TEST BANK: LEHNE'S PHARMACOTHERAPEUTICS
FOR ADVANCED PRACTICE NURSES & PHYSICIAN
ASSISTANT 2ND ED
An infant who receives a drug that does not produce CNS side effects in adults
exhibits drowsiness and sedation. The nurse understands that this is because of
differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration - ANSWER ANS: A
The blood-brain barrier is not fully developed at birth, making infants much more
sensitive to CNS drugs than older children and adults. CNS symptoms may include
sedation and drowsiness. The first-pass effect and GI absorption affect metabolism
and absorption of drugs, and renal filtration affects elimination of drugs, all of which
may alter drug levels.
Which monoamines act as neurotransmitters in the central nervous system? Select
all that apply.
a. Acetylcholine
b. Norepinephrine
c. Serotonin
d. Dopamine
e. Epinephrine
f. Histamine - ANSWER ANS: B , C , D , E
Acetylcholine and histamines are not monoamines.
A patient asks a nurse to explain what drug tolerance means. The nurse responds by
telling the patient that when tolerance occurs, it means the patient:
a. has developed a psychological dependence on the drug.
b. may need increased amounts of the drug over time.
c. will cause an abstinence syndrome if the drug is discontinued abruptly.
d. will have increased sensitivity to drug side effects. - ANSWER ANS: B
When tolerance develops, a dose increase may be needed, because a decreased
response may occur with prolonged use. Psychologic dependence involves cravings
for drug effects and does not define tolerance. Physical dependence occurs when
the drug becomes necessary for the brain to function "normally," meaning the patient
should be weaned from the drug slowly to prevent an abstinence syndrome. Patients
may have a decreased sensitivity to drug side effects over time as the brain adapts
to the medication.
A group of nursing students asks a nurse to explain the blood-brain barrier. The
nurse would be correct to say that the blood-brain barrier:
a. prevents some potentially toxic substances from crossing into the central nervous
system.
,b. causes infants to be less sensitive to CNS drugs and thus require larger doses.
c. allows only ionized or protein-bound drugs to cross into the central nervous
system.
d. prevents lipid-soluble drugs from entering the central nervous system. - ANSWER
ANS: A
The blood-brain barrier can prevent some drugs and some toxic substances from
entering the CNS. The blood-brain barrier in infants is not fully developed, so infants
are more sensitive to CNS drugs and often require lower doses. The blood-brain
barrier prevents highly ionized and protein- bound drugs from crossing into the CNS
and allows lipid-soluble drugs and those that can cross via specific transport systems
to enter.
A nurse is teaching a group of students about how CNS drugs are developed. Which
statement
by a student indicates a need for further teaching?
a. "Central nervous system drug development relies on observations of their effects
on human behavior."
b. "Studies of new central nervous system drugs in healthy subjects can produce
paradoxical
effects."
c. "Our knowledge of the neurochemical and physiologic changes that underlie
mental illness
is incomplete."
d. "These drugs are developed based on scientific knowledge of CNS transmitters
and receptors." - ANSWER ANS: D
The deficiencies in knowledge about how CNS transmitters and receptors work
make systematic development of CNS drugs difficult. Testing in healthy subjects
often leads either to no effect or to paradoxical effects. Medical knowledge of the
neurochemical and physiologic changes underlying mental illness is incomplete. The
development of CNS drugs depends less on knowledge of how the CNS functions
and how these drugs affect that process and more on how administering one of
these agents leads to changes in behavior.
A nurse is teaching a group of nursing students how the CNS adapts to
psychotherapeutic
medications. Which statement by a nursing student indicates a need for further
teaching?
a. "Adaptation can lead to tolerance of these drugs with prolonged use."
b. "Adaptation helps explain how physical dependence occurs."
c. "Adaptation often must occur before therapeutic effects develop."
d. "Adaptation results in an increased sensitivity to side effects over time." -
ANSWER ANS: D
With adaptation of the central nervous system to prolonged exposure to CNS drugs,
many adverse effects diminish and therapeutic effects remain. Adaptation helps
explain how tolerance and physical dependence occur, as the brain adapts to the
presence of the drug. Therapeutic effects can take several weeks to manifest,
because they appear to work by initiating adaptive changes in the brain.
