Unit 5: Chapter 24 (Karch 7th Ed) - Antiparkinsonism Agents

Question 1

1. Degeneration in neurons that release a neurotransmitter leads to Parkinson’s disease. What
neurotransmitter is involved?
A) Gamma-aminobutyric acid (GABA)
B) Acetylcholine
C) Dopamine
D) Serotonin

Answer 1

Ans: C
Feedback:
Degeneration of dopamine-releasing neurons in the substantia nigra leads to Parkinson’s disease. When
dopamine is decreased in the area of the corpus striatum, a chemical imbalance allows the cholinergic
or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and
cerebellar components of the extrapyramidal motor system. This system provides coordination for
unconscious muscle movements, including those that control position, posture, and movement. The
result of the imbalance produces the signs and symptoms of Parkinson’s disease. The corpus striatum in
the brain is connected to the substantia nigra by a series of neurons that use the inhibitory
neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of
the corpus striatum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is
not involved in these functions.

Question 2

2. A 10-year-old boy has been prescribed an antiparkinsonian drug. Which drug would the nurse expect as
the first choice for this child?
A) Benztropine (Cogentin)
B) Diphenhydramine (Benadryl)
C) Trihexyphenidyl (Artane)
D) Procyclidine (Kemadrin)

Answer 2

Ans: B
Feedback:
Parkinson’s disease is rare in children. However, if a child needs an antiparkinsonian drug, diphenhydramine is the drug of choice. Benztropine, trihexyphenidyl, and procyclidine are not
recommended for use in children.

Question 3

3. A patient is newly diagnosed with Parkinson’s disease. An anticholinergic drug is ordered for the
   patient. When reviewing the patient’s medical history, the nurse realizes an anticholinergic drug is
   contraindicated for this patient because of what secondary diagnosis? (Select all that apply.)
   A) Benign prostatic hypertrophy
   B) Narrow-angle glaucoma
   C) Myasthenia gravis
   D) Dysrhythmias
   E) Hepatic dysfunction

Answer 3

Ans: A, B, C
Feedback:
Anticholinergics are contraindicated in the presence of narrow-angle glaucoma, GI obstruction,
genitourinary (GU) obstruction, and prostatic hypertrophy, all of which could be exacerbated by the
peripheral anticholinergic effects of these drugs, and in myasthenia gravis, which could be exacerbated
by the blocking of acetylcholine-receptor sites at the neuromuscular synapses. These agents should be
administered cautiously, but they are not contraindicated in therapy for the following conditions:
tachycardia and other dysrhythmias and hypertension or hypotension because the blocking of the
parasympathetic system may cause a dominance of sympathetic stimulatory activity, and in hepatic
dysfunction, which could interfere with the metabolism of the drugs and lead to toxic levels.

Question 4

4. A patient is newly diagnosed with Parkinson’s disease and levodopa (Dopar) has been prescribed. What
   patient teaching information should be considered a high priority for this patient?
   A) Avoid vitamin B6 intake.
   B) Avoid hot environments.
   C) Many adverse effects will subside when the body adjusts to the drug.
   D) Allow rest periods.

Answer 4

Ans: A
Feedback:
The priority information would be to avoid vitamin B6 intake, which would include grains and bran. Vitamin B6 speeds the conversion of levodopa to dopamine before it can cross the blood brain barrier.
This leads to Parkinson’s symptoms. The other options are all important and should be discussed with
the patient. However, sweating, headaches, difficulty sleeping, fatigue, weakness, and dizziness are
expected adverse effects, which will eventually subside or decrease.

Question 5

5. A patient with Parkinsonism has been told that the levodopa prescribed is no longer controlling the
   disease. What drug would the nurse question if ordered as adjunctive therapy?
   A) Diphenhydramine (Benadryl)
   B) Pramipexole (Mirapex)
   C) Trihexyphenidyl (Artane)
   D)
   Vitamin B6

Answer 5

Ans: D
Feedback:
Vitamin B6 would further decrease the therapeutic effects of levodopa and is contraindicated with
levodopa, so the nurse would question this order. Pramipexole, diphenhydramine, and trihexyphenidyl
are all useful adjunctive drugs when Parkinson’s disease is no longer controlled with levodopa therapy
alone.

Question 6

6. The nurse provides patient teaching about use of levodopa for treatment of Parkinson’s disease. What
   statement by the patient would indicate a good understanding of levodopa?
   A) I will take the medication for about a year and then stop.
   B) I should avoid exercising while taking this drug.
   C) I should take this drug with meals to avoid GI upset.
   D) I will take megavitamins to ensure that I have good nutrition.

