NU141- Chapter 24 Antiparkinsonism Agents

An older adult client has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What client education should be provided by the nurse?

"Avoid high environmental temperatures."

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?

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

After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson's disease and will soon begin treatment with carbidopa-levodopa. Which statement indicates that the patient has an accurate understanding of the new medication?

"I've read that carbidopa-levodopa is quite short-acting so I'll have to take it several times a day."

A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease?

"It is characterized abnormalities in posture."

The nurse is educating a client diagnosed with Parkinson's disease about the dietary implications of prescribed treatment with levodopa/carbidopa. Which statement by the nurse demonstrated an understanding of the proper administration of this medication?

"It's important to take this medication on a full stomach so that it doesn't make you nauseous."

A male client is prescribed levodopa for his Parkinson's disease. The dosage has been modified on multiple occasions. The client asks the nurse how the prescriber decides on the optimal dose. What is the nurse's best response?

"The optimal dose is the lowest one that allows the client to function adequately."

A female client has been prescribed ropinirole (Requip). She states, "I don't know why they are giving me this medicine. I don't have restless leg syndrome." What is the nurse's best response in teaching this client with newly diagnosed Parkinson's disease about ropinirole (Requip)?

"You are right about ropinirole, but it is also used in early Parkinson's disease."

A client with Parkinson's 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?

0.5

A pediatric client with a complex health history has developed early signs of drug-induced parkinsonism. The client's provider has prescribed diphenhydramine 25 mg PO tid. The medication is available as an oral solution with a concentration of 12.5 mg/ 5mL. How many mL should the nurse administer for each dose?

10

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?

A client who began taking a dopaminergic three days ago and who is uncharacteristically disoriented.

The nurse in a long term care facility cares for several clients with Parkinson's disease or parkinsonism. Which client should the nurse refer to his or her provider for the possible use of adjunctive agents?

A client who has been taking carbidopa-levodopa for three years but with decreasing therapeutic effects

A client is taking tolcapone for Parkinson's disease. What blood test will the nurse perform often on this client?

ALT

A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action?

Administer the medication as prescribed and monitor for therapeutic and adverse effects

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?

Administer the next drug dose with meals.

Which would lead the nurse to suspect that a client is experiencing an adverse effect to an anticholinergic agent?

Agitation

When is Parkinson's disease usually diagnosed?

Around 60 years of age

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?

Assess renal function

A client is newly diagnosed with Parkinson's disease. The client has been placed on an anticholinergic drug. Which symptom would cause the greatest concern for the nurse?

Blurred vision

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

Blurred vision

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?

Carbidopa

When administering entacapone, the nurse understands that this drug affects which enzyme?

Catecholamine-O-methyl transferase

When administered with other drugs that enhance stimulation of serotonergic receptors (Demerol, Dextromethorphan, antidepressants), rasagiline can:

Cause a potentially fatal CNS toxic reaction.

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?

Central nervous system

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

Choreiform movements Dry mouth Anorexia

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?

Confusion and disorientation

After administering an antiparkinson drug to a client, the nurse assesses for the drug's effectiveness. The nurse determines that the drug is effective based on assessment of which of the following? Select all that apply.

Decrease in muscle rigidity Improved gait Reduction in tremors

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

Decreased tremors

When describing the possible adverse effects associated with trihexyphenidyl therapy, what would the nurse include? (Select all that apply.)

Delirium Agitation Blurred vision

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?

Dopamine

The client is taking an anticholinergic medication. The nurse is teaching about the medication and adverse reactions. Which adverse reactions would be correct for the nurse to include? Select all that apply.

Dry mouth Blurred vision

A client is prescribed a catechol-O-methyltransferase (COMT) inhibitor. Which drug would the nurse expect to administer?

Entacapone

Which are classified as catechol-O-methyltransferase (COMT) inhibitor drugs? (Select all that apply.)

Entacapone (Comtan) Tolcapone (Tasmar)

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?

Evaluate the client for adverse reactions from the centrally acting anticholinergics

A nurse is making a care plan for a client with Parkinson's disease and has started on an antiparkinson medication. Which nursing diagnosis would be appropriate for this client's care plan? (Select all that apply.)

Imbalanced Nutrition: Less than Body Requirements Altered Bowel Movements: Constipation Risk for Injury

A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client?

Imbalanced nutrition: less than body requirements

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

It stimulates the natural release of dopamine

For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?

Levodopa

A client is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa. Why is this course of treatment most effective?

Levodopa restores dopamine, and carbidopa decreases peripheral breakdown of levodopa.

The most effective drug to treat major symptoms associated with Parkinson's is:

Levodopa.

