ATI PHARM - Neurological Medications Exam Questions & Answers 2025

The client with myasthenia gravis is suspected of having cholinergic crisis. Which sign/symptom indicates this crisis is taking place? Hypertension Rationale:Cholinergic crisis occurs as a result of an overdose of medication. Indications of cholinergic crisis include gastrointestinal disturbances, nausea, vomiting, diarrhea, abdominal cramps, increased salivation and tearing, miosis, hypertension, sweating, and increased bronchial secretions. The client is receiving meperidine hydrochloride for pain. Which signs/symptoms are side and adverse effects of this medication? Select all that apply. Tremors Drowsiness Hypotension Rationale:Meperidine hydrochloride is an opioid analgesic. Side and adverse effects include respiratory depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors. The client with myasthenia gravis becomes increasingly weak. The primary health care provider (PHCP) prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which change in condition indicates that the client is in cholinergic crisis? A temporary worsening of the condition Rationale:An edrophonium injection makes the client experiencing cholinergic crisis temporarily worse. This is known as a negative test. An improvement of weakness would occur if the client were experiencing myasthenia gravis. Carbidopa-levodopa is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse effects of the medication. Which sign/symptom indicates the client is experiencing an adverse effect? Impaired voluntary movements Rationale:Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication. Phenytoin, 100 mg orally three times daily, has been prescribed for a client for seizure control. The nurse reinforces instructions regarding the medication to the client. Which statement by the client indicates an understanding of the instructions? "I will use a soft toothbrush to brush my teeth." Rationale:Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, swelling, and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not skip medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity. The client is taking phenytoin for seizure control, and a blood sample for a serum drug level is drawn. Which laboratory finding indicates a therapeutic serum drug result? 15 mcg/mL (59.52 mcmol/L) Rationale:The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/mL (39.68 to 79.36 mcmol/L). Ibuprofen is prescribed for a client. Which instruction should the nurse give the client about taking this medication? Take with 8 oz of milk. Rationale:Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. The nurse is caring for a client who is taking phenytoin for control of seizures. During data collection, the nurse notes that the client is taking birth control pills. Which information should the nurse provide to the client? The potential for decreased effectiveness of the birth control pills exists while taking phenytoin. Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. The client with trigeminal neuralgia is being treated with carbamazepine. Which laboratory result indicates that the client is experiencing an adverse effect of the medication? White blood cell count, 3000 mm3 (3 × 109/L) Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbance, thrombophlebitis, dysrhythmia, and dermatological effects. The client with myasthenia gravis is receiving pyridostigmine. The nurse monitors for signs and symptoms of cholinergic crisis caused by overdose of the medication. The nurse checks the medication supply to ensure that which medication is available for administration if a cholinergic crisis occurs? Atropine sulfate Rationale:The antidote for cholinergic crisis is atropine sulfate. Acetylcysteine is the antidote for acetaminophen. Vitamin K is the antidote for warfarin and protamine sulfate is the antidote for heparin. The nurse is caring for an older client with a diagnosis of myasthenia gravis and has reinforced self-care instructions. Which statement by the client indicates a need for further teaching? "I can change the time of my medication on the mornings that I feel strong." Rationale:The client with myasthenia gravis should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If not given on time, the client may become too weak to swallow. The nurse is reinforcing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which statement indicates the client understands the instructions? "I should not stop taking my medications even if my seizures go away." Rationale:The anticonvulsant medication should not be stopped even if there are no seizures. Adolescents can obtain a driver's license in most states when they have been seizure free for 1 year. Anticonvulsants cause acne and oily skin; therefore, a dermatologist may need to be consulted. If an anticonvulsant medication is missed, the primary health care provider should be notified. The nurse is caring for a client receiving morphine sulfate intravenously for pain. Because morphine sulfate has been prescribed for this client, which nursing action should be included in the plan of care? Encourage the client to cough and deep breathe. Rationale:Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. The remaining options are not specifically associated with this medication. Meperidine hydrochloride is prescribed for the client with pain. Which should the nurse monitor as a side effect of this medication? Urinary retention Rationale:Meperidine hydrochloride is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention. The nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which should the nurse include in the plan of care while the client is taking this medication? Monitor bowel activity. Rationale:While the client is taking codeine sulfate, an opioid analgesic, the nurse should monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication. Carbamazepine is prescribed for a client with a diagnosis of psychomotor seizures. The nurse reviews the client's health history knowing that this medication is contraindicated if which disorder is present? Liver disease Rationale:Carbamazepine is contraindicated in liver disease, and liver function tests are routinely prescribed for baseline purposes and are monitored during therapy. It is also contraindicated if the client has a history of blood dyscrasias. It is not contraindicated in the conditions noted in the incorrect options. A client with trigeminal neuralgia tells the nurse that acetaminophen is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which indicates toxicity associated with the medication? A direct bilirubin level of 2 mg/dL Rationale:In adults, overdose of acetaminophen causes liver damage. Option 3 is an indicator of liver function and is the only option that indicates an abnormal laboratory value applicable to liver dysfunction. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L. The nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination? The client is experiencing magnesium toxicity. Rationale:Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression; loss of deep tendon reflexes; sudden decrease in fetal heart rate, maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL). A client with epilepsy is taking the prescribed dose of phenytoin to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/mL. Which symptom would be expected as a result of this laboratory result? Slurred speech Rationale:The therapeutic phenytoin level is 10 to 20 mcg/mL. At a level higher than 20 mcg/mL, involuntary movements of the eyeballs (nystagmus) appear. At a level higher than 30 mcg/mL, ataxia and slurred speech occur. Mannitol is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which indicates the therapeutic action of this medication? Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes Rationale:Mannitol is an osmotic diuretic that induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes. It is used to reduce intracranial pressure in the client with head trauma. A primary health care provider initiates carbidopa/levodopa therapy for the client with Parkinson's disease. A few days after the client starts the medication, the client complains of nausea and vomiting. What should the nurse tell the client regarding how to avoid side effects when taking this combination medication? Taking the medication with food will help prevent the nausea. Rationale:If carbidopa/levodopa is causing nausea and vomiting, the nurse would tell the client that taking the medication with food may decrease the nausea. Additionally, the client should be instructed not to take the medication with a high- protein meal because the high-protein will affect absorption. Antiemetics from the phenothiazine class should not be used because they block the therapeutic action of dopamine. The nurse has administered a dose of diazepam to a client. The nurse should take which most important action before leaving the client's room? Per agency policy, put up the side rails on the bed. Rationale:Diazepam is a sedative-hypnotic with anticonvulsant and skeletal muscle relaxant properties. The nurse should institute safety measures before leaving the client's room to ensure that the client does not injure herself or himself. The most frequent side effects of this medication are dizziness, drowsiness, and lethargy. For this reason, the nurse puts the side rails up on the bed before leaving the room to prevent falls. Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine. Which medication should the nurse prepare in anticipation of the prescription to treat this adverse effect related to the use of chlorpromazine? Bromocriptine Rationale:Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome. Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Enalapril maleate is an antihypertensive used in the treatment of hypertension. A client is placed on hydrate sedative-hypnotic for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication? Instructing the client to call for ambulation assistance Rationale:A sedative-hypnotic causes sedation and impairment of motor coordination; therefore, safety measures need to be implemented. The client is instructed to call for assistance with ambulation. Options 1 and 2 are not specifically associated with the use of this medication. Although option 4 is an appropriate nursing intervention, it is most important to instruct the client to call for assistance with ambulation. A client with Parkinson's disease has been prescribed benztropine. The nurse monitors for which gastrointestinal (GI) side effect of this medication? Dry mouth Rationale:Common GI side effects of benztropine therapy include constipation and dry mouth. Other GI side effects include nausea and ileus. These effects are the result of the anticholinergic properties of the medication. A client with a history of simple partial seizures is taking clorazepate, and asks the nurse if there is a risk of addiction. The nurse's response is based on which fact? Clorazepate leads to physical and psychological dependence with prolonged high- dose therapy. Rationale:Clorazepate is classified as an anticonvulsant, antianxiety agent, and sedative-hypnotic. One of the concerns with clorazepate therapy is that the medication can lead to physical or psychological dependence with prolonged therapy at high doses. For this reason, the amount of medication that is readily available to the client at any one time is restricted. A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. How should the nurse respond to the client's concerns? "Clumsiness and unsteadiness are worse during initial therapy and decrease or disappear with long-term use." Rationale:Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. A hospitalized client is having the dosage of clonazepam adjusted. The nurse should plan to implement which action? Instituting seizure precautions Rationale:Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. A client has a prescription for valproic acid orally once daily. How should the nurse plan to administer the medication? Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels. A client taking carbamazepine asks the nurse what to do if he misses one dose. Which response should the nurse give? "Take the medication as long as it is not immediately before the next dose." Rationale:Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the primary health care provider. The nurse has given medication instructions to a client beginning anticonvulsant therapy with carbamazepine. The nurse determines that the client understands the use of the medication if the client knows to perform which activity? Use sunscreen when outside. Rationale:Carbamazepine acts by depressing synaptic transmission in the central nervous system (CNS). Because of this, the client should avoid driving or doing other activities that require mental alertness until the effect on the client is known. The client should use protective clothing and sunscreen to avoid photosensitivity reactions. The medication may cause dry mouth (not excessive salivation), and the client should be instructed to provide good oral hygiene and use sugarless candy or gum as needed. The medication should not be abruptly discontinued because it could cause return of seizures or status epilepticus. Fever and sore throat should be reported to the primary health care provider (PHCP). A client with vascular headaches is taking ergotamine. Which client complaint should the nurse monitor? Cool, numb fingers and toes Rationale:Ergotamine produces vasoconstriction, which suppresses vascular headaches when given at a therapeutic dose range. The nurse monitors for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting. The nurse is caring for a client with myasthenia gravis who has received edrophonium intravenously to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. The nurse's response is based on the understanding that the duration is usually how many minutes? 30 Rationale:Edrophonium may be given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication and lasts for about 30 minutes. A client with narcolepsy has been prescribed a central nervous system (CNS) stimulant. The client complains to the nurse that he cannot sleep well anymore at night and does not want to take the medication any longer. Before making any specific comment, the nurse plans to investigate whether the client takes the medication at which time schedule? At least 6 hours before bedtime Rationale:A central nervous system (CNS) stimulant acts by releasing norepinephrine from nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep. Taking the medication at the time frames indicated in options 1, 2, and 3 will prevent the client from sleeping because of the stimulant properties of the medication. A client on the nursing unit has a prescription for a central nervous (CNS) stimulant orally daily. The nurse collaborates with the dietitian to limit the amount of which item on the client's dietary trays? Caffeine Rationale:Caffeine is a stimulant and should be limited in the client taking a central nervous system (CNS) stimulant. The client should also be taught to limit caffeine intake as well. A client with Parkinson's disease has begun therapy with carbidopa/levodopa. The nurse determines that the client understands the action of the medication if the client verbalizes that results may not be apparent for which length of time? 2 to 3 weeks Rationale:Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. Clients need to understand this concept to aid in compliance with medication therapy. A client is taking trihexyphenidyl for the treatment of Parkinson's disease. The nurse should monitor for which side effect of this medication? Urinary retention Rationale:Trihexyphenidyl is an anticholinergic medication. Because of this, it can cause urinary hesitancy and retention, constipation, dry mouth, and decreased sweating as side effects. A client receiving therapy with carbidopa/levodopa is upset and tells the nurse that his urine has turned a darker color since he began to take the medication. The client wants to discontinue its use. In formulating a response to the client's concerns, how does the nurse interpret this development? A harmless side effect of the medication Rationale:With carbidopa/levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. A client began taking amantadine approximately 2 weeks ago. A decrease in which should the nurse expect to see if the medication is having a therapeutic effect? Rigidity and akinesia Rationale:Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all adverse effects of the medication. A client is receiving anticonvulsant therapy with phenytoin. The nurse plans to monitor the results of which laboratory tests closely? Select all that apply. Urinalysis Serum calcium Alkaline phosphatase Complete blood cell count Rationale:The nurse would monitor the client's complete blood cell counts because hematological side effects of this therapy include aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia. Other values that warrant monitoring include serum calcium levels and the results of urinalysis, and hepatic and thyroid function tests. Serum sodium is not affected by phenytoin. The nurse is caring for a hospitalized child with a history of seizures who is receiving oral phenytoin sodium. Which should be included in the plan of care for this child? Providing oral hygiene, especially care of the gums Rationale:Phenytoin sodium causes gum bleeding and hypertrophy; therefore, oral hygiene is important. Soft toothbrushes and gum massage should be instituted to reduce the risk of complications and prevent further trauma. Options 1 and 4 are incorrect because the intake and output, as well as heart rate, are not affected by this medication. Option 3 is incorrect because directions for administration of this medication include administering with food to minimize gastrointestinal upset. The nurse is caring for a child receiving carbamazepine who has a carbamazepine level drawn. Which result indicates a therapeutic level? 