an overdose of the medication?
- Temporarily worsening of the condition.
- Improvement of the weakness and fatigue.
- No change in the condition.
- Complaints of muscle spasms.
2. A client with juvenile pilocytic astrocytoma who is receiving Dexamethasone (Decadron) 4mg/IV every 6 hours to relieve symptoms of right arm weakness and headache. Which of the following assessment will concern the nurse most?
- Blood glucose level of 280 mg/dl.
- Daily weight gain of 0.5 kg.
- Client no longer recognizes the family member.
- Client still complains of headache.
3. A client is who is receiving edrophonium chloride suddenly is complaining of abdominal cramps and the nurse observes the client is experiencing increased perspiration and salivation. The nurse makes sure the availability of which of the following?
- Levodopa.
- Methylphenidate hydrohloride (Ritalin).
- Atropine sulfate.
- Carbamazepine (Tegretol).
4. A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson’s disease. The nurse tells the client that which of the following is a side effect of the medication?
- Difficulty performing a voluntary movement.
- Increased blood pressure.
- Increased heart rate.
- Itchiness of the skin.
5. A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food items should be avoided by the client?
- Goat yogurt.
- Whole grain cereal.
- Asparagus.
- Apples.
6. Biperiden hydrochloride (Akineton) is added to a list of antiparkinsonian medications that an elderly client is taking. Which of the following instructions made by the nurse that needs further learning?
- To avoid smoking, alcohol and caffeine.
- To use ice chips, candy or gum for dry mouth.
- Walking in the morning to have a daily source of direct sunlight.
- Eating foods rich in fiber and increase fluid intake.
7. The nurse is giving instructions to a client receiving Phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that:
- “Wearing a medical alert tag is not required”.
- “Alcohol is permitted in while taking this medication”.
- “I can take the medicine with milk”.
- “Have the serum phenytoin level taken before giving the medication”.
8. A 17-year-old client is taking Phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result?
- No symptoms, because the value is within the normal range.
- Hypoglycemia.
- Tachycardia.
- Nystagmus.
9. A client is prescribed with Carbamazepine (Tegretol) for the treatment of bipolar disorder. Which of the following laboratory results indicates that the client is experiencing a side effect of this medication?
- Neutrophil count of 1,200/mm3.
- Platelet count of 160,000/mm3.
- Uric acid level of 4mg/dl.
- SGPT (ALT) level 50 units per liter of serum.
10. A female client who has a history of seizure went to a health care facility to ask the nurse regarding the use of birth control pills while on phenytoin therapy. The nurse correctly states to the client that:
- Taking phenytoin decreases the effectivity of the birth control pills.
- Pregnancy is not allowed while taking phenytoin.
- There is no known interaction between these medicines so there is nothing to worry about.
- To discontinue phenytoin and proceed with the oral contraceptive.
11. Phenobarbital (luminal) is given to a client for a short treatment of anxiety. Which of the following results would indicate a therapeutic serum range of the medication?
- 5-10 mcg/ml.
- 15-40 mcg/ml.
- 45-65 mcg/ml.
- 50-90 mcg/ml.
12. A pediatric client went to the emergency room complaining of right upper quadrant abdominal pain, nausea, and vomiting. Upon the interview of the nurse to the mother, the client has been taking a long-term use of acetaminophen. An overdosage of the medication is suspected. Which of the following medication should be readily available?
- Naltrexone (ReVia).
- Urea (Ureaphil).
- Acetylcysteine (Mucomyst).
- Valproic acid (Depakene).
13. A client with bell’s palsy tells the nurse that acetaminophen (Tylenol) is taken daily as prescribed by the physician. Which laboratory value would indicate a toxicity of the medication?
- Blood urea nitrogen of 60 mg/dl.
- Total bilirubin of 1.5 mg/dl.
- Alkaline phosphatase of 120 IU/L.
- Direct bilirubin of 0.3 mg/dl.
14. A nurse is caring for a client with a history of overdosage of aspirin. The nurse suspects which of the following can be an early sign of aspirin toxicity?
- Unsteady gait.
- Drowsiness.
- Confusion.
- Tinnitus.
15. Meperidine hydrochloride (Demerol) is given to a client who is experiencing post-operative pain. Which of the following are the side effects of the medication, except?
- Tremors.
- Diarrhea.
- Urinary retention.
- Hypotension.
16. Codeine sulfate is prescribed to a client with a severe back pain. Which of the following side effect is associated with this medication?
- Hypertension.
- Urinary frequency.
- Constipation.
- Hyperactivity.
17. Mannitol (Osmitrol) an osmotic diuretic which is contraindicated to which conditions? Select all that apply
- Pulmonary edema.
- Narrow-angle glaucoma.
- Heart failure.
- Chemotherapy.
- Hyponatremia.
18. A client with tonic-clonic seizure is receiving Phenobarbital (Luminal) and Valproic acid (Depakene). The nurse tells the client that:
- Valproic acid decreases phenobarbital metabolism.
- Valproic acid increases phenobarbital metabolism.
- There is no interaction between the two.
- Increase the dosage of the two medications.
19. A nurse is providing instructions to a client is taking Doxapram (Dopram). Which of the following statements made by the client needs further instructions?
- “I need to take the medication before meals”.
- “I need to take the medication at bedtime”.
- “I need to avoid drinking coffee”.
- “I will not chew or crush long acting form of the medications”.
20. Diazepam (Valium) is prescribed to a client with alcohol withdrawal. Which of the following statements made by the client indicates an understanding of the treatment regimen?
- “This medication causes a blurring of vision”.
- “This medication will cause a decrease platelet and white blood cell count in my blood”.
