PHA 053 - PHARMACOLOGY

P1 W5 POST TEST ANSWER KEY c RATIONALE

1.The physician determines a patient needs to be started on a selective serotonin reuptake

inhibitor (SSRI). As the nurse you know which medication below is NOT an SSRI?
A. Citalopram C. Paroxetine
B. Rasagiline D. Fluoxetine

The answer is B. Rasagiline is a MAOI (monoamine oxidase inhibitor) and is used to treat
Parkinson's Disease.

2. Fill in the blank: After the pre-synaptic neuron releases serotonin, it enters the __________
and some of the serotonin binds with receptors found on the post-synaptic neuron. The
serotonin that did not bind with a receptor is removed from this space via a protein
serotonin-transporter back into the _________ for future use.
A. synaptic vesicle; pre-synaptic neuron
B. synaptic cleft; post-synaptic neuron
C. axon terminal; pre-synaptic neuron
D. synaptic cleft; pre-synaptic neuron

The answer is D. After the pre-synaptic neuron releases serotonin, it enters the SYNAPTIC CLEFT
and some of the serotonin binds with receptors found on the post-synaptic neuron. The
serotonin that did not bind with a receptor is removed from this space via a protein
serotonin-transporter back into the PRE-SYNAPTIC NEURON for further use.

3. Which statement below best describes the mechanism of action of how SSRIs work?
A. "SSRIs enhance the reuptake of serotonin by the receptors on the post-synaptic neuron."
B. "SSRIs enhance the reuptake of GABA by amplifying the action of the serotonin
receptors found on the post-synaptic neuron."
C. "SSRIs inhibit the reuptake of the neurotransmitter serotonin by the pre-synaptic
neuron."
D. "SSRIs inhibit the reuptake of GABA by blocking the reuptake of serotonin from the
pre-synaptic neuron."

The answer is C. SSRIs, (selective serotonin reuptake inhibitors), inhibit the reuptake of the
neurotransmitter serotonin by the pre-synaptic neuron. It does this by blocking the
serotonin-transporter protein (SERT).

4. A patient is prescribed Fluvoxamine for treatment of obsessive compulsive disorder. What

should the nurse include in the patient education about this medication?
A. Expect signs and symptoms to improve within one month to 6 weeks
B. Avoid consuming foods with tyramine
C. Limit alcohol consumption to 8 oz. a day
D. Stop taking the medication if side effects are experienced
The answer is A. Option B is education for patients taking MAOIs (not SSRIs), Option C is wrong
because any amount of alcohol needs to be avoided, Option D is wrong because the medication
should be tapered off not abruptly stopped...this could lead to discontinuation syndrome. SSRIs
take time to work and the patient should be aware it can take a month to six weeks to feel
improvement.

5. A patient has been taking an SSRI for the treatment of depression for about one month. The
patient reports insomnia. To help provide relief from this side effect, when should the patient
take this medication?
A. At bedtime C. In the morning
B. In the afternoon

The answer is C. Some types of SSRIs can cause insomnia. If this occurs, taking the medication in
the morning may help this symptom. However, if the medication causes drowsiness, taking the
medication at night may help with this symptom.

6. A 36-year-old patient is admitted to the ER. The patient is extremely diaphoretic, shivering,
experiencing muscle rigidity, and irritability. The patient’s heart rate is 140 and temperature
102.6 ‘F. The patient has a history of depression, diabetes, atrial fibrillation, and hypertension.
The patient’s family reports the patient has also been experiencing a constant dry cough and
has been taking an over-the-counter medication in an attempt to get relief from the cough. The
patient is currently taking Sertraline and the other medications below. What other medication
taken by the patient should the nurse immediately notify the doctor about?
A. Glyburide C. Lisinopril
B.Metoprolol D. Dextromethorphan

The answer is D: dextromethorphan. Based on the patient’s sign and symptom, serotonin
syndrome may be presenting. This syndrome can occur when the patient takes an SSRI along
with another medication like dextromethorphan. Dextromethorphan is an over-the-counter
cough medicine. Both of these medications can increase serotonin levels.

