SAS#9
1. A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will
significantly increase the availability of which neurotransmitter?
a. GABA
b. Glutamate
c. Serotonin
d. Norepinephrine
ANSWER: D. Norepinephrine
RATIO: Secondary amines increase the availability and enhance the action of
norepinephrine.
2. Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression
and insomnia. Benefits specific to use of nortriptyline would include:
a. regular bowel movements.
b. improved sleep pattern.
c. weight loss.
d. anhedonia.
ANSWER: B. improved sleep pattern.
RATIO: The side effect profile of nortriptyline, a secondary amine, is favorable. The
danger of falling is modest because it has a negligible propensity to induce orthostatic
hypotension. Due to its mild sedative effects, it is beneficial for people with insomnia.
The remaining possibilities either have undesired or vague results.
3. Priority assessments for a patient beginning amitriptyline (Elavil) include:
a. nausea, diarrhea, and irritability.
b. seizures, agranulocytosis, and insomnia.
c. headache, sexual dysfunction, and weight loss.
d. history of falls, arrhythmias, and blurred vision.
ANSWER: D. history of falls, arrhythmias, and blurred vision.
RATIO: Anticholinergic (blurred vision) and antiadrenergic (orthostatic hypotension
resulting in falls and arrhythmias) adverse effects are brought on by tricyclic
antidepressants (TCAs). Selective serotonin reuptake inhibitor (SSRI) therapy is
associated with gastrointestinal problems, sexual dysfunction, and weight changes.
Therapy with bupropion results in seizures. None of the antidepressant groups view
agranulocytosis as a significant issue.
4. A 75-year-old patient with a long history of depression begins amitriptyline (Elavil) 100
mg/day. The patient also takes a diuretic daily for hypertension. The highest priority nursing
diagnosis is risk for:
a. falls related to dizziness and orthostatic hypotension.
b. ineffective thermoregulation related to anhidrosis.
c. infection related to suppressed white blood cell count.
d. constipation related to slowed peristalsis.
ANSWER: A. falls related to dizziness and orthostatic hypotension.
RATIO: A TCA with a high likelihood of causing orthostatic hypotension is amitriptyline.
Due to their advanced age and diuretic medication, which decreases fluid volume, the
patient is at an even higher risk. The alternative choices are either unrelated or
improbable possibilities.
5. A depressed patient prepares for discharge. The patient is prescribed desipramine
(Norpramin) and will have outpatient visits. The patient reports, "They gave me only a 1-week
supply of my medicine." Select the nurse's best reply.
a. "Federal law limits the amount you may be given at any one time."
b. "It will save you money if the drug doesn't work well for your symptoms."
c. "This is a way of ensuring that you will come in for your follow-up appointment."
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."
ANSWER: D. "Prescribing a small amount of drug addresses our concerns for your
continuing safety."
RATIO: As an activating antidepressant, desipramine may provide a patient who harbors
suicide thoughts the drive to act. TCA overdose is a common method of suicide because
the therapeutic dose and deadly dose cannot be distinguished by a significant margin.
Desipramine looks to be the most dangerous TCA, therefore prescription just a 7-day
supply reduces the chance that the medication may be used in a suicide attempt. The
alternative choices are either inaccurate or less pertinent.
6. Evaluation of a patient's response after 1 week of tricyclic antidepressant therapy would be
expected to show:
a. no change in objective or subjective symptoms.
b. increased appetite and weight gain.
c. decreased suicidal ideation.
d. improved mood and affect.
ANSWER: B. increased appetite and weight gain.
RATIO: The drug's antihistaminic action may be the reason for the improvement in
appetite. It can take two to four weeks for your mood to improve. For two to four weeks,
suicidal ideation could not decrease.
7. A patient diagnosed with depression who has reported vague suicidal ideation will stay at
home, have close family supervision, and make weekly visits to the health care provider.
Bupropion (Wellbutrin) is prescribed. What is the benefit of bupropion in this scenario?
a. It has antianxiety properties as well as antidepressant effects.
b. It lowers the seizure threshold to a lesser extent than TCAs.
c. There is reduced potential for lethal overdose.
d. It stimulates appetite and weight gain.
ANSWER: C. There is reduced potential for lethal overdose.
RATIO: Bupropion is a good choice for use in outpatient treatment of depression
because it has no possibility for a lethal overdose. Bupropion is significantly less deadly
than TCAs or monoamine oxidase inhibitors while having a restricted therapeutic index
(MAOIs). However, it could also result in anorexia, agitation, anxiety, seizures, and
weight loss.
