NR-293 Pharmacology for Nursing Practice - Set 4 - Part 1

Correct Answer: Constant thirst, frequent urination, and blurred vision

Polydipsia, polyuria, and blurred vision are the classic markers of new hyperglycemia, which second generation antipsychotics can cause. A fasting glucose or A1C is needed rather than reassurance over the telephone. Option a is incorrect because sedation is expected with quetiapine and is the reason bedtime dosing is chosen. Mild drowsiness after the evening dose reflects histamine blockade and calls for no urgent workup. Option b is incorrect because dry mouth comes from muscarinic blockade and already has a working solution in this client. Sugar free gum, frequent sips, and good dental care handle it without a change in therapy. Option d is incorrect because looser clothing suggests weight loss, the opposite of what this class usually produces. Losing a little weight is welcome news and would prompt praise rather than an urgent laboratory order.

Correct Answer: Dry mouth, blurred vision and urinary retention

Tricyclics block muscarinic receptors alongside their reuptake action, producing the classic anticholinergic cluster of dry mouth, blurred vision, constipation and urinary retention. Older men with prostate enlargement are especially prone to retention. Option b is incorrect because tearing, salivation and diarrhea describe cholinergic excess, the opposite of what this drug does. Amitriptyline dries secretions and slows the bowel instead of stimulating either. Option c is incorrect because bradycardia with constricted pupils and wheeze suggests opioid or organophosphate exposure. Tricyclic therapy tends to speed the heart and widen the pupils rather than produce that picture. Option d is incorrect because heavy sweating with hunger points toward low blood sugar or thyroid excess. Anticholinergic blockade reduces sweating, so this combination runs against the drug's known receptor profile.

Correct Answer: Assess respiratory rate and withhold the lorazepam

Benzodiazepines carry a boxed warning against combined use with opioids because the pair produces profound sedation and respiratory depression. Breathing is assessed first, the dose is held, and the prescriber is notified. Option a is incorrect because side rails address falling out of bed while the real hazard is a rate of breathing that keeps dropping. Adding a second central nervous system depressant to an already obtunded client invites arrest. Option b is incorrect because hourly rounds detect a problem an hour after it starts. Sedation from these two drugs multiplies rather than adds, and an older adult can stop breathing well before the next check. Option c is incorrect because a sitter provides observation without any clinical judgment about whether the drug should go in. Delegating supervision does not substitute for the nurse assessing ventilation and questioning an unsafe combination.

Correct Answer: Nausea, headache and trouble sleeping

Gastrointestinal upset, headache and altered sleep head the list of early complaints with serotonin reuptake inhibitors. These usually settle within a week or two, and taking the dose with food eases the nausea. Option a is incorrect because bradycardia with cold intolerance suggests hypothyroidism rather than serotonergic therapy. Reuptake inhibitors more often speed the pulse slightly and cause jitteriness, not the sluggish picture described here. Option b is incorrect because tinnitus with hearing loss points toward salicylate toxicity or aminoglycoside injury. Serotonin reuptake inhibitors do not damage the eighth cranial nerve, so this pairing fits another drug entirely. Option d is incorrect because jaundice with hair loss suggests liver injury and belongs to other agents entirely. Serotonin reuptake inhibitors are chosen partly because their early effects are mild and self limiting.

Correct Answer: Administer acetylcysteine without waiting for levels

Acetylcysteine restores glutathione and works best within eight to ten hours of ingestion, so treatment starts on the history rather than waiting for a level. Early symptoms are mild and falsely reassuring. Option b is incorrect because naloxone reverses opioids at mu receptors and has no effect on acetaminophen. Giving it here wastes the narrow window in which the true antidote can still protect liver tissue. Option c is incorrect because enzymes stay normal during the first day even when a lethal amount was swallowed. Delaying until morning pushes the client past the window when the antidote still prevents necrosis. Option d is incorrect because watchful waiting ignores how this poisoning behaves. The quiet first stage gives way to hepatic necrosis two to three days later, by which time acetylcysteine offers far less protection.

Correct Answer: Growing difficulty waking the client

Deepening sedation is the earliest sign that respiratory depression is coming, because opioids blunt the drive to breathe before the rate falls. The nurse stops the opioid and assesses breathing at once. Option a is incorrect because itching after morphine comes from histamine release rather than an allergic reaction. An antihistamine handles it, and the finding never outranks a client who is slipping out of consciousness. Option b is incorrect because slowed bowel motility is expected from the first dose onward and is managed with a stimulant laxative and softener. Constipation matters greatly, but breathing takes priority over the bowel. Option d is incorrect because orthostatic drops are common with opioid vasodilation and are handled by slow position changes and assistance. The finding threatens a fall, not the airway, so it is addressed second.