Answer 6

Ans: C
Feedback:
The patient should be instructed to take levodopa with meals if GI upset occurs. Patients being treated
for Parkinson’s disease should be taught that drug treatment will be needed for life and cannot be
stopped in a year. The patient should continue to be as active as possible. Multivitamins will contain
vitamin B6, which should be avoided when taking levodopa.

Question 7

7. What drug does the nurse administer to treat Parkinson’s disease that is also classified as an antiviral?
A) Amantadine (Symmetrel)
B) Entacapone (Comtan)
C) Diphenhydramine (Benadryl)
D) Ropinirole (Requip)

Answer 7

Ans: A
Feedback:
Amantadine is an antiviral drug that increases the release of dopamine and is effective in Parkinson’s
disease so long as there is a possibility of more dopamine release. Ropinirole is a dopaminergic
antiparkinsonism drugs. Entacapone is used as adjunctive treatment of idiopathic Parkinson’s disease
with levodopa carbidopa for patients who are experiencing wearing off of drug effects.
Diphenhydramine is used, particularly in children, to treat parkinsonism and is also classified as an
antihistamine.

Question 8

8. A patient has Parkinson’s disease. Apomorphine (Apokyn), a dopamine agonist, has been prescribed
   for periods of hypomobility. What will the nurse teach the patient regarding administration of the drug?
   A) The drug will be injected intramuscularly three times a day in a range of 1.0 to 1.5 mL.
   B) The drug will be given intravenously, 50 mg every third day.
   C) The drug will be administered subcutaneously three times a day with a dosage range of 2 to 6 mg.
   D) The drug is taken orally, 20 mg three times a day.

Answer 8

Ans: C
Feedback:
The drug is administered subcutaneously three times a day in a range of 2 to 6 mg per dose. A dosing
pen is available for patient use. The other options are inappropriate for this drug.

Question 9

9. An order is written for a drug that is an adjunctive therapy for Parkinson’s disease. The nurse reviews
   the order before administering the drug. What medication orders should the nurse question?
   A) Levodopa 0.5 to 1 g/d orally in 2 divided doses
   B) Amantadine (Symmetrel) 200 mg orally b.i.d.
   C) Tolcapone (Tasmar) 400 mg orally t.i.d.
   D) Selegiline (Carbex) 10 mg/d orally

Answer 9

Ans: C
Feedback:
The order for tolcapone should be questioned. The maximum dose is 600 mg daily. The order is a total
of 1,200 mg a day (400 times 3 equals 1,200 mg). The other options are correct dosages.

Question 10

10. The expected outcome for a patient taking benztropine as drug therapy for Parkinson’s disease would
be what?
A) Decrease in rigidity
B) Decrease in light-headedness
C) Decrease in disorientation
D) Decrease in flushing

Answer 10

Ans: A
Feedback:
Benztropine should cause a decrease in rigidity. Light-headedness, disorientation, and flushing are all
adverse effects of benztropine and can be expected with a patient taking this drug

Question 11

11. A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with
    long-term use of antipsychotics, can be treated with what drug type?
    A) Anticholinergic agents
    B) Monoamine oxidase inhibitors (MAOIs)
    C) Synthetic antiviral agents
    D) Dopaminergic drugs

Answer 11

Ans: A
Feedback: Anticholinergic drugs that are centrally active are useful in treating parkinsonism. MAOIs, synthetic
antiviral agents, and dopaminergic agents are incorrect.

Question 12

12. The nurse is presenting an educational event to a local community group on Parkinson’s disease. What
    will the nurse tell the attendees causes the classic Parkinson’s disease symptoms?
    A) Decreased enzyme aromatic l-amino acid decarboxylase (AADC)
    B) Increased gamma-aminobutyric acid (GABA)
    C) Brain lesions
    D) Degeneration of dopamine-producing nerve cells

Answer 12

Ans: D
Feedback:
Classic Parkinson’s disease results from destruction or degenerative changes in dopamine-producing
nerve cells in an area of the brain that controls movement.

