Pharmacology - Neurological Medications

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for side/adverse effects to the medication. Which finding indicates that the client is experiencing an adverse effect?
1. Pruritus
2. Tachycardia
3. Hypertension
4. Impaired voluntary movements

The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan?
1. Pregnancy should be avoided while taking phenytoin.
2. The client may stop the medication if it is causing severe gastrointestinal effects.
3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin.
4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen (Tylenol), and acetaminophen overdose is suspected. Which antidote should the nurse anticipate to be prescribed?
1. Pentostatin (Nipent)
2. Auranofin (Ridaura)
3. Fludarabine (Fludara)
4. Acetylcysteine (Mucomyst)

Meperidine hydrochloride (Demerol) has been prescribed for a client to treat pain. Which are side/adverse effects of this medication? Select all that apply.
1. Diarrhea
2. Tremors
3. Drowsiness
4. Hypotension
5. Urinary frequency
6. Increased respiratory rate

A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this laboratory result?
1. Hypotension
2. Tachycardia
3. Slurred speech
4. No abnormal finding

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking two to three aspirin every 4 hours for the last week, and it hasn't helped my back." Since aspirin intoxication is suspected, the nurse should assess the client for which manifestation?
1. Tinnitus
2. Diarrhea
3. Constipation
4. Photosensitivity

A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol), 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication?
1. Uric acid level, 5 mg/dL
2. Sodium level, 140 mEq/L
3. Blood urea nitrogen level, 15 mg/dL
4. White blood cell count, 3000 cells/mm³

The nurse is caring for a client with severe back pain. Codeine sulfate has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication?
1. Monitor radial pulse.
2. Monitor bowel activity.
3. Monitor apical heart rate.
4. Monitor peripheral pulses.

The nurse has given medication instructions to a client receiving phenytoin (Dilantin). Which statement indicates that the client has an adequate understanding of the instructions?
1. "Alcohol is not contraindicated while taking this medication."
2. "Good oral hygiene is needed, including brushing and flossing."
3. "The medication dose may be self-adjusted, depending on side effects."
4. "The morning dose of the medication should be taken before a serum drug level is drawn."

A client with myasthenia gravis has become increasingly weaker. The health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition

A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?
1. Sodium level of 140 mEq/L
2. Prothrombin time of 11.8 seconds
3. Direct bilirubin level of 2 mg/dL
4. Platelet count of 400,000 cells/mm³

The nurse is caring for a client receiving mannitol (Osmitrol) via intravenous (IV) infusion. A vial is sent from the pharmacy, and in preparing the medication the nurse notes that the vial contains crystals. What is the most appropriate nursing action?
1. Discard the vial.
2. Place the vial in warm water.
3. Send the vial back to the pharmacy.
4. Shake the vial to dissolve the crystals.

The nurse in a long-term care facility is reviewing the health care provider's (HCP) prescriptions on an assigned client. The nurse notes that the HCP prescribed ropinirole hydrochloride (Requip). The nurse determines that this medication has been prescribed to treat which condition in the client?
1. Depression
2. Diabetes mellitus
3. Coronary artery disease
4. Parkinsonian syndrome

A client is receiving phenobarbital sodium (Luminal) for the treatment of a seizure disorder. Which finding on the nursing assessment would indicate that the client is experiencing a common side effect of this medication?
1. Drowsiness
2. Hypocalcemia
3. Blurred vision
4. Seizure activity

A client with suspected opioid overdose has received a dose of naloxone hydrochloride (Narcan). The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information?
1. The client may next become suicidal.
2. These are signs of opioid withdrawal.
3. These effects will last only a few moments.
4. The client may otherwise sign out against medical advice.

