Correct answer: b)It can be prescribed by telephone or fax in an emergency.

Rationale: Schedule II medications are those with a high potential for abuse and dependence, but have accepted medical uses. They require a written prescription from a licensed prescriber, except in an emergency situation when a telephone or fax order is allowed. However, the written prescription must follow within 72 hours. Schedule II medications cannot be refilled; a new prescription is required for each dispensing.

Incorrect choices:

a) It can be refilled up to five times within six months.: This is true for Schedule III and IV medications, not Schedule II.

c) It can be obtained without a prescription for medical use.: This is true for Schedule V medications, not Schedule II.

d) It can be dispensed by any healthcare provider.: Only licensed prescribers with a DEA number can prescribe controlled substances.

Correct answer: c) The medication should be tapered off gradually to avoid withdrawal symptoms.

Rationale: Zolpidem is a sedative-hypnotic medication that acts on the central nervous system to induce sleep. It has a low potential for abuse and dependence, but it can still cause withdrawal symptoms such as anxiety, insomnia, and seizures if discontinued abruptly. Therefore, the medication should be tapered off gradually under the supervision of a prescriber.

Incorrect choices:

a) The medication should be taken only as needed for sleep.: Zolpidem should be taken regularly as prescribed for short-term treatment of insomnia, not on an as-needed basis.

b) The medication should be taken with food to enhance absorption.: Zolpidem should be taken on an empty stomach to facilitate its onset of action, which is within 15 to 30 minutes.

d) The medication should be avoided if the client has a history of substance abuse.: Although zolpidem has a low potential for abuse and dependence, it can still interact with other substances such as alcohol, opioids, and benzodiazepines, which can increase the risk of respiratory depression and overdose. Therefore, the client should inform the prescriber of any history of substance abuse and use Zolpidem with caution.

Correct answer: a) Naloxone

Rationale: Naloxone is an opioid antagonist that binds to opioid receptors and displaces opioids from them, thereby reversing their effects. It is used as an antidote for opioid overdose and can rapidly restore respiration and consciousness.

Incorrect choices:

b) Flumazenil: This is a benzodiazepine antagonist that reverses the effects of benzodiazepines, not opioids.

c) Acetylcysteine: This is an antidote for acetaminophen overdose, not opioid overdose.

d) Physostigmine: This is an antidote for anticholinergic overdose, not opioid overdose.

Correct answer: a) Constipation

Rationale: Oxycodone is an opioid analgesic that acts on the central nervous system to relieve pain. It also has peripheral effects, such as decreasing gastrointestinal motility and secretion, which can cause constipation. The nurse should advise the client to increase fluid and fiber intake, exercise regularly, and use stool softeners or laxatives as needed to prevent or treat constipation.

Incorrect choices:

b) Hypertension: Oxycodone can cause hypotension, not hypertension, due to its vasodilatory effect.

c) Tachycardia: Oxycodone can cause bradycardia, not tachycardia, due to its vagal stimulation effect.

d) Diarrhea: Oxycodone can cause constipation, not diarrhea, due to its decreased gastrointestinal motility and secretion effect.

Correct answer: a) Grapefruit juice

Rationale: Grapefruit juice can inhibit the metabolism of diazepam, a benzodiazepine that acts on the central nervous system to reduce anxiety and induce sedation. This can increase the blood levels and effects of diazepam, which can lead to excessive sedation, respiratory depression, and overdose. The client should avoid grapefruit juice and other citrus fruits while taking this medication.

Incorrect choices:

b) Milk: Milk does not interact with diazepam and can be consumed safely while taking this medication.

c) Coffee: Coffee does not interact with diazepam and can be consumed safely while taking this medication. However, caffeine can have a stimulant effect that may counteract the sedative effect of diazepam.

d) Water: Water does not interact with diazepam and can be consumed safely while taking this medication. In fact, the client should drink plenty of water to prevent dehydration and maintain renal function.

Correct answer: a) Agranulocytosis

Rationale: Clozapine is an atypical antipsychotic that acts on the central nervous system to reduce psychotic symptoms such as hallucinations, delusions, and paranoia. It also has a low potential for abuse and dependence, which is why it is classified as a Schedule V medication. However, it can cause agranulocytosis, a life-threatening condition characterized by a severe decrease in white blood cells that increases the risk of infection. The nurse should monitor the client's complete blood count (CBC) regularly and report any signs of infection such as fever, sore throat, or mouth ulcers.

Incorrect choices:

b) Stevens-Johnson syndrome: This is a rare but serious skin reaction that can be caused by some medications such as sulfonamides, anticonvulsants, and allopurinol, not clozapine.

c) Torsades de pointes: This is a rare but serious cardiac arrhythmia that can be caused by some medications such as antiarrhythmics, antibiotics, and antidepressants that prolong the QT interval, not clozapine.

d) Rhabdomyolysis: This is a rare but serious condition characterized by muscle breakdown and renal failure that can be caused by some medications such as statins, antipsychotics, and corticosteroids, not clozapine.

