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Neuro Pharmacology Exam Questions And
Accurate Answers
An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? a. Carbidopa-levodopa (Sinemet) b. Donepezil (Aricept) c. Rivastigmine (Exelon) d. Tacrine (Cognex) - answer A ~ This patient is exhibiting signs of Parkinson's disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer's disease. A nursing student asks the nurse to differentiate the pathology of Alzheimer's disease from that of Parkinson's disease. Which description is correct? a. Alzheimer's disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimer's disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinson's disease involves increased dopamine production and decreased acetylcholine. - answer C ~ Parkinson's disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to exceed the inhibitory response of dopamine. Alzheimer's disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimer's disease. A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product a. allows larger doses of levodopa to be given without causing increased adverse
reactions. b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier. c. eliminates almost all drug side effects of both levodopa and carbidopa. d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system. - answer D ~ Without carbidopa, about 99% of levodopa is converted to dopamine before crossing the blood-brain barrier, causing peripheral adverse effects. When carbidopa is added, the enzyme decarboxylase is inhibited, allowing levodopa to cross into the brain before being converted to the active metabolite dopamine. The result is less levodopa required to achieve the desired effect. The drug still has many side effects, but the peripheral effects are lessened. A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication? a. Call your health care provider immediately if your urine or perspiration turn a dark color. b. Rise slowly from your bed or your chair to avoid dizziness and falls. c. Take the drug with foods high in protein to improve drug delivery. d. Discontinue the drug if you experience insomnia. - answer B ~ Carbidopa-levodopa can cause orthostatic hypotension, so patients should be taught to take care when getting out of bed or a chair. Darkening of the urine and perspiration is a harmless side effect. Patients should take the drug with low-protein foods to improve drug transport to the CNS. Carbidopa-levodopa should not be discontinued abruptly because rebound parkinsonism may occur; insomnia is an expected adverse effect of the drug, and the patient should report this effect to his or her health care provider. The nurse is teaching a patient who has Parkinson's disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching? a. I may experience urinary retention, dry mouth, and constipation. b. I may feel dizzy at first, but this side effect will go away with time. c. I should report nightmares and mental disturbances to my provider. d. I should take the drug with food to increase absorption. - answer D ~ Taking carbidopa- levodopa with food decreases absorption of the drug, although gastrointestinal distress
major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms. The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns that the patient receives cyclophosphamide (Cytoxan). The nurse knows that this patient is in which stage of MS? a. Acute attack phase b. Chronic, progressive phase c. End-stage phase d. Remission-exacerbation phase - answer B ~ Cyclophosphamide is used to treat MS patients who are in the chronic, progressive phase. A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (SATA) a. Bradycardia b. Rash c. Vomiting d. Fever e. Drooling f. Weakness - answer A, C, E, F ~ Bradycardia, drooling, and weakness can all occur with cholinergic crisis. An emergency department nurse cares for a client who experienced a spinal cord injury 1 hour ago. Which prescribed medication should the nurse prepare to administer? a. Intrathecal baclofen (Lioresal) b. Methylprednisolone (Medrol) c. Atropine sulfate d. Epinephrine (Adrenalin) - answer B ~ Methylprednisolone (Medrol) should be given
within 8 hours of the injury. Clients who receive this therapy usually show improvement in motor and sensory function. The other medications are inappropriate for this client. Which of the following statements are true regarding Baclofen and dantrolene sodium A. Baclofen and dantrolene sodium are prescribed to lessen muscle spasticity associated with MS. B. Baclofen and dantrolene sodium are prescribed to make muscles contraction occur with MS. C. Baclofen and dantrolene sodium are prescribed to make people - answer Baclofen and dantrolene sodium are prescribed to lessen muscle spasticity associated with MS. A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol). Which statement should the nurse include in this clients discharge teaching? a. Take warm baths to promote muscle relaxation. b. Avoid crowds and people with colds. c. Relying on a walker will weaken your gait. d. Take prescribed medications when symptoms occur. - answer B ~ The client should be taught to avoid people with any type of upper respiratory illness because these medications are immunosuppressive. Warm baths will exacerbate the clients symptoms. Assistive devices may be required for safe ambulation. Medication should be taken at all times and should not be stopped. Which neurotransmitter is deficient in Parkinson's? a. Dopamine b. GABA c. Epinephrine d. Norepinephrine - answer A. Dopamine
The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson's disease asks the nurse what, besides medication, can be done to manage the disease? Select all Recommend exercise Recommend seeking a new doctor nutritional counseling let her cope alone for a few days add foods rich in calcium group support - answer Recommend exercise, nutritional counseling, and group support to help manage the disease. A patient who has Parkinson's disease is being treated with anticholinergic medication benztropine (Cognetin). The nurse will tell the patient that this drug will have which effect? Reduction of s/s reduction of tremors sedition increase focus - answer Reduction of tremors The nurse is preparing to administer a first dose of benztropine (Cognetin) to a patient diagnosed with Parkinsonism. The nurse would notify the patients provider if the patient had a history of which condition? Heart Failure Stroke
HTN
Glaucoma - answer Glaucoma The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat Parkinsonism. The patient reports having dry mouth, and the nurse notes a urine output of 300mL in the past 8 hours. Which action will the nurse perform? Do nothing that's with in normal limits start insertion of a foley contact the health care provider for further instruction pretend you never checked the I/o - answer Contact provider A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication would the nurse expect the provider to order for this patient to replace carbidopa-levodopa? Bromocriptine mesylate (Parlodel) Donepezil Galantamine - answer Bromocriptine mesylate (Parlodel) A patient who has Parkinsonism will begin taking Selegiline HCL (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? Avoid eating foods high in fiber
b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors. - answer Inhibits Cholinesterase The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug a. acts on muscarinic receptors. b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors. - answer Acts on muscarinic receptors because there are receptors on various organs of the body. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure. - answer Hold the medication and notify the provider of the decreased blood pressure The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patients blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects.
