Getiatrics Pediatrics And Antidepressment And Mood Stabalizers

Front 1

Neonate and infants have a decreased metabolism and excretion of drugs because of immature

Back 1

Decreased

Hint 1

As a result of immature kidney function, drugs are eliminated more slowly, requiring vigilant monitoring for toxicity

Front 2

Client teaching to family members with children includes:

Back 2

instructing family members to purchase child-resistant medication containers

Hint 2

child-proofing medications may decrease the risk for inadverlent ingestion

Front 3

 route is the most exact and predictable route through which to administer medications

Back 3

intravenous

Hint 3

The IV route allows for the greatest titration and bioavailability of the medication. The other routes are less exact

Front 4

 A parent is learning to administer medication to a preschool aged child. Which of the following strategies would be most effective in achieving cooperation

Back 4

providing age-appropriate explanations

Hint 4

Preschool-age children are beginning to understand complex concepts. Physical restraints is needed more with infants and toddlers, violent reactions are characteristic of toddlers, and contracts are best made with adolescents

Front 5

An 8 month old child is discharged from the hospital with a plan of care to recieve intramuscular (IM) injections each day. The parents have been taught the procedure to administer the injections. The nurse would reinforce using which of the following sites for IM injections in an 8 month old child

Back 5

Gluteal

Hint 5

The leg is the optimal site for injection until the children been walking well for 1 year and the gluteal muscle is well developed

Front 6

An infant client is ordered to recieve a topical silver nitrate ointment to prevent infection after sustaining burns. The nurse must be vigilant for signs of silver toxicity primarily because

Back 6

infants have thinner skin, allowing for greater absorption

Hint 6

The thinner the epidermis allows for greater absorption of topical medications, increasing the risk for toxicity

Front 7

A client is to be discharged to home on an oral liquid suspension in the amount of 4 mL per dose. Which of the following would ensure the highest level of accuracy in home administration of the medication

Back 7

using an oral syringe

Hint 7

The oral syringe provides the greatest accuracy in measuring medications

Front 8

A child is diagnosed with an ear infection. The physician orders an oral antibiotic. Which of the following is true of the calculation of this medicine

Back 8

The dose is calculated on body weight

Hint 8

Pediatric medication should be calculated on body weight or body surface area

Front 9

Two major organs affecting drug clearance from the body that should be closely monitored when an older adult client is receiving multiple drugs are

Back 9

liver and kidneys

Hint 9

These are the organs primarily responsible for medication metabolism and excretion

Front 10

Hepatic blood flow in the older adult is decreased, thus possibly causing a decrease in drug clearance. This results in

Back 10

decreased excretion of the drug

Hint 10

With a change in hepatic blood flow, there will be impaired drug metabolism. This leads to decrease excretion, increasing the risk for accumulation

Front 11

Which of the following laboratory tests is prescribed to evaluate renal function

Back 11

blood urea nitrogen (BUN)

Hint 11

BUN measures the amount of urea in the blood after filtration, indicating kidney function

Front 12

Polypharmacy is more common in the older adult. Polypharmacy means

Back 12

taking man drugs together

Front 13

There are many factors that are likely to decrease drug adherence in the elderly. One factor that can cause noncompliance in the older adult is:

Back 13

a decrease in finances (inability to pay for the drugs)

Front 14

An older adult client says that she has difficulty in removing the cap from the bottle of the prescription drug. She states that is the reason she does not always take her medication. The nurse can suggest that she

Back 14

ask the pharmacist to put the drug in a non-child proof container

Hint 14

Childproof caps may be difficult for older adults with arthritis or decreased strength or motor function

Front 15

A client is demonstrating signs and symptoms of disorientation. Which of the following questions by the nurse would be appropriate as related to medication use

Back 15

"Are you taking any new medication"

Hint 15

A new medication may be associated with changes in sensorium or other behavioral characteristics. This should be evaluated

Front 16

As a result of the specific physiologic characteristics of the older adult, most medication doses are _______ middle-aged adult doses

Back 16

less than

Hint 16

Because of the changes in metabolism and excretion, doses are generally decreased to avoid accumulation and toxicity

Front 17

An older adult client is ordered to recieve digoxin. The client has decreased renal function. Which of the following could indicate digoxin toxicity

Back 17

a heart rate less than 60 beats/minute

Hint 17

digoxin slows and strengthens the heart. Toxicity may be manifested by bradycardia.