Correct answer: d) All of the above.

Rationale: The nurse should follow all of these actions to ensure the safe and legal administration of controlled substances. These actions help prevent medication errors, diversion, and misuse of controlled substances.

Incorrect choices:
a) Verify the client's identity using two identifiers before administering the medication.: This is correct but not comprehensive as it does not include other actions that are required for controlled substances.
b) Document the administration of the medication on a separate controlled substance record.: This is correct but not comprehensive as it does not include other actions that are required for controlled substances.
c) Count the remaining tablets of oxycodone with another nurse at the end of each shift.: This is correct but not comprehensive as it does not include other actions that are required for controlled substances.

Correct answer: d) All of the above.
Rationale: The nurse should provide all of these responses to educate the client about the risks and alternatives of taking zolpidem, a controlled substance. Taking more than the prescribed dose can lead to physical and psychological dependence, tolerance, and withdrawal symptoms, which can be dangerous and unpleasant. Changing the medication may be necessary if zolpidem is not effective for the client's insomnia, as there may be other underlying causes or better options for treatment. Trying some nonpharmacological methods can also help improve sleep quality and reduce reliance on medications.

Incorrect choices:
a) "You should not take more than the prescribed dose because it can cause dependence and withdrawal symptoms.": This is correct but not comprehensive as it does not include other responses that are helpful for the client.
b) "You should talk to your provider about changing your medication because zolpidem is not effective for you.": This is correct but not comprehensive as it does not include other responses that are helpful for the client.
c) "You should try some nonpharmacological methods to improve your sleep quality, such as relaxation techniques and avoiding caffeine.": This is correct but not comprehensive as it does not include other responses that are helpful for the client.

Correct answer: d) All of the above.
Rationale: The nurse should make all of these statements to discourage
the client from sharing their medication with others. Sharing controlled substances with others is illegal and can result in criminal charges, fines, or imprisonment for both parties. It can also cause harm to others who may have different medical conditions, allergies, or interactions with other medications. Methylphenidate is a stimulant that can cause adverse effects such as increased blood pressure, heart rate, anxiety, insomnia, and appetite suppression. It can also be addictive and abused by some people. Therefore, it should only be taken by a person who has a valid prescription and under the supervision of a psychiatrist who can monitor the dosage, effectiveness, and side effects.

Incorrect choices:
a) "Sharing your medication with others is illegal and can result in serious consequences for you and your friends.": This is correct but not comprehensive as it does not include other statements that are important for the client.
b) "Your medication is specifically tailored to your needs and may not be appropriate or safe for others.": This is correct but not comprehensive as it does not include other statements that are important for the client.
c) "Your friends should see a psychiatrist if they have ADHD and need medication treatment.": This is correct but not comprehensive as it does not include other statements that are important for the client.

Correct answer: a) Constricted pupils

Rationale: Opioids are central nervous system depressants that can cause miosis (constricted pupils), respiratory depression, bradycardia, hypotension, and sedation.

Incorrect choices:
b) Tachycardia: This is a sign of sympathetic stimulation, which can be caused by stimulants, withdrawal, or anxiety.
c) Hypertension: This is also a sign of sympathetic stimulation, which can be caused by stimulants, withdrawal, or anxiety.
d) Agitation: This is a sign of psychological distress, which can be caused by stimulants, withdrawal, or anxiety.

Correct answer: a) "You should not take more than the prescribed dose because it can cause serious side effects."

Rationale: Methylphenidate is a stimulant that can increase alertness, attention, and energy. However, taking more than the prescribed dose can cause adverse effects such as insomnia, anxiety, palpitations, hypertension, psychosis, and seizures.

Incorrect choices:
b) "You should talk to your doctor about adjusting your dose if you feel that it is not effective.": This may encourage the client to continue misusing the medication and may not address the underlying causes of their academic difficulties.
c) "You should stop taking this medication because it is addictive and can lead to dependence.": This may discourage the client from adhering to their treatment plan and may not acknowledge the benefits of the medication for their condition.
d) "You should use other strategies to improve your concentration and memory, such as exercise and meditation.": This may imply that the medication is unnecessary or ineffective and may not address the risks of misusing the medication.

Correct answer: a) Assess the client's pain level and quality

Rationale: The first action the nurse should take when using the nursing process is to assess the client's condition. By assessing the client's pain level and quality, the nurse can determine the possible causes of their inadequate pain relief and plan appropriate interventions.

Incorrect choices:
b) Educate the client about the dangers of opioid overdose: This is an important action, but not the first one. The nurse should first assess the client's pain before providing education.
c) Refer the client to a pain management specialist: This may be a helpful action, but not the first one. The nurse should first assess the client's pain and collaborate with the prescriber before making referrals.
d) Notify the prescriber about the client's medication misuse: This is an essential action, but not the first one. The nurse should first assess the client's pain and communicate their findings to the prescriber.

