1. What adjustment in pain medication may be needed for an elderly person with elevated liver enzymes due to anticonvulsant therapy? The timer between doses should be expanded to allow for metabolism in hepatic dysfunction 2. The nurse reads that the half-life of morphine is roughly 3 hours. How would the nurse use this information to decide if it is safe to give Morphine every 3 hours as needed for pain? The half-life of Morphine would be longer in hepatic insufficiency; the drug would accumulate 3. A client with persistent pain due to cancer is brought to the ED by his spouse. Upon assessment, the nurse notes pinpoint pupils and a RR of 6 breaths per minute. The nurse should immediately prepare for administration of which medication? naloxone (Narcan), the antidote for opiates 4. A nurse is providing client education about the use of a fentanyl transdermal delivery system. Which of these statements would indicate accurate understanding of self-care expectations? Change the patch every 72 hours 5. What should the nurse do after giving a young man Dilaudid (hydromorphone) for a migraine? Provide a restful, dimly lit environment 6. Sumatriptan (Imitrex) is orered for an elderly client experiencing a migraine. The nurse understands that triptans are contraindicated in which condition? Cerebrovascular insufficiency 7. A client is returning to the clinic for follow-up related to elevated liver enzymes. Which of the following medications on the client's medication list would concern the nurse most? Acetaminophen PRN for pain 8. A client taking paroxetine (Paxil), a serotonin reuptake inhibitor for post-traumatic stress disorder, calls the clinic complaining of confusion, restlessness, and fever. What should the nurse reply? Have him talk to his doctor before taking any more Paxil since these are signs of serotonin toxicity 9. A client taking amitriptyline (a tricyclic antidepressant) complains of having blurred vision and dry mouth, and he states that he hasn't had a bowel movement in 3 days. His vital signs are T 97.6 F, P 90/m, BP 130/79, and RR 20/m. Based on this, the nurse should suspect which of the following causes? Anticholinergic effects 10.A client experiencing loss of libido wants to know why he was started on citalopram, an SSRI, rather than one of the other types of antidepressants. Which response would be most appropriate? "SSRIs have fewer side effects than other antidepressants. Should I mention the concern to your provider?" 11.A depressed client is starting phenelzine (Nardil), a MAOi. Which statement shows he knows the needed self-care precautions? "When I go to cookouts this summer, I should eat chicken instead of hot dogs" 12.A client who started an antidepressant 1 week ago tells his nurse, "I really don't think this medication is helping me." Which response by the nurse would be most appropriate? "It can take weeks for antidepressants to work. How are you doing?" 13.A friend of a nurse who is being treated for anxiety with a selective serotonin reuptake inhibitor (SSRI) wants to know why Zoloft (sertraline) is better for controlling anxiety than a benzodiazepine. Which of the following is the nurse's best response? "Zoloft is better for reducing cognitive symptoms of anxiety than benzodiazepines" 14.The client has been prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory finding should the nurse watch closely, since it may be altered by this medication? The client's WBC count; The medicine is known for causing bone marrow depression 15.A client who has been taking haloperidol (Haldol), a traditional antipsychotic, is now also complaining of severe muscle spasms of the neck and back. Based on these manifestations, which of these PRN prescriptions could the nurse offer to help stop the symptoms? Benadryl (diphenhydramine) 16.A client who was involved in a MVC comes into the ER distraught and complaining of leg pain. Knowing that the client is experiencing a stress response to trauma, what signs or symptoms would the nurse expect to see? Elevated pulse and RR 17.An elderly person is being assessed for repeated falls. Which of their medications increases that risk? Lyrica (pregabalin), a GABA sustainer for nerve pain Halcion (triazolam), a benzodiazepine for sleep OxyContin (oxycodone), an opiate for back pain