ATI Pharmacology Made Easy 4.0 ~ The Neurological System (Part 1)

A nurse is teaching a client who has a new prescription for carbamazepine. Which of the following instructions should the nurse include to help the client avoid adverse effects of this drug? A. Begin taking the drug at a low dosage. B. Discontinue the drug immediately if diarrhea occurs. C. Have serum glucose levels checked regularly. D. Take the drug on an empty stomach.

A. Begin taking the drug at a low dosage. Rationale: A. Visual disturbances, vertigo, and ataxia can result from taking carbamazepine, a drug that treats seizure disorders. Dosages should be low to minimize or prevent these adverse effects. B. As with any drug that controls seizures, stopping it abruptly can make seizure activity return and possibly even trigger status epilepticus. Carbamazepine can cause diarrhea. If diarrhea does develop, a better alternative is to treat the diarrhea and see if it resolves as drug therapy with carbamazepine continues. C. Carbamazepine is not likely to alter glucose levels. It can, however, alter liver function. D. Taking carbamazepine with meals can help prevent GI upset and can enhance absorption.

A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects? A. Chest pain B. Polyuria C. Joint pain D. Insomnia

A. Chest pain Rationale: A. Sumatriptan, a serotonin agonist, can cause coronary vasospasm and chest pain. Clients should report any pressure, pain, or tightness in the jaw, chest, or back. Sumatriptan is not an appropriate choice for clients who have a history of coronary artery disease. B. Sumatriptan, a serotonin agonist, is unlikely to cause polyuria. Lithium carbonate can cause polyuria. C. Sumatriptan, a serotonin agonist, is more likely to cause muscle pain than joint pain. D. Sumatriptan, a serotonin agonist, is unlikely to cause insomnia. It can cause drowsiness and sedation.

A nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of the following instructions should the nurse include? A. Take the drug in the morning. B. Take the drug 30 min before bedtime. C. Anticipate daytime drowsiness. D. Expect urinary frequency.

A. Take the drug in the morning. Rationale: A. Modafinil is a non-amphetamine stimulant. Taking it in the morning helps improve wakefulness for clients who have narcolepsy. Clients taking the drug for shift-work sleepiness should take it 1 hr before work. B. Modafinil is a non-amphetamine stimulant. Evening dosage can cause insomnia. Zolpidem is a drug clients should take just before bedtime to improve sleep and to prevent daytime drowsiness. C. Modafinil is a non-amphetamine stimulant that promotes wakefulness. It is unlikely to cause daytime drowsiness. Eszopiclone is a drug that can cause daytime drowsiness. D. Modafinil is a non-amphetamine stimulant. It is unlikely to cause urinary frequency, but it can cause diarrhea.

A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects. (Select all that apply.) A. Hirsutism B. Drowsiness C. Headache D. Ataxia E. Rash

B. Drowsiness C. Headache E. Rash Rationale: A. Valproic acid is more likely to cause hair loss rather than hirsutism, or excessive hair growth. B. Clients taking valproic acid should report CNS depressant effects, such as sedation or drowsiness, because these adverse effects can indicate the need for a reduction in dose. C. Valproic acid can cause headache, along with other CNS adverse effects, such as sleep disturbances. D. Ataxia is an adverse effect of phenytoin and carbamazepine, which are drugs used to treat seizure disorders. E. Skin rash is an adverse effect of valproic acid and other antiepileptic drugs.

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should identify that which of the following laboratory tests requires monitoring? A. Serum potassium B. Liver function C. Serum sodium D. Thyroid function

B. Liver function Rationale: A. Dantrolene, a direct-acting muscle antispasmodic, is unlikely to alter serum potassium levels. Hydrochlorothiazide is a drug that can alter potassium levels. B. Liver toxicity is a serious adverse effect of dantrolene. The nurse should monitor the client's liver function prior to treatment and at regular intervals and advise the client to report jaundice or abdominal pain. C. Dantrolene, a direct-acting muscle antispasmodic, is unlikely to alter serum sodium level. Hydrochlorothiazide is a drug that can alter sodium levels. D. Dantrolene, a direct-acting muscle antispasmodic, is unlikely to alter thyroid function. Interferon alfa preparations are drugs than can alter thyroid function.

A nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these drugs? A. Hyperammonemia B. Phenytoin toxicity C. Hypertension D. Peptic ulcer disease

B. Phenytoin toxicity Rationale: A. Hyperammonemia is unlikely to result from a drug interaction between valproic acid and phenytoin. Taking valproic acid with topiramate, however, can increase the risk of excess ammonia in the blood. B. Valproic acid can cause an increase in phenytoin blood levels, resulting in phenytoin toxicity. The nurse should monitor serum phenytoin levels and notify the provider if levels begin to exceed the therapeutic range. C. Hypertension is unlikely to result from a drug interaction between valproic acid and phenytoin. Phenytoin does have CNS depressive effects and can cause hypotension, especially when administered via IV. D. Peptic ulcer disease is unlikely to result from a drug interaction between valproic acid and phenytoin. Taking cimetidine with phenytoin, however, can increase phenytoin levels.

A nurse is caring for a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects? A. Cardiac excitability B. Respiratory depression C. Hyperthermia D. Hypertension

B. Respiratory depression Rationale: A. Methohexital, a short-acting barbiturate, can cause cardiovascular depression. It is essential to have resuscitation equipment available whenever clients receive the drug. B. Methohexital, a short-acting barbiturate, causes respiratory depression. Mechanical ventilation and continuous monitoring are essential for clients receiving the drug. C. Methohexital, a short-acting barbiturate, is more likely to cause hypothermia than hyperthermia. D. Methohexital, a short-acting barbiturate, poses a significant risk for hypotension, not hypertension.

A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how levodopa/carbidopa can help control symptoms. The nurse should identify that the drug has which of the following pharmacologic effects? A. Increases available acetylcholine in the brain B. Inhibits norepinephrine metabolism in the brain C. Inhibits serotonin metabolism in the brain D. ​Increases available dopamine in the brain

D. ​Increases available dopamine in the brain. Rationale: A. Anticholinergics treat Parkinson's disease by decreasing available acetylcholine in the extrapyramidal system of the brain. B. Levodopa/carbidopa relieves tremors associated with Parkinson's disease by converting to dopamine in the brain and serving as a neurotransmitter. Altered levels of cerebral norepinephrine can correlate with depression. C. Levodopa/carbidopa relieves tremors associated with Parkinson's disease by converting to dopamine in the brain and serving as a neurotransmitter. Altered levels of cerebral serotonin can correlate with depression. D. Levodopa/carbidopa, a dopaminergic agent, can increase dopamine in the extrapyramidal center of the brain, reducing involuntary motion, or tremors, associated with Parkinson's disease.

A nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug? A. "Premedicate with acetaminophen." B. "Take the drug with food." C. "Increase your fluid intake." D. "Take the drug in the morning."

A. "Premedicate with acetaminophen." Rationale: A. Interferon beta drugs can cause fever, chills, headaches, and muscle aches. Acetaminophen can help minimize these symptoms. B. The routes of administration of interferon beta drugs are parenteral (IM and subcutaneous). C. Increasing fluid intake will not help relieve the adverse effects of interferon beta drugs. D. Evening administration of interferon beta drugs ensures that flu-like adverse effects, such as muscle aches, stiffness, and malaise, will occur while the client is sleeping.

A nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include? A. Avoid driving until the drug's effects are evident. B. Stop taking the drug immediately if headache occurs. C. Take the drug as needed for spasticity. D. Take the drug with antacids to reduce gastric effects.

