Question 1

Which drug to manage multiple sclerosis should be avoided by patients who also have epilepsy?

Accepted Answer

Dalfampridine (also known as 4-aminopyridine) should be avoided by patients who also have epilepsy as it can increase the risk of seizures. The other options (A, B, and D) do not have a significant interaction with epilepsy.

Question 2

Which symptoms in a patient taking levodopa for Parkinson disease indicate the drug is "wearing off?" (Select all that apply.)

Accepted Answer

When levodopa is "wearing off," symptoms of Parkinson's disease such as difficulty swallowing, increased tremors, and a slower gait may re-emerge or worsen.

Question 3

Why is intramuscular (IM) injection of phenytoin avoided?

Accepted Answer

Phenytoin is very irritating to the tissues and can cause tissue damage at the injection site if given intramuscularly. It is recommended to administer the drug slowly through a large vein using an intravenous infusion whenever possible.

Question 4

What is the most important precaution to teach patients taking any monoclonal antibody or neurologic drug to manage multiple sclerosis?

Accepted Answer

Patients taking monoclonal antibodies or neurologic drugs to manage multiple sclerosis may have weakened immune systems, which makes them more susceptible to infections. Therefore, avoiding crowds and people who are sick is crucial in preventing infections. Option B is applicable for drugs that cause photosensitivity or skin reactions, which is not typically associated with monoclonal antibodies or neurologic drugs used for multiple sclerosis. Option C and D are not specific to the management of multiple sclerosis with these drugs.

Question 5

When admitting a new patient with Alzheimer's to a memory unit of a long-term care facility, you note that she is prescribed both memantine and rivastigmine. What is your best action?

Accepted Answer

Memantine and rivastigmine work through different mechanisms to manage Alzheimer's disease symptoms and can be prescribed together to provide a synergistic effect. Therefore, giving both drugs as prescribed is appropriate.

Question 6

A family member of a patient using the rivastigmine patches reports that the patient keeps taking the patches off his chest. Where will you suggest the family member apply the patches to avoid this problem?

Accepted Answer

The upper or lower back would be the best choice for applying the rivastigmine patches as it is a location that the patient is less likely to reach and remove the patch. Applying the patch on the forehead may cause irritation to the skin and may not be convenient for the patient to wear. Applying the patch on the buttocks may also be inconvenient for the patient as it may interfere with sitting or lying down. Applying the patch on the outer aspect of the thigh may be too easily accessible for the patient to remove. Therefore, the upper or lower back would be the best option.

Question 7

A patient in your long-term care facility is prescribed to receive a total of 24 mg of ropinirole daily in three divided doses. The drug on hand is ropinirole 4 mg/tablet. How many tablets will you give for one dose? _______

Accepted Answer

The answer of A patient in your long-term care facility...

Question 8

Which changes are most important to assess for in a patient who is taking topirimate for seizure control? (Select all that apply.)

Accepted Answer

The answer of Which changes are most important to assess...

Question 9

Why are carbidopa and levodopa usually given together?

Accepted Answer

Carbidopa enhances the action of levodopa, allowing less drug to be needed to achieve the desired effect. This reduces the risk of side effects. Therefore, carbidopa and levodopa are usually given together for the treatment of Parkinson's disease.

Question 10

A patient newly diagnosed with Parkinson disease is prescribed an oral dopamine agonist. Which precaution is most important to teach the patient and family about the timing for taking this drug?

Accepted Answer

It is important to take the dopamine agonist on an empty stomach 30 to 60 minutes before meals to allow for optimal absorption. If taken with food, especially high protein meals, it can interfere with the absorption and effectiveness of the medication. Timing the dose with symptoms or first thing in the morning may not be as crucial as taking it on an empty stomach.

Question 11

When assessing a patient before starting the first dose of a newly prescribed antiepileptic drug, what is the most important nursing action to perform?

Accepted Answer

Before starting a patient on a new antiepileptic drug, it's crucial to ask about all other medications the patient is taking. This is to avoid potential drug interactions, which can affect the efficacy of the antiepileptic drug or cause adverse effects.

