Unit 5 Pharm Chapter 24

Question 1

A nurse is assessing a client with Parkinson disease. The nurse determines that the client’s drug therapy is effective when the client exhibits what?

A) Improved short-term memory

B) Decreased aggression

C) Improved level of intellectual functioning

D) Decreased tremors

Answer 1

D) Decreased tremors

Rationale:Decreased tremors would indicate effective antiparkinsonism therapy. Intellectual dysfunction is not a manifestation associated with Parkinson disease. Parkinson disease is not associated with aggression.

Question 2

The nurse provides drug teaching to a client who has Parkinson disease and has been prescribed amantadine. How should the nurse describe the action of this drug?

A) It binds directly with postsynaptic dopamine receptors.

B) It acts on effector cells in the same manner as dopamine.

C) It acts as a direct precursor of dopamine synthesis.

D) It stimulates the natural release of dopamine.

Answer 2

D) It stimulates the natural release of dopamine.

Rationale:Amantadine increases the release of dopamine. Levodopa is a precursor of dopamine that crosses the blood–brain barrier where it is converted to dopamine, acting like a replacement therapy. Apomorphine directly binds with postsynaptic dopamine receptors

Question 3

A client with Parkinson disease has been prescribed diphenhydramine 25 mg IV. The nurse knows that the drug must be added to a 50-mL minibag of 0.9% NaCl and that diphenhydramine is available in single-use vials of 50 mg/1 mL. How many mL of diphenhydramine should the nurse add to the minibag?
___________mL

Answer 3

0.5ml

Rationale:The drug is available with a concentration of 50 mg/mL, and the client requires 25 mg. 25 ÷ 50 = 0.5.

Question 4

Clients with Parkinson’s disease experience deterioration in intellectual functioning along with lack of coordination of unconscious muscle movement.

A) FALSE

B) TRUE

Answer 4

A) FALSE

Rationale:Parkinson’s disease does not affect a person’s intellectual functioning. Parkinson disease does not affect the higher levels of the cerebral cortex, so a very alert and intelligent person may be trapped in a progressively degenerating body.

Question 5

A client is taking levodopa. What should the nurse caution the client to avoid?

A) Analgesics

B) Vitamin B6

C) Aged cheese

D) St. John’s wort

Answer 5

B) Vitamin B6

Rationale:Vitamin B6 interacts with levodopa decreasing its effectiveness. St. John’s wort is not known to interact with levodopa but does interact with rasagiline. Aged cheese contains tyramine and should be avoided if the client is taking rasagiline, but there is no caution associated with levodopa. Analgesics are not known to interact with levodopa.

Question 6

The nurse learns that the client who has been taking an anticholinergic drug to treat Parkinson disease was recently started on amitriptyline to treat the depression resulting from their worsening condition. What is the nurse’s best action?

A) Contact the care provider to question the prescription

B) Monitor the client for urinary hesitancy

C) Assess the client bowel function frequently

D) Initiate cardiac monitoring for the first 24 hours

Answer 6

A) Contact the care provider to question the prescription

Rationale:When anticholinergic drugs are used with tricyclic antidepressants, there is a risk of potentially fatal paralytic ileus and an increased risk of toxic psychoses. Consequently, questioning the order would be a priority.

Question 7

The nurse is planning the care of an older adult client who has been diagnosed with Parkinson disease and begun on levodopa. What should the nurse include in the care plan? Select all that apply.

A) Monitor the client’s vital signs each shift.

B) Monitor the client’s urine output each shift.

C) Monitor the client’s creatinine clearance whenever available.

D) Auscultate the client’s lung sounds each shift.

E) Auscultate the client’s bowel sounds once per shift.

Answer 7

A) Monitor the client’s vital signs each shift.
B) Monitor the client’s urine output each shift.
C) Monitor the client’s creatinine clearance whenever available.
E) Auscultate the client’s bowel sounds once per shift.

Rationale:The potential adverse effects of levodopa are varied and necessitate a number of assessments. These should include assessments of vital signs, kidney function, urine output, and bowel motility. Respiratory effects, however, are less common, and there is no direct indication for lung auscultation.

Question 8

When reviewing the medical record of a client receiving levodopa, what client factors should alert the nurse to the need for closer monitoring after administering the drug?