A. Avoid driving until the drug's effects are evident. Rationale: A. Baclofen, a centrally-acting muscle relaxant, causes CNS depression. Clients taking the drug should avoid alcohol and other CNS depressants, and should not drive a vehicle until they know how the drug will affect them. B. Abrupt withdrawal of baclofen, a centrally-acting muscle relaxant, can cause seizures, fever, and hypotension. A better alternative is to treat the headache, which can have many other causes, and see if it resolves as drug therapy with baclofen continues. C. Clients typically take baclofen, a centrally-acting muscle relaxant, daily at regular doses. Clients should start with a low dose and titrate up as tolerated. D. Clients may take baclofen, a centrally-acting muscle relaxant, with food to help prevent nausea. They should take antacids 1 hr before or 2 hr after other drugs, including baclofen.

A nurse is teaching a client who is taking levodopa/carbidopa to treat Parkinson's disease. Which of the following instructions should the nurse include? A. Change position slowly to prevent orthostatic hypotension. B. Eat a high-protein snack to increase absorption. C. Take the drug at bedtime to avoid daytime drowsiness. D. Expect eye twitching to develop with long-term therapy.

A. Change position slowly to prevent orthostatic hypotension. Rationale: A. Levodopa/carbidopa can cause orthostatic hypotension. B. High-protein foods can reduce the effectiveness of levodopa/carbidopa. Gastric irritation can be alleviated by eating shortly after taking the drug, but protein intake should be divided amongst all meals to avoid consuming foods high in protein at the same time the drug is taken. C. Clients typically take levodopa/carbidopa in divided doses during the day. D. Muscle twitching can indicate drug toxicity. This is an adverse effect clients should report.

A nurse is caring for a client who has been taking amphetamine/dextroamphetamine sulfate for the treatment of attention deficit hyperactivity disorder (ADHD) for 2 weeks. The nurse should report which of the following findings to the provider? A. Weight loss of 2.3 kg (5 lb) B. BP 110/70 mm Hg C. Apical pulse 80/min D. Respiratory rate 16/min

A. Weight loss of 2.3 kg (5 lb) Rationale: A. Amphetamine/dextroamphetamine sulfate can cause a decreased appetite and weight loss. The nurse should instruct the client to weigh themself twice weekly and report unintended weight loss. B. This blood pressure is within the expected reference range and does not warrant reporting to the provider. The nurse should report hypertension or hypotension as adverse effects of the drug. C. This apical pulse is within the expected reference range and does not warrant reporting to the provider. The nurse should report tachycardia, or an elevated heart rate. D. This respiratory rate is within the expected reference range and does not warrant reporting to the provider. The nurse should monitor the client's respiratory rate periodically during therapy and report any abnormalities.

A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests requires monitoring? A. C-reactive protein B. Creatinine clearance C. Thyroid function D. CBC

B. Creatinine clearance Rationale: A. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter C-reactive protein. Pravastatin is a drug that alters C-reactive protein in a beneficial way by helping to lower the risk of heart disease. B. Pramipexole, a direct-acting dopamine receptor agonist, should be used with caution for clients who have renal disease. Therefore, the nurse should monitor the client's renal function. C. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter thyroid function. Amiodarone is a drug that can alter thyroid function. D. Pramipexole, a direct-acting dopamine receptor agonist, is unlikely to alter CBCs. Interferon beta-1b, an immunomodulator, can cause myelosuppression and warrants monitoring of CBCs periodically.

A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should instruct the client that sumatriptan is indicated for which of the following conditions? A. Tonic-clonic seizures B. Presence of a migraine headache C. Exacerbation of multiple sclerosis D. Alzheimer's disease

B. Presence of a migraine headache Rationale: A. Fosphenytoin is administered to treat tonic-clonic seizures. B. Sumatriptan is used in the treatment of migraine headaches. C. Interferon beta-1a is administered for the treatment of multiple sclerosis. D. Memantine is used to treat Alzheimer's disease.