b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider. - answer Record the urine output and the blood pressure and continue to monitor. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. Excessive sweating is a normal reaction to this medication. b. Excess salivation is a serious side effect. c. I should get out of bed slowly while taking this drug. d. I will not take the drug if my heart rate is less than 60 beats per minute. - answer Excessive sweating is a normal reaction to this medication. Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection - answer ANS: A This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction. The nurse is preparing to administer the anticholinergic medication benztropine
their actions to decrease gastric secretions and gastrointestinal spasms. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimers disease? a. Ambenonium chloride (Myletase) b. Benztropine (Cogentin) c. Donepezil HCl (Aricept) d. Neostigmine methylsulfate (Prostigmin) - answer ANS: C Donepezil is used to treat Alzheimers disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinsons disease. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patients bladder. d. Reassess the patient in 15 minutes. - answer ANS: C Atropine can cause urinary retention. The patients urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration. A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin)
c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan) - answer ANS: A Atropine is used to treat bradycardia caused by vagal stimulation.
- Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils - answer ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs. What are the 5 antidepressant groups? - answer SSRI SNRI MAOI Tricyclic Atypical What are some suicidal risks with antidepressants Select all that apply A. suicidality
syndrome: increased heart rate, sweating, dilated pupils, tremors, twitching, hyperthermia, agitation, confusion, disorientation, hallucinations Rare and life-threatening event Treatment of cardiac toxicity Select all A. gastric lavage B. ingestion of charcoal C. isopropanol D. intravenous sodium bicarb E. atropine - answer Gastric lavage, Ingestion of charcoal, Sodium bicarb With MAOI-can produce Neuroleptic malignant syndrome which is a life threatening idiosyncratic reaction to antiphychotic drugs characterized by Select all a. Fever b. Altered mental status c.muscle rigidity, and autonomic d. dysfunction e. drastic changes in bp - answer ABCD Tyicyclic Antidepressants(TCA) What is the most common medication will you see?
A. Amitriptyline B. atropine C. bechlanechol D. phenelzine - answer Amitriptyline (Elavil) A patient with depression has been prescribed flouxetine (Prozac). Which statement made by the nurse indicated an understanding of the medication? A. "Disorientation and hallucinations are common" B. "The drug may enhance interest in sex" C. "It may take several weeks before my mood is elevated" D. " I can stop the medication when I feel less depressed" - answer C Examples of MAOI inhibitors are A. Phenelzine (Nardil) B. Selegilin (Emsam) C. Isocarboxazid (Marplan) D. Tranylcypromine (Parnate.) - answer All are correct True or False: If you are taking an MAOI what do you need to limit tyramine? - answer True What foods do you need to be careful with when taking an MAOI
c. smoking cessation, weight gain, arrhythmia's - answer B. Smoking cessation, weight loss, headache Bipolar disorder is which alters between hopelessness and depression in the state of mania. Which of the following is true regarding therapy for bipolar disorders. A. Lithium B. Valproic acid and phenelzine C. a combination of lithium and Phenelzine D. A combination of lithium and valproic acid - answer A combo of valproic acid and lithium What are some common side effects of lithium carbonate? A. renal toxicity b. tremors c. polyuria d. bradycardia e. lyte imbalances - answer All answers are correct Lithium toxicity range A. .8-1. B. .9-1. C. 1.1-1.
D. 11.1-21.2 - answer A A patient diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity the nurse should observe the patient for which s/s? A. Insomnia , increased appetite, and abdominal distention B. Dry cough, hyperactive reflexes, and HTN C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, astrexis and edema - answer c A patient with BPD is described lithium. Which statement if made by the patient indicates the need for further teaching? a. I can take the medication with milk or a snack b. I will call my doctor if I feel hyperactive c. I should drink at least 8-10 glasses of water a day d. I will reduce my salt intake while taking this medication - answer D Sedative-hyponic drugs may require therapy, biofeedback, relaxation, or meds. Which of the following disorder(S) are treated with these types of medications? A. Anxiety, Panic, OCD, PTSD B. Depression, panic attacks C. Depression, OCP D. Bipolar disorders - answer A.