6 mcg/mL Rationale:When carbamazepine is administered, blood levels need to be drawn periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum level for this medication is 4 to 12 mcg/mL. A client is admitted to the hospital because of complaints of vomiting and abdominal pain. During data collection, the client tells the nurse that he is taking entacapone. Based on this finding, the nurse elicits information from the client regarding the presence of which condition? Parkinson's disease Rationale:Entacapone is an antiparkinsonian agent used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. It is not used to treat cardiovascular disorders. Morphine sulfate is being administered to a client with cancer. The nurse is monitoring the client for signs of overdose related to this medication therapy. Which finding noted in the client should require the need to notify the registered nurse? Respirations of 10 breaths per minute Rationale:Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be determined. The registered nurse is notified immediately if the respiratory rate is below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value. The registered nurse would then contact the primary health care provider. The nurse is reinforcing instructions to a client taking phenytoin for seizure control. Which statement should the nurse make to the client regarding the administration of this medication? "If you develop a sore throat, it is necessary to notify the primary health care provider." Rationale:Phenytoin is an anticonvulsant. Gingival hyperplasia, bleeding, and swelling and tenderness of the gums can occur with the use of this medication. The client needs to be taught good oral hygiene, gum massage, and the need for regular dentist visits. The client should not miss medication doses because this could precipitate a seizure. Capsules should not be chewed or broken, and they must be swallowed. The client needs to be instructed to report a sore throat, fever, glandular swelling, or any skin reaction because this indicates hematological toxicity. A client with a history of seizures is taking phenytoin for seizure control. The client arrives at the health care clinic, and a serum phenytoin drug level is drawn. The laboratory calls the nurse and reports a result of 10 mcg/mL. Which interpretation should the nurse make of this value? The laboratory value is at the low end of therapeutic range. Rationale:The therapeutic serum drug level range for phenytoin is 10 to 20 mcg/L. A laboratory result of 10 mcg/mL is at the low end of therapeutic range. The nurse reviews the laboratory results of a client with trigeminal neuralgia who is being treated with carbamazepine 400 mg orally daily. The client's white blood cell (WBC) count is 3000 cells/mm3, blood urea nitrogen (BUN) is 15 mg/dL, sodium is 140 mEq/L, and uric acid is 5 ng/dL. Which laboratory result should the nurse report to the primary health care provider? The WBC is low, indicating a blood dyscrasia. Rationale:Adverse effects of carbamazepine appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. The nurse is assisting in preparing a plan of care for a client with a diagnosis of cancer who is receiving morphine sulfate in an extended format by mouth. The nurse should include which priority nursing action in the plan of care for this client? Encourage the client to cough and deep breathe. Rationale:Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent complications related to the use of this medication. The nurse is assisting in preparing a plan of care for a client with renal colic receiving meperidine hydrochloride for pain. The nurse includes in the plan of care to monitor for which side effect of this medication? Urinary retention Rationale:Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention. The nurse is providing instructions to a client who is taking codeine sulfate for severe back pain. Which action does the nurse instruct the client to do? Increase fluid intake. Rationale:Codeine sulfate can cause constipation. The client is instructed to increase fluid intake to prevent constipation. Options 2, 3, and 4 are incorrect because they do not address the side effects associated with the use of this medication. Although lightheadedness can occur with the use of this medication, all exercise is not avoided. It is important that the client ambulate frequently. Entacapone is prescribed for a client with a diagnosis of Parkinson's disease. The nurse reinforces medication instructions to the client and instructs on which frequent side effect? Urine discoloration to dark yellow or orange Rationale:Entacapone is an antiparkinsonian agent that is used in conjunction with levodopa to improve the quality of life in clients with Parkinson's disease. A frequent side effect is a urine discoloration to dark yellow or orange. Joint pains, muscle weakness and pruritus are not associated with the use of this medication. The nurse is reinforcing instructions to the spouse of a client who is taking tacrine for the management of moderate dementia associated with Alzheimer's disease. The nurse should tell the spouse which information? "If a change in the color of the stools occurs, notify the primary health care provider." Rationale:Tacrine may be administered between meals on an empty stomach, and if gastrointestinal upset occurs, it may be administered with meals. Flulike symptoms without fever and gastrointestinal symptoms are frequent side effects of the medication. The client or spouse should never be instructed to double the dose of any medication if it was missed, and the client and caregiver are instructed to notify the primary health care provider if nausea, vomiting, diarrhea, rash, jaundice, or changes in the color of the stool occur. This may be indicative of hepatitis. The nurse is caring for a client who has been prescribed carbidopa/levodopa. The nurse should monitor the client for which side effects? Select all that apply. Urinary retention Orthostatic hypotension Rationale:Monitor clients taking carbidopa/levodopa for orthostatic hypotension and urinary retention. Amantadine and pergolide may cause insomnia. Anticholinergics cause dry mouth and constipation. A client who was started on anticonvulsant therapy with clonazepam tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these symptoms and asks the nurse what to do. The nurse's response is based on which understanding of these symptoms? These are expected effects during initial therapy and decrease or disappear with long-term use.