[Music] hi guys it's me professor d and welcome back to my channel on this video i'm going to be covering pharmacology and to be more specific i'm going to be going over neurological medications guys if you haven't done so already please don't forget to like and subscribe below you can also find more content different content on my tick tock and instagram my handle still the same nexus nursing i also have audio lessons that are going to be released a very soon and you can check and check that out information about it on my website nexusnursinginstitute.com so without any further ado guys let's get started first question the male client diagnosed with urinary retention is receiving beth guys you know i cannot pronounce bethenny call uricholine uh muscarinic agonist medication which intervention should the nurse implement one limit the client's fluid intake to a thousand milliliters daily two have the clients a urinal readily available three maintain hourly input intake and output for the client or four monitor the client serum creatinine level let me adjust my camera all right guys and the correct answer is to have the client's urinal readily available so guys this medication it relaxes that bladder sphincter and it causes contraction of um that muscle that's why in the questions tells you that it's a muscarinic agonist it worked towards the muscle right so that detroit muscle it causes contraction of the detrusor muscle while it actually relaxes the sphincter what effect does that have that's going to make the patient want to urinate because it will cause pressure for the patient wants to urinate and plus that sphincter is already relaxed so two is the correct answer we're gonna have a urinal readily available now let's look at the wrong answer choices one limit the client's fluid intake are you trying to put this patient into dehydration because i just told you what this medication does so here we have a patient that's letting go of all of their fluid they're urinating all over the place but we're not giving them fluids so we're not replacing what they're losing you're going to throw that patient to electrolyte imbalance you're going to cause them to have dehydration so that's wrong choice number three maintain hourly ino um hourly ionos really not necessary you do want to do i know but you can do it per shift it's not necessary to do our hourly ino um choice four monitor their serum creatinine level well we're looking at serum creatinine level when we're concerned about kidney function okay but with this patient we're not concerned about their kidneys that's not what we're worried about so the correct answer is going to be choice number two next question which client would the nurse question administering the muscarinic agonist atropine one a 69 year old client diagnosed with glaucoma two 60 year old client diagnosed with symptomatic sinus bradycardia three 55-year-old client being prepped for abdominal surgery or four 28 year old client with severe diarrhea and the correct answer guys is one the 69 year old client diagnosed with glaucoma we're not going to blindly give that medication we're going to question it why atropine is contra indicated in a patient that has glaucoma i want you to think about this guys what is glaucoma that's basically hypertension in the eyeballs right the patient got all this pressure in the eyeballs what does um uh atrophy atropine do is causes pupil dilation so it will make the patient have even more pressure in their eyeball and it could cause that patient go blind right so if that patient has a history of glaucoma are we going to give atropine absolutely not we're going to withhold that medication and you're going to place a phone call to the doctor now let's look at our wrong answer choices choice two um the sixty-year-old client diagnosed with symptomatic sinus bradycardia actually patients that have symptomatic bradycardia atropine is a drug of choice that's wonderful yes we're gonna give that there's nothing to question there um choice three the 55 year old client being prepped for abdominal surgery um atropine is often given to patients who are getting surgery one for the off chance if their heart rate gets too low that's number one and number two what does atropine do it also dries up secretion so that's great for surgery so there's nothing wrong with that and then we have choice uh for the 28 year old client with severe diarrhea well i just told you what is one of the things that atropine what is one of the things that atropine does it drives up secretion so that given for um diarrhea there's nothing wrong with that so the only one that we would question which is contraindicated is that patient that has glaucoma a 20-year a 28-year-old client who's obese is complaining of nervousness irritability insomnia and heart palpitations which question should the clinic nurse ask the client first one how much weight have you gained or lost within the last 12 months two do you make yourself vomit after eating large meals three is there any history of you taking illegal drugs such as amphetamines four have you been taking any over-the-counter appetite suppressants and guys the correct answers for have you been taking any over-the-counter appetites of presence what do appetite suppressants besides you know helping you lose weight by suppressing your appetite what do they cause all of those signs and symptoms that we're looking at right now and they gave us a hint in the question they told us that the patient is what obese they're overweight so the first thing we're going to ask them have you been taking any appetite suppressants because that's most likely what's causing that nervousness irritability insomnia heart palpitations okay those um appetite suppressants cause all of those symptoms that we're seeing now so that's the first thing you're gonna ask the clients undergoing ect for major depression and is receiving two brocarine you guys know i can't pronounce tubacarine a non-depolarizing neuromuscular blocker what data would want immediate intervention by the nurse one the client's apical pulse is 58 2 the oral temperature is 99.8 3 the