N316B Pharmacology Full Midterm Exam 2025

A client develops extrapyramidal effects after taking a neuroleptic medication, and the nurse notes extrapyramidal effects. Which medication can limit these side effects? Zolpidem Hydroxyzine Dantrolene Benztropine mesylate - Correct Ans-benztropine mesylate rationale Benztropine mesylate, an anticholinergic, helps balance neurotransmitter activity in the central nervous system (CNS) and helps control extrapyramidal tract symptoms. Zolpidem is a sedative-hypnotic medication used for short-term insomnia. Hydroxyzine is a sedative that depresses activity in the subcortical areas in the CNS; it is used to reduce anxiety. Dantrolene, a muscle relaxant, has a direct effect on skeletal muscle by acting on the excitation-contraction coupling of muscle fibers and not at the level of the CNS, unlike most other muscle relaxation medications. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. An 11-year-old client reports having bedwetting issues (enuresis). Which medication would the nurse anticipate when developing a teaching plan ? Alprazolam Imipramine Lithium salts Clomipramine - Correct Ans-Imipramine rationale Certain conditions of pediatric clients necessitate the usage of tricyclic antidepressant medications as an adjuvant. Childhood enuresis is one such condition that necessitates the administration of imipramine. Alprazolam is the medication of choice for treating anxiety disorders. Lithium salt is prescribed to treat bipolar disorders. Clomipramine is a tricyclic antidepressant medication prescribed for treating obsessive-compulsive disorder. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options . N316B N316B 13) Which medication class includes amitriptyline? Tricyclics Monoamine oxidase inhibitors (MAOIs) Selective serotonin reuptake inhibitors (SSRIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs) - Correct Ans-Tricyclics rationale Amitriptyline is one of several tricyclic antidepressants used to treat anxiety disorders. It is not an MAOI, SSRI, or SNRI. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. 48) A client with a history of methamphetamine use is admitted to the medical unit. Which clinical manifestation would the nurse expect when assessing the client who is under the influence on admission? Constricted pupils Intractable diarrhea Increased heart rate Decreased respirations :rationale Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system and causes increased heart rate. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will increase, not decrease, because of the activation of the sympathetic nervous system. 48) A client with a history of methamphetamine use is admitted to the medical unit. Which clinical manifestation would the nurse expect when assessing the client who is under the influence on admission? Constricted pupils Intractable diarrhea Increased heart rate Decreased respirations - Correct Ans-Increased heart rate rationale Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system and causes increased heart rate. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will increase, not decrease, because of the activation of the sympathetic nervous system. # 60) Which conclusion would the nurse make about the development of loose stools and increased salivation two days after a client with myasthenia gravis begins taking pyridostigmine? N316B N316B The client is experiencing a myasthenic crisis. The medication is causing cholinergic side effects. The medication is triggering a paradoxical reaction. The client is exhibiting toxic effects of the medication. - Correct Ans-The medication is causing cholinergic side effects rationale Because this medication inhibits the destruction of acetylcholine, parasympathetic activity may increase, resulting in cholinergic side effects such as diarrhea and increased salivation. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, a weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary and not paradoxical; they continue as long as the medication is continued. The dosage may be adjusted or an anticholinergic may be given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration. 68) Nortriptyline is prescribed for a depressed client. Which time period identifies when the nurse would expect a therapeutic response? 1 to 3 days 12 to 24 hours 30 minutes to 2 hours 2 to 3 weeks - Correct Ans-2-3 weeks rationale As with other tricyclics, optimal therapeutic effects take 2 to 3 weeks to occur. One to 3 days, 12 to 24 hours, and 30 minutes to 2 hours are all too soon to expect a response to nortriptyline. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions. 86) A client is admitted to the acute medical unit for severe amphetamine intoxication. Which medications are indicated to counteract the effects of stimulant intoxication? Select all that apply. One, some, or all responses may be . Diazepam Propranolol Benztropine Bupropion Amitriptyline - Correct Ans-Diazepam, propranolol rationale Because stimulants act by increasing both adrenaline and dopamine, seizures may occur. Diazepam can reduce the chance of seizures. Because amphetamines act by increasing adrenaline, which can stimulate the heart, propranolol, a beta-blocker, will decrease this adrenergic stimulation. Benztropine, a cholinergic blocker, is not indicated N316B N316B as a treatment for stimulant intoxication. Bupropion is contraindicated because it increases dopamine and adrenaline, which will exacerbate stimulant intoxication. Amitriptyline is contraindicated because it increases dopamine and adrenaline, which will exacerbate stimulant intoxication. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. 92) An 80-year-old client with depression requires the prescription of antidepressant medication. Which tricyclic antidepressant medication causes fewer complications in older clients? Doxepin Amoxapine Nortriptyline Trimipramine - Correct Ans-Nortriptyline rationale Nortriptyline and desipramine are preferred for use in older adults because these antidepressant medications have less anticholinergic activity. Doxepin, amoxapine, and trimipramine have more cholinergic activity than nortriptyline and are not the preferred medications for older adult clients. 116) A 65-year-old client is receiving amitriptyline. Which recommendation will the nurse make to the client concerning this medication? 