,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
Table of Contents
Section 1: Anti-Alzheimer's Agents Section 27: Beta Blockers
Section 2: Antianemics Section 28: Bone Resorption
Section 3: Antianginals Inhibitors
Section 4: Antianxiety Agents Section 29: Bronchodilators
Section 5: Antiarrhythmics Section 30: Calcium Channel
Section 6: Antiasthmatics Blockers
Section 7: Anticholinergics Section 31: Central Nervous System
Section 8: Anticoagulants Stimulants
Section 9: Anticonvulsants Section 32: Corticosteroids
Section 10: Antidepressants Section 33: Diuretics
Section 11: Antidiabetics Section 34: Hormones
Section 12: Antidiarrheals Section 35: Immunosuppressants
Section 13: Antiemetics Section 36: Laxatives
Section 14: Antifungals Section 37: Lipid-Lowering Agents
Section 15: Antihistamines Section 38: Nonopioid Analgesics
Section 16: Antihypertensives Section 39: Nonsteroidal Anti-
Section 17: Anti-infectives Inflammatory Agents
Section 18: Antineoplastics Section 40: Opioid Analgesics
Section 19: Antiparkinson Agents Section 41: Sedative/Hypnotics
Section 20: Antiplatelet Agents Section 42: Skeletal Muscle
Section 21: Antipsychotics Relaxants
Section 22: Antiretrovirals Section 43: Thrombolytics
Section 23: Antirheumatics Section 44: Vascular Headache
Section 24: Antituberculars Suppressants
Section 25: Antiulcer Agents Section 45: Weight Control
Section 26: Antivirals Agents
Page 2 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
Section 1: Anti-Alzheimer's Agents
1. Which primary pharmacological mechanism defines the action of donepezil?
A. Direct activation of central post-synaptic nicotinic receptors
B. Irreversible inhibition of central catecholamine degradation enzymes
C. Competitive blockade of peripheral muscarinic receptor pathways
D. Reversible inhibition of synaptic acetylcholinesterase breakdown enzymes
Answer: D
Rationale: Donepezil reversibly binds and inactivates acetylcholinesterase within the central nervous
system. This action prevents the enzymatic degradation of acetylcholine, thereby increasing
neurotransmitter availability at functional neuronal synapses to improve cognitive signaling.
Keywords: donepezil, acetylcholinesterase inhibitor, mechanism of action
2. What primary cellular mechanism underlies the therapeutic action of memantine?
A. Stimulation of postsynaptic dopamine receptor subtype pathways
B. Facilitation of gamma-aminobutyric acid inhibitory transmission routes
C. Enhancement of presynaptic choline uptake across neuronal borders
D. Uncompetitive antagonism of postsynaptic glutamate receptor channels
Answer: D
Rationale: Memantine functions as an uncompetitive, low-affinity antagonist at N-methyl-D-aspartate
receptors in the brain. By blocking excessive tonic levels of glutamate, it limits pathological calcium
influx into neurons and prevents excitotoxic neurodegeneration while preserving normal physiological
transmission.
Keywords: memantine, NMDA receptor antagonist, excitotoxicity
3. When planning discharge education, a nurse prepares instructions for a client newly prescribed
donepezil tablets. At which time of day should the nurse instruct the client to take this medication to
reduce gastrointestinal adverse effects?
A. At bedtime with or without light evening food intake
B. Before breakfast thirty minutes prior to morning food intake
C. Midday immediately following the daily completion of lunch meals
D. Late afternoon approximately one hour before the evening dinner
Answer: A
Rationale: Administering donepezil at bedtime reduces the clinical impact of peak plasma drug
concentrations that commonly induce nausea and vomiting. Taking the tablet in the evening allows the
patient to sleep through initial peak cholinergic gastrointestinal stimulation.