client's respiratory rate is 10 or 4 the client's blood pressure is 110 over 70. and so guys the correct answer is three the client's respiratory rate is 10. so guys this medication relaxes the muscles that's important for us to know let me be more specific it relaxes the skeletal muscles so if that patient's respiratory rate is already 10 and we know that the respiratory rate is supposed to be 12 to 20 or 12 to 22 depending on the textbook you're using but the minimum is 12 and they're already at 10. do we want them to take anything that's going to relax those skeletal muscles even more and make that breathing be even more shallow and go lower absolutely not so that is the correct answer airway airway airway we don't care about listen we don't care about that pulse of 58 that blood pressure or temperature we don't care about any of that if that patient can't breathe if there's not enough oxygen going to the brain going to the kidneys just fleeing the liver and all your major organs we don't care about anything else airway that is um why that's the correct answer next question a client prescribed phentoin dilantin for epilepsy calls a clinic and reports a measles-like rash which action should the nurse implement one instruct the client to come to the clinic immediately two determine if the client is drinking grapefruit juice three encourage a client to apply a hydrocortisone cream to the rash or four explain that this is a common side effect of this medication and guys the correct answer is one instruct the client to come to to come to the clinic immediately immediately this is what's known as a more biliform rash and it's a sign of possible um anaphylactic adverse reaction that we don't want that patient to have so we're going to have them come in immediately and that patient's gonna have to be assessed okay all of the other choices you're showing the test rider that you have no idea what's going on because this is not normal this is not something that's expected no we're not going to tell them oh just to put some hydrocortisone no this is a sign that um patient may be having a very bad reaction and we need them to come in so we can assess them immediately the client diagnosed with parkinson's disease has been taking amenadine symmetral and anti-parkinsonian drug the home health nerd nurse notes a new finding of model discoloration of the skin what action should the nurse take one ask the client if he or she has changed soul products to prepare the significant other for the client's imminent death three notify the health care provider to discontinue the medication or four explain that this is expected and document the finding and the correct answer is four you're going to let them know it's expected and document the finding so guys this is an expected uh reaction to this medication the patient usually develops it about four weeks into taking that medication it's benign and it goes away on its own as soon as that medication is discontinued it's gonna go away on its own it's not harmful to the patient so you're gonna teach the patient that and let them know the clients diagnosed with a late-stage alzheimer's disease they are agitated and having delusions which medication should the nurse anticipate the health care provider prescribing one the cholinesterase inhibitor densopro arecep to the antipsychotic medication haldol three the ssri prozac or for the tca elevel and guys the correct answers to the anti-psychotic haldol they told us in the question that the patient is having delusions delusions guys so this patient is um out of touch with reality and that's what psychosis is when you are out of touch with reality when somebody's going through a psychotic period day for that time they are out of touch with reality so we expect that antipsychotics such as haloperidol or haldol is going to be given now let's look at our wrong answer choices one the cholinesterase inhibitor error set that we give for patients who are in the early stages of alzheimer's three the ssr ssri prozac that we give for patients which what have depression remember and ssris those are our first line treatment for depression but that's not what our patient in this situation is going through and then choice for tca that's also an um antidepressant but uh something else i want you to know about tcas even if this patient who had alzheimer's also had depression we still would not give a tca we would give it ssri and let me explain to you why tcas make those effects of alzheimer's those symptoms even worse right so if a patient has alzheimer's they're going to get an ssri but we are not going to give them a tca so that is the wrong answer for our question anyhow the client diagnosed with parkinson's disease who's taken taking select selegaline elderpril has had hip surgery and is admitted to the orthopedic department the nurse is transcribing the post-op orders which post-op order with the nurse question one the low molecular weight heparin um love knots two the narcotic analgesic meperidine demerol three the maob inhibitor elderpro or four the prophylactic broad spectrum antibiotic and ceph okay guys and the correct answer is to the narcotic analgesic demerol guys you cannot give that medication demerol and um elder pro together they cause adverse reactions such as hyperthermia the patient's gonna have a high high fever muscle rigidity stupor agitation we just don't want it so you never give a patient that's taking that med elder pril and demerol together okay so that's the correct answer now let's look at our wrong answer choices one um questioning lovenox we're not going to question level knocks the patient just had surgery and if you've been following me for any amount of time i've said this to you guys a million times if a patient has surgery i don't care what kind of surgery they had we're always concerned about these three things happening infection dvt or pulmonary embolism and bleeding right so giving that patient um love nox that's great we don't want that patient to develop a dvt or that clock travel go to the lungs and now they got a pulmonary embolism so there's nothing wrong with that three m-a-o-b