The nurse is preparing to give a postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates which information about codeine sulfate?
1. Is one of the strongest opioid analgesics available
2. Cannot lead to physical or psychological dependence
3. Does not alter respirations or mask neurological signs as do other opioids
4. Does not cause gastrointestinal (GI) upset or constipation as do other opioids

The nurse is administering medications to a client with trigeminal neuralgia. The nurse expects that which medication will be prescribed for pain relief?
1. Oxycodone plus aspirin (Percodan)
2. Acetaminophen (Tylenol) and codeine sulfate
3. Carbamazepine (Tegretol) and gabapentin (Neurontin)
4. Meperidine hydrochloride (Demerol) and hydroxyzine (Vistaril)

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation?
1. Methylprednisolone (Solu-Medrol) intravenously
2. Carbamazepine (Tegretol) and phenytoin (Dilantin) by mouth
3. Phenytoin (Dilantin) intravenously, then tapered to oral route
4. Lioresal (Baclofen) by mouth and diazepam (Valium) intravenously

The nurse is observing a new nursing graduate who is preparing an intermittent intravenous (IV) infusion of phenytoin (Dilantin) for a client with a diagnosis of seizures. Which solution used by the nursing graduate should indicate to the nurse an understanding of proper preparation of this medication?
1. 5% dextrose in water
2. Lactated Ringer's solution
3. 0.9% sodium chloride (normal saline)
4. 5% dextrose and 0.45% sodium chloride

The nurse has given instructions for taking codeine sulfate to a client with a severe headache. Which statement by the client indicates the teaching has been effective?
1. "I should increase fluid intake."
2. "I should maintain a low-fiber diet."
3. "I should avoid all exercise to prevent lightheadedness."
4. "I should avoid the use of stool softeners to prevent diarrhea."

A client experiencing spasticity as a result of spinal cord injury has a new prescription for dantrolene (Dantrium). Before administering the first dose, the nurse checks to see if which baseline study has been done?
1. Liver function studies
2. Renal function studies
3. Otoscopic examination
4. Blood glucose measurements

The client with a head injury is experiencing signs of increased intracranial pressure (ICP), and mannitol (Osmitrol) is prescribed. The nurse administering this medication expects which as an intended effects of this medication? Select all that apply.
1. Increased diuresis
2. Reduced intracranial pressure
3. Increased osmotic pressure of glomerular filtrate
4. Reduced tubular reabsorption of water and solutes
5. Reabsorption of sodium and water in the loop of Henle

The nurse has a prescription to give dexamethasone (Decadron) by the intravenous (IV) route to a client with cerebral edema. How should the nurse prepare this medication?
1. Diluting the medication in 500 mL of 5% dextrose
2. Preparing an undiluted direct injection of the medication
3. Diluting the medication in 1 mL of lactated Ringer's solution for direct injection
4. Diluting the medication in 10% dextrose in water and administering it as a direct injection

The nurse who is caring for a client with myasthenia gravis has a prescription to perform an Enlon (Tensilon) test. After obtaining edrophonium (Enlon), the nurse should be certain that which also is available at the bedside?
1. Atropine sulfate
2. Protamine sulfate
3. Calcium gluconate
4. Magnesium sulfate

After review of the client's laboratory values, the nurse notes that a phenytoin (Dilantin) level for a client receiving phenytoin (Dilantin) is 7 mcg/mL. The nurse makes which interpretation regarding this laboratory result?
1. The level is within the expected therapeutic range.
2. The level indicates the medication should be stopped.
3. The level is lower than the expected therapeutic range.
4. The level is higher than the expected therapeutic range.