Keywords: donepezil, bedtime administration, cholinergic adverse effects
Page 2 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
4. A 71-year-old client with mild cognitive impairment due to Alzheimer's disease is scheduled to
begin intravenous lecanemab infusions. The client's pretreatment evaluation confirms baseline
amyloid pathology, and the care team is outlining the mandatory safety monitoring schedule. Which
diagnostic evaluation sequence is essential to safely monitor for amyloid-related imaging
abnormalities during therapy?
A. Baseline and serial lumbar punctures for tau protein measurement
B. Baseline and periodic magnetic resonance imaging of the brain
C. Baseline and quarterly positron emission computed tomography scans
D. Baseline and monthly electroencephalogram studies for cortical slowing
Answer: B
Rationale: Monoclonal antibodies targeting amyloid-beta, such as lecanemab, carry a documented risk
of amyloid-related imaging abnormalities, including brain edema and microhemorrhages. Obtaining a
baseline brain MRI and scheduling periodic follow-up MRIs prior to specific infusions allows early
detection of radiographic changes, often before overt clinical neurological symptoms manifest.
Keywords: lecanemab, ARIA, magnetic resonance imaging, safety monitoring
5. During a home visit, a nurse observes a caregiver applying a daily rivastigmine transdermal patch to
an older adult client with Alzheimer's disease. Which action by the caregiver indicates correct
administration technique?
A. Applying the fresh patch over the exact site from the prior day
B. Cutting the transdermal patch in half to administer a lower starting dose
C. Removing the old adhesive patch completely before applying a new system
D. Placing a therapeutic heating pad over the patch site to hasten absorption
Answer: C
Rationale: Removing the previous day's transdermal patch prior to applying a new patch prevents
cumulative drug absorption and dangerous cholinergic overdose. Rotating the application site daily to
clean, dry, hairless skin on the upper back, chest, or upper arm reduces localized cutaneous irritation.
Keywords: rivastigmine, transdermal patch, administration technique
Page 3 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
6. Following the initiation of donepezil therapy 4 weeks ago, an 82-year-old client is brought to the
outpatient clinic after experiencing two syncopal episodes at home. The client's baseline
electrocardiogram was normal, but current vital signs reveal a resting heart rate of 46 beats/min and
a blood pressure of 102/60 mm Hg. What physiological mechanism explains this hemodynamic
adverse reaction to donepezil?
A. Enhanced vagal stimulation provoking sinus node deceleration
B. Peripheral alpha-adrenergic blockade inducing marked systemic venodilation
C. Excessive sympathetic activation triggering sudden reflex arterial collapse
D. Direct myocardial membrane toxicity suppressing ventricular contractility
Answer: A
Rationale: Cholinesterase inhibitors increase acetylcholine levels throughout the autonomic nervous
system, augmenting parasympathetic vagal stimulation to the cardiac conduction system. This vagotonic
effect can cause clinically significant bradycardia, sinoatrial block, and advanced atrioventricular
conduction delays, predisposing vulnerable older adults to syncope and falls.
Keywords: donepezil, bradycardia, syncope, vagotonic effects
7. Why must a nurse routinely monitor body weight and dietary intake in a client receiving
maintenance therapy with galantamine?
A. Fluid retention frequently provokes peripheral dependent edema
B. Decreased metabolic rate leads to rapid central adiposity
C. Elevated blood glucose levels cause persistent severe hyperphagia
D. Cholinergic stimulation frequently triggers chronic nausea and anorexia
Answer: D
Rationale: Cholinesterase inhibitors like galantamine amplify acetylcholine signaling in the
gastrointestinal tract and chemoreceptor trigger zone, frequently precipitating nausea, vomiting,
anorexia, and diarrhea. Over time, these persistent upper gastrointestinal effects can result in
substantial unintended weight loss in elderly clients with dementia.
Keywords: galantamine, anorexia, weight loss, cholinergic adverse effects
Page 4 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
8. Which adverse effect is most commonly associated with memantine therapy?
A. Severe watery diarrhea accompanied by abdominal cramping
B. Transient dizziness, headache, and mild constipation
C. Symptomatic sinus bradycardia with syncope episodes
D. Profuse diaphoresis accompanied by excessive oral salivation
Answer: B
Rationale: Memantine exhibits an adverse effect profile that differs distinctly from cholinergic agents.