8. A patient with depression has taken an SSRI for 1 month. The nurse should use direct
questions to evaluate which potential side effect?
a. Aggressive impulses
b. Sexual dysfunction
c. Paranoid delusions
d. Weight gain
ANSWER: B. Sexual dysfunction
RATIO: Sexual dysfunction, such as a drop in libido, is a common side effect of SSRIs.
Patients are open with nurses about gastrointestinal, anticholinergic, and other side
effects, but they are less honest about sexual issues. To get this information, the nurse
might need to ask directly. Patients are more open to talking about alternative
possibilities.
9. A patient prescribed fluoxetine (Prozac) is being changed to tranylcypromine (Parnate). The
nurse schedules a time lapse between the last dose of fluoxetine and the first dose of
tranylcypromine of at least:
a. 7 days.
b. 14 days.
c. 3 weeks.
d. 6 weeks.
ANSWER: D. 6 weeks.
RATIO: As fluoxetine is flushing out of the system, medications with a high risk of
dangerous interactions (such MAOIs) must be avoided for up to 6 weeks or longer. The
other possibilities have too little time between them.
10. A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made
him impotent. The nurse can be most helpful by saying:
a. "Your doctor wants you to continue taking your medication."
b. "Have you talked with your therapist regarding your feelings about sex?"
c. "Let's talk with your doctor. Changing your medication might be a possibility."
d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks."
ANSWER: C. "Let's talk with your doctor. Changing your medication might be a
possibility."
RATIO: Commonly, SSRIs lead to sexual dysfunction. A popularly marketed SSRI,
sertraline was the second medication in this family to be prescribed in the US. Sertraline
can also be taken with or without food once day (morning or evening). Both men and
women experience sexual dysfunction from sertraline. After stopping drugs, sexual
function usually returns to normal within two to three days. It may be beneficial to switch
to a different antidepressant or take low doses of bupropion. The alternatives are neither
therapeutic nor compassionate.
11. A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular
injection. What is the most important nursing intervention related to the injection?
a. Massage the site vigorously after injection.
b. Administer the drug using Z-tracking.
c. Avoid rotating the injection sites.
d. Select a 22- to 23-gauge needle.
ANSWER: B. Administer the drug using Z-tracking.
RATIO: This medication is very viscous and requires Z-track, deep IM injection to avoid
muscle irritation.
12. The client has been diagnosed with schizophrenia and is exhibiting a loss of function and
motivation. The nurse recognizes that these symptoms are categorized as:
a. positive.
b. paranoiac.
c. negative.
d. incoherent.
ANSWER: C. negative.
RATIO: Negative symptoms are manifested as the inability to initiate voluntary motor
function. The others are considered positive symptoms.
13. What is a common side effect for which the nurse must monitor during administration of both
phenothiazine and non-phenothiazine medications?
a. Hypertension
b. Renal failure
c. Increase in number of white blood cells
d. Extrapyramidal symptoms
ANSWER: D. Extrapyramidal symptoms
RATIO: These medications are known for their extrapyramidal symptoms.
14. The client with major depressive disorder taking the selective serotonin reuptake inhibitor
(SSRI) fluoxetine (Prozac) calls the psychiatric clinic and Reports feeling confused and restless
and having an elevated temperature. Which action should the psychiatric nurse take?
a. Determine if the client has flulike symptoms
b. Instruct the client to stop taking the SSRI
c. Recommend the client take the medication at night.
d. Explain that these are expected side effects.
ANSWER: B. Instruct the client to stop taking the SSRI
RATIO: Serotonin syndrome is a severe side effect of SSRIs that causes ataxia,
hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and hyperpyrexia
(confusion, anxiety, and restlessness). Stopping the SSRI is part of the conservation
treatment, along with supportive care. ESE can cause mortality if left untreated.
15. The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine
oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication
teaching is effective?
a. "I am taking the herb ginseng to help my attention span"
b. "I drink extra fluids, especially coffee and iced tea"
c. "I am eating three well-balanced meals a day"
d. "At a family cookout I had chicken instead of a hotdog"
ANSWER: D. "At a family cookout I had chicken instead of a hotdog."
RATIO: Tyramine-containing foods including processed meat (hot dogs, salami, and
bologna), yeast products, beer, and red wines must strictly be avoided while using
MAOIs. Consuming these foods can result in a hypertensive crisis that is life-threatening.