A client with status epilepticus has been prescribed phenytoin (Dilantin) to be given by the intravenous (IV) route. The nurse administering the medication is careful not to exceed which recommended infusion rate?
1. 50 mg/min
2. 60 mg/min
3. 100 mg/min
4. 750 mg/min

A client is scheduled to begin medication therapy with valproic acid (Depakene). The nurse looks for the results of which laboratory test(s) before administering the first dose?
1. Liver function tests
2. Renal function tests
3. Pulmonary function test
4. Pancreatic enzyme studies

A client is scheduled to begin therapy with carbamazepine (Tegretol). The nurse should assess the results of which test(s) before administering the first dose of this medication to the client?
1. Liver function tests
2. Renal function tests
3. Pancreatic enzyme studies
4. Complete blood cell count

Dantrolene sodium (Dantrium) has been administered to a client with a spinal cord injury. The nurse determines that the client is experiencing an adverse effect of the medication if which is noted?
1. Dizziness
2. Drowsiness
3. Abdominal pain
4. Lightheadedness

The nurse notes that a client taking ergotamine tartrate (Cafergot) is having the intended effects of therapy if the client states relief from which symptom?
1. Cough
2. Diarrhea
3. Backache
4. Headaches

A client who has been taking phenytoin (Dilantin) for seizure control has a serum phenytoin drug level of 8 mcg/mL. The nurse should make which interpretation about this value?
1. A toxic level
2. An inadequate drug level
3. The low end of therapeutic range
4. The high end of therapeutic range

A client has a medication prescription for phenytoin (Dilantin) to be administered by the intravenous route. After drawing up the medication, the nurse notes the presence of precipitate in the syringe. Which action should the nurse take?
1. Discard the syringe and begin again.
2. Add sterile water to dissolve the precipitate.
3. Draw up an additional 1 mL of normal saline into the syringe.
4. Chart the medication as "not given," and write a note in the medical record.

A client with a diagnosis of Parkinson's disease began taking amantadine (Symmetrel) approximately 2 weeks ago. The client reports to the clinic for a follow-up evaluation. The nurse determines that the client is experiencing an adverse effect related to the use of this medication if which is noted?
1. Decreased rigidity
2. Decreased akinesia
3. A blood pressure of 118/74 mm Hg
4. Client complaints of urinary retention

A client with insomnia has been started on zolpidem (Ambien). After instructing the client in how to obtain the maximal effect of zolpidem, the nurse determines that the client demonstrates understanding of correct administration of the medication by which statement?
1. "I take the medication just after my evening meal."
2. "I need to take the medication with a full glass of water."
3. "I wait until bedtime and take the medication with a snack."
4. "I take the medication with milk or an antacid to avoid stomach upset."

A client with Parkinson's disease is taking benztropine mesylate (Cogentin) orally daily. In monitoring this client for medication side effects, the nurse should plan to focus the assessment on which item?
1. Pupil response
2. Voiding pattern
3. Prothrombin time
4. Respiratory status

Benztropine mesylate (Cogentin) is prescribed for a client with a diagnosis of Parkinson's disease. What statement by the client indicates that the client needs additional information about the medication?
1. "I will avoid driving if I get drowsy or dizzy."
2. "I'll watch my urinary output and look for signs of constipation."
3. "I will sit in the sun for an hour a day to enhance medication effectiveness."
4. "I will call the health care provider (HCP) if I have difficulty swallowing or if I start vomiting."

A client has received a dose of dimenhydrinate (Dramamine). The nurse evaluates the effect of the medication by noting whether the client obtained relief from what symptom?
1. Chills
2. Headache
3. Ringing in the ears
4. Nausea and vomiting

A home health nurse visits a client who suffered a back injury. On review of the health care provider's prescriptions, the nurse notes that codeine sulfate has been prescribed for the client, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates an understanding of health measures related to the medication?
1. "The medication is not addicting."
2. "I should watch out for diarrhea as a side effect."
3. "I should increase my fluid intake while taking this medication."
4. "I need to be sure to eat foods that are low in fiber to prevent diarrhea."

Phenytoin (Dilantin), 100 mg to be given orally three times daily, has been prescribed to a client for seizure control. The home health nurse visits the client and provides instructions regarding the medication. Which statement, if made by the client, would indicate an understanding of the instructions?
1. "I will use a soft toothbrush to brush my teeth."
2. "It's okay to break the capsules to make it easier for me to swallow them."
3. "If I forget to take my medication, I can wait until the next dose and eliminate that dose."
4. "If my throat becomes sore, it's a normal effect of the medication, and it's nothing to be concerned about."

