Question 1

The nursing instructor is teaching students on the effects of a medication on the neurons and synapses within the nervous system. What should the instructor include about about the characteristics of a synapse?

Accepted Answer

Rationale 1: Synapses are junctions between two neurons.
Rationale 2: Although acetylcholine and norepinephrine are the most abundant neurotransmitters in the autonomic nervous system, other neurotransmitters such as dopamine exist.
Rationale 3: The function of a neuron is not to communicate messages through an action potential.
Rationale 4: Synapses are junctions between a neuron and a muscle.
Rationale 5: Synapses do not stimulate an emotional response.

Question 2

A client sees her health care provider with complaints of insomnia. After completing her physical and assessment, it is determined that she has secondary insomnia due to poor sleep hygiene. Which of the following non-pharmacological strategies does the nurse suggest to improve the client's sleep?

Accepted Answer

Rationale 1: Exercise should be avoided in the evening to promote sleep.
Rationale 2: Too much light in the room can prevent sleep, use of room darkening shades will promote optimum rest.
Rationale 3: Drinks with caffeine should be avoided in the evening.
Rationale 4:Heavy meals late in the evening can contribute to poor sleep.
Rationale 5. Use of ear plugs will help block out noise that can prevent sleep.

Question 3

A client who recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia. Which response by the nurse is the most appropriate?

Accepted Answer

Rationale 1: Ginger root is not used to improve sleep.
Rationale 2: Ginkgo is not used to improve sleep.
Rationale 3: Diphenhydramine is an antihistamines frequently used to produce drowsiness.
Rationale 4: An herbal product with demonstrated efficacy in promoting relaxation is valerian root. Supplemental melatonin, 0.5-3.0 mg at bedtime, is alleged to decrease the time required to fall asleep and to produce a deep and restful sleep.
Rationale 5: High doses of kava can damage the liver and should not be used unless recommended by a health care provider.

Question 4

Lorazepam (Ativan) is ordered to be given through the intravenous route for a client with status epilepticus. The client currently has an intravenous infusion of dextrose 5% and 0.9% normal saline at the rate of 125 mL/hr. Which action demonstrates the correct administration of this medication by the nurse?

Accepted Answer

Rationale 1: Ativan should be administered over a 2- to 4-minute period when given via IV push.
Rationale 2: Rapid IV administration can result in apnea, hypotension, bradycardia, or cardiac arrest.
Rationale 3: The intravenous infusion does not need to be discontinued prior to administering the medication.
Rationale 4: Giving Ativan over 30 minutes would not benefit the client who needs immediate treatment for status epilepticus.

Question 5

A client being treated for an anxiety disorder is prescribed medication for sleep. She asks the nurse how that will help her anxiety. What is the nurse's best response?

Accepted Answer

Rationale 1: There is a pathophysiological link between sleep and anxiety.
Rationale 2: Insomnia therapy is more than just a nighttime problem. Anxiety and insomnia need to be treated together.
Rationale 3: There is no evidence to support that improving sleep will reduce the need for anti-anxiety medication during the day.
Rationale 4: Rebound insomnia occurs when a sedative drug is abruptly discontinued after it has been taken for several months or longer. Providing a medication for sleep may or may not prevent rebound insomnia in the client.
Rationale 5: Providing a sleeping medication may prevent the client from worrying about getting enough sleep and reduce the anxiety associated with sleeplessness.

Question 6

The client tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?" Which response by the nurse is the most appropriate?

Accepted Answer

Rationale 1: A mood change that becomes worse in the winter is called seasonal affective disorder.
Rationale 2: Clients with bipolar disorder can shift from emotions of extreme depression to extreme rage and agitation. Mania can include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions.
Rationale 3: Bipolar disorder must include either mania or hypomania, not just depression.
Rationale 4: Bipolar disorder must include depression with either mania or hypomania, not attention deficit disorder.

Question 7

Students are learning about the classifications of medications used to treat depression. Which of the following classifications do they learn is considered the classification of choice due to more tolerable side effects?

Accepted Answer

Rationale 1: TCAs produce fewer side effects and are less dangerous than MAO inhibitors. However, TCAs have some unpleasant and serious side effects, including a potential to accumulate in cardiac tissue causing cardiac dysrhythmias.
Rationale 2: SSRIs are drugs of choice in the pharmacotherapy of depression due to their more tolerable side effects.
Rationale 3. MAO inhibitors are usually prescribed in cases where other antidepressants have not been successful. They have more serious side effects than other antidepressants.
Rationale 4: Norepinephrine re-uptake inhibitors have specific symptoms that they are used for and is currently only available through Health Canada's Special Access program.

Question 8

The mother of a school-age client tells the school nurse, "My son is so hyperactive. I can't see any harm in putting him on medication, especially since the stimulants have so few side effects." Which response by the nurse is the most appropriate?

Accepted Answer

Rationale 1: A side effect of stimulants is excessive excitation.
Rationale 2: The misunderstanding is regarding whether stimulants have side effects, not obtaining an appointment with the health care provider.
Rationale 3: The mother already perceives that stimulants would help her son's behaviour.
Rationale 4: In order to be prescribed a stimulant, the son would need to see a health care provider to determine symptoms of hyperactivity, but the misunderstanding here is regarding stimulants having side effects.
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Question 9

A school-age client who is taking methylphenidate (Ritalin) for treatment of ADHD is seen in the clinic for routine follow-up. The nurse will automatically perform which functions?

