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A health care professional is caring for a patient who is about to begin taking amphetamine

sulfate (Adderall).The health care professional should monitor the patient for which of the
following adverse effects?
Tachycardia
Rationale
Amphetamine sulfate is an amphetamine stimulant. It can cause tachycardia and
dysrhythmias. Patients should notify the health care professional if they develop
palpitations or chest pain.
A health care professional is talking to a patient and her family about how
methylphenidate (Ritalin) will help manage attention-deficit hyperactivity disorder
(ADHD). Which of the following therapeutic effects should they expect?
Increased focus
Rationale:
Stimulants, such as methylphenidate, regulate levels of dopamine and
norepinephrine in the brain to produce calmness, reduce hyperactivity, and increase
focus for patients who have ADHD.
A health care professional is talking to a patient about beginning sumatriptan
(Imitrex) therapy to treat migraine headaches. The health care professional should
advise the patient to watch for which of the following adverse effects?
Chest pain
Rationale
Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain.
Patients should report any pressure, pain, or tightness in the jaw, chest, or back.
Sumatriptan is not an appropriate choice for patients who have a history of coronary
artery disease.
A health care professional is reviewing the medical record of a patient who has a
newly diagnosed seizure disorder. The patient is to begin taking both valproic acid
(Depakote) and phenytoin (Dilantin). The health care professional should recognize
that which of the following can occur as a result of a drug interaction between
valproic acid and phenytoin?
Phenytoin toxicity
Rationale:
Valproic acid can cause an increase in phenytoin blood levels, causing phenytoin
toxicity. The primary care provider should monitor serum phenytoin levels and
reduce the dosage if levels begin to exceed the therapeutic range.
A health care professional is caring for a patient who is about to begin taking
dantrolene (Dantrium) for skeletal muscle spasms. The health care professional
should recognize that which of the following laboratory tests requires monitoring?

Liver function
Rationale:
Liver toxicity is a serious adverse effect of dantrolene. The health care professional
should monitor liver function prior to treatment and at regular intervals, and advise
patients to report jaundice or abdominal pain.
Because of the potential for adverse effects, which of the following should a health
care professional recommend for patients who begin taking carbamazepine
(Tegretol)?
Begin taking the drug at a low dosage.
Rationale:
Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, an
iminostilbene that treats seizure disorders. Dosages should be low to minimize or
prevent these adverse effects.
For which of the following should a health care professional monitor a patient who is
taking donepezil (Aricept) for Alzheimer's disease?
Nausea
Rationale:
The most common adverse effects of donepezil, a cholinesterase inhibitor, are
nausea, vomiting, and diarrhea. Taking the drug with food can help minimize
adverse effects.
Which of the following information should a health care professional include when
talking to a patient about taking baclofen (Lioresal)?
Avoid driving until the drug's effects are evident.
Rationale:
Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Patients taking
the drug should avoid alcohol and other CNS depressants and should not drive a
vehicle until they know how the drug will affect them.
A patient is taking selegiline (Eldepryl) to treat Parkinson's disease. The provider is
considering the use of analgesics for the patient but should be aware that a drug
interaction between selegiline and meperidine (Demerol) can result in which of the
following?
Muscle rigidity
Rationale:
A drug interaction between selegiline and opioids, especially meperidine, can result
in a serious reaction resulting in rigidity, stupor, agitation, hypertension, and fever.
A health care professional is caring for a patient who is about to begin taking
pramipexole (Mirapex) to treat Parkinson's disease. The health care professional
should recognize that which of the following laboratory tests require monitoring?
Creatine phosphokinase (CPK)
Rationale:

CPK is an enzyme found in the heart, brain, and skeletal muscles. Patients taking
pramipexole can develop muscle weakness with a lack of energy, creating a
situation that can be more problematic for patients than their original muscle
dysfunction. Monitoring CPK can alert health care professionals to the possibility of
skeletal muscle damage from the drug.
Which of the following findings should alert a health care professional that a patient
is developing a potentially serious adverse reaction to interferon beta-1b
(Betaseron)?
Fatigue
Rationale:
Because of the potential for bone marrow suppression and decreased platelet count,
patients should report unexplained bruising, bleeding, or fatigue.
A health care professional is caring for a patient who is about to begin taking
dantrolene (Dantrium) for skeletal muscle spasms. The health care professional
should tell the patient to report which of the following adverse effects?
Diarrhea
Rationale:
Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea is an
adverse effect of dantrolene, as are nausea and vomiting. Patients should report
these effects so the health care professional can monitor fluid balance and
intervene accordingly.
A health care professional is caring for a patient who is receiving thiopental
(Pentothal). For which of the following should the health care professional monitor?
Respiratory depression
Rationale:
Thiopental, a short-acting barbiturate, causes respiratory depression. Mechanical
ventilation and continuous monitoring are essential for patients receiving the drug.
Anesthetists often administer midazolam (Versed) during induction of anesthesia
because of which of the following pharmacological actions?
Causes amnesia
Rationale:
Midazolam, a benzodiazepine, is appropriate during induction because of its
antianxiety and amnesiac properties.
A health care professional is caring for a patient who is taking zolpidem (Ambien).
The patient has a history of benzodiazepine abuse and reports insomnia. The health
care professional should caution the patient that the drug can cause
memory impairment.
Rationale:
Zolpidem, a non-benzodiazepine, can cause anterograde amnesia, or memory
impairment, particularly an inability to recall activities patients carry out just before
or during sleep.

A health care professional is talking to a patient who is newly diagnosed with


Parkinson's disease about how levodopa/carbidopa (Sinemet) will help control her
symptoms. With which of the following mechanisms is the drug effective in treating
the disorder?
Increases available dopamine in the brain
Rationale:
Levodopa/carbidopa, a dopaminergic agent, can act by increasing dopamine in the
extrapyramidal center of the brain, reducing involuntary motion.
A health care professional should include which of the following instructions when
talking with a patient about taking levodopa/carbidopa (Sinemet) to treat
Parkinson's disease?
Change position slowly to prevent orthostatic hypotension.
Rationale:
Levodopa/carbidopa can cause orthostatic hypotension.
A health care professional is talking to a patient who is about to begin taking
valproic acid (Depakote) for a newly diagnosed seizure disorder. He should tell the
patient to watch for which of the following adverse effects? (Select all that apply.)
Drowsiness, rash
Rationale:
Drowsiness is correct. Patients taking valproic acid should report CNS depressant
effects, such as sedation or drowsiness, because these effects can indicate the need
for a reduction in dose.
Rash is correct. Skin rash is a side effect of valproic acid and other antiepileptic
drugs.
A health care professional is talking with a patient who is to begin taking valproic
acid (Depakote) to treat a seizure disorder. He should advise the patient to monitor
for which of the following adverse effects?
Jaundice
Rationale:
Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain,
and nausea. Patients taking the drug should report these symptoms, and health
care professionals should monitor liver function studies prior to treatment and
periodically during therapy.
A health care professional administers fentanyl (Sublimaze) to a patient to reduce
pain. Which of the following drugs should she have available to reverse the effects
of fentanyl?
Naloxone
Rationale:
Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an
opioid agonist, can cause severe respiratory depression. Health care professionals
administering fentanyl should also have resuscitation equipment available.