Patients commonly experience central nervous system symptoms such as dizziness and headache,
alongside gastrointestinal hypomotility leading to constipation.
Keywords: memantine, adverse effects, dizziness, constipation
9. An advanced practice nurse discusses pharmacotherapy with the spouse of a client diagnosed with
moderate-to-severe Alzheimer's disease who is currently taking donepezil. For which clinical purpose
is memantine added to the client's existing donepezil regimen?
A. Providing dual-mechanism cellular neuroprotection against excessive glutamate excitotoxicity
B. Counteracting the adverse gastrointestinal effects of long-term donepezil therapy
C. Inducing rapid structural remyelination across depleted cerebral cortical pathways
D. Eliminating established extracellular neurofibrillary tau tangles from brain tissue
Answer: A
Rationale: Combining memantine with a cholinesterase inhibitor like donepezil provides complementary
therapeutic mechanisms in moderate-to-severe Alzheimer's disease. While donepezil enhances
cholinergic transmission, memantine modulates glutamate pathways to protect functional neurons from
excitotoxic injury and slow functional decline.
Keywords: memantine, donepezil, combination therapy, neuroprotection
10. What is the primary pharmacological classification of galantamine?
A. Monoclonal antibody targeting vascular amyloid deposition pathways
B. Uncompetitive glutamate receptor antagonist blocking postsynaptic channels
C. Reversible inhibitor of synaptic acetylcholinesterase breakdown enzymes
D. Selective agonist of peripheral muscarinic cholinergic receptor pathways
Answer: C
Rationale: Galantamine is classified as a reversible, competitive acetylcholinesterase inhibitor. It
elevates endogenous acetylcholine concentrations in the synaptic cleft and also acts allosterically on
nicotinic receptors to enhance cognitive neurotransmission in mild-to-moderate Alzheimer's disease.
Keywords: galantamine, classification, acetylcholinesterase inhibitor
Page 5 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
11. How are Amyloid-Related Imaging Abnormalities subtyped into ARIA-E and ARIA-H on magnetic
resonance imaging?
A. ARIA-E indicates acute hemorrhage, whereas ARIA-H indicates vasogenic edema
B. ARIA-E indicates cortical atrophy, whereas ARIA-H indicates severe ventriculomegaly
C. ARIA-E indicates active hydrocephalus, whereas ARIA-H indicates chronic fibrosis
D. ARIA-E indicates vasogenic edema, whereas ARIA-H indicates cerebral microhemorrhages
Answer: D
Rationale: Amyloid-related imaging abnormalities are classified into two radiological categories. ARIA-E
reflects parenchymal vasogenic edema or sulcal effusions, whereas ARIA-H represents cerebral
microhemorrhages and superficial cortical siderosis.
Keywords: ARIA-E, ARIA-H, amyloid-related imaging abnormalities, MRI
12. Prior to initiating intravenous aducanumab, the medical team orders apolipoprotein E (APOE)
gene testing. What rationale explains obtaining the client's APOE ε4 carrier status before treatment?
A. Homozygous carriers experience accelerated renal clearance of monoclonal antibodies
B. Carriers exhibit a significantly elevated risk of developing ARIA complications
C. Non-carriers require double the standard weight-based maintenance infusion dosage
D. Carriers possess complete pharmacokinetic resistance to amyloid-clearing therapeutic infusions
Answer: B
Rationale: Clients who carry the APOE ε4 allele, particularly homozygous individuals, have a
substantially higher incidence of amyloid-related imaging abnormalities, including both brain edema and
microhemorrhages, during treatment with amyloid-targeting antibodies. Establishing carrier status
informs risk stratification and clinical monitoring intensity.
