1
Q
Which of the following meds would you expect may be given to a child who has ADHD? (SATA)
A. methylphenidate
B. atomoxetine
C. clonidine
D. dextroamphetamine
E. selegiline
A
A, B, C, D
2
Q
True or False: Methylphenidate should be served with breakfast.
A
True - it should be given with food
3
Q
True or False: The last Methylphenidate dose should be administered at bedtime.
A
False - it can cause insomnia and should be given at least 6 hours before bed
4
Q
Which of the following is a risk factor for ADHD?
A. high-sugar diet
B. high birth weight
C. hispanic ethnicity
D. prenatal exporuse to alcohol or tabacco
A
D
5
Q
Which of the following supports a diagnosis of oppositional defiant disorder? (SATA)
A. Violates rights of others
B. Blames others for misbehavior
C. Spiteful towards parents
D. Has difficulty controlling their anger
E. Argumentative with teachers at school
F. Cruelty towards animals
A
B, C, D, E
6
Q
What does TCA stand for?
A
tricyclic antidepressants
7
Q
What are the five types of medications used to treat depression?
A
tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), monoamine oxidase inhibitors, and atypical antidepressants
8
Q
What class is amitriptyline?
A
tricyclic antidepressant
9
Q
When should you educate patients to take TCAs such as amitriptyline?
A
take the medication at bedtime to prevent daytime drowsiness
10
Q
A client is to start taking amitriptyline. For which of the following should you instruct the client to watch for and report?
A. blurred vision
B. diarrhea
C. tachycardia
D. urinary hesitancy
E. joint pain
A
A, C, D
11
Q
What are three reasons a provider may recommend a drug ‘holiday’ for ADHD CNS stimulants?
A
For the purpose of:
1. Weight gain/appetite
2. Determine effectiveness of the medication and/or need for continuation.
3. Avoid tolerance
12
Q
Why would a CNS stimulant (Methylphenidate or
Amphetamines) be given after breakfast instead of before?
A
If given before breakfast they may not eat since these suppress appetite.
13
Q
What are the two exemplar non-stimulant medications for ADHD?
A
atomoxetine and guanfacine
14
Q
What drug class is amoxotine?
A
SNRI
15
Q
What drug class is guanfacine?
A
alpha2 agonist
16
Q
True or False. There are no drug ‘holidays’ for patients on non-stimulant ADHD meds.
A
True
17
Q
This is an unexpected catastrophic event that results in the loss of function such as mobility or sensation
A
spinal cord injury (SCI)
18
Q
After an SCI, the barrier is broken, and ______ can invade the surrounding tissue and trigger an inflammatory response
A
WBCs
19
Q
What are the two spinal cord injury classifications?
A
complete and incomplete inuries
20
Q
True or False: Once spinal cord damage occurs it can be reversible.
A
False - it can not be reversed
21
Q
Which type of stroke involves bleeding into the brain?
A
hemorrhagic
22
Q
Which type of stroke involves disruption in blood flow to the brain, which can be caused by a blockage of a blood vessel?
A
ischemic
23
Q
What are the top two modifiable risk factors for a stroke?
A
Hypertension and smoking
24
Q
What are the top three non-modifiable risk factors for stroke?
A
age over 55, race, sex
25
Which tests are vital for patients on lithium?
Kidney function tests
26
Normal lithium level?
0.4-1.5 mE/L
27
What happens if lithium level is below 0.5?
Can see depression or mania
28
What should patients on lithium know in regards to pregnancy?
Lithium is teratogenic and will most likely have birth defects.
29
What education will you give to patients on lithium in regards to pregnancy?
Important to be on birth control, lithium is teratogenic, will have to stop lithium during pregnancy.
30
What do you expect to see in patients taking lithium with regards to urination?
Urination frequency increases
31
What will happen to lithium levels if patient has vomit, diarrhea, sweating?
They rise because patient isn't filtering lithium through the kidneys.
32
What two things are important to monitor to correctly filter lithium?
Water and sodium. Sodium helps transport lithium to the kidneys and water helps filter and excrete properly.
33
What should patients on methylphenidate avoid?
caffeine - methylphenidate is already a stimulant and these patients need to avoid all other stiumlants.