,A psychiatric nurse is teaching a patient about an antidepressant medication. The
nurse tells the patient that therapeutic effects may not occur for several weeks. The
nurse understands that this is likely the result of:
a. changes in the brain as a result of prolonged drug exposure.
b. direct actions of the drug on specific synaptic functions in the brain.
c. slowed drug absorption across the blood-brain barrier.
d. tolerance to exposure to the drug over time. - ANSWER ANS: A
It is thought that beneficial responses to central nervous system (CNS) drugs are
delayed because they result from adaptive changes as the CNS modifies itself in
response to prolonged drug exposure, and that the responses are not the result of
the direct effects of the drugs on synaptic functions. The blood-brain barrier prevents
protein-bound and highly ionized drugs from crossing into the CNS, but it does not
slow the effects of drugs that can cross the barrier. Tolerance is a decreased
response to a drug after prolonged use.
Which are medical applications of central nervous system drugs? Select all that
apply.
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control - ANSWER ANS: A, B, E
CNS drugs have medical uses for pain management, anesthesia, and seizure
control. Depression and euphoria are side effects that can contribute to abuse of
these drugs.
A nurse is assessing a patient who becomes motionless and seems to stare at the
wall and then
experiences about 60 seconds of lip smacking and hand wringing. What should the
nurse do?
a. Ask the patient about a history of absence seizures.
b. Contact the provider to report symptoms of a complex partial seizure.
c. Notify the provider that the patient has had a grand mal seizure.
d. Request an order for intravenous diazepam [Valium] to treat status epilepticus. -
ANSWER ANS: B
This patient showed signs of a complex partial seizure, characterized by impaired
consciousness beginning with a period of motionlessness with a fixed gaze, followed
by a period of automatism. The entire episode generally lasts 45 to 90 seconds.
Absence seizures are characterized by loss of consciousness for a brief period
(about 10 to 30seconds) and may involve mild, symmetric motor activity or no motor
signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by
alternating muscle relaxation and contraction and then periods of cyanosis, all with a
loss of consciousness. Status epilepticus is a seizure that persists for 30 minutes or
longer.
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy.
Which statement by the patient indicates understanding of the teaching?
a. "I should brush and floss my teeth regularly."
b. "Once therapeutic blood levels are reached, they are easy to maintain."
c. "I can consume alcohol in moderation while taking this drug."
, d. "Rashes are a common side effect but are not serious." - ANSWER ANS: A
Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be
minimized with good oral hygiene, so patients should be encouraged to brush and
floss regularly. Because small fluctuations in phenytoin levels can affect response,
maintaining therapeutic levels is not easy. Patients should be cautioned against
consuming alcohol while taking phenytoin. Rashes can be serious and should be
reported immediately.
A nurse is caring for a patient who has been taking an antiepileptic drug for several
weeks. The nurse asks the patient if the therapy is effective. The patient reports little
change in seizure frequency. What will the nurse do?
a. Ask the patient to complete a seizure frequency chart for the past few weeks.
b. Contact the provider to request an order for serum drug levels.
c. Reinforce the need to take the medications as prescribed.
d. Request an order to increase the dose of the antiepileptic drug. - ANSWER ANS:
B
If medication therapy is not effective, it is important to measure serum drug levels of
the medication to determine whether therapeutic levels have been reached and to
help monitor patient compliance. Patients should be asked at the beginning of
therapy to keep a seizure frequency chart to help deepen their involvement in
therapy; asking for historical information is not helpful. Until it is determined that the
patient is not complying, the nurse should not reinforce the need to take the
medication. Until the drug level is known, increasing the dose is not indicated.
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the
nurse that she is taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth
defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness
of phenytoin. - ANSWER ANS: B
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and
because avoiding pregnancy is desirable when taking phenytoin, patients should be
advised to increase the dose of oral contraceptives or use an alternative method of
birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do
not affect phenytoin levels. Phenytoin is linked to birth defects; OCPs have
decreased effectiveness in patients treated with phenytoin, and the patient should be
advised to increase the OCP dose or to use an alternative form of birth control.
OCPs do not alter the effects of phenytoin.
A patient with a formof epilepsy that may have spontaneous remission has been
taking an AED
for a year. The patient reports being seizure free for 6 months and asks the nurse
when the drug can be discontinued. What will the nurse tell the patient?
a. AEDs must be taken for life to maintain remission.
b. Another AED will be substituted for the current AED.
c. The provider will withdraw the drug over a 6- to 12-week period.
d. The patient should stop taking the AED now and restart the drug if seizures recur.