Question 13

13. The nurse has a patient who is receiving selegiline (Carbex, Eldepryl). What is the nurse’s priority
assessment?
A) Irregular heart rate
B) Elevated blood pressure
C) Decreased urinary output
D) Gingival hyperplasia

Answer 13

Ans: B
Feedback:
The excessive stimulation of the sympathetic nervous system can cause severe hypertension and stroke
so it is important for the nurse to assess blood pressure. Gingival hyperplasia is an adverse effect of
phenytoin (Dilantin). Irregular heart rate and decreased urinary output are not adverse effects of
selegiline

Question 14

14. The nurse is speaking to a group at the senior citizen’s center about Parkinson’s disease and explains
    the importance of avoiding what when taking an anticholinergic medication?
    A) Strenuous exercise in high environmental temperatures
    B) Fluids high in potassium
    C) Foods high in vitamin K
    D) Anything containing red dye

Answer 14

Ans: A
Feedback:
Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal
temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do
not need to avoid fluids high in potassium, foods high in vitamin K, or anything containing red dye.

Question 15

15. When providing patient teaching for older adults, the nurse employs what priority strategy to improve
patient understanding?
A) Repetition
B) Meticulous detail
C) Extensive written teaching
D) Family involvement

Answer 15

Ans: C
Feedback:
The drugs that are used to manage Parkinson’s disease are associated with many adverse effects in
older people with long-term problems. In many cases, other pharmacotherapeutic agents are given to
counteract the adverse effects of these drugs. So patients then have complicated drug regimens with
many associated adverse effects and problems. Consequently, it is essential for these patients to have
extensive written drug-teaching protocols. Repetition, attention to detail, and family involvement can
further improve effectiveness of teaching, but providing written instructions is the highest priority
strategy.

Question 16

16. A patient, newly diagnosed with Parkinson’s disease, has been prescribed an anticholinergic drug.
    What common adverse effect of anticholinergic agents used for the treatment of Parkinson’s disease
    will the nurse share with the patient?
    A) Blood dyscrasias
    B) Diaphoresis
    C) Memory loss
    D) Diarrhea

Answer 16

Ans: C
Feedback:
Most people diagnosed with Parkinson’s disease are older adult men so it is important for the nurse to
warn the patient that memory loss may occur to reduce anxiety the patient may experience with this
adverse effect. Blood dyscrasias are not associated with these drugs. Constipation is more likely than
diarrhea and lack of sweating rather than diaphoresis is associated with anticholinergics.

Question 17

17. The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed
    to reach a therapeutic level in the brain, thereby reducing adverse effects? What is the name of this
    drug?
    A) Bromocriptine
    B) Carbidopa
    C) Amantadine
    D) Trihexyphenidyl

Answer 17

Ans: B
Feedback:
Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or
Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery,
diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues,
thereby leading to higher levels crossing the blood brain barrier. Because carbidopa decreases the
amount of levodopa needed to reach a therapeutic level in the brain, the dosage of levodopa can be
decreased, which reduces the incidence of adverse effects. Bromocriptine, amantadine, and
trihexyphenidyl may be effective longer than levodopa but are not usually prescribed together.

Question 18

18. When the nurse develops a plan of care for a patient newly diagnosed with Parkinson’s disease, the
    nurse includes what appropriate goal for this patient?
    A) Deficient knowledge related to the disease process
    B) Increase compliance with drug regimen as evidenced by no missed dosages within 1 week of
    discharge
    C) Risk for injuries related to the disease process
    D) Symptom improvement as demonstrated by ability to ambulate the length of the hall within 24
    hours of starting medication

Answer 18

Ans: D
Feedback:
One goal of drug therapy is to reduce symptoms to allow for more normal movement involving
muscles. Goals should be specific and measurable, so the ability to ambulate the length of the hall is a
valid assessment. The patient cannot increase compliance when he or she has not been lacking in
compliance because this is a new diagnosis. Deficient knowledge and risk for injury are nursing
diagnoses and not goals.

Question 19

19. The nurse is teaching a new patient about levodopa (L-dopa). What is important to instruct the patient
to avoid using concurrently with L-dopa?
A) Aspirin compounds
B) Multivitamin-mineral preparations
C) Alcohol
D) Antianginal agents

Answer 19

Ans: B
Feedback:
Iron preparations and multivitamin mineral preparations containing iron should not be given with Ldopa.
Aspirin compounds, alcohol, and antianginal agents are not contraindicated in concurrent therapy
with L-dopa.

Question 20

20. When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa must be reduced. What would
    the reduction of L-dopa cause?
    A) Heightened levels of sedation
    B) Prolonged effect of medications
    C) Decreased adverse effects
    D) Decreased effectiveness of symptom control

Answer 20

Ans: C
Feedback:
Because carbidopa decreases the amount of L-dopa needed to reach a therapeutic level in the brain, the
dosage of L-dopa can be decreased, which reduces the incidence of adverse effects. Other options are
incorrect.