'Obtain a complete cholesterol and lipid profile.' 'Have an eye examination to check for glaucoma.' 'Check your temperature daily for nighttime increases.' 'Watch for excessive sweating and possible weight loss.' - Correct Ans-Have an eye exam to check for glaucoma rationale In addition to baseline laboratory tests, an older adult should have an eye examination with glaucoma testing when taking amitriptyline. It causes dilation of the pupil (mydriasis), which interferes with drainage of aqueous humor through the canal of Schlemm. Interfering with the outflow of aqueous humor will increase intraocular pressure and may cause a progressive loss of vision in clients with glaucoma. Amitriptyline does not affect cholesterol production or temperature regulation. It does not cause excessive sweating or weight loss, but it can increase appetite especially for sweets, resulting in weight gain. 185) A depressed client has been prescribed a tricyclic antidepressant. Which time period indicates how long it usually takes before the client notices a significant change in the depression? 4 to 6 days 2 to 4 weeks 5 to 6 weeks 12 to 16 hours - Correct Ans-2-4 weeks N316B N316B rationale It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Time spans of 4 to 6 days and 12 to 16 hours are both too short for a therapeutic blood level of the medication to be achieved. Improvement in depression should be demonstrated sooner than 5 to 6 weeks. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. 208) Which adverse effect of imipramine requires further assessment and possible immediate medical intervention? Dry mouth Weight gain Blurred vision Urinary hesitancy - Correct Ans-Urinary hesitancy rationale Urinary hesitancy and retention are adverse effects of imipramine that may require immediate medical intervention. Dry mouth, weight gain related to increased appetite, and blurred vision may occur as side effects of imipramine; they usually decrease over time or can be managed through nursing interventions. 226) Which drug category applies to cocaine? Opioids Stimulants Barbiturates Hallucinogens - Correct Ans-Stimulants rationale Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis. 305) Which body system is affected by excessive use of amphetamine/dextroamphetamine? Renal Cardiac Musculoskeletal Gastrointestinal - Correct Ans-Cardiac N316B N316B rationale Norepinephrine is released when amphetamine/dextroamphetamine is taken. Excessive doses of amphetamine/dextroamphetamine can cause an increase in heart rate and dysrhythmias. Amphetamine/dextroamphetamine overuse does not directly affect the renal, musculoskeletal, or the gastrointestinal systems. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal. 327) A client receiving fluphenazine decanoate develops dystonia early in therapy. Which medication would the nurse anticipate administering to reverse this side effect? Nafarelin Fluoxetine Trandolapril Benztropine - Correct Ans-Benztropine rationale Dystonia is an extrapyramidal side effect (EPS) of fluphenazine decanoate. The anticholinergic benztropine is used to reverse the signs and symptoms (e.g., oculogyric crisis, torticollis, retrocollis) of dystonia. Nafarelin is a gonadotropin that stimulates the release of luteinizing hormone and follicle-stimulating hormone. Fluoxetine is a selective serotonin reuptake inhibitor antidepressant. Trandolapril is an angiotensin-converting enzyme inhibitor antihypertensive. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. 346) Which nursing action is appropriate when administering imipramine? Telling the client steroids will not be prescribed Warning the client not to eat cheese Monitoring the client for increased tolerance Having the client checked for increased intraocular pressure - Correct Ans-Having the client checked for increased intraocular pressure rationale Glaucoma is one of the side effects of imipramine, and the client should be taught about the symptoms. The prescribing of steroids and avoiding cheese are true of monoamine oxidase inhibitors (MAOIs); imipramine is not an MAOI. Tolerance is not an issue with tricyclic antidepressants such as imipramine. Test-Taking Tip: The most reliable way to ensure that you select the response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the N316B N316B choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of ly answering each question. 358) Which statement accurately describes nortriptyline? Select all that apply. One, some, or all responses may be . Overdosage is often lethal. Constipation and urinary retention may occur. It is a selective serotonin reuptake inhibitor (SSRI). Weight gain is a common side effect. It increases effectiveness of monoamine oxidase inhibitors (MAOIs). - Correct Ans- Overdosage is often lethal -constipation and urinary retention may occur -weight gain is a common side effect rationale Nortriptyline is notoriously lethal; between 70% and 80% of people who die from overdose do so before reaching the hospital. Nortriptyline can cause constipation and urinary retention because it causes blockage of cholinergic receptors, and it tends to increase appetite and cause weight gain. Nortriptyline is not an SSRI; it is a tricyclic antidepressant and affects the balance of neurotransmitters in the brain. The interaction between nortriptyline and MAOIs is severe and possibly fatal. 374) Which action would the nurse perform when beginning pyridostigmine bromide therapy for a client with myasthenia gravis? Administer the medication after meals. Administer the medication on an empty stomach. Evaluate the client's psychological responses between medication doses. Evaluate the client's muscle strength every hour after the medication is given. - Correct Ans-Evaluate the client's muscle strength every hour after the medication is given rationale The onset of action of pyridostigmine is 30 to 45 minutes after administration, and the effects last up to 6 hours; the client's response will influence dosage levels. Pyridostigmine usually is administered before meals to promote mastication. Pyridostigmine should be administered with food to prevent gastric irritation. There are no psychological side effects associated with pyridostigmine. 376) Which test would the nurse identify as specific for the diagnosis of myasthenia gravis? Electromyography Pyridostigmine test Edrophonium chloride test