Correct Answer: Tolerance along with physical dependence

Needing more drug for the same effect is tolerance, and withdrawal symptoms after a missed dose show physical dependence. Both are expected physiologic responses to steady opioid use and are managed by titration and tapering. Option a is incorrect because addiction is a behavioural diagnosis built on compulsive use, loss of control and continued use despite harm. This client follows the prescription exactly, so none of those features are present. Option b is incorrect because pseudoaddiction describes drug seeking that springs from pain left undertreated and disappears once relief improves. Nothing here suggests the client is chasing extra doses or reporting uncontrolled pain. Option c is incorrect because hypersensitivity produces hives, wheezing or swelling shortly after a dose. Sweating, cramping and loose stools between doses are the classic withdrawal picture, which points to dependence rather than immune reaction.

Correct Answer: Support the airway and summon emergency help

Laryngeal and pharyngeal involvement turns acute dystonia into an airway emergency. The nurse stays with the client, keeps the airway open, and calls for help so parenteral benztropine or diphenhydramine can be given at once. Option a is incorrect because watchful documentation treats a closing airway as a routine finding. Spasm of the larynx can obstruct breathing within minutes, so waiting to see what happens risks a respiratory arrest. Option b is incorrect because handing a tablet and water to someone who cannot manage his own secretions invites aspiration. The parenteral route is used in dystonia precisely because relief must come within minutes. Option d is incorrect because thickened liquids belong to the care of a client with chronic dysphagia after a stroke. This is a sudden drug induced muscle spasm, and no change in food texture will release it.

Correct Answer: It does not cause sexual dysfunction

Bupropion blocks norepinephrine and dopamine reuptake with no serotonin effect, so sexual dysfunction is not part of its profile. That makes it a common choice when a serotonergic agent has been abandoned. Option a is incorrect because this drug is activating and insomnia ranks among its frequent early complaints. Clients are usually advised to take the later dose well before bedtime to protect sleep. Option b is incorrect because weight loss, not gain, is the usual pattern with bupropion. Mirtazapine is the antidepressant deliberately chosen when appetite and body weight both need to increase. Option c is incorrect because a monoamine oxidase inhibitor must be stopped fourteen days before bupropion begins. Free combination with any antidepressant would invite exactly the interactions the label warns against.

Correct Answer: "Naloxone wears off first, so we will watch him for hours."

Naloxone lasts roughly thirty to eighty minutes, shorter than most opioids, so sedation and slow breathing can return once it fades. Continued monitoring, repeat doses or an infusion may all be required. Option b is incorrect because the antagonist only competes for receptors while it is present. Oxycodone, methadone and extended release products stay in the body far longer, so the opioid is still there when naloxone leaves. Option c is incorrect because unmonitored sleep is exactly how renarcotisation kills. Level of consciousness, respiratory rate and oxygen saturation are followed closely for several hours, with a bag valve mask kept at the bedside. Option d is incorrect because the comparison runs the wrong way. A half life measured in minutes cannot outlast an opioid that acts for hours, which is the whole reason repeated doses become necessary.

Correct Answer: "A beer at night will help these tablets work."

Alcohol adds central nervous system depression to an opioid and deepens sedation and respiratory depression. Clients are taught to avoid alcohol and other sedatives entirely, so this statement shows the teaching has not taken hold. Option a is incorrect because locked storage is precisely what the nurse wants to hear. Opioids kept out of reach protect children and visitors, and secure storage is standard teaching for every take home supply. Option c is incorrect because avoiding the wheel is correct while sedation and slowed reaction time persist. A client who repeats this instruction has understood the safety message and needs no further correction on that point. Option d is incorrect because starting a softener early is exactly right. Slowed gut motility begins with the first tablet and never improves with tolerance, so bowel care belongs in the plan from day one.

Correct Answer: Explain that anticholinergics worsen these movements

Lip smacking and tongue protrusion after years of exposure describe tardive dyskinesia, and anticholinergics such as benztropine make it worse. The provider is notified so the antipsychotic can be tapered or changed. Option a is incorrect because benztropine helps dystonia and pseudoparkinsonism but aggravates the late oral movements. Giving it and waiting an hour would let a potentially permanent problem deepen while nothing useful is done. Option b is incorrect because stacking another dopamine blocker on top of the first raises cumulative exposure, which is the very thing driving the movements. Two agents also multiply metabolic and cardiac risk without benefit. Option d is incorrect because a higher dose may briefly mask the movements and then leave them worse once tolerance develops. Tapering or switching the drug, not escalating it, is what the evidence supports.

Correct Answer: A widened QRS complex on the electrocardiogram

Tricyclics act like class one antiarrhythmics, slowing conduction and widening the QRS complex, which is dangerous after a myocardial infarction. An already widened complex at baseline must be reported before dosing. Option b is incorrect because that rate sits comfortably within normal limits for an adult at rest. Tricyclics do tend to raise heart rate through muscarinic blockade, but a normal baseline is no barrier. Option c is incorrect because a modestly raised glucose reflects the diabetes already being treated. It calls for glycemic management rather than a hold on an antidepressant chosen for nerve pain. Option d is incorrect because extra weight matters for long term counseling, not for the decision facing the nurse tonight. Tricyclics do add pounds through histamine blockade, yet cardiac conduction is the urgent baseline question.