Accepted Answer

Rationale 1: Placing children on amphetamines for ADHD can affect their weight. Height and weight should be checked regularly.
Rationale 2: Amphetamines can increase BP and heart rate. Both should be monitored.
Rationale 3: A cardiovascular workup is to be performed prior to starting amphetamines. There is nothing in the stem to indicate further workup is necessary at this time.
Rationale 4: There is no evidence that the client is having symptoms of blood glucose imbalance.
Rationale 5: There is no reason to perform a 24-hour urine, as there is no indication that the client is experiencing renal problems.

Question 10

The nurse provides information regarding methylphenidate (Concerta) to the parents of a school-age client. Which statements indicate that the parents have good understanding of the information?

Accepted Answer

Rationale 1: Concerta is a long duration form of methylphenidate. Midday dosing is not necessary.
Rationale 2: Concerta is not available in a patch form.
Rationale 3: Physical dependence is uncommon at therapeutic dosages.
Rationale 4: The use of drug-free periods is common when therapy with Concerta is prolonged.
Rationale 5: Loss of appetite is a common adverse effect of Concerta. Notifying the health care provider is not necessary.

Question 11

The mother of a paediatric client prescribed Clonidine (Catapres) for treatment of ADHD makes these remarks. Which statements indicate that the nurse should provide additional information about the drug?

Accepted Answer

Rationale 1: Catapres can cause sedation and fatigue.
Rationale 2: The original indication for clonidine was hypertension.
Rationale 3: Drug holidays are not used with Catapres. If the medication is discontinued abruptly, rebound hypotension can occur.
Rationale 4: Catapres is not interchangeable with other forms of clonidine.
Rationale 5: There is no risk of physical dependence with Catapres.

Question 12

A mother tells the nurse, "My son has ADHD and so does my sister's daughter. They are the same age, but they are on two different drugs. Why is that?" Which information should the nurse provide?

Accepted Answer

Rationale 1: This is not a correct statement regarding drugs for ADHD.
Rationale 2: Severe reactions are rare, and it is not appropriate to alarm the mother regarding this possibility.
Rationale 3: This is a correct statement and may be the reason these two children are on different medications.
Rationale 4: This is a true statement. Children react differently to the drugs and may try more than one drug before their symptoms are controlled.
Rationale 5: This is not a true statement. Medication therapy works for both genders.

Question 13

What should the nurse teach a client about obtaining prescribed central nervous system stimulant medications?

Accepted Answer

Rationale 1: Prescriptions for these medications cannot be called in to the pharmacy. A hard-copy prescription must be presented.
Rationale 2: Any regularly licensed pharmacy can dispense these medications.
Rationale 3: This is a true statement of the laws concerning these medications.
Rationale 4: These prescriptions are for a single fill only and do not have refills authorized.
Rationale 5: This is a true statement regarding these medications.

Question 14

A client with a history of suicidal behaviour and schizophrenia stopped taking perphenazine after four weeks of therapy. The client is currently experiencing a return of hallucinations. What might the nurse assess when determining the reason the client stopped taking the medication?

Accepted Answer

Rationale 1: Clients do not like the side effect of being sedated all the time.
Rationale 2: Substantial weight gain has been reported in some clients taking this medication. This is a reason some stop taking the medication.
Rationale 3: Agitation may be an extrapyramidal symptom of treatment with this medication and is an unwanted adverse effect.
Rationale 4: Fatigue and headache are possible side effects of this medication.
Rationale 5: The desire to drink alcohol would be a reason for the client to stop taking this medication.

Question 15

A student nurse, caring for a client diagnosed with schizophrenia asks how medications work to help control the client's symptoms. Which responses by the nurse are appropriate in this situation?

Accepted Answer

Rationale 1: There is a theory that overactive dopaminergic pathways in the basal ganglia are associated with the symptoms of schizophrenia.
Rationale 2: Most antipsychotic drugs act by entering dopaminergic synapses and competing with dopamine. By blocking dopamine receptors, antipsychotic drugs reduce the symptoms of schizophrenia.
Rationale 3: Antipsychotic medications do not correct the genetic component of schizophrenia.
Rationale 4: Antipsychotic medications are not sedatives.
Rationale 5: Antipsychotic medications do not stimulate dopamine receptors.

Question 16

A client prescribed Chlorpromazine medication for chronic schizophrenia abruptly stops taking the medication and is in the emergency department. Which findings does the nurse anticipate when assessing this client?

Accepted Answer

Rationale 1: Abrupt cessation of chlorpromazine may cause withdrawal symptoms, including nausea.
Rationale 2: Abrupt cessation of chlorpromazine may cause withdrawal symptoms, including nausea.
Rationale 3: Abrupt cessation of chlorpromazine may cause withdrawal symptoms, including nausea.
Rationale 4: Abrupt cessation of chlorpromazine may cause withdrawal symptoms, including nausea.
Rationale 5: Paralysis is not a symptom of withdrawal from antipsychotic medication.

Question 17

Which of the following drug classifications used to treat psychosis is known for abilities to control both positive and negative symptoms of schizophrenia?

Accepted Answer

Rationale 1: Phenothiazines promotes positive relief of positive symptoms.
Rationale 2: Non phenothiazines as well exert their action on the positive symptoms of schizophrenia
Rationale 3. Atypical anti-psychotics control both the positive and negative symptoms of schizophrenia.
Rationale 4. Benzodiazepams are not a commonly used drug to treat psychoses.
Rationale 5. Dopamine System Stabilizers control both the positive and negative symptoms of schizophrenia.

Quiz 8: Brief Review of the Central Nervous System