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63 Cards in this Set
- Front
- Back
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If you are dealing with a patient with a diagnosis of ADHD and the physician might have ordered a medication, what would be the nurse’s baseline assessment?
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If you are dealing with a patient with a diagnosis of ADHD and the physician might have ordered a medication, what would be the nurse’s baseline assessment?
- You need baseline assessment in Neurology; Glasgow Coma Scale is a measurement that becomes a baseline |
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If you have a client diagnosed with narcolepsy, what are patient teachings regarding the medication Nuvigil (armodafinil) (an Analeptic)?
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If you have a client diagnosed with narcolepsy, what are patient teachings regarding the medication Nuvigil (armodafinil) (an Analeptic)?
**Take in Morning - Administer CNS stimulant early in the day to diminish sleep disturbances - Instruct client to avoid coffee, tea, or cola if taking CNS stimulants |
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*If you have child diagnosed with ADHD, the nurse needs to know the scientific rationale for prescribing a medication like Adderall and Ritalin, what is it?
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*If you have child diagnosed with ADHD, the nurse needs to know the scientific rationale for prescribing a medication like Adderall and Ritalin, what is it?
- ? - In ADHD, the drug is given in the morning 30-45 minutes before breakfast and before lunch; a journal of the child’s behavior pattern is kept - In ADHD, drugs are kept with the school nurse - Amphetamines – drugs used to treat children with ADHD - Improvement of symptoms of ADHD in children such as increased ability to focus and complete tasks and interact with peers - Ritalin fine-tunes the functioning of neurons in the prefrontal cortex (PFC) - a brain region involved in attention, decision-making and impulse control |
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If you have a child or adult that has a seizure disorder, and you have patient on Dilantin, What special patient instructions do you need to teach?
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If you have a child or adult that has a seizure disorder, and you have patient on Dilantin, What special patient instructions do you need to teach?
- Dilantin causes an overgrowth of gum tissue (Gingival Hyperplasia) - Instruct clients taking phenytoin (Dilantin) to use a **soft bristled toothbrush (may have bleeding due to gingivitis and gingival hyperplasia) |
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*Patient taking the anticonvulsant medication valproic acid (Depakene, Depacon), what two things do you need to monitor?
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*Patient taking the anticonvulsant medication valproic acid (Depakene, Depacon), what two things do you need to monitor?
- Monitor serum blood level of valproic acid – normal maybe 50 to 100 mcg/mL - Monitor Liver enzymes – normal AST 8-20 U/L; normal ALT 8-20 U/L |
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When you are doing teaching for patients with Trigeminal Neuralgia, the physician is going to try to get the patient on non-narcotic meds, what are they?
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When you are doing teaching for patients with Trigeminal Neuralgia, the physician is going to try to get the patient on non-narcotic meds, what are they?
- 1 – Neurontin (gabapentin) - 2 – Tegretol (carbamazepine) - 3 – Dilantin (phenytoin) - 4 – Valproic - Only use narcotics as last resort |
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What are the serum blood levels of the following medications: Tegretol (carbamazepine), Klonopin (clonazepam), phenytoin (Dilantin), Zarontin (ethosuximide), Luminal (phenobarbital)?
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What are the serum blood levels of the following medications: Tegretol (carbamazepine), Klonopin (clonazepam), phenytoin (Dilantin), Zarontin (ethosuximide), Luminal (phenobarbital)?
- Tegretol (carbamazepine): 3-14 mcg/mL - Klonopin (clonazepam): 20-80 ng/mL - phenytoin (Dilantin): 10-20 mcg/mL - Zarontin (ethosuximide): 40-100 mcg/mL - Luminal (phenobarbital) 15-40 mcg/mL |
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If patient is on anticonvulsant medications (fosphenytoin (Cerebyx)), there should be certain things you need to teach the patient (patient education), what are these?
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If patient is on anticonvulsant medications (fosphenytoin (Cerebyx)), there should be certain things you need to teach the patient (patient education), what are these?
-** Wear medic-alert bracelet - **Don’t medicate with a lot of OTC medications and avoid alcohol - **Maintain adequate fluid and nutritional intake (because of N/V) - Client should use caution when driving or performing activities that require alertness - Client should maintain follow-up healthcare visits with periodic blood studies related to determining toxiciy |
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What can you teach the pt with Trigeminal Neuralgia that was prescribed Tegretol?
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What can you teach the pt with Trigeminal Neuralgia that was prescribed Tegretol?
