ATI Pharmacology Made Easy 5.0 - The Neurological System (Part 1) Test

A nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include?

A. Avoid driving until the medication's effects are evident.

B. Stop taking the medication immediately if headache occurs.

C. Take the medication as needed for spasticity.

D. Take the medication with antacids to reduce gastric effects.

ANSWER:

A. Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Clients taking the medication should avoid alcohol and other CNS depressants, and sholuld not drive a vehicle until they know how the medication will affect them.

INCORRECT:

B. Abrupt withdrawal of baclofen, a centrally-acting muscle relaxant, can cause seizures, fever, and hypotension. A better alternative is to treat the headache, which can have many other causes, and see if it resolves as medication therapy with baclofen continues.

C. Clients typically take baclofen, a centrally-acting muscle relaxant, daily at regular doses. Clients should start with a low dose and titrate up as tolerated.

D. Clients may take baclofen, a centrally-acting muscle relaxant, with food to help prevent nausea. They should take antacids, 1 hr before or 2 hr after other medications, including baclofen.

A nurse is teaching a client who is taking levodopa/carbidopa to treat Parkinson's disease. Which of the following instructions should the nurse include?

A. Expect eye twitching to develop with long-term therapy.

B. Eat a high-protein snack to increase absorption.

C. Take the medication at bedtime to avoid daytime drowsiness.

D. Change position slowly to prevent orthostatic hypotension.

ANSWER:

D. Levodopa/carbidopa can cause orthostatic hypotension.

INCORRECT:

A. Muscle twitching can indicate medication toxicity. This is an adverse effect clients should report.

B. High-protein foods can reduce the effective ness of levodpa/carbidopa. Gastric irritation can be alleviated by eating shortly after taking the medication but protein intake should be divided amongst all meals to avoid consuming foods high in protein at the same time the medication is taken.

C. Clients typically take levodopa/carbidopa in divided doses during the day.

A nurse is adminsitering fentanyl to a client to reduce pain. Which of the following medications should the nurse have available to reverse the effects of fentanyl?

A. Neostigmine

B. Succinylcholine

C. Naloxone

D. Dantrolene

ANSWER:

C. Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an opioid agonist, can cause severe respiratory depression. The nurse should also have resuscitation equipment available when administering fentanyl to a client.

INCORRECT:

A. Neostigmine, a cholinesterase inhibitor, reverses the effect of pancuronium, a nondepolarizing neuromuscular blocking agent.

B. Succinylcholine is a depolarizing neuromuscular blocking agent that will cause increased muscle relaxation.

D. Dantrolene is a skeletal muscle relaxant that treats malignant hyperthermia and spasticity.

A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects?

A. Chest pain

B. Polyuria

C. Joint pain

D. Insomnia

ANSWER:

A. Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. CLients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for clients who have a history of coronary artery diseas.

INCORRECT:

B. Sumatriptan, a serotonin agonist, is unlikely to cause polyuria. Lithium carbonate can cause polyuria.

C. Sumatriptan, a serotonin agonist, is more likely to cause muscle pain than joint pain.

D. Sumatriptan, a serotonin agonist, is unlikely to cause insomnia. It can cause drowsiness and sedation.

A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the client but should be aware that a medication interaction between selegiline and meperidine can result in which of the following?

A. Frequent urination

B. Jaundice

C. Cellulitis

D. Muscle rigidity

ANSWER:

D. An interaction between selegiline and opioids, especially meperidine, can result in rigidity, stupor, agitation, hypertension, and fever.

INCORRECT:

A. An interaction between selegiline and meperidine is unlikely to result in frequent urination, which can indicate a urinary tract infection and glucose intolerance.

B. An interaction between selegiline and meperidine is unlikely to result in jaundice. Liver toxicity is a serious adverse effect of dantrolene and many anticonvulsants, such as valproic acid.

C. An interaction between selegiline and meperidine is unlikely to result in oral ulcers. Skin inflammation is a serious adverse effect of some anticonvulsants, such as phenytoin.

A nurse is caring for a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects?

A. Cardiac excitability

B. Respiratory depression

C. Hyperthermia

D. Hypertension

ANSWER:

B. Methohexital, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for clients receiving the medication.

INCORRECT:

A. Methohexital, a short-acting barbiturate, can cuse cardiovascular depression. It is essential to have resuscitation equipment available whenever clients receive the medication.

C. Methohexital, a short-acting barbiturate, is more likely to cause hypothermia than hyperthermia.

D. Methohexital, a short-acting barbiturate, poses a significant risk for hypotension, not hypertension.

A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include?

A. Increase fluid intake to improve renal excretion.

B. Report memory loss or confusion.

C. Watch for manifestations of liver impairment, such as jaundice and abdominal pain.

D. Avoid taking over-the-counter antacids.

ANSWER:

D. Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity.