um inhibitor um elder pro elder pearl guys um that's an anti-parkinsonian medication and it can't be stopped abruptly so we're not gonna question that order because the patient has to get it we can't stop that abruptly so you know that's not gonna be the one to go so that's wrong and then choice form the antibiotic and stuff we're not going to question that because i just told you if a patient has surgery i don't care what kind of surgery the patient has we are concerned about what infection that's why they're getting that prophylactic antibiotic we're worried about dvt pulmonary embolism and we're worried about them bleeding to death cl so we don't want um them to hemorrhage so the correct answer for this uh question is number two the client diagnosed with epilepsy has undergone a spontaneous remission of the epilepsy a rare but occasional occurrence what information should the nurse discuss with the client when discontinuing epileptic drugs one discuss the need to slowly taper off the anti-epileptic drug two explain the importance of getting routine serum levels three teach the client to continue taking the anti-epileptic drugs or four can instruct the client to use soft bristle toothbrush and guys the correct answer is one you have to teach them that they have to taper off this drug anti-epileptic drugs are never stopped abruptly it takes a minimum of six weeks to taper off that drug so you have to teach the patient they can't just stop taking that drug because them immediately stop taking that drug that can throw them into seizures and you can even throw them into status epilepticus which is a medical emergency right so one is the correct answer now let's look at our wrong answer choices um two explain the importance of routine serum levels um patient needs routine serum levels when they are on that drug this patient's getting off the drug that's not necessary choice three teach them to continue taking the anti-epileptic drugs no we're going to teach them that they're being tapered off choice number one then choice number four instruct them to use soft bristle toothbrush that is for the patient that's taking the anti-epileptic drug um what drug is that uh dilantin right but this patient is being what dc they're being um tapered off of this drug so the correct answer is one teach them that they're going to need to be tapered off it's going to take at least six weeks before they can be tapered off this drug it cannot be something that will be done abruptly the client diagnosed with a history of gastric ulcer is having transient ischemic attacks and is prescribed a daily 325 milligram aspirin what information is most important for the nurse to discuss with the client one encourage the client to take the aspirin with food two notify the healthcare provider if ringing in the ear occurs three instruct the client to take a terry coded a brand of aspirin or four explain that the client may experience a tarry skulls and the correct answer guys is one instruct decline to take an anterior coated brand of aspirin why guys when something is anterior coded that means it's not going to be dissolved in the stomach and we don't want the aspirin to be dissolved in the stomach why if you go back to question it says the patient has what gastric ulcers so the last thing we need is this aspirin to be dissolved in the stomach that will make the ulcer even worse and can cause that patient to start bleeding right so we're going to have them take enteric coated aspirin because of the ulcers a client with severe head injury is exhibiting a decorticate posturing during the nurse's assessment two hours ago the client is receiving mannitol osmotrol and osmotic diuretic which data indicates the medication is not effective one the client pushes the nurse's hand away in response to pain two the client's glass cocoa score is a thirteen three the client is not able to state the day of the week or four the client exhibits flaccid paralysis to painful stimuli and the correct answer guys is for the client exhibits flaccid paralysis to painful stimuli guys that's as bad as it gets can't get worse than that right that client you see for that client that's exhibiting flaccid paralysis i mean we're getting no reaction nothing that's a three on the glasgow coma score that's the worst again that's a three all right now um let's look at the wrong answer choices one the client pushes the nurse's hand away in response to pain that's good we want to react into pain so that's good choice two the client's glass coco scale is 13. well the best you can get on the coma scale is 15. so if if it's a 13 that's actually better than where they were before because in the question it tells us that the patient initially had decorticate posturing if a patient has the cortical posturing they're out of five so the patient went from a level five to a thirteen so that's good that means that patient's gotten better and then choice three the client's not able to state the day of the week if that patient went from a five to not even being alert to now that they're alert they just can't tell us what day of the week that is they're still improving they are still improving so that's why choice number four is the wrong answer flaccid paralysis they're at a level three okay next question the client presents to the emergency department complaining of a migraine headache the healthcare provider prescribes sumatriptan immatrix a serotonin receptor agonist when the nurse enters the room to administer the medication the client is laughing with his or her significant other what action should the nurse take one notified the doctor of the client's drug seeking behavior to ask the client how bad the headache if he or she is able to laugh three administer the medication after checking for allergies and the id bracelet or four discharge the client and recommend taking over the counter medication and the correct answer three after you check allergies and you check the identity to make sure you have the right patient you give them their medication pain is whatever that client says it is period period we don't do anything else we don't question them we