Question 21

21. What is the main purpose of the drugs used to treat Parkinson’s disease?
    A) Adjust the balance of neurotransmitters.
    B) Make the catechol-O-methyltransferase (COMT) inhibitors work better.
    C) Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists.
    D) Increase the actions of acetylcholine in the brain.

Answer 21

Ans: A
Feedback:
Drugs used in Parkinson’s disease increase levels of dopamine (levodopa, dopamine agonists,
monoamine oxidase [MAO] inhibitors, COMT inhibitors) or inhibit the actions of acetylcholine (i.e.,
anticholinergic agents) in the brain. Thus, the drugs help adjust the balance of neurotransmitters

Question 22

22. The nurse is teaching a group of student nurses about Parkinson’s disease. The nurse would determine
    teaching was successful if the students identified what neurotransmitters as imbalanced in Parkinson’s
    disease?
    A) Cholinergic and anticholinergic neurotransmitters
    B) Gamma-aminobutyric acid (GABA) and dopamine
    C) GABA and anticholinergic neurotransmitters
    D) Dopamine and acetylcholine

Answer 22

Ans: D
Feedback:
The correct balance of dopamine and acetylcholine is important in regulating posture, muscle tone, and
voluntary movement. People with Parkinson’s disease have an imbalance in these neurotransmitters,
resulting in a decrease in inhibitory brain dopamine and a relative increase in excitatory acetylcholine.

Question 23

23. The nurse is caring for a patient diagnosed with Parkinson’s disease who has been prescribed an
    anticholinergic drug. When are anticholinergic drugs usually added to the therapeutic regimen?
    A) When symptoms increase
    B) Sporadically to reduce development of toleration to levodopa
    C) When levodopa does not elicit a therapeutic response
    D) During the end stage of the disease process

Answer 23

Ans: C
Feedback:
Although anticholinergics are not as effective as levodopa in the treatment of advancing cases of the
disease, they may be useful as adjunctive therapies and for patients who no longer respond to levodopa.
They are not withheld until symptoms advance or end-stage symptoms occur and they are not given
sporadically.

Question 24

24. 2 Drugs in Focus Anticholinergic Agents
    A) Combines with anticholinergic receptors to increase the action of levodopa
    B) Stimulates postsynaptic dopamine receptors directly
    C) Combines with anticholinergic receptors to increase dopamine action
    D) Inhibits postsynaptic dopamine receptors directly

Answer 24

Ans: B
Feedback:
Ropinirole is a newer drug that directly stimulates dopamine receptors. It is also used to treat restless
legs syndrome. The other options are incorrect because ropinirole only works as a dopamine receptor
stimulant.

Question 25

25. A home health nurse is visiting an elderly patient with Parkinson’s disease. What would the nurse
    assess this man for related to common adverse effects?
    A) Blood dyscrasias
    B) Increased dopamine activity
    C) Pliability
    D) Urinary retention

Answer 25

Ans: D
Feedback:
The nurse would assess the patient for urinary retention because this reaction is caused by loss of
muscle tone in the bladder and is most likely to occur in elderly men who have enlarged prostate
glands. Parkinson’s does not generally cause blood dyscrasias. The nurse cannot assess for increased
dopamine activity except to assess for reduced symptoms caused by medication therapy. Pliability is a
distracter for this question.

Question 26

26. What patient is most likely to be diagnosed with Parkinson’s disease?
A) A 45-year-old woman
B) A 35-year-old man
C) A 55-year-old person of either gender
D) A 60-year-old man

Answer 26

Ans: D
Feedback:
Although Parkinson’s disease may affect people of any age, gender, or nationality, the frequency of the
disease increases with age. This debilitating condition, which affects men more often than women, may
be one of many chronic problems associated with aging.

Question 27

27. The nurse is teaching a patient about antiparkinson drugs. What drug would the nurse expect to be
    prescribed for the patient experiencing wearing off of drug effects?
    A) Pramipexole
    B) Entacapone
    C) Ropinirole
    D) Amantadine

Answer 27

Ans: B
Feedback:
Entacapone is an adjunctive drug that is prescribed when a patient with Parkinson’s disease has a
wearing off effect of his or her other Parkinson’s medications, meaning the drugs previously prescribed
are having less of an effect. Therefore, options A, C, and D are incorrect.

