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Lehne's Pharmacotherapeutics for Nurse Practitioners and Physician Assistants 1st Edition By Jacqueline Burchum, Laura Rosenthal 9780323447836 Chapter 1-89 Complete Guide$17.99
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Lehne's Pharmacotherapeutics for Nurse Practitioners and Physician Assistants 1st Edition By Jacqueline Burchum, Laura Rosenthal 9780323447836 Chapter 1-89 Complete Guide
Test Bank Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants 2nd Edition by Laura D. Rosenthal & Jacqueline Rosenjack Burchum 9780323554954 Chapter 1-92| Complete Gui...
Test Bank - Lehne’s Pharmacotherapeutics For Advanced Practice Nurses And Physician Assistants, 2nd Edition (Jacqueline Burchum; Laura D. Rosenthal, 2024) | All Chapters (1- 92)
Test Bank Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants 2nd Edition by Laura D. Rosenthal & Jacqueline Rosenjack Burchum 9780323554954 Chapter 1-92| Complete Gui...
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Test Bank For Lehne's Pharmacotherapeutics for Nurse
Practitioners and Physician Assistants 1st Edition By
Jacqueline Burchum, Laura Rosenthal 9780323447836 Chapter
1-89 Complete Guide
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 - ANSWER: 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.
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 - ANSWER: ANS: B , C , D , E
Acetylcholine and histamines are not monoamines.
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. - ANSWER: 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," 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.
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. - ANSWER: 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.
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 underlie mental illness
is incomplete."
d. "These drugs are developed based on scientific knowledge of CNS transmitters and receptors." -
ANSWER: 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 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.
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." - ANSWER: 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.
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. - ANSWER: 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.
Which are medical applications of central nervous system drugs? Select all that apply.
a. Analgesia
b. Anesthesia
c. Depression
d. Euphoria
e. Seizure control - ANSWER: 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.
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 epilepticus. - ANSWER: 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.
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." - ANSWER: ANS: A
Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized with
good oral hygiene, so patients should be encouraged to brush and floss regularly. Because small
fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not easy.
Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes can be
serious and should be reported immediately.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse
asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What
will the nurse do?
a. Ask the patient to complete a seizure frequency chart for the past few weeks.
b. Contact the provider to request an order for serum drug levels.
c. Reinforce the need to take the medications as prescribed.
d. Request an order to increase the dose of the antiepileptic drug. - ANSWER: ANS: B
If medication therapy is not effective, it is important to measure serum drug levels of the medication
to determine whether therapeutic levels have been reached and to help monitor patient compliance.
Patients should be asked at the beginning of therapy to keep a seizure frequency chart to help deepen
their involvement in therapy; asking for historical information is not helpful. Until it is determined
that the patient is not complying, the nurse should not reinforce the need to take the medication.
Until the drug level is known, increasing the dose is not indicated.
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is
taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. -
ANSWER: ANS: B
Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding
pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral
contraceptives or use an alternative method of birth control. Increasing the patient's dose of
phenytoin is not necessary; OCPs do not affect phenytoin levels. Phenytoin is linked to birth defects;
OCPs have decreased effectiveness in patients treated with phenytoin, and the patient should be
advised to increase the OCP dose or to use an alternative form of birth control. OCPs do not alter the
effects of phenytoin.
A patient with a formof epilepsy that may have spontaneous remission has been taking an AED
for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can
be discontinued. What will the nurse tell the patient?
a. AEDs must be taken for life to maintain remission.
b. Another AED will be substituted for the current AED.
c. The provider will withdraw the drug over a 6- to 12-week period.
d. The patient should stop taking the AED now and restart the drug if seizures recur. - ANSWER: ANS:
C
The most important rule about withdrawing AEDs is that they should be withdrawn slowly over 6
weeks to several months to reduce the risk of status epilepticus (SE). AEDs need not be taken for life if
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