Pharm & Neuro/Sensory Nursing Review

These Question-and-Answer flashcards review major nursing concepts from the lecture: anticonvulsant and benzodiazepine pharmacology, dosage calculations, otic/ophthalmic medication administration, seizure precautions, Parkinson’s care, glaucoma management, sleep physiology & hygiene, and fundamental neuro-autonomic principles. Use them to quiz yourself and reinforce key facts for the upcoming exam.

What client statement about phenytoin indicates a need for further teaching?

"I'll be glad when my seizures stop so I can quit taking this medicine." (Phenytoin is usually lifelong and must not be stopped abruptly.)

Why should a client taking phenytoin notify the provider before starting new medications?

Numerous drug–drug interactions can occur with phenytoin.

How should phenytoin be taken to reduce GI distress?

With meals.

Common oral adverse effect of phenytoin that warrants dental follow-up?

Gingival hyperplasia (gum overgrowth).

Which adverse effect of phenytoin must be reported immediately?

Skin rash (possible Stevens-Johnson syndrome/TEN).

What urine color change can occur with phenytoin?

Pink, red, or red-brown urine.

Alcohol + phenytoin: teaching point?

Alcohol can raise phenytoin levels and increase toxicity risk.

Proper dropper position for adult otic drops

Hold dropper ~1 cm (½ in) above ear canal, don’t touch canal.

After instilling otic drops in an adult, what maneuver helps distribute medication?

Gently press the tragus.

How to straighten adult ear canal for drops

Pull auricle upward and back.

How to straighten ear canal for a child <3 yr

Pull auricle down and back.

Why should otic medication be room temperature?

Cold solution can cause dizziness/vertigo.

Benzodiazepine alprazolam (Xanax): most common early adverse effect

Sedation/drowsiness.

Alprazolam adverse effect requiring monitoring of client’s memory

Anterograde amnesia / inability to recall events.

Alprazolam is contraindicated in clients with what substance-use disorder?

Alcohol use disorder (↑ CNS-depression risk).

Diazepam teaching: activity precautions

Causes drowsiness; avoid hazardous activities (driving, machinery).

Does grapefruit juice inactivate diazepam?

No—grapefruit juice doesn’t significantly affect diazepam.

Calculation: 500 mg valproic acid ordered, solution 250 mg/5 mL. Volume to give?

10 mL.

Calculation: Clonazepam 1 mg ordered, 0.5 mg tablets available. Tablets to give?

2 tablets.

Calculation: Lorazepam 2 mg ordered, 1 mg tablets available. Tablets to give?

2 tablets.

Calculation: Lorazepam 1 mg PO, solution 2 mg/mL available. Volume to give?

0.5 mL.

Post-seizure period when client is very sleepy/confused

Postictal phase.

Priority nursing action when client is actively seizing on floor

Place pillow/soft padding under head and turn head/ client to side.

During tonic-clonic seizure, should objects be placed in mouth?

No—never insert anything into the mouth.

Essential equipment at bedside for clients on seizure precautions (select 3)

Suction setup, oxygen setup, padded/raised side rails.

Action to promote sleep in long-term care client with insomnia

Establish consistent bedtime routine and sleep schedule.

Older adult sleep principle: effect of chronic pain

Pain & illness often fragment sleep; address underlying pain.

Key symptom of chronic open-angle glaucoma

Gradual loss of peripheral vision (tunnel vision).

Untreated glaucoma can result in what outcome?

Irreversible blindness from optic-nerve damage.

Primary treatment frequency for glaucoma eye drops

Usually every 12 hours for life; do not skip doses.

OTC meds & glaucoma: teaching

Consult provider before using OTC drugs that dilate pupils (can raise IOP).

Timolol ophthalmic drops systemic adverse effect to monitor

Bradycardia (beta-blocker absorption).

Correct eye-drop placement technique

Drop medication into conjunctival sac without touching eye.

Parkinson’s disease neurotransmitter deficit

Dopamine.

Definition of bradykinesia in Parkinson’s

Slowed movements—e.g., slurred speech, ↓ blinking, masklike face.

