Marshalltown Community College - NURSING PNN101

Chapter 09: Drug Therapy for Central Nervous System Problems Visovsky: Introduction to Clinical Pharmacology, 9th Edition

MULTIPLE CHOICE

1)Which neurotransmitter has an inhibitory action within the central nervous system?

1. 1. Epinephrine
   2. Acetylcholine
   3. Norepinephrine
   4. Gamma-aminobutyric acid

2. How does the drug tolcapone relieve the symptoms of Parkinson disease?
   1. Acts as a dopamine agonist, replacing the activity of dopamine
   2. Forces the substantia nigra to increase the production and release of natural dopamine
   3. Suppresses the activity of an enzyme that normally breaks down naturally occurring dopamine
   4. Increases the number of dopamine receptors sites throughout the central nervous system, thus increasing the effectiveness of dopamine and dopamine agonists

3. Why are carbidopa and levodopa usually given together?
   1. Carbidopa is a dopamine agonist and levodopa is a dopamine antagonist.
   2. Levodopa is a dopamine agonist and carbidopa is a dopamine antagonist.
   3. Carbidopa enhances the action of levodopa, and less drug is needed.
   4. Levodopa reverses or prevents the side effects of carbidopa.

4. When assessing a patient with Parkinson disease who takes a carbidopa/levodopa combination drug, you find that he now has almost constant muscle movements that look like uncoordinated dancing. What is your best action?
   1. Document the finding as the only action.
   2. Hold the next drug dose and report the finding to the healthcare provider.
   3. Give the next dose earlier than scheduled because the drugs are wearing off.
   4. Request that the healthcare provider prescribe a one-time dose of a muscle relaxant.

5. A patient newly diagnosed with Parkinson disease is prescribed an oral dopamine agonist. Which precaution is most important to teach the patient and family about the timing for taking this drug?
   1. “Take the drug 30 to 60 min before meals on an empty stomach.”
   2. “Take the drug 30 to 60 min after eating a high protein meal.”
   3. “Take the drug first thing in the morning before getting out of bed.”
   4. “Take the drug when your symptoms are at their worst.”

6. When asking the family of a patient with Alzheimer’s disease who takes the drug donepezil (Aricept) what other prescribed or over-the-counter drugs the patient takes, they list all the following drugs. Which one will you tell them to stop giving the patient?
   1. Aspirin
   2. Buspirone
   3. Vitamin C
   4. Dextromethorphan

7. When admitting a new patient with Alzheimer’s to a memory unit of a long-term care facility, you note that she is prescribed both memantine and rivastigmine. What is your best action?
   1. Give both drugs as prescribed.
   2. Ask the patient when she usually takes these drugs.
   3. Notify the prescriber that both drugs are for Alzheimer’s disease.
   4. Give the memantine one odd-numbered days and rivastigmine on even-numbered days.

8. A family member of a patient using the rivastigmine patches reports that the patient keeps taking the patches off his chest. Where will you suggest the family member apply the patches to avoid this problem?
   1. On the forehead
   2. On the buttocks
   3. On the upper or lower back
   4. On the outer aspect of the thigh

9. A patient is prescribed to receive memantine extended release (XR) 14 mg orally once daily. You have on hand memantine XR 7-mg capsule and memantine 28-mg capsule. What is the best way to ensure the patient gets a 14-mg dose?
   1. Give the patient two 7-mg capsules every day.
   2. Give the patient one 28-mg capsule every other day.
   3. Cut the 28-mg capsule in half and give the patient one of the halves.
   4. Open a 28-mg capsule, empty it into a drug cup, divide the contents in half, and give one half to the patient.

10. When assessing a patient before starting the first dose of a newly prescribed antiepileptic drug, what is the most important nursing action to perform?

1. 1. Determine the type of aura a patient usually has before a seizure.
   2. Obtain an accurate weight because most drug dosages are based on weight.
   3. Ask the patient about all other prescribed or over-the-counter drugs he or she takes daily.
   4. Ensure that oxygen and suction equipment are in the patient’s room and in good working order.

11. Why is intramuscular (IM) injection of phenytoin avoided?
    1. Rapid absorption can cause bradycardia.
    2. The drug is very irritating to the tissues.
    3. Gum hyperplasia is worsened by IM injection.
    4. The drug is a known teratogen that can induce birth defects.

12. When reviewing the preoperative laboratory results of a patient taking oxcarbazepine for seizure control, you note all of the following values. For which one will you notify the surgeon immediately?
    1. White blood cell count 8700 per mm³
    2. Serum sodium level of 128 mEq/L
    3. International normalized ratio (INR) 0.9
    4. Serum chloride level of 100 mEq/L

13. Which precaution is most important to tell parents of young children prescribed lamotrigine for epilepsy?
    1. “Give this drug to your child at night only to prevent dizziness.”
    2. “Ensure that your child takes a multiple vitamin daily while he or she is on this drug.”
    3. “Check your child daily for a rash and call your healthcare provider immediately if one develops.”
    4. “Weigh your child weekly and be sure to report a weight loss of 2 lb or more to

your healthcare provider at your next visit.”

14. A patient taking lacosamide tells you that he never forgets to take his prescribed doses because he feels so good and happy when he is on the drug. What is your best response?
    1. “Anything that helps you remember to take your drug on time is helpful in preventing seizures.”
    2. “Even though you feel good on this drug, do not increase the dose or number of times you take it.”
    3. “Probably knowing that you are less likely to have a seizure is contributing to these positive feelings.”
    4. It is important to remember that taking the drug at a different time of day may change your feelings.”

15. Which drug to manage multiple sclerosis should be avoided by patients who also have epilepsy?
    1. Beta-interferon
    2. Daclizumab
    3. Dalfampridine
    4. Tecfidera
16. What is the most important precaution to teach patients taking any monoclonal antibody or neurologic drug to manage multiple sclerosis?
    1. “Avoid crowds and people who are sick.”
    2. “Always wear protective clothing or sunscreen when outdoors.”
    3. “Report any weight loss immediately to your healthcare provider”.
    4. “Rest as much as possible and avoid any weight-bearing activities.”

MULTIPLE RESPONSE

1. Which symptoms in a patient taking levodopa for Parkinson disease indicate the drug is “wearing off?” (Select all that apply.)
   1. Decreased muscle tone
   2. Difficulty swallowing
   3. Dry mouth
   4. Increased appetite
   5. Increased tremors
   6. Slower gait

2. Which changes are most important to assess for in a patient who is taking topirimate for seizure control? (Select all that apply.)
   1. Weight loss
   2. Decreased seizure activity
   3. Warm flushed skin
   4. Insomnia
   5. Pain at the IV site
   6. Decreased heart rate

COMPLETION

1. A patient in your long-term care facility is prescribed to receive a total of 24 mg of ropinirole daily in three divided doses. The drug on hand is ropinirole 4 mg/tablet. How many tablets will you give for one dose?