SAS #10
1. A nurse is providing instructions to a client is taking Doxapram (Dopram). Which of the
following statements made by the client needs further instructions?
a.“I need to take the medication before meals”.
b. “I need to take the medication at bedtime”.
c. “I need to avoid drinking coffee”.
d. “I will not chew or crush long acting form of the medications”.
ANSWER : B. “I need to take the medication at bedtime”.
RATIO: Doxapram (Dopram) is a stimulant of the central nervous system. In order to avoid one
of the adverse effects which is the insomnia, advise the client to take the medication at least 6
hours before bed.
2. Narcolepsy can be best explained as:
a. A sudden muscle weakness during exercise
b. Stopping breathing for short intervals during sleep
c. Frequent awakenings during the night
d. An overwhelming wave of sleepiness and falling asleep
ANSWER: D. An overwhelming wave of sleepiness and falling asleep
RATIO: A malfunction of the processes that control wakefulness and sleep is narcolepsy. The
most prevalent symptom of this disease is excessive daytime sleepiness. A person may
experience a sudden, overpowering wave of drowsiness during the day and pass out. The rapid
eye movement ( REM) sleep can start 15 minutes after passing out.
3. Older adults who take long-acting sedatives or hypnotics are likely to experience:
a. Hallucinations
b. Ataxia
c. Alertness
d. Dyspnea
ANSWER: B. Ataxia
RATIO: Sedative Hypnotic are class of drugs that tend to depress the central nervous system.
In older adults, ataxia was a common symptoms that causes loss of coordination, movement,
and sometimes speech.
4. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic
agent?
a. Alteration in tissue perfusion
b. Fluid volume excess
c. Risk for injury
d. Risk for infection
ANSWER: C. Risk for injury
RATIO: Drugs that promote central nervous system depression, such as sedative-hypnotics,
increase the risk of injury and falls in the patient.
5. A patient is admitted to the emergency department with an overdose of a barbiturate. The
nurse immediately prepares to administer which of the following from the emergency drug cart?
a. naloxone HCl (Narcan
b. activated charcoal
c. flumazenil (Romazicon)
d. ipecac syrup
ANSWER: B. Activated charcoal
RATIO: Barbiturates have no effective counter measure. Using activated charcoal prevents
drug absorption by tying up with it in the stomach and gastrointestinal tract.
6. During patient teaching, the nurse explains the difference between a sedative and hypnotic
by stating:
a. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods
of time."
b. "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis."
c. "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses."
d. "There really is no difference; the terms are used interchangeably."
ANSWER: C. "Most drugs produce sedation at low doses and sleep (the hypnotic effect)
at higher doses."
RaTIO: Many medicines have both sedative and hypnotic effects, with the sedative effects it is
produced at lower dosages and the hypnotic effects at higher doses.
7. The patient's chart notes the administration of dantrolene (Dantrium) immediately
postoperatively. The nurse suspects that the patient experienced:
a. Delirium tremens
b. Malignant hyperthermia
c. A tonic-clonic seizure
d. Respiratory arrest
ANSWER: B. Malignant hyperthermia
RATIO: Malignant hyperthermia is a medical condition that may occur in some people before or
after surgery or anesthesia and can be prevented or treated using dantrolene.
8. Which of the following is an important nursing action for the administration of a
benzodiazepine as a sedative-hypnotic agent?
a. Use IM dosage forms for longer duration
b. Administer safely with other CNS depressants for insomnia
c. Monitor geriatric patients for the common occurrence of paradoxical reactions.
d. Evaluate for physical dependence that occurs within 48 hours of beginning the drug.
ANSWER: C. Monitor geriatric patients for the common occurrence of paradoxical
reactions.
RATIO: The age, genetics, psychological background, and alcohol usage are risk factors for
paradoxical reactions. The patient's age especially in geriatric should be monitored for the
common occurence of paradoxical reactions
9. Pediatric and geriatric patients often react with more sensitivity to CNS depressants. This
type of sensitivity manifests itself in the development of which type of reaction?
a. Idiopathic
b. Teratogenic
c. Paradoxical
d. Psychogenic
ANSWER: C. Paradoxical
RATIO: The paradoxical effects to children and elderly such as tremors, agitation, or visual
hallucination is higher. Patients who are elderly or disabled may be particularly vulnerable to
lorazepam's sedative and respiratory depressant effects. As a result, these patients should get
regular monitoring and careful dosage adjustments based on patient response.