- ANSWER ANS: C
FOR ADVANCED PRACTICE NURSES & PHYSICIAN
ASSISTANT 2ND ED
An infant who receives a drug that does not produce CNS side effects in adults
exhibits drowsiness and sedation. The nurse understands that this is because of
differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration - ANSWER ANS: A
The blood-brain barrier is not fully developed at birth, making infants much more
sensitive to CNS drugs than older children and adults. CNS symptoms may include
sedation and drowsiness. The first-pass effect and GI absorption affect metabolism
and absorption of drugs, and renal filtration affects elimination of drugs, all of which
may alter drug levels.
Which monoamines act as neurotransmitters in the central nervous system? Select
all that apply.
a. Acetylcholine
b. Norepinephrine
c. Serotonin
d. Dopamine
e. Epinephrine
f. Histamine - ANSWER ANS: B , C , D , E
Acetylcholine and histamines are not monoamines.
A patient asks a nurse to explain what drug tolerance means. The nurse responds by
telling the patient that when tolerance occurs, it means the patient:
a. has developed a psychological dependence on the drug.
b. may need increased amounts of the drug over time.
c. will cause an abstinence syndrome if the drug is discontinued abruptly.
d. will have increased sensitivity to drug side effects. - ANSWER ANS: B
When tolerance develops, a dose increase may be needed, because a decreased
response may occur with prolonged use. Psychologic dependence involves cravings
for drug effects and does not define tolerance. Physical dependence occurs when
the drug becomes necessary for the brain to function "normally," meaning the patient
should be weaned from the drug slowly to prevent an abstinence syndrome. Patients
may have a decreased sensitivity to drug side effects over time as the brain adapts
to the medication.
A group of nursing students asks a nurse to explain the blood-brain barrier. The
nurse would be correct to say that the blood-brain barrier:
a. prevents some potentially toxic substances from crossing into the central nervous
system.
,b. causes infants to be less sensitive to CNS drugs and thus require larger doses.
c. allows only ionized or protein-bound drugs to cross into the central nervous
system.
d. prevents lipid-soluble drugs from entering the central nervous system. - ANSWER
ANS: A
The blood-brain barrier can prevent some drugs and some toxic substances from
entering the CNS. The blood-brain barrier in infants is not fully developed, so infants
are more sensitive to CNS drugs and often require lower doses. The blood-brain
barrier prevents highly ionized and protein- bound drugs from crossing into the CNS
and allows lipid-soluble drugs and those that can cross via specific transport systems
to enter.
A nurse is teaching a group of students about how CNS drugs are developed. Which
statement
by a student indicates a need for further teaching?
a. "Central nervous system drug development relies on observations of their effects
on human behavior."
b. "Studies of new central nervous system drugs in healthy subjects can produce
paradoxical
effects."
c. "Our knowledge of the neurochemical and physiologic changes that underlie
mental illness
is incomplete."
d. "These drugs are developed based on scientific knowledge of CNS transmitters
and receptors." - ANSWER ANS: D
The deficiencies in knowledge about how CNS transmitters and receptors work
make systematic development of CNS drugs difficult. Testing in healthy subjects
often leads either to no effect or to paradoxical effects. Medical knowledge of the
neurochemical and physiologic changes underlying mental illness is incomplete. The
development of CNS drugs depends less on knowledge of how the CNS functions
and how these drugs affect that process and more on how administering one of
these agents leads to changes in behavior.
A nurse is teaching a group of nursing students how the CNS adapts to
psychotherapeutic
medications. Which statement by a nursing student indicates a need for further
teaching?
a. "Adaptation can lead to tolerance of these drugs with prolonged use."
b. "Adaptation helps explain how physical dependence occurs."
c. "Adaptation often must occur before therapeutic effects develop."
d. "Adaptation results in an increased sensitivity to side effects over time." -
ANSWER ANS: D
With adaptation of the central nervous system to prolonged exposure to CNS drugs,
many adverse effects diminish and therapeutic effects remain. Adaptation helps
explain how tolerance and physical dependence occur, as the brain adapts to the
presence of the drug. Therapeutic effects can take several weeks to manifest,
because they appear to work by initiating adaptive changes in the brain.
