The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

suspect worsening of the anxiety disorder.

contact the provider to discuss changing to another benzodiazepine.

understand that the patient has developed tolerance to this drug.

notify the provider and discuss increasing the dose of lorazepam.

Answer and Explanation

The Correct Answer is C

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.

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Correct Answer is D

Explanation

A) Norepinephrine: Norepinephrine is a neurotransmitter primarily involved in the sympathetic nervous system. It is not involved in terminating the stimulation caused by acetylcholine. Norepinephrine acts on adrenergic receptors, whereas acetylcholine primarily acts on cholinergic receptors.
B) Decarboxylase: Decarboxylase is an enzyme that plays a role in the synthesis of certain neurotransmitters, including dopamine, but it does not have a role in terminating the action of acetylcholine at the effector cell. It is unrelated to the termination of acetylcholine signaling.
C) Catecholamine: Catecholamines (such as dopamine, norepinephrine, and epinephrine) are a group of neurotransmitters involved in the sympathetic nervous system. While they play a role in synaptic transmission, they are not responsible for breaking down acetylcholine or terminating its effects. Their primary function is in adrenergic signaling.
D) Acetylcholinesterase: Acetylcholinesterase is the correct enzyme. It is responsible for breaking down acetylcholine (ACh) in the synaptic cleft after it has stimulated the effector cell. By hydrolyzing acetylcholine into acetate and choline, acetylcholinesterase effectively terminates the signal and allows the effector cell's membrane to repolarize. This action prevents continuous stimulation and ensures proper function of the cholinergic system.

A. Myasthenia gravis (MG) B. Multiple sclerosis (MS) C. Cerebral palsy (CP) D. Parkinson disease (PD)

Correct Answer is A

Explanation

A) Myasthenia gravis (MG):
Weakness of the extremities and diplopia (double vision) are hallmark symptoms of myasthenia gravis, an autoimmune disorder that affects the neuromuscular junction. In MG, antibodies attack acetylcholine receptors, leading to muscle weakness that worsens with activity and improves with rest. The weakness typically affects voluntary muscles, including those responsible for eye movement, which leads to symptoms such as diplopia and ptosis (drooping eyelids).

B) Multiple sclerosis (MS):
Multiple sclerosis involves the demyelination of neurons in the central nervous system, leading to a variety of neurological symptoms. While MS can cause weakness and visual disturbances, the typical symptoms of MS include fatigue, muscle spasticity, ataxia, and sensory deficits. Diplopia can occur in MS but is usually accompanied by other neurological signs such as numbness, tingling, or loss of coordination.

C) Cerebral palsy (CP):
Cerebral palsy is a group of disorders affecting movement and posture due to non-progressive brain injury or abnormal brain development, often occurring in early childhood. While CP can cause muscle weakness and coordination issues, it does not typically present with diplopia. Instead, it often involves spasticity, motor impairment, and difficulty with fine motor tasks.

D) Parkinson disease (PD):
Parkinson disease is characterized by tremors, bradykinesia (slowness of movement), rigidity, and postural instability. While PD can lead to muscle weakness and visual issues like blurred vision, it is not typically associated with diplopia as a primary symptom. The hallmark motor symptoms are primarily related to tremor and difficulty initiating movements rather than generalized weakness and double vision.

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The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

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Naxlex Comprehensive Predictor Exams

After the effector cell has being stimulated by acetylcholine (ACh), what enzyme stop the stimulation and allows the effector membrane to repolarize?

Correct Answer is D

Explanation

A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition?

Correct Answer is A

Explanation

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