10. Which of the following is an appropriate nursing intervention for patients who are receiving
CNS depressants?
a. Prevent any activity within the hospital setting while on oral muscle relaxants
b. Make sure that the patient knows that sedation should be minimal with these agents.
c. Cardiovascular stimulation, a common side effect, would lead to hypertension
d. Make sure the patient's call light is close by in case of the need for assistance with activities.
ANSWER: D. Make sure the patient's call light is close by in case of the need for
assistance with activities.
RATIO: An appropriate nursing intervention for patients who are receiving CNS depressants is
make sure the patient's call light is close by in case of the need for assistance with activities.
11. Which of the following conditions characterizes rapid eye movement (REM) sleep?
a. Disorientation and disorganized thinking
b. Jerky limb movements and position changes
c. Pulse rate slowed by 5 to 10 beats/minute
d. Highly active brain and physiological activity levels.
ANSWER: D. Highly active brain and physiological activity levels.
RATIO: REM stage is characterized by high levels of physiological activity and cerebral activity.
Disorientation and disarray are the hallmarks of stages 3 and 4 of NREM sleep, while bodily
movement is completely stopped except for eye movement during REM sleep. Not REM sleep,
but NREM sleep causes a 5–10 beats per minute slowdown in heart rate.
12. Abrupt withdrawal of barbiturates can precipitate what medical condition?
A. Ascites
B. Hypertensive crisis
C. Status epilepticus
D. Coma
ANSWER: C. Status epilepticus
RATIO: Status epilepticus refers to a seizure that lasts longer than five minutes or many
seizures within five minutes of one another without regaining consciousness. This is a serious
medical emergency that could result in death or irreversible brain damage.
13. What drug refers to the ability to help patient feel calm and unaware of his environment?
a. Anesthesia
b. Sedatives
c. Hypnotics
d. Anxiolytics
ANSWER: B. Sedatives.
RATIO: Sedatives-Calm and make patients unaware of the environment. Drug that depresses
the CNS; produces a loss of awareness of and reaction to the environmentHypnotic effect helps
patients sleep and anxiolytic effect helps patients relieve feelings of tension and fear.
14. What is the most commonly used anxiolytics.
a. Benzodiazepines
b. Diphenhydramine
c. Barbiturates
d. Buspirone
ANSWER: A. Benzodiazepines
RATIO: Due to their ability to reduce anxiety at doses that are significantly lower than those
required to induce drowsiness or hypnosis, benzodiazepines are the most widely used anxiolytic
medications.
15. Which of the following medical condition(s) can be considered as contraindication(s) to use
of anxiolytics and hypnotics?
a. Psychosis
b. Alcoholic intoxication
c. Acute gastroenteritis
d. Both A and B
ANSWER: D. Both A and B
RATIO: The sedative effect of the medicine may make psychosis worse. On the other hand, the
depressive effects of these medicines have the potential to make alcohol intoxication worse.
SAS 11 PHARMA RATIONALE
1. A client with chronic pain reports to you, the charge nurse, that the nurse have not been
responding to requests for pain medication. What is your initial action?
A. Check the MARs and nurses’ notes for the past several days.
B. Ask the nurse educator to give an in-service about pain management.
C. Perform a complete pain assessment and history on the client.
D. Have a conference with the nurses responsible for the care of this client.
As charge nurse, you must assess for the performance and attitude of the staff in relation to this client.
After gathering data from the nurses, additional information from the records and the client can be
obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance
improvement is the problem. (ANSWER: D)
2. Family members are encouraging your client to “tough it out” rather than run the risk of
becoming addicted to narcotics. The client is stoically abiding by the family’s wishes. Priority
nursing interventions for this client should target which dimension of pain?
A. Sensory.
B. Affective.
C. Sociocultural.
D. Behavioral.
E. Cognitive.
The family is a part of the pain's sociocultural dimension. They have an impact on the client and should
be included in educational sessions about the proper use of narcotics and the negative effects of pain on
the healing process. Other dimensions should be included to assist the client/family in comprehending
the overall treatment plan and pain mechanism. (ANSWER: C)
3. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that
is not responding to NSAIDs. You anticipate that the physician will order which adjuvant
medication for this type of pain?