- The adverse reactions include somnolence (sleepiness), nystagmus, gingival hyperplasia. It should not be taken within 14 days of an MAOI. Normal serum levels for Tegretol is 3-14 mcg/dl - Carbazepine (Tegretol) should not be given within 14 days of a monamine oxidase inhibitor (MAOI) antidepressant |
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What is Cerebyx (fosphenytoin) used for and what are its adverse reactions?
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What is Cerebyx (fosphenytoin) used for and what are its adverse reactions?
- Cerebyx is an anticonvulsant (Hydantoin) used for tonic-clonic seizures, partial seizures, status epilepticus, and seizure prevention - Adverse reactions are hypotension, drowsiness, sedation, blood dyscrasias and elevated glucose |
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Teach a pt about Cerebyx?
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Teach a pt about Cerebyx?
- Wear medic alert bracelet, No OTC drugs and maintain adequate nutritional intake |
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A patient is diagnosed by Type II diabetes, what medication will increase a patient’s blood sugar (glucose) levels?
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A patient is diagnosed by Type II diabetes, what medication will increase a patient’s blood sugar (glucose) levels?
- Dilantin (phenytoin) - Phenytoin (Dilantin) may elevate serum glucose levels; monitor serum glucose levels more often in clients with diabetes mellitus |
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What is the scientific rationale for Dilantin (phenytoin)?
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What is the scientific rationale for Dilantin (phenytoin)?
-Stabilizes hyper-excitability postsynaptically in the motor cortex |
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What type of drugs does Dilantin (phenytoin) decrease the effectiveness of?
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What type of drugs does Dilantin (phenytoin) decrease the effectiveness of?
- Dilantin (phenytoin) decreases the effectiveness of some birth control pills and can have teratogenic effects if taken during pregnancy |
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Pt on Selegiline for Parkisons, would you question an order for Demerol?
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Pt on Selegiline for Parkisons, would you question an order for Demerol?
- YES, contraindicated - The dopamine agonists, which are MAOIs, selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) **should not be used with the opioid meperidine (Demerol) because of antimetabolite conversion which causes **stupor, rigidity, and hyperthermia |
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Pt on Dilantin for seizures and also has DM, what nurse intervention to teach client?
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Pt on Dilantin for seizures and also has DM, what nurse intervention to teach client?
- Monitor glucose levels closely |
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Patient has been on Dilantin (phenytoin) for 5 days and calls to say her urine is reddish brown, nurse tells her?
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Patient has been on Dilantin (phenytoin) for 5 days and calls to say her urine is reddish brown, nurse tells her?
- This is a normal side effect, not to worry - phenytoin (Dilantin) may cause the urine to turn a harmless **pinkish-red or reddish-brown color |
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Patient being discharged and asks nurse about Dilantin (phenytoin), (taken for seizures) what is one thing the nurse can advise about?
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Patient being discharged and asks nurse about Dilantin (phenytoin), (taken for seizures) what is one thing the nurse can advise about?
- Dilantin (phenytoin) will probably be taken for life |
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Proper administration of phenytoin (Dilantin) can cause a very serious possible adverse effect, what is it?
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Proper administration of phenytoin (Dilantin) can cause a very serious possible adverse effect, what is it?
- Dysrhythmias - Rapid IV administration of phenytoin (Dilantin) may cause hypotension and dysrhythmias - Myocardia’s |
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What does the nurse need to know about liquid Dilantin (phenytoin) and tube feedings (what are the interactions)?
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What does the nurse need to know about liquid Dilantin (phenytoin) and tube feedings (what are the interactions)?
- The tube feedings can interfere with the absorption so higher doses of Dilantin (phenytoin) may be needed for therapeutic level to be maintained - Oral tube feedings may interfere with the absorption of orally administered phenytoin (Dilantin), therefore, bolus feedings should be scheduled as far as possible from drug administration; if on continuous feedings higher doses of the drug may be necessary |
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A patient has a history of status epilepticus, because of this what emergency drug would you be wise to have available if you have this patient on your unit?
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A patient has a history of status epilepticus, because of this what emergency drug would you be wise to have available if you have this patient on your unit?
- Ativan (lorazepam) - lorazepam (Ativan), is the drug of choice for status epilepticus, an emergency characterized by continual seizure activity with no interruption - Valium (diazepam) can also be given |
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If you have a patient on Tegratol (carbamazepine) for the management of their pain for trigeminal Neuralgia, how are you going to evaluate the effectiveness of the drug?
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If you have a patient on Tegratol (carbamazepine) for the management of their pain for trigeminal Neuralgia, how are you going to evaluate the effectiveness of the drug?