,A psychiatric nurse is teaching a patient about an antidepressant medication. The
nurse tells the patient that therapeutic effects may not occur for several weeks. The
nurse understands that this is likely the result of:
a. changes in the brain as a result of prolonged drug exposure.
b. direct actions of the drug on specific synaptic functions in the brain.
c. slowed drug absorption across the blood-brain barrier.
d. tolerance to exposure to the drug over time. - ANSWER ANS: A
It is thought that beneficial responses to central nervous system (CNS) drugs are
delayed because they result from adaptive changes as the CNS modifies itself in
response to prolonged drug exposure, and that the responses are not the result of
the direct effects of the drugs on synaptic functions. The blood-brain barrier prevents
protein-bound and highly ionized drugs from crossing into the CNS, but it does not
slow the effects of drugs that can cross the barrier. Tolerance is a decreased
response to a drug after prolonged use.
Which are medical applications of central nervous system drugs? Select all that
apply.
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control - ANSWER ANS: A, B, E
CNS drugs have medical uses for pain management, anesthesia, and seizure
control. Depression and euphoria are side effects that can contribute to abuse of
these drugs.
A nurse is assessing a patient who becomes motionless and seems to stare at the
wall and then
experiences about 60 seconds of lip smacking and hand wringing. What should the
nurse do?
a. Ask the patient about a history of absence seizures.
b. Contact the provider to report symptoms of a complex partial seizure.
c. Notify the provider that the patient has had a grand mal seizure.
d. Request an order for intravenous diazepam [Valium] to treat status epilepticus. -
ANSWER ANS: B
This patient showed signs of a complex partial seizure, characterized by impaired
consciousness beginning with a period of motionlessness with a fixed gaze, followed
by a period of automatism. The entire episode generally lasts 45 to 90 seconds.
Absence seizures are characterized by loss of consciousness for a brief period
(about 10 to 30seconds) and may involve mild, symmetric motor activity or no motor
signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by
alternating muscle relaxation and contraction and then periods of cyanosis, all with a
loss of consciousness. Status epilepticus is a seizure that persists for 30 minutes or
longer.
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy.
Which statement by the patient indicates understanding of the teaching?
a. "I should brush and floss my teeth regularly."
b. "Once therapeutic blood levels are reached, they are easy to maintain."
c. "I can consume alcohol in moderation while taking this drug."
, d. "Rashes are a common side effect but are not serious." - ANSWER ANS: A
Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be
minimized with good oral hygiene, so patients should be encouraged to brush and
floss regularly. Because small fluctuations in phenytoin levels can affect response,
maintaining therapeutic levels is not easy. Patients should be cautioned against
consuming alcohol while taking phenytoin. Rashes can be serious and should be
reported immediately.
A nurse is caring for a patient who has been taking an antiepileptic drug for several
weeks. The nurse asks the patient if the therapy is effective. The patient reports little
change in seizure frequency. What will the nurse do?
a. Ask the patient to complete a seizure frequency chart for the past few weeks.
b. Contact the provider to request an order for serum drug levels.
c. Reinforce the need to take the medications as prescribed.
d. Request an order to increase the dose of the antiepileptic drug. - ANSWER ANS:
B
If medication therapy is not effective, it is important to measure serum drug levels of
the medication to determine whether therapeutic levels have been reached and to
help monitor patient compliance. Patients should be asked at the beginning of
therapy to keep a seizure frequency chart to help deepen their involvement in
therapy; asking for historical information is not helpful. Until it is determined that the
patient is not complying, the nurse should not reinforce the need to take the
medication. Until the drug level is known, increasing the dose is not indicated.
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the
nurse that she is taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth
defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness
of phenytoin. - ANSWER ANS: B
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and
because avoiding pregnancy is desirable when taking phenytoin, patients should be
advised to increase the dose of oral contraceptives or use an alternative method of
birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do
not affect phenytoin levels. Phenytoin is linked to birth defects; OCPs have
decreased effectiveness in patients treated with phenytoin, and the patient should be
advised to increase the OCP dose or to use an alternative form of birth control.
OCPs do not alter the effects of phenytoin.
A patient with a formof epilepsy that may have spontaneous remission has been
taking an AED
for a year. The patient reports being seizure free for 6 months and asks the nurse
when the drug can be discontinued. What will the nurse tell the patient?
a. AEDs must be taken for life to maintain remission.
b. Another AED will be substituted for the current AED.
c. The provider will withdraw the drug over a 6- to 12-week period.
d. The patient should stop taking the AED now and restart the drug if seizures recur.
- ANSWER ANS: C