Dexamethasone (Decadron) intravenously is prescribed for the client with cerebral edema. The nurse prepares the medication for administration and plans to perform which action?
1. Mix the medication in 1000 mL of 5% dextrose.
2. Prepare an undiluted direct injection of the medication.
3. Mix the medication in 100 mL of lactated Ringer's solution.
4. Dilute the medication in lactated Ringer's solution and administer as a direct injection.

The nurse has the following prescription for a postcraniotomy client, "dexamethasone (Decadron) 4 mg by the intravenous (IV) route now." How does the nurse administer the medication?
1. IV push over 1 minute
2. IV push over 4 minutes
3. IV piggyback in 50 mL of normal saline over 10 minutes
4. IV piggyback in 50 mL of normal saline over 30 minutes

A client is experiencing impotence after taking guanfacine (Tenex). The client states, "I would sooner have a stroke than keep living with the effects of this medication." What is the most appropriate response by the nurse?
1. "I can understand completely."
2. "You wouldn't really want to have a stroke."
3. "You are concerned about the effects of your medication."
4. "The health care provider should change your prescription."

A client with Parkinson's disease has been prescribed benztropine (Cogentin). The nurse should assess for which gastrointestinal (GI) problems as a side effect of this medication?
1. Diarrhea
2. Dry mouth
3. Increased appetite
4. Hyperactive bowel sounds

A client has been prescribed cyclobenzaprine (Flexeril) for the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client has a concurrent prescription for which medication?
1. Furosemide (Lasix)
2. Ibuprofen (Motrin IB)
3. Valproic acid (Depakene)
4. Tranylcypromine (Parnate)

The nurse has a prescription to administer diazepam (Valium) 5 mg by the intravenous (IV) route to a client. The nurse should administer the medication over a period of at least how long?
1. 15 seconds
2. 30 seconds
3. 1 minute
4. 5 minutes

A client is receiving anticonvulsant therapy with phenytoin (Dilantin). To monitor for adverse effects of this medication, the nurse assesses the results of which laboratory test?
1. Serum sodium
2. Serum potassium
3. Blood urea nitrogen
4. Complete blood count (CBC)

A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on which understanding?
1. These symptoms probably result from interaction with another medication.
2. These symptoms usually occur when the client takes the medication with food.
3. These symptoms are most severe during initial therapy and decrease or disappear with long-term use.
4. These symptoms indicate that the client is experiencing a severe adverse reaction to the medication.

A client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to perform which action?
1. Weigh the client daily.
2. Monitor blood glucose levels.
3. Institute seizure precautions.
4. Observe for areas of ecchymosis.

The nurse has a prescription to administer phenytoin (Dilantin) 100 mg by the intravenous (IV) route to a client. The nurse administers the medication after preparing it in which solution?
1. Lactated Ringer's solution
2. 5% dextrose in 0.45% normal saline
3. 0.9% normal saline with an in-line filter
4. 5% dextrose in water with an in-line filter

The nurse in the health care provider's office is reviewing the results of a client's phenytoin (Dilantin) level determination performed that morning. The nurse identifies that a therapeutic drug level has been achieved if which result is noted?
1. 3 mcg/mL
2. 8 mcg/mL
3. 15 mcg/mL
4. 24 mcg/mL

A client with a history of simple partial seizures is taking clorazepate (Tranxene). The client asks the nurse if there is a risk of addiction with this medication. The nurse's response is based on which information about this medication?
1. Is not habit forming either physically or psychologically
2. Leads to physical tolerance, but only after 10 or more years of therapy
3. Leads to physical and psychological dependence with prolonged high-dose therapy
4. Can result in psychological dependence only because of the nature of the medication

A client has a prescription for valproic acid (Depakene) 250 mg once daily. To maximize the client's safety, the nurse should plan to schedule the medication at what time?
1. At bedtime
2. With lunch
3. After breakfast
4. Before breakfast

A client taking carbamazepine (Tegretol) asks the nurse what to do if a dose is inadvertently missed. The nurse responds that which action should be taken?
1. Withhold until the next scheduled dose.
2. Withhold and call the health care provider (HCP).
3. Take the dose as long as it is not close to the time for the next dose.
4. Withhold until the next scheduled dose, which should then be doubled.

