NCLEX Practice Exam for Pharmacology for Neurologic and Psychiatric Medications

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1. Which group of drugs mimics parasympathetic activity?

1. Cholinergic agents
2. Anticholinergic agents
3. Adrenergic agents
4. Antiadrenergic agents

2. Cholinergic agents are used to:

1. Produce miosis
2. Facilitate neuromuscular blockade
3. Synergize neuromuscular blockers
4. Facilitate tricyclic activity

3. Cholinergics are contraindicated in:

1. Tachycardia
2. Hypothyroidism
3. Hypotension
4. Asthma

4. Drugs that mimic sympathetic activity are known as:

1. Cholinergics
2. Anticholinergics
3. Adrenergics
4. Antiadrenergics

5. Which of the following metabolic effects may be a consequence of administration of adrenergic agents?

1. Hypoglycemia
2. Metabolic acidosis
3. Hyperglycemia
4. Respiratory alkalosis

6. Adrenergic blockers are contraindicated in:

1. Hypertension
2. Pheochromocytoma
3. Migraines
4. Obstructive airway disease

7. A side effect of cholinergic administration is:

1. Nausea
2. Diarrhea
3. Increase salivation
4. All of the above

8. Joseph is child diagnosed with attention deficit disorder. Which of the following drugs is commonly used for his condition?

1. methylphenidate (Ritalin)
2. diethylpropion (Nobesine)
3. phendimetrazine (Adipost)
4. caffeine

9. Amphetamines are included in the category of drugs of abuse because of their ability to:

1. Cause nervousness
2. Decrease weight
3. Raise blood pressure
4. Enhance performance

10. The nurse would monitor for decreased effect of amphetamines when these drugs are given with:

1. Caffeine
2. Antidiabetic agents
3. Tricyclic antidepressants
4. All of the above

11. As a knowledgeable nurse, you know that you should never give amphetamines in combination with:

1. Oral hypoglycemics
2. Insulin
3. MAO inhibitors
4. Antihypertensives

12. Use of methylphenidate for attention deficit disorders in children can result in:

1. Tourette’s syndrome
2. Growth suppression
3. Growth spurt
4. A and B

13. Amphetamines and amphetamine-like compounds re most commonly used for:

1. Narcolepsy
2. Attention deficit disorder
3. Exogenous obesity
4. All of the above

14. When administering IV phenytoin (Dilantin), the nurse should:

1. Administer it at a rate 100 mg/min.
2. Protect the drug from light exposure.
3. Mix the drug in dextrose solution.
4. Mix the drug in saline solution.

15. When caring for a client who is receiving phenytoin and warfarin (Coumadin), the nurse would expect which of the following drug-drug interactions?

1. Decreased effectiveness of warfarin
2. Increased effectiveness of phenytoin
3. Increased effectiveness of warfarin
4. Decreased effectiveness of phenytoin

16. The client asks the nurse why he is taking bromocriptine (Parlodel). The nurse’s reply is based in the understanding that bromocriptine mimics the effects of dopamine by:

1. Decreasing dopamine levels in the brain
2. Decreasing the storage of dopamine peripherally
3. Activating dopamine receptors in the brain
4. Inhibiting monoamine oxidase type B

17. Before administering amantadine (Symadine), the nurse should investigate which of the following client statements?

1. “My hands are always shaking.”
2. “I had to take Dilantin 6 months ago.”
3. “I take low-dose enteric aspirin each day.”
4. “Simple tasks seem to take so long to perform.”

18. The priority nursing intervention for a client receiving amantadine is to teach the client to:

1. Monitor the pulse for rate and regularity.
2. Take the last dose of medication at bedtime.
3. Inspect the skin for erythematous rash.
4. Stop taking the drug if the mouth becomes dry.

