1. Which group of drugs mimics parasympathetic activity?

A. Cholinergic agents
B. Anticholinergic agents
C. Adrenergic agents
D. Antiadrenergic agents

2. Cholinergic agents are used to:

A. Produce miosis
B. Facilitate neuromuscular blockade
C. Synergize neuromuscular blockers
D. Facilitate tricyclic activity

3. Cholinergics are contraindicated in:

A. Tachycardia
B. Hypothyroidism
C. Hypotension
D. Asthma

4. Drugs that mimic sympathetic activity are known as:

A. Cholinergics
B. Anticholinergics
C. Adrenergics
D. Antiadrenergics

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

adrenergic agents?

A. Hypoglycemia
B. Metabolic acidosis
C. Hyperglycemia
D. Respiratory alkalosis

6. Adrenergic blockers are contraindicated in:

A. Hypertension
B. Pheochromocytoma
C. Migraines
D. Obstructive airway disease

7. A side effect of cholinergic administration is:

A. Nausea
B. Diarrhea
C. Increase salivation
D. All of the above

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

A. methylphenidate (Ritalin)
B. diethylpropion (Nobesine)
C. phendimetrazine (Adipost)
D. caffeine

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

A. Cause nervousness
B. Decrease weight
C. Raise blood pressure
D. Enhance performance

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

A. Caffeine
B. Antidiabetic agents
C. Tricyclic antidepressants
D. All of the above

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

A. Oral hypoglycemics
B. Insulin
C. MAO inhibitors
D. Antihypertensives

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

A. Tourette’s syndrome
B. Growth suppression
C. Growth spurt
D. A and B

13. Amphetamines and amphetamine-like compounds are most commonly used for:
A. Narcolepsy
B. Attention deficit disorder
C. Exogenous obesity
D. All of the above

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

A. Administer it at a rate 100 mg/min.

B. Protect the drug from light exposure.
C. Mix the drug in dextrose solution.
D. 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?

A. Decreased effectiveness of warfarin

B. Increased effectiveness of phenytoin
C. Increased effectiveness of warfarin
D. 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:

A. Decreasing dopamine levels in the brain

B. Decreasing the storage of dopamine peripherally
C. Activating dopamine receptors in the brain
D. Inhibiting monoamine oxidase type B

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

A. “My hands are always shaking.”

B. “I had to take Dilantin 6 months ago.”
C. “I take low-dose enteric aspirin each day.”
D. “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:

A. Monitor the pulse for rate and regularity.

B. Take the last dose of medication at bedtime.
C. Inspect the skin for erythematous rash.
D. 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?
A. Date of birth
B. Ethnic background
C. History of diabetes
D. Activity intolerance

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

A. Decreased GI responses
B. Increased tolerance to pyridoxine
C. Decreased tremors at rest
D. Increased urinary output

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

A. Seizure disorders
B. Alcohol detoxification
C. Parkinson’s disease
D. Panic disorder

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

A. Monitor Vital signs.

B. Suggest reduced doses.
C. Taper dose before stopping.
D. Implement a fall prevention protocol.

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

A. Blurred vision, anorexia, dysarthria

B. Seizures, tremors, diaphoresis
C. Ataxia, sedation, dizziness
D. Libido changes, edema, dystonia

24. Antidepressants generally exert influence by:

A. Increasing the reuptake of norepinephrine

B. Altering the action of the cyproprotein (MAO)
C. Changing the availability of dopamine
D. 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:

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

26. Antipsychotic drugs are indicated:

A. For treatment of Tourette’s syndrome.

B. For treatment of major depression.
C. As an adjunct in the management of seizures.
D. 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:

A. The client probably has refractory illness.

B. The client needs a stronger medication.
C. It is too early to see a full therapeutic response.
D. 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:

A. Be aware that this is probably delusional thinking because these agents cause weight loss.
B. Encourage the client to follow a healthy diet and use diet soda to help stabilize her weight.
C. Discuss a switch to a high-potency agent so the weight gain will not be a problem.
D. 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:

A. Spasm due to trauma or inflammation

B. Chronic spasm due to old injury
C. Pain from arthritis
D. Surgical complications

30. Peripherally acting skeletal muscle relaxants are used:

A. To treat neuromuscular diseases

B. To treat spinal trauma
C. To relieve spasms from trauma
D. As adjuncts to general anesthesia
Answers and Rationale

Here are the answers for this exam. Gauge your performance by counter checking your answers
to those below. If you have any disputes or clarifications, please direct them to the comments
section.

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.