Front 18

A client takes ibuprofen (motrin) to deal with the pain of arthritis. The client complains of gastrointestinal symptoms. Which fo the following is an appropriate stategy for the nurse to teach the client

Back 18

"try to take an antacid 1 hour before your dose"

Hint 18

An antacid may decrease the gastrointestional side effect of the NSAID. It may also impair absorption, so it must be evaluated for effectiveness

Front 19

A nurse is administering a medication to an older adult client. The nurse the nurse is aware that the clients t1/2 is longer than those in middle-aged adults. the nursing intervention indicated by this pemise is

Back 19

monitoring the client for signs of accumulation

Hint 19

Because older adults may have less efficient medication elimination, monitoring for accumulation is an important component of nursing care

Front 20

As a result of the specific physiologic characteristics of the older adult, most medication doses are _______ middle-aged adult doses

Back 20

less than

Hint 20

Because of the changes in metabolism and excretion, doses are generally decreased to avoid accumulation and toxicity

Front 21

An older adult client is ordered to recieve digoxin. The client has decreased renal function. Which of the following could indicate digoxin toxicity

Back 21

a heart rate less than 60 beats/minute

Hint 21

digoxin slows and strengthens the heart. Toxicity may be manifested by bradycardia.

Front 22

A client takes ibuprofen (motrin) to deal with the pain of arthritis. The client complains of gastrointestinal symptoms. Which fo the following is an appropriate stategy for the nurse to teach the client

Back 22

"try to take an antacid 1 hour before your dose"

Hint 22

An antacid may decrease the gastrointestional side effect of the NSAID. It may also impair absorption, so it must be evaluated for effectiveness

Front 23

A nurse is administering a medication to an older adult client t 1/2 is longer than those in middle-aged adults. The nursing intervention indicatied by this premise is:

Back 23

monitoring the client for signs of accumulation

Hint 23

Because older adults may have less efficient medication elimination, monitoring for accumilation is an important component of nursing care

Front 24

A nurse is discussing depression with a new nurse. The experienced nurse explains that major depression is thought to be related to the following hormonal changes

Back 24

An increase in serotonin and increase in norepinephorine levels

Front 25

Two herbal supplements have been indicated for mild depression

Back 25

St. John's wort and ginkgo

Hint 25

These herbs may be recommended in the treatment of mild depression

Front 26

A nurse is scheduling a clients medications. The client is ordered to recieve a daily dose of fluoxetine (Prozac). Because of the major side effects of this medication, the nurse correctly schedule this medication at

Back 26

0800

Hint 26

This medication, an SSRI, may cause insomnia so it should be given early in the day

Front 27

A client is ordered a tricyclic antidepressant. In monitoring this client, the nurse would assess for

Back 27

orthostatic hypotension

Hint 27

Tricyclic antidepressants are known to cause orthostatic hypotension, hypotension, and sedation

Front 28

A client is ordered fluoxetine (Prozac) for mild depression. The nurse would monitor for the following side effects

Back 28

nervousness, restlessness, and insomnia

Front 29

A Latino client is ordered to recieve an antidepressent drug. The nurse would anticipate that this client's dose would be

Back 29

lower than that for other cultural groups

Hint 29

Latino clients are more sensitive to antidepressants; therefore the dose must be decreased

Front 30

A nurse works in an assisted living setting. The nurse is administering an antidepressant to a 78 yr old client. The nurse is aware that the daily dose of antidepressants for the older adult would be

Back 30

about half of the adult dose

Hint 30

Older adults require half the adult dose related to physiologic differences in absorbtion, distribution, metabolism, and excretion

Front 31

Health teaching for clients taking MAO inhibitors such as tranylcypromine (Parnate) is very important. Which of hte following foods would the nurse instruct the client to avoid

Back 31

cheese

Hint 31

MAO inhibitors, if eaten with aged foods or those with tyramine, can lead to hypertensive crisis

Front 32

Serum lithium level is important to monitor because it has a narrow therapeutic range. Reference (therapeutic) ranges is

Back 32

0.5 to 1.5 mEq/L

Hint 32

Hyponatremia can occur with the diuresis and sodium loss may occur with lithium therapy. Adaquate sodium intake must be ensured

Front 33

A nurse is scheduling a client's medications. The client is ordered to recieve a daily dose of amitriptline (Elavil). Because of the major side effects of this medication, the nurse correctly schedule this medication at

Back 33

2200

Hint 33

This medication, a tricyclic antidepressant, may cause sedation, so it should be given at bedtime