A nurse is administering fentanyl to a client to reduce pain. Which of the following drugs should the nurse have available to reverse the effects of fentanyl? A. Neostigmine B. Succinylcholine C. Naloxone D. Dantrolene

C. Naloxone Rationale: A. Neostigmine, a cholinesterase inhibitor, reverses the effects of pancuronium, a nondepolarizing neuromuscular blocking agent. B. Succinylcholine is a depolarizing neuromuscular blocking agent that will cause increased muscle relaxation. C. Naloxone is an opioid antagonist that reverses the effects of opioids. Fentanyl, an opioid agonist, can cause severe respiratory depression. The nurse should also have resuscitation equipment available when administering fentanyl to a client. D. Dantrolene is a skeletal muscle relaxant that treats malignant hyperthermia and spasticity.

A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor? A. Confusion B. Dry mouth C. Nausea D. Double vision

C. Nausea Rationale: A. Donepezil, a cholinesterase inhibitor, can improve memory and reduce confusion. B. Muscarinic antagonists, not donepezil, can cause dry mouth. C. The most common adverse effects of donepezil, a cholinesterase inhibitor, are nausea, vomiting, and diarrhea. Taking donepezil with food can help minimize adverse effects. D. Donepezil, a cholinesterase inhibitor, is more likely to cause blurred vision than double vision.

A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the drug and notify the provider? A. Pancreatic cancer B. Hypotension C. Cirrhosis D. Osteoporosis

C. Cirrhosis Rationale: A. A past diagnosis of pancreatic cancer does not affect the administration of memantine. Memantine should be used cautiously in clients who have severe renal impairment. B. Memantine can cause hypertension. Therefore, it is not contraindicated for a client who has hypotension. C. Memantine should be used cautiously in clients who have severe hepatic impairment. The nurse should contact the provider about the client's history of cirrhosis to see if laboratory testing is required before starting the drug or if the dosage needs to be adjusted. D. Osteoporosis has no effect on the administration of memantine. Taking drugs that alter the pH of the urinary tract can be a cause for cautious administration.

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should instruct the client to report which of the following adverse effects? A. Slow heart rate B. Cough C. Diarrhea D. Hearing loss

C. Diarrhea Rationale: A. Dantrolene is more likely to cause tachycardia than bradycardia. B. Dantrolene is unlikely to cause a cough, but it can cause difficulty swallowing. C. Prolonged diarrhea can cause dehydration and other serious effects. Diarrhea, nausea, and vomiting are adverse effects of dantrolene. The client should report these effects so the nurse can monitor fluid balance and intervene accordingly. D. Dantrolene can cause blurred vision, but it is unlikely to cause hearing loss.

A nurse is caring for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects? A. Hirsutism B. Depression C. Jaundice D. Gum irritation

C. Jaundice Rationale: A. Valproic acid is unlikely to cause hirsutism, or excessive hair growth, but it can cause transient hair loss. B. Valproic acid is unlikely to cause depression, but it can cause aggression. C. Valproic acid can cause hepatic toxicity, characterized by jaundice, abdominal pain, and nausea. Clients taking the drug should report these manifestations, and the nurse should monitor liver function studies prior to treatment and periodically during therapy. D. Valproic acid is unlikely to cause gum irritation. Phenytoin can cause gingival hyperplasia.

A nurse is caring for a client who has a new prescription for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects? A. Hypotension B. Tinnitus C. Tachycardia D. Bronchospasm

C. Tachycardia Rationale: A. Amphetamine sulfate is an amphetamine stimulant. It is more likely to cause hypertension rather than hypotension. B. Amphetamine sulfate is an amphetamine stimulant. It is unlikely to cause tinnitus, but it can cause irritability and insomnia. C. Amphetamine sulfate is an amphetamine stimulant. It can cause tachycardia and dysrhythmias. The client should notify the nurse if they develop palpitations or chest pain. D. Amphetamine sulfate is an amphetamine stimulant. It is unlikely to cause bronchospasm, but it can cause diarrhea and nausea. Taking the drug with food can help reduce these effects.

A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include? A. Monitor for constipation. B. The dosage will be increased weekly to provide optimum therapeutic effect. C. Administering the drug first thing in the morning promotes effectiveness. D. Avoid the use of NSAIDs for pain.

