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?

A) Synapses are junctions between two neurons.
B) Synapses respond only to acetylcholine and norepinephrine.
C) The function of the synapse is to communicate messages through an action potential.
D) Synapses are junctions between a neuron and a muscle.
E) Synapses stimulate an emotional response.

Synapses are junctions between two neurons.
Synapses are junctions between a neuron and a muscle.

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?

A) Exercise in the evening to help relax.
B) Use room darkening shades over the windows.
C) Drink cola no later than 8 pm in the evening.
D) No heavy meals past 6 pm.
E) Use ear plugs to block out extraneous noise.

Use room darkening shades over the windows.
No heavy meals past 6 pm.
Use ear plugs to block out extraneous noise.

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?

A) "Ginger root is commonly taken to improve sleep."
B) "Ginkgo is an herb commonly taken to improve sleep."
C) "Diphenhydramine (Benadryl) is an OTC drug sometimes taken to produce drowsiness."
D) "Valerian and melatonin are natural health products commonly taken to improve sleep."
E) "Kava is an herb taken to improve sleep."

"Diphenhydramine (Benadryl) is an OTC drug sometimes taken to produce drowsiness."
"Valerian and melatonin are natural health products commonly taken to improve sleep."

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?

A) Administering Ativan by slow IV injection over a 2- to 4-minute period.
B) Injecting the Ativan quickly via IV push.
C) Discontinuing the intravenous infusion prior to administering the medication.
D) Mixing the Ativan in a 50cc bag of NS and administering piggyback over 30 minutes.

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?&#10;A) There is a link between anxiety and sleep.&#10;B) Improving sleep will help with the anxiety disorder.&#10;C) Less anti-anxiety medication will be needed during the day.&#10;D) It will prevent rebound insomnia.&#10;E) It will stop the client from worrying about not getting enough sleep.&#10;

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, &#34;I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?&#34; Which response by the nurse is the most appropriate?&#10;A) &#34;Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter.&#34;&#10;B) &#34;Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania.&#34;&#10;C) &#34;Bipolar disorder is just another type of depression, except your depression occurs in cycles.&#34;&#10;D) &#34;Bipolar disorder is a type of depression that includes attention deficit disorder symptoms.&#34;&#10;

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?

A) Tricyclic antidepressants (TCAs)
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Monoamine oxidase (MAO) inhibitors
D) Norepinephrine re-uptake inhibitors

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?

A) "Stimulants can cause the side effect of excessive excitation."
B) "Have you made an appointment for your son to see the health care provider?"
C) "Stimulants can be helpful in hyperactivity disorders."
D) "What actions lead you to think your son is hyperactive?"

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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.
.

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?&#10;A) Measure the client's height and weight.&#10;B) Assess vital signs, especially heart rate and BP.&#10;C) Obtain labs to assess cardiovascular status.&#10;D) Obtain a fasting blood glucose.&#10;E) Obtain a 24-hour urine collection for proteinuria.&#10;

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?&#10;A) &#34;I will talk with the school nurse about administering a dose at about noon each day.&#34;&#10;B) &#34;We should fold the patch with the medication side facing in before it is thrown in the garbage.&#34;&#10;C) &#34;We should not expect physical dependence at the low dose given for ADHD.&#34;&#10;D) &#34;We can expect that the health care provider will occasionally tell us to stop giving the medication for a few days.&#34;&#10;E) &#34;If our child experiences loss of appetite, we should immediately contact the health care provider.&#34;&#10;

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?

A) "I'm so glad that the doctor chose a medication that won't make my child sleepy."
B) "I think my dad takes that for his high blood pressure."
C) "I can expect that the doctor will take my child off this medication for a few days every 6 months or so."
D) "I must warn my parents that Dad's clonidine cannot be substituted for the Catapres."
E) "At least my child will not become addicted to this medication."

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Accepted Answer

The answer of The mother of a paediatric client prescribed...

Question 12

A mother tells the nurse, &#34;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?&#34; Which information should the nurse provide?&#10;A) &#34;All the drugs used to treat ADHD are basically the same.&#34;&#10;B) &#34;Children often have severe reactions to ADHD drugs and have their therapy changed.&#34;&#10;C) &#34;The choice of drug can be guided by different dosing schedules.&#34;&#10;D) &#34;Some children just do better on one drug or the other.&#34;&#10;E) &#34;Girls don't respond to medications as well as boys.&#34;&#10;

Accepted Answer

The answer of A mother tells the nurse, &#34;My son...

Question 13

What should the nurse teach a client about obtaining prescribed central nervous system stimulant medications?&#10;A) Have the health care provider call the prescription in to a pharmacy that knows your health history.&#10;B) The prescription can be filled only at a pharmacy especially licensed to dispense these drugs.&#10;C) There must be a new prescription written each time additional medication is needed.&#10;D) Ask the pharmacy to pre-certify the number of refills indicated on the prescription form.&#10;E) Extra rules apply to the dispensing of these drugs because of their abuse potential.&#10;

Accepted Answer

The answer of What should the nurse teach a client...

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?

A) Feeling sedated all the time
B) Significant weight gain
C) Agitation
D) Fatigue and headache
E) Lack of desire to consume alcohol

Accepted Answer

The answer of A client with a history of suicidal...

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?&#10;A) &#34;Medications for schizophrenia work on the basal ganglia of the brain.&#34;&#10;B) &#34;Most antipsychotic drugs block dopamine receptors to reduce the symptoms of the disorder.&#34;&#10;C) &#34;They help correct the genetic component of the disorder.&#34;&#10;D) &#34;They are really sedatives to stop the client from causing harm.&#34;&#10;E) &#34;They stimulate dopamine receptors to reduce the symptoms of the disorder.&#34;&#10;

Accepted Answer

The answer of A student nurse, caring for a client...

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?

A) Nausea
B) Dizziness
C) Vomiting
D) Tremors
E) Paralysis

Accepted Answer

The answer of A client prescribed Chlorpromazine medication for chronic...

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?&#10;A) Phenothiazines&#10;B) Non-phenothiazines&#10;C) Atypical anti-psychotics&#10;D) Benzodiazepines&#10;E) Dopamine System Stabilizers&#10;

Accepted Answer

The answer of Which of the following drug classifications used...

Deck 8: Brief Review of the Central Nervous System