19. Which of the following assessment is most essential before beginning a drug regimen of an antimuscarinic agent?

1. Date of birth
2. Ethnic background
3. History of diabetes
4. Activity intolerance

20. The nurse evaluates that carbidopa and levodopa (Sinemet) is therapeutically effective if the client has:

1. Decreased GI responses
2. Increased tolerance to pyridoxine
3. Decreased tremors at rest
4. Increased urinary output

21. For which of the following medical conditions would the nurse anticipate that an antianxiety agent would not be indicated?

1. Seizure disorders
2. Alcohol detoxification
3. Parkinson’s disease
4. Panic disorder

22. When administering antianxiety medications to an elderly client, which of the following actions by the nurse is essential?

1. Monitor Vital signs.
2. Suggest reduced doses.
3. Taper dose before stopping.
4. Implement a fall prevention protocol.

23. When monitoring a client who is taking benzodiazepines, the nurse should be alert for which CNS side effects?

1. Blurred vision, anorexia, dysarthria
2. Seizures, tremors, diaphoresis
3. Ataxia, sedation, dizziness
4. Libido changes, edema, dystonia

24. Antidepressants generally exert influence by:

1. Increasing the reuptake of norepinephrine
2. Altering the action of the cyproprotein (MAO)
3. Changing the availability of dopamine
4. Changing the availability of select neurotransmitters

25. The nurse performs an initial assessment and nursing history with a client admitted fir a major depression. The client has a history of narrow-angle glaucoma. The nurse’s best action would be to:

1. Encourage the client to use his or her own eyedrops until the drops can be ordered.
2. Administer the TCA as orders, and expect an ophthalmology consult.
3. Administer the TCA as ordered, and monitor for visual changes.
4. Inform the physician of the client’s history before administering the TCA.

26. Antipsychotic drugs are indicated:

1. For treatment of Tourette’s syndrome.
2. For treatment of major depression.
3. As an adjunct in the management of seizures.
4. To cure psychotic disorders.

27. Sheila who has been on a low-potency antipsychotic for 2 weeks has shown minimal response. The most probable explanation is:

1. The client probably has refractory illness.
2. The client needs a stronger medication.
3. It is too early to see a full therapeutic response.
4. The client is definitely not taking the medication.

28. Ansherina who is receiving a traditional antipsychotic agent complains that she is gaining weight. The nurse would:

1. Be aware that this is probably delusional thinking because these agents cause weight loss.
2. Encourage the client to follow a healthy diet and use diet soda to help stabilize her weight.
3. Discuss a switch to a high-potency agent so the weight gain will not be a problem.
4. Establish a contract with the client to carefully follow her high-calorie diet.

29. Drugs classified as centrally acting skeletal muscle relaxants are most effective in relieving:

1. Spasm due to trauma or inflammation
2. Chronic spasm due to old injury
3. Pain from arthritis
4. Surgical complications

30. Peripherally acting skeletal muscle relaxants are used:

1. To treat neuromuscular diseases
2.  To treat spinal trauma
3. To relieve spasms from trauma
4. As adjuncts to general anesthesia

31. A nurse provides instructions to a client taking fluoxetine (Prozac) a selective serotonin reuptake inhibitors (SSRI) antidepressant. The nurse tells the client to take the medication:

1. Early in the morning.
2. During lunch time.
3. At snack time.
4. At bedtime.

32. The risk of experiencing serotonin syndrome when SSRI’s are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following?

1. Hypotension and urinary retention.
2. Muscle rigidity and high fever.
3. A productive cough and vomiting.
4. Tea-colored urine and constipation.

33. A client with depression who has been taking amitriptyline for three months returns to the clinic for a follow-up. The nurse observes the client in which of the following symptoms?

1. Suicidal thoughts.
2. Lack of energy.
3. Loss of interest in personal appearance.
4. Neglect of responsibilities.

34. A client is prescribed with sertraline (Zoloft). To guarantee a safe administration of the medication, a nurse would administer the dose:

1. As needed only for depressions.
2. Early in the morning.
3. Take on an empty stomach.
4. At bedtime.

35. A client arrives in the emergency room with a tricyclic antidepressant overdose. Which of the following measures should the nurse do, except?

