(TOPIC 5) Central and Peripheral Nervous Systems Quiz

Questions and Answers

Which instruction would a nurse provide a patient who is receiving the first dose of an antiseizure drug at home?

Lie in bed for at least an hour after taking the antiseizure drug.

Take the antiseizure drug with vitamin B complex, because the antiseizure drug reduces these vitamin levels.

Wait to see how you react to the drug before driving. (correct)

Do not take the drug if you have a fever.

Which potential complication could occur if a patient abruptly stops taking an antiseizure drug?

Rebound seizure activity (correct)

Hypotension

Drug dependence

Confusion and delirium

By which mechanism do selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function?

Increasing the placebo effect

Increasing alertness levels in the brain

Decreasing levels of epinephrine and serotonin at nerve endings

Blocking the reuptake of neurotransmitters at nerve endings (correct)

Which finding indicates a contraindication that should be discussed by the patient with the healthcare provider regarding seizure activity in spite of taking the prescribed medication?

Gingko biloba Signup and view all the answers

Which would be the best information for the nurse to include in medication education to promote adherence to the therapeutic regimen if a patient who has taken fluoxetine for 2 weeks reports dissatisfaction with the therapy?

A therapeutic effect can be expected in another 2 to 4 weeks. Signup and view all the answers

Which side effect will a patient receiving phenytoin minimize with regular visits to the dentist and appropriate oral hygiene?

Gingival hyperplasia Signup and view all the answers

Which activity would the patient be cautioned to avoid while taking a monoamine oxidase inhibitor (MAOI)?

Eating aged cheese Signup and view all the answers

Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants?

CNS stimulants increase release of and block reuptake of neurotransmitters. Signup and view all the answers

Which substance(s) does the nurse advise the patient to avoid if the patient has been prescribed cyclobenzaprine? (Select all that apply)

Barbiturates Signup and view all the answers

Which assessment would the nurse make a priority if a patient taking an antidepressant for major depression reports feeling dizzy when getting up after sitting in a chair?

Blood pressure Signup and view all the answers

Which condition is the patient most likely experiencing when prescribed alprazolam?

Anxiety with depression Signup and view all the answers

Which substance would the nurse question a patient about using if the nurse suspects serotonin syndrome and the patient, who is currently taking duloxetine, reports restlessness, agitation, diaphoresis, and tremors?

St.John’s wort Signup and view all the answers

Which intervention(s) would the nurse implement for a patient who has been prescribed a benzodiazepine for anxiety? (Select all that apply)

Instruct the patient not to drive during therapy Signup and view all the answers

Which medication would the nurse expect the primary health care provider to prescribe for a suspected benzodiazepine overdose?

Flumazenil Signup and view all the answers

Which sign or symptom would the nurse observe when caring for a patient who experienced an absence seizure?

Brief loss of consciousness Signup and view all the answers

Which patient finding indicates the goals were met when the nurse is evaluating the plan of care for a patient receiving phenytoin for the treatment of a seizure disorder?

Noting a phenytoin level of 15 mcg/mL Signup and view all the answers

Which assessment is priority for the emergency room nurse caring for a patient who reports taking 'cold medicine' at home and is now dizzy and sweaty?

Blood pressure Signup and view all the answers

Which statement explains why a patient would be cautioned not to drink alcohol while taking benzodiazepines?

Alcohol combined with benzodiazepines may result in respiratory depression. Signup and view all the answers

Which can benefit from fluoxetine? (Select all that apply)

Premenstrual dysphoric disorder Signup and view all the answers

Which finding indicates the nurse administered an initial dose of diazepam 5 mg intravenous (IV) push to a patient experiencing status epilepticus too rapidly?

Respirations seven breaths per minute Signup and view all the answers

Which is an adverse effect of cyclobenzaprine? (Select all that apply)

Myocardial infarction Signup and view all the answers

Which instruction will the nurse provide to a patient taking both phenytoin and an oral contraceptive?

'Use an additional form of contraception, because your oral contraceptive may not be as effective while on phenytoin.' Signup and view all the answers

Which information would the nurse provide to a patient taking anticonvulsants for a seizure disorder? (Select all that apply)

Be aware urine may turn a reddish-brown color. Signup and view all the answers

Which condition(s), if found in the patient’s medical history, would prompt the nurse to contact the health care provider for an alternative prescription if the health care provider has prescribed cyclobenzaprine to treat muscle spasms? (Select all that apply)

Narrow-angle glaucoma Signup and view all the answers

Which reversal agent needs to be on hand when administering intravenous lorazepam?