Question 12

Which precaution is most important to tell parents of young children prescribed lamotrigine for epilepsy?

Accepted Answer

Lamotrigine can cause a potentially life-threatening rash known as Stevens-Johnson syndrome or toxic epidermal necrolysis. Parents should be instructed to watch for any development of rash and contact the healthcare provider immediately if one occurs. This is the most important precaution to be followed while on this medication. The other options are not specific to the medication and do not address the potential serious adverse effects of lamotrigine.

Question 13

Which neurotransmitter has an inhibitory action within the central nervous system?

Accepted Answer

Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter within the central nervous system. It works by binding to specific receptors on the postsynaptic membrane of neurons, causing an influx of chloride ions and hyperpolarization of the neuron, making it less likely to fire an action potential. This helps to regulate excitability and prevent excessive activity within the brain.

Question 14

When asking the family of a patient with Alzheimer's disease who takes the drug donepezil (Aricept) what other prescribed or over-the-counter drugs the patient takes, they list all the following drugs. Which one will you tell them to stop giving the patient?

Accepted Answer

Dextromethorphan can interact with donepezil and increase the risk of side effects such as confusion, dizziness, and difficulty breathing. Therefore, the patient should stop taking this medication. Aspirin, buspirone, and vitamin C do not have significant interactions with donepezil. However, it is always a good idea to check with the prescribing physician or pharmacist before adding or discontinuing any medication.

Question 15

When reviewing the preoperative laboratory results of a patient taking oxcarbazepine for seizure control, you note all of the following values. For which one will you notify the surgeon immediately?

Accepted Answer

A serum sodium level of 128 mEq/L is below the normal range of 135-145 mEq/L and may indicate hyponatremia, a potential complication of oxcarbazepine use. Hyponatremia can lead to neurological symptoms and an increased risk of complications during surgery, so the surgeon should be notified immediately. The white blood cell count and serum chloride level are both within normal range, while an INR of 0.9 is also within the therapeutic range for most surgeries.

Question 16

How does the drug tolcapone relieve the symptoms of Parkinson disease?

Accepted Answer

Tolcapone suppresses the activity of an enzyme called COMT that normally breaks down naturally occurring dopamine. By inhibiting this enzyme, tolcapone increases the amount of dopamine available for use in the brain, relieving the symptoms of Parkinson disease.

Question 17

A patient taking lacosamide tells you that he never forgets to take his prescribed doses because he feels so good and happy when he is on the drug. What is your best response?

Accepted Answer

It is important to remind the patient that increasing the dose or changes in the regimen must not be made without consulting their healthcare provider. It is essential to prevent any possible adverse effects that may arise from the medication.

Question 18

A patient is prescribed to receive memantine extended release (XR) 14 mg orally once daily. You have on hand memantine XR 7-mg capsule and memantine 28-mg capsule. What is the best way to ensure the patient gets a 14-mg dose?

Accepted Answer

The best way to ensure the patient receives a 14-mg dose is by giving them two 7-mg capsules every day, as this directly adds up to the prescribed 14 mg without altering the medication's formulation.

Question 19

When assessing a patient with Parkinson disease who takes a carbidopa/levodopa combination drug, you find that he now has almost constant muscle movements that look like uncoordinated dancing. What is your best action?

Accepted Answer

The described muscle movements are likely to be dyskinesia, a common side effect of long-term use of carbidopa/levodopa combination drugs. Holding the next dose and reporting the finding to the healthcare provider is the best action to prevent further worsening of dyskinesia. Option A is not enough as it does not address the potential harm of the medication side effect. Option C is not advisable as it may increase the risk of dyskinesia, and option D is not recommended as it may interact with the patient's medication and exacerbate symptoms.

Question 20

The healthcare provider orders valproic acid at 10 mg/kg orally every 12 hours. The patient weighs 160 lb. How many mg will you give for each dose? How many mg is the total daily dose? _______

Accepted Answer

The answer of The healthcare provider orders valproic acid at...

Quiz 9: Drug Therapy for Central Nervous System Problems