Deck 5: Pharmacology of Alterations in the Central Nervous System

Question 1

A client recovering from a recent stroke is having difficulty with speech, memory, and movement of the extremities on the left side of the body. The nurse explains to the family that which area of the CNS has most likely been affected by the stroke?
1) Limbic system
2) Cerebrum
3) Cerebellum
4) Thalamus

Answer 1

2

Question 2

A client is prescribed a serotonin supplement. For which disorder(s) is this neurotransmitter replacement indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Anxiety
2) Bipolar disorder
3) Depression
4) Panic attacks
5) Psychosis

Answer 2

1,2,3

Question 3

A client newly diagnosed with depression is given a prescription for an antidepressant. Which neurotransmitter is affected by the medication ordered?
1) Glutamate
2) Serotonin
3) Dopamine
4) Acetylcholine

Answer 3

2

Question 4

The nurse recognizes the action of psychotherapeutic medications is mediated by which processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Some neurotransmitters are stimulatory.
2) The electrical impulse causes the release of an inhibitory neurotransmitter.
3) Some neurotransmitters are inhibitory.
4) The electrical impulse inhibits the neurotransmitter from being released.
5) The electrical impulse at the synapse activates a receptor.

Question 5

A client, prescribed an antidepressant for symptoms of depression, is expressing feelings of hopelessness and thoughts of suicide. The nurse's response will be based on which conclusion?
1) There is great variability in individual responses to drugs that affect the CNS.
2) The client has not been taking the antidepressant.
3) The antidepressant needs to be taken for several months in order to eliminate suicidal ideations.
4) Drug levels should be obtained to see if the dose needs to be increased.

Question 6

A client admitted to the hospital with a possible brain tumour has symptoms of increased thirst and hunger, despite an increase in weight, and complains of feeling cold all the time. Which region of the CNS system most likely has been affected?
1) Thalamus
2) Hypothalamus
3) Cerebellum
4) Limbic system

Question 7

The family of a client who has a tumour deep in the brain is concerned about the client's demonstration of aggression and anger over the last few months. Which is the best response by the nurse?
1) "I will inform the health care provider about the client's anger and aggression."
2) "I will request a referral for anger management."
3) "The tumour might affect areas of the brain responsible for emotional expression."
4) "This may be a normal reaction to his diagnosis."

Question 8

A client is admitted with a spinal cord injury. Which clinical manifestations does the nurse anticipate upon assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Paresthesia
2) Paralysis
3) Jerky body movements
4) Obsessive-compulsive disorder
5) Drowsiness

Question 9

A client with depression and a sleep disorder is prescribed a central nervous system medication. The nurse will expect to assess which effects of this medication in the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Improved mood
2) Improved sleep pattern
3) Activation of the fight-or-flight response
4) Onset of seizures
5) Increased pain levels

Question 10

The nurse is concerned that a client taking an antipsychotic medication is experiencing extrapyramidal side effects. For which effects should the nurse notify the health care provider?
1) Complaints of slight drowsiness
2) Urinary hesitancy
3) Muscular spasms of the head and neck
4) Dry mouth

Question 11

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Synapses are junctions between two neurons.
2) Synapses respond only to acetylcholine and norepinephrine.
3) The function of the synapse is to communicate messages through an action potential.
4) Synapses are junctions between a neuron and a muscle.
5) Synapses stimulate an emotional response.

Question 12

A client with Parkinson disease is prescribed a medication that affects a particular central nervous system neurotransmitter. Which neurotransmitter is the medication acting on to treat the symptoms of Parkinson disease?
1) Acetylcholine
2) Norepinephrine
3) An endorphin
4) Gamma aminobutyric acid (GABA)

Question 13

The nurse is taking care of a client who has been in the intensive care unit (ICU) for 10 days. Which nursing action would cause a decrease in stimulation of the reticular activating system?
1) Keeping the door closed and the lights dim
2) Assisting with bathing and activities for elimination
3) Allowing family members, including children, to visit
4) Turning on the television

Question 14

A client is prescribed medication to treat bipolar disorder. Which statement indicates the client understands the medication regimen?
1) "This medication is going to cure me."
2) "I will take this medication when I remember to."
3) "This medication may help my symptoms."
4) "This is the only medication that I can take for my illness."