1. Maintain a patent airway.
2. Administration of sodium bicarbonate.
3. Gastric lavage with activated charcoal.
4. Obtain an electrocardiogram.
5. Administration of an antipyretic.

36. A newly admit client has started taking bupropion (Wellbutrin). The nurse monitors in which of the following side effects that would indicate an overdosage of the medication?

1. Headache.
2. Dizziness.
3. Constipation.
4. Seizure.

37. A nurse is giving discharge instructions to a client who is prescribed with isocarboxazid (Marplan). The nurse will tell the client to anticipate which of the following side effects of this medication?

1. Weight loss.
2. Dry skin.
3. Dizziness.
4. Fever.

38. A client with depression is taking phenelzine (Nardil). The nurse advises the client to avoid consuming which foods while taking the medication

1. Crackers.
2. Vegetable salad.
3. Oatmeal.
4. Yogurt.

39. Patients taking MAOIs have the tendency to experience hypertensive crisis especially during an interaction with other drugs such as epinephrine. Which of the following is a sign of hypertensive crisis?

1. Orthostatic hypotension.
2. Diplopia.
3. Delay in ejaculation.
4. Hair loss.

40. During a hypertensive crisis, the nurse make sure which of this medicine is readily available?

1. Lithium citrate.
2. Diazepam.
3. Phentolamine.
4. Phenobarbital sodium.

41. A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as:

1. Normal level.
2. Toxic level.
3. Below normal level.
4. Above normal level.

42. A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent lithium toxicity:

1. Avoid becoming dehydrated during exercise.
2. Instruct the client to change positions slowly.
3. Restrict salt intake in the diet.
4. Limit fluid intake.

43. Which of the following symptoms is classified as a mild lithium toxicity:

1. Confusion and ataxia.
2. Muscle fasciculations and oliguria.
3. Tinnitus and blurred vision.
4. Apathy and Lethargy.

44. A nurse is giving instructions to a client taking risperidone (Risperdal). The nurse advise the client to which of the following?

1. Take it on an empty stomach.
2. Change position slowly.
3. Get a daily source of sunlight.
4. Discontinue medication once the symptoms went away.

45. A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines that the client is experiencing?

1. Hypertensive crisis.
2. Parkinsonism.
3. Tardive dyskinesia.
4. Neuroleptic malignant syndrome.

46. A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). A nurse assesses the results of which laboratory study to monitor for adverse effect related to this medication?

1. White blood cell.
2. Platelet count.
3. Liver function studies.
4. Random blood sugar.

47. Methylphenidate (Ritalin) is prescribed to an 8-year-old child for the treatment of attention deficit hyperactivity disorder (ADHD). The nurse will most likely monitor which of the following during the medication therapy?

1. Deep tendon reflex.
2. Intake and output.
3. Temperature and breath sound.
4. Height and weight.

48. Which of the following medications that treat Alzheimer’s disease causes slowing of the heart rate and fainting episodes?

1. Tacrine (Cognex).
2. Galantamine (Razadyne).
3. Donepezil (Aricept).
4. All of the above.

49. A client who has been taking buspirone (BuSpar) for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of?

1. Feelings of panic, fear, and uneasiness.
2. Thought broadcasting or delusions.
3. Paranoid and suicidal thought process.
4. Alcohol withdrawal symptoms.

50. A nurse is giving discharge instructions to a client who will be taking phenobarbital (Luminal). The nurse would educate the client in which of the following that directly correlates with the safety of the client?

1. Take the medication at the same time each day.
2. Take the medication with meals only.
3. Avoid using sleep aids while taking the medication.
4. Decrease the dosage once with symptoms of dizziness and lightheadedness.