don't put them on the defense we don't call the doctor assuming that they have drug seeking behavior pain is whatever the client says it is all right next question the client's admitted to the emergency department complaining of profuse salivation excessive tearing and diarrhea the client tells the nurse he'd been camping and living off the land what medication would the nurse anticipate and administering one atropine a muscularity antagonist two diphenhydramine benadryl and antihistamine 3 magnesium aluminum hydroxide amalox and antacid or 4 pantoprazole protonix a proton pump inhibitor and guys the correct answer is one atropine a muscarinic antagonist so the reason we're going to give atropine atropine is the antidote for muscarinic poisoning what are we suspend suspecting in the question they tell us that the patient's been living off the land so they probably had some wild mushroom right and so we want to give that um the antidote because that those wild mushroom has that muscarinic poisons in it so we're going to give atropine which is the antidote for that muscarinic poisoning now let's look at our wrong answer choices two benadryl we give that for what um allergies allergic reaction uh three malox we give that for what heartburn and four ppi we give that for what gerd all right next question the client with epilepsy is seen in the clinic and has a serum dilantin level of 5.4 which action should the nurse implement first one request the laboratory verify the results of the test two ask the client when the dose was last taken three instruct the client to not take thailand for two days or four discuss the need to increase the dose of the medication and guys the correct answer is too you're going to ask them when the last dose is taken ad pie the first step of adpie's assessment ask questions gather information okay first of all you have to know what your normal dilantine level is and it's what 10 to 20. so this question what is this question it says it's 5.4 so this patient's getting a sub therapeutic level so the first thing we want to do is find out are they even taking their medication and if they're taking their medication are they taking it consistently so we're going to assess we're going to ask questions so two is the correct answer a client diagnosed with cerebral vascular accident is complaining of a headache what intervention should the nurse should the rehab nurse implement list the order of performance so guys i'm going to list it to you and then we have to put it in order one assess the client's neurostatus two administer oral sediment tylenol three have the client swallow a drink of water four ask the client to give his or her date of birth five ask the client to rate pain on a scale of one to ten so guys the first thing we're gonna do is assess the client says they have a headache they have a history cva we're going to do a neural check we're going to assess our client first so the first thing we're going to do is assess the neural um status the next thing we're going to do is ask what their pain level is on a scale of one to ten remember guys we assess their neural status first because we want to rule out anything neurological going on so we ruled that out the next thing we're going to do is ask them what their level of pain is on the scale of one to ten they tell us what their level of pain is the next thing we're going to do is for as the client um um ask the client to give his or her date of birth why we want to identify that we have the right client because we're about to give that client the med then of course we're going to give the client the med and we're going to have them drink water with the med to swallow that medication okay so the um the order is assess the neurological status then you're going to ask them for their um pain the rate rate their pain on a scale of one to ten then we're going to ask them for their date of birth so we can identify that we have the right patient then we're gonna have the client swallow a drink of water and then take their oral tylenol okay so that is the order of what we're gonna do guys always assess assess assess that comes first before you ever intervene okay and we're down to our last question the clients prescribed meclizine antivert and antihistamine from vertigo which statement by the client would warrant intervention by the nurse one i have had someone drive my car because i have been getting dizzy two i'll tell my health care providers about taking this medication three i usually have one or two glasses of wine with my evening meal four i will choose sugarless gum or suck hard candy if my mouth is dry and guys the correct answer is three i usually have one or two glasses of wine with my evening meal we are going to question that we're going to provide further teaching because the patient cannot take anything that causes cns um depression including alcohol so they cannot have wine while they're taking this medication because guys alcohol is a cns depressant i know you think alcohol is a stimulant because people are drunk and they're you know going all crazy but no it's actually a depressant it's a cns depression everything else is good choice one two and four is correct so that's why we would question answer number three guys i hope uh this time that i spent with you i hope you found it helpful i hope you learned at least one thing that's new guys if you haven't done so already please i'm really trying to grow please help support me by liking and subscribing to this channel but also checking me out on tick tock and instagram and following me there as well please leave me a comment if there's anything you'd like to see me cover that i have not done so already and please don't forget guys i have audio lessons coming soon so if you're in the nursing program you're stressed out and you'd like to have my little voice next to you you can put on your earphones and listen to me teach while you're working out when you're at the gym where you're doing whatever so make sure you check out my website www for information on my audio lessons thank you for sharing this time with me and i'll see you on the next video