TEST BANK LEHNE'S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS, 2ND EDITION BY LAURA ROSENTHAL
TEST BANK ISBN: 9780323554954 (2025) NEWEST
EDITION PDF
AnxinfantxwhoxreceivesxaxdrugxthatxdoesxnotxproducexCNSxsidexeffectsxinxadultsxexhibitsxdr
owsinessxandxsedation.xThexnursexunderstandsxthatxthisxisxbecausexofxdifferencesxinxwhic
hxphysiologicxsystemxinxinfantsxandxadults?
a.xBlood-brainxbarrier
b.xFirst-passxeffect
c.xGastrointestinalxabsorption
d.xRenalxfiltrationx-xANS:xAx
Thexblood-
brainxbarrierxisxnotxfullyxdevelopedxatxbirth,xmakingxinfantsxmuchxmorexsensitivextoxCNSxdru
gsxthanxolderxchildrenxandxadults.xCNSxsymptomsxmayxincludexsedationxandxdrowsiness.x
Thexfirst-
passxeffectxandxGIxabsorptionxaffectxmetabolismxandxabsorptionxofxdrugs,xandxrenalxfiltrati
onxaffectsxeliminationxofxdrugs,xallxofxwhichxmayxalterxdrugxlevels.
Whichxmonoaminesxactxasxneurotransmittersxinxthexcentralxnervousxsystem?xSelectxallxtha
txapply.
a.xAcetylcholine
b.xNorepinephrine
c.xSerotonin
d.xDopamine
e.xEpinephrine
f.xHistaminex-xANS:xBx,xCx,xDx,xEx
Acetylcholinexandxhistaminesxarexnotxmonoamines.
Axpatientxasksxaxnursextoxexplainxwhatxdrugxtolerancexmeans.xThexnursexrespondsxbyxtellin
gxthexpatientxthatxwhenxtolerancexoccurs,xitxmeansxthexpatient:
a.xhasxdevelopedxaxpsychologicalxdependencexonxthexdrug.x
b.xmayxneedxincreasedxamountsxofxthexdrugxoverxtime.
c.xwillxcausexanxabstinencexsyndromexifxthexdrugxisxdiscontinuedxabruptly.
d.xwillxhavexincreasedxsensitivityxtoxdrugxsidexeffects.x-xANS:xBx
Whenxtolerancexdevelops,xaxdosexincreasexmayxbexneeded,xbecausexaxdecreasedxrespon
sexmayxoccurxwithxprolongedxuse.xPsychologicxdependencexinvolvesxcravingsxforxdrugxeff
ectsxandxdoesxnotxdefinextolerance.xPhysicalxdependencexoccursxwhenxthexdrugxbecomesx
necessaryxforxthexbrainxtoxfunctionx"normally,"xmeaningxthexpatientxshouldxbexweanedxfrom
xthexdrugxslowlyxtoxpreventxanxabstinencexsyndrome.xPatientsxmayxhavexaxdecreasedxsens
itivityxtoxdrugxsidexeffectsxoverxtimexasxthexbrainxadaptsxtoxthexmedication.
,Axgroupxofxnursingxstudentsxasksxaxnursextoxexplainxthexblood-
brainxbarrier.xThexnursexwouldxbexcorrectxtoxsayxthatxthexblood-brainxbarrier:
a.xpreventsxsomexpotentiallyxtoxicxsubstancesxfromxcrossingxintoxthexcentralxnervousxsyste
m.
b.xcausesxinfantsxtoxbexlessxsensitivextoxCNSxdrugsxandxthusxrequirexlargerxdoses.x
c.xallowsxonlyxionizedxorxprotein-boundxdrugsxtoxcrossxintoxthexcentralxnervousxsystem.
d.xpreventsxlipid-solublexdrugsxfromxenteringxthexcentralxnervousxsystem.x-xANS:xAx
Thexblood-
brainxbarrierxcanxpreventxsomexdrugsxandxsomextoxicxsubstancesxfromxenteringxthexCNS.x
Thexblood-
brainxbarrierxinxinfantsxisxnotxfullyxdeveloped,xsoxinfantsxarexmorexsensitivextoxCNSxdrugsxa
ndxoftenxrequirexlowerxdoses.xThexblood-brainxbarrierxpreventsxhighlyxionizedxandxprotein-
xboundxdrugsxfromxcrossingxintoxthexCNSxandxallowsxlipid-
solublexdrugsxandxthosexthatxcanxcrossxviaxspecificxtransportxsystemsxtoxenter.