While talking with a patient and his family about taking memantine (Namenda) for
Alzheimer's disease, the health care professional should include which of the
following instructions?
Notify the health care professional before taking over-the-counter antacids.
Rationale:
Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease
drug excretion, ultimately leading to toxicity.
An anesthetist is about to administer lidocaine (Xylocaine) as part of the protocol for
spinal anesthesia for a patient who is undergoing a surgical procedure. The health
care professional should be aware that the patient could develop which of the
following potentially serious effects?
Hypotension
Rationale:
When systemically absorbed in sufficient amounts, lidocaine, a local anesthetic, can
cause hypotension, particularly when used as spinal anesthesia.
When talking with a patient about taking temazepam (Restoril), which of the
following instructions should the health care professional include? (Select all that
apply.)
Avoid alcohol and other depressants.
Take the drug 30 min before bedtime.
Taper the drug slowly to prevent withdrawal symptoms.
Avoid alcohol and other depressants is correct. Temazepam can cause CNS
depression. Combined use with alcohol or other depressants can cause severe
respiratory depression.
Take the drug 30 min before bedtime is correct. Patients should take
temazepam 30 min before bedtime to improve sleep and to prevent daytime
drowsiness.
Taper the drug slowly to prevent withdrawal symptoms is correct. Abrupt
discontinuation of temazepam can cause withdrawal symptoms. Patients should
taper the drug slowly to prevent or minimize withdrawal.
A health care professional is talking to a patient about the adverse effects of
interferon beta-1a (Avonex). To help minimize these effects, she should tell the
patient to
premedicate with acetaminophen (Tylenol).
Rationale:
Interferon beta drugs can cause fever, chills, headaches, and muscle aches.
Acetaminophen or a nonsteroidal anti-inflammatory drug can help minimize these
symptoms.
When talking to a patient about taking modafinil (Provigil) to treat narcolepsy, which
of the following instructions should the health care professional include?

Take the drug in the morning.


Rationale:
Modafinil is a non-amphetamine stimulant. Taking it in the morning helps improve
wakefulness for patients who have narcolepsy. Patients taking the drug for shiftwork sleepiness should take it 1 hr before work.
NEURO PART 2
A health care professional is caring for a patient who is about to begin using
betaxolol (Betoptic) eye drops to treat open-angle glaucoma. The health care
professional should advise the patient to expect which of the following reactions?
Ocular stinging
Rationale:
Betaxolol, a beta-adrenergic blocker, can cause short-term, mild stinging and
burning of the eye. Patients should expect transient eye discomfort, but should not
rub their eyes. Severe or continuous irritation should be reported.
A patient is admitted to the emergency department with spasms of his face and
back. He has recently begun taking chlorpromazine to treat schizophrenia. Which of
the following adverse reactions should the health care professional suspect?
Acute dystonia
Rationale:
Acute dystonia can develop during the first few days of treatment with
chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and
tongue. Treatment includes immediate administration of an anticholinergic drug,
such as diphenhydramine.
A health care professional is caring for a patient who is about to begin taking
echothiophate (Phospholine Iodide) to treat glaucoma. The health care professional
should monitor the patient for the development of which of the following adverse
effects?
Cataracts
Rationale:
Echothiophate, a cholinesterase inhibitor, can cause cataracts, or opacity of the lens
of the eye. Patients should report any changes in vision, such as cloudiness or halos
around lights.
A health care professional should expect which of the following adverse effects for a
patient who is taking betaxolol (Betoptic) eye drops to treat glaucoma?
Bradycardia
Rationale:
Betaxolol and timolol (Timoptic) can cause bradycardia because of the blockade of
cardiac beta1 receptors. Patients should check their pulse rate regularly and report
any sustained decreases.

Which of the following instructions should a health care professional include when
advising a patient about instilling pilocarpine (Isopto Carpine) for managing openangle glaucoma? (Select all that apply.)
Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops.
Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after
instillation helps keep the drug from entering the systemic circulation.
Do not touch the tip of the dropper.
The tip of the dropper should remain sterile. It is important that patients
avoid touching the dropper's tip or touching it to the eye area.
Remove contact lenses prior to instilling the drops.
Patients should remove contact lenses before instilling eye drops because
they can cause further irritation if left in place.
When caring for a patient who is taking risperidone (Risperdal) for schizophrenia,
the health care professional should monitor for which of the following adverse
effects of the drug?
Polyuria
Rationale:
Risperidone, an atypical antipsychotic, can cause new-onset diabetes mellitus. It is
essential to monitor patients taking the drug for signs of hyperglycemia, and check
their glucose levels regularly.
Soon after beginning fluoxetine (Prozac), a patient is admitted to the emergency
department with agitation and confusion. The health care professional should
suspect which of the following?
Serotonin syndrome
Rationale:
Serotonin syndrome can begin 2 to 72 hr after beginning to take fluoxetine, a
selective serotonin reuptake inhibitor. Manifestations include mental confusion,
difficulty concentrating, and agitation.
During and immediately following IV administration of chlorpromazine to a patient
who has schizoaffective disorder, the health care professional should monitor which
of the following?
Blood pressure
Patients receiving chlorpromazine are at risk for hypotension during and
immediately after IV administration. They should remain supine for 30 min while the
health care professional monitors their blood pressure. It is essential to infuse the
chlorpromazine solution slowly and not to mix it with other drugs.
A health care professional is caring for a patient who has been taking alprazolam
(Xanax) for an extended period of time to treat anxiety. The health care professional
should recognize that stopping alprazolam therapy suddenly can result in which of
the following?
Withdrawal symptoms

