Rosenthal: Lehne's Pharmacotherapeutics for
Advanced Practice Nurses and Physician
Assistants Questions, Answers and Rationale
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 - CORRECT ANSWER 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
e. Epinephrine
f. Histamine - CORRECT ANSWER 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. - CORRECT ANSWER 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. - CORRECT ANSWER 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." -
CORRECT ANSWER 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." - CORRECT ANSWER 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. - CORRECT ANSWER 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
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control - CORRECT ANSWER ANS: A, B, E
CNS drugs have medical uses for pain management, anesthesia, and seizure control. Depression and
euphoria are side effects that can contribute to abuse of these drugs.
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then
experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?
a. Ask the patient about a history of absence seizures.
b. Contact the provider to report symptoms of a complex partial seizure.
c. Notify the provider that the patient has had a grand mal seizure.
d. Request an order for intravenous diazepam [Valium] to treat status epilepticus. - CORRECT ANSWER
ANS: B
This patient showed signs of a complex partial seizure, characterized by impaired consciousness
beginning with a period of motionlessness with a fixed gaze, followed by a period of automatism. The
entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of
consciousness for a brief period (about 10 to 30seconds) and may involve mild, symmetric motor activity
or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by
alternating muscle relaxation and contraction and then periods of cyanosis, all with a loss of
consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer.
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by
the patient indicates understanding of the teaching?
a. "I should brush and floss my teeth regularly."
b. "Once therapeutic blood levels are reached, they are easy to maintain."
c. "I can consume alcohol in moderation while taking this drug."
d. "Rashes are a common side effect but are not serious." - CORRECT ANSWER ANS: A
Advanced Practice Nurses and Physician
Assistants Questions, Answers and Rationale
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 - CORRECT ANSWER 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
e. Epinephrine
f. Histamine - CORRECT ANSWER 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. - CORRECT ANSWER 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. - CORRECT ANSWER 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." -
CORRECT ANSWER 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." - CORRECT ANSWER 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. - CORRECT ANSWER 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
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control - CORRECT ANSWER ANS: A, B, E
CNS drugs have medical uses for pain management, anesthesia, and seizure control. Depression and
euphoria are side effects that can contribute to abuse of these drugs.
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then
experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?
a. Ask the patient about a history of absence seizures.
b. Contact the provider to report symptoms of a complex partial seizure.
c. Notify the provider that the patient has had a grand mal seizure.
d. Request an order for intravenous diazepam [Valium] to treat status epilepticus. - CORRECT ANSWER
ANS: B
This patient showed signs of a complex partial seizure, characterized by impaired consciousness
beginning with a period of motionlessness with a fixed gaze, followed by a period of automatism. The
entire episode generally lasts 45 to 90 seconds. Absence seizures are characterized by loss of
consciousness for a brief period (about 10 to 30seconds) and may involve mild, symmetric motor activity
or no motor signs. A grand mal seizure is characterized by jaw clenching and rigidity followed by
alternating muscle relaxation and contraction and then periods of cyanosis, all with a loss of
consciousness. Status epilepticus is a seizure that persists for 30 minutes or longer.
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by
the patient indicates understanding of the teaching?
a. "I should brush and floss my teeth regularly."
b. "Once therapeutic blood levels are reached, they are easy to maintain."
c. "I can consume alcohol in moderation while taking this drug."
d. "Rashes are a common side effect but are not serious." - CORRECT ANSWER ANS: A