AxnursexisxteachingxaxgroupxofxstudentsxaboutxhowxCNSxdrugsxarexdeveloped.xWhichxstate
ment
byxaxstudentxindicatesxaxneedxforxfurtherxteaching?
a.x"Centralxnervousxsystemxdrugxdevelopmentxreliesxonxobservationsxofxtheirxeffectsxonxhu
manxbehavior."
b.x"Studiesxofxnewxcentralxnervousxsystemxdrugsxinxhealthyxsubjectsxcanxproducexparadoxi
cal
effects."
c.x"Ourxknowledgexofxthexneurochemicalxandxphysiologicxchangesxthatxunderliexmentalxilln
ess
isxincomplete."
d.x"ThesexdrugsxarexdevelopedxbasedxonxscientificxknowledgexofxCNSxtransmittersxandxrec
eptors."x-xANS:xDx
ThexdeficienciesxinxknowledgexaboutxhowxCNSxtransmittersxandxreceptorsxworkxmakexsyst
ematicxdevelopmentxofxCNSxdrugsxdifficult.xTestingxinxhealthyxsubjectsxoftenxleadsxeitherxt
oxnoxeffectxorxtoxparadoxicalxeffects.xMedicalxknowledgexofxthexneurochemicalxandxphysiol
ogicxchangesxunderlyingxmentalxillnessxisxincomplete.xThexdevelopmentxofxCNSxdrugsxdep
endsxlessxonxknowledgexofxhowxthexCNSxfunctionsxandxhowxthesexdrugsxaffectxthatxproces
sxandxmorexonxhowxadministeringxonexofxthesexagentsxleadsxtoxchangesxinxbehavior.
AxnursexisxteachingxaxgroupxofxnursingxstudentsxhowxthexCNSxadaptsxtoxpsychotherapeutic
medications.xWhichxstatementxbyxaxnursingxstudentxindicatesxaxneedxforxfurtherxteaching?
a.x"Adaptationxcanxleadxtoxtolerancexofxthesexdrugsxwithxprolongedxuse."
b.x"Adaptationxhelpsxexplainxhowxphysicalxdependencexoccurs."
c.x"Adaptationxoftenxmustxoccurxbeforextherapeuticxeffectsxdevelop."
d.x"Adaptationxresultsxinxanxincreasedxsensitivityxtoxsidexeffectsxoverxtime."x-xANS:xDx
WithxadaptationxofxthexcentralxnervousxsystemxtoxprolongedxexposurextoxCNSxdrugs,xmany
xadversexeffectsxdiminishxandxtherapeuticxeffectsxremain.xAdaptationxhelpsxexplainxhowxtol
erancexandxphysicalxdependencexoccur,xasxthexbrainxadaptsxtoxthexpresencexofxthexdrug.xT
herapeuticxeffectsxcanxtakexseveralxweeksxtoxmanifest,xbecausextheyxappearxtoxworkxbyxini
tiatingxadaptivexchangesxinxthexbrain.
,Axpsychiatricxnursexisxteachingxaxpatientxaboutxanxantidepressantxmedication.xThexnursext
ellsxthexpatientxthatxtherapeuticxeffectsxmayxnotxoccurxforxseveralxweeks.xThexnursexunders
tandsxthatxthisxisxlikelyxthexresultxof:
a.xchangesxinxthexbrainxasxaxresultxofxprolongedxdrugxexposure.
b.xdirectxactionsxofxthexdrugxonxspecificxsynapticxfunctionsxinxthexbrain.
c.xslowedxdrugxabsorptionxacrossxthexblood-brainxbarrier.