Correct answer: a) "You should not take more than one pill per night because it can impair your memory and coordination."

Rationale: Zolpidem is a hypnotic that can help with falling asleep and staying asleep. However, taking more than the recommended dose can cause adverse effects such as anterograde amnesia, impaired motor skills, and increased risk of falls and injuries.

Incorrect choices:
b) "You should switch to a different medication because zolpidem is not effective for long-term use.": This may not be necessary or appropriate for the client, as zolpidem may still be beneficial for their condition. The nurse should not suggest changing the medication without consulting the prescriber.
c) "You should try to avoid taking zolpidem because it can cause dependence and withdrawal symptoms.": This may not be realistic or helpful for the client, as zolpidem may be prescribed for a legitimate reason and may not cause dependence or withdrawal if used as directed.
d) "You should consult your doctor about reducing your dose because zolpidem can cause rebound insomnia.": This may not be relevant or accurate for the client, as rebound insomnia is more likely to occur with abrupt discontinuation of zolpidem rather than gradual dose reduction.

Correct answers:

a) Store prescription drugs in a secure place away from children and pets;

d) Follow the directions on the prescription label and do not adjust the dose without

consulting the prescriber;

e) Inform the prescriber and pharmacist about any allergies or other medications being

taken

Rationale: These are examples of safe practices that can prevent prescription drug misuse, abuse, diversion, and adverse reactions.

Incorrect choices:
b) Dispose of unused or expired prescription drugs in the trash or toilet: This is not a safe practice, as it can pose environmental and health hazards. The nurse should advise the clients to follow the FDA guidelines for proper disposal of prescription drugs, such as using drug take-back programs or mixing them with unpalatable substances before throwing them away in a sealed container.
c) Share prescription drugs with family or friends who have similar symptoms: This is not a safe practice, as it can lead to inappropriate use, overdose, interactions, or allergic reactions. The nurse should emphasize that prescription drugs are intended for individual use only and that self-medication or medication borrowing is dangerous.

Correct answer: b) Flumazenil

Rationale: Flumazenil is an antidote that can reverse the central nervous system depression caused by benzodiazepines by antagonizing their binding to GABA receptors.

Incorrect choices:
a) Naloxone: This is an antidote that can reverse the respiratory depression caused by opioids by antagonizing their binding to opioid receptors.
c) Acetylcysteine: This is an antidote that can prevent liver damage caused by acetaminophen overdose by replenishing glutathione levels.
d) Physostigmine: This is an antidote that can reverse the anticholinergic effects caused by atropine overdose by inhibiting acetylcholinesterase activity.

Correct answer: a) Hypertension, tachycardia, and diaphoresis

Rationale: Opioid withdrawal symptoms are similar to those of sympathetic nervous system activation and include hypertension, tachycardia, diaphoresis, restlessness, anxiety, muscle aches, nausea, vomiting, and diarrhea.

Incorrect choices:

b) Hypotension, bradycardia, and constipation: These are signs of opioid intoxication or overdose, not withdrawal.

c) Hypothermia, lethargy, and miosis: These are also signs of opioid intoxication or overdose, not withdrawal.

d) Hyperthermia, agitation, and mydriasis: These are signs of stimulant abuse or withdrawal, not opioid withdrawal.

Correct answer: a) Grapefruit juice

Rationale: Grapefruit juice can increase the blood levels of alprazolam and other benzodiazepines by inhibiting their metabolism in the liver. This can result in increased sedation, drowsiness, and risk of adverse effects.

Incorrect choices:

b) Green tea: Green tea does not interact with alprazolam or other benzodiazepines.

c) Vitamin C: Vitamin C does not interact with alprazolam or other benzodiazepines.

d) Calcium supplements: Calcium supplements do not interact with alprazolam or other benzodiazepines.

Correct answer: d) Notify the provider of the client's symptoms

Rationale: Insomnia, weight loss, and palpitations are common adverse effects of amphetamine and other stimulants. The nurse should notify the provider of these symptoms as they may indicate a need for dosage adjustment or discontinuation of the medication.

Incorrect choices:

a) Advise the client to stop taking the medication immediately: The nurse should not advise the client to stop taking a prescribed medication without consulting with the provider. Abrupt cessation of amphetamine can cause withdrawal symptoms such as fatigue, depression, and irritability.

b) Assess the client for signs of substance abuse: While amphetamine has a high potential for abuse and dependence, these symptoms do not necessarily indicate that the client is abusing the medication. The nurse should assess the client for other signs of substance abuse such as increased tolerance, craving, loss of control, and impaired functioning.

c) Encourage the client to increase fluid and food intake: While increasing fluid and food intake may help with dehydration and malnutrition caused by amphetamine use, this does not address the underlying problem of adverse effects from the medication.

Correct answer: a) Ibuprofen (Advil)

Rationale: Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the blood levels of lithium by reducing its renal excretion. This can result in lithium toxicity, which can cause nausea, vomiting, tremors, confusion, and seizures.