Question 28

28. While providing patient education for a patient newly diagnosed with Parkinson’s disease and his or
    her family, the nurse will explain that Parkinson’s disease is characterized by what?
    A) Reduced cognitive function
    B) Abnormalities in stature
    C) Postural instability
    D) Reduced nerve transmission

Answer 28

Ans: C
Feedback:
Parkinson’s disease is a chronic, progressive, and degenerative disorder of the central nervous system
(CNS) characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and
muscular rigidity, postural instability).

Question 29

29. The nurse is assessing a patient who was prescribed levodopa 1 week earlier. How might the nurse
    evaluate the effectiveness of drug therapy?
    A) Stable mood
    B) Psoriasis
    C) Drug drug interactions with dopaminergic agents
    D) Improvement in handwriting

Answer 29

Ans: D
Feedback:
The nurse would evaluate the patient for improvement in function and reduction in symptoms. With
preparations containing levodopa and with dopaminergic agents, assess for improvement in mobility,
balance, posture, gait, speech, handwriting, and ability to provide self-care. Drooling and seborrhea
may be abolished, and mood may be elevated. Stable mood and psoriasis are not findings associated with Parkinson’s disease. Assessing for drug drug interactions is an important nursing assessment but it
is not related to evaluating effectiveness of the drug.

Question 30

30. When describing Parkinson’s disease to a patient with a new diagnosis, what statement made by the
    nurse would be accurate?
    A) Parkinson’s disease can be cured if medication is taken regularly as prescribed.
    B) Degeneration of the neurons is arrested by medication.
    C) Surgical procedures involving the basal ganglia have had varying degrees of success.
    D) Diet-related therapy is the primary treatment for managing Parkinson’s disease.

Answer 30

Ans: C
Feedback:
Surgical procedures involving the basal ganglia have been tried with varying success at prolonging the
physical degeneration caused by this disease. Drug therapy remains the primary treatment. At this time,
no available treatment arrests the neuron degeneration of Parkinson’s disease and the eventual decline
in patient function.

Question 31

31. What is the primary reason a nurse might administer an antiparkinsonism drug to a child?
A) New-onset Parkinson’s disease
B) Drug abuse
C) Fibromyalgia
D) Parkinsonian symptoms

Answer 31

Ans: D
Feedback:
The incidence of Parkinson’s disease in children is very low. Children do, however, experience
parkinsonian symptoms as a result of drug adverse effects, not of drug abuse. Fibromyalgia is not
usually diagnosed in children either.

Question 32

32. The nurse is caring for a patient who is unable to swallow properly. What drug would the nurse expect
to be prescribed?
A) Apomorphine (Apokyn)
B) Bromocriptine (Parlodel)
C) Levodopa (Dopar)
D) Ropinirole (Requip)

Answer 32

Ans: A
Feedback:
Only apomorphine can be given parenterally so this would be an appropriate drug to give to a patient
with difficulty swallowing. Bromocriptine, levodopa, and ropinirole are only given in oral
formulations

Question 33

33. How does the drug levodopa contrast with dopamine? (Select all that apply.)
    A) Levodopa is a precursor of dopamine.
    B) Levodopa crosses the blood brain barrier.
    C) Levodopa is converted to dopamine.
    D) Levodopa is effective for 8 to 10 years.
    E) Dopamine returns to levodopa for metabolism

Answer 33

Ans: A, B, C
Feedback:
Levodopa is a precursor of dopamine, which is deficient in parkinsonism; it crosses the blood brain
barrier, where it is converted to dopamine and acts as a replacement neurotransmitter; it is effective for
2 to 5 years in relieving the symptoms of Parkinson’s disease.

Question 34

34. The nurse is preparing to administer the patient’s first dosage of trihexyphenidyl (Artane). What will
    the nurse tell the patient about the dosage?
    A) Initial dose is 1 to 2 mg and then dosage is titrated up to manage symptoms of disease.
    B) Initial dose is 6 mg to establish serum levels and then 1 mg is taken daily.
    C) A 5-mg dose is taken orally twice a day starting with first dose.
    D) Take 1 to 2 mg orally every day starting with first dosage.

Answer 34

Ans: A
Feedback:
Trihexyphenidyl (Artane) is given 1 to 2 mg orally daily initially and then titrated up to 6 to 10 mg/d
with a maximum of up to 15 mg/d to control symptoms. Trihexyphenidyl is an adjunctive therapy to
levodopa in treatment of parkinsonism but it can be used alone for the control of drug-induced
extrapyramidal disorders.