Keywords: aducanumab, APOE epsilon 4, ARIA risk factor, genetic testing
Page 6 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
13. While receiving a scheduled intravenous infusion of lecanemab, a 69-year-old client suddenly
develops chills, facial flushing, generalized pruritus, dyspnea, and a temperature spike to 101.4°F
(38.6°C). Blood pressure drops from 128/78 mm Hg to 106/62 mm Hg. Which immediate sequence of
nursing interventions is most appropriate?
A. Stopping the infusion immediately, maintaining airway patency, and notifying the provider
B. Decreasing the pump infusion rate by half and administering oral acetaminophen tablets
C. Continuing the infusion at the scheduled rate while providing warm blanket therapy
D. Flushing the intravenous line rapidly with heparinized saline and elevating lower limbs
Answer: A
Rationale: Monoclonal antibody infusions can trigger acute systemic infusion-related reactions ranging
from mild chills and flushing to severe anaphylactoid hemodynamic compromise. The immediate nursing
priority is to stop the infusion to prevent further antigen delivery, assess and support airway and
breathing, and notify the prescribing provider for emergency medication administration.
Keywords: lecanemab, infusion-related reaction, nursing intervention, priority
14. Which pre-existing cardiac conduction disturbance represents a major clinical caution for starting
rivastigmine?
A. Isolated left bundle branch conduction block
B. Sick sinus syndrome or atrioventricular block
C. Frequent premature ventricular contraction beats
D. Controlled chronic resting sinus tachycardia
Answer: B
Rationale: Cholinesterase inhibitors exhibit vagotonic effects on the sinoatrial and atrioventricular
nodes, slowing intrinsic cardiac conduction. They carry a significant caution in clients with pre-existing
conduction disorders such as sick sinus syndrome, second- or third-degree atrioventricular block, or
unexplained bradycardia due to severe syncope risk.
Keywords: rivastigmine, heart block, sick sinus syndrome, cardiac conduction
Page 7 of 561
Table of Contents
Section 1: Anti-Alzheimer's Agents Section 27: Beta Blockers
Section 2: Antianemics Section 28: Bone Resorption
Section 3: Antianginals Inhibitors
Section 4: Antianxiety Agents Section 29: Bronchodilators
Section 5: Antiarrhythmics Section 30: Calcium Channel
Section 6: Antiasthmatics Blockers
Section 7: Anticholinergics Section 31: Central Nervous System
Section 8: Anticoagulants Stimulants
Section 9: Anticonvulsants Section 32: Corticosteroids
Section 10: Antidepressants Section 33: Diuretics
Section 11: Antidiabetics Section 34: Hormones
Section 12: Antidiarrheals Section 35: Immunosuppressants
Section 13: Antiemetics Section 36: Laxatives
Section 14: Antifungals Section 37: Lipid-Lowering Agents
Section 15: Antihistamines Section 38: Nonopioid Analgesics
Section 16: Antihypertensives Section 39: Nonsteroidal Anti-
Section 17: Anti-infectives Inflammatory Agents
Section 18: Antineoplastics Section 40: Opioid Analgesics
Section 19: Antiparkinson Agents Section 41: Sedative/Hypnotics
Section 20: Antiplatelet Agents Section 42: Skeletal Muscle
Section 21: Antipsychotics Relaxants
Section 22: Antiretrovirals Section 43: Thrombolytics
Section 23: Antirheumatics Section 44: Vascular Headache
Section 24: Antituberculars Suppressants
Section 25: Antiulcer Agents Section 45: Weight Control
Section 26: Antivirals Agents
Page 2 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
Section 1: Anti-Alzheimer's Agents
1. Which primary pharmacological mechanism defines the action of donepezil?
A. Direct activation of central post-synaptic nicotinic receptors
B. Irreversible inhibition of central catecholamine degradation enzymes
C. Competitive blockade of peripheral muscarinic receptor pathways
D. Reversible inhibition of synaptic acetylcholinesterase breakdown enzymes
Answer: D
Rationale: Donepezil reversibly binds and inactivates acetylcholinesterase within the central nervous
system. This action prevents the enzymatic degradation of acetylcholine, thereby increasing
neurotransmitter availability at functional neuronal synapses to improve cognitive signaling.
