Side Effects - NCLEX-PN
Card 0 of 340
A 42 year old man with a history of severe depression who is currently prescribed multiple antidepressants presents with tachycardia, hyperreflexia, sweating, mydriasis, myoclonus. He is confused and mildly agitated. On questioning he admits that he may have taken "one too many" of one or more of his medications. What is the most likely cause of his symptoms?
A 42 year old man with a history of severe depression who is currently prescribed multiple antidepressants presents with tachycardia, hyperreflexia, sweating, mydriasis, myoclonus. He is confused and mildly agitated. On questioning he admits that he may have taken "one too many" of one or more of his medications. What is the most likely cause of his symptoms?
The symptoms this patient are presenting with are consistent with serotonin syndrome, a rapid onset and potentially life-threatening condition of excess circulating serotonin. Symptoms can range from mild to severe, and may include tachycardia, nausea and vomiting, diarrhea, hyperreflexia, sweating, mydriasis, myoclonus, mental status changes, headache, and coma. Serotonin syndrome is generally caused by drug interaction or overdose of drugs that raise circulating serotonin levels, such as selective serotonin reuptake inhibitors (SSRI's) and monoamine oxidase inhibitors (MAOI's).
The symptoms this patient are presenting with are consistent with serotonin syndrome, a rapid onset and potentially life-threatening condition of excess circulating serotonin. Symptoms can range from mild to severe, and may include tachycardia, nausea and vomiting, diarrhea, hyperreflexia, sweating, mydriasis, myoclonus, mental status changes, headache, and coma. Serotonin syndrome is generally caused by drug interaction or overdose of drugs that raise circulating serotonin levels, such as selective serotonin reuptake inhibitors (SSRI's) and monoamine oxidase inhibitors (MAOI's).
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Which of the following best describes extrapyramidal side effects?
Which of the following best describes extrapyramidal side effects?
Extrapyramidal side effects generally present as slow or repetitive motions or postures (dystonia), spasm, tremor, slurred speech, slowed thought process, restlessness and anxiety, paranoia, and general overall distress. These effects are caused by antipsychotic drugs that act as dopamine D2 receptor antagonists.
Extrapyramidal side effects generally present as slow or repetitive motions or postures (dystonia), spasm, tremor, slurred speech, slowed thought process, restlessness and anxiety, paranoia, and general overall distress. These effects are caused by antipsychotic drugs that act as dopamine D2 receptor antagonists.
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Which of the following drugs would be least likely to cause extrapyramidal side effects?
Which of the following drugs would be least likely to cause extrapyramidal side effects?
Extrapyramidal side effects are common with typical antipsychotic drugs that act as dopamine D2 receptor antagonists. These include many selective serotonin reuptake inhibitors (SSRI's), serotonin–norepinephrine reuptake inhibitors (SNRI's), and norepinephrine–dopamine reuptake inhibitors (NDRI's), as well as antiemetics such as metclopramide.
Alprazolam is a benzodiazepine and is not associated with extrapyramidal adverse effects.
Extrapyramidal side effects are common with typical antipsychotic drugs that act as dopamine D2 receptor antagonists. These include many selective serotonin reuptake inhibitors (SSRI's), serotonin–norepinephrine reuptake inhibitors (SNRI's), and norepinephrine–dopamine reuptake inhibitors (NDRI's), as well as antiemetics such as metclopramide.
Alprazolam is a benzodiazepine and is not associated with extrapyramidal adverse effects.
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You are the nurse in a primary care clinic taking care of a 26-year old female with a urinary tract infection. You are counseling her about taking her antibiotic, cephalexin. You warn her that a common side effect is which of the following?
You are the nurse in a primary care clinic taking care of a 26-year old female with a urinary tract infection. You are counseling her about taking her antibiotic, cephalexin. You warn her that a common side effect is which of the following?
The correct answer is "diarrhea." Diarrhea is a common side effect associated with antibiotic use, including cephalexin. This diarrhea is typically self-limited and resolves within the first day or two of administration. Sometimes patients are advised to take a probiotic or consume yogurt when starting a new antibiotic if they experienced diarrhea when starting antibiotics in the past.
