Deck 5: Central Nervous System Drugs

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?

A) Add sodium bicarbonate to the patient's drug regimen.
B) Order a serum creatinine level to validate the creatinine clearance.
C) Discontinue the memantine.
D) Reduce the dose of memantine.

Answer 1

Reduce the dose of memantine.

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?

A) "Doses are lower but more steady with the transdermal patch."
B) "Reduced side effects occur with the transdermal patch."
C) "We only need to change the patch every 2 weeks."
D) "We should remove the old patch before applying the new one."

Answer 2

"We only need to change the patch every 2 weeks."

Question 3

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

A) "I should brush and floss my teeth regularly."
B) "Once therapeutic blood levels are reached, they are easy to maintain."
C) "I can consume alcohol in moderation while taking this drug."
D) "Rashes are a common side effect but are not serious."

Answer 3

"I should brush and floss my teeth regularly."

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?

A) "I may need to try several drugs before finding one is effective."
B) "I will know that the drug is effective if I am seizure-free for two months."
C) "Serious side effects may occur, and if they do, I should stop taking the medication."
D) "When the drug level is maintained at therapeutic levels, I can expect to be seizure free."

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?

A) She may need to increase her dose of phenytoin while taking oral contraceptives.
B) She should consider a different form of birth control while taking phenytoin.
C) She should adhere strictly to oral contraceptive schedules because phenytoin causes birth defects.
D) She should not take oral contraceptives, because they reduce the effectiveness of phenytoin.

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?

A) Add an antipsychotic medication to the patient's medication regimen.
B) Discontinue the bromocriptine and prescribe cabergoline.
C) Reduce the dose of bromocriptine.
D) Reduce the dose of levodopa/carbidopa.

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?

A) Dizziness
B) Fatigue
C) Hallucinations
D) Dyspnea

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?

A) Baclofen
B) Dantrolene
C) Diazepam
D) Metaxalone

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?

A) Reduce the carbamazepine dose to 50 mg twice daily.
B) Reduce the lamotrigine dose to 225 mg twice daily.
C) Increase the carbamazepine dose to 200 mg twice daily.
D) Increase the lamotrigine dose to 500 mg twice daily.

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?

A) "Do you have any history of alcohol abuse or compulsive behaviors?"
B) "Have you any previous history of hypertension?"
C) "Do you have any difficulty falling asleep or staying asleep?"
D) "Do you have family history associated with psychoses?"

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?

A) Levodopa
B) Ondansetron
C) Prochlorperazine
D) Trimethobenzamide

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?

A) "Have you taken any extra doses of baclofen?"
B) "Are you aware of the most common adverse effect of baclofen?"
C) "Did you know that seizures are an idiopathic response to baclofen?"
D) Have you missed any doses of baclofen?"

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?

A) Prescribing the patient a dopamine agonist
B) Discussing the effects of the "on-off" phenomenon with the patient
C) Increasing the daily dose of levodopa/carbidopa
D) Ordering tests to reevaluate the patient's diagnosis

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?

A) Chronic use of aspirin
B) A history of hepatitis
C) A history of malignant hyperthermia
D) Occasional use of alcohol

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?

A) Ask the patient to complete a seizure frequency chart for the past few weeks.
B) Write an order for serum drug levels.
C) Reinforce to the patient the need to take the medications as prescribed.
D) Increase the dose of the antiepileptic drug.

Question 16

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

A) A 20-year-old woman with a spinal cord injury
B) A 45-year-old man with a history of malignant hyperthermia
C) A 55-year-old woman with multiple sclerosis
D) An 8-year-old child with cerebral palsy

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?

A) "This drug carries some risk of developing hallucinations and psychotic symptoms."
B) "This medication may cause your urine to turn brown, black, or dark green."
C) "You may experience blurred vision, dry mouth, or constipation."
D) "You will need to have liver function tests performed while taking this medication."

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?

A) Blood-brain barrier
B) First-pass effect
C) Gastrointestinal absorption
D) Renal filtration

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?

A) Prescribe a COMT inhibitor, such as entacapone.
B) Add the DA-releasing agent amantadine to the regimen.
C) Prescribe a direct-acting dopamine agonist.
D) Shorten the dosing interval of levodopa/carbidopa.

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?

A) Sleep attacks
B) Dizziness
C) Hallucinations
D) Dyskinesias

Question 21

An older adult patient with Alzheimer disease is prescribed a cholinesterase inhibitor drug. When providing medication education to the care giver, the prescriber will prioritize which possible side effects? (Select all that apply.)

A) Confusion
B) Memory impairment
C) Constipation
D) Slowed heart rate
E) Lightheadedness

Question 22

An older adult patient displays confusion, memory loss, and disorientation in familiar surroundings. Although the patient has been taking donepezil 10 mg once daily for 6 months, the symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What response will the prescriber provide to best address the spouse's concerns?

A) "The dose can be increased, because the patient has been taking the drug for longer than 3 months."
B) "The dose can be increased to twice daily dosing instead of once daily dosing."
C) "The increase in symptoms is the result of hepatotoxicity from the medication's side effects."
D) "The patient must take the drug for longer than 1 year before the dose can be increased."