d.xtolerancextoxexposurextoxthexdrugxoverxtime.x-xANS:xAx
Itxisxthoughtxthatxbeneficialxresponsesxtoxcentralxnervousxsystemx(CNS)xdrugsxarexdelayedx
becausextheyxresultxfromxadaptivexchangesxasxthexCNSxmodifiesxitselfxinxresponsextoxprolo
ngedxdrugxexposure,xandxthatxthexresponsesxarexnotxthexresultxofxthexdirectxeffectsxofxthexdr
ugsxonxsynapticxfunctions.xThexblood-brainxbarrierxpreventsxprotein-
boundxandxhighlyxionizedxdrugsxfromxcrossingxintoxthexCNS,xbutxitxdoesxnotxslowxthexeffects
xofxdrugsxthatxcanxcrossxthexbarrier.xTolerancexisxaxdecreasedxresponsextoxaxdrugxafterxprol
ongedxuse.
Whichxarexmedicalxapplicationsxofxcentralxnervousxsystemxdrugs?xSelectxallxthatxapply.
a.xAnalgesia
b.xAnesthesia
c.xDepression
d.xEuphoria
e.xSeizurexcontrolx-xANS:xA,xB,xEx
CNSxdrugsxhavexmedicalxusesxforxpainxmanagement,xanesthesia,xandxseizurexcontrol.xDe
pressionxandxeuphoriaxarexsidexeffectsxthatxcanxcontributextoxabusexofxthesexdrugs.
Axnursexisxassessingxaxpatientxwhoxbecomesxmotionlessxandxseemsxtoxstarexatxthexwallxan
dxthen
experiencesxaboutx60xsecondsxofxlipxsmackingxandxhandxwringing.xWhatxshouldxthexnursex
do?
a.xAskxthexpatientxaboutxaxhistoryxofxabsencexseizures.
b.xContactxthexproviderxtoxreportxsymptomsxofxaxcomplexxpartialxseizure.
c.xNotifyxthexproviderxthatxthexpatientxhasxhadxaxgrandxmalxseizure.
d.xRequestxanxorderxforxintravenousxdiazepamx[Valium]xtoxtreatxstatusxepilepticus.x-
xANS:xBx
Thisxpatientxshowedxsignsxofxaxcomplexxpartialxseizure,xcharacterizedxbyximpairedxconscio
usnessxbeginningxwithxaxperiodxofxmotionlessnessxwithxaxfixedxgaze,xfollowedxbyxaxperiodxo
fxautomatism.xThexentirexepisodexgenerallyxlastsx45xtox90xseconds.xAbsencexseizuresxarex
characterizedxbyxlossxofxconsciousnessxforxaxbriefxperiodx(aboutx10xtox30seconds)xandxma
yxinvolvexmild,xsymmetricxmotorxactivityxorxnoxmotorxsigns.xAxgrandxmalxseizurexisxcharacte
rizedxbyxjawxclenchingxandxrigidityxfollowedxbyxalternatingxmusclexrelaxationxandxcontractio
nxandxthenxperiodsxofxcyanosis,xallxwithxaxlossxofxconsciousness.xStatusxepilepticusxisxaxsei
zurexthatxpersistsxforx30xminutesxorxlonger.
Axnursexcounselsxaxpatientxwhoxisxtoxbeginxtakingxphenytoinx[Dilantin]xforxepilepsy.xWhichxs
tatementxbyxthexpatientxindicatesxunderstandingxofxthexteaching?
a.x"Ixshouldxbrushxandxflossxmyxteethxregularly."
, b.x"Oncextherapeuticxbloodxlevelsxarexreached,xtheyxarexeasyxtoxmaintain."
c.x"Ixcanxconsumexalcoholxinxmoderationxwhilextakingxthisxdrug."
d.x"Rashesxarexaxcommonxsidexeffectxbutxarexnotxserious."x-xANS:xAx
Gingivalxhyperplasiaxoccursxinxaboutx20%xofxpatientsxwhoxtakexphenytoin.xItxcanxbexminimi
zedxwithxgoodxoralxhygiene,xsoxpatientsxshouldxbexencouragedxtoxbrushxandxflossxregularly
.xBecausexsmallxfluctuationsxinxphenytoinxlevelsxcanxaffectxresponse,xmaintainingxtherape
uticxlevelsxisxnotxeasy.xPatientsxshouldxbexcautionedxagainstxconsumingxalcoholxwhilextakin
gxphenytoin.xRashesxcanxbexseriousxandxshouldxbexreportedximmediately.