A) The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma

B) The client is obese and has usually led a sedentary lifestyle

C) The client has taken calcium and vitamin D supplements for many years to prevent osteoporosis

D) The client had cataract surgery last year and has hypertension

Answer 8

A) The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma

Rationale:Levodopa should be used cautiously in clients with peptic ulcer disease or asthma, both of which could be exacerbated by dopamine receptor stimulation. None of the other listed client factors contraindicates the use of levodopa or necessitates close monitoring.

Question 9

Entacapone has been recently added to the medication regimen of a client with Parkinson disease. The nurse should recognize what likely rationale for this change in medication regimen?

A) The client likely developed worsening adverse effects of carbidopa–levodopa

B) The client was likely unable to adhere to the strict dosing schedule of other medications

C) The client’s carbidopa–levodopa was likely less effective than in the past

D) The client likely developed a comorbidity that contraindicated the use of levodopa

Answer 9

C) The client’s carbidopa–levodopa was likely less effective than in the past

Rationale:Entacapone is an adjunctive agent used to treat Parkinson disease. It is used with levodopa–carbidopa for clients who are experiencing “wearing off” of drug effects

Question 10

The nurse is preparing to administer a client’s scheduled dose of the combination drug carbidopa–levodopa. What is the nurse’s rationale for administering the combination?

A) Carbidopa makes the blood–brain barrier temporarily permeable.

B) The combination allows a lower dose of levodopa than if levodopa were administered alone.

C) Carbidopa potentiates the action of levodopa to prevent nerve cell degeneration.

D) Carbidopa prevents excessive amounts of levodopa from being excreted by the kidneys and in feces.

Answer 10

B) The combination allows a lower dose of levodopa than if levodopa were administered alone.

Rationale:Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain so that the dosage of levodopa can be decreased, which reduces the incidence of adverse side effects. When levodopa is used in combination with carbidopa, the enzyme dopa is inhibited in the periphery, diminishing the metabolism of levodopa in the GI tract and in peripheral tissues, thereby leading to higher levels crossing the blood–brain barrier.

Question 11

The client is taking carbidopa–levodopa and is having a deteriorating response to the drug. The provider has consequently prescribed selegiline to begin today. What subsequent change in the client’s treatment regimen should the nurse anticipate?

A) Benztropine will be added to the client’s drug regimen in 1 to 2 weeks

B) The client’s carbidopa–levodopa will be discontinued

C) The client’s carbidopa–levodopa dose will be decreased in 2 or 3 days

D) The client will be admitted to critical care for monitoring during the transition

Answer 11

C) The client’s carbidopa–levodopa dose will be decreased in 2 or 3 days

Rationale:After starting selegiline, the client’s carbidopa–levodopa should be trialed at a lower dose after 2 or 3 days. It should not be wholly discontinued, and there is no indication for benztropine. There is no obvious need for critical care admission.

Question 12

With Parkinson disease, nerve cell bodies in the medulla begin to degenerate.

A) TRUE

B) FALSE

Answer 12

B) FALSE

Rationale:Parkinson disease affects the nerve cell bodies in the substantia nigra.

Question 13

A client has been diagnosed with Parkinson disease, and the nurse is providing health education. The client asks the nurse, “Why can’t I take a dopamine pill if that’s what is lacking?” When responding, the nurse should address what topic?

A) The differences in anatomy and physiology between the central nervous system and the peripheral nervous system

B) The functioning of the sodium–potassium pump

C) The role of acetylcholinesterase

D) The structure and function of the blood–brain barrier

Answer 13

D) The structure and function of the blood–brain barrier

Rationale:Dopamine cannot cross the blood–brain barrier, so exogenous supplements would have no therapeutic benefit. This is unrelated to the functions of acetylcholinesterase, sodium–potassium pumps, or the CNS and PNS.

Question 14

Levodopa is used as treatment for Parkinson disease, primarily acting as a replacement neurotransmitter.

A) TRUE

B) FALSE

Answer 14

A) TRUE

Rationale:Levodopa is the mainstay of treatment for Parkinson disease. This precursor of dopamine crosses the blood–brain barrier and is converted into dopamine. In this way, it acts like a replacement therapy.