Answers and Rationale

1. Answer: A. Cholinergic agents. Cholinergic drugs mimic the effects of the parasympathetic nervous system. Anticholinergic agents antagonize the parasympathetic nervous system. Adrenergic agents stimulate sympathetic nervous system. Antiadrenergic agents block the effect of the sympathetic nervous system.
2. Answer: A. Produce miosis. Miosis is a parasympathetic activity and is therefore the correct choice. B, C and D are incorrect because cholinergic agents are antidotes to neuromuscular blockers and tricyclic antidepressants.
3. Answer: D. Asthma. Bronchial asthma is a contraindication of cholinergics because administration of cholinergics will cause bronchoconstriction.
4. Answer: C. Adrenergics. Drugs that mimic the effects of sympathetic activity are known as adrenergics.
5. Answer: C. Hyperglycemia. A, B, and D are incorrect because the effects of insulin are antagonized by adrenaline or adrenergic agents.
6. Answer: D. Obstructive airway disease. Adrenergic blockers tend to cause bronchoconstriction, so are therefore contraindicated in obstructive pulmonary disease.
7. Answer: D. All of the above. Cholinergic drugs increase GI activity, causing all of these side effects.
8. Answer: A. methylphenidate (Ritalin). Methylphenidate (Ritalin) is the drug of choice for attention deficit disorder. B and C are commonly used for exogenous obesity. Caffeine is a mild CNS stimulant that is not used for attention deficit disorder.
9. Answer: D. Enhance performance. Drugs that produce a desired effect, such as feelings of euphoria and improved performance, tend to be overused and abused. Nervousness, decreased weight, and increased blood pressure are all effects of amphetamine. However, they are considered drugs of abuse because of their ability to enhance performance and produce a euphoric effect.
10. Answer: B. Antidiabetic agents. Antidiabetic agents tend to decrease the effectiveness of amphetamines. A and C increase the effects of amphetamines.
11. Answer: C. MAO inhibitors. MAO inhibitors must never be given with drugs affecting the CNS because hypertension can occur. Amphetamines can be given with oral hypoglycemics and insulin as long as blood sugar levels are monitored because these can decrease antidiabetic requirements.
12. Answer: D. A and B. Use of Ritalin does not cause a growth spurt. Instead, it can cause Tourette’s syndrome and growth suppression in children.
13. Answer: D. All of the above. The most common uses of amphetamines and amphetamine-like compounds are narcolepsy, exogenous obesity, and attention deficit disorder.
14. Answer: D. Mix the drug in saline solution. Phenytoin must be mixed in saline solution only. Phenytoin should be administered at a rate of 50 mg/min. There is no need to protect phenytoin from light because it does not destabilize with light exposure. Phenytoin will precipitate when mixed with a dextrose solution.
15. Answer: A. Decreased effectiveness of warfarin. The interaction will reduce the effectiveness of warfarin.
16. Answer: C. Activating dopamine receptors in the brain. Bromocriptine is a dopaminergic agent, and this response refers to its action. Choice A refers to the action of levodopa. Choice B refers to the action of carbidopa and levodopa. Choice D refers to the action of selegiline.
17. Answer: B. “I had to take Dilantin 6 months ago.”. Amantadine is used cautiously in clients with a history of seizures. A and D are clinical manifestations of Parkinson’s disease. Amantadine does not interact negatively with aspirin.
18. Answer: A. Monitor the pulse for rate and regularity. Dopaminergic agents can cause heart rate changes and cardiac arrhythmias. Choice B is incorrect because amantadine can cause insomnia. Choice C is incorrect because an adverse effect of amantadine is a mottled discoloration of the skin. Choice D is incorrect because dry mouth is an expected side effect and not an indication to discontinue amantadine.
19. Answer: A. Date of birth. Antimuscarinic agents are contraindicated in elderly patients.
20. Answer: C. Decreased tremors at rest. Carbidopa and levodopa help restore the balance between dopamine and acetylcholine, thereby controlling the responses of Parkinson’s disease.
21. Answer: C. Parkinson’s disease. Benzodiazepines may exacerbate the symptoms of Parkinson’s disease.