34
**BEEP** What two organs does lithium affect most?
thyroid and kidneys
35
What labs for Lithium?
CMP (sodium), Lithium levels, BUN, creatinine, TSH, T3, T4
36
At what level is lithium considered toxic?
greater than 1.5 mEq/L
37
What symptoms would you see with severe lithium toxicity?
seizures, coma, ataxia, slurred speech, death, respiratory distress, severe hypotension
38
What level of Lithium would tell you to hold the dose?
1.6 and above
39
What are your first signs of lithium toxicity?
nausea, vomiting, diarrhea
40
When a patient shows signs of toxicity, has nausea, vomiting, diarrhea the levels go up. Then what do we do for the patient?
1st give mannitol - helps excrete. 2nd option if that doesn't work is dialysis
41
What other medication should patients on lithium not take?
NSAIDS and thiazide diuretics
42
Why should lithium patients NOT take thiazide diuretics?
Because it lowers the sodium level which increases lithium levels
43
What does methylphenidate treat?
ADHD
44
What does methylphenidate do to the appetite?
Lowers the appetite
45
If a patient with ADHD can't take methylphenidate or amphetamines because they are recovering from a drug addiction - what should they be taking?
a non-stimulant like Atomoxetine and guanfacine
46
***What two organs are we concerned with for patients taking divalproex?
Liver and pancreas
(remember by the LP in the name divaLProex)
47
What lab will you look at to monitor the levels of divalproex?
valproic acid levels
48
What does divalproex treat?
Mania and bipolar
49
What labs should be checked for patients taking divalproex (4 of them)
valproic acid levels, CBC, LFTs (AST, ALT), pancreatic enzymes (amylase, lipase)
50
What does divalproex treat?
Bipolar / mania portion
51
What is a circumstantial answer?
Patient circles around and eventually answers the question
52
What is a tangential answer?
Patient goes off on a tangent and never answers the question
53
What are symptoms of mania?
Ideas of reference, grandiosity, flight of ideas, sleep deficit, distractibility
54
If a patient looks at a sign that says 'mechanical' and then says in the sign they read 'I can' so 'I can' go buy a new purse ... what is this called?
Ideas of reference
55
True of False: Mania can physiologically cause you to die if left untreated.
True
56
What is the mechanism of action of Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in the treatment of Rheumatoid Arthritis?
A. They increase the body's production of RBCs
B. They provide immediate pain relief
C. They suppress the immune system to reduce inflammation and prevent joint damage
D. They enhance the absorption of calcium
C
57
A nurse is caring for a client with a traumatic brain injury. Which finding is the earliest sign of increased intracranial pressure (ICP)?
A. Bradycardia
B. Decreased level of consciousness
C. Fixed dilated pupils
D. Widened pulse pressure
B
58
Which set of findings represents Cushing’s Triad?
A. Hypotension, tachycardia, fever
B. Bradycardia, hypertension, irregular respirations
C. Tachycardia, hypertension, tachypnea
D. Bradycardia, hypotension, shallow respirations
B - Cushing’s Triad is a late sign of increased ICP and indicates brainstem compression:
Hypertension with widening pulse pressure
Bradycardia
Irregular respirations
59
A client has the following Glasgow Coma Scale (GCS) findings:
Opens eyes to pain
Inappropriate words
Withdraws from pain
What is the client’s total GCS score?
9
60
A nurse is caring for a client with increased ICP. Which nursing intervention is most appropriate?
A. Place the client in Trendelenburg position
B. Keep the head of the bed at 30 degrees
C. Encourage coughing every hour
D. Flex the client’s neck forward
B
61
Which finding in a client with a traumatic brain injury requires immediate intervention?
A. GCS of 14
B. Headache rated 3/10
C. Unequal pupils
D. Oriented to person only
C
62
A client with a severe TBI has a GCS score of 6. How would the nurse interpret this score?
A. Mild brain injury
B. Moderate brain injury
C. Severe brain injury
D. No brain injury
C
63
Which action by the nurse helps prevent increases in ICP?
A. Clustering all nursing activities
B. Maintaining neutral head alignment
C. Frequent suctioning every hour
D. Placing pillows under the neck
B
64
A nurse assesses the following vital signs in a client with a head injury:
BP: 180/60
HR: 48
Irregular respirations
What does the nurse suspect?