Physical dependence can develop with extended use of alprazolam, a


benzodiazepine. To prevent withdrawal symptoms, patients should taper the dose
slowly over several weeks.
A health care professional should advise a patient who is taking phenelzine (Nardil)
to avoid tyramine-enriched foods because of an increased risk for which of the
following adverse reactions?
Hypertensive crisis
Tyramine-enriched foods, such as aged cheese and processed meat, can trigger
severe hypertension in patients who are taking phenelzine. Manifestations include
hypertension, headache, and nausea.
When talking to a patient about taking buspirone, the health care professional
should include which of the following instructions?
Allow 2 to 4 weeks before expecting to feel better.
Rationale:
It can take up to 4 weeks for patients to feel the drug's full therapeutic effects.
A health care professional should question the use of alprazolam (Xanax) for a
patient who
drinks two 8-oz glasses of wine each evening.
Rationale:
To prevent severe sedation and respiratory depression, patients should avoid
alcohol and other CNS depressants when taking benzodiazepines.
While talking with a patient about taking chlorpromazine, which of the following
instructions should the health care professional include?
Wear sunscreen when exposed to sunlight.
Rationale:
hlorpromazine, a conventional antipsychotic, can cause photosensitivity, or
increased susceptibility to sunburn, when exposed to sunlight. Patients should limit
their exposure to sunlight and wear sunscreen and protective clothing while
outdoors.
A health care professional should question the use of timolol (Timoptic) for a patient
who has which of the following disorders?
Asthma
Rationale:
Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty
breathing. Patients who have asthma or any disorder that compromises respiratory
function should not use the drug.
A health care professional is caring for a patient who is about to begin amitriptyline
therapy to treat major depression. The health care professional should include
which of the following instructions when talking with the patient about taking the
drug? (Select all that apply.)

Change position slowly from sitting or lying to standing.


Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension.
Patients should move slowly from sitting or lying to standing.
Do not stop taking the drug abruptly.
Relapse and withdrawal symptoms can occur with abrupt discontinuation of
amitriptyline. When discontinuing the drug, it is important to reduce the
dosage over a 2-week period to prevent or minimize withdrawal symptoms.
Take the drug at bedtime to prevent daytime drowsiness.
Amitriptyline, a tricyclic antidepressant, can cause drowsiness. Patients
should take the drug at bedtime and avoid activities that require alertness
until they know how the drug will affect them.
Increase fiber and fluid intake.
Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such
as dry mouth, constipation, and urinary retention. Patients should increase
fiber and fluid intake during drug therapy and urinate before taking the drug.
A health care professional is obtaining a patient's drug history when he finds that
the patient is taking lithium carbonate (Lithobid) for bipolar disorder. Which of the
following findings in the patient's drug history should alert the health care
professional to monitor for lithium toxicity?
Furosemide (Lasix) for hypertension
Rationale:
Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause
lithium reabsorption. The health care professional should evaluate the patient for
lithium toxicity.
A health care professional is caring for a patient who is taking venlafaxine to treat
major depression. The health care professional should recognize that which of the
following drugs can cause serotonin syndrome when patients take it concurrently
with venlafaxine?
Phenelzine (Nardil)
Rationale:
Patients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor,
within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin
syndrome is a life-threatening complication characterized by anxiety, confusion,
hallucinations, and fever.
When reviewing the indications for various antidepressants, a health care
professional should understand that bupropion hydrochloride (Wellbutrin) is an
appropriate choice for patients who have which of the following? (Select all that
apply.)
Seasonal affective disorder is correct. Bupropion, an atypical antidepressant,
helps prevent and treat seasonal affective disorder, a type of depression associated
with the reduction of natural light during winter months.
Nicotine addiction is correct. Bupropion, an atypical antidepressant, is an
appropriate adjunct for patients who are trying to quit smoking.
Depression is correct. Bupropion, an atypical antidepressant, can help treat
depression.

