NU 578 UNIT 2 EXAM
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
-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. DIF: Cognitive Level: Comprehension REF: pp. 139TOP:
Nursing Process: N/A MSC: NCLEX Client Needs Category: Physiologic Integrity:
Physiologic Adaptation
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
-Acetylcholine and histamines are not monoamines. DIF: Cognitive Level:
Comprehension REF: pp. 140TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
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 psychologic 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.
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. DIF: Cognitive Level: Comprehension REF: pp. 140TOP: Nursing
Process: N/A MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
,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.
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 lipidsoluble 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."
, 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."
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.
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
-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. DIF: Cognitive Level: Comprehension REF: pp. 139TOP:
Nursing Process: N/A MSC: NCLEX Client Needs Category: Physiologic Integrity:
Physiologic Adaptation
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
-Acetylcholine and histamines are not monoamines. DIF: Cognitive Level:
Comprehension REF: pp. 140TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
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 psychologic 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.
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. DIF: Cognitive Level: Comprehension REF: pp. 140TOP: Nursing
Process: N/A MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
,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.
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 lipidsoluble 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."
, 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."
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.
