2 0 2 4 /2025 | © copyright | This work may not be copied for profit gain Excel!
Rosenthal: Lehne's Pharmacotherapeutics
for Advanced Practice Nurses and
Physician Assistants Questions and
Correct Answers the Latest Update and
Recommended Version
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
→ 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
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e. Epinephrine
f. Histamine
→ 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.
→ 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.
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→ 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."
→ 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?
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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.
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.
→ 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
1|Page| GradeA+ | 2 0 0 2 5
Rosenthal: Lehne's Pharmacotherapeutics
for Advanced Practice Nurses and
Physician Assistants Questions and
Correct Answers the Latest Update and
Recommended Version
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
→ 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
1|Page| GradeA+ | 2 0 0 2 5
,2 0 2 4 /2025 | © copyright | This work may not be copied for profit gain Excel!
e. Epinephrine
f. Histamine
→ 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.
→ 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.
1|Page| GradeA+ | 2 0 0 2 5
,2 0 2 4 /2025 | © copyright | This work may not be copied for profit gain Excel!
→ 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."
→ 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?
1|Page| GradeA+ | 2 0 0 2 5
, 2 0 2 4 /2025 | © copyright | This work may not be copied for profit gain Excel!
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.
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.
→ 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
1|Page| GradeA+ | 2 0 0 2 5