Safety device to assist gait in Parkinson’s

Cane or walker for stability.

Meal pattern recommendation for Parkinson’s client

Six small meals/day (slow eating, ↓ aspiration risk).

Definition of an aura in seizure disorders

Sensory warning indicating imminent seizure (flashes, odors, sounds).

Status epilepticus definition

Continuous seizure state with rapid succession of seizures.

Priority after lowering seizing child to floor

Turn child to lateral position to maintain airway & allow drainage.

Parent report that is priority with carbamazepine therapy

Increased bruising (possible bone-marrow suppression).

Toddler ear-drop technique justification for parent

Pulling ear down & back opens canal for full medication delivery.

Total fluid intake calculation components

Sum oral ml, converted ounces ×30 mL, and IV rate × time.

Total intake example: 3 oz + 2 oz + 10 mL meds + IV 20 mL/hr for 8 hr

320 mL.

First priority when admitting client with vision loss

Describe environment thoroughly to reduce fall risk.

Night-light rationale for older adult fearing falls

Improves orientation & illuminates path to bathroom, reducing falls.

Sleep hygiene: beverage without caffeine

Lemon-lime soda (clear, caffeine-free).

Healthy sleep habit the nurse should correct

Watching television until falling asleep—stimulating and disruptive.

Caffeine limitation for sleep hygiene

Eliminate caffeine in evening hours to improve sleep quality.

Non-pharmacologic sleep improvement method

Establishing regular sleep–wake routine.

Exercise timing in relation to sleep

Avoid vigorous exercise within 2–3 hr of bedtime.

NREM sleep physiologic changes

Body temp, HR, BP, and RR all decrease; energy conserved.

Stage of sleep with delta waves (deepest NREM)

Stage 3 NREM (sometimes grouped with Stage 4 as slow-wave sleep).

Primary characteristic of Stage 1 NREM

Light sleep; easy arousal.

Stage of sleep with decreased muscle tone & heightened brain activity

REM sleep (Stage 5).

Which nervous-system division activates “fight or flight”?

Sympathetic nervous system.

Afferent vs efferent nerves: which carry sensory input to CNS?

Afferent nerves.

Efferent nerves in voluntary movement belong to what system?

Somatic nervous system (part of PNS).

Primary neurotransmitter of cholinergic drugs

Acetylcholine.

Common anticholinergic side effect trio

Dry mouth, constipation, blurred vision.

Cholinergic drugs therapeutic use in eye care

Lower intraocular pressure in glaucoma.

Adrenergic agent first-line emergency use

Treatment of anaphylaxis (e.g., epinephrine).

Side effects of cholinergic stimulation (select 2)

Increased salivation & diarrhea.

Sleep hygiene lifestyle change to recommend

Avoid caffeine consumption in the evening.

Client refusing medication: therapeutic response

“Tell me more about this decision.” (Explores reasons without judgment.)

Teach-back method example

Client explains or demonstrates procedure (e.g., eye-drop instillation) in own words.

Position for administering vaginal cream

Dorsal recumbent position.

Priority when child has tonic-clonic seizure with vomiting

Turn child to side-lying position to prevent aspiration.

Action NOT to take during a seizure

Restrain limbs or insert tongue blade—both can cause injury.

Loosening clothing during seizure: rationale

Prevents restrictive injury and aids ventilation.

Proper use of cotton after otic drops

Place loosely at canal opening for 15–20 min; do not pack firmly.

Why limit toddler naps to 30 min for insomnia

Long daytime sleep reduces nighttime sleep drive.

Physiologic change during NREM sleep regarding growth hormone

Growth hormone secretion increases.

What system do anticholinergic drugs inhibit?

Parasympathetic (cholinergic) system, reducing secretions & motility.

Effect of anticholinergics on urination

Urinary retention, not increased urination.

Key safety teaching for glaucoma eye-drop self-administration

Continue drops for life; never stop when vision “improves.”

Glaucoma follow-up schedule

Ophthalmology visit at least annually—often more frequently.