INCORRECT:

A. It is not necessary to increase fluids. Memantine is essentially unchanged when it is excreted in the urine. Therefore, it is not necessary to increase fluids because fluid intake does not affect this process.

B. Clients who have Alzheimer's disease already have and will continue to have memory loss and confusion. The drug help slow the progressive decline but will not eliminate the disease's manifestations.

C. Memantine should not result in liver impairment, although it should be used cautiously with clients who have severe liver impairment.

A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects? Select all that apply.

A. Hirsutism

B. Drowsiness

C. Headache

D. Ataxia

E. Rash

ANSWER:

B. Clients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these adverse effects can indicate the need for a reduction in dose.

C. Valproic acid can cause headache, along with other CNS depressant effects, such as sleep disturbances.

E. Skin rash is an adverse effect of valproic acid and other antiepileptic medications.

INCORRECT:

A. Valproic acid is more likely to cause hair loss rather than hirsutism, or excessive hair growth.

D. Ataxia is an adverse effect of phenytoin and carbamazepine, which are drugs used to treat seizure disorders.

A nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of the following instructions should the nurse include?

A. Take the medication 30 min before bedtime.

B. Take the medication in the morning.

C. Anticipate daytime drowsiness.

D. Expect urinary frequency.

ANSWER:

B. Modafinil is a nonamphetamine stimulant. Taking it in the morning helps improve wakefulness for clients who have narcolepsy. Clients taking the medication for shift-work sleepiness should take it 1 hr before work.

INCORRECT:

A. Modafinil is a nonamphetamine stimulant. Evening dosage can cause insomnia. Zolpidem is a medication clients should take just before bedtime to improve sleep and to prevent daytime drowsiness.

C. Modafinil is a nonamphetamine stimulant that promotes wakefulness. It is unlikely to cause daytime drowsiness. Eszopiclone is a drug that can cause daytime drowsiness.

D. Modafinil is a nonamphetamine stimulant. It is unlikely to cause urinary frequency, but it can cause diarrhea.

A nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these medications?

A. Hyperammonemia

B. Phenytoin toxicity

C. Hypertension

D. Peptic ulcer disease

ANSWER:

B. Valproic acid can cause an increase in phenytoin blood levels, resulting in phenytoin toxicity. The nurse should monitor serum phenytoin levels and notify the provider if levels begin to exceed the therapeutic range.

INCORRECT:

A. Hyperammonemia is unlikely to result from a medication interaction between valproic acid and phenytoin. Taking valproic acid with topiramate, however, can increase the risk of excess ammonia in the blood.

C. Hypertension is unlikely to result from a medication interaction between valproic acid and phenytoin. Phenytoin does have CNS depressive effects and can cause hypotension, especially when administered via IV.

D. Peptic ulcer disease is unlikely to result from a medication interaction between valproic acid and phenytoin. Taking cimetidine with phenytoin, however, can increase phenytoin levels.

A nurse is caring for a client who has been taking amphetamine/dextroamphetamine sulfate for the treatment of attention deficit hyperactivity disorder (ADHD) for 2 weeks. The nurse should report which of the following to the provider?

A. Weight loss of 2.3 kg (5 lb)

B. Blood pressure 110/70 mm Hg

C. Heart rate 80/min

D. Respiratory rate 16/min

ANSWER:

A. Amphetamine/dextroamphetamine sulfate can cause a decreased appetite and weight loss. The nurse should instruct the client to weigh themself twice weekly and report unintended weight loss.

INCORRECT:

B. This blood pressure is within the expected reference range and does not warrant reporting to the provider. The nurse should report hypertension or hypotension as a adverse effects of thie medication.

C. This heart rate is within the expected reference range and does not warrant reporting to the provider. The nurse should report tachycardia, or an elevated heart rate.

D. This respiratory rate is within the expected reference range and does not warrant reporting to the provider. The nurse should monitor the client's respiratory rate periodically during therapy and report any abnormalities.

A nurse is teaching a client who has a prescription for carbamazepine. Which of the following instructions should the nurse include to help the client avoid adverse effects of this medication?

A. Begin taking the medication at a low doage.

B. Discontinue the medication immediately if diarrhea occurs.

C. Have serum glucose levels checked regularly.

D. Take the medication on an empty stomach.

ANSWER:

A. Visual disturbance, vertigo, and ataxia can result from taking carbamazepine, a drug that treats seizure disorder. Dosage should be low to minimize or prevent these adverse effects.

INCORRECT:

B. As with any medication that controls seizures, stopping it abruptly can make seizure activity return and possibly even trigger status epileptics. Carbamazepine can cause diarrhea. If diarrhea does develop, a better alternative is to treat the diarrhea and see if it resolves as medication therapy with carbamazepine continues.

