NCLEX Pharmacology Quiz 40 Neurological Medications

1. A client is who is receiving edrophonium chloride suddenly is complaining of abdominal cramps and the nurse observes the client is experiencing increased perspiration and salivation. The nurse makes sure the availability of which of the following?

Levodopa.

Methylphenidate hydrohloride (Ritalin).

Atropine sulfate.

Carbamazepine (Tegretol).

The client is experiencing signs of cholinergic crisis. When administering edrophonium chloride. have emergency resuscitation equipment on hand and atropine sulfate available.Option A is used alone or in combination with carbidopa to treat Parkinson’s disease.Option B is a central nervous system stimulant used to treat ADHD and narcolepsy.Option D is used to prevent and control seizures.

Explanation

The client is experiencing signs of cholinergic crisis. When administering edrophonium chloride. have emergency resuscitation equipment on hand and atropine sulfate available.Option A is used alone or in combination with carbidopa to treat Parkinson’s disease.Option B is a central nervous system stimulant used to treat ADHD and narcolepsy.Option D is used to prevent and control seizures.

2. A female client who has a history of seizure went to a health care facility to ask the nurse regarding the use of birth control pills while on phenytoin therapy. The nurse correctly states to the client that:

Taking phenytoin decreases the effectivity of the birth control pills.

Pregnancy is not allowed while taking phenytoin.

There is no known interaction between these medicines so there is nothing to worry about.

To discontinue phenytoin and proceed with the oral contraceptive.

Clients taking oral contraceptive are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone. phenytoin. and carbamazepine because they decrease the effectiveness of the birth control pills.Options B. C. and D are inappropriate instructions.

Explanation

Clients taking oral contraceptive are known to suffer contraceptive failure while taking anticonvulsants such as phenobarbitone. phenytoin. and carbamazepine because they decrease the effectiveness of the birth control pills.Options B. C. and D are inappropriate instructions.

3. The nurse is giving instructions to a client receiving Phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that:

“Wearing a medical alert tag is not required”.

“Alcohol is permitted in while taking this medication”.

“I can take the medicine with milk”.

“Have the serum phenytoin level taken before giving the medication”.

Taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level before taking the morning dose.Option A: Wearing a medical tag allows any medical care provider to know that the client is on seizure medication.Option B: Alcohol use can increase the blood levels of phenytoin and may increase side effects.Option C: Taking it with milk will impair the absorption.

Explanation

Taking the prescribed daily dosage to keep the blood level of the drug constant and having a sample drawn for serum drug level before taking the morning dose.Option A: Wearing a medical tag allows any medical care provider to know that the client is on seizure medication.Option B: Alcohol use can increase the blood levels of phenytoin and may increase side effects.Option C: Taking it with milk will impair the absorption.

4. A client with myasthenia gravis has become frequently complaining of weakness and fatigue. The physician plans to identify whether the client is responding to an overdose of the medication or a worsening of the disease. A tensilon test is performed. Which of the following would indicate that the client is experiencing an overdose of the medication?

Temporarily worsening of the condition.

Improvement of the weakness and fatigue.

No change in the condition.

Complaints of muscle spasms.

Tensilon test/ injection of edrophonium is performed to diagnose cholinergic crisis (overdose with anticholinesterase) or myasthenic crisis (under medication). A tensilon injection makes the client in cholinergic crisis temporarily worse (negative tensilon test). An improvement in the weakness indicates myasthenia crisis.

Explanation

Tensilon test/ injection of edrophonium is performed to diagnose cholinergic crisis (overdose with anticholinesterase) or myasthenic crisis (under medication). A tensilon injection makes the client in cholinergic crisis temporarily worse (negative tensilon test). An improvement in the weakness indicates myasthenia crisis.

5. A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson's disease. The nurse tells the client that which of the following is a side effect of the medication?

Difficulty performing a voluntary movement.

Increased blood pressure.

Increased heart rate.

Itchiness of the skin.

Dyskinesia (difficulty performing a voluntary movement) is one of the symptoms of a levodopa overdose. Other side effects include nausea. diarrhea. vomiting. hypotension. bradycardia. confusion and hallucinations.