A. Amitriptyline (Elavil)
B. Corticosteroids
C. Methylphenidate (Ritalin)
D. Lorazepam (Ativan)
Diabetic neuropathy can be treated with antidepressants such as amitriptyline. Corticosteroids are used
to treat pain caused by inflammation. If the client is on opioids, methylphenidate is given to counteract
sedation. Lorazepam is an anti-anxiety medication. ANSWER: A
4.
A.
B.
C.
D.
Which client is most likely to receive opioids for extended periods of time?
A client with fibromyalgia
A client with phantom limb pain
A client with progressive pancreatic cancer
A client with trigeminal neuralgia
Cancer pain generally worsens with disease progression, and opioid use becomes more liberal. Nonopioid and adjuvant medications are more commonly used to treat fibromyalgia. Anti-seizure
medications such as carbamazepine are used to treat trigeminal neuralgia (Tegretol). Phantom limb pain
usually subsides after ambulation begins. ANSWER: C
5.
A.
B.
C.
D.
In caring for a young child with pain, which assessment tool is the most useful?
Simple description pain intensity scale
0-10 numeric pain scale
Faces pain-rating scale
McGill-Melzack pain questionnaire
The Faces pain rating scale (depicting smiling, neutral, frowning, crying, and so on) is appropriate for
young children who may struggle to describe pain or understand the relationship between pain and
numerical or verbal descriptors. To make analogies and use advanced vocabulary, the other tools
require abstract reasoning abilities. ANSWER: C
6.
A.
B.
C.
In applying the principles of pain treatment, what is the first consideration?
Treatment is based on client goas.
A multidisciplinary approach is needed.
The client must be believed about perceptions of own pain.
D. Drug side effects mst be prevented and managed.
The client must be believed, and his or her pain experience must be validated. The information gathered
from client reports can then be used to develop other treatment options. ANSWER: C
7. A client appears upset and tearful, but denies pain and refuses pain medication, because "my
sibling is a drug addict and has ruined out lives." What is the priority intervention for this client?
A. Encourage expression of fears on past experiences.
B. Provide accurate information about use of pain medication.
C. Explain that addiction is unlikely among acute care clinics
D. Seek family assistance in resolving this problem.
This client has strong feelings and beliefs about the issue of sibling addiction. To begin, encourage
expression. This demonstrated to the client that his or her feelings were genuine and valid. It also
provides an opportunity to evaluate beliefs and fears. Giving facts and information at the appropriate
time is appropriate. Family involvement is critical, because their beliefs about drug addiction may be
similar to the client's. ANSWER: A
8.
A.
B.
C.
D.
It is a rare type of seizures that appears sporadically.
Febrile seizure
Myoclonic seizure
Jacksonian seizure
Absence seizure
It is characterized by short, sporadic periods of muscle contractions that last for several minutes. It is
relatively rare. ANSWER: B
9.
A.
B.
C.
D.
Which antiseizure agent is used to treat absence seizures?
Hydantoins
Benzodiazepines
Barbiturates
Succinimides
This is the drug most doctors start with for absence seizures. In most cases, seizures respond well to this
drug. ANSWER: D
10. A patient on Dilantin began showing bruises and signs of active infection. The nurse would be
right to anticipate that these manifestations give clue to _________.
A. Drug underdose
B. Hypersensitivity reactions
C. Cellular toxicity
D. None of the above
It causes severe liver toxicity, bone marrow suppression, gingival hyperplasia, and severe dermatological
reactions (e.g. hirsutism, Steven-Johnson syndrome). ANSWER: C
11.
A.
B.
C.
D.
Which barbiturate is also indicated for management of anxiety?
Mephobarbital
Primidone
Phenobarbital
Mysoline
Anxiety is also treated with phenobarbital. It is also used to prevent withdrawal symptoms in people
who are dependent ('addicted'; have a strong desire to continue taking the medication) on another
barbiturate medication and are about to stop taking it. ANSWER: C
12.
A.
B.
C.
D.
Benzodiazepines exert their effect primarily on which neurotransmitter?
GABA
Serotonin
Norepinephrine
Both A and B
Benzodiazepines exert their pharmacologic effects by facilitating the actions of -aminobutyric acid
(GABA), the central nervous system's primary inhibitory neurotransmitter. ANSWER: A
13. The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder, Which
statement indicates the client understands the discharge teaching concerning this medications?