Neither headaches, hair loss, pharyngitis, nor necrotizing skin rash are known common side effects of cephalexin use.
The correct answer is "diarrhea." Diarrhea is a common side effect associated with antibiotic use, including cephalexin. This diarrhea is typically self-limited and resolves within the first day or two of administration. Sometimes patients are advised to take a probiotic or consume yogurt when starting a new antibiotic if they experienced diarrhea when starting antibiotics in the past.
Neither headaches, hair loss, pharyngitis, nor necrotizing skin rash are known common side effects of cephalexin use.
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A male client is receiving 150mg of gentamicin every 8 hours for a soft tissue infection. The nurse giving this medication is aware there are several serious side effects associated with gentamicin, including ototoxicity.
Which statement by the client indicates that he may be experiencing this serious side effect?
A male client is receiving 150mg of gentamicin every 8 hours for a soft tissue infection. The nurse giving this medication is aware there are several serious side effects associated with gentamicin, including ototoxicity.
Which statement by the client indicates that he may be experiencing this serious side effect?
The ringing in the ear is tinnitus, which is indicative of ototoxicity. Nausea, metallic taste in mouth, difficulty swallowing and skin reactions are not associated with the development of ototoxicity.
The ringing in the ear is tinnitus, which is indicative of ototoxicity. Nausea, metallic taste in mouth, difficulty swallowing and skin reactions are not associated with the development of ototoxicity.
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Which of the following is a symptom of digoxin toxicity?
Which of the following is a symptom of digoxin toxicity?
Nausea, vomiting, and diarrhea are common symptoms of digoxin toxicity. Other symptoms may include confusion, anorexia, irregular heartbeat, and palpitations. Tremors, mood swings, and rash are not generally seen with digoxin toxicity.
Nausea, vomiting, and diarrhea are common symptoms of digoxin toxicity. Other symptoms may include confusion, anorexia, irregular heartbeat, and palpitations. Tremors, mood swings, and rash are not generally seen with digoxin toxicity.
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Which of the following is the most serious potential adverse effect of enalapril?
Which of the following is the most serious potential adverse effect of enalapril?
All of these are potential side effects of ACE (angiotensin-converting enzyme) inhibitors such as enalapril, but angioedema (the swelling of the face, lips, and/or tongue) is a potentially life threatening condition, as swelling can obstruct the airway.
All of these are potential side effects of ACE (angiotensin-converting enzyme) inhibitors such as enalapril, but angioedema (the swelling of the face, lips, and/or tongue) is a potentially life threatening condition, as swelling can obstruct the airway.
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A 19-year-old client presents to the emergency department explaining that he has a history of sickle cell anemia. He is complaining of severe pain in his arms and legs. The nurse recognizes that the patient is experiencing a sickle cell crisis, and is going to administer pain medication as ordered.
The nurse is aware that which of the following pain medications is contraindicated for this disorder?
A 19-year-old client presents to the emergency department explaining that he has a history of sickle cell anemia. He is complaining of severe pain in his arms and legs. The nurse recognizes that the patient is experiencing a sickle cell crisis, and is going to administer pain medication as ordered.
The nurse is aware that which of the following pain medications is contraindicated for this disorder?
Meperidine is contraindicated because in high doses it can form a toxic metabolite that can lead to seizures. All other drugs listed are appropriate for pain control for sickle cell crisis.
Meperidine is contraindicated because in high doses it can form a toxic metabolite that can lead to seizures. All other drugs listed are appropriate for pain control for sickle cell crisis.
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What is the most common vitamin deficiency seen in patients taking metformin?
What is the most common vitamin deficiency seen in patients taking metformin?
B12 deficiency is common in patients on metformin, and should be monitored and supplemented either sublingually or intramuscularly.
B12 deficiency is common in patients on metformin, and should be monitored and supplemented either sublingually or intramuscularly.
