Mod 14- Antiparkinsonism Agents

Question 1

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?

Answer 1

Pyridoxine (vitamin B6)
Explanation:
A nurse should counsel clients receiving levodopa to avoid foods high in pyridoxine (vitamin B6) as it reduces the effect of levodopa.

Question 2

A nurse monitoring a client taking carbidopa/levodopa may notice which common adverse reactions? (Select all that apply.)

Answer 2

Choreiform movements
 Dry mouth
 Anorexia
  Explanation:
The most common adverse reactions associated with carbidopa/levodopa include anorexia, nausea, vomiting, abdominal pain, dysphagia, dry mouth, mental changes, headache, dizziness, increased hand tremor, choreiform and dystonic movements.

Question 3

Which action would be a priority for a client receiving apomorphine?

Answer 3

Monitoring cardiac status
Explanation:
Apomorphine is associated with a risk for hypotension and a prolonged QT interval. Therefore, the priority would be to monitor the client’s cardiac status closely.

Question 4

A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson’s disease. The nurse would expect to administer this drug by which route?

Answer 4

Oral

Question 5

A client diagnosed with Parkinson’s disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death?

Answer 5

St. John’s wort
Explanation:
Rasagiline administered with the herbal supplement St. John’s wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death

Question 6

A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient?

Answer 6

Administer the next drug dose with meals.

Question 7

A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson’s disease with success. Why would his health care provider consider discontinuing the amantadine?

Answer 7

With amantadine, excretion is primarily via the kidneys.
Explanation:
With amantadine, excretion is primarily via the kidneys, and the drug should be used with caution in clients with renal failure.

Question 8

A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient?

Answer 8

Confusion and disorientation
Explanation:
The nurse should assess for confusion and disorientation when caring for this elderly patient undergoing anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases.

Question 9

Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of _______, which is a dopaminergic drug.

Answer 9

levodopa

Question 10

What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy?

Answer 10

Blurred vision
Explanation:
Blurred vision is considered a peripheral anticholinergic effect

Question 11

A female client is diagnosed with Parkinson’s disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose?

Answer 11

To improve motor performance and improve ability to participate in usual activities of daily living

Question 12

A female client is prescribed centrally acting anticholinergics for her Parkinson’s disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter’s request?

Answer 12

Evaluate the client for adverse reactions from the centrally acting anticholinergics
Explanation:
When centrally active anticholinergics are given for Parkinson’s disease, agitation, mental confusion, hallucinations, and psychosis may occur.

Question 13

A client who diagnosed with Parkinson’s disease is being treated with levodopa/carbidopa. Which disorder will result in the discontinuation of this drug based on a disease-related contraindication?

Answer 13

Narrow-angle glaucoma
Explanation:
Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma

Question 14

One of the neurotransmitters can become decreased in the area of the corpus striatum. This results in the manifestations of Parkinson’s disease. Which neurotransmitter will cause this?

Answer 14

dopamine

Question 15

A nurse is reviewing a client’s history for conditions that would contraindicate the use of anticholinergics for Parkinson’s disease. Which would cause the nurse to be concerned?

Answer 15

Myasthenia gravis
Explanation:
Anticholinergics are contraindicated for clients with myasthenia gravis, which could be exacerbated by the blocking of acetylcholine receptor sites at the neuromuscular synapses.

Question 16

Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:

Answer 16

decrease salivation, spasticity, and tremors.

Question 17

A nurse has been invited to speak to a support group for Parkinson’s disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies?

Answer 17

“Drugs do not cure these disorders; they instead enhance quality of life.”

Question 18

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson’s disease. The nurse knows that this drug may place the patient at increased risk for:

Answer 18

falls
Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls

Question 19

The nurse should be cautious and closely monitor clients receiving carbidopa/levodopa (Sinemet) with which medical conditions? (Select all that apply.)

Answer 19

Renal disease
Asthma
Peptic ulcer disease

Question 20

A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following?

Answer 20

Central nervous system

Question 21

A client who has been receiving long-term levodopa therapy tells the nurse, “I was making good progress and then it was like the drug stopped working.” The nurse interprets this as which of the following?

Answer 21

On-off phenomenon
Explanation:
The on-off phenomenon may occur in clients taking levodopa. In this condition, the client may suddenly alternate between improved clinical status and loss of therapeutic effect

Question 22

An older adult client diagnosed with Parkinson’s disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention?

Answer 22

Assess renal function
Explanation:
It is necessary to administer this medication therapy with caution in clients with severe renal impairment.

Question 23

A nurse is caring for a patient who requires antiparkinsonism drugs. What should the nurse confirm to ensure that the use of COMT inhibitors is not contraindicated in this patient?

Answer 23

The patient is not lactating.
Explanation:
The nurse should confirm that the patient is not pregnant, lactating, or that the patient does not have a hypersensitivity to the drug to ensure that the use of COMT inhibitors is not contraindicated in the patient.

Question 24

A nurse is caring for a client who is prescribed biperiden as treatment of drug-induced extrapyramidal symptoms. After administering the drug, the nurse would assess the client for which of the following?

Answer 24

Skin rash
Dry mouth
Explanation:
The nurse should monitor for skin rashes in a client who is receiving biperiden, a cholinergic blocking drug. Other adverse reactions include dry mouth, blurred vision, dizziness, mild nausea, nervousness, urticaria (hives), urinary retention, dysuria, tachycardia, muscle weakness, disorientation, and confusion

Question 25

A nurse is educating a client who has Parkinson’s disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?

Answer 25

involuntary movements.
Explanation:
Abnormal and involuntary movements are among the most common and serious adverse effects of carbidopa-levodopa therapy.

Question 26

The nurse is caring for a client who has been diagnosed with both Parkinson’s disease and narrow-angle glaucoma. What medication should cause the nurse concern?

Answer 26

levodopa
Explanation:
Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma.

Question 27

A client diagnosed with Parkinson’s disease is being treated with tolcapone. When reviewing the client’s medication history, the nurse should confirm that the client is concurrently taking what other drug?

Answer 27

levodopa/carbidopa
Explanation:
It is necessary to administer tolcapone in conjunction with levodopa/carbidopa and to monitor the client’s response to the medication.

Question 28

A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents?

Answer 28

Carbidopa
Explanation:
Carbidopa (Lodosyn) is classified as a dopaminergic agent that treats parkinsonism by supplementing the amount of dopamine in the brain.

Question 29

A registered nurse who oversees the care in a large long-term care facility cares for several clients with Parkinson’s disease. When reviewing the assessment findings from the practical nurses at the facility, what finding should the RN prioritize for follow-up?

Answer 29

A client who began taking a dopaminergic three days ago and who is uncharacteristically disoriented.
Explanation:
A client’s acute change in cognition would be a priority for the nurse since it could indicate serious adverse effects or a time-dependent need to change the drug regimen.