Flumazenil Signup and view all the answers

Which intervention is most important to ensure safety in a patient being treated with anxiolytic medications?

Monitor for orthostatic hypotension. Signup and view all the answers

Which conclusion will the nurse make when a patient states, 'When my brother had anesthesia, he developed a really high temperature,' in completing an assessment regarding general anesthesia?

The patient is at risk for malignant hyperthermia. Signup and view all the answers

Which serum drug level is within the therapeutic range for phenytoin?

12 mcg/mL Signup and view all the answers

Which cue related to central nervous system side or adverse effects in a patient taking lorazepam should the nurse be alert for? Select all that apply.

Amnesia Signup and view all the answers

Which is an anticholinergic side effect of cyclobenzaprine? Select all that apply.

Constipation Signup and view all the answers

Which assessment question will the nurse ask before administering zolpidem tartrate to an older patient with insomnia? Select all that apply.

Do you have any problems with your liver? Signup and view all the answers

How does phenytoin work to control seizures?

Prevents an influx of sodium into cells Signup and view all the answers

Which statement by the patient is a characteristic finding in narcolepsy?

My spouse tells me I walk in my sleep. Signup and view all the answers

Which method is most effective when the nurse is teaching a patient about antidepressant medications?

Verbal instructions and reinforcement of instructions via videos Signup and view all the answers

Which feature of phenytoin makes it most susceptible to drug interactions?

Protein-bound Signup and view all the answers

Which diagnosis would the nurse expect for a patient who has involuntary movements of the body and extremities?

Tardive dyskinesia Signup and view all the answers

Which condition is a contraindication to lorazepam therapy?

Alcoholism Signup and view all the answers

Which alteration would the nurse monitor for if a central nervous system stimulant is abruptly stopped?

Depression Signup and view all the answers

Which symptom would the nurse recognize as a side effect of fluoxetine? Select all that apply.

Nausea Signup and view all the answers

Which parameter would the nurse plan to monitor in a patient who is beginning treatment of major depression with a selective serotonin reuptake inhibitor (SSRI)? Select all that apply.

Fluid volume Signup and view all the answers

Which action would the nurse take to ensure the well-being of a patient taking lorazepam who reports headaches, dry mouth, and constipation?

Check whether the drug dosage has been reduced gradually. Signup and view all the answers

Which intervention would the nurse include in the plan of care for a patient hospitalized with a history of convulsions?

Implement seizure precautions. Signup and view all the answers

Which substance(s) does the nurse instruct the patient to avoid to help prevent intensification of alprazolam’s adverse effects? Select all that apply.

Alcohol Signup and view all the answers

Which action is appropriate for a nurse who determines a patient’s phenytoin level is 8 mcg/mL?

Contact the health care provider for an increase in dosage. Signup and view all the answers

Which symptom(s) would the nurse expect a patient with major depression to describe when the nurse is gathering a health history? Select all that apply.

No interest in working Signup and view all the answers

Which instruction is important for a nurse to include in discharge teaching for a 25-year-old female patient who has been prescribed phenytoin for seizures?

Discuss alternate forms of birth control with the health care provider. Signup and view all the answers

Which action will a nurse take for a patient who has a serum phenytoin level of 31 mg/mL?

Hold the drug. Signup and view all the answers

Which action would the nurse take when providing care to a patient who has recently been prescribed a benzodiazepine?

Assess sedation level. Signup and view all the answers

Which nonpharmacologic nursing intervention can be provided to help promote sleep in a patient who reports unusual sleep patterns and lack of sleep?

Arise at a specific hour in the morning. Signup and view all the answers

Study Notes

Benzodiazepine Interventions

Instruct patients to change positions slowly to prevent dizziness from orthostatic hypotension.
Advise against driving while on benzodiazepines due to sedation effects.
Caution patients to avoid alcohol to prevent increased CNS depression.
Teach relaxation techniques before initiating anxiolytic treatment.

Benzodiazepine Overdose Management

Flumazenil is the preferred medication for suspected benzodiazepine overdose.

Absence Seizures

Characterized by brief loss of consciousness lasting less than 10 seconds.

Evaluation of Phenytoin Treatment

Goals met if a therapeutic phenytoin level (10-20 mcg/mL) is noted; a level of 15 mcg/mL is acceptable.
New seizure activity indicates goals are not met, warranting further education.

