Question 1

Monitoring of a patient on gabapentin to treat seizures includes:

Accepted Answer

A)   Routine therapeutic drug levels every 3 to 4 months
B)   Assessing for dermatologic reactions, including Steven's Johnson
C)   Routine serum electrolytes, especially in hot weather
D)   Recording seizure frequency, duration, and severity

Question 2

Anticholinergic agents, such as benztropine (Cogentin) , may be given with a phenothiazine to:

Accepted Answer

A)   Reduce the chance of tardive dyskinesia
B)   Potentiate the effects of the drug
C)   Reduce the tolerance that tends to occur
D)   Increase central nervous system (CNS)  depression

Question 3

Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs)  and St John's wort due to:

Accepted Answer

A)   Additive respiratory depression risk
B)   Additive effects affecting liver function
C)   The risk of serotonin syndrome
D)   The risk of altered cognitive functioning

Question 4

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

Accepted Answer

A)   For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
B)   For pedal edema throughout therapy
C)   Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
D)   For vision changes, such as red-green blindness, at least annually A

Question 5

Zainab is taking lamotrigine (Lamictal)  and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Accepted Answer

A)   Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
B)   Ruling out a hypersensitivity reaction that may lead to multi-organ failure
C)   Rapid strep test and symptomatic care if strep test is negative
D)   Observation only, with further assessment if she worsens

Question 6

Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

Accepted Answer

A)   Understanding that obesity is a contraindication to prescribing phentermine
B)   Anorexiants may cause tolerance and should only be prescribed for 6 months
C)   Patients should be monitored for postural hypotension
D)   Renal function should be monitored closely while on anorexiants

Question 7

A patient with anxiety and depression may respond to:

Accepted Answer

A)   Duloxetine (Cymbalta) 
B)   Fluoxetine (Prozac) 
C)   Oxazepam (Serax) 
D)   Buspirone (Buspar)  and an SSRI combined

Question 8

Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

Accepted Answer

A)   He should not play sports due to the risk of increased seizures
B)   He should monitor his temperature and ability to sweat in the heat while playing
C)   Reminding him that he may need higher dosages of topiramate when exercising
D)   Encouraging him to use sunscreen due to photosensitivity from topiramate

Question 9

Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:

Accepted Answer

A)   Fluoxetine
B)   Fluvoxamine
C)   Sertraline
D)   Escitalopram

Question 10

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

Accepted Answer

A)   Orthostatic hypotension
B)   Agitation and irritability
C)   Drowsiness and nausea
D)   Painful urination and abdominal distention

Question 11

Patients who are prescribed olanzapine (Zyprexa)  should be monitored for:

Accepted Answer

A)   Insomnia
B)   Weight gain
C)   Hypertension
D)   Galactorrhea A

Question 12

When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3) , instructions to the patient should include:

Accepted Answer

A)   The medication may cause sedation and they should not drive.
B)   Constipation is a common side effect and they should increase fluids and fiber.
C)   Patients should not take any other acetaminophen-containing medications at the same time.
D)   All of the above D

Question 13

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Accepted Answer

A)   Ibuprofen (Advil) 
B)   Acetaminophen with hydrocodone (Vicodin) 
C)   Oxycodone (Oxycontin) 
D)   Oral morphine (Roxanol)

Question 14

Long-term monitoring of patients who are taking carbamazepine includes:

Accepted Answer

A)   Routine troponin levels to assess for cardiac damage
B)   Annual eye examinations to assess for cataract development
C)   Monthly pregnancy tests for all women of childbearing age
D)   Complete blood count every 3 to 4 months

Question 15

The tricyclic antidepressants should be prescribed cautiously in patients with:

Accepted Answer

A)   Eczema
B)   Asthma
C)   Diabetes
D)   Heart disease

Question 16

A 66-year-old male was prescribed phenelzine (Nardil)  while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs) :

Accepted Answer

A)   He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) 
B)   MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce
C)   Symptoms of hypertensive crisis (headache, tachycardia, sweating)  require immediate treatment
D)   All of the above

Question 17

Tom is taking lithium for bipolar disorder. He should be taught to:

Accepted Answer

A)   Take his lithium with food
B)   Eat a diet with consistent levels of salt (sodium) 
C)   Drink at least 2 quarts of water if he is in a hot environment
D)   Monitor blood glucose levels

Question 18

Samantha is taking lamotrigine (Lamictal)  for her seizures and requests a prescription for combined oral contraceptives (COCs) , which interact with lamotrigine and may cause:

Accepted Answer

A)   Contraceptive failure
B)   Excessive weight gain
C)   Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
D)   Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed

Question 19

Suzanne is started on paroxetine (Paxil) , a selective serotonin reuptake inhibitor (SSRI) , for depression. Education regarding her antidepressant includes:

Accepted Answer

A)   SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
B)   Red-green color blindness may occur and should be reported.
C)   If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately.
D)   She should eat lots of food high in fiber to prevent constipation.

Question 20

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

Accepted Answer

A)   Dwayne hasn't been taking his carbamazepine because it causes insomnia.
B)   Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
C)   Dwayne was not originally prescribed the correct amount of carbamazepine.
D)   Carbamazepine is probably not the right antiseizure medication for Dwayne.

Exam 15: Drugs Affecting the Central Nervous System

Monitoring of a patient on gabapentin to treat seizures includes:

Correct AnswerverifiedShow Answer

Anticholinergic agents, such as benztropine (Cogentin) , may be given with a phenothiazine to:

Correct AnswerverifiedShow Answer

Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John's wort due to:

Correct AnswerverifiedShow Answer

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

Correct AnswerverifiedA

Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Correct AnswerverifiedShow Answer

Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

Correct AnswerverifiedShow Answer

A patient with anxiety and depression may respond to:

Correct AnswerverifiedShow Answer

Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

Correct AnswerverifiedShow Answer

Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:

Correct AnswerverifiedShow Answer

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

Correct AnswerverifiedShow Answer

Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

Correct AnswerverifiedA

When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3) , instructions to the patient should include:

Correct AnswerverifiedD

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Correct AnswerverifiedShow Answer

Long-term monitoring of patients who are taking carbamazepine includes:

Correct AnswerverifiedShow Answer

The tricyclic antidepressants should be prescribed cautiously in patients with:

Correct AnswerverifiedShow Answer

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs) :

Correct AnswerverifiedShow Answer

Tom is taking lithium for bipolar disorder. He should be taught to:

Correct AnswerverifiedShow Answer

Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs) , which interact with lamotrigine and may cause:

Correct AnswerverifiedShow Answer

Suzanne is started on paroxetine (Paxil) , a selective serotonin reuptake inhibitor (SSRI) , for depression. Education regarding her antidepressant includes:

Correct AnswerverifiedShow Answer

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

Correct AnswerverifiedShow Answer

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