Correct Answer: Report the episode and expect the drug discontinued

Sleep cooking is a complex sleep behavior, the boxed warning for this class. The drug is stopped immediately after such an event and is contraindicated afterward, because these episodes have caused serious injury and death. Option a is incorrect because moving the dose earlier only widens the window in which she is awake and impaired. The label directs taking it immediately before bed with a full night available, and neither timing prevents the behavior. Option b is incorrect because hunger is not driving this. The client was never fully awake, so appetite counseling misses a neurologic event in which she carried out a complicated task with no memory of it. Option c is incorrect because environmental barriers cannot cover every risk this warning describes. Clients on these agents have also driven cars while asleep, so locking one room leaves the fundamental hazard fully in place.

Correct Answer: "I will keep my salt intake steady and drink plenty of water."

Lithium is handled by the kidney much like sodium, so steady salt intake paired with generous daily fluids keeps the serum level stable. This statement captures both halves of the teaching precisely. Option a is incorrect because lowering salt makes the kidney hold on to lithium, and the level rises toward toxicity. Renal protection comes from consistent sodium and adequate hydration, not from restriction. Option c is incorrect because withholding evening fluids invites the volume depletion that concentrates lithium. Polyuria is an expected effect of the drug, and the answer is to replace fluid rather than to ration it. Option d is incorrect because skipping doses on good days invites relapse into mania. Lithium requires uninterrupted daily dosing, and abrupt stopping carries a high rate of recurrence that the client should hear about.

Correct Answer: Have blood drawn just before the next dose

Lithium levels are drawn as troughs, eight to twelve hours after the previous dose and immediately before the next one. Sampling at any other point gives a number that cannot be interpreted. Option b is incorrect because a sample taken an hour after dosing catches the absorption peak. The result reads falsely high, and a provider acting on it might cut a dose the client actually needs. Option c is incorrect because random timing destroys comparability between visits. Two levels drawn at different points in the dosing cycle cannot be lined up, and trends are what guide adjustments in a narrow range. Option d is incorrect because waiting for symptoms defeats the purpose of surveillance. Levels are checked every one to three months in stable clients precisely so that a dangerous rise is caught before confusion or ataxia arrives.

Correct Answer: A histamine effect that antihistamines relieve

Morphine releases histamine directly, producing itching and flushing without airway or circulatory involvement. This is not a true allergy, so an antihistamine relieves it and the opioid can usually continue as ordered. Option a is incorrect because anaphylaxis brings wheezing, stridor, tongue swelling and a falling blood pressure within minutes. All of those markers are absent here, and epinephrine would be an aggressive response to simple histamine itch. Option b is incorrect because withdrawal follows abrupt stopping or an antagonist, never a first dose. Its picture includes yawning, tearing, gooseflesh, cramping and dilated pupils rather than the flushed itching described here. Option c is incorrect because serotonin syndrome arises from serotonergic drugs such as tramadol combined with antidepressants or triptans. Agitation, fever, tremor, rigidity and overactive reflexes define it, and none of those appear in this client.

Correct Answer: Arrange liver function testing and notify the provider

Anorexia, vomiting and right upper quadrant pain within the first six months suggest valproate hepatotoxicity, the drug's most feared boxed warning. Liver enzymes and immediate provider notification take priority over comfort measures. Option a is incorrect because lowering the dose is a prescriber decision and a month of waiting is far too long. Fatal hepatic failure develops quickly in young children, so enzymes are checked now rather than later. Option b is incorrect because dietary adjustment fits ordinary stomach upset, which valproate does cause early in therapy. This cluster of findings points instead at the liver, and food changes will not alter a failing organ. Option d is incorrect because suppressing the vomiting removes the warning sign the family just described. An antiemetic would let injury progress silently toward jaundice and dark urine while the child keeps receiving the drug.

Correct Answer: Dietary amino acids compete with levodopa for absorption

Amino acids from a high protein meal compete with levodopa for the same transport carriers in the gut wall and at the blood brain barrier, so the dose is blunted. Spreading protein through the day helps. Option a is incorrect because delayed emptying would slow the onset without cutting the amount that finally reaches the brain. The client describes lost benefit, which points to a transport problem rather than a timing one. Option c is incorrect because gastric acid is not what limits this drug. Levodopa survives the stomach well enough, and taking a dose with a light snack is routinely recommended to reduce nausea. Option d is incorrect because carbidopa keeps working regardless of the meal. Its job is blocking peripheral conversion of levodopa so more reaches the brain, and food does not inactivate that enzyme blockade.

Correct Answer: Hold the dose and notify the provider

A rate below twelve with rising sedation is the signal to withhold the opioid and call the provider. Sedation comes before respiratory depression, so an unrousable client already shows the early warning. Option b is incorrect because a smaller amount still adds opioid to a client whose drive to breathe is already blunted. Dose changes belong to the provider, and the nurse may not alter an order independently. Option c is incorrect because rechecking later does nothing about the depression already present. Giving the drug now would deepen sedation over the next half hour, exactly when the peak effect arrives. Option d is incorrect because position changes nothing about a drug that blunts the medullary response to carbon dioxide. Upright posture may help lung expansion, yet the opioid must still be withheld until breathing improves.