Incorrect choices:

b) Levothyroxine (Synthroid): Levothyroxine and other thyroid hormones do not interact with lithium.

c) Omeprazole (Prilosec): Omeprazole and other proton pump inhibitors (PPIs) do not interact with lithium.

d) Metformin (Glucophage): Metformin and other antidiabetic drugs do not interact with lithium.

Correct answer: b) "I should avoid using mouthwash that contains alcohol."

Rationale: Disulfiram works by inhibiting the enzyme that metabolizes alcohol, causing a buildup of acetaldehyde in the body. This produces a severe reaction when alcohol is consumed, which includes flushing, headache, nausea, vomiting, chest pain, and hypotension. The reaction can occur even with small amounts of alcohol found in mouthwash, cough syrup, perfume, or food.

Incorrect choices:

a) "I can drink alcohol as long as I skip the dose of disulfiram.": This is incorrect as the effects of disulfiram can last for up to two weeks after the last dose. The client should abstain from alcohol completely while taking disulfiram and for at least 14 days after stopping the medication.

c) "I will experience euphoria if I drink alcohol while taking disulfiram.": This is incorrect as the reaction caused by disulfiram and alcohol is unpleasant and aversive, not euphoric. The purpose of disulfiram is to deter the client from drinking alcohol by creating a negative association.

d) "I can stop taking disulfiram once I have been sober for a month.": This is incorrect as disulfiram is not a cure for alcohol use disorder, but a tool to help the client maintain sobriety. The client should continue taking disulfiram as prescribed by the provider and participate in other forms of treatment such as counseling, support groups, and relapse prevention.

Correct answer: b) Administer flumazenil (Romazicon)

Rationale: Flumazenil is an antidote for benzodiazepine overdose that works by blocking the benzodiazepine receptors in the brain. It can reverse the effects of benzodiazepines such as sedation, respiratory depression, and coma.

Incorrect choices:

a) Administer naloxone (Narcan): Naloxone is an antidote for opioid overdose that works by displacing opioids from their receptors in the brain. It has no effect on benzodiazepines or their receptors.

c) Administer activated charcoal: Activated charcoal is a substance that binds to drugs or toxins in the gastrointestinal tract and prevents their absorption into the bloodstream. It may be useful for some cases of drug overdose, but it is not effective for benzodiazepines as they are rapidly absorbed and distributed in the body.

d) Administer acetylcysteine (Mucomyst): Acetylcysteine is an antidote for acetaminophen overdose that works by replenishing glutathione, a substance that helps detoxify acetaminophen in the liver. It has no effect on benzodiazepines or their metabolism.

Correct answer: b) Drowsiness and respiratory depression

Rationale: Drowsiness and respiratory depression are signs of opioid overdose and indicate that the client is taking more than the prescribed dose or combining oxycodone with other depressants. The nurse should monitor the client's vital signs, administer naloxone if indicated, and report the situation to the prescriber.

Incorrect choices:
a) Constipation and dry mouth: These are common side effects of opioids and do not necessarily indicate abuse.
c) Nausea and vomiting: These are also common side effects of opioids and can be managed with antiemetics.
d) Pupillary constriction and itching: These are also common side effects of opioids and do not necessarily indicate abuse.

Correct answer: b) Agitation and paranoia

Rationale: Agitation and paranoia are signs of stimulant intoxication and indicate that the client is experiencing a psychotic reaction to amphetamines. The nurse should provide a calm and safe environment, administer antipsychotics if ordered, and monitor the client for violence or self-harm.

Incorrect choices:
a) Hypotension and bradycardia: These are signs of depressant intoxication and indicate that the client is taking sedatives, opioids, or alcohol.
c) Slurred speech and ataxia: These are signs of depressant intoxication and indicate that the client is taking sedatives, opioids, or alcohol.
d) Sedation and respiratory depression: These are signs of depressant intoxication and indicate that the client is taking sedatives, opioids, or alcohol.

Correct answer: c) Educate the client about the risks of benzodiazepine dependence and withdrawal

Rationale: Taking more than the prescribed dose of benzodiazepines can lead to physical and psychological dependence, tolerance, and withdrawal symptoms. The nurse should educate the client about these risks and advise them to consult with their prescriber before making any changes to their medication regimen.

Incorrect choices:
a) Encourage the client to continue taking benzodiazepines as needed: This can worsen the client's dependence, tolerance, and withdrawal symptoms.
b) Advise the client to stop taking benzodiazepines abruptly: This can cause severe withdrawal symptoms such as seizures, delirium, or death.
d) Suggest alternative therapies for anxiety such as meditation or exercise: While these therapies can be helpful for anxiety management, they are not a substitute for medication therapy for clients who have been prescribed benzodiazepines.

Correct answer: b) Count the remaining tablets of oxycodone with another nurse.

