Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
1. 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.
2. 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: ANS: B , C , D , E
Acetylcholine and histamines are not monoamines.
3. 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,"
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
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.
4. 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.:
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.
5. 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
under-lie mental illness is incomplete."
d. "These drugs are developed based on scientific knowledge of CNS
trans-mitters 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
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
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.
6. 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.":
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.
7. 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.
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
8. Which are medical applications of central nervous system drugs? Select
all that apply.
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control: 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.
9. 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 epilep-
ticus.: 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.
10. 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.": ANS: A
Physician Assistants
1. 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.
2. 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: ANS: B , C , D , E
Acetylcholine and histamines are not monoamines.
3. 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,"
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
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.
4. 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.:
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.
5. 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
under-lie mental illness is incomplete."
d. "These drugs are developed based on scientific knowledge of CNS
trans-mitters 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
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
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.
6. 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.":
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.
7. 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.
, Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and
Physician Assistants
8. Which are medical applications of central nervous system drugs? Select
all that apply.
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control: 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.
9. 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 epilep-
ticus.: 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.
10. 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.": ANS: A
