Question

1. A client who has an affinity for herbal remedies is asking when the Food and Drug administration (FDA) can remove an herbal remedy. Which response by the nurse would be accurate?

1. When the label is accurate and undeclared ingredients are found
2. When a pharmaceutical company has created a better remedy
3. When an herb has been found to interact with a commonly prescribed pharmaceutical remedy
4. When herbs are not grown under identical conditions to control property
5. When an herb is marketed on the internet

2. A client who has taken a lethal overdose of their tricyclic antidepressant has just received physostigmine for a heart rate if 185. What effects should the nurse watch for that might result from tis cholinergic antidote?

1. Rebound bradycardia
2. Insomnia
3. Hyperglycemia
4. Nervousness

3. A teenager has been bought into the emergency department following of lorazepam (Ativan) overdose. What antidote should the nurse have available in anticipation that it may be needed?
4. Acetylcysteine(mucomyst)
5. Flumazenil(Romazicon)
6. Naloxone(narcan)
7. Physostigmine(anbilirium)
8. The elderly client with osteoporosis will be going home on a fentanyl patch, which statement by the elderly indicates the need for further teaching?
9. “The patch should only be changed every third day”
10. “Indeed to avoid alcohol even though this is just a patch”
12. A client has just received their first dose of doxazosin (Cardura). What follow-up nursing intervention would occur following the administration of this alpha-adrenergic blocker?
13. Ambulate the client to prevent venous status
14. Check the blood pressure twice within the next hour
15. Obtain the order for a urinary catheter
16. “I should shave the area for the patch just before applying it”
17. “I should avoid hot baths when I am wearing a patch”
18. “I should avoid putting pressure on this patch”
19.    

Answer 1

ANSWER :

1)Option A - When the lable is accurate and undeclared ingredients are found.

Reason :

According to FDA the lables of herbal products should include :

• The herbal supplement name
• Serving size , amount and active ingredient.
• List of all the ingredients present in it.

2)Option A - Rebound bradycardia.

Reason :

Physostigmine inhibits cholinesterase enzyme.

Effects of physostigmine when given in Tricyclic antidepressants toxicity :

• Reduces mean arterial pressure
• Reduces the heart rate, enhances the reflex bradycardia , causes hypotension and asystole
• Can cause generalized seizures , excessive salivation etc.

So, Physostigmine is not used in TCA toxicity when the client is already having bradycardia.

3)Option B - Flumazenil(Romazicon)

Reason :

Flumazenil :

• Antidote for Benzodiazepine (lorazepam) overdose
• It is a Benzodiazepine analogue ,so it attaches to the GABA (Gamma Amino Butyric acid ) receptors and competitively displaces lorazepam blocking its further binding and its action.

4)Option B - Indeed to avoid alcohol even though this is just a patch.

Reason :

• Drinking alcohol or taking alcohol containing medications when on fentanyl patch can lead to life threatening side effects like : unresponsiveness , extreme sleepiness, difficult breathing , lightheadedness, dizziness etc