C. Carbamazepine is not likely to alther glucose levels. It can, however, alter liver function.

D. Taking carbamazepine with meals can help prevent GI upset and can enhance absorption.

A nurse is providing teaching for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects?

A. Hirsutism

B. Jaundice

C. Depression

D. Gum irritation

ANSWER:

B. Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. Clients taking the drug should report these manifestations, and the nurse should monitor liver function studies prior to treatment and periodically during therapy.

INCORRECT:

A. Valproic acid is unlikely to cause hirsutism, or excessive hair growth, but it can cause transient hair loss.

C. Valproic acid is unlikely to cause depression, but it can cause aggression.

D. Valproic acid is unlikely to cause gum irritation. Phenytoin can cause gingival hyperplasia.

A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how levodopa/carbidopa can help control manifestations. The nurse should identify that the medication has which of the following pharmacologic effects?

A. Increase available acetylcholine in the brain.

B. Inhibits norepinephrine metabolism in the brain.

C. Inhibits serotonin metabolism in the brain.

D. Increases available dopamine in the brain.

ANSWER:

D. Levodopa/carbidopa, a dopamine agent, can increase dopamine in the extrapyramidal center of the brain, reducing involuntary motion, or tremors, associated with Parkinson's disease.

INCORRECT:

A. Anticholinergics treat Parkinson's disease by decreasing available acetylcholine in the extrapyramidal system of the brain.

B. Levodopa/carbidopa relieves tremors associated with Parkinson's disease by converting to dopamine in the brain and serving as a neurotransmitter. Altered levels of cerebral norepinephrine can correlate with depression.

C. Levodpa/carbidopa relieves tremors associated with Parkinson's disease by converting to dopamine in the brain and serving as a neurotransmitter. Altered level of cerebral serotonin can correlate with depression.

A nurse is caring for a client who has a new prescription for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects?

A. Hypotension

B. Tinnitus

C. Tachycardia

D. Bronchospasm

ANSWER:

C. Amphetamine sulfate is an amphetamine stimulant. It can cause tachycardia and dysrhythmias. The client should notify the nurse if they develop palpitations or chest pain.

INCORRECT:

A. Amphetamine sulfate is an amphetamine stimulant. It is more likely to cause hypertension rather than hypotension.

B. Amphetamine sulfate is an amphetamine stimulant. It is unlikely to cause tinnitus, but it can cause irritability and insomnia.

D. Amphetamine sulfate is an amphetamine stimulant. It is unlikely to cause broncospasm, but it can cuse diarrhea and nausea. Taking the medication with food can help reduce these effects.

A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests requires monitoring?

A. C-reactive protein

B. Creatinine clearance

C. Thyroid function

D. CBC

ANSWER:

B. Pramipexole, a direct-acting dopamine receptor agonist, should be used with caution for clients who have renal disease. Therefore, the nurse should monitor the client's renal function.

INCORRECT:

A. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter C-reactive protein. Pravastatin is a medication that alters C-reactive protein in a beneficial way by helping to lower the risk of heart disease.

C. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter thyroid function. Amiodarone is a medication that can alter thyroid function.

D. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter CBCs. Interferon beta-1b, an immunomodulator, can cause myelosuppression and warrants monitoring of CBCs periodically.

A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the medication and notify the provider?

A. Pancreatic cancer

B. Hypotension

C. Cirrhosis

D. Osteoporosis

ANSWER:

C. Memantine should be used cautiously in clients who have severe hepatic impairment. The nurse should contact the provider about the client's history of cirrhosis to see if laboratory testing is required before starting the medication or if the dosage needs to be adjusted.

INCORRECT:

A. A past diagnosis of pancreatic cancer does not affect the administration of memantine. Memantine should be used cautiously in clients who have severe renal impairment.

B. Memantine can cause hypertension. Therefore, it is not contraindicated foe a client who has hypotension.

D. Osteoporosis has no effect on the administration of memantine. Taking medication that alter the pH of the urinary tract can be a cause for cautious administration.

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should instruct the client to report which of the following adverse effects?

A. Slow heart rate

B. Cough

C. Diarrhea

D. Hearing loss

ANSWER:

C. Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea, nausea, and vomiting are adverse effects of dantrolene. The client should report these effects so the nurse can monitor fluid balance and intervene accordingly.

INCORRECT:

A. Dantrolene is amore liekly to cause tachycardia than bradycardia.

B. Dantrolene is unlikely to cause a cough, but it can cause difficulty swallowing.

D. Dantrolene can cause blurred vision, but it is unlikely to cause hearing loss.

A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor?

