NUR2474 Test # 1 Review Blueprint_ Spring 25/26.
Please review general tips from the Quiz review document (test-taking strategies, select all that apply
questions, etc.). The test will utilize the Respondus browser and monitor (using webcam). No notes or
textbooks are allowed on the test. The calculator will be enabled in the browser.
General tips for studying:
1. Memorize medication categories from the presentation (SSRI’s, benzodiazepines, first/second-
generation antipsychotics, etc.) used to treat common neuro conditions (PD, Alzheimer’s
disease, BPD, ADHD, etc.)
2. Memorize essential drugs from the categories above (there are many questions with specific
drug names)
3. Use generic names
4. When reviewing particular drugs, note category, indications, typical side effects, toxicity signs (if
applicable)
Topics to review:
1. TCA overdose S/S and management – TCAs relieve depressive symptoms. The most dangerous
adverse effect is cardiotoxicity. Common side effects are: Orthostatic hypotension, sedation,
constipation, and anticholinergic effects. When taken in overdose, TCAs can readily prove lethal.
S/s include:
▪ Dysrhythmias (Tachycardia, intraventricular blocks, complete atrioventricular block,
ventricular tachycardia, and ventricular fibrillation).
▪ Peripheral muscunaric blockade (hyperthermia, flushing, dry mouth, and dilation of the
pupils)
▪ Early symptoms: confusion, agitation, and hallucinations. Seizures and coma may follow.
▪ T/x: Symptoms can be reduced with gastric lavage followed by ingestion of charcoal. IV
of sodium bicarbonate is recommended to control dysrhythmias cause by cardiac
toxicity.
▪ Dysrhythmias should NOT treated with procainamide or quinidine because these drugs
can cardiac depression.
2. Clonazepam (indications, side/adverse effects, patient teaching, nursing interventions)
▪ Category: CNS depressant - Benzodiazepine
▪ Indication: Seizure and panic disorders.
▪ Side/adverse effects:
- Sedation!! Everything low and slow (low HR and BP, low RR, sedation in brain).
- Can cause suicidal thoughts.
- Sleep driving (carrying out complex behaviors and not having an memory of
their actions).
- Anterograde amnesia.
- CNS depression (drowsiness, light-headedness, incoordination, and difficulty
concentrating).
▪ Patient teaching:
- Higly addictive, and not safe for long-term use.
- Take at bedtime. Don’t skip doses.
, - Make sure to teach about sedation, sleepiness, and suppression of ABCs.
- No drinking alcohol.
- Do not operate dangerous machines or drive if daytime sedation occurs.
- Do NOT increase dosage or discontinue treatment w/o talking to prescriber.
- Swallow sustained release med without crushing or chewing.
- Could have drug dependency insomnia during or after benzodiazepine
withdrawal.
- Notify provider if paradoxical reactions occurs (rage, insomnia, excitement,
heightened anxiety, euphoria) or complex sleep related behaviors.
- Can harm fetus during pregnancy or while breastfeeding.
▪ Nursing interventions: Give flumazenil as an antidote for respiratory arrest and for
toxicity.
3. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side effects, toxic effects)
▪ Blood testing: Plasma lithium levels
▪ Therapeutic levels: Lithium levels MUST be kept below 1.5. Levels should range from 0.4
to 1mEq. Generally levels are desired bw 0.6 to 0.8 mEq/L. Lithium levels should be
measured every 3 to 6 months.
▪ Toxicity levels: Below 1.5 | 1.5-2 | 2-2.5 | Above 2.5
▪ Normal therapeutic side effects:
- Early effects: Polyuria and thirst, Transient fatigue, muscle, and GI effects
(nausea, diarrhea, abdominal bloating, and anorexia). Weight loss
- Tremor: Fine hand tremor especially in the fingers.
- Polyuria: Occurs 50 to 70% of pts taking chronically. Pts should be instructed to
drink 8 to 12 glasses of fluids daily.
- Renal toxicity: Long term usage or high dosages can cause kidney injury.
- Goiter and hypothyroidism: Reduces incorporation of iodine into thyroid
hormone.
- Teratogenesis: Dangerous during pregnancy (especially first trimester) and
during lactation too.
▪ Toxic effects:
- Below 1.5: N/V, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine
hand tremor
- 1.5-2: Persisten GI upset, coarse hand tremor, confusion, hyperirritability of muscles,
ECG changes, sedation, incoordination.
- 2-2.5: Ataxia, giddiness, high output of dilute urine, serious ECG changes, fasciculations,
tinnitus, blurred vision, clonic movements, seizures, stupor, sever hypotension, coma,
death
- 2.5 and above: Generalized convulsions, oliguria, and death.
- Diuretics can cause sodoium reabsorption if given with lithium
4. BPD patients on Lithium and adjunct meds for mania/depression
▪ If taken with fluoxetine (antidepressant) it can elevate plasma lithium levels.
5. Benzodiazepines and alcohol withdrawal: Chlordiazepoxide, clorazepate, diazepam, and
oxazepam are the meds used for alcohol withdrawal.