Emergency Room Priorities

Blood pressure assessment is crucial for patients on 'cold medicine' who present with dizziness and sweating, due to potential hypertensive crises.

Alcohol Consumption with Benzodiazepines

Alcohol can cause respiratory depression when combined with benzodiazepines, highlighting the need for patient education regarding safety.

Fluoxetine Applications

Effective for panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder; does not treat ADHD.

Diazepam Administration Cautions

Rapid IV administration of diazepam can lead to respiratory depression; monitor for a low respiratory rate (e.g., seven breaths per minute).

Adverse Effects of Cyclobenzaprine

Possible effects include seizures, angioedema, bronchospasm, and myocardial infarction with chronic use.

Phenytoin and Contraceptive Interactions

Patients on phenytoin should use additional contraception as it can reduce the efficacy of oral contraceptives.

Anticonvulsant Patient Instructions

Wear medical alert bracelets, monitor serum drug levels regularly, and maintain dental check-ups every six months to manage gingival hyperplasia.

Cyclobenzaprine Contraindications

Use caution in patients with hyperthyroidism or narrow-angle glaucoma due to potential increased intraocular pressure.

Lorazepam Safety Measures

The reversal agent flumazenil should be readily available during lorazepam administration for potential rapid sedation reversal.

Anxiolytics Safety Monitoring

Monitor for orthostatic hypotension as a significant safety issue when treating patients with anxiolytics.

Malignant Hyperthermia Risk

Family history of high fever post-anesthesia suggests potential risk for malignant hyperthermia in the patient.

Therapeutic Levels for Phenytoin

Therapeutic serum levels for phenytoin: 10-20 mcg/mL; levels below 10 mcg/mL are subtherapeutic, above 20 mcg/mL are supratherapeutic.

CNS Effects of Lorazepam

Watch for seizures, suicidal ideation, confusion, and amnesia in patients taking lorazepam.

Anticholinergic Effects of Cyclobenzaprine

Common effects include tachycardia, constipation, and urinary retention; monitor for these symptoms as part of patient assessment.### Zolpidem Tartrate Administration
Ask older patients about alcohol consumption to prevent additive CNS depression when administering zolpidem.
Inquire about liver and kidney issues as zolpidem is cautioned in patients with these conditions.
Crohn disease and thyroid conditions are not relevant to zolpidem therapy.

Phenytoin and Seizure Control

Phenytoin works by preventing sodium influx into neurons, stabilizing cell membranes and reducing neuron firing.
Unlike phenytoin, levetiracetam and gabapentin suppress calcium movement while gabapentin enhances GABA action.

Narcolepsy Characteristic Findings

"My spouse tells me I walk in my sleep" indicates narcolepsy, characterized by excessive daytime sleepiness.
Other statements may indicate different conditions: difficulty falling asleep relates to insomnia, while leg movement at night suggests restless legs syndrome.

Teaching about Antidepressants

Verbal instructions paired with video reinforcement are the best teaching methods for patient understanding of antidepressants.
Printed instructions may be ineffective if the patient cannot read or understand them, and online resources may not be accessible.

Phenytoin Drug Interactions

Phenytoin is highly protein-bound, making it susceptible to drug interactions by competing for plasma protein-binding sites.
Alkalinity, fat solubility, and water solubility do not significantly increase drug interaction risk.

Involuntary Movements and Diagnoses

Tardive dyskinesia is diagnosed for involuntary body and extremity movements, while akathisia involves restlessness and pacing.

Lorazepam Contraindications

History of alcoholism is a contraindication for lorazepam therapy due to potential for further substance abuse.
Lorazepam can be suitable for patients with convulsions or myocardial infarctions.

Withdrawal from CNS Stimulants

Abrupt cessation of CNS stimulants may lead to depression and withdrawal symptoms.
Agitation, anorexia, and psychosis are not typical outcomes of stopping stimulants suddenly.

Fluoxetine Side Effects

Common side effects of fluoxetine include nausea, headache, and dry mouth.
Bleeding and muscle pain are not recognized side effects of this medication.

Monitoring Patients on SSRIs

Monitor fluid volume and skin integrity in patients starting SSRIs due to risks of edema and possible Stevens-Johnson syndrome.
Assess for suicidal ideations since SSRIs may increase suicide risk.

Lorazepam Patient Management

Ensure gradual reduction of lorazepam dosage to prevent complications; sudden withdrawal can heighten risks.
Do not administer CNS depressants concurrently due to the risk of respiratory depression.