Question 15

A client is treated in the emergency department for an overdose of cocaine. What does the nurse monitor based on her knowledge of the effect of cocaine?
1) Cholinergic synapses
2) Adrenergic synapses
3) Dopamine receptors
4) Glutamate

Question 16

A client is demonstrating a disorder involving the limbic system. Which physiological findings associated with this disorder does the nurse anticipate upon assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Rapid heart rate
2) High blood pressure
3) Peptic ulcer disease
4) Increased peristalsis
5) Slow respirations

Question 17

A client is believed to have a disorder that affects the basal ganglia. What should the nurse instruct the client about this structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) It helps regulate skeletal muscle movement.
2) It helps with memory.
3) It is needed for learning.
4) It is useful for being attentive.
5) Disorders can cause myasthenia gravis.

Question 18

A client is found to have a reduction in the amount of the neurotransmitter acetylcholine. The nurse realizes this client is prone to developing which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Myasthenia gravis
2) Alzheimer disease
3) Parkinson disease
4) Seizure disorders
5) Anxiety

Question 19

Which statements describe the function of the central nervous system synapse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Suppression, or inhibition, of the firing of neurons
2) Inhibition of the release of a neurotransmitter
3) Serving as the primary functioning cell within the nervous system
4) Simulation, or activation, of the firing of neurons
5) Release of an inhibitory neurotransmitter that suppresses conduction

Question 20

A client tells the nurse about taking a medication that affects the central nervous system but cannot recall the name of the drug. When assessing the client, it would be appropriate for the nurse to ask about which possible symptoms?
1) Weight loss despite an increase in appetite, inability to sleep, feeling fidgety, palpitations, intolerance to heat
2) Weight loss despite an increase in appetite and food consumption, extreme thirst, and increase in urination
3) Moodiness, crying, or feelings of anxiety
4) More than usual shortness of breath, or tightness in the chest with physical activity.

Question 21

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) There is a link between anxiety and sleep.
2) Improving sleep will help with the anxiety disorder.
3) Less anti-anxiety medication will be needed during the day.
4) It will prevent rebound insomnia.
5) It will stop the client from worrying about not getting enough sleep.

Question 22

A client is prescribed a medication that will inhibit the function of the reticular activating system. What will the nurse assess as effects of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Drowsiness
2) Sleeping
3) Alertness
4) Dilated pupils
5) Elevated blood pressure

Question 23

Nursing students have completed their pharmacological module on sleep disorders. Which of the following medical conditions did they learn contribute to secondary insomnia? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Diabetes
2) Hyperthyroidism
3) Coronary Artery Disease
4) Sleep apnea
5) Renal Failure

Question 24

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Exercise in the evening to help relax.
2) Use room darkening shades over the windows.
3) Drink cola no later than 8 pm in the evening.
4) No heavy meals past 6 pm.
5) Use ear plugs to block out extraneous noise.

Question 25

A client whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications. Which strategies for sleep could the nurse suggest? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Walking 2-3 miles or engaging in some other exercise every morning can enhance sleep."
2) "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy."
3) "Eating a large meal at bedtime will help induce sleep."
4) "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime."
5) "Reading at nighttime sometimes may help you fall asleep."

Question 26

The nurse distinguishes medications used in general surgery as either hypnotic or sedative, or sedative-hypnotic. The nurse can anticipate the anesthesiologist using which sedative-hypnotic for induction of anesthesia?
1) Lorazepam (Ativan)
2) Oxazepam (Serax)
3) Phenobarbital (Phenobarb)
4) Temazepam (Restoril)

Question 27

A hospitalized client who is not prescribed medication for sleep tells the nurse about using a sedative to sleep "for years." What will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Sleeplessness
2) Anxiety
3) Daytime drowsiness
4) Dizziness
5) Blurred vision

Question 28

A client Is ordered temazepam ( Restoril) 7.5 mg at hs. The nurse completes her teaching with the client on the recommended use of this drug. Which of the following statements by the client indicates that more teaching is necessary?
1) "I will take this medication immediately before bedtime."
2) "I will not take this medication with alcohol."
3) "I can take this with a cup of chamomile tea."
4) " I should taper this medication slowly once my sleep improves."

Question 29

A client has asked the nurse about taking Melatonin for occasional insomnia. Which of the following reasons that the client discusses during her history would preclude her from using this drug?
1) Corticosteroid use for polymyalgia rheumatica
2) Migraine headaches
3) Peptic ulcer disease
4) Asthma

Question 30

A student nurse, under the supervision of her instructor is preparing to give IV lorazepam (Ativan) for a client undergoing a endoscopy. The instructor asks the student to tell her the mechanism of action before she gives the drug. What information does the student share with her instructor?
1) Potentiates the synthesis of tryptophan to serotonin.
2) It has an agonist effect on presynaptic dopamine receptors.
3) Potentiates the effect of GABA, a neurotransmitter in the CNS
4) It has an agonist effect on the neurotransmitter norepinephrine.

