Neurologic and Psychiatric Drugs
1. Which group of
drugs mimics parasympathetic activity?
A. Cholinergic agents
B. Anticholinergic agents
C. Adrenergic agents
D. Anti adrenergic agents
2. Cholinergic agents
are used to:
A. Produce miosis
B. Facilitate neuromuscular blockade
C. Synergize neuromuscular blockers
D. Facilitate tricyclic activity
3. Cholinergics are
contraindicated in:
A. Tachycardia
B. Hypothyroidism
C. Hypotension
D. Asthma
4. Drugs that mimic
sympathetic activity are known as:
A. Cholinergics
B. Anticholinergics
C. Adrenergics
D. Antiadrenergics
5. Which of the
following metabolic effects may be a consequence of administration of
adrenergic agents?
A. Hypoglycemia
B. Metabolic acidosis
C. Hyperglycemia
D. Respiratory alkalosis
6. Adrenergic
blockers are contraindicated in:
A. Hypertension
B. Pheochromocytoma
C. Migraines
D. Obstructive airway disease
7. A side effect of
cholinergic administration is:
A. Nausea
B. Diarrhea
C. Increase salivation
D. All of the above
8. Joseph is child
diagnosed with attention deficit disorder. Which of the following drugs is
commonly used for his condition?
A. methylphenidate (Ritalin)
B. diethylpropion (Nobesine)
C. phendimetrazine (Adipost)
D. caffeine
9. Amphetamines are
included in the category of drugs of abuse because of their ability to:
A. Cause nervousness
B. Decrease weight
C. Raise blood pressure
D. Enhance performance
10. The nurse would
monitor for decreased effect of amphetamines when these drugs are given with:
A. Caffeine
B. Antidiabetic agents
C. Tricyclic antidepressants
D. All of the above
11. As a
knowledgeable nurse, you know that you should never give amphetamines in
combination with:
A. Oral hypoglycemics
B. Insulin
C. MAO inhibitors
D. Antihypertensives
12. Use of
methylphenidate for attention deficit disorders in children can result in:
A. Tourette’s syndrome
B. Growth suppression
C. Growth spurt
D. A and B
13. Amphetamines and
amphetamine-like compounds re most commonly used for:
A. Narcolepsy
B. Attention deficit disorder
C. Exogenous obesity
D. All of the above
14. When
administering IV phenytoin (Dilantin), the nurse should:
A. Administer it at a rate
100 mg/min.
B. Protect the drug from light exposure.
C. Mix the drug in dextrose solution.
D. Mix the drug in saline solution.
15. When caring for a
client who is receiving phenytoin and warfarin (Coumadin), the nurse would
expect which of the following drug-drug interactions?
A. Decreased effectiveness of
warfarin
B. Increased effectiveness of phenytoin
C. Increased effectiveness of warfarin
D. Decreased effectiveness of phenytoin
16. The client asks
the nurse why he is taking bromocriptine (Parlodel). The nurse’s reply is based
in the understanding that bromocriptine mimics the effects of dopamine by:
A. Decreasing dopamine levels
in the brain
B. Decreasing the storage of dopamine peripherally
C. Activating dopamine receptors in the brain
D. Inhibiting monoamine oxidase type B
17. Before
administering amantadine (Symadine), the nurse should investigate which of the
following client statements?
A. “My hands are always
shaking.”
B. “I had to take Dilantin 6 months ago.”
C. “I take low-dose enteric aspirin each day.”
D. “Simple tasks seem to take so long to perform.”
18. The priority
nursing intervention for a client receiving amantadine is to teach the client
to:
A. Monitor the pulse for rate
and regularity.
B. Take the last dose of medication at bedtime.
C. Inspect the skin for erythematous rash.
D. Stop taking the drug if the mouth becomes dry.
19. Which of the
following assessment is most essential before beginning a drug regimen of an
antimuscarinic agent?
A. Date of birth
B. Ethnic background
C. History of diabetes
D. Activity intolerance
20. The nurse
evaluates that carbidopa and levodopa (Sinemet) is therapeutically effective if
the client has:
A. Decreased GI responses
B. Increased tolerance to pyridoxine
C. Decreased tremors at rest
D. Increased urinary output
21. For which of the
following medical conditions would the nurse anticipate that an antianxiety
agent would not be indicated?
A. Seizure disorders
B. Alcohol detoxification
C. Parkinson’s disease
D. Panic disorder
22. When
administering antianxiety medications to an elderly client, which of the
following actions by the nurse is essential?