The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine (Tegretol). The nurse determines that the client understands the use of the medication if he or she makes which statement?
1. Use sunscreen when outdoors.
2. Drive a car as long as it is not at night.
3. Keep tissues handy because of excess salivation.
4. Discontinue the medication if fever or sore throat occurs.

A client with vascular headaches is taking ergotamine (Cafergot). The home health nurse should periodically assess him or her for which finding?
1. Hypotension
2. Constipation
3. Dependent edema
4. Cool, numb fingers and toes

The nurse is caring for a client with myasthenia gravis who has received edrophonium (Enlon) by the intravenous route to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. The nurse's response is based on the understanding that the effects have a duration of approximately how long?
1. 5 minutes
2. 10 minutes
3. 30 minutes
4. 60 minutes

A client with narcolepsy has been prescribed dextroamphetamine (DextroStat). The client complains to the nurse that he cannot sleep well at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which proper time schedule?
1. 2 hours before bedtime
2. After supper each night
3. Just before going to sleep
4. At least 6 hours before bedtime

A client on the nursing unit has a prescription for dextroamphetamine (DextroStat) daily. The unit nurse collaborates with the dietitian to limit the amount of which item on the client's dietary trays?
1. Fat
2. Starch
3. Caffeine
4. Protein

A client with Parkinson's disease has begun therapy with levodopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long?
1. 1 week
2. 24 hours
3. 2 to 3 days
4. 2 to 3 weeks

A client is taking trihexyphenidyl hydrochloride for the treatment of Parkinson's disease. The nurse should assess for which adverse effect of this medication?
1. Diarrhea
2. Urinary retention
3. Urinary incontinence
4. Excessive perspiration

A client receiving therapy with carbidopa/levodopa (Sinemet) is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to his concerns, the nurse interprets that this change is indicative of which condition?
1. Developing toxicity
2. A harmless side effect of the medication
3. A result of taking the medication with milk
4. A sign of interaction with another medication

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine (Mestinon). The nurse should check to see that the client takes the medication at what time?
1. With meals
2. Between meals
3. Just after meals
4. 30 minutes before meals

A client with myasthenia gravis who is taking neostigmine (Prostigmin) is experiencing frequent exacerbations of myasthenic crisis and cholinergic crisis. The nurse teaches the client that it is most important that this medication be taken in which manner?
1. On time
2. On an empty stomach
3. Double-dosed if one dose is missed
4. Titrated for dosage, depending on the symptoms

A client began taking amantadine (Symmetrel) approximately 2 weeks ago. The nurse determines that the medication is having a therapeutic effect if the client exhibits which finding?
1. Decreased voiding
2. Decreased blood pressure
3. Decreased rigidity and akinesia
4. Decreased white blood cell count

A client has been prescribed a cough formula containing codeine sulfate. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect?
1. Excitability
2. Rapid pulse
3. Constipation
4. Excessive urination

Propofol (Diprivan) is prescribed to induce sedation in a client who is intubated and is being mechanically ventilated. The nurse prepares the medication and selects which solution to dilute the medication?

