Rosenthal: Lehne's
Pharmacotherapeutics for Advanced
Practice Nurses and Physician
Assistants 2 COMPLETE QUESTIONS
AND ANSWERS)
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 - 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 - 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. - 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. - 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." - 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." - 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. - 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 - 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. -
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." - ANSWER>>ANS: A
Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized
with good oral hygiene, so patients should be encouraged to brush and floss regularly. Because
small fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not
easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes
can be serious and should be reported immediately.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The
nurse asks the patient if the therapy is effective. The patient reports little change in seizure
frequency. What will the nurse do?
a. Ask the patient to complete a seizure frequency chart for the past few weeks.
b. Contact the provider to request an order for serum drug levels.
c. Reinforce the need to take the medications as prescribed.
d. Request an order to increase the dose of the antiepileptic drug. - ANSWER>>ANS: B
If medication therapy is not effective, it is important to measure serum drug levels of the
medication to determine whether therapeutic levels have been reached and to help monitor
patient compliance. Patients should be asked at the beginning of therapy to keep a seizure
frequency chart to help deepen their involvement in therapy; asking for historical information is
not helpful. Until it is determined that the patient is not complying, the nurse should not
reinforce the need to take the medication. Until the drug level is known, increasing the dose is
not indicated.
Pharmacotherapeutics for Advanced
Practice Nurses and Physician
Assistants 2 COMPLETE QUESTIONS
AND ANSWERS)
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 - 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 - 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. - 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. - 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." - 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." - 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. - 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 - 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. -
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." - ANSWER>>ANS: A
Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized
with good oral hygiene, so patients should be encouraged to brush and floss regularly. Because
small fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not
easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes
can be serious and should be reported immediately.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The
nurse asks the patient if the therapy is effective. The patient reports little change in seizure
frequency. What will the nurse do?
a. Ask the patient to complete a seizure frequency chart for the past few weeks.
b. Contact the provider to request an order for serum drug levels.
c. Reinforce the need to take the medications as prescribed.
d. Request an order to increase the dose of the antiepileptic drug. - ANSWER>>ANS: B
If medication therapy is not effective, it is important to measure serum drug levels of the
medication to determine whether therapeutic levels have been reached and to help monitor
patient compliance. Patients should be asked at the beginning of therapy to keep a seizure
frequency chart to help deepen their involvement in therapy; asking for historical information is
not helpful. Until it is determined that the patient is not complying, the nurse should not
reinforce the need to take the medication. Until the drug level is known, increasing the dose is
not indicated.