7. Serotonin neurons are found in the brainstem in the _________________.

A. raphe nucleus C. raphe obscuris
B. raphe pontis D. raphe pallidus

The answer is A: raphe nucleus

8. A patient presents to the ER with severe stomach pain, diarrhea, insomnia, and ataxia. In
addition, the patient reports experiencing electrical shock sensations and tingling in his body.
The nurse collects the patient’s medication history, which includes Fluoxetine. What
IMPORTANT question should the nurse ask the patient next to help determine the cause of the
patient's presenting signs and symptoms?
 A. "Have you taken any over-the-counter cough medications or herbal substances in the
past week?"
B. "Are you allergic to shellfish?"
C. "Have you consumed alcohol or any illegal substances in the past week?"
D. "When was the last time you took Fluoxetine?"

The answer is D. Based on the patient's signs and symptoms, the patient may be experiencing
discontinuation syndrome which can happen if a patient suddenly quits taking an SSRI
(Fluoxetine). The nurse should immediately ask the patient when the last dose of Fluoxetine was
taken.

9. SSRIs can interact with other types of medications. What medications below should the nurse
educate the patient to avoid while taking an SSRI? Select all that apply:
I. St. John's Wort III. Statins
II. MAOIs (Monoamine oxidase inhibitors) IV. Benzodiazepines

A. IV&III B.III&II C. II&I D. I&IV

The answers are A and B. If SSRIs are combined with St. John's Wort or MAOIs it can lead to
serotonin syndrome (this occurs due to high serotonin levels). Therefore, patients should avoid
these types of medications together.

10.A patient is currently taking Vilazodone and is experiencing nausea. The patient started
taking the medication about 1 week ago. What education can the nurse provide the patient
about this type of side effect?
I. "Nausea is not normal with SSRIs and may indicate intolerance to the medication."
II. "Nausea is normal with SSRIs and tends to decrease overtime."
III. "Avoid taking the medication with food to help decrease the occurrence of nausea."
IV. "Taking the medication with food will help decrease the nausea."

A. II &IV B. 1&II C. III&IV D. 1&III

The answers is A. SSRIs definitely can cause nausea. However, it tends to decrease over a couple
of weeks into therapy. Sometimes taking the medication with food will help decrease the
nausea.

11. Nurse Sarah ensures a therapeutic environment for all the clients. Which of the following
best describes a therapeutic milieu?
A. A therapy that rewards adaptive behavior.
B. A living, learning or working environment.
C. A cognitive approach to change behavior.
D. A permissive and congenial environment.
Correct Answer: B. A living, learning or working environment.
A therapeutic milieu refers to a broad conceptual approach in which all aspects of the
environment are channeled to provide a therapeutic environment for the client. The six
environmental elements include structure, safety, norms; limit setting, balance, and unit
modification. A therapeutic milieu is a structured environment that creates a safe, secure place
for people who are in therapy. It is the therapeutic environment that supports the individual in
their process toward recovery and wellness. This milieu involves not just the provision of safe
physical surroundings, but also of supportive therapists and staff.

12.Antipsychotic drugs are also known as sedative hypnotics.

A. TRUE B. FALSE

13.Anxiolytics are also known as antianxiety drugs.

A. TRUE B. FALSE

14. Atypical antipsychotics have more extrapyramidal effects than typical antipsychotics.
B. TRUE B. FALSE

15. Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression
and insomnia. Benefits specific to use of nortriptyline would include:
A. Improved sleep pattern. C. Anhedonia.
B. Weight loss. D. Regular bowel movements.
Nortriptyline is a secondary amine with a good side effect profile. It has a minimal tendency to
cause orthostatic hypotension, meaning the risk of falls is low. It is somewhat sedating, which is
helpful to patients with insomnia. The other options are either undesirable or nonspecific
outcomes.

16. A nurse is providing instructions to a client who is taking Doxapram (Dopram). Which of the
following statements made by the client needs further instructions?
A. “I need to avoid drinking coffee“.
B. “I will not chew or crush long acting form of the medications”.
C. “I need to take the medication before meals”.
D. “I need to take the medication at bedtime”.
ANSWER D.
“I need to take the medication at bedtime”.Doxapram (Dopram) is a central nervous system
stimulant. One of the side effects is insomnia so instruct the client to take it at least 6 hours
before bedtime to prevent it.

17. Narcolepsy can be best explained as:

A. An overwhelming wave of sleepiness and falling asleep
B. A sudden muscle weakness during exercise
C. Stopping breathing for short intervals during sleep
D. Frequent awakenings during the night
ANSWER A. An overwhelming wave of sleepiness and falling asleep. Narcolepsy is a dysfunction
of mechanisms that regulate the sleep and wake states. Excessive daytime sleepiness is the
most common complaint associated with this disorder. During the day a person may suddenly
feel an overwhelming wave of sleepiness and fall asleep; REM sleep can occur within 15
minutes of falling asleep.

