Question 23 1 out of 1 points A nurse is talking to an 18-year-old patient who has had a seizure disorder since she was 10 years old and is taking phenytoin (Dilantin). The nurse should suggest that she take which of the following? Response Feedback: Long-term phenytoin therapy is associated with folate deficiency. Folic acid and phenytoin are structurally similar and thought to compete with each other for the same receptors. A deficiency in folic acid in a pregnant woman can cause birth defects. Potassium, iron, and vitamin C do not compete with phenytoin nor are they directly affected by phenytoin. Question 24 1 out of 1 points A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient's concerns?
Response Feedback: Addiction to opioids is a rare occurrence among hospital patients who do not have a history of drug abuse. It would be inappropriate to downplay the patient's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction. Question 25 1 out of 1 points A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for Response Feedback: The patient who has history of alcohol or substance abuse may be a poor candidate for lorazepam because the patient is more likely to develop dependence on the drug. Alcohol will also have an additive effect with lorazepam. A diet high in fat and carbohydrates or nicotine use should not affect the use of lorazepam. Question 26 1 out of 1 points A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin? Response Feedback: A protein deficit puts the patient at greater risk for having greater amounts of free, active drug in the blood because less protein albumin is available for binding than would normally be expected. Alcohol does not compete with phenytoin for binding sites and the drug is not necessarily contraindicated with recent alcohol intake, though alcohol does influence the metabolism of phenytoin. Oral phenytoin would not significantly minimize the risk of adverse effects. Question 27 1 out of 1 points
A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by Response Feedback: Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs
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- Summer '15
- Benzodiazepine, Phenytoin