1. A
2. B
3. C
4. D

A nurse is collecting data from a client and notes that the client is taking carbamazepine (Tegretol). The nurse determines that this medication has been prescribed to treat which condition?
1. Glaucoma
2. Diabetes mellitus
3. Parkinson's disease
4. Trigeminal neuralgia

Carbamazepine (Tegretol) has been prescribed for a client, and the client asks the nurse about the action of the medication. The nurse's response should incorporate which information as a primary effect of this medication?
1. Anticonvulsant effect
2. Prevention of cellular division
3. Decrease in intraocular pressure
4. Interference with DNA production

The health care provider (HCP) writes a prescription for carbamazepine (Tegretol) for a client who was admitted to the hospital. The nurse contacts the HCP to verify the prescription if which condition is noted in the assessment data?
1. Hypertension
2. Tonic-clonic seizures
3. Trigeminal neuralgia
4. Bone marrow depression

Carbamazepine (Tegretol) has been prescribed for a client. The nurse should tell the client that which blood test will be done periodically while the client is taking this medication?
1. Lipase level
2. Amylase level
3. Ammonia level
4. Complete blood cell (CBC) count

A nurse is transcribing a prescription for antibiotic therapy for a client with bacterial meningitis. The nurse understands that the medication that will be prescribed for the client will have which characteristic?
1. Metabolizes slowly
2. Acts within minutes to hours
3. Crosses the blood-brain barrier
4. Excretes readily and easily in the urine

The health care provider is preparing to administer edrophonium (Enlon) to the client with myasthenia gravis. In planning care, the nurse understands which about the administration of edrophonium? Select all that apply.
1. Edrophonium is a long-acting cholinesterase inhibitor.
2. Atropine is used to reverse the effects of edrophonium.
3. If symptoms worsen following administration of edrophonium, the crisis is cholinergic.
4. Edrophonium is used to distinguish between a myasthenic crisis and a cholinergic crisis.
5. An improvement in symptoms following administration of edrophonium indicates worsening of myasthenia gravis.

A client has a prescription to receive valproic acid (Depakene) daily. To maximize the client's safety, when is the best time for the nurse to schedule the administration of this medication?
1. After lunch
2. After breakfast
3. Before bedtime
4. Before breakfast

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on methyldopa (levodopa). Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care?
1. History of falls
2. Use of assistive devices
3. Postural (orthostatic) vital signs
4. Degree of exhibited intention tremor

The nurse is caring for a client with Parkinson's disease who is taking oral benztropine mesylate (Cogentin) daily. What is the priority nursing assessment for the client?
1. Intake and output
2. The prothrombin time
3. The pupillary response
4. The partial thromboplastin time

A client with a diagnosis of trigeminal neuralgia is started on a regimen of carbamazepine (Tegretol). The nurse provides instructions to the client about the side/adverse effects of the medication. Which client statement indicates an understanding of the side/adverse effects of the medication?
1. "I will report a fever or sore throat to my health care provider."
2. "I must brush my teeth frequently to avoid damage to my gums."
3. "If I notice ringing in my ears that doesn't stop, I'll seek medical attention."
4. "If I notice a pink color to my urine, I will stop the medication and call my health care provider (HCP)."

A home care nurse visits a client at home. Clonazepam (Klonopin) has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates that further teaching is necessary?
1. "My drowsiness will decrease over time with continued treatment."
2. "I should take my medicine with food to avoid any stomach problems."
3. "I can take my medicine at bedtime if it tends to make me feel drowsy."
4. "If I experience slurred speech, this problem will disappear in about 8 weeks."

A client who is taking phenytoin (Dilantin) for a seizure disorder is being admitted to the hospital because of an increase in seizure activity. The client reports severe vomiting for the last 24 hours and inability to take phenytoin during that time. The nurse anticipates that the health care provider will most likely prescribe which medication?
1. Phenobarbital (Luminal)
2. Clonazepam (Klonopin)
3. Valproic acid (Depakene)
4. Fosphenytoin sodium (Cerebyx)

The nurse teaches the wife of a client who is receiving levodopa/carbidopa (Sinemet) to avoid pyridoxine (vitamin B₆) medications. Which statement by the wife indicates an understanding of the instructions?
1. "Vitamin B₆ reverses the effectiveness of levodopa, meaning a higher dose is needed."
2. "Vitamin B₆ will change perspiration and urine to a dark color, which may stain clothing."
3. "Levodopa competes with vitamin B₆ for absorption in the intestine, blocking absorption."
4. "The two medications in combination will cause the blood sugar to drop, causing hypoglycemia."