D. Avoid the use of NSAIDs for pain. Rationale: A. Donepezil can cause diarrhea, not constipation. The family should also monitor for and report nausea, anorexia, and vomiting. B. Donepezil dosages are only increased after 1 to 3 months of taking the initial dose to minimize adverse effects. C. Donepezil should be taken immediately before going to bed because it causes drowsiness and dizziness. D. Combining NSAIDs with donepezil can cause gastrointestinal bleeding. Therefore, the nurse should instruct the client's family to avoid the use of NSAIDs.

A nurse is teaching a client who received a prescription for interferon beta-1a for the treatment of multiple sclerosis. Which of the following information should the nurse include? A. "Have kidney function tests done every month for a year." B. "Take an extra dose if muscle aches occur." C. "Store the drug at room temperature after mixing it." D. "Administer the drug in your thigh or upper arm."

D. "Administer the drug in your thigh or upper arm." Rationale: A. Liver function tests should be performed before initiating treatment, and then at 1-month, 3-month, and 6-month intervals. B. Flu-like manifestations, such as muscle aches, sweating, weakness, and chills, can occur while taking interferon drugs. The nurse should instruct the client to take the drug exactly as prescribed and to take acetaminophen if fever and muscle aches occur. C. Interferon beta-1a should be stored in the refrigerator after reconstitution, not at room temperature. D. Interferon beta-1a is administered via the subcutaneous route. Therefore, the nurse should instruct the client how to perform subcutaneous injections for self-administration.

A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include? A. Increase fluid intake to improve renal excretion. B. Report memory loss or confusion. C. Watch for signs of liver impairment, such as jaundice and abdominal pain. D. Avoid taking over-the-counter antacids.

D. Avoid taking over-the-counter antacids. Rationale: A. It is not necessary to increase fluids. Memantine is essentially unchanged when it is excreted in the urine. Therefore, it is not necessary to increase fluids because fluid intake does not affect this process. B. Clients who have Alzheimer's disease already have and will continue to have memory loss and confusion. The drug can help slow the progressive decline, but will not eliminate the disease's manifestations. C. Memantine should not result in liver impairment, although it should be used cautiously with clients who have severe liver impairment. D. Antacids that contain sodium bicarbonate increase urine alkalinity and can decrease drug excretion, ultimately leading to toxicity.

A nurse is caring for a client who is taking interferon beta-1a. The nurse should identify that which of the following findings indicates a potential serious adverse effect of this drug? A. Tinnitus B. Twitching eyelids C. Blue-green skin discoloration D. Fatigue

D. Fatigue Rationale: A. Tinnitus is not a typical adverse effect of interferon beta-1b. However, tinnitus is common with aspirin therapy. B. Eyelid and muscle twitching can be a sign of toxicity caused by some anticonvulsants. It is not a typical adverse effect of interferon beta-1b. C. Interferon beta-1b does not cause skin, sclerae, or urine to turn a blue-green color. This is an adverse effect of amphetamine/dextroamphetamine sulfate. D. The nurse should identify that potential serious adverse effects of interferon beta-1b include unexplained bruising, bleeding, and fatigue. Clients should report these adverse effects to their provider immediately because they can indicate bone marrow suppression and decreased platelet count.

A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the client but should be aware that a drug interaction between selegiline and meperidine can result in which of the following? A. Frequent urination B. Jaundice C. Cellulitis D. Muscle rigidity

D. Muscle rigidity Rationale: A. A drug interaction between selegiline and meperidine is unlikely to result in frequent urination, which can indicate a urinary tract infection and glucose intolerance. B. A drug interaction between selegiline and meperidine is unlikely to result in jaundice. Liver toxicity is a serious adverse effect of dantrolene and many anticonvulsants, such as valproic acid. C. A drug interaction between selegiline and meperidine is unlikely to result in oral ulcers. Skin inflammation is a serious adverse effect of some anticonvulsants, such as phenytoin. D. A drug interaction between selegiline and opioids, especially meperidine, can result in rigidity, stupor, agitation, hypertension, and fever.