Keywords: donepezil, acetylcholinesterase inhibitor, mechanism of action
2. What primary cellular mechanism underlies the therapeutic action of memantine?
A. Stimulation of postsynaptic dopamine receptor subtype pathways
B. Facilitation of gamma-aminobutyric acid inhibitory transmission routes
C. Enhancement of presynaptic choline uptake across neuronal borders
D. Uncompetitive antagonism of postsynaptic glutamate receptor channels
Answer: D
Rationale: Memantine functions as an uncompetitive, low-affinity antagonist at N-methyl-D-aspartate
receptors in the brain. By blocking excessive tonic levels of glutamate, it limits pathological calcium
influx into neurons and prevents excitotoxic neurodegeneration while preserving normal physiological
transmission.
Keywords: memantine, NMDA receptor antagonist, excitotoxicity
3. When planning discharge education, a nurse prepares instructions for a client newly prescribed
donepezil tablets. At which time of day should the nurse instruct the client to take this medication to
reduce gastrointestinal adverse effects?
A. At bedtime with or without light evening food intake
B. Before breakfast thirty minutes prior to morning food intake
C. Midday immediately following the daily completion of lunch meals
D. Late afternoon approximately one hour before the evening dinner
Answer: A
Rationale: Administering donepezil at bedtime reduces the clinical impact of peak plasma drug
concentrations that commonly induce nausea and vomiting. Taking the tablet in the evening allows the
patient to sleep through initial peak cholinergic gastrointestinal stimulation.
Keywords: donepezil, bedtime administration, cholinergic adverse effects
Page 2 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
4. A 71-year-old client with mild cognitive impairment due to Alzheimer's disease is scheduled to
begin intravenous lecanemab infusions. The client's pretreatment evaluation confirms baseline
amyloid pathology, and the care team is outlining the mandatory safety monitoring schedule. Which
diagnostic evaluation sequence is essential to safely monitor for amyloid-related imaging
abnormalities during therapy?
A. Baseline and serial lumbar punctures for tau protein measurement
B. Baseline and periodic magnetic resonance imaging of the brain
C. Baseline and quarterly positron emission computed tomography scans
D. Baseline and monthly electroencephalogram studies for cortical slowing
Answer: B
Rationale: Monoclonal antibodies targeting amyloid-beta, such as lecanemab, carry a documented risk
of amyloid-related imaging abnormalities, including brain edema and microhemorrhages. Obtaining a
baseline brain MRI and scheduling periodic follow-up MRIs prior to specific infusions allows early
detection of radiographic changes, often before overt clinical neurological symptoms manifest.
Keywords: lecanemab, ARIA, magnetic resonance imaging, safety monitoring
5. During a home visit, a nurse observes a caregiver applying a daily rivastigmine transdermal patch to
an older adult client with Alzheimer's disease. Which action by the caregiver indicates correct
administration technique?
A. Applying the fresh patch over the exact site from the prior day
B. Cutting the transdermal patch in half to administer a lower starting dose
C. Removing the old adhesive patch completely before applying a new system
D. Placing a therapeutic heating pad over the patch site to hasten absorption
Answer: C
Rationale: Removing the previous day's transdermal patch prior to applying a new patch prevents
cumulative drug absorption and dangerous cholinergic overdose. Rotating the application site daily to
clean, dry, hairless skin on the upper back, chest, or upper arm reduces localized cutaneous irritation.
Keywords: rivastigmine, transdermal patch, administration technique
Page 3 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
6. Following the initiation of donepezil therapy 4 weeks ago, an 82-year-old client is brought to the
outpatient clinic after experiencing two syncopal episodes at home. The client's baseline
electrocardiogram was normal, but current vital signs reveal a resting heart rate of 46 beats/min and
a blood pressure of 102/60 mm Hg. What physiological mechanism explains this hemodynamic
adverse reaction to donepezil?