- Pain scale - Pain relief |
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If you have a patient that has trigeminal neuralgia, what S/S would you be alert for that might be an adverse reaction, particularly what are you going to teach patient to be alert for (probably taking carbamazepine (Tegretol))?
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If you have a patient that has trigeminal neuralgia, what S/S would you be alert for that might be an adverse reaction, particularly what are you going to teach patient to be alert for (probably taking carbamazepine (Tegretol))?
- **Unusual bleeding - Monitor for S/S of liver dysfunction for clients on carbamazepine (Tegretol): persistent nausea, fatigue, lethargy, anorexia, jaundice, **dark urine, clay colored stools, unusual bleeding, pruritus, and RUQ tenderness |
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A patient diagnosed with a stroke is prescribed phenytoin (Dilantin), what is the rationale for this?
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A patient diagnosed with a stroke is prescribed phenytoin (Dilantin), what is the rationale for this?
- Damage to the brain tissue from the stroke could result in seizures - phenytoin (Dilantin) is an anticonvulsant given to prevent seizures |
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Another drug to help with pain from Trigeminal Neuralgia?
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Another drug to help with pain from Trigeminal Neuralgia?
- Gabapentin (Neurontin) |
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Tegretol can cause liver failure/damage, watch for what problem?
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Tegretol can cause liver failure/damage, watch for what problem?
- Unusual bleeding |
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After giving Ativan (lorazepam) IV, what do you need to monitor your patient for?
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After giving Ativan (lorazepam) IV, what do you need to monitor your patient for?
- Respiratory depression - Intravenous administration of lorazepam (Ativan) or diazepam (Valium) may cause respiratory depression |
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Patient on 200mg of phenytoin (Dilantin) daily, what kinds of side effects might the nurse see?
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Patient on 200mg of phenytoin (Dilantin) daily, what kinds of side effects might the nurse see?
- **Sedation - Hypotension, drowsiness, sedation, blood dyscrasias and elevated glucose, and gingival hyperplasia (Dilantin only) |
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What do you always infuse Dilantin (phenytoin) with?
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What do you always infuse Dilantin (phenytoin) with?
- Normal Saline, because the dextrose can cause the medication to crystalize - IV phenytoin (Dilantin) is diluted in NS because dextrose causes medication to crystalize (precipitate) |
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The nurse monitors a Patient carefully and uses caution when administering phenobarbital (Luminal) with which drug also used for epilepsy?
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The nurse monitors a Patient carefully and uses caution when administering phenobarbital (Luminal) with which drug also used for epilepsy?
- Valproic acid (Depakene, Depacon) - Use with extreme caution with valproic acid, may cause phenobarbital toxicity - Use with extreme caution with phenobarbital (Luminal) may cause phenobarbital toxicity - S/S somnolence, respiratory depression |
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If you have a patient taking phenytoin (Dilantin), what are some of the common adverse effects you might see?
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If you have a patient taking phenytoin (Dilantin), what are some of the common adverse effects you might see?
- **Gingival hyperplasia - Hypotension, drowsiness, sedation, blood dyscrasias and elevated glucose, and gingival hyperplasia (Dilantin only) - Instruct clients taking phenytoin (Dilantin) to use a **soft bristled toothbrush (may have bleeding due to gingivitis and gingival hyperplasia) |
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If you have a Patient receiving Zarontin (ethosuximide), what adverse effects would you expect to see and what lab results would you expect to monitor?
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If you have a Patient receiving Zarontin (ethosuximide), what adverse effects would you expect to see and what lab results would you expect to monitor?
- May cause drowsiness, ataxia, dizziness, anorexia, N/V, urinary frequency, pruritus, urticarial, and **gingival hyperplasia - **CBC and liver function tests (LFT’s) should be monitored |
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Sinemet is a combination of what two drugs?
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Sinemet is a combination of what two drugs?
- Carbidopa/levodopa - Combining levodopa with carbidopa allows more levodopa to reach the brain allowing for a better drug effect - The combination of levodopa/carbidopa makes more levodopa available and enables the dosage of levodopa to be reduced which decreases peripheral effects - If we can get more dopamine to the brain in a parkinson’s patient, the patient is going to have an improvement in symptoms - Antiparkinsonism drugs if effective should decrease severity of symptoms not eliminate them |
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After administering Sinemet, what data would you document that indicates that this medication has been effective in the treatment of parkinson’s disease? (How can you assess that an elderly patient taking Sinemet, that the med is working?)