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A 63 year old female presents with involuntary grimacing, lip smacking, excessive blinking, and sticking out of the tongue. She also flicks her fingers and her wrists. She states that she has no control over these movements, and that they have gotten progressively worse over the last three years. Her family is worried that she may be experiencing an early form of dementia. Her medical history is significant for depression, for which she has been taking aripiprazole for the last nine years. Which of the following is the most likely cause of her symptoms?
A 63 year old female presents with involuntary grimacing, lip smacking, excessive blinking, and sticking out of the tongue. She also flicks her fingers and her wrists. She states that she has no control over these movements, and that they have gotten progressively worse over the last three years. Her family is worried that she may be experiencing an early form of dementia. Her medical history is significant for depression, for which she has been taking aripiprazole for the last nine years. Which of the following is the most likely cause of her symptoms?
The most likely cause of uncontrollable muscle movements in the absence of other systemic symptoms in a patient with a history of antipsychotic drug use is tardive dyskinesia. This is a disorder of rapid involuntary movements, most often in the face or head but also potentially affecting the extremities. It's exact cause is not well understood, but it is theorized to be an issue of sensitization of the D2 dopamine receptors after long-term neuroleptic use.
The most likely cause of uncontrollable muscle movements in the absence of other systemic symptoms in a patient with a history of antipsychotic drug use is tardive dyskinesia. This is a disorder of rapid involuntary movements, most often in the face or head but also potentially affecting the extremities. It's exact cause is not well understood, but it is theorized to be an issue of sensitization of the D2 dopamine receptors after long-term neuroleptic use.
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Which of the following is not a common side effects in individuals using selective serotonin reuptake inhibitors (SSRI's)?
Which of the following is not a common side effects in individuals using selective serotonin reuptake inhibitors (SSRI's)?
While SSRI's have been known to cause a variety of adverse effects, including diminished libido, increased risk of suicide in children and adolescents, restlessness, photosensitivity, and increased risk of bone fracture, individuals taking SSRI's are not associated with any increased incidence of coronary heart disease.
While SSRI's have been known to cause a variety of adverse effects, including diminished libido, increased risk of suicide in children and adolescents, restlessness, photosensitivity, and increased risk of bone fracture, individuals taking SSRI's are not associated with any increased incidence of coronary heart disease.
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Which of the following over-the-counter medications has been associated with hepatotoxicity and liver failure?
Which of the following over-the-counter medications has been associated with hepatotoxicity and liver failure?
Acetaminophen has surpassed viral hepatitis as the most common cause of acute hepatic failure in the United States. Hepatotoxicity can occur in doses of 7.5g or up for adults and 150millg/kg of body weight in children aged 1-6. None of the other drugs listed are particularly hepatotoxic.
Acetaminophen has surpassed viral hepatitis as the most common cause of acute hepatic failure in the United States. Hepatotoxicity can occur in doses of 7.5g or up for adults and 150millg/kg of body weight in children aged 1-6. None of the other drugs listed are particularly hepatotoxic.
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What is the mechanism of cytotoxicity in acetaminophen-related liver failure?
What is the mechanism of cytotoxicity in acetaminophen-related liver failure?
Acetaminophen depletes glutathione, one of the body's most important antioxidants. The liver is the body's main processing organ for environmental and ingested toxins, and glutathione is the primary molecule the liver uses to rid itself of the harmful biproducts of the detoxification process. When glutathione is severely depleted, such as with acetaminophen overdose, hepatic cells can rapidly necrose, resulting in liver failure and even death.
Acetaminophen depletes glutathione, one of the body's most important antioxidants. The liver is the body's main processing organ for environmental and ingested toxins, and glutathione is the primary molecule the liver uses to rid itself of the harmful biproducts of the detoxification process. When glutathione is severely depleted, such as with acetaminophen overdose, hepatic cells can rapidly necrose, resulting in liver failure and even death.
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An individual taking which of the following medications must be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis?
An individual taking which of the following medications must be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis?
Alendronate is a bisphosphonate drug used in the treatment of osteoporosis and osteogenesis imperfecta. An individual taking this medication should be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis. Other gastrointestinal adverse effects of alendronate include esophageal strictures, achalasia, gastric ulcers, and gastritis. None of the other medications listed are associated with esophagitis.