Cushing Triad
65
A client with TBI has the following GCS assessment:
Opens eyes spontaneously
Confused conversation
Obeys commands
What is the GCS score?
14
66
A way to remember Cushing's Triad with BHI...
Bradycardia, hypertension, irregular respirations
67
How do you calculate pulse pressure?
Systolic BP - diastolic BP
68
Which situation is the most common cause of autonomic dysreflexia?
A. Fever
B. Bladder distention
C. Anxiety
D. Dehydration
B
69
A client with a T5 spinal cord injury develops autonomic dysreflexia. Which symptom would the nurse expect?
A. Hypotension
B. Tachycardia
C. Severe hypertension
D. Decreased respirations
C
70
If a patient has a RBC level of 3.0, which medication would you suspect they are taking?
A. methotrexate
B. mannitol
C. corticosterroids
A
71
Where is RA most common?
A. hands
B. hips
C. hands and feet
C
72
What is the normal CPP level?
70-100
73
The emergency dept nurse receives a client with extensive injuries to the head and upper back. The nurse will perform what action to allow the best visualization of the airway?
A. Head-tilt chin-lift in the supine position on a backboard
B. Jaw-thrust maneuver in the supine position on a backboard
B. Until assessed the client should remain on a backboard stabilizer. The nurse should use the jaw-thrust maneuver to avoid movement of an unstable spine
74
What's the lowest score someone can get on the Glasgow Coma Score?
3
75
A client is admitted with HR of 140 along with A fib. Which prescription should the nurse perform first?
A. Administer diltiazem 20mg IVP
B. Admisiterd rivaroxaban 20mg PO
C. Draw blood for thyroid function test
D. send the client for echocardiogram
A
76
The nurse is caring for a client with a cervical spinal cord injury who is diaphoretic, anxious, and trembling, with a BP of 182/104 mm Hg and a HR of 45/min. Which action should the nurse complete first?
A. Administer an as-needed dose of hydralazine IVP
B. Observe the rectum for stool and administer an as-needed enema
C. Perform bladder scan and intermittent catheterization
D. Position client upright and remove constrictive clothing
D
77
The clinic nurse evaluates the treatment plan of a client with long-standing rheumatoid arthritis. Which question is most important for the nurse to ask?
A. Have the assistive devices helped with dressing and grooming?
B. How is your pain control with the current med regimen?
C. Is your level of energy adequate for completing your daily activities?
B
78
The home health nurse is evaluating a client's use of complementary therapies to manage pain and inflammation associated with RA. Which client statement requires follow-up by the nurse?
A. I have been drinking a few cups of turmeric tea each day to help reduce inflammation in my joints
B. I rub capsaicin cream on my knee before applying a heating pad to get more relief from stiffness
C. I wear splints when my wrists are still and painful, but I remove them twice each day to do wrist exercises
B - capsaicin removes pain perception so patient is at risk for burns when combined with heating pad
79
A client with SLE presents with swelling of the lower extremities, frothy urine, and fatigue. Which complication should the nurse suspect?
A) Pericarditis
B) Lupus nephritis
C) Raynaud’s phenomenon
D) Pulmonary embolism
B
80
What three meds can induce lupus?
Procainamide, hydralazine, isoniazid
81
A nurse is teaching a client taking methotrexate for rheumatoid arthritis. Which instruction is most important?
A. Take the medication every day
B. Avoid alcohol while taking this medication
C. Increase potassium intake
D. Take the medication with grapefruit juice
B
82
True or False? If a patient on methotrexate reports mouth sores, ulcers, or sore throat, the nurse should suspect toxicity or bone marrow suppression and notify the provider.
True
83
Do patients with RA get nodules or nodes?
nodules
84
What are the signs and symptoms of sickle cell?
tachypnea, tachycardia, pallor, shortness of breath, jaundice, pain, fatigue
85
Which medication is commonly used to reduce the frequency of sickle cell crises?
A. Hydroxyurea
B. Acetaminophen
C. Metformin
D. Furosemide
A
86
A nurse is educating a client with sickle cell disease about avoiding triggers. Which situation should the client avoid?