- “I’ll have my physician to lower my dosage once I started to feel okay”.
- “Drinking grapefruit can decrease the side effects with this medication”.
Answers and Rationale
1. Answer: A. Temporarily worsening of the condition. Tensilon test/ injection of edrophonium is performed to diagnose cholinergic crisis (overdose with anticholinesterase) or myasthenic crisis (under medication). A tensilon injection makes the client in cholinergic crisis temporarily worse (negative tensilon test). An improvement in the weakness indicates myasthenia crisis.
2. Answer: D. Client still complains of headache. The inability to recognize family members is a new neurologic deficit for this client and indicates a possible increasing intracranial pressure (ICP).
- Options A and B are common side effects of the medication.
- Option D: The continuing headache indicates an increased ICP but is not a new problem.
3. Answer: C. Atropine sulfate. The client is experiencing signs of cholinergic crisis. When administering edrophonium chloride, have emergency resuscitation equipment on hand and atropine sulfate available.
- Option A is used alone or in combination with carbidopa to treat Parkinson’s disease.
- Option B is a central nervous system stimulant used to treat ADHD and narcolepsy
- Option D is used to prevent and control seizures.
4. Answer: A. Difficulty performing a voluntary movement. Dyskinesia (difficulty performing a voluntary movement) is one of the symptoms of a levodopa overdose. Other side effects include nausea, diarrhea, vomiting, hypotension, bradycardia, confusion and hallucinations.
5. Answer: B. Whole grain cereal. When administering levodopa, the client should avoid excessive intake of foods rich in pyridoxine (vitamin B6) which has been found to reduce the effects of levodopa. Large amounts of pyridoxine are also contained in some foods such as bananas, egg yolks, lima beans, meats, peanuts, and whole grain cereals.
- Options A, C, and D are foods low in vitamin B6.
6. Answer: C. Walking in the morning to have a daily source of sunlight. Biperiden hydrochloride (Akineton) is an anticholinergic antiparkinson agent used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson’s disease. Photophobia is one of the side effects of this medication so instruct the client to use sunglasses in direct sunlight.
- Options A, B, and D are correct instructions regarding the use of this medication.
7. Answer: D. “Have the serum phenytoin level taken before giving the medication”. Taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level before taking the morning dose.
- Option A: Wearing a medical tag allows any medical care provider to know that the client is on seizure medication.
- Option B: Alcohol use can increase the blood levels of phenytoin and may increase side effects.
- Option C: Taking it with milk will impair the absorption.
8. Answer: D. Nystagmus. The therapeutic level of phenytoin is 10-20mcg/ml. Higher than 20mcg/ml results in nystagmus (Involuntary eye movement).
9. Answer: A. Neutrophil count of 1,200/mm3. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It causes a decreased level of platelet count, white blood cells, and neutrophil count. The normal range for neutrophil is 1,500 to 8,000/mm3).
- Options B, C, and D all have a normal value.
10. Answer: A. Taking phenytoin decreases the effectivity of the birth control pills. Clients taking oral contraceptive are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone, phenytoin, and carbamazepine because they decrease the effectiveness of the birth control pills.
- Options B, C, and D are inappropriate instructions.
11. Answer: B. 15-40 mcg/ml. The therapeutic serum range of phenobarbital is 15-40 ng/ml.
12. Answer: C. Acetylcysteine (Mucomyst). Acetylcysteine (Mucomyst) is the antidote for acetaminophen toxicity.
- Option A is an opioid antagonist.
- Option B is an osmotic diuretic.
- Option C is a valproate.
13. Answer: A. Blood urea nitrogen of 60 mg/dl. Acetaminophen is hepatotoxic. Among the choices, the blood urea nitrogen is elevated. The normal value of BUA is between 7 to 20 mg/dL (2.5 to 7.1 mmol/L).
- Options B, C, and D all have normal values.
14. Answer: D. Tinnitus. The earliest symptoms of acute aspirin poisoning may include ringing in the ears (tinnitus) and impaired hearing.
- Options A, B, and C are the late signs of aspirin poisoning.
15. Answer: B. Diarrhea. Meperidine hydrochloride is an opioid analgesic. Side effects of this medication are as follows: nausea, vomiting, tremors, hypotension, urinary retention, confusion and respiratory depression
16. Answer: C. Constipation. Codeine Sulfate is an opioid analgesic indicated for the relief of mild to moderately severe pain. Side effects include drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation.
17. Answer: A. Pulmonary edema, C. Heart failure, and E. Hyponatremia. Too rapid infusion of large amounts of mannitol injection will cause a shift of intracellular water into the extracellular compartment resulting in cellular dehydration and overexpansion of the intravascular space with hyponatremia, congestive heart failure, and pulmonary edema.
- Option B: Mannitol is used to decrease ICP in clients with narrow-angle glaucoma.
- Option D: Mannitol is used with chemotherapy to induce diuresis.
18. Answer: A. Valproic acid decreases phenobarbital metabolism. Valproic acid appear to decrease phenobarbital metabolism, thus there is increase levels of phenobarbital in the body. Therefore, phenobarbital blood levels should be monitored and appropriate dosage adjustments made as indicated.
19. Answer: B. “I need to take the medicaton at bedtime”. Doxapram (Dopram) is a central nervous system stimulant. One of the side effects is insomnia so instruct the client to take it at least 6 hours before bedtime to prevent it.
20. Answer: “Drinking grapefruit can decrease the side effects with this medication”. Diazepam (Valium) can cause side effects such as sleepiness and drowsiness. Meanwhile, grapefruit can reduce the metabolism of this drug. This can result in increased pharmacologic effect of Valium as well as its side effects.