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After administering Sinemet, what data would you document that indicates that this medication has been effective in the treatment of parkinson’s disease? (How can you assess that an elderly patient taking Sinemet, that the med is working?)
- Improved gait, walk without stumbling |
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Scientific rationale for Sinemet?
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Scientific rationale for Sinemet?
- the carbidopa helps the levodopa work. carbidopa allows the levodopa to reach the brain with reduced peripheral effects |
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A client diagnosed with Parkinson’s has been on long term levodopa, what data would support a drug holiday?
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A client diagnosed with Parkinson’s has been on long term levodopa, what data would support a drug holiday?
- The therapeutic effects are decreased and the adverse effects have increased - The “on-off” phenomenon may occur in clients taking levodopa - **The “on-off” phenomenon is when the therapeutic effects of the drug have decreased and the adverse effects have increased - The effect is associated with long term levodopa treatment - Low doses of the drug, reserving the drug for severe cases, or the use of a drug holiday (off drug for 5-14 days) may be prescribed |
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A nurse caring for a patient newly diagnosed with Parkinson’s has just started on levodopa, what patient teaching would you do?
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A nurse caring for a patient newly diagnosed with Parkinson’s has just started on levodopa, what patient teaching would you do?
- Instruct client to rise slowly from a sitting or lying position, especially after sitting or lying for a prolonged time - The “on-off” phenomenon is when the therapeutic effects of the drug have decreased and the adverse effects have increased - Levodopa may cause dizziness, dark sweat or urine - Do not abruptly discontinue use of the antiparkinsonism drugs, a neuroleptic malignant-like syndrome may occur: muscular rigidity, elevated body temperature, and mental changes - Avoid alcohol |
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What interventions can the nurse teach pt on Levodopa?
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What interventions can the nurse teach pt on Levodopa?
- Rise slowly, watch for the on/off effects and they may have dark colored sweat/urine |
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A patient has Parkinson’s disease and also has another condition where Cogentin (benztropine) is contraindicated, what is this mystery condition?
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A patient has Parkinson’s disease and also has another condition where Cogentin (benztropine) is contraindicated, what is this mystery condition?
- The nurse would question an order for Cogentin in a patient with **glaucoma - Contraindications: **Glaucoma, prostatic hypertrophy, myasthenia gravis |
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Occasionally the Doctor may order Mirapex (pramipexole) for a patient with Parkinson’s disease, what would be the S/E the nurse teaches the patient about?
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Occasionally the Doctor may order Mirapex (pramipexole) for a patient with Parkinson’s disease, what would be the S/E the nurse teaches the patient about?
- Day time sleepiness - May cause dizziness, somnolence, insomnia, hallucinations, confusion, nausea, dyspepsia, syncope |
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What drugs are contraindicated in a patient over the age of 65 (DOB 11/13/1928)?
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What drugs are contraindicated in a patient over the age of 65 (DOB 11/13/1928)?
- Digoxin, Demerol (meperidine) - These drugs are on the Beers list (list of medications that are generally considered inappropriate when given to elderly people |
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A patient is diagnosed with Parkinson’s disease and is taking selegiline (Eldepryl, Zelapar) (MAOIs), what post-op order would the nurse question?
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A patient is diagnosed with Parkinson’s disease and is taking selegiline (Eldepryl, Zelapar) (MAOIs), what post-op order would the nurse question?
- Question the medication meperidine (Demerol) - The dopamine agonists, which are MAOIs, selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) **should not be used with the opioid meperidine (Demerol) because of antimetabolite conversion which causes **stupor, rigidity, and hyperthermia - selegiline: Do not administer with demerol |
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A patient receiving prostigmine/Neostigmine with a diagnosis of Myasthenia Gravis, what would be the pathophysiology of this drug?
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A patient receiving prostigmine/Neostigmine with a diagnosis of Myasthenia Gravis, what would be the pathophysiology of this drug?
- Blocks the action of cholinesterase (acetylcholinesterase) - Drugs used to treat myasthenia gravis act indirectly to inhibit the activity of AChE and promote muscle contraction |
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Pt on Cogentin (benztropine), what adverse reaction should the nurse monitor for?
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Pt on Cogentin (benztropine), what adverse reaction should the nurse monitor for?
- urinary retention - Used cautiously in clients with tendency towards urinary retention |
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If you have a patient with Parkinson’s disease, what patient teaching are you going to do? (Plan of Care for Parkinsons pt)?
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If you have a patient with Parkinson’s disease, what patient teaching are you going to do? (Plan of Care for Parkinsons pt)?