Question 31

The nurse notes that a client is prescribed oxazepam (Serax) at a dose smaller than is recommended. What would the nurse review to determine the reason for the reduced dose? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Client's age
2) Blood-urea-nitrogen level
3) Increased HbA1C
4) Liver function studies
5) White blood cell count

Question 32

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

Question 33

The nurse's client is prescribed medication for sleep, and the nurse is providing instruction on lifestyle changes that may influence the drug's effectiveness. What would be included in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Avoid caffeine.
2) Reading on computer screens may help induce sleep.
3) Limit alcohol intake.
4) Exercise before bedtime.
5) Limit the intake of green leafy vegetables.

Question 34

A client who recently returned from duty in Iraq is diagnosed with post-traumatic stress disorder (PTSD). The client's family questions what this means. How should the nurse respond to the family?
1) "The client might experience sweating, increased heart rate, and blushing when asked to speak to an audience."
2) "Whenever in an enclosed, small space, the client might experience an attack of sweating, racing heart, shortness of breath, and trembling."
3) "The client might experience nightmares, hallucinations, or flashbacks, accompanied by a racing heart, sweating, shortness of breath, and trembling."
4) "It might be common for the client to repetitively wash his hands over and over without apparent reason."

Question 35

Which of the following assessment findings would cause the nurse to withhold a scheduled dose of secobarbital? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Respiratory rate of 8 breaths per minute
2) Heart rate of 98 beats per minute
3) Blood pressure 95/62 mmHg
4) Temperature 99.8ºF
5) Pain level 5 on numeric pain scale

Question 36

A nursing instructor asks her student why benzodiazepines are more commonly used for anxiety and insomnia. Which statement by the student indicates the need for clarification?
1) " Withdrawal from barbiturates is severe and can be fatal."
2)"They have less severe side effects when given orally."
3) "They produce less physical dependance than other drugs in their class."
4) "Larger doses can be used for anaesthesia."

Question 37

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? Standard Text: Select all that apply.
1) "Ginger root is commonly taken to improve sleep."
2) "Ginkgo is an herb commonly taken to improve sleep."
3) "Diphenhydramine (Benadryl) is an OTC drug sometimes taken to produce drowsiness."
4) "Valerian and melatonin are natural health products commonly taken to improve sleep."
5) "Kava is an herb taken to improve sleep."

Question 38

A client is prescribed a medication for anxiety that will affect the limbic system. When instructing the client, the nurse explains that this medication will affect which areas? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Emotions
2) Behaviour
3) Long-term memory
4) Secretion of corticotropin-releasing factor
5) Production of melatonin

Question 39

The nurse is preparing to administer intravenous lorazepam (Ativan) to a client. Which nursing intervention is a priority following the parenteral administration of this medication?
1) Assess for drug interactions with other medications.
2) Instruct client to change positions slowly, especially from lying to standing.
3) Monitor for changes in respirations.
4) Assess for seizure activity.

Question 40

A client is taking verapamil for hypertension, Glucotrol for management of type II diabetes, and melatonin for sleep. Which question should the nurse ask about these medications?
1) "How is the melatonin helping you with sleep?"
2) "How long have you been taking the verapamil for blood pressure control?"
3) "What was the result of your last hemoglobin A1C level?"
4) "What was your blood pressure before you began taking the verapamil?"

Question 41

MCSA A nurse is conducting a health history and physical on a client who has been ordered phenelzine (Nardil) an MAO inhibitor. She has tried other antidepressants in the past but they have not been effective in treating her symptoms. What does the nurse uncover during her history that should be reported to the health care provider?
1) Client has a history of heart failure
2) Client has had colon cancer
3) Client has osteoporosis
4) Client has an eating disorder

Question 42

A client taking amitriptyline (Elavil) for two weeks tells the nurse that the medication "isn't working" because feelings of depression continue. Which response by the nurse is the most appropriate?
1) "This might not be the best medicine for you; I'll call your doctor."
2) "You might still feel depressed, but you are looking much better."
3) "It is working, but it can take several months to have an effect."
4) "It is working, but it can take several weeks to have an effect."