22. Answer: D. Implement a fall prevention protocol. Increased sedation, dizziness, and hypotension are side effects that place the elderly at high risk for falls. All clients need to have vital signs monitored periodically when taking these medications. Geriatric clients may require reduced doses, but the risk for falls is still present. Dose tapering is not related to age.
23. Answer: C. Ataxia, sedation, dizziness. These are common side effects. Anorexia is a GI effect. Choice B are the result of acute withdrawal. Libido and edema are not CNS-related side effects.
24. Answer: D. Changing the availability of select neurotransmitters. This choice best describes the effect of antidepressants in general.
25. Answer: D. Inform the physician of the client’s history before administering the TCA. Narrow-angle glaucoma is a contraindication for use of TCAs; therefore, the physician should be informed so that an alternative category can be used.
26. Answer: A. For treatment of Tourette’s syndrome. Haloperidol (Haldol) is used for this syndrome. Major depression is an affective disorder. When psychotic symptoms accompany depression, antipsychotics may be used to manage the symptoms. However, this choice does not address that situation. Antipsychotics are used with caution in the presence of a history of seizures. Generally, the antipsychotics decrease the seizure threshold. Antipsychotics are used to ameliorate, reduce, or manage psychotic symptoms; they do not provide a cure.
27. Answer: C. It is too early to see a full therapeutic response. The initial response may be seen 1 to 2 days after initiation of treatment, with full therapeutic response in approximately 6 to 8 weeks.
28. Answer: B. Encourage the client to follow a healthy diet and use diet soda to help stabilize her weight. These agents have a known side effect of weight gain. Managing dietary intake can assist in the management of the potentially distressing effect.
29. Answer: A. Spasm due to trauma or inflammation. Centrally acting skeletal muscle relaxants are most effective in relieving spasm due to trauma or inflammation.
30. Answer: D. As adjuncts to general anesthesia. Peripherally acting skeletal muscle relaxants are used as an adjunct to general anesthesia.
31. Answer: A. Early in the morning. Fluoxetine is used to treat major depressive disorder, bulimia nervosa  obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). It is taken early in the morning to prevent interference with sleep.
32. Answer: B. Muscle rigidity and high fever. Serotonin syndrome symptoms include high body temperature, agitation, muscle rigidity, tremor, sweating, dilated pupils, and diarrhea.
33. Answer: A. Suicidal thoughts. Clients may have thoughts about suicide when taking an antidepressant such as amitriptyline, especially clients younger than 24 years old.
    • Options B, C, and D are signs of depressions but are most likely improved as the treatment goes on.
34. Answer: D. At bedtime. Sertraline (Zoloft) is an antidepressant. It may be administered in the morning or evening, but giving it in the evening is more favored since drowsiness is one of the side effects.
35. Answer: E. Administration of an antipyretic. One of the signs and symptoms of a tricyclic antidepressant overdose is hypothermia, so an administration of an antipyretic will not help in the treatment.
    • Option A: Maintain a patent airway by providing measures such as oxygen.
    • Option B: Sodium bicarbonate resolves metabolic acidosis and cardiovascular complications.
    • Option C: Gastric lavage with activated charcoal is done for GI decontamination.
    • Option D: An ECG is done to check for dysrhythmias.
36. Answer: D. Seizure. Wellbutrin (bupropion) is an antidepressant medication used to treat major depressive disorder and seasonal affective disorder. Overdose symptoms may include seizure, muscle stiffness, hallucinations, fast or uneven heartbeat, shallow breathing, or fainting.
    • Options A, B, and C are the common side effects of the medication.
37. Answer: C. Dizziness. Isocarboxazid is a monoamine oxidase (MAO) inhibitor. Dizziness, drowsiness, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur while taking it.
    • Options A, B, and D are not side effects related to the medication.