Axnursexisxcaringxforxaxpatientxwhoxhasxbeenxtakingxanxantiepilepticxdrugxforxseveralxweeks.
xThexnursexasksxthexpatientxifxthextherapyxisxeffective.xThexpatientxreportsxlittlexchangexinxse
izurexfrequency.xWhatxwillxthexnursexdo?
a.xAskxthexpatientxtoxcompletexaxseizurexfrequencyxchartxforxthexpastxfewxweeks.
b.xContactxthexproviderxtoxrequestxanxorderxforxserumxdrugxlevels.
c.xReinforcexthexneedxtoxtakexthexmedicationsxasxprescribed.
d.xRequestxanxorderxtoxincreasexthexdosexofxthexantiepilepticxdrug.x-xANS:xBx
Ifxmedicationxtherapyxisxnotxeffective,xitxisximportantxtoxmeasurexserumxdrugxlevelsxofxthexm
edicationxtoxdeterminexwhetherxtherapeuticxlevelsxhavexbeenxreachedxandxtoxhelpxmonitorx
patientxcompliance.xPatientsxshouldxbexaskedxatxthexbeginningxofxtherapyxtoxkeepxaxseizur
exfrequencyxchartxtoxhelpxdeepenxtheirxinvolvementxinxtherapy;xaskingxforxhistoricalxinforma
tionxisxnotxhelpful.xUntilxitxisxdeterminedxthatxthexpatientxisxnotxcomplying,xthexnursexshouldx
notxreinforcexthexneedxtoxtakexthexmedication.xUntilxthexdrugxlevelxisxknown,xincreasingxthex
dosexisxnotxindicated.
Axpatientxisxtoxbeginxtakingxphenytoinx[Dilantin]xforxseizures.xThexpatientxtellsxthexnursexthat
xshexisxtakingxoralxcontraceptives.xWhatxwillxthexnursextellxthexpatient?
a.xShexmayxneedxtoxincreasexherxdosexofxphenytoinxwhilextakingxoralxcontraceptives.
b.xShexshouldxconsiderxaxdifferentxformxofxbirthxcontrolxwhilextakingxphenytoin.
c.xShexshouldxremainxonxoralxcontraceptives,xbecausexphenytoinxcausesxbirthxdefects.
d.xShexshouldxstopxtakingxoralxcontraceptives,xbecausextheyxreducexthexeffectivenessxofxp
henytoin.x-xANS:xBx
Becausexphenytoinxcanxreducexthexeffectsxofxoralxcontraceptivexpillsx(OCPs)xandxbecausex
avoidingxpregnancyxisxdesirablexwhenxtakingxphenytoin,xpatientsxshouldxbexadvisedxtoxincr
easexthexdosexofxoralxcontraceptivesxorxusexanxalternativexmethodxofxbirthxcontrol.xIncreasi
ngxthexpatient'sxdosexofxphenytoinxisxnotxnecessary;xOCPsxdoxnotxaffectxphenytoinxlevels.x
Phenytoinxisxlinkedxtoxbirthxdefects;xOCPsxhavexdecreasedxeffectivenessxinxpatientsxtreate
dxwithxphenytoin,xandxthexpatientxshouldxbexadvisedxtoxincreasexthexOCPxdosexorxtoxusexan
xalternativexformxofxbirthxcontrol.xOCPsxdoxnotxalterxthexeffectsxofxphenytoin.
Axpatientxwithxaxformofxepilepsyxthatxmayxhavexspontaneousxremissionxhasxbeenxtakingxanx
AED
forxaxyear.xThexpatientxreportsxbeingxseizurexfreexforx6xmonthsxandxasksxthexnursexwhenxth
exdrugxcanxbexdiscontinued.xWhatxwillxthexnursextellxthexpatient?
a.xAEDsxmustxbextakenxforxlifextoxmaintainxremission.
b.xAnotherxAEDxwillxbexsubstitutedxforxthexcurrentxAED.
c.xThexproviderxwillxwithdrawxthexdrugxoverxax6-xtox12-weekxperiod.