- Maintain Functional Ability |
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Patient prescribed Levodopa and Artane, which statement says the patient understands how these meds work?
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Patient prescribed Levodopa and Artane, which statement says the patient understands how these meds work?
- I will not eat liver or boxed cereals (B6) - Instruct the client taking levodopa to avoid vitamin B6 (pyridoxine), this vitamin may interfere with the action of levodopa (found in whole grains, fortified cereals, liver, and green vegetables) |
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Instruction to patient taking Parlodel (bromocriptine)?
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Instruction to patient taking Parlodel (bromocriptine)?
- use extra method of birth control - Parlodel interferes with oral contraceptives, another method of birth control should be used |
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Selegeline (Eldepryl) is ordered post op, what other drug ordered would be questioned?
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Selegeline (Eldepryl) is ordered post op, what other drug ordered would be questioned?
- Demerol |
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Prostigmine/Neostigmine does what?
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Prostigmine/Neostigmine does what?
- Blocks action of cholinesterase |
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What is the antidote for Prostigmine/Neostigmine overdose?
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What is the antidote for Prostigmine/Neostigmine overdose?
- Atropine Sulfate - Atropine, an anticholinergic drug, antagonizes the effects of cholinergic drugs and is considered an antidote for over dosage of cholinergic drugs |
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What S/S would indicate an overdose of pyridostigmine bromide (Mestinon, Regonol)?
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What S/S would indicate an overdose of pyridostigmine bromide (Mestinon, Regonol)?
- **Patient cannot open their mouth - Monitor for drug toxicity or cholinergic crisis: abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, **clenching of the jaw |
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If you have a patient receiving pyridostigmine bromide (Mestinon), what kind of adverse reaction would you teach the patient to monitor for?
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If you have a patient receiving pyridostigmine bromide (Mestinon), what kind of adverse reaction would you teach the patient to monitor for?
- Bradycardia |
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Patient with Myasthenia Gravis being discharged on pyridostigmine bromide, what kind of patient teaching would you do at the time of discharge on this medication?
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Patient with Myasthenia Gravis being discharged on pyridostigmine bromide, what kind of patient teaching would you do at the time of discharge on this medication?
- their daily dose will be adjusted to meet the individuals needs - **vary individualized medication adjustments needed when dealing with this drug and condition - Many clients with myasthenia gravis learn to adjust dosage according to needs -Assess the client with myasthenia graivs for the presence or absence of symptoms prior to each drug dose because the dosage frequency and interval has to be increased or decreased early in therapy depending on the client’s response |
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Adverse reaction of Mestinon (pyridostigmine bromide)?
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Adverse reaction of Mestinon (pyridostigmine bromide)?
- Bradycardia |
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Pt is diagnosed with a stroke, which medication could have contributed to this?
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Pt is diagnosed with a stroke, which medication could have contributed to this?
- oral contraceptive, orthocyclen - ortho-tricyclen |
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If you are giving Decadron after a brain attack, what kind of Therapeutic action are you looking for?
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If you are giving Decadron after a brain attack, what kind of Therapeutic action are you looking for?
- Reduced ICP |
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What are S/S of Myasthenic Crisis?
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What are S/S of Myasthenic Crisis?
- **Restlessnes, dyspnea, and increased salivation/tearing - increased Pulse, RR, and B/P - anoxia, cyanosis - Total Incontinence - decreased urine output - absence of cough or swallow reflex |
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What are S/S of Cholinergic Crisis?
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What are S/S of Cholinergic Crisis?
- **Abdominal cramps, blurred vision, facial muscle twitching - N/V/D - miosis, pallor, bradycardia, hypotension |
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Why would a pt get Mannitol/Osmitol?
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Why would a pt get Mannitol/Osmitol?
- To decrease ICP |
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Increased ICP pt on Mannitol, what intervention to evaluate?
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Increased ICP pt on Mannitol, what intervention to evaluate?
- Assess neuro status |
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Which med would you question for a stroke pt?
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Which med would you question for a stroke pt?
- Plavix |
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What people should not receive ergotamine tartrate?
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What people should not receive ergotamine tartrate?
- Pregnant women - Patients on CNS Stimulants: instruct client to avoid coffee, tea, or cola if taking CNS stimulants |
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What can you tell a pt that was rx'd Dilantin (phenytoin)?
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What can you tell a pt that was rx'd Dilantin (phenytoin)?
- Use a soft toothbrush - Instruct clients taking phenytoin (Dilantin) to use a **soft bristled toothbrush (may have bleeding due to gingivitis and gingival hyperplasia) |