A client is taking phenytoin (Dilantin) for seizure control. A blood sample is drawn to determine the serum drug level, and the nurse reviews the results. Which would indicate a therapeutic serum drug range?
1. 5 to 10 mcg/mL
2. 10 to 20 mcg/mL
3. 20 to 30 mcg/mL
4. 30 to 40 mcg/mL

The nurse is preparing an intravenous infusion of phenytoin (Dilantin) as prescribed by the health care provider for the client with seizures. Which solution should the nurse plan to use to dilute this medication?
1. Dextrose 5%
2. Normal saline solution
3. Lactated Ringer's solution
4. Dextrose 5% and half-normal saline (0.45%)

A client is suspected of having myasthenia gravis. Edrophonium (Enlon) is administered intravenously to determine the diagnosis. Which indicates that the client may have myasthenia gravis?
1. Joint pain following administration of the medication
2. Feelings of faintness, dizziness, hypotension, and signs of flushing in the client
3. A decrease in muscle strength within 30 to 60 seconds following administration of the medication
4. An increase in muscle strength within 30 to 60 seconds following administration of the medication

Meperidine hydrochloride (Demerol) is prescribed for a client with pain. What should the nurse monitor for as a side/adverse effect of this medication?
1. Diarrhea
2. Bradycardia
3. Hypertension
4. Urinary retention

The nurse is caring for a client receiving morphine sulfate for pain. Because this medication has been prescribed for this client, which nursing action should be included in the plan of care?
1. Encourage fluids.
2. Monitor the client's temperature.
3. Maintain the client in a supine position.
4. Encourage the client to cough and deep breathe.

A nurse is caring for a client who has been taking hydrocodone for the last 3 months. Which side/adverse effects of this medication should the nurse assess the client for?
1. Tachycardia and hypertension
2. Diarrhea and abdominal cramping
3. Psychological and physical dependence
4. Increased respiratory rate and bronchospasm

A nurse is reviewing the results of a test on a sample drawn from a child who is receiving carbamazepine (Tegretol) for the control of seizures. The results indicate a serum carbamazepine level of 10 mcg/mL. The nurse analyzes the results and anticipates that the health care provider (HCP) will note which prescription?
1. Discontinuation of the medication
2. An increased dose of the medication
3. A decreased dose of the medication
4. Continuation of the presently prescribed dosage

The nurse is caring for a client who underwent an open reduction internal fixation to the right hip. When administering opioid analgesics for pain, the nurse should instruct the client that which are side/adverse effects of opioid analgesics? Select all that apply.
1. Sedation
2. Diarrhea
3. Constipation
4. Increased pain level
5. Respiratory depression

A nurse should question a prescription for which medication in the client concurrently receiving tramadol (Ultram)?
1. β-Blockers
2. Histamine 2 antagonists
3. Calcium channel blockers
4. Monoamine oxidase inhibitors (MAOIs)

Sumatriptan (Imitrex) is prescribed for a client. Based in this prescription, the nurse suspects that the client has which condition?
1. Sinus headache
2. Simple headache
3. Migraine headache
4. Episodic headache

A nurse preparing to administer carbamazepine (Tegretol) notices each of the following items on the client's breakfast tray. Which item should be a cause for concern and should be removed from the tray?
1. Carton of milk
2. Scrambled eggs
3. Grapefruit juice
4. Toast with honey

The nurse is told that the result of a serum carbamazepine (Tegretol) level for a child who is receiving the medication for the control of seizures is 10 mcg/mL. Based on this laboratory result, the nurse anticipates that the health care provider (HCP) will document which prescription?
1. Discontinuation of the medication
2. A decrease of the dosage of the medication
3. An increase of the dosage of the medication
4. Continuation of the presently prescribed dosage