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS, 2ND EDITION BY LAURA ROSENTHAL
TEST BANK ISBN: 9780323554954 (2025) NEWEST
EDITION PDF
AnxinfantxwhoxreceivesxaxdrugxthatxdoesxnotxproducexCNSxsidexeffectsxinxadultsxexhibitsxdr
owsinessxandxsedation.xThexnursexunderstandsxthatxthisxisxbecausexofxdifferencesxinxwhic
hxphysiologicxsystemxinxinfantsxandxadults?
a.xBlood-brainxbarrier
b.xFirst-passxeffect
c.xGastrointestinalxabsorption
d.xRenalxfiltrationx-xANS:xAx
Thexblood-
brainxbarrierxisxnotxfullyxdevelopedxatxbirth,xmakingxinfantsxmuchxmorexsensitivextoxCNSxdru
gsxthanxolderxchildrenxandxadults.xCNSxsymptomsxmayxincludexsedationxandxdrowsiness.x
Thexfirst-
passxeffectxandxGIxabsorptionxaffectxmetabolismxandxabsorptionxofxdrugs,xandxrenalxfiltrati
onxaffectsxeliminationxofxdrugs,xallxofxwhichxmayxalterxdrugxlevels.
Whichxmonoaminesxactxasxneurotransmittersxinxthexcentralxnervousxsystem?xSelectxallxtha
txapply.
a.xAcetylcholine
b.xNorepinephrine
c.xSerotonin
d.xDopamine
e.xEpinephrine
f.xHistaminex-xANS:xBx,xCx,xDx,xEx
Acetylcholinexandxhistaminesxarexnotxmonoamines.
Axpatientxasksxaxnursextoxexplainxwhatxdrugxtolerancexmeans.xThexnursexrespondsxbyxtellin
gxthexpatientxthatxwhenxtolerancexoccurs,xitxmeansxthexpatient:
a.xhasxdevelopedxaxpsychologicalxdependencexonxthexdrug.x
b.xmayxneedxincreasedxamountsxofxthexdrugxoverxtime.
c.xwillxcausexanxabstinencexsyndromexifxthexdrugxisxdiscontinuedxabruptly.
d.xwillxhavexincreasedxsensitivityxtoxdrugxsidexeffects.x-xANS:xBx
Whenxtolerancexdevelops,xaxdosexincreasexmayxbexneeded,xbecausexaxdecreasedxrespon
sexmayxoccurxwithxprolongedxuse.xPsychologicxdependencexinvolvesxcravingsxforxdrugxeff
ectsxandxdoesxnotxdefinextolerance.xPhysicalxdependencexoccursxwhenxthexdrugxbecomesx
necessaryxforxthexbrainxtoxfunctionx"normally,"xmeaningxthexpatientxshouldxbexweanedxfrom
xthexdrugxslowlyxtoxpreventxanxabstinencexsyndrome.xPatientsxmayxhavexaxdecreasedxsens
itivityxtoxdrugxsidexeffectsxoverxtimexasxthexbrainxadaptsxtoxthexmedication.
,Axgroupxofxnursingxstudentsxasksxaxnursextoxexplainxthexblood-
brainxbarrier.xThexnursexwouldxbexcorrectxtoxsayxthatxthexblood-brainxbarrier:
a.xpreventsxsomexpotentiallyxtoxicxsubstancesxfromxcrossingxintoxthexcentralxnervousxsyste
m.
b.xcausesxinfantsxtoxbexlessxsensitivextoxCNSxdrugsxandxthusxrequirexlargerxdoses.x
c.xallowsxonlyxionizedxorxprotein-boundxdrugsxtoxcrossxintoxthexcentralxnervousxsystem.
d.xpreventsxlipid-solublexdrugsxfromxenteringxthexcentralxnervousxsystem.x-xANS:xAx
Thexblood-
brainxbarrierxcanxpreventxsomexdrugsxandxsomextoxicxsubstancesxfromxenteringxthexCNS.x
Thexblood-
brainxbarrierxinxinfantsxisxnotxfullyxdeveloped,xsoxinfantsxarexmorexsensitivextoxCNSxdrugsxa
ndxoftenxrequirexlowerxdoses.xThexblood-brainxbarrierxpreventsxhighlyxionizedxandxprotein-
xboundxdrugsxfromxcrossingxintoxthexCNSxandxallowsxlipid-
solublexdrugsxandxthosexthatxcanxcrossxviaxspecificxtransportxsystemsxtoxenter.