A health care professional is caring for a patient who is taking lithium carbonate
(Lithobid) to treat bipolar disorder. Which of the following diagnostic tests should
the health care professional recommend periodically for the patient?
Thyroid function tests
Rationale:
Hypothyroidism is an adverse effect of lithium carbonate. Patients should report
neck enlargement, weight gain, lethargy, and constipation. They should also have
their thyroid function checked before they begin taking lithium and annually
thereafter.
A health care professional is caring for a patient who is about to begin taking lithium
carbonate (Lithobid) to treat bipolar disorder. The health care professional should
caution the patient to watch for which of the following indications of lithium toxicity?
(Select all that apply.)
Tremors is correct. A fine hand tremor is an early indication of lithium toxicity. A
coarse tremor indicates advanced toxicity that can lead to seizure activity.
Confusion is correct. Confusion, slurred speech, and ataxia are indications of
lithium toxicity that develop because of the drug's narrow therapeutic range.
Nausea is correct. Nausea, vomiting, and diarrhea are early indications of lithium
toxicity that develop because of the drug's narrow therapeutic range. Patients
should report any signs of these adverse effects.
Muscle weakness is correct. Muscle weakness is an early indication of lithium
toxicity that develops because of the drug's narrow therapeutic range. The health
care professional should monitor lithium levels periodically.
A health care professional is caring for a young adult patient who is taking
fluoxetine (Prozac) to treat depression. The health care professional should tell the
patient and the patient's family to report which of the following?

Suicidal thoughts
Rationale:
Young adults taking fluoxetine, a selective serotonin reuptake inhibitor, have an
increased risk for suicide, especially in the early stages of treatment. Patients who
are severely depressed can have, with drug therapy, the energy for self-harm. With
awareness of this risk, family members and patients can watch for indications of
worsening depression.
When reviewing the adverse effects of drug therapy with a patient, a health care
professional should explain that orthostatic hypotension is a common adverse
reaction of which of the following drugs?
Imipramine (Tofranil)
Rationale:
Imipramine, a tricyclic antidepressant, can result in orthostatic (postural)
hypotension. Patients taking this drug should change positions slowly from sitting or
lying to standing.
A health care professional is collecting data from a patient who is taking bupropion
hydrochloride (Wellbutrin) to treat depression. The health care professional notes
that the patient has a recent history of a head injury. She should recognize that the
drug is inappropriate for the patient because of the increased risk for which of the
following?
Seizure activity
Bupropion, an atypical antidepressant, can cause seizure activity when patients
take high doses or have a seizure disorder, a CNS tumor, or a history of head
trauma.
A health care professional should monitor an older adult patient who is taking
alprazolam (Xanax) for which of the following adverse effects? (Select all that
apply.)
Tolerance is correct. Tolerance and dependence can develop with
benzodiazepines, such as alprazolam. Patients should use these drugs only as
needed and for short periods of time.
Anxiety is correct. Paradoxical reactions, such as anxiety and insomnia, can
develop, especially in older adults. Patients should report these findings.
Sedation is correct. CNS depression, manifested as sedation and drowsiness, is
an adverse effect of benzodiazepines, such as alprazolam. Patients should take a
benzodiazepine 30 min prior to bedtime.
Respiratory depression is correct. Benzodiazepines, such as alprazolam, can
cause CNS depression when patients, especially older adults, take them with other
CNS depressants. It is important to monitor for respiratory depression and
recommend the lowest effective dose. Patients should avoid alcohol and other CNS
depressants while taking a benzodiazepine.
A health care professional is talking to a patient who is taking lithium carbonate
(Lithobid). Which of the following instructions should be included to reduce the risk
of lithium toxicity?
Avoid taking NSAIDs.

NSAIDs increase renal reabsorption of lithium and sodium. Patients taking lithium
should not take NSAIDs.

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