18. What are the most commonly used anxiolytics?

A. Barbiturates C. Buspirone
B. Benzodiazepines D. Diphenhydramine
ANSWER B.
Benzodiazepines.They are the most commonly used anxiolytics because they can lyse or break
the feeling of anxiety without causing much sedation and are less likely to make patients
physically dependent.

19. Which of the following medical condition(s) can be considered as contraindication(s) to use
of anxiolytics and hypnotics?
A. Acute gastroenteritis C. Alcoholic intoxication
B. Psychosis D. Both B and C

ANSWER D.
Both B and C. Psychosis can be exacerbated by the sedative effect of the drug. On the other
hand, alcoholic intoxication can be exacerbated by depressant effects of these drugs.

20. Older adults who take long-acting sedatives or hypnotics are likely to experience:
A. Ataxia C. Dyspnea
B. Alertness D. Hallucinations
ANSWER A. Ataxia. If longer-acting barbiturates are used in older adults, these clients may
experience daytime sedation, ataxia, and memory deficits.

21. Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic
agent?
A. Alteration in tissue perfusion C. Risk for injury
B. Fluid volume excess D. Risk for infection
ANSWER C. Risk for injury. Sedative-hypnotics cause CNS depression, putting the patient at risk
for injury.

22. What drug refers to the ability to help a patient feel calm and unaware of his environment?
A. Sedatives C. Anesthesia
B. Hypnotics D. Anxiolytics
ANSWER A.
Sedatives.Hypnotic effect helps patients sleep and anxiolytic effect helps patients relieve
feelings of tension and fear.

23. Abrupt withdrawal of barbiturates can precipitate what medical condition?

A. Ascites C. Hypertensive crisis
B. Coma D. Status epilepticus
ANSWER D.Withdrawal from phenobarbital can be severe and include seizures and (rarely)
death.

25. During patient teaching, the nurse explains the difference between a sedative and hypnotic
by stating:
A. “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher
doses.”
B. “There really is no difference; the terms are used interchangeably.”
C. “Sedatives are much stronger than hypnotic drugs and should only be used for short
periods of time.”
D. “Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis.”
ANSWER A. “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher
doses.”. Many drugs have both sedative and hypnotic properties, with the sedative properties
evident at low doses and the hypnotic properties demonstrated at larger doses.

26. 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) C. Ipecac syrup
B. Activated charcoal D. Flumazenil (Romazicon)
ANSWER B. Activated charcoal. There is no antidote for barbiturates. The use of activated
charcoal absorbs any drug in the GI tract, preventing absorption.

27. The patient’s chart notes the administration of dantrolene (Dantrium) immediately
postoperatively. The nurse suspects that the patient experienced:
A. A tonic-clonic seizure C. Delirium tremens
B. Respiratory arrest D. Malignant hyperthermia
ANSWER D. Malignant hyperthermia. Dantrolene is a direct-acting musculoskeletal muscle
relaxant and is the drug of choice to treat malignant hyperthermia, a complication of
generalized anesthesia.

28. Which of the following is an important nursing action for the administration of a
benzodiazepine as a sedative-hypnotic agent?
A. Evaluate for physical dependence that occurs within 48 hours of beginning the drug.
B. Monitor geriatric patients for the common occurrence of paradoxical reactions.
C. Administer safely with other CNS depressants for insomnia
D. Use IM dosage forms for longer duration
ANSWER B.Monitor geriatric patients for the common occurrence of paradoxical reactions.

29. 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. Make sure the patient’s call light is close by in case of the need for assistance with
activities.
 D. Cardiovascular stimulation, a common side effect, would lead to hypertension
ANSWER C. Make sure the patient’s call light is close by in case of the need for assistance with
activities.

30. 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 C. Psychogenic
B. Paradoxical D. Teratogenic
ANSWER B. Paradoxical reactions due to benzodiazepines occur as a result of an altered level of
consciousness, which generates automatic behaviors, anterograde amnesia and uninhibited
aggression. These aggressive reactions may be caused by a disinhibiting serotonergic
mechanism and is more common to pediatric and geriatric patients.