Rationale: Counting the remaining tablets of oxycodone with another nurse is a standard procedure to prevent the diversion of controlled substances and ensure accountability. The nurse should also document the administration and disposal of any controlled substances on a separate record.

Incorrect choices:

a) Document the administration of oxycodone on a separate record.: This is correct but not the best answer as it does not prevent the diversion of controlled substances by itself.

c) Dispose of any unused portions of oxycodone in a sharps container.: This is incorrect as unused portions of oxycodone should be disposed of in a designated container for controlled substances, not in a sharps container.

d) Educate the client about the potential for addiction and dependence.: This is correct but not relevant to the question as it does not prevent diversion of controlled substances by the nurse.

Correct answer: b) Flumazenil

Rationale: Flumazenil is an antidote for benzodiazepine overdose as it reverses its sedative effects by blocking its action on the GABA receptors.

Incorrect choices:

a) Naloxone: This is an antidote for opioid overdose as it displaces opioids from their receptors and restores respiration.

c) Acetylcysteine: This is an antidote for acetaminophen overdose as it replenishes glutathione and prevents liver damage.

d) Atropine: This is an antidote for organophosphate poisoning as it blocks the effects of acetylcholine and relieves bronchoconstriction and bradycardia.

Correct answer: d) Scan their own identification badge.

Rationale: Scanning their own identification badge is a required step when obtaining any medication from the automated dispensing system, especially for controlled substances, as it ensures accountability and security.

Incorrect choices:

a) Enter the client's name and date of birth.: This is not a required step when obtaining medication from the automated dispensing system, but it is a required step when administering medication to the client to verify their identity.

b) Scan the barcode on the medication label.: This is not a required step when obtaining medication from the automated dispensing system, but it is a required step when administering medication to the client to verify its accuracy.

c) Enter the prescriber's name and license number.: This is not a required step when obtaining medication from the automated dispensing system, but it may be required when documenting medication administration in some facilities.

Correct answer: a) Assess the client's vital signs and level of consciousness.

Rationale: According to the priority-setting framework, the nurse should first address the client's physiological needs before addressing their psychological or social needs. Therefore, the nurse should first assess the client's vital signs and level of consciousness, which can be altered by withdrawal symptoms, and intervene accordingly.

Incorrect choices:

b) Administer the prescribed medication for withdrawal symptoms.: This is an important action but not the first one as the nurse should first assess the client's condition and determine if they need any immediate interventions.

c) Provide a calm and supportive environment for the client.: This is an important action but not the first one as it addresses the client's psychological needs, which are lower in priority than their physiological needs.

d) Refer the client to a substance abuse counselor or program.: This is an important action but not the first one as it addresses the client's social needs, which are lower in priority than their physiological or psychological needs.

Correct answer: b) The client has a history of hypertension and angina.

Rationale: Hypertension and angina are contraindications for methylphenidate, which is a stimulant that can increase blood pressure and heart rate and cause cardiac complications.

Incorrect choices:

a) The client has a diagnosis of attention deficit hyperactivity disorder (ADHD).: This is an indication for methylphenidate, which is used to treat ADHD by increasing attention and focus.

c) The client has a positive urine drug screen for cannabis.: This is not a contraindication for methylphenidate, but it indicates that the client may have a substance use disorder and may need further assessment and intervention.

d) The client has a family history of bipolar disorder.: This is not a contraindication for methylphenidate, but it indicates that the client may be at risk for developing bipolar disorder and may need close monitoring for mood changes.

Correct answer: d) "Methadone will block the effects of opioids if I relapse."

Rationale: Methadone is an opioid agonist that blocks the effects of opioids by occupying their receptors and preventing them from binding. This reduces the risk of overdose and relapse by eliminating the reward or pleasure of using opioids.

Incorrect choices:

a) "Methadone will help me stop craving opioids.": This is incorrect as methadone does not eliminate cravings for opioids, but it reduces them by preventing withdrawal symptoms.

b) "Methadone will make me feel euphoric like opioids do.": This is incorrect as methadone does not produce euphoria or sedation like opioids do, but it maintains a steady state of opioid tolerance and dependence.

c) "Methadone will cause me to have withdrawal symptoms when I stop taking it.": This is incorrect as methadone prevents withdrawal symptoms by providing a long-acting opioid substitute. However, methadone itself can cause dependence and withdrawal if discontinued abruptly, so it should be tapered off gradually under medical supervision.

Correct answer: a, b, c, e

Rationale: Methadone is a Schedule II controlled substance that requires strict regulation and documentation. The nurse should verify the client's identity, document the dose and time of administration, count the remaining tablets with another nurse, and assess the client for adverse effects. Disposing of unused or expired methadone tablets in a sharps container is not appropriate as it poses a risk of needlestick injury and environmental contamination.

Incorrect choices:
d) Dispose of any unused or expired methadone tablets in a sharps container.: This is incorrect as it poses a risk of needlestick injury and environmental contamination.