Question 43

Mood disorders are closely associated with which part of the brain?
1) Limbic
2) Hippocampus
3) Hypothalamus
4) Brainstem

Question 44

A client with depression is to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask?
1) "Are you allergic to any medications?"
2) "How long have you been depressed?"
3) "Have you had any thoughts about killing yourself?"
4) "How much alcohol do you consume during the week?"

Question 45

The client asks the nurse why she needs to continue using table salt, because her prescribed lithium (Carbolith) is a salt. What is the best response by the nurse?
1) "You must continue to use salt to avoid lithium (Carbolith) toxicity. If you use sea salt, you don't need as much."
2) "You must use table salt or your kidneys will retain lithium (Carbolith), and you will become toxic."
3) "Salt is very important to avoid lithium (Carbolith) toxicity, but not as important as drinking 1 to 1.5 L of water per day."
4) "The amount is not important; just increase your table salt if you notice signs of lithium (Carbolith) toxicity."

Question 46

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

Question 47

A client with bipolar disorder in the manic phase is started on lithium (Carbolith). The client's current lithium level is 0.4 mEq/L. What will the nurse expect to assess in this client?
1) A return to baseline behaviour: calm and rational
2) Signs and symptoms of depression
3) Hyperactivity and pressured speech
4) A decrease in manic behaviour

Question 48

A mother expresses concern that her school-age child may need to be started on medication for ADHD. Which statements by the mother does the nurse interpret as a potential indicator of ADHD?
1) "When I ask him to do his chores, he finishes his game before he starts."
2) "His teacher says that he isn't able to complete assignments that require him to sit and write for 5 to10 minutes at a time. He doodles on his paper or badgers others in the classroom instead of working on his assignment."
3) "In the last month, he has twice forgotten to ask me to give him his lunch money for the day."
4) "When I tell him to clean his room, he doesn't clean under furniture or dust his furniture.

Question 49

Which medication, when administered with lithium, increases the risk of toxicity?
1) Ciprofloxacin
2) Sodium bicarbonate
3) Calcium iodine
4) Furosemide

Question 50

The nurse is instructing a client on the cause of bipolar disorder. Which neurotransmitters will the nurse describe as contributing to the manic phase of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Excessive glutamate
2) Excessive norepinephrine
3) Deficiency of gamma-aminobutyric acid
4) Deficiency of dopamine
5) Excessive serotonin

Question 51

Methylphenidate (Ritalin) has been prescribed for a school-age client newly diagnosed with ADHD. Which comment by the mother would indicate that the nurse should provide more teaching about this medication?
1) "I will give this medication in the evening after meals to decrease stomach upsets."
2) "I will monitor my child's appetite and watch for excessive weight loss."
3) "I will give him a drug free holiday in the summertime."
4) "I will give this medication early in the day in order to reduce chances of insomnia."

Question 52

The nurse has completed medication education for a client about to begin therapy with phenelzine (Nardil). The nurse evaluates the education as effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I can't eat fried chicken and gravy."
2) "I'll have to give up my beer at the football games."
3) "I really shouldn't eat at a restaurant; too many foods are on my restricted list."
4) "I am not supposed to have processed meats or cheese."
5) "I am really going to miss my morning coffee and sweet roll."

Question 53

MCSA A student is about to administer an MAO inhibitor to her client. Her instructor asks her to identify it's mechanism of action. What is the correct response of the student ?
1) "It inhibits norepinephrine re-uptake."
2) " It Inhibit norepinephrine, serotonin, and dopamine reuptake."
3) " It's the enzyme that terminates the actions of neurotransmitters."
4) " It inhibits the amino acid tyranine.

Question 54

A client, prescribed fluoxetine (Prozac) for anxiety and depression, reports experiencing delayed ejaculation since being on this medication. Which response by the nurse is the most appropriate?
1) "I am concerned that you will become suicidal if you stop the medication."
2) "Keep taking the medicine, as this usually goes away after a few months."
3) " We should discuss this with your physician."
4) "This does happen, but treating your depression is a bigger priority."