A. Monitor Vital signs.
B. Suggest reduced doses.
C. Taper dose before stopping.
D. Implement a fall prevention protocol.
23. When monitoring a
client who is taking benzodiazepines, the nurse should be alert for which CNS
side effects?
A. Blurred vision, anorexia,
dysarthria
B. Seizures, tremors, diaphoresis
C. Ataxia, sedation, dizziness
D. Libido changes, edema, dystonia
24. Antidepressants
generally exert influence by:
A. Increasing the reuptake of
noradrenaline
B. Altering the action of the cyproprotein (MAO)
C. Changing the availability of dopamine
D. Changing the availability of select neurotransmitters
25. The nurse
performs an initial assessment and nursing history with a client admitted fir a
major depression. The client has a history of narrow-angle glaucoma. The
nurse’s best action would be to:
A. Encourage the client to
use his or her own eyedrops until the drops can be ordered.
B. Administer the TCA as orders, and expect an ophthalmology consult.
C. Administer the TCA as ordered, and monitor for visual changes.
D. Inform the physician of the client’s history before administering the TCA.
26. Antipsychotic
drugs are indicated:
A. For treatment of
Tourette’s syndrome.
B. For treatment of major depression.
C. As an adjunct in the management of seizures.
D. To cure psychotic disorders.
27. Sheila who has
been on a low-potency antipsychotic for 2 weeks has shown minimal response. The
most probable explanation is:
A. The client probably has
refractory illness.
B. The client needs a stronger medication.
C. It is too early to see a full therapeutic response.
D. The client is definitely not taking the medication.
28. Ansherina who is
receiving a traditional antipsychotic agent complains that she is gaining
weight. The nurse would:
A. Be aware that this is
probably delusional thinking because these agents cause weight loss.
B. Encourage the client to follow a healthy diet and use diet soda to help
stabilize her weight.
C. Discuss a switch to a high-potency agent so the weight gain will not be a
problem.
D. Establish a contract with the client to carefully follow her high-calorie
diet.
29. Drugs classified
as centrally acting skeletal muscle relaxants are most effective in relieving:
A. Spasm due to trauma or
inflammation
B. Chronic spasm due to old injury
C. Pain from arthritis
D. Surgical complications
30. Peripherally
acting skeletal muscle relaxants are used:
A. To treat neuromuscular
diseases
B. To treat spinal trauma
C. To relieve spasms from trauma
D. As adjuncts to general anesthesia
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Answers and Rationale
1. Answer: A.
Cholinergic agents
Cholinergic drugs mimic the
effects of the parasympathetic nervous system. Anticholinergic agents
antagonize the parasympathetic nervous system. Adrenergic agents stimulate
sympathetic nervous system. Antiadrenergic agents block the effect of the
sympathetic nervous system.
2. Answer: A. Produce
miosis
Miosis is a parasympathetic
activity and is therefore the correct choice. B, C and D are incorrect because
cholinergic agents are antidotes to neuromuscular blockers and tricyclic
antidepressants.
3. Answer: D. Asthma
Bronchial asthma is a
contraindication of cholinergics because administration of cholinergics will
cause bronchoconstriction.
4. Answer: C.
Adrenergics
Drugs that mimic the effects
of sympathetic activity are known as adrenergics.
5. Answer: C.
Hyperglycemia
A, B, and D are incorrect
because the effects of insulin are antagonized by adrenaline or adrenergic
agents.
6. Answer: D.
Obstructive airway disease
Adrenergic blockers tend to
cause bronchoconstriction, so are therefore contraindicated in obstructive
pulmonary disease.
7. Answer: D. All of
the above
Cholinergic drugs increase GI
activity, causing all of these side effects.
8. Answer: A.
methylphenidate (Ritalin)
Methylphenidate (Ritalin) is
the drug of choice for attention deficit disorder. B and C are commonly used
for exogenous obesity. Caffeine is a mild CNS stimulant that is not used for
attention deficit disorder.
9. Answer: D. Enhance
performance
Drugs that produce a desired
effect, such as feelings of euphoria and improved performance, tend to be
overused and abused. Nervousness, decreased weight, and increased blood
pressure are all effects of amphetamine. However, they are considered drugs of
abuse because of their ability to enhance performance and produce a euphoric
effect.
10. Answer: B.
Antidiabetic agents
Antidiabetic agents tend to
decrease the effectiveness of amphetamines. A and C increase the effects of
amphetamines.