Please review general tips from the Quiz review document (test-taking strategies, select all that apply
questions, etc.). The test will utilize the Respondus browser and monitor (using webcam). No notes or
textbooks are allowed on the test. The calculator will be enabled in the browser.
General tips for studying:
1. Memorize medication categories from the presentation (SSRI’s, benzodiazepines, first/second-
generation antipsychotics, etc.) used to treat common neuro conditions (PD, Alzheimer’s
disease, BPD, ADHD, etc.)
2. Memorize essential drugs from the categories above (there are many questions with specific
drug names)
3. Use generic names
4. When reviewing particular drugs, note category, indications, typical side effects, toxicity signs (if
applicable)
Topics to review:
1. TCA overdose S/S and management – TCAs relieve depressive symptoms. The most dangerous
adverse effect is cardiotoxicity. Common side effects are: Orthostatic hypotension, sedation,
constipation, and anticholinergic effects. When taken in overdose, TCAs can readily prove lethal.
S/s include:
▪ Dysrhythmias (Tachycardia, intraventricular blocks, complete atrioventricular block,
ventricular tachycardia, and ventricular fibrillation).
▪ Peripheral muscunaric blockade (hyperthermia, flushing, dry mouth, and dilation of the
pupils)
▪ Early symptoms: confusion, agitation, and hallucinations. Seizures and coma may follow.
▪ T/x: Symptoms can be reduced with gastric lavage followed by ingestion of charcoal. IV
of sodium bicarbonate is recommended to control dysrhythmias cause by cardiac
toxicity.
▪ Dysrhythmias should NOT treated with procainamide or quinidine because these drugs
can cardiac depression.
2. Clonazepam (indications, side/adverse effects, patient teaching, nursing interventions)
▪ Category: CNS depressant - Benzodiazepine
▪ Indication: Seizure and panic disorders.
▪ Side/adverse effects:
- Sedation!! Everything low and slow (low HR and BP, low RR, sedation in brain).
- Can cause suicidal thoughts.
- Sleep driving (carrying out complex behaviors and not having an memory of
their actions).
- Anterograde amnesia.
- CNS depression (drowsiness, light-headedness, incoordination, and difficulty
concentrating).
▪ Patient teaching:
- Higly addictive, and not safe for long-term use.
- Take at bedtime. Don’t skip doses.
, - Make sure to teach about sedation, sleepiness, and suppression of ABCs.
- No drinking alcohol.
- Do not operate dangerous machines or drive if daytime sedation occurs.
- Do NOT increase dosage or discontinue treatment w/o talking to prescriber.
- Swallow sustained release med without crushing or chewing.
- Could have drug dependency insomnia during or after benzodiazepine
withdrawal.
- Notify provider if paradoxical reactions occurs (rage, insomnia, excitement,
heightened anxiety, euphoria) or complex sleep related behaviors.
- Can harm fetus during pregnancy or while breastfeeding.
▪ Nursing interventions: Give flumazenil as an antidote for respiratory arrest and for
toxicity.
3. Lithium therapy (blood testing, therapeutic levels, toxicity levels, side effects, toxic effects)
▪ Blood testing: Plasma lithium levels
▪ Therapeutic levels: Lithium levels MUST be kept below 1.5. Levels should range from 0.4
to 1mEq. Generally levels are desired bw 0.6 to 0.8 mEq/L. Lithium levels should be
measured every 3 to 6 months.
▪ Toxicity levels: Below 1.5 | 1.5-2 | 2-2.5 | Above 2.5
▪ Normal therapeutic side effects:
- Early effects: Polyuria and thirst, Transient fatigue, muscle, and GI effects
(nausea, diarrhea, abdominal bloating, and anorexia). Weight loss
- Tremor: Fine hand tremor especially in the fingers.
- Polyuria: Occurs 50 to 70% of pts taking chronically. Pts should be instructed to
drink 8 to 12 glasses of fluids daily.
- Renal toxicity: Long term usage or high dosages can cause kidney injury.
- Goiter and hypothyroidism: Reduces incorporation of iodine into thyroid
hormone.
- Teratogenesis: Dangerous during pregnancy (especially first trimester) and
during lactation too.
▪ Toxic effects:
- Below 1.5: N/V, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine
hand tremor
- 1.5-2: Persisten GI upset, coarse hand tremor, confusion, hyperirritability of muscles,
ECG changes, sedation, incoordination.
- 2-2.5: Ataxia, giddiness, high output of dilute urine, serious ECG changes, fasciculations,
tinnitus, blurred vision, clonic movements, seizures, stupor, sever hypotension, coma,
death
- 2.5 and above: Generalized convulsions, oliguria, and death.
- Diuretics can cause sodoium reabsorption if given with lithium
4. BPD patients on Lithium and adjunct meds for mania/depression
▪ If taken with fluoxetine (antidepressant) it can elevate plasma lithium levels.
5. Benzodiazepines and alcohol withdrawal: Chlordiazepoxide, clorazepate, diazepam, and
oxazepam are the meds used for alcohol withdrawal.