A. Enhanced vagal stimulation provoking sinus node deceleration
B. Peripheral alpha-adrenergic blockade inducing marked systemic venodilation
C. Excessive sympathetic activation triggering sudden reflex arterial collapse
D. Direct myocardial membrane toxicity suppressing ventricular contractility
Answer: A
Rationale: Cholinesterase inhibitors increase acetylcholine levels throughout the autonomic nervous
system, augmenting parasympathetic vagal stimulation to the cardiac conduction system. This vagotonic
effect can cause clinically significant bradycardia, sinoatrial block, and advanced atrioventricular
conduction delays, predisposing vulnerable older adults to syncope and falls.
Keywords: donepezil, bradycardia, syncope, vagotonic effects
7. Why must a nurse routinely monitor body weight and dietary intake in a client receiving
maintenance therapy with galantamine?
A. Fluid retention frequently provokes peripheral dependent edema
B. Decreased metabolic rate leads to rapid central adiposity
C. Elevated blood glucose levels cause persistent severe hyperphagia
D. Cholinergic stimulation frequently triggers chronic nausea and anorexia
Answer: D
Rationale: Cholinesterase inhibitors like galantamine amplify acetylcholine signaling in the
gastrointestinal tract and chemoreceptor trigger zone, frequently precipitating nausea, vomiting,
anorexia, and diarrhea. Over time, these persistent upper gastrointestinal effects can result in
substantial unintended weight loss in elderly clients with dementia.
Keywords: galantamine, anorexia, weight loss, cholinergic adverse effects
Page 4 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
8. Which adverse effect is most commonly associated with memantine therapy?
A. Severe watery diarrhea accompanied by abdominal cramping
B. Transient dizziness, headache, and mild constipation
C. Symptomatic sinus bradycardia with syncope episodes
D. Profuse diaphoresis accompanied by excessive oral salivation
Answer: B
Rationale: Memantine exhibits an adverse effect profile that differs distinctly from cholinergic agents.
Patients commonly experience central nervous system symptoms such as dizziness and headache,
alongside gastrointestinal hypomotility leading to constipation.
Keywords: memantine, adverse effects, dizziness, constipation
9. An advanced practice nurse discusses pharmacotherapy with the spouse of a client diagnosed with
moderate-to-severe Alzheimer's disease who is currently taking donepezil. For which clinical purpose
is memantine added to the client's existing donepezil regimen?
A. Providing dual-mechanism cellular neuroprotection against excessive glutamate excitotoxicity
B. Counteracting the adverse gastrointestinal effects of long-term donepezil therapy
C. Inducing rapid structural remyelination across depleted cerebral cortical pathways
D. Eliminating established extracellular neurofibrillary tau tangles from brain tissue
Answer: A
Rationale: Combining memantine with a cholinesterase inhibitor like donepezil provides complementary
therapeutic mechanisms in moderate-to-severe Alzheimer's disease. While donepezil enhances
cholinergic transmission, memantine modulates glutamate pathways to protect functional neurons from
excitotoxic injury and slow functional decline.
Keywords: memantine, donepezil, combination therapy, neuroprotection
10. What is the primary pharmacological classification of galantamine?
A. Monoclonal antibody targeting vascular amyloid deposition pathways
B. Uncompetitive glutamate receptor antagonist blocking postsynaptic channels
C. Reversible inhibitor of synaptic acetylcholinesterase breakdown enzymes
D. Selective agonist of peripheral muscarinic cholinergic receptor pathways
Answer: C
Rationale: Galantamine is classified as a reversible, competitive acetylcholinesterase inhibitor. It
elevates endogenous acetylcholine concentrations in the synaptic cleft and also acts allosterically on
nicotinic receptors to enhance cognitive neurotransmission in mild-to-moderate Alzheimer's disease.