A. “I will brush my teeth after every meal”
B. “I will check my Dilantin level daily
C. “My urine will turn orange while on Dilantin”
D. “I won’t have any seizures while on this medication”
Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are
essential to prevent or control gingival hyperplasia, which is a common occurrence in clients taking
Dilantin. ANSWER: A
14. The client is admitted to the intensive care department (ICD) experiencing status epilepticus.
Which collaborative intervention should the nurse anticipate?
A. Assess the client’s neurological status every hour.
B. Monitor the client’s heart rhythm via telemetry.
C. Administer an anticonvulsant medication by intravenous push.
D. Prepare to administer a glucocorticosteroid orally.
Administering an anticonvulsant medication by intravenous push requires the nurse to have an order or
confer with another member of the health-care team. ANSWER: C
15. The client has been newly diagnosed with epilepsy. Which discharge instructions should be
taught to the client? Select all that apply.
A. Keep a record of seizure activity.
B. Take tub baths only; do not take showers.
C. Avoid over-the-counter medications.
D. Do not drive alone; have some in the car.
A. Keeping a seizure and medication chart will help you keep track of follow-up appointments with your
doctor and identify activities that may cause a seizure.
C. Over-the-counter medications may contain ingredients that interact with antiseizure medications or,
in some cases, cause a seizure, as with stimulant use.
D. Most anticonvulsant medications have therapeutic serum levels that must be maintained, and regular
serum level checks help to ensure the correct level. ANSWER: A C D
SAS 12 PHARMA ANSWERS AND RATIONALE
1. A client with myasthenia gravis has become frequently complaining of weakness and fatigue.
The physician plans to identify whether the client is responding to an overdose of the
medication or a worsening of the disease. A tensilon test is performed. Which of the following
would indicate that the client is experiencing an overdose of the medication?
A. Temporarily worsening of the condition
B. Improvement of the weakness and fatigue.
C. No change in the condition.
D. Complaints of muscle spasms.
A TEMPORARILY WRSENING - Tensilon test/edrophonium injection is used to diagnose cholinergic crisis
(anticholinesterase overdose) or myasthenic crisis (under medication). Tensilon injections temporarily
worsen the client's cholinergic crisis (negative tensilon test). An improvement in weakness indicates a
myasthenia crisis.
2. The diagnostic work-up of a client hospitalized with complaints of progressive weakness and
fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia
gravis is:
A.
B.
C.
D.
Prostigmine (neostigmine)
Atropine (atropine sulfate)
Didronel (etidronate)
Tensilon (edrophonium)
A PROSTIGMINE - Protigmine is used to treat patients with myasthenia gravis. Atropine (atropine
sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate) is
incorrect because the drug has nothing to do with the treatment of myasthenia gravis. Tensilon
(edrophonium) is incorrect because it is a test for myasthenia gravis.
3. Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse
understands that this therapy is effective because it:
A. Decreases the production of autoantibodies that attack the acetylcholine receptors.
B. Stimulates the production of acetylcholine at the neuromuscular junction.
C. Inhibits the breakdown of acetylcholine at the neuromuscular junction.
D. Promotes the removal of antibodies that impair the transmission of impulses
A DECREASES THE PRODUCTION OF AUTOANTIBIOTICS THAT ATTECK THE ACETLCHOLINE RECEPTORS Steroids decrease the body's immune response thus decreasing the production of antibodies that attack
the acetylcholine receptors at the neuromuscular junction
4. Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
A.
B.
C.
D.
Epinephrine
Nicotinic
Acetylcholine
Transient
C ACETYLCHOLINE - Antibodies (immune proteins produced by the body's immune system) block, alter,
or destroy acetylcholine receptors at the neuromuscular junction in myasthenia gravis, preventing the
muscle from contracting.
5.
A.
B.
C.
D.
A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
Stimulating the cerebral cortex
Blocking the action of cholinesterase
Replacing deficient neurotransmitters
Accelerating transmission along neural swaths
B BLOCKING THE ACTION OF CHOLINESTERASE - Neostigmine works by slowing the breakdown of
acetylcholine when it is released from nerve endings. This means that there is more acetylcholine
available to attach to muscle receptors, improving muscle strength.
6. The most significant initial nursing observations that need to be made about a client with
myasthenia include:
A. Ability to chew and speak distinctly
B. Degree of anxiety about her diagnosis.
C. Ability to smile an to close her eyelids
D. Respiratory exchange and ability to swallow
A ABILITY TO CHEW AND SPEAK DISTINCLY- Muscle weakness can cause respiratory failure, requiring
emergency treatment, and an inability to swallow can result in aspiration.