38. Answer: D. Yogurt. Phenelzine (Nardil) is a monoamine oxidase (MAO) inhibitor. The client should avoid eating tyramine-rich foods such as chocolate, alcoholic beverages, aged cheese, yogurt, processed meats, and fruits such as raisins, avocados, bananas, or figs.
39. Answer: B. Diplopia. Monoamine Oxidase Inhibitor Toxicity symptoms include hypertension, tachycardia, diplopia, nausea, dilated pupils, palpitations, constricting chest pain and altered mental status.
    • Options A and C are a common side effect of monoamine oxidase inhibitor.
    • Option D is not a related symptoms of hypertensive crisis.
40. Answer: C. Phentolamine. In a hypertensive emergency, the first goal is to bring down the blood pressure as quickly as possible with intravenous (IV) blood pressure medications to prevent further organ damage. Phentolamine Mesylate (phentolamine mesylate) is used as an antidote for a hypertensive crisis.
    • Option A: Lithium citrate is a mood stabilizer.
    • Option C: Diazepam is a benzodiazpepines.
    • Option D: Phenobarbital sodium is a barbiturate and sedative hypnotics.
41. Answer: B. Toxic level. The therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L.
42. Answer: A. Avoid becoming dehydrated during exercise. Lithium toxicity usually occurs during chronic treatment because of reduced drug excretion (dehydration, worsening renal function, concurrent infections, and drug interactions).
    • Option B is not a related intervention to prevent lithium toxicity.
    • Options C and D: The client should maintain a fluid intake of 6-8 glasses of water a day and an adequate salt intake to prevent lithium toxicity.
43. Answer: D. Apathy and Lethargy. Mild toxicity has a lithium serum level of 1.5 mEq/L. Symptoms include apathy, lethargy, coarse hand tremors and slight muscle weakness.
    • Options A and C are classified under moderate lithium toxicity.
    • Option B is classified under severe lithium toxicity.
44. Answer: B. Change position slowly. Risperidone (Risperdal) can cause orthostatic hypotension so instruct the client to change positions slowly to avoid it.
    • Option A: The medication is taken with food or milk to decrease gastric upset.
    • Option C: Sunlight should be avoided while taking the medication.
    • Option D: The medication is to be reduced gradually to avoid sudden recurrence of psychotic symptoms.
45. Answer: C. Tardive dyskinesia. Tardive dyskinesia is characterized by uncontrollable involuntary movements of the body and extremities (especially of the face, lips, mouth, tongue, arms or legs).
    • Option A: Hypertensive crisis occurs from the use of MAOIs.
    • Option B: Parkinsonism is characterize by tremor, slow movement, impaired speech or muscle stiffness.
    • Option D: Neuroleptic malignant syndrome is a life-threatening condition caused by an adverse reaction to antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity, and autonomic dysfunction.
46. Answer: A. White blood cell. Agranulocytosis my experience by the client taking clozapine which can be monitored by evaluating the white blood cell count.
    • Options B, C, and D are not related specifically to the use of the medication.
47. Answer: D. Height and weight. Methylphenidate (Ritalin) may cause slow growth. The nurse will need to keep track of the client’s height and weight to make sure that there is a normal growth and development.
48. Answer: D. All of the above. Tacrine (Cognex), Galantamine (Razadyne), and Donepezil (Aricept) are anti-Alzheimer drugs known to provoke slower heart rates and fainting episodes.
49. Answer: A. Feelings of panic, fear, and uneasiness. Buspirone (BuSpar) is used to treat symptoms of anxiety, such as fear, tension, irritability, dizziness, pounding heartbeat, and other physical symptoms.
50. Answer: C. Avoid using sleep aids while taking the medication. Phenobarbital (Luminal) is an anticonvulsant and hypnotic drug. The client should avoid drinking alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers).
    • Option A: Taking the medication at the same time daily improves compliance and maintains more stable blood levels of the medication.
    • Option B: The medication is taken without regard to meals.
    • Option D: Decreasing the dosage is not done without the approval of the physician.