AxnursexisxteachingxaxgroupxofxstudentsxaboutxhowxCNSxdrugsxarexdeveloped.xWhichxstate
ment
byxaxstudentxindicatesxaxneedxforxfurtherxteaching?
a.x"Centralxnervousxsystemxdrugxdevelopmentxreliesxonxobservationsxofxtheirxeffectsxonxhu
manxbehavior."
b.x"Studiesxofxnewxcentralxnervousxsystemxdrugsxinxhealthyxsubjectsxcanxproducexparadoxi
cal
effects."
c.x"Ourxknowledgexofxthexneurochemicalxandxphysiologicxchangesxthatxunderliexmentalxilln
ess
isxincomplete."
d.x"ThesexdrugsxarexdevelopedxbasedxonxscientificxknowledgexofxCNSxtransmittersxandxrec
eptors."x-xANS:xDx
ThexdeficienciesxinxknowledgexaboutxhowxCNSxtransmittersxandxreceptorsxworkxmakexsyst
ematicxdevelopmentxofxCNSxdrugsxdifficult.xTestingxinxhealthyxsubjectsxoftenxleadsxeitherxt
oxnoxeffectxorxtoxparadoxicalxeffects.xMedicalxknowledgexofxthexneurochemicalxandxphysiol
ogicxchangesxunderlyingxmentalxillnessxisxincomplete.xThexdevelopmentxofxCNSxdrugsxdep
endsxlessxonxknowledgexofxhowxthexCNSxfunctionsxandxhowxthesexdrugsxaffectxthatxproces
sxandxmorexonxhowxadministeringxonexofxthesexagentsxleadsxtoxchangesxinxbehavior.
AxnursexisxteachingxaxgroupxofxnursingxstudentsxhowxthexCNSxadaptsxtoxpsychotherapeutic
medications.xWhichxstatementxbyxaxnursingxstudentxindicatesxaxneedxforxfurtherxteaching?
a.x"Adaptationxcanxleadxtoxtolerancexofxthesexdrugsxwithxprolongedxuse."
b.x"Adaptationxhelpsxexplainxhowxphysicalxdependencexoccurs."
c.x"Adaptationxoftenxmustxoccurxbeforextherapeuticxeffectsxdevelop."
d.x"Adaptationxresultsxinxanxincreasedxsensitivityxtoxsidexeffectsxoverxtime."x-xANS:xDx
WithxadaptationxofxthexcentralxnervousxsystemxtoxprolongedxexposurextoxCNSxdrugs,xmany
xadversexeffectsxdiminishxandxtherapeuticxeffectsxremain.xAdaptationxhelpsxexplainxhowxtol
erancexandxphysicalxdependencexoccur,xasxthexbrainxadaptsxtoxthexpresencexofxthexdrug.xT
herapeuticxeffectsxcanxtakexseveralxweeksxtoxmanifest,xbecausextheyxappearxtoxworkxbyxini
tiatingxadaptivexchangesxinxthexbrain.
,Axpsychiatricxnursexisxteachingxaxpatientxaboutxanxantidepressantxmedication.xThexnursext
ellsxthexpatientxthatxtherapeuticxeffectsxmayxnotxoccurxforxseveralxweeks.xThexnursexunders
tandsxthatxthisxisxlikelyxthexresultxof:
a.xchangesxinxthexbrainxasxaxresultxofxprolongedxdrugxexposure.
b.xdirectxactionsxofxthexdrugxonxspecificxsynapticxfunctionsxinxthexbrain.
c.xslowedxdrugxabsorptionxacrossxthexblood-brainxbarrier.