7. In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows
that this drug will cause a temporary increase in:
A. Muscle strength
B. Symptoms
C. Blood pressure
D. Consciousness
A MUSCLE STRENGTH - Tensilon, an anticholinesterase drug, temporarily relieves symptoms of
myasthenia gravis in patients with the disease and is thus an effective diagnostic aid.
8. A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of
Parkinson's disease. The nurse tells the client that which of the following is a side effect of the
medication?
A. Difficulty performing a voluntary movement.
B. Increased blood pressure.
C. Increased heart rate.
D. Itchiness of the skin.
A DIFFICULTY PERFORMING A VOLUNTARY MOVEMENT- One of the symptoms of a levodopa overdose is
dyskinesia (difficulty performing a voluntary movement). Nausea is another side effect. diarrhea.
vomiting. hypotension. bradycardia. Hallucinations and confusion
9. A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food
items should be avoided by the client?
A. Goat yogurt.
B. Whole grain cereal.
C. Asparagus.
D. Apples.
B WHOLE GRAIN CEREAL - When delivering levodopa. The client should avoid consuming too much
pyridoxine (vitamin B6), which has been shown to reduce the effects of levodopa. Some foods, such as
bananas, contain high levels of pyridoxine. egg whites Limon beans meats. peanuts. as well as whole
grain cereals. C. and D are vitamin B6 deficient foods.
10. Biperiden hydrochloride (Akineton) is added to a list of antiparkinsonian medications that an
elderly client is taking. Which of the following instructions made by the nurse that needs further
learning?
A. To avoid smoking. alcohol and caffeine.
B. To use ice chips. candy or gum for dry mouth.
C. Walking in the morning to have a daily source of direct sunlight.
D. Eating foods rich in fiber and increase fluid intake.
C WALKING IN THE MORNING TO HAVE A DAILY SOURCE OF DIRECT SUNLIGHT - Biperiden hydrochloride
(Akineton) is a Parkinson's disease anticholinergic agent used to treat stiffness. tremors. spasms.
Parkinson's disease causes poor muscle control. Because photophobia is one of the side effects of this
medication, advise the client to wear sunglasses in direct sunlight. B. and D are correct directions for
using this medication.
11.
A.
B.
C.
D.
What is the goal of pharmacologic therapy in treating Parkinson's disease?
To decrease dopamine and to increase cholinergic neurons
To balance dopamine and cholinergic neurons
To excite neurons more
To inhibit neurons more
B TO BALANCE DOPAMINE AND CHOLINERGIC NEURONS- To maintain a healthy balance of cholinergic
and dopaminergic activity in the brain
12.
A.
B.
C.
D.
What is the goal of pharmacologic therapy in treating Parkinson's disease?
Symmetrel
Levodopa
Cogentin
Pariodel
B LEVODOPA- The mainstay of Parkinson's therapy is levodopa in combination with carbidopa or
Sinemet. Dopa decarboxylase (DDC), an enzyme found in the central and peripheral nervous systems,
rapidly converts levodopa to dopamine.
13.
A.
B.
C.
D.
The drug of choice in children with parkinsonian symptom.
Levodopa
Artane
Benadryl
Benztropine
A LEVODOPA - If the patient's lifestyle is jeopardized by Parkinson's disease symptoms, levodopa is the
drug of choice. Levodopa is typically taken three times per day, with the dose gradually increasing over
time based on the patient's response. (See also 'Levodopa.')
14.
A.
B.
C.
D.
Which can decrease efficacy of levodopa
Phenyytoin
Pyridoxine
Niacin
Both A and B
D BOTH A AND B - Carbidopa belongs to a class of drugs known as decarboxylase inhibitors. It works by
preventing the breakdown of levodopa before it reaches the brain. This allows for a lower levodopa
dose, resulting in less nausea and vomiting.
15. A construction worker for 10 years is about to receive anticholinergics. What should the nurse
consider in handling this patient?
A. Do not give the drug to the patient
B. Administer it with caution
C. Discuss it with the doctor and have the order engaged
D. Arrange for a possible increase in the dose.
B ADMINISTER IT WITH CAUTION- Benefits include effective illness/disease management, slowed
disease progression, and improved patient outcomes with few, if any, errors. Medication harm can
result from unintended consequences as well as medication error (wrong medication, wrong time,
wrong dose, etc.).