ATI RN
Central Nervous System Stimulants and Related Drugs NCLEX Style Questions Questions
Question 1 of 5
A 59-year-old man with Parkinson's disease begins a course of bromocriptine in hopes of improving his significant symptoms of cogwheel rigidity and bradykinesia. After being on the medication for 6 months, a renal ultrasound is obtained that reveals bilateral hydronephrosis and elevation of his serum creatinine to 2.5 mg/dL. What is the most likely explanation for these findings?
Correct Answer: C
Rationale: In this case, the correct answer is C) Retroperitoneal fibrosis. Bromocriptine, a dopamine agonist used in Parkinson's disease, has been associated with rare cases of retroperitoneal fibrosis. Retroperitoneal fibrosis can lead to ureteral obstruction, resulting in hydronephrosis and subsequent elevation of serum creatinine levels due to impaired kidney function. Option A) Drug toxicity is less likely as the symptoms presented are more indicative of a structural issue rather than a generalized toxic effect of the drug. Option B) Renal artery stenosis would typically present with hypertension and possibly a bruit on physical examination, which are not mentioned in the case scenario. Option D) Renal vein thrombosis is less likely in this case as it usually presents with flank pain, hematuria, and a history of hypercoagulable states, which are absent in this patient. Educationally, this question highlights the importance of recognizing rare but serious side effects of medications, emphasizing the need for close monitoring and awareness of potential complications associated with specific drug classes. Understanding these associations is crucial for healthcare providers to provide safe and effective care for patients with various conditions.
Question 2 of 5
A 34-year-old woman with chronic irritable bowel syndrome with predominance of diarrhea and left lower quadrant pain begins smoking in response to the numerous stresses in her personal and professional life. She smokes one pack per day. She presents to her primary care physician for treatment of her irritable bowel syndrome. The physician expects a change in which of the following symptoms of her irritable bowel syndrome?
Correct Answer: A
Rationale: In this scenario, the correct answer is A) Diarrhea. Smoking can exacerbate symptoms of irritable bowel syndrome (IBS) with diarrhea due to nicotine's stimulant effect on the gastrointestinal system. Nicotine can increase gut motility, leading to more frequent bowel movements and worsening diarrhea in individuals with IBS. Option B) Muscle aches is incorrect as smoking is not directly related to muscle aches in the context of IBS. Option C) Right lower quadrant pain and D) Right upper quadrant pain are also incorrect as they are not typically associated with IBS symptoms, especially in relation to smoking. From an educational perspective, understanding the impact of smoking on gastrointestinal health is crucial for healthcare providers treating patients with IBS. Educating patients about the detrimental effects of smoking on IBS symptoms can help them make informed decisions about their health. It is important for healthcare professionals to stay updated on the latest research and evidence regarding lifestyle factors, such as smoking, that can influence gastrointestinal conditions like IBS.
Question 3 of 5
A 57-year-old man with a seizure disorder takes anti-epileptic medications. His physician would like to use a medicine that is metabolized only by the CYP1A2 receptor. Which of the following agents would be preferred?
Correct Answer: C
Rationale: In this scenario, the preferred agent for the 57-year-old man with a seizure disorder who takes anti-epileptic medications and needs a drug metabolized only by the CYP1A2 receptor is Felbamate (Option C). Felbamate is the preferred choice because it is primarily metabolized by the CYP1A2 enzyme, ensuring minimal drug interactions and optimal therapeutic effect in this patient population. Carbamazepine (Option A) is metabolized by CYP3A4 and CYP2C19 enzymes, not CYP1A2. Divalproex (Option B) is metabolized by various enzymes including CYP2C9 and CYP2C19, not CYP1A2. Phenobarbital (Option D) is mainly metabolized by CYP2C19 and CYP2C9, not CYP1A2. Educationally, understanding the metabolic pathways of drugs is crucial for healthcare professionals to make informed decisions about drug selection, dosing, and potential drug interactions in patients. This knowledge helps in providing safe and effective care to patients with complex medical conditions like seizure disorders. It also highlights the importance of individualized treatment plans based on the patient's unique characteristics to optimize therapeutic outcomes and minimize adverse effects.
Question 4 of 5
A 44-year-old man with schizophrenia is being treated with a low-potency typical antipsychotic. He complains that his medication's side effects are more than he can handle and wants to try another medication. If he was to switch from a low-potency to a high-potency antipsychotic drug, which of the following side effects would likely diminish?
Correct Answer: A
Rationale: In this scenario, the correct answer is A) Anticholinergic effects. Low-potency typical antipsychotics, such as chlorpromazine, are more likely to cause side effects like anticholinergic effects due to their stronger anticholinergic properties. These side effects include dry mouth, constipation, blurred vision, and urinary retention. High-potency antipsychotics, like haloperidol, have a lower affinity for muscarinic receptors, leading to fewer anticholinergic side effects. Option B) Parkinsonism is more commonly associated with high-potency antipsychotics due to their higher propensity to block dopamine receptors. Perioral tremor (Option C) can be a side effect of both low and high-potency antipsychotics but is not specifically linked to potency. Tardive dyskinesia (Option D) is a serious side effect associated with long-term use of antipsychotic medications, more commonly seen with typical antipsychotics and less likely to diminish by switching from low to high-potency medications. Educationally, this question highlights the importance of understanding the differences in side effect profiles between low and high-potency antipsychotic medications when managing patients with schizophrenia. It emphasizes the need for healthcare providers to consider individual patient responses to medications and tailor treatment plans to minimize side effects and improve overall patient outcomes.
Question 5 of 5
A 72-year-old man is brought to his physician by his son. The son complains that this patient has been becoming forgetful, confused, moody, and aggressive over the past few months. One drug that may be used to treat this patient's symptoms is donepezil. Which of the following describes an effect of donepezil?
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.