d.xtolerancextoxexposurextoxthexdrugxoverxtime.x-xANS:xAx
Itxisxthoughtxthatxbeneficialxresponsesxtoxcentralxnervousxsystemx(CNS)xdrugsxarexdelayedx
becausextheyxresultxfromxadaptivexchangesxasxthexCNSxmodifiesxitselfxinxresponsextoxprolo
ngedxdrugxexposure,xandxthatxthexresponsesxarexnotxthexresultxofxthexdirectxeffectsxofxthexdr
ugsxonxsynapticxfunctions.xThexblood-brainxbarrierxpreventsxprotein-
boundxandxhighlyxionizedxdrugsxfromxcrossingxintoxthexCNS,xbutxitxdoesxnotxslowxthexeffects
xofxdrugsxthatxcanxcrossxthexbarrier.xTolerancexisxaxdecreasedxresponsextoxaxdrugxafterxprol
ongedxuse.
Whichxarexmedicalxapplicationsxofxcentralxnervousxsystemxdrugs?xSelectxallxthatxapply.
a.xAnalgesia
b.xAnesthesia
c.xDepression
d.xEuphoria
e.xSeizurexcontrolx-xANS:xA,xB,xEx
CNSxdrugsxhavexmedicalxusesxforxpainxmanagement,xanesthesia,xandxseizurexcontrol.xDe
pressionxandxeuphoriaxarexsidexeffectsxthatxcanxcontributextoxabusexofxthesexdrugs.
Axnursexisxassessingxaxpatientxwhoxbecomesxmotionlessxandxseemsxtoxstarexatxthexwallxan
dxthen
experiencesxaboutx60xsecondsxofxlipxsmackingxandxhandxwringing.xWhatxshouldxthexnursex
do?
a.xAskxthexpatientxaboutxaxhistoryxofxabsencexseizures.
b.xContactxthexproviderxtoxreportxsymptomsxofxaxcomplexxpartialxseizure.
c.xNotifyxthexproviderxthatxthexpatientxhasxhadxaxgrandxmalxseizure.
d.xRequestxanxorderxforxintravenousxdiazepamx[Valium]xtoxtreatxstatusxepilepticus.x-
xANS:xBx
Thisxpatientxshowedxsignsxofxaxcomplexxpartialxseizure,xcharacterizedxbyximpairedxconscio
usnessxbeginningxwithxaxperiodxofxmotionlessnessxwithxaxfixedxgaze,xfollowedxbyxaxperiodxo
fxautomatism.xThexentirexepisodexgenerallyxlastsx45xtox90xseconds.xAbsencexseizuresxarex
characterizedxbyxlossxofxconsciousnessxforxaxbriefxperiodx(aboutx10xtox30seconds)xandxma
yxinvolvexmild,xsymmetricxmotorxactivityxorxnoxmotorxsigns.xAxgrandxmalxseizurexisxcharacte
rizedxbyxjawxclenchingxandxrigidityxfollowedxbyxalternatingxmusclexrelaxationxandxcontractio
nxandxthenxperiodsxofxcyanosis,xallxwithxaxlossxofxconsciousness.xStatusxepilepticusxisxaxsei
zurexthatxpersistsxforx30xminutesxorxlonger.
Axnursexcounselsxaxpatientxwhoxisxtoxbeginxtakingxphenytoinx[Dilantin]xforxepilepsy.xWhichxs
tatementxbyxthexpatientxindicatesxunderstandingxofxthexteaching?
a.x"Ixshouldxbrushxandxflossxmyxteethxregularly."
, b.x"Oncextherapeuticxbloodxlevelsxarexreached,xtheyxarexeasyxtoxmaintain."
c.x"Ixcanxconsumexalcoholxinxmoderationxwhilextakingxthisxdrug."
d.x"Rashesxarexaxcommonxsidexeffectxbutxarexnotxserious."x-xANS:xAx
Gingivalxhyperplasiaxoccursxinxaboutx20%xofxpatientsxwhoxtakexphenytoin.xItxcanxbexminimi
zedxwithxgoodxoralxhygiene,xsoxpatientsxshouldxbexencouragedxtoxbrushxandxflossxregularly
.xBecausexsmallxfluctuationsxinxphenytoinxlevelsxcanxaffectxresponse,xmaintainingxtherape
uticxlevelsxisxnotxeasy.xPatientsxshouldxbexcautionedxagainstxconsumingxalcoholxwhilextakin
gxphenytoin.xRashesxcanxbexseriousxandxshouldxbexreportedximmediately.