Correct answer: a) Opioids

Rationale: Opioids are controlled substances that act on opioid receptors to produce analgesia, euphoria, sedation, and respiratory depression. Nausea and vomiting are common adverse effects of opioids due to stimulation of the chemoreceptor trigger zone in the brain.

Incorrect choices:
b) Stimulants: Stimulants are controlled substances that increase alertness, energy, mood, and heart rate. Nausea and vomiting are not typical adverse effects of stimulants.
c) Depressants: Depressants are controlled substances that reduce anxiety, agitation, and insomnia. Nausea and vomiting are not typical adverse effects of depressants.
d) Hallucinogens: Hallucinogens are controlled substances that alter perception, cognition, mood, and behavior. Nausea and vomiting are not typical adverse effects of hallucinogens.

Correct answer: d) Schedule IV

Rationale: Diazepam is a benzodiazepine that acts as a central nervous system depressant. It belongs to Schedule IV of controlled substances, which have a low potential for abuse and dependence compared to Schedule I, II, or III substances.

Incorrect choices:
a) Schedule I: Schedule I substances have no accepted medical use and a high potential for abuse and dependence. Examples include heroin, LSD, and ecstasy.
b) Schedule II: Schedule II substances have a high potential for abuse and dependence but have some accepted medical uses with severe restrictions. Examples include morphine, oxycodone, and cocaine.
c) Schedule III: Schedule III substances have a moderate potential for abuse and dependence but have accepted medical uses. Examples include codeine, ketamine, and anabolic steroids.

Correct answer: d) Drowsiness

Rationale: Phenobarbital is a barbiturate that acts as a central nervous system depressant. It belongs to Schedule IV of controlled substances, which have a low potential for abuse and dependence compared to Schedule I, II, or III substances. Drowsiness is a common adverse effect of phenobarbital and other barbiturates.

Incorrect choices:
a) Hypertension: Hypertension is not a typical adverse effect of phenobarbital or other barbiturates. Phenobarbital can cause hypotension due to vasodilation.
b) Tachycardia: Tachycardia is not a typical adverse effect of phenobarbital or other barbiturates. Phenobarbital can cause bradycardia due to decreased cardiac output.
c) Insomnia: Insomnia is not a typical adverse effect of phenobarbital or other barbiturates. Phenobarbital can cause sedation and sleepiness.

Correct answer: b) Stimulants

Rationale: Methylphenidate is a stimulant that acts on the central nervous system to increase alertness, attention, and focus. It belongs to Schedule II of controlled substances, which have a high potential for abuse and dependence but have some accepted medical uses with severe restrictions.

Incorrect choices:
a) Opioids: Opioids are controlled substances that act on opioid receptors to produce analgesia, euphoria, sedation, and respiratory depression. They belong to Schedule II or III of controlled substances depending on their potency and formulation.
c) Depressants: Depressants are controlled substances that reduce anxiety, agitation, and insomnia. They belong to Schedule IV or V of controlled substances depending on their potential for abuse and dependence.
d) Hallucinogens: Hallucinogens are controlled substances that alter perception, cognition, mood, and behavior. They belong to Schedule I of controlled substances, which have no accepted medical use and a high potential for abuse and dependence.

Correct answer: b) Legend drug

Rationale: Lithium carbonate is a legend drug, which means that it requires a prescription from a licensed provider and has a label that states "Caution: Federal law prohibits dispensing without prescription." Legend drugs are not classified as controlled substances unless they have a potential for abuse or dependence.

Incorrect choices:
a) Controlled substances: Controlled substances are drugs that have a potential for abuse or dependence and are regulated by the Drug Enforcement Administration (DEA). They are classified into five schedules based on their medical use and abuse potential.
c) Over-the-counter drug: Over-the-counter drugs are drugs that do not require a prescription and can be purchased by consumers without supervision from a health care provider. They have labels that state "Drug Facts" and provide information about their ingredients, uses, warnings, directions, and other information.
d) Herbal supplement: Herbal supplements are products that contain plant extracts or other natural ingredients that are intended to supplement the diet or promote health. They are not regulated by the Food and Drug Administration (FDA) as drugs but as dietary supplements. They have labels that state "Supplement Facts" and provide information about their ingredients, serving size, amount per serving, and other information

Correct answer: A, D, E

Rationale: Fentanyl patches are transdermal delivery systems that provide continuous opioid analgesia for up to 72 hours. The nurse should instruct the client to apply the patch to a dry, hairless area of intact skin; avoid exposing the patch to heat sources that can increase absorption and cause overdose; and report any signs of opioid toxicity such as confusion, drowsiness, or difficulty breathing.

Incorrect choices:
b) Change the patch every 24 hours or as needed for pain relief.: This is incorrect as changing the patch more frequently than every 72 hours can cause overdose and dependence.

c) Dispose of the used patch by flushing it down the toilet.: This is incorrect as flushing the patch down the toilet can contaminate the water supply and pose a risk of accidental ingestion by children or pets. The nurse should instruct the client to fold the patch in half with the sticky sides together and dispose of it in a secure trash container.