Front 34

A client is on maintenance lithium therapy for bipolar disorder. The client enters the emergency department complaining of tremors and feeling "funny". The client appears to be giddy and confused. A serum lithium level is drawn. The lab calls, stating the client''s level is 2 mEq/L. the nurse would anticipate

Back 34

holding the next dose of lithium

Hint 34

This serum lithium level is above therapeutic range and the client is demonstrating symptoms of early lithium toxicity. The next dose would be held

Front 35

A client begins taking paroxetine (Paxil) for obsessive-compulsive disorder. Which of the following client statements would indicate that the medication is effective

Back 35

"I am learning to set priorities for what has to be done"

Hint 35

This demonstrates that the client is less compulsive

Front 36

A client enters the nurse practioner's office. The client has been treated with antidepressants for mild depression for 3 years. The client says his medication is no longer working and he states that he has heard that MAO inhibitors are effective meidcations in treating depression. The nurse would respond based on the knowledge that:

Back 36

this medication requires significant dietary restrictions

Hint 36

MAO inhibitors, when eaten with aged foods and those with tyramine, can lead to hypertensive crisis. The medication alone does not do this; is is effective for depression and has some side effects

Front 37

Which of the following interventions is highest priority for the care plan for a client on lithium therapy?

Back 37

Drink 1 to 2 L of water per day

Hint 37

Drinking and staying hydrated is of highest priority. Lithium may cause polyuria and lead to dehydration

Front 38

A client is taking an antidepressant. Which of the follwoing would indicate a side effect of anticholinergic origin

Back 38

urinary retension

Hint 38

Urinary retention, constipation, tachycardia, and dry mouth are anticholinergic symptoms.

Front 39

A client is taking fluoxeine (Prozac) for mild depressive disorder. The nurse is providing teaching and counseling. The client complains of lak of sexual desire and diminished sexual arousal. The nurse's response is based on the fact that:

Back 39

This is a known side effect and may require intervention

Hint 39

This side effect is expected of the SSRIs and may require specific interventions and counseling.

Front 40

A client is being treated withan MAO inhibitor. The client needs to be instructed to avoid foods with tyramine, such as

Back 40

aged cheeses

Hint 40

Aged foods and foods with tyramine may lead to life threatening hypertensive crisis if digested with MAO inhibitors.

Front 41

A client is ordered to receive fluoxetine (Prozac) for premenstrual depressive disorder. The client is receiving client teaching. Which of the following statements made by the client would indicate a need for more teaching

Back 41

"I should feel better in 1 week

Hint 41

This medication often takes 2-4 weeks for a therapeutic effect. The medication does decrease appetite and may cause nausea. It is taken early in the day to avoid insomnia

Front 42

A client is ordered to receive an MAO inhibitor in the treatment of major depression. Select the food to be restricted while on this medication

Back 42

aged cheese

Hint 42

Hypertensive crisis from fatal tyramine interaction (cheese, coffee, cream, yogurt, bananas, liver, yeast, chocolate, beer, red wine)

Front 43

Why is it important to provide age appropriate explanations to a school aged child when working with their medication

Back 43

this will most enlist their co-operation with the medication

Front 44

The client is due to be started on Prozac. What changes in the client's functioning should the nurse anticipate

Back 44

ECG changes

Hint 44

ECG changes can occur when the client is treated with Prozac

Front 45

The nurse needs to understand the differences in drug excretion in children. The nurse bases decisions in medication administration on the knowledge that drug excretion in infants and children is usually

Back 45

decreased

Hint 45

As a result of immature kidney function, drugs are eliminated more slowly, requiring vigilant monitoring for toxicity

Front 46

Drug half life for an older child can be shortened because of increase metabolic rate. The drug dose for older children may be

Back 46

increased because of drug metabolism

Hint 46

With shorter half life, more of the drug is eliminated quickly. This requires a higher dose of the medication

Front 47

Infants have decrease plasma protien-binding sites because of decrease plasma protien and albumin levels. Compared to adults, with drugs that are highly protien-bound the drug dose for infants usually

Back 47

decreased

Hint 47

With fewer binding sites, there is more active drug available. This requires a reduction in the dose

Front 48

The gastric pH of children younger than 3 years is greater (more alkaline) than adults. Penicillin can be destroyed by gastric aciditiy. Compared to an adult, the penicillin dose for a child should be

Back 48

decreased

Hint 48

Because the gastric pH is more alkaline, less penicillin would be destroyed