Explanation

Dyskinesia (difficulty performing a voluntary movement) is one of the symptoms of a levodopa overdose. Other side effects include nausea. diarrhea. vomiting. hypotension. bradycardia. confusion and hallucinations.

6. Biperiden hydrochloride (Akineton) is added to a list of antiparkinsonian medications that an elderly client is taking. Which of the following instructions made by the nurse that needs further learning?

To avoid smoking. alcohol and caffeine.

To use ice chips. candy or gum for dry mouth.

Walking in the morning to have a daily source of direct sunlight.

Eating foods rich in fiber and increase fluid intake.

Biperiden hydrochloride (Akineton) is an anticholinergic antiparkinson agent used to treat the stiffness. tremors. spasms. and poor muscle control of Parkinson’s disease. Photophobia is one of the side effects of this medication so instruct the client to use sunglasses in direct sunlight.Options A. B. and D are correct instructions regarding the use of this medication.

Explanation

Biperiden hydrochloride (Akineton) is an anticholinergic antiparkinson agent used to treat the stiffness. tremors. spasms. and poor muscle control of Parkinson’s disease. Photophobia is one of the side effects of this medication so instruct the client to use sunglasses in direct sunlight.Options A. B. and D are correct instructions regarding the use of this medication.

7. A client is prescribed with Carbamazepine (Tegretol) for the treatment of bipolar disorder. Which of the following laboratory results indicates that the client is experiencing a side effect of this medication?

Neutrophil count of 1.200/mm3.

Platelet count of 160.000/mm3.

Uric acid level of 4mg/dl.

SGPT (ALT) level 50 units per liter of serum.

Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It causes a decreased level of platelet count. white blood cells. and neutrophil count. The normal range for neutrophil is 1.500 to 8.000/mm3).Options B. C. and D all have a normal value.

Explanation

Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It causes a decreased level of platelet count. white blood cells. and neutrophil count. The normal range for neutrophil is 1.500 to 8.000/mm3).Options B. C. and D all have a normal value.

8. A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food items should be avoided by the client?

Goat yogurt.

Whole grain cereal.

Asparagus.

Apples.

When administering levodopa. the client should avoid excessive intake of foods rich in pyridoxine (vitamin B6) which has been found to reduce the effects of levodopa. Large amounts of pyridoxine are also contained in some foods such as bananas. egg yolks. lima beans. meats. peanuts. and whole grain cereals.Options A. C. and D are foods low in vitamin B6.

Explanation

When administering levodopa. the client should avoid excessive intake of foods rich in pyridoxine (vitamin B6) which has been found to reduce the effects of levodopa. Large amounts of pyridoxine are also contained in some foods such as bananas. egg yolks. lima beans. meats. peanuts. and whole grain cereals.Options A. C. and D are foods low in vitamin B6.

9. A 17-year-old client is taking Phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result?

No symptoms. because the value is within the normal range.

Hypoglycemia.

Tachycardia.

Nystagmus.

The therapeutic level of phenytoin is 10-20mcg/ml. Higher than 20mcg/ml results in nystagmus (Involuntary eye movement).

Explanation

The therapeutic level of phenytoin is 10-20mcg/ml. Higher than 20mcg/ml results in nystagmus (Involuntary eye movement).

10. A client with juvenile pilocytic astrocytoma who is receiving Dexamethasone (Decadron) 4mg/IV every 6 hours to relieve symptoms of right arm weakness and headache. Which of the following assessment will concern the nurse most?

Blood glucose level of 280 mg/dl.

Daily weight gain of 0.5 kg.

Client no longer recognizes the family member.

Client still complains of headache.

The inability to recognize family members is a new neurologic deficit for this client and indicates a possible increasing intracranial pressure (ICP).Options A and B are common side effects of the medication.Option D: The continuing headache indicates an increased ICP but is not a new problem.

Explanation

The inability to recognize family members is a new neurologic deficit for this client and indicates a possible increasing intracranial pressure (ICP).Options A and B are common side effects of the medication.Option D: The continuing headache indicates an increased ICP but is not a new problem.