Correct answer: a) "Schedule I drugs have no accepted medical use and a high potential for abuse."

Rationale: Schedule I drugs, such as heroin, LSD, and ecstasy, are the most restricted category of controlled substances and have no currently accepted medical use in the United States. Schedule II drugs, such as morphine, oxycodone, and cocaine, have a high potential for abuse and can only be dispensed with a written prescription that cannot be refilled. Schedule III drugs, such as codeine, ketamine, and anabolic steroids, have a moderate potential for abuse and can be refilled up to five times within six months with a prescription. Schedule IV drugs, such as diazepam, alprazolam, and zolpidem, have a low potential for abuse and can also be refilled up to five times within six months with a prescription. Schedule V drugs, such as cough syrups with codeine, have the lowest potential for abuse and may be dispensed without a prescription under certain conditions.

Incorrect choices:
b) "Schedule II drugs can be refilled up to five times within six months.": This is incorrect as Schedule II drugs cannot be refilled.
c) "Schedule III drugs have a lower potential for abuse than Schedule IV drugs.": This is incorrect as Schedule III drugs have a higher potential for abuse than Schedule IV drugs.
d) "Schedule V drugs are available over-the-counter without a prescription.": This is incorrect as Schedule V drugs may require a prescription depending on the state law and the amount dispensed.

Correct answer: a) "You should keep your medication in its original container with the label attached."

Rationale: Keeping the medication in its original container with the label attached helps to prevent errors, confusion, misuse, or diversion of the medication. The label also provides important information about the medication name, dosage, instructions, expiration date, and prescriber.

Incorrect choices:
b) "You should share your medication with your family members if they have similar symptoms.": This is incorrect as sharing prescription medication with others is illegal and dangerous. Prescription medication should only be taken by the person for whom it was prescribed and as directed by the prescriber.
c) "You should dispose of any unused or expired medication by flushing it down the toilet.": This is incorrect as flushing medication down the toilet can contaminate the water supply and harm the environment. Unused or expired medication should be disposed of properly according to the FDA guidelines or local regulations.
d) "You should stop taking your medication if you experience any side effects.": This is incorrect as stopping medication abruptly can cause adverse effects or worsen the condition. The client should report any side effects to the prescriber and follow their advice on how to manage them or whether to adjust or discontinue the medication.

Correct answer: c) Assess the client's vital signs and level of consciousness.

Rationale: The first action that the nurse should take when using the nursing process is to assess the client. Assessing the client's vital signs and level of consciousness is essential to determine the severity of the overdose and the need for immediate interventions. The nurse should also monitor the client for signs of respiratory depression, cardiac arrhythmias, seizures, or other complications.

Incorrect choices:
a) Notify the health care provider and request an order for a urine drug screen.: This is an important action, but not the first one. The nurse should notify the health care provider and request an order for a urine drug screen after assessing the client and stabilizing their condition. A urine drug screen can help to identify the type and amount of drugs that the client has ingested and guide the treatment plan.

b) Administer naloxone as prescribed to reverse the effects of opioids.: This is an important action, but not the first one. The nurse should administer naloxone as prescribed to reverse the effects of opioids after assessing the client and confirming that they have signs of opioid toxicity, such as pinpoint pupils, decreased respiratory rate, and decreased level of consciousness. Naloxone is an opioid antagonist that can rapidly restore normal respiration and alertness in opioid overdose cases. However, naloxone has no effect on other types of drugs and may precipitate withdrawal symptoms in opioid-dependent clients.

d) Educate the client about the risks and consequences of drug abuse.: This is an important action, but not the first one. The nurse should educate the client about the risks and consequences of drug abuse after assessing the client and ensuring their safety and stability. The nurse should also provide emotional support and refer the client to appropriate resources for substance abuse treatment and recovery.

Correct answer: d) All of the above.

Rationale: Schedule II drugs are highly regulated by the federal Controlled Substances Act and require a new written prescription for each refill. Morphine sulfate can cause nausea and vomiting, so taking it with food may help prevent these adverse effects. Morphine sulfate is also a potential drug of abuse and diversion, so it should be stored securely and disposed of properly when no longer needed.

Incorrect choices:
a) "You will need a new written prescription from your provider every time you need a refill.": This is correct, but not the only information the nurse should include in the teaching.

b) "You can take this medication with or without food, depending on your preference.": This is correct, but not the only information the nurse should include in the teaching.

c) "You should store this medication in a locked cabinet away from children and pets.": This is correct, but not the only information the nurse should include in the teaching.

Correct answer: b) "I should store my medication in a locked cabinet."

Rationale: Schedule II controlled substances have a high potential for abuse and addiction and are subject to strict regulations by the DEA. The client should store the medication in a secure place to prevent theft or misuse. The client cannot refill the prescription by calling the pharmacy but must obtain a new written prescription from the provider. The client should not share the medication with anyone else, as this is illegal and dangerous. The client should take the medication as prescribed and report any inadequate pain relief to the provider.