A. Confusion

B. Dry mouth

C. Double vision

D. Nausea

ANSWER:

D. The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking donepezil with food can help minimize adverse effects.

INCORRECT:

A. Donepezil, a cholinesterase inhibitor, can improve memory and reduce confusion.

B. Muscarinic antagonists, not donepezil, can cause dry mouth.

C. Donepezil, a cholinesterase inhibitor, is more likely to cause blurred vision than double vision.

A nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug?

A. "Take the medication with food."

B. "Premedicate with acetaminophen."

C. "Increase your fluid intake."

D. "Take the medication in the morning."

ANSWER:

B. Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen can help minimize these manifestations.

INCORRECT:

A. The routes of administration of interferon beta medications are parenteral (IM and subcutaneous).

C. Increasing fluid intake will not help relieve the adverse effects of interferon beta medications.

D. Evening administration of interferon beta medications ensures that flu-like adverse effects, such as muscle aches, stiffness, and malaise, will occur while the client is sleeping.

A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that which of the following findings indicates a potenital serious adverse effect of this medication?

A. Tinnitus

B. Twitching eyelids

C. Blue-green skin discoloration

D. Fatigue

ANSWER:

D. The nurse should identify that potential serious adverse effects of interferon beta-1b include unexplained bruising, bleeding, and fatigue. Clients should report these adverse effects to their provider immediately because they can indicate bone marrow suppression and decreased platelet count.

INCORRECT:

A. Tinnitus is not a typical adverse effect of interferon beta-1b. However, tinnitus is common with aspirin therapy.

B. Eyelid and muscle twitching can be a manifestation of toxicity caused by some anticonvulsants. It is not a typical adverse effect of interferon beta-1b.

C. Interferon beta-1b does not cause skin, sclera, or urine to turn a blue-green color. This is an adverse effect of amphetamine/dextroamphetamine sulfate.

A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include?

A. Monitor for constipation

B. The dosage will be increased weekly to provide optimum therapeutic effect.

C. Administering the medication first thing in the morning promotes effectiveness.

D. Avoid the use of NSAIDs for pain.

ANSWER:

D. Combining NSAIDs with donepezil can cause gastrointestinal bleeding. Therefore, the nurse should instruct the client's family to avoid the use of NSAIDs.

INCORRECT:

A. Donepezil can cause diarrhea, not constipation. The family should also monitor for and report nausea, anorexia, and vomiting.

B. Donepezil dosages are only increased after 1 to 3 months of taking the initial dose to minimize adverse effects.

C. Donepezil should be taken immediately before going to bed because it causes drowsiness and dizziness.

A nurse in a clinic is caring for a client who has multiple sclerosis.

When evaluating the client's response to the prescribed muscle relaxant, the nurse should understand that the mechanism of action is to __________ at __________.

ANSWER:

alter intracellular calcium exchange; the muscle cells

When evaluating the client's response to the prescribed muscle relaxant, the nurse should recognize that the therapeutic effect of dantrolene, a peripherally acting muscle relaxant, results from its direct action to inhibit muscle contraction by preventing the release of calcium in skeletal muscles. Anticholinergic medications or muscarinic antagonists block acetylcholine at the neuromuscular junction. Centrally acting muscle relaxants relieve spasticity by interrupting nerve signals from the spinal cord. Cholinesterase inhibitors prevent eh breakdown of acetylcholine in cholinergic receptors. Traditional anti-seizure medications prevent soidum from entering neurons.

A nurse is caring for a client in a primary care provider's office.

Before the client leaves the office, the provider prescribes a new medication for the client to use for migraine headaches. Which of the following instructions should the nurse include when teaching the client about administration of their newly prescribed medication? Select all that apply.

A. Take the medication after onset of the migraine.

B. Allow the tablet to dissolve under the tongue.

C. Administer one nasal spray into each nostril.

D. Take it once per day to prevent migraine.

E. Repeat the dose if the headache returns.

ANSWER:

A. Take the medication after onset of the migraine.

E. Repeat the dose if the headache returns.

The client should use sumatriptan, a serotonin agonist for abortive therapy of migraine headaches after the onset of a migraine headache. They should spray the medication once into one nostril. They nay repeat the dose once, 1 hr after the initial doese by the intranasal route.

A nurse in a provider's office is caring for a client who has received a diagnosis of multiple sclerosis.

Which of the following findings should the nurse identify as possible adverse effects of the medication that has been prescribed? Select the 4 findings that the nurse should identify.

A. Platelet

B. ALT

C. Serum osmolality

D. WBC

E. Serum glucose

F. ECG

G. AST

ANSWER:

A. Platelet

B. ALT

D. WBC

G. AST

When identifying possible adverse effects caused by interferon beta-1a, the nurse recognizes that decreased WBC and platelets indicate myelosuppression, and increased ALT and AST indicate hepatotoxicity.