Explain the mechanism of action of Carbamazepine in management of seizure

  1. A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

a) Document that the client experienced an anaphylactic reaction to the medication.

b) Change the IV infusion site.

c) Decrease the infusion rate on the IV.

d) Apply cold compresses to the neck area.

Answer Rationale:

  1. A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client?

a) “If the medicine causes an upset stomach, take an antacid at the same time.”

b) “Limit your daily fluid intake while taking this medication.”

c) “This medication can cause photophobia, so be sure to wear sunglasses outdoors.”

d) “You should report any tendon discomfort you experience while taking this medication.”

Answer Rationale:

  1. A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

a) tachycardia

b) Constipation

c) Drowsiness

d) Hypoactive deep-tendon reflexes

Answer Rationale:

  1. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effect?

a) Hyperglycemia

b) Adrenocortical insufficiency

c) Severe dehydration

d) Rebound pulmonary congestion

Answer Rationale:

  1. A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?

a) NPH insulin

b) Insulin glargine

c) Insulin detemir

d) Regular insulin

Answer Rationale:

  1. A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?

a.) Stop the infusion.

b) Call the client’s provider.

c) Elevate the head of the bed.

d) Auscultate the client’s breath sounds.

Answer Rationale:

  1. A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level?

a) Draw a trough level at 0900 and a peak level at 2100.

b) Draw a peak level 90 min prior to administering the medication and a trough level 90 min after the dose.

c) Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose.

d) Draw a peak level at 0900 and a trough level at 2100.

Answer Rationale:

  1. A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

a) Decrease in level of thyroxine (T4)

b) Increase in weight

c) Increase in hr of sleep per night

d) Decrease in level of thyroid stimulating hormone (TSH).

Answer Rationale:

  1. A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H2 receptor antagonist (H2RA). Which of the following outcomes indicates the H2RA is therapeutic?

a) Relief of heartburn

b) Cessation of diarrhea

c) Passage of flatus

d) Absence of constipation

Answer Rationale:

  1. A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching?

a) “I will notify my doctor before taking any other medications.”

b) “I have made an appointment to see my dentist next week.”

c) “I know that I cannot switch brands of this medication.”

d) “I’ll be glad when I can stop taking this medicine.”

Answer Rationale:

  1. A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching?

a) The client holds his breath for 10 seconds after inhaling the medication.

b) The client takes a quick inhalation while releasing the medication from the inhaler.

c) The client exhales as the medication is released from the inhaler.

d) The client waits 10 min between inhalations.

Answer Rationale:

  1. A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?

a) “Glipizide absorbs the excess carbohydrates in your system.”

b) “Glipizide stimulates your pancreas to release insulin.”

c) “Glipizide replaces insulin that is not being produced by your pancreas.”

d) “Glipizide prevents your liver from destroying your insulin.”

Answer Rationale:

  1. Ms. S is a 70-year-old male who was recently diagnosed with Parkinson’s Disease, she is admitted to your unit with pneumonia. You are reviewing the medical record and see that Ms. S’s symptoms have progressively gotten worse as an outpatient. She was previously taking Selegiline (MAO-B inhibitor), you see that the neurologist recently stopped the Selegiline and started her on Levodopa/ Carbidopa. Please explain why would the neurologist changed her medication? (1 point)
  2. Ms S now presents 8 months later with worsening symptoms from her Parkinson’s disease. She continues to take Levodopa/ Carbidopa. Last month the neurologist added Entacapone (COMT Inhibitor), you know the main effects of a COMT inhibitor is which of the following:

a. Prevent the excretion of Levodopa

b. Prevent the metabolism of Levodopa

c. Increase excretion of Levodopa

d. Increase metabolism of Levodopa

Answer Rationale:

  1. You are on the medical-surgical floor today. Your patient is a 30-year-old male who has known seizure disorder. You have an order to give this patient Oral (PO) Phenytoin 125mg three times a day (Dilantin, an antiseizure medication). You check the labs and note that his liver enzymes are going up dramatically. You suspect that the Phenytoin is causing the elevation in liver enzymes. Please explain why would this drug be contributing to an increase in this patients liver enzymes? This goes back to pharmacokinetics. (1 pt)
  2. Explain the mechanism of action of Carbamazepine in management of seizure and 2 safety considerations the nurse needs to consider when administering this drug to a patient (1pts)
  3. A patient with bronchitis is taking Sulfonamide/Trimethoprim (Bactrim), 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103°F, and a heart rate of 100 beats per minute. The patient looks ill and reports not feeling well. What will the nurse do?

a. Administer the dose and request an order for an antipyretic medication.

b. withhold the dose and request an order for an antihistamine to treat the rash.

c. Withhold the dose and notify the provider of the symptoms.

d. Request an order for intravenous Sulfonamide/Trimethoprim (Bactrim), because the patient is getting worse.