Axnursexisxcaringxforxaxpatientxwhoxhasxbeenxtakingxanxantiepilepticxdrugxforxseveralxweeks.
xThexnursexasksxthexpatientxifxthextherapyxisxeffective.xThexpatientxreportsxlittlexchangexinxse
izurexfrequency.xWhatxwillxthexnursexdo?
a.xAskxthexpatientxtoxcompletexaxseizurexfrequencyxchartxforxthexpastxfewxweeks.
b.xContactxthexproviderxtoxrequestxanxorderxforxserumxdrugxlevels.
c.xReinforcexthexneedxtoxtakexthexmedicationsxasxprescribed.
d.xRequestxanxorderxtoxincreasexthexdosexofxthexantiepilepticxdrug.x-xANS:xBx
Ifxmedicationxtherapyxisxnotxeffective,xitxisximportantxtoxmeasurexserumxdrugxlevelsxofxthexm
edicationxtoxdeterminexwhetherxtherapeuticxlevelsxhavexbeenxreachedxandxtoxhelpxmonitorx
patientxcompliance.xPatientsxshouldxbexaskedxatxthexbeginningxofxtherapyxtoxkeepxaxseizur
exfrequencyxchartxtoxhelpxdeepenxtheirxinvolvementxinxtherapy;xaskingxforxhistoricalxinforma
tionxisxnotxhelpful.xUntilxitxisxdeterminedxthatxthexpatientxisxnotxcomplying,xthexnursexshouldx
notxreinforcexthexneedxtoxtakexthexmedication.xUntilxthexdrugxlevelxisxknown,xincreasingxthex
dosexisxnotxindicated.
Axpatientxisxtoxbeginxtakingxphenytoinx[Dilantin]xforxseizures.xThexpatientxtellsxthexnursexthat
xshexisxtakingxoralxcontraceptives.xWhatxwillxthexnursextellxthexpatient?
a.xShexmayxneedxtoxincreasexherxdosexofxphenytoinxwhilextakingxoralxcontraceptives.
b.xShexshouldxconsiderxaxdifferentxformxofxbirthxcontrolxwhilextakingxphenytoin.
c.xShexshouldxremainxonxoralxcontraceptives,xbecausexphenytoinxcausesxbirthxdefects.
d.xShexshouldxstopxtakingxoralxcontraceptives,xbecausextheyxreducexthexeffectivenessxofxp
henytoin.x-xANS:xBx
Becausexphenytoinxcanxreducexthexeffectsxofxoralxcontraceptivexpillsx(OCPs)xandxbecausex
avoidingxpregnancyxisxdesirablexwhenxtakingxphenytoin,xpatientsxshouldxbexadvisedxtoxincr
easexthexdosexofxoralxcontraceptivesxorxusexanxalternativexmethodxofxbirthxcontrol.xIncreasi
ngxthexpatient'sxdosexofxphenytoinxisxnotxnecessary;xOCPsxdoxnotxaffectxphenytoinxlevels.x
Phenytoinxisxlinkedxtoxbirthxdefects;xOCPsxhavexdecreasedxeffectivenessxinxpatientsxtreate
dxwithxphenytoin,xandxthexpatientxshouldxbexadvisedxtoxincreasexthexOCPxdosexorxtoxusexan
xalternativexformxofxbirthxcontrol.xOCPsxdoxnotxalterxthexeffectsxofxphenytoin.
Axpatientxwithxaxformofxepilepsyxthatxmayxhavexspontaneousxremissionxhasxbeenxtakingxanx
AED
forxaxyear.xThexpatientxreportsxbeingxseizurexfreexforx6xmonthsxandxasksxthexnursexwhenxth
exdrugxcanxbexdiscontinued.xWhatxwillxthexnursextellxthexpatient?
a.xAEDsxmustxbextakenxforxlifextoxmaintainxremission.
b.xAnotherxAEDxwillxbexsubstitutedxforxthexcurrentxAED.
c.xThexproviderxwillxwithdrawxthexdrugxoverxax6-xtox12-weekxperiod.