Question 15

A client has been diagnosed with Parkinson disease, and the primary healthcare provider has prescribed levodopa (100 mg)–carbidopa (10 mg) PO q8h. What is the nurse’s best action?

A) intact the provider to question the dose.

B) Administer the medication as prescribed and monitor for therapeutic and adverse effects.

C) Contact the provider to question the route.

D) Contact the provider to question the frequency.

Answer 15

B) Administer the medication as prescribed and monitor for therapeutic and adverse effects.

Rationale:This prescription is within recommended parameters. The nurse should administer the medication and monitor the client.

Question 16

An older adult client with Parkinson disease currently takes carbidopa–levodopa 100–25 mg PO t.i.d. and benztropine 3 mg PO daily. What change in this client’s health status would necessitate a change in the medication regimen?

A) The client’s mood and affect have deteriorated and the provider believes the client needs an antidepressant.

B) The client’s most recent hemoglobin value is 11.5 g/dL.

C) The client’s blood urea nitrogen levels have been gradually rising over the past month.

D) The client’s latest digital–rectal exam suggests prostatic hypertrophy.

Answer 16

D) The client’s latest digital–rectal exam suggests prostatic hypertrophy.

Rationale:Prostatic hypertrophy often contraindicates the use of an anticholinergic. Most antidepressants can be safely used with these two drugs, and a modest decline in hemoglobin is not problematic. A gradual increase in BUN must be monitored but would not likely require a change in medications.

Question 17

A client’s dose of the combination drug carbidopa–levodopa has recently been increased due to an exacerbation of the client’s parkinsonian symptoms. What assessment finding would suggest that the client is experiencing adverse effects?

A) The client is retaining urine and has required a urinary catheter

B) The client has had diarrhea twice in the past 2 days

C) The client is diaphoretic despite being afebrile

D) The client’s blood pressure is 152/93 mm Hg and the client has no history of hypertension

Answer 17

A) The client is retaining urine and has required a urinary catheter

Rationale:Adverse effects of levodopa include urinary retention. Diarrhea, increased blood pressure, and diaphoresis would likely be attributable to other factors

Question 18

For the past year, the client has been taking carbidopa–levodopa to treat Parkinson disease. When the client’s response to this drug declines, the provider adds tolcapone. Prior to administering the first dose of tolcapone, the nurse should contact the provider to question administration of this drug based on what test result?

A) Elevated AST, ALT, and bilirubin

B) Prolonged QT interval on the ECG

C) Slight elevation of red blood cell count

D) Elevated blood urea nitrogen and creatinine

Answer 18

A) Elevated AST, ALT, and bilirubin

Rationale:Tolcapone has been associated with fulminant and potentially fatal liver damage, so it is contraindicated in the presence of liver disease. Reduced renal function may indicate a need for dosage reduction but would not contraindicate the drug. Prolonged QT interval and elevated red blood cell count would have no direct impact on administration of tolcapone.

Question 19

The nurse is teaching the client about the combination drug carbidopa-levodopa. What teaching points will the nurse include in the teaching plan? Select all that apply.

A) Cleanse the injection site with alcohol prior to administration in order to prevent infection

B) Suspicious skin lesions should be reported to the provider immediately

C) Do not drive until effects of the drug are known

D) Follow-up with the provider regularly for disease monitoring as well as dosage adjustments

E) Take a daily multivitamin to compensate for common side effects of drug therapy

Answer 19

B) Suspicious skin lesions should be reported to the provider immediately
C) Do not drive until effects of the drug are known
D) Follow-up with the provider regularly for disease monitoring as well as dosage adjustments

Rationale:Levodopa has been associated with the development of melanoma so the client should be taught what a suspicious skin lesion will look like and know to call the doctor immediately if one is found. CNS effects are multiple, so clients should be taught to avoid driving or operating dangerous equipment until they have an opportunity to see what effects they will experience. Clients will need to understand the importance of following up with their physician both so their disease progression can be monitored as well as for drug and dosage adjustments that will be needed to minimize symptoms. Carbidopa–levodopa is taken only PO. Clients who take dopaminergics should be cautioned to avoid over-the-counter vitamins; if such medications are used, the client should be monitored closely because a decrease in dopaminergic effectiveness can result.