Answer Rationale:

  1. A patient is receiving tobramycin three times daily. A tobramycin peak level is 6 (normal 5-10) and the trough is 1.2 (normal 0.5-2). What will the nurse do?

a. Give the next dose as ordered

b. Hold the next dose and notify the provider

c. Call the provider and ask the dose of tobramycin to be increased

d. Call the provider and ask the dose of tobramycin to be increased

Answer Rationale:

  1. A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?

a. Request an order for a gentamicin peak level.

b. Suspect ototoxicity and notify the prescriber.

c. Tell the patient to ask for help with ambulation.

d. Tell the patient to report any tinnitus.

  1. A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?

a. The provider may increase the clindamycin dose to treat this infection.

b. This is a known side effect of clindamycin, and the patient should consume extra fluids.

c. The patient should stop taking the clindamycin now and contact the provider immediately.

d. The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms.

Answer Rationale:

  1. You have a 10-year-old patient admitted with acute exacerbation of asthma. On admission mom tells you that her child has been using the short acting inhaler (Albuterol) 3-4 times a day. You know that the patient is failing step 1 therapy and needs to progress to step 2. Which of the following treatments represents step 2 in the asthma guideline?

a. anticholinergics

b. long acting beta agonists

c. inhaled glucocorticoid steroids

d. short acting beta agonists

  1. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?

a. “I should use the glucocorticoid as needed when symptoms flare.”

b. “I will need to use the beta2-adrenergic agonist drug daily.”

c. “The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators.”

d. “The glucocorticoid is used as prophylaxis to prevent exacerbations.”

Answer Rationale:

  1. Which medication should be used for asthma patients as part of step 1 management?

a. Combination inhaled glucocorticoids/long-acting beta2 agonists

b. Inhaled low-dose glucocorticoids

c. Long-acting beta2 agonists

d. Short-acting beta2 agonists

  1. A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] (inhaled glucocorticoid) 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA] (a SABA), 90 mcg/puff, every 4 hours for the past 2 days. Which of the following drug therapies would the nurse expect to administer next based on the information above?

a. Four puffs of albuterol (B2 agonist), oxygen, and intravenous theophylline

b. Intramuscular glucocorticoids and salmeterol (B2 agonist) by metered-dose inhaler

c. Intravenous glucocorticoids, nebulized albuterol and ipratropium (anticholinergic), and oxygen

d. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg

Answer Rationale:

  1. Which of the following adverse effects with the use of long-term glucocorticoid steroids does the nurse need to monitor for?

a. Decrease in renal function

b. Decreased in hepatic function

c. Adrenal insufficiency

d. Thyroid gland deficiency

  1. When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin?

a. Onset

b. Peak

c. Duration

d. Duration & Peak

  1. A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia?

a. 1900

b. 1300

c. 1130

d. 0400

Answer Rationale:

  1. Ms S is a type II diabetic who is insulin dependent. You are checking her daily labs and note that her fasting morning blood sugar is 250. You have a standing order to give Ms S 6u of Regular Insulin for a blood sugar between 200-250. You give Ms S her insulin at 0730. What time would this patient be most susceptible to hypoglycemia?

a. 1700

b. 1300

c. 1000

d. 1500

Answer Rationale:

  1. Your assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient’s lung fields and note expiratory wheezes. The patient’s peak flow rate is 250 (hint normal is 400-700) less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?

a. Theophylline

b. Tiotropium (anticholinergic)

c. Albuterol (short acting beta agonist)

d. Cromolyn

Answer Rationale:

  1. Which of the following is a potential harmful adverse effect of Azithromycin (Macrolide):

a. Prolonged QT interval

b. Constipation

c. Headache

d. Dizziness

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