A. High altitudes with low oxygen levels
B. Drinking adequate water
C. Moderate exercise
D. Eating balanced meals
A
87
The nurse is caring for a client with sickle cell disease who develops fatigue and a sudden drop in hemoglobin after a viral infection. Which type of crisis is most likely occurring?
A. Vaso-occlusive crisis
B. Hyperhemolytic crisis
C. Aplastic crisis
D. Splenic sequestration crisis
C
88
What vital sign changes would you see in a patient experiencing hypovolemic shock?
increased HR, decreased BP, increased RR
89
What are the three things you are going to do for a patient that comes in with sickle cell crisis in order?
Oxygen, hydration, pain meds
90
How much oral hydration per hour for sickle cell patients?
200 ml/h
91
How much IV hydration per hour for a sickle cell patient?
250 ml/h
92
A nurse is assessing a patient with hepatic encephalopathy. Which finding is a key indicator of this condition?
A. Jaundice and itching
B. Asterixis and altered mental status
C. Hypertension and headache
D. Bradycardia and hypotension
B
93
A nurse assesses a patient with a traumatic brain injury. Which finding is part of Cushing’s triad, indicating increased intracranial pressure?
A. Tachycardia, hypotension, tachypnea
B. Bradycardia, hypertension, decreased respirations
C. Hypertension, tachycardia, fever
D. Bradycardia, hypotension, tachypnea
B
94
A stroke patient is diagnosed with homonymous hemianopia. Which teaching should the nurse provide?
A. Avoid walking independently
B. Use scanning techniques to view the affected side
C. Cover one eye when reading
D. Avoid bright lights
B
95
What virus commonly causes chronic liver disease?
Hep C
96
What are symptoms of depression? Use mnemonic WASTED
Weight loss, anhedonia (lack of pleasure), sleep, trouble making choices, energy low, decreased mood and concentration.
97
MAOIs are the PITS – What meds are they?
Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline
98
What are 5 symptoms of serotonin syndrome? Use mnemonic CHARMED
Confusion, hallucinations, agitation, restless/rigidity, myoclonus, elevated VS, Diarrhea/diaphoresis/dilated pupils
99
Major side effects of TCAs (tricyclic antidepressants)?
Toxicity, cardiac, anticholinergic, sleepy/sexual dysfunction
100
What are the key safety concerns for a patient on lamotrigine?
Rash, Steven Johnsons Syndrome, epidermal necrolysis
101
What are the early signs and symptoms of RA?
Joint inflammation, low grade fever, generalized weakness, anorexia, paresthesia (mostly upper extremities), morning stiffness in the hands with no/minimal pain
102
What are the late signs of RA?
Deformities, stiffness with pain (IE: fingers sideways with nodules), pericarditis, fibrotic lung disease, OA, Sjogren’s syndrome
103
What labs would you look at for RA?
ESR (increased), ANA (not definitive), CRP, WBC (increased = exacerbation)
104
What does cool treat for patient with RA?
Inflammation
105
How does methotrexate work?
It blasts the chemicals that cause inflammation by releasing adenosine
106
Why will RA patients have signs and symptoms of anemia?
B/C they have low erythropoietin levels
107
What is erythropoietin?
A hormone produced primarily by the kidneys that regulates RBC production
108
What can sequestration SCD lead to?
Hypovolemic shock and cardiovascular failure
109
What should we do for patients in sickle cell crisis?
Remove tight clothes, extend extremities, keep room warm, check perfusion hourly
110
What is the goal for sickle cell patients?
Promote perfusion
111
What are examples of secondary injury in regard to a TBI?
Ischemia, cerebral edema, hypercapnia, meningitis, biochemical changes
112
What happens to the vital signs when herniation is happening?
HR goes down, BP goes up, RR goes down
113
What can autonomic dysreflexia lead to?
Seizures, stroke or death if untreated
114
The most important sign of autonomic dysreflexia is?
Sudden, severe rise in BP
115
What is apraxia?
Inability to use an object correctly
116
What is agnosia?
Neglect to one side of the body
117
For patients vomitting blood due to esophageal varicose what does VOP stand for?
vasopressors (if no cardiac issue), octreotide, propranolol
118
What will you give after VOP?
fluids or blood products and O2 for perfusion
119
4th Semester Nursing
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