Keywords: galantamine, classification, acetylcholinesterase inhibitor
Page 5 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
11. How are Amyloid-Related Imaging Abnormalities subtyped into ARIA-E and ARIA-H on magnetic
resonance imaging?
A. ARIA-E indicates acute hemorrhage, whereas ARIA-H indicates vasogenic edema
B. ARIA-E indicates cortical atrophy, whereas ARIA-H indicates severe ventriculomegaly
C. ARIA-E indicates active hydrocephalus, whereas ARIA-H indicates chronic fibrosis
D. ARIA-E indicates vasogenic edema, whereas ARIA-H indicates cerebral microhemorrhages
Answer: D
Rationale: Amyloid-related imaging abnormalities are classified into two radiological categories. ARIA-E
reflects parenchymal vasogenic edema or sulcal effusions, whereas ARIA-H represents cerebral
microhemorrhages and superficial cortical siderosis.
Keywords: ARIA-E, ARIA-H, amyloid-related imaging abnormalities, MRI
12. Prior to initiating intravenous aducanumab, the medical team orders apolipoprotein E (APOE)
gene testing. What rationale explains obtaining the client's APOE ε4 carrier status before treatment?
A. Homozygous carriers experience accelerated renal clearance of monoclonal antibodies
B. Carriers exhibit a significantly elevated risk of developing ARIA complications
C. Non-carriers require double the standard weight-based maintenance infusion dosage
D. Carriers possess complete pharmacokinetic resistance to amyloid-clearing therapeutic infusions
Answer: B
Rationale: Clients who carry the APOE ε4 allele, particularly homozygous individuals, have a
substantially higher incidence of amyloid-related imaging abnormalities, including both brain edema and
microhemorrhages, during treatment with amyloid-targeting antibodies. Establishing carrier status
informs risk stratification and clinical monitoring intensity.
Keywords: aducanumab, APOE epsilon 4, ARIA risk factor, genetic testing
Page 6 of 561
,Davis’s Drug Guide for Nurses (19th Edition) — Master Test Bank
13. While receiving a scheduled intravenous infusion of lecanemab, a 69-year-old client suddenly
develops chills, facial flushing, generalized pruritus, dyspnea, and a temperature spike to 101.4°F
(38.6°C). Blood pressure drops from 128/78 mm Hg to 106/62 mm Hg. Which immediate sequence of
nursing interventions is most appropriate?
A. Stopping the infusion immediately, maintaining airway patency, and notifying the provider
B. Decreasing the pump infusion rate by half and administering oral acetaminophen tablets
C. Continuing the infusion at the scheduled rate while providing warm blanket therapy
D. Flushing the intravenous line rapidly with heparinized saline and elevating lower limbs
Answer: A
Rationale: Monoclonal antibody infusions can trigger acute systemic infusion-related reactions ranging
from mild chills and flushing to severe anaphylactoid hemodynamic compromise. The immediate nursing
priority is to stop the infusion to prevent further antigen delivery, assess and support airway and
breathing, and notify the prescribing provider for emergency medication administration.
Keywords: lecanemab, infusion-related reaction, nursing intervention, priority
14. Which pre-existing cardiac conduction disturbance represents a major clinical caution for starting
rivastigmine?
A. Isolated left bundle branch conduction block
B. Sick sinus syndrome or atrioventricular block
C. Frequent premature ventricular contraction beats
D. Controlled chronic resting sinus tachycardia
Answer: B
Rationale: Cholinesterase inhibitors exhibit vagotonic effects on the sinoatrial and atrioventricular
nodes, slowing intrinsic cardiac conduction. They carry a significant caution in clients with pre-existing
conduction disorders such as sick sinus syndrome, second- or third-degree atrioventricular block, or
unexplained bradycardia due to severe syncope risk.
Keywords: rivastigmine, heart block, sick sinus syndrome, cardiac conduction
Page 7 of 561