Incorrect choices:

a) "I can refill my prescription by calling the pharmacy.": This is incorrect as Schedule II drugs cannot be refilled by phone, but require a new written prescription.

c) "I can share my medication with my spouse if they have similar symptoms.": This is incorrect as sharing controlled substances is illegal and can cause harm to others.

d) "I should take more medication if my pain is not relieved.": This is incorrect as taking more medication than prescribed can lead to overdose, addiction, or adverse effects.

Correct answer: a) Naloxone

Rationale: Naloxone is an opioid antagonist that blocks the opioid receptors and reverses the respiratory depression, sedation, and hypotension caused by opioids. It is given intravenously, intramuscularly, or intranasally to treat opioid overdose.

Incorrect choices:

b) Flumazenil: This is a benzodiazepine antagonist that reverses the effects of benzodiazepines, such as diazepam or alprazolam.

c) Acetylcysteine: This is an antidote for acetaminophen overdose that replenishes glutathione and prevents liver damage.

d) Glucagon: This is a hormone that increases blood glucose levels and is used to treat hypoglycemia caused by insulin or oral antidiabetic drugs.

Correct answer: d) The amount and strength of medication

Rationale: The amount and strength of medication are not required to be documented in the MAR for Schedule IV controlled substances, as these are low-abuse potential drugs that have accepted medical uses. However, they are required for Schedule I, II, and III controlled substances, which have higher abuse potential and stricter regulations.

Incorrect choices:

a) The nurse's signature and initials: These are required to be documented in the MAR for all medications, including controlled substances, to ensure accountability and accuracy.

b) The date and time of administration: These are required to be documented in the MAR for all medications, including controlled substances, to ensure adherence to the prescribed schedule and avoid errors.

c) The route and site of administration: These are required to be documented in the MAR for all medications, including controlled substances, to ensure proper delivery and avoid complications.

Correct answer: c) Verify the client's identity using two identifiers

Rationale: The first action that the nurse should take before administering any medication is to verify the client's identity using two identifiers, such as name and date of birth, to ensure that the right medication is given to the right client. This is one of the six rights of medication administration that help prevent medication errors and promote client safety.

Incorrect choices:

a) Check the expiration date of the drug: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should check the expiration date after comparing the drug label with the MAR and before opening the drug container.

b) Compare the drug label with the MAR: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should compare the drug label with the MAR after verifying the client's identity and before checking the expiration date.

d) Explain the purpose and side effects of the drug: This is an important action that the nurse should take before administering any medication, but it is not the first action. The nurse should explain the purpose and side effects of the drug after checking the expiration date and before administering the drug.

Correct answer: d) "I should use over-the-counter drugs instead of prescription drugs if I have pain."

Rationale: This statement indicates a need for further teaching, as over-the-counter drugs can also be abused or misused and cause harm to the client. The client should consult with their provider before taking any medications for pain and follow the directions carefully. The client should also use nonpharmacological methods for pain relief, such as relaxation techniques, massage, or ice packs.

Incorrect choices:

a) "I should avoid situations or people that trigger my urge to use drugs.": This statement indicates an understanding of the teaching, as avoiding triggers is one of the prevention and education strategies for substance abuse.

b) "I should seek professional help if I have signs of depression or anxiety.": This statement indicates an understanding of the teaching, as seeking professional help is one of the prevention and education strategies for substance abuse. Depression and anxiety are common co-occurring disorders with substance abuse and can increase the risk of relapse.

c) "I should join a support group or a 12-step program to stay sober.": This statement indicates an understanding of the teaching, as joining a support group or a 12-step program is one of the prevention and education strategies for substance abuse. Support groups and 12-step programs can provide peer support, guidance, and accountability for clients who are recovering from substance abuse.

Correct answer: b) Count and document the remaining supply of medication

Rationale: Schedule III controlled substances are drugs that have a moderate potential for abuse and addiction and are subject to moderate regulations by the DEA. The nurse should count and document the remaining supply of medication every time they administer a Schedule III controlled substance to ensure accuracy and prevent diversion.

Incorrect choices:

a) Obtain a written prescription from the provider every time: This is not required for Schedule III controlled substances, as they can be refilled up to five times within six months by phone or fax. However, this is required for Schedule II controlled substances, which have a higher potential for abuse and addiction.

c) Dispose of any unused medication in a sharps container: This is not an appropriate way to dispose of any unused medication, as it can pose a risk of injury or infection to others. The nurse should dispose of any unused medication by using a DEA-approved disposal company or following the facility's policy.

d) Administer the medication only by intravenous route: This is not required for Schedule III controlled substances, as they can be administered by various routes depending on the formulation and indication. However, some Schedule II controlled substances, such as morphine or fentanyl, are administered only by intravenous route for acute pain management.