Question 55

The nurse is caring for a client receiving electroconvulsive therapy (ECT). What is the priority assessment for this client?
1) Orientation
2) Level of consciousness
3) Airway
4) Vital signs

Question 56

Which of the following symptoms would be assessed in a client in a manic phase of bipolar disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Not sleeping
2) Losing weight
3) Sluggish activity
4) Complaints of muscle pain
5) Constant talking

Question 57

Mood disorders are emotional disorders characterized by changes in mood, and they range from mania to depression. Which symptoms characterize major depressive disorder?
1) Fatigue and decreased appetite
2) Anxiety and elevated mood
3) Low mood and increased activity
4) Psychosis and euphoria

Question 58

The nurse educator is conducting class on depression. Which of the following statements by a student indicates an understanding of the pathophysiology?
1) "May involve an excess of excitatory neurotransmitters ."
2) "Low level of neurotransmitters in the limbic region are a possible cause of depression."
3) " Low serum cortisol levels may be responsible for depression"
4) " The re-uptake of neurotransmitters are inhibited"

Question 59

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?
1) "Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter."
2) "Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania."
3) "Bipolar disorder is just another type of depression, except your depression occurs in cycles."
4) "Bipolar disorder is a type of depression that includes attention deficit disorder symptoms."

Question 60

A client diagnosed with depression has been placed on imipramine ( Impril). What would the nurse most likely assess if the client experiences adverse effects of this medication?
1) Various anemias accompanied by bradycardia
2) Hypertension with severe emesis
3) Dizziness accompanied by possible photosensitivity
4) Polyuria with gross proteinuria

Question 61

A client is prescribed thiothixene (Navane) and is experiencing muscle spasms of the neck. The client is grimacing and having difficulty speaking. Which action should the nurse take?
1) Call the health care provider and prepare to give chlorpromazine (Thorazine) IM.
2) Distract the client to confirm the client is not faking a muscle spasm.
3) Call the health care provider and prepare to give Benztropine.
4) Anti-inflammatories and heat to the neck will alleviate symptoms.

Question 62

A client prescribed haloperidol (Haldol) is not demonstrating an improvement of psychotic behaviour after taking the medication for 5 days. What changes in his treatment regime would the nurse expect?
1) No changes are necessary.
2) The dose will be increased.
3) The drug will be discontinued.
4) Xanax might be added to improve behaviour.

Question 63

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Measure the client's height and weight.
2) Assess vital signs, especially heart rate and BP.
3) Obtain labs to assess cardiovascular status.
4) Obtain a fasting blood glucose.
5) Obtain a 24-hour urine collection for proteinuria.

Question 64

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "All the drugs used to treat ADHD are basically the same."
2) "Children often have severe reactions to ADHD drugs and have their therapy changed."
3) "The choice of drug can be guided by different dosing schedules."
4) "Some children just do better on one drug or the other."
5) "Girls don't respond to medications as well as boys."

Question 65

An adult client who is seen by the primary care provider for complaints of inability to focus and concentrate on college studies is prescribed methylphenidate (Ritalin). Which client comment indicates that the nurse should provide additional information about the drug?
1) "I'll wait until I've taken the medication a few days before driving."
2) "I'll call the doctor immediately if I become jaundiced."
3) "It would be nice if my appetite were decreased with this medication, as I've been wanting to shed a few pounds."
4) "I'll take the drug in the evening before bedtime."

Question 66

What should the nurse teach a client about obtaining prescribed central nervous system stimulant medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Have the health care provider call the prescription in to a pharmacy that knows your health history.
2) The prescription can be filled only at a pharmacy especially licensed to dispense these drugs.
3) There must be a new prescription written each time additional medication is needed.
4) Ask the pharmacy to pre-certify the number of refills indicated on the prescription form.
5) Extra rules apply to the dispensing of these drugs because of their abuse potential.

Question 67

A client was prescribed chlorpromazine four weeks ago to treat symptoms of schizophrenia. The client's family has noted only a small improvement in symptoms and asks about changing to another treatment. Which response by the nurse is the most appropriate?
1) "The client will need to see a psychotherapist in conjunction with the medication."
2) "It might take 6-8 weeks to see definite improvement in most symptoms."
3) "It might take 8-12 weeks to begin seeing improvement on this therapy."
4) "There should have been improvement within 1-2 weeks."

Question 68

A nurse is developing the initial care plan for a client who is prescribed a central nervous system stimulant for the treatment of ADHD. Which nursing diagnoses will most likely be a part of this care plan? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Family Processes, Interrupted
2) Development: Delayed, Risk for
3) Sleep Pattern, Disturbed
4) Gas Exchange, Impaired
5) Nutrition, Imbalanced: Less than Body Requirements

Question 69

A client with a history of benign prostatic hyperplasia is beginning treatment for schizophrenia. Which medication would be contraindicated for this client?
1) Pimozide (Orap)
2) Chlorpromazine
3) Aripiprazole (Abilify)
4) Haloperidol (Haldol)

Question 70

The nurse is preparing discharge instructions for a client being treated with medication and psychotherapy for schizophrenia. What priority should the nurse address with the client prior to discharge?
1) The client smokes 1-3 cigarettes per day.
2) The client drinks 1-3 beers before bedtime per day.
3) The client likes to eat grapefruit for breakfast.
4) The client drinks 1-3 caffeinated sodas per day.