Alendronate is a bisphosphonate drug used in the treatment of osteoporosis and osteogenesis imperfecta. An individual taking this medication should be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis. Other gastrointestinal adverse effects of alendronate include esophageal strictures, achalasia, gastric ulcers, and gastritis. None of the other medications listed are associated with esophagitis.
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Which of the following is not as side effect associated with beta blockers?
Which of the following is not as side effect associated with beta blockers?
The most common side effects of beta blockers are fatigue, dizziness, weakness, cold hands or feet, dry mouth, headache, nausea, diarrhea, and shortness of breath.
The most common side effects of beta blockers are fatigue, dizziness, weakness, cold hands or feet, dry mouth, headache, nausea, diarrhea, and shortness of breath.
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Which of the following medications is associated with increased risk of SIADH (syndrome of inappropriate antidiuretic hormone secretion)?
Which of the following medications is associated with increased risk of SIADH (syndrome of inappropriate antidiuretic hormone secretion)?
Chlorpropamide, an antidiabetic medication in the sulfonylurea class, has been associated with drug-induced SIADH (syndrome of inappropriate antidiuretic hormone secretion). This is a rare but serious complication that will generally resolve once drug treatment has stopped. None of the other drugs listed are associated with this side effect.
Chlorpropamide, an antidiabetic medication in the sulfonylurea class, has been associated with drug-induced SIADH (syndrome of inappropriate antidiuretic hormone secretion). This is a rare but serious complication that will generally resolve once drug treatment has stopped. None of the other drugs listed are associated with this side effect.
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Death by opiate overdose is generally the result of .
Death by opiate overdose is generally the result of .
Most opiates can cause respiratory depression when taken in toxic levels. They do this by reducing the sensitivity of respiratory center neurons to carbon dioxide, which results in decreased breathing. In more moderate cases brain damage can precede death due to CNS hypoxia. Opiates generally are not associated with liver failure (unless taken as a combination drug with acetaminophen, such as hydrocodone), heart attack, or serotonin syndrome.
Most opiates can cause respiratory depression when taken in toxic levels. They do this by reducing the sensitivity of respiratory center neurons to carbon dioxide, which results in decreased breathing. In more moderate cases brain damage can precede death due to CNS hypoxia. Opiates generally are not associated with liver failure (unless taken as a combination drug with acetaminophen, such as hydrocodone), heart attack, or serotonin syndrome.
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A nurse is working with a 36 year old patient comes in for a back injury after a motor vehicle accident. He is prescribed oxycodone-acetaminophen for pain relief. Three days later he calls the nurse to complain that he is experiencing itching all over. He is concerned that he might be having an allergic reaction to the pain medication. There is no rash associated with his pruritus. He has no hives, no nausea or vomiting, no shortness of breath, no swelling of the mouth or face. What is the most likely cause of his itching?
A nurse is working with a 36 year old patient comes in for a back injury after a motor vehicle accident. He is prescribed oxycodone-acetaminophen for pain relief. Three days later he calls the nurse to complain that he is experiencing itching all over. He is concerned that he might be having an allergic reaction to the pain medication. There is no rash associated with his pruritus. He has no hives, no nausea or vomiting, no shortness of breath, no swelling of the mouth or face. What is the most likely cause of his itching?
Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.
Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.
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Which of the following is a common side effect of non-steroidal anti-inflammatory (NSAID) use?
Which of the following is a common side effect of non-steroidal anti-inflammatory (NSAID) use?
NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension.
NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension.
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Which of the following medications can cause the (benign) side effect of causing an orange-red tint to urine and tears?
Which of the following medications can cause the (benign) side effect of causing an orange-red tint to urine and tears?
Of the drugs listed, the only one associated with this bizarre side effect is rifampicin, a broad spectrum antibiotic used in tuberculosis. Urine, sweat, saliva, or tears may be turned any shade from red to reddish orange.
Of the drugs listed, the only one associated with this bizarre side effect is rifampicin, a broad spectrum antibiotic used in tuberculosis. Urine, sweat, saliva, or tears may be turned any shade from red to reddish orange.
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