11. Answer: C. MAO
inhibitors
MAO inhibitors must never be
given with drugs affecting the CNS because hypertension can occur. Amphetamines
can be given with oral hypoglycemics and insulin as long as blood sugar levels
are monitored because these can decrease antidiabetic requirements.
12. Answer: D. A and
B
Use of Ritalin does not cause
a growth spurt. Instead, it can cause Tourette’s syndrome and growth
suppression in children.
13. Answer: D. All of
the above
The most common uses of
amphetamines and amphetamine-like compounds are narcolepsy, exogenous obesity,
and attention deficit disorder.
14. Answer: D. Mix
the drug in saline solution.
Phenytoin must be mixed in
saline solution only. Phenytoin should be administered at a rate of 50 mg/min.
There is no need to protect phenytoin from light because it does not
destabilize with light exposure. Phenytoin will precipitate when mixed with a
dextrose solution.
15. Answer: A.
Decreased effectiveness of warfarin
The interaction will reduce
the effectiveness of warfarin.
16. Answer: C.
Activating dopamine receptors in the brain
Bromocriptine is a
dopaminergic agent, and this response refers to its action. Choice A refers to
the action of levodopa. Choice B refers to the action of carbidopa and
levodopa. Choice D refers to the action of selegiline.
17. Answer: B. “I had
to take Dilantin 6 months ago.”
Amantadine is used cautiously
in clients with a history of seizures. A and D are clinical manifestations of
Parkinson’s disease. Amantadine does not interact negatively with aspirin.
18. Answer: A.
Monitor the pulse for rate and regularity.
Dopaminergic agents can cause
heart rate changes and cardiac arrhythmias. Choice B is incorrect because amantadine
can cause insomnia. Choice C is incorrect because an adverse effect of
amantadine is a mottled discoloration of the skin. Choice D is incorrect
because dry mouth is an expected side effect and not an indication to
discontinue amantadine.
19. Answer: A. Date
of birth
Antimuscarinic agents are
contraindicated in elderly patients.
20. Answer: C.
Decreased tremors at rest
Carbidopa and levodopa help
restore the balance between dopamine and acetylcholine, thereby controlling the
responses of Parkinson’s disease.
21. Answer: C.
Parkinson’s disease
Benzodiazepines may
exacerbate the symptoms of Parkinson’s disease.
22. Answer: D.
Implement a fall prevention protocol.
Increased sedation,
dizziness, and hypotension are side effects that place the elderly at high risk
for falls. All clients need to have vital signs monitored periodically when
taking these medications. Geriatric clients may require reduced doses, but the
risk for falls is still present. Dose tapering is not related to age.
23. Answer: C. Ataxia,
sedation, dizziness
These are common side
effects. Anorexia is a GI effect. Choice B are the result of acute withdrawal.
Libido and edema are not CNS-related side effects.
24. Answer: D.
Changing the availability of select neurotransmitters
This choice best describes
the effect of antidepressants in general.
25. Answer: D. Inform
the physician of the client’s history before administering the TCA.
Narrow-angle glaucoma is a
contraindication for use of TCAs; therefore, the physician should be informed
so that an alternative category can be used.
26. Answer: A. For
treatment of Tourette’s syndrome.
Haloperidol (Haldol) is used
for this syndrome. Major depression is an affective disorder. When psychotic
symptoms accompany depression, antipsychotics may be used to manage the
symptoms. However, this choice does not address that situation. Antipsychotics
are used with caution in the presence of a history of seizures. Generally, the
antipsychotics decrease the seizure threshold. Antipsychotics are used to ameliorate,
reduce, or manage psychotic symptoms; they do not provide a cure.
27. Answer: C. It is
too early to see a full therapeutic response.
The initial response may be
seen 1 to 2 days after initiation of treatment, with full therapeutic response
in approximately 6 to 8 weeks.
28. Answer: B.
Encourage the client to follow a healthy diet and use diet soda to help
stabilize her weight.
These agents have a known
side effect of weight gain. Managing dietary intake can assist in the
management of the potentially distressing effect.
29. Answer: A. Spasm
due to trauma or inflammation
Centrally acting skeletal
muscle relaxants are most effective in relieving spasm due to trauma or
inflammation.
30. Answer: D. As
adjuncts to general anesthesia
Peripherally acting skeletal
muscle relaxants are used as an adjunct to general anesthesia.
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