Question 71

A school-age client comes to the clinic for routine follow-up after being placed on Methylphenidate (Ritalin) 2 weeks ago for a diagnosis of ADHD. The client weighed 15 pounds over normal for height prior to the start of the Ritalin. The mother states concern that the client is no longer snacking, barely finishes meals, and "will lose too much weight." What is the nurse's best response to this concern?
1) "Make an appointment each week for us to monitor against too much weight loss."
2) "It is normal for clients to lose weight when taking Ritalin."
3) "The diminished appetite may reduce. Begin by offering small, frequent meals, continue to monitor weight loss."
4) "The Ritalin will help the client to return to normal weight for his height."

Question 72

A student nurse is about to administer her client aripiprazole (Abilify) to treat both the positive and negative symptoms of schizophrenia. What will the student nurse inform her instructor is the medication's mechanism of action?
1) Increasing norepinephrine activity by blocking its synaptic re-uptake
2) Partial agonist activity at dopamine type 2 (D2 and D3) and serotonin type 2
3) Inhibiting the re-uptake of serotonin at the synapse
4) Binding to the GABA receptor

Question 73

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I will talk with the school nurse about administering a dose at about noon each day."
2) "We should fold the patch with the medication side facing in before it is thrown in the garbage."
3) "We should not expect physical dependence at the low dose given for ADHD."
4) "We can expect that the health care provider will occasionally tell us to stop giving the medication for a few days."
5) "If our child experiences loss of appetite, we should immediately contact the health care provider."

Question 74

MCSA Nursing students have completed their module on pharmacology for Attention Deficit/Hyperactivity Disorder. What statement by a student indicates an understanding of the actions of a CNS stimulant?
1) "They work by activating the reticular activating system increasing focus and awareness."
2) "They Inhibit the neurotransmitters norepinephrine, dopamine, and serotonin."
3) "They are an alpha2 agonist that decreases sympathetic tone."
4) " They Selectively inhibit norepinephrine re-uptake."

Question 75

A client who was prescribed thioridazine 2 days ago presents with muscle spasms of the tongue. The health care provider orders diphenhydramine Benztropine. What is the rationale for this medication?
1) To decrease saliva and mucous secretions
2) To reverse the acute dystonia
3) To prevent anaphylaxis
4) To sedate the client

Question 76

A client recently prescribed methylphenidate (Ritalin) for treatment of ADHD complains of an inability to go to sleep at night. Which nursing actions are indicated? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Assess for caffeine intake, especially late in the afternoon or evening hours.
2) Assess for time of day that Ritalin is taken.
3) Assess for nonpharmacologic measures taken to induce sleep.
4) Inform the health care provider that the client is unable to fall asleep while taking Ritalin.
5) Suggest taking melatonin to assist in nighttime drowsiness.

Question 77

An infant in the neonatal intensive care unit is prescribed caffeine IV as treatment for apnea. Which medical orders should the nurse plan for, based on the addition of this medication? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Blood glucose measurements every 2 hours
2) Bilirubin measurement daily
3) Seizure precautions
4) Deep tendon reflex monitoring every 4 hours
5) Skin assessment every 4 hours

Question 78

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? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I'm so glad that the doctor chose a medication that won't make my child sleepy."
2) "I think my dad takes that for his high blood pressure."
3) "I can expect that the doctor will take my child off this medication for a few days every 6 months or so."
4) "I must warn my parents that Dad's clonidine cannot be substituted for the Catapres."
5) "At least my child will not become addicted to this medication."

Question 79

MCSA A young mother asks the nurse, why her son is being ordered atomoxetine instead of Ritalin to treat his ADHD. How does the nurse respond to this question?
1) "It is an equally effective drug with less side effects."
2) "It is a scheduled drug so it has improved safety."
3) "It can be given as a patch once weekly."
4) " It is similar to medications used to treat hypertension."

Question 80

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Feeling sedated all the time
2) Significant weight gain
3) Agitation
4) Fatigue and headache
5) Lack of desire to consume alcohol