A client reports frequent use of acetaminophen (Tylenol) for relief of headaches and other discomforts. The nurse should evaluate which diagnostic data to determine if the client is at risk for toxicity?
1. Chest x-ray
2. The electrocardiogram
3. The liver function studies
4. The upper gastrointestinal x-ray results

The nurse is assisting in the care of a client who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium (Enlon). Evaluation of the results indicates that the test is positive. Which would be the expected response noted by the nurse?
1. Joint pain for the next 15 minutes
2. An immediate increase in blood pressure
3. An increase in muscle strength within 1 to 3 minutes
4. Feelings of faintness or dizziness for 5 to 10 minutes

The nurse is assisting in the care of a client with myasthenia gravis who is receiving pyridostigmine (Mestinon). Which medication should the nurse plan to have readily available should the client develop cholinergic crisis because of excessive medication dosage?
1. Vitamin K
2. Atropine sulfate
3. Protamine sulfate
4. Acetylcysteine (Mucomyst)

A client with myasthenia gravis becomes increasingly weaker. The health care provider (HCP) injects a dose of edrophonium (Enlon) to determine whether the client is experiencing a myasthenic crisis or a cholinergic crisis. The nurse expects that the client will have which reaction if in cholinergic crisis?
1. No change in the condition
2. Complaints of muscle spasms
3. An improvement of the weakness
4. A temporary worsening of the condition

A nurse is providing instructions to a client beginning medication therapy with divalproex sodium (Depakote) for treatment of absence seizures. The nurse instructs the client that which represents the most frequent side effect of this medication?
1. Tinnitus
2. Irritability
3. Blue vision
4. Nausea and vomiting

A nurse is speaking with a client taking phenytoin (Dilantin) for seizure control. The client states that she has started using birth control pills to prevent pregnancy. Which would be an important point for the nurse to emphasize to the client?
1. Oral contraceptives decrease the effectiveness of phenytoin.
2. Severe gastrointestinal side effects can occur when phenytoin and oral contraceptives are taken together.
3. There is an increased risk of thrombophlebitis when phenytoin and oral contraceptives are taken at the same time.
4. Phenytoin may decrease effectiveness of birth control pills, and additional measures should be taken to avoid pregnancy.

A nurse is reading the laboratory results for a client being treated with carbamazepine (Tegretol) for prophylaxis of complex partial seizures. When evaluating the client's laboratory data, the nurse determines that which value is consistent with an adverse effect of this medication?
1. Sodium level, 136 mEq/L
2. Platelet count, 350,000 cells/mm³
3. White blood cell count, 3200 cells/mm³
4. Blood urea nitrogen (BUN), 19 mg/dL

A nurse is caring for a client receiving codeine sulfate for pain. The nurse determines that the client is experiencing a side effect of the medication based on which finding?
1. Distended jugular veins
2. Bounding peripheral pulses
3. No bowel movement in 3 days
4. Change in blood pressure from 120/60 to 140/80 mm Hg

A nurse is assisting in the care of a client being discharged on phenytoin (Dilantin), 100 mg three times daily, for seizure control. When providing client teaching about this medication, the nurse should be sure to include which points? Select all that apply.
1. Break the capsules so they are easier to swallow.
2. Use a soft toothbrush while taking this medication.
3. If a dose is missed, just wait until the next one is due.
4. Alcohol should be avoided while taking this medication.
5. The medication may turn the client's urine pink, red, or brown.
6. Sore throat is a common side effect of the medication and is nothing to worry about.

The nurse is providing instructions to an adolescent prescribed phenytoin (Dilantin) for the control of seizures. Which statement by the adolescent indicates a need for further teaching regarding the medication?
1. "The medication may cause acne or oily skin."
2. "Drinking alcohol may affect the medication."
3. "If my gums become sore and swollen I need to stop the medication."
4. "Birth control pills may not be effective when I take this medication."