Question 1

The patient who is on memantine therapy has a slight elevation in the creatinine clearance. What action will the provider take in response to this laboratory result?

Accepted Answer

Memantine dosage may need adjustment in patients with renal impairment, as it is primarily excreted by the kidneys. A slight elevation in creatinine clearance indicates altered kidney function, necessitating a dose reduction to prevent potential toxicity.

Question 2

The spouse of a patient with Alzheimer disease asks the provider for more information about the rivastigmine transdermal patch that is being used. After the discussion with the provider, which statement by the spouse indicates a need for further explanation?

Accepted Answer

The rivastigmine transdermal patch needs to be changed every 24 hours, not every 2 weeks, indicating a misunderstanding about the correct usage of the patch.

Question 3

A provider counsels a patient who is prescribed phenytoin for epilepsy. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Phenytoin can cause gingival hyperplasia, making good oral hygiene practices, such as regular brushing and flossing, essential to prevent gum disease.

Question 4

A provider provides teaching for a patient with a newly diagnosed partial complex seizure disorder who will begin therapy with an antiepileptic drug (AED). Which statement by the patient indicates to the provider an understanding of the teaching?

Accepted Answer

The patient's statement indicates an understanding of the teaching because it acknowledges that finding an effective AED may require trying several different drugs.

Question 5

A patient who takes phenytoin for seizures asks the provider for a prescription for oral contraceptives. What recommendation will the provider make to help assure the effectiveness of the contraception method?

Accepted Answer

Phenytoin is an enzyme inducer that can decrease the effectiveness of oral contraceptives, making them less reliable. Therefore, patients on phenytoin are often advised to consider alternative or additional forms of contraception.

Question 6

The provider prescribes bromocriptine for a patient who takes levodopa/carbidopa. Afterward, the patient becomes agitated and has frequent nightmares. What action will the provider take to manage the patient's symptoms?

Accepted Answer

Reducing the dose of bromocriptine can help manage the patient's symptoms of agitation and frequent nightmares, as these can be side effects of dopamine agonists like bromocriptine. Adjusting the dose can mitigate these adverse effects while still providing therapeutic benefits.

Question 7

A patient reports stopping baclofen the day before being admitted to the hospital. The provider instructs the hospital staff to monitor the patient for which withdrawal effects?

Accepted Answer

Abrupt discontinuation of baclofen can lead to withdrawal symptoms, including hallucinations, seizures, and confusion.

Question 8

A patient with cerebral palsy has severe muscle spasticity and muscle weakness which makes it difficult to take anything by mouth. The provider will prescribe and educate the patient on which medication for home therapy?

Accepted Answer

Baclofen is commonly used to treat muscle spasticity in patients with cerebral palsy. It acts as a muscle relaxant and antispastic agent, making it suitable for home therapy to manage symptoms.

Question 9

A patient with a seizure disorder is admitted to the hospital after an increase in seizure frequency. The prescriber considers adding carbamazepine 100 mg twice daily to the patient's medication regimen, but notes that the patient is already taking lamotrigine 375 mg twice daily. What changes will the prescriber make to the patient's medication regimen?

Accepted Answer

The answer of A patient with a seizure disorder is...

Question 10

A patient has been newly diagnosed with Parkinson disease. Before beginning therapy with pramipexole, the provider will ask the patient which assessment question in order to minimize risk for injury?

Accepted Answer

Pramipexole, a dopamine agonist used in the treatment of Parkinson's disease, has been associated with the development or exacerbation of compulsive behaviors, such as gambling, shopping, eating, and sexual activity, as well as alcohol abuse. Therefore, assessing for a history of these behaviors is important to minimize the risk of exacerbating these conditions.

Question 11

A hospitalized patient newly diagnosed with Parkinson disease is prescribed apomorphine but develops medication-related nausea and vomiting. What drug will the provider prescribe to manage these side effects effectively?

Accepted Answer

Trimethobenzamide is an antiemetic that is often used to manage nausea and vomiting associated with apomorphine in Parkinson's disease patients, as it does not interfere with dopamine receptors.

Question 12

A patient with cerebral palsy who has been receiving baclofen for 3 months is admitted to the hospital for evaluation of new-onset seizures. What assessment question will the provider ask to help identify the most likely cause of these seizures?

Accepted Answer

Baclofen withdrawal can lead to seizures among other symptoms. Asking if the patient has missed any doses can help identify if withdrawal from baclofen is the cause of the new-onset seizures.

Question 13

A patient diagnosed with Parkinson disease (PD) begins treatment with levodopa/carbidopa. After several months of therapy, the patient reports no change in symptoms. The provider will implement what action?

Accepted Answer

If there is no change in symptoms after several months of levodopa/carbidopa therapy, it may indicate that the diagnosis of Parkinson's disease should be reevaluated, as this medication is typically effective in managing PD symptoms.

Question 14

A provider is considering prescribing tizanidine for patient who is experiencing localized muscle spasms after an injury. What information in the patient's health history will be concerning enough to the provider to warrant selecting a different drug?

Accepted Answer

Tizanidine is metabolized in the liver and can cause liver damage. A history of hepatitis indicates pre-existing liver issues, making tizanidine a potentially harmful choice for this patient.

Question 15

A patient who has been taking an antiepileptic drug for several weeks reports little change in seizure frequency, what action will the provider take to provide effective care?

Accepted Answer

Measuring serum drug levels helps determine if the drug is at a therapeutic level, which can guide further treatment decisions.

Question 16

A provider has prescribed dantrolene for the following patients. Which patient will the provider monitor most closely for risk of injury?

Accepted Answer

Dantrolene can cause muscle weakness, which may be particularly concerning in a 55-year-old woman with multiple sclerosis, as she may already have compromised muscle function and strength. This increases her risk of injury.

Question 17

When a patient with a lower back injury begins experiencing muscle spasms, the provider orders cyclobenzaprine 10 mg three times a day. What information will the provider include when teaching this patient about this drug?

Accepted Answer

Cyclobenzaprine, a muscle relaxant, can cause anticholinergic side effects such as blurred vision, dry mouth, and constipation. These are common side effects due to its mechanism of action.

Question 18

An infant is prescribed a central nervous system (CNS) drug. The parents are concerned that the child exhibits unusual drowsiness and sedation. The provider explains these effects based on an understanding of which difference in the physiology of infants and adults?

Accepted Answer

The blood-brain barrier in infants is not fully developed, which allows drugs to pass more easily into the central nervous system, potentially causing increased sensitivity to the effects of CNS drugs, such as drowsiness and sedation.

Question 19

A patient who takes levodopa/carbidopa for Parkinson disease reports periods of lost drug effect lasting from minutes to several hours with no relationship to the timing of drug administration. What course of action will the provider take?

Accepted Answer

The answer of A patient who takes levodopa/carbidopa for Parkinson...

Question 20

When selecting a dopamine agonist for a patient with Parkinson disease, the provider identifies which side effect associated with pramipexole as being less likely to occur than with other dopamine agonists?

Accepted Answer

Pramipexole is less likely to cause sleep attacks than other dopamine agonists.

Quiz 5: Central Nervous System Drugs