Seizure Precautions

Implement seizure precautions for patients with a history of convulsions during hospitalization.
Monitor serum electrolytes if dehydration is suspected.

Avoiding Alprazolam Interactions

Advise patients to avoid alcohol, opioids, antihistamines, and muscle relaxants while taking alprazolam due to increased CNS depression risk.
Tobacco is harmful but does not intensify alprazolam effects; caffeine may counteract depression effects.

Phenytoin Therapeutic Levels

Therapeutic phenytoin levels range from 10 to 20 mcg/mL. A level of 8 mcg/mL may necessitate dosage adjustment.
A level of 31 mg/mL indicates toxicity, requiring the nurse to hold the drug and consult a healthcare provider.

Benzodiazepine Monitoring

Assess sedation levels in patients prescribed benzodiazepines due to CNS depressant effects.
Benzodiazepines do not typically impact bowel sounds, orientation, or potassium levels.

Nonpharmacologic Sleep Promotion

Encouraging patients to arise at a specific time each morning aids sleep regulation.
Advise against fluid intake before bedtime to minimize nocturia, and avoid alcohol close to bedtime due to sleep disturbance risks.

Antiseizure Medication Instructions

Patients should understand their reaction to antiseizure medication prior to activities like driving.
Fever does not contraindicate taking antiseizure medication, and patients do not need to lie down after dosing.

Complications of Antiseizure Withdrawal

Stopping antiseizure medications abruptly may lead to rebound seizures and status epilepticus.
Other complications like drug dependence or confusion are unlikely from abrupt withdrawal.

Mechanism of SSRIs and TCAs

Both SSRIs and TCAs block neurotransmitter reuptake at nerve endings, enhancing serotonin and norepinephrine levels.
They do not increase alertness and do not contribute solely to placebo effects.

Herbal Interactions with Anticonvulsants

Patients should discuss the use of gingko biloba with healthcare providers as it may interact adversely with anticonvulsants.
Medications like aspirin, lisinopril, and furosemide do not pose significant risks with phenytoin.### Medication Education for Fluoxetine
Fluoxetine, an SSRI, may take 4 to 6 weeks to show full therapeutic effects.
Patients should be informed they can expect therapeutic effects in another 2 to 4 weeks to support adherence.
Adverse effects can be managed, but patients may struggle with compliance due to depression.

Phenytoin Side Effects

Common side effect of phenytoin is gingival hyperplasia, characterized by gum overgrowth and bleeding.
Regular dental visits and good oral hygiene can minimize this side effect.
Phenytoin is not associated with oral candidiasis, dental abscess risk, or dental caries increase.

Cautions for Monoamine Oxidase Inhibitors (MAOIs)

Patients on MAOIs must avoid tyramine-rich foods like aged cheese to prevent hypertensive crises.
Sunbathing, smoking low-nicotine cigarettes, and participating in activities like bowling are not contraindicated with MAOIs.

Lorazepam Administration and Response

Lorazepam can cause oversedation; if a patient is unresponsive with shallow breathing, immediate administration of flumazenil is crucial.
Monitor vital signs but prioritize administering the reversal agent first.

CNS Stimulants Pharmacodynamics

CNS stimulants increase the release and alter the reuptake of excitatory neurotransmitters.
They do not inhibit neurons nor reduce the production of excitatory neurotransmitters.

Cyclobenzaprine Advisories

Cyclobenzaprine, a CNS depressant, requires avoidance of alcohol, barbiturates, and tricyclic antidepressants to prevent excessive CNS depression.
Anesthetics and aminoglycosides can be safely used with cyclobenzaprine.

Priority Assessments for Antidepressants

Patients on antidepressants experiencing dizziness upon standing need a blood pressure measurement due to potential orthostatic hypotension.
Other measures like potassium levels, pulse oximetry, and respiratory rate are less immediately critical.

Alprazolam Use

Alprazolam primarily treats anxiety associated with depression; it's not first-line for insomnia, seizures, or alcohol withdrawal.

Serotonin Syndrome and Duloxetine

Caution is warranted with St. John’s wort use alongside duloxetine, as it increases the risk of serotonin syndrome.
Ginkgo, ibuprofen, and glucosamine chondroitin do not pose such risks with SSRIs.

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Test your knowledge on the Central and Peripheral Nervous Systems with this quiz. It covers various interventions and concepts vital for understanding the nervous system's function. Ideal for nursing students and those studying neuroscience.