A female client begins tolcapone therapy, and her health care provider arranges for laboratory testing to be completed on a routine basis. The nurse expects which laboratory study to be ordered?

Liver transaminase enzymes

Teach the client and family how to correctly apply a transdermal patch

Meperidine

The dopamine agonists selegiline and rasagiline, which are monoamine oxidase inhibitors, should not be administered with which drug as the combination increases the risk of serotonin syndrome?

Meperidine

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

Monitoring cardiac status

In which clients should the nurse review medical conditions prior to administering a carbidopa/levodopa (Sinemet), as its use is contraindicated in these clients? (Select all that apply.)

Narrow angle glaucoma Renal disease Hepatic disease Use of MAOI antidepressants

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?

Narrow-angle glaucoma

Which would a nurse expect to assess as a potential adverse effect of dopaminergic therapy?

Nervousness

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?

On-off phenomenon

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

Oral

Parkinsonism

Parkinson disease-like extrapyramidal symptoms that are adverse effects associated with particular drugs or brain injuries

A 60-year-old client has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing, the client states having sustained several head injuries. This information supports which possible diagnosis?

Parkinson's disease

A nurse is caring for a client who has been prescribed diphenhydramine for the treatment of Parkinson disease in an older adult. The client reports diplopia and blurred vision. Which intervention would be most appropriate?

Provide proper assistance with ambulation.

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?

Pyridoxine (vitamin B6)

A client taking carbidopa-levodopa for the treatment of Parkinson's disease reports blurred vision and the nurse observes that the client has worsening ataxia. Which nursing diagnosis should the nurse prioritize?

Risk for injury

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? Select all that apply.

Skin rash Dry mouth

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?

St. John's wort

Clients taking levodopa should avoid what due to their ability to increase dopa decarboxylase action?

Supplemental vitamins

A client's symptoms of Parkinson's disease have worsened despite the use of dopaminergics. The client's provider has prescribed the addition of rotigotine to the client's medication regimen. What is the nurse's best action?

Teach the client and family how to correctly apply a transdermal patch

A client with a complex medical history has been diagnosed with Parkinson's disease and prescribed carbidopa-levodopa. What aspect of this client's health status should most prompt the nurse to monitor the client closely?

The client had a myocardial infarction ten months ago

A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect?

The client is able to walk more briskly and stably than two weeks ago

A client's dose of Sinemet 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?

The client is retaining urine and has required a urinary catheter

The nurse is preparing to administer a client's scheduled dose of Sinemet. What is the nurse's rationale for administering levodopa with carbidopa?

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

A client has been diagnosed with Parkinson's 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?

The structure and function of the blood-brain barrier

A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms?

There is an imbalance between dopamine and acetylcholine.

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?

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

A client has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What client education should be provided?

Void before taking the medication.

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?

With amantadine, excretion is primarily via the kidneys.

Substantia nigra

a part of the brain rich in dopamine and dopamine receptors; site of degenerating neurons in Parkinson disease

A client asks the nurse to explain parkinsonism to him. Which possible causes of parkinsonism might be included in the explanation? a. Adverse effects of drug therapy b. Brain injury c. Viral infection d. Dementia e. Bacterial infection f. Birth defect

a. Adverse effects of drug therapy b. Brain injury c. Viral infection

Anticholinergic drugs are effective in early Parkinson disease. They act to a. block stimulating effects of acetylcholine in the brain to bring activity back into balance. b. block the signs and symptoms of the disease, making it more acceptable. c. inhibit dopamine effects in the brain and increase neuron activity. d. increase the effectiveness of the inhibitory neurotransmitter gamma-aminobutyric acid.

a. block stimulating effects of acetylcholine in the brain to bring activity back into balance

A client was diagnosed with Parkinson's disease and the client's provider prescribed levodopa 400 mg PO b.i.d. The client has experienced a reduction in tremors and an improvement in gait but is having significant adverse effects. Consequently, the client's medication has been changed to Sinemet. When educating the client, the nurse should explain that this drug:

allows the client to benefit from levodopa while taking a lower dose.

A patient receiving an anticholinergic drug for Parkinson disease is planning a winter trip to Tahiti. The temperature in Tahiti is 70 degrees warmer than at home. What precautions should the patient be urged to take? a. Take the drug with plenty of water to stay hydrated. b. Reduce the dose, and take precautions to reduce the risk for heat stroke. c. Wear sunglasses and use sunscreen because of photophobia that will develop. d. Avoid drinking the water to prevent gastric distress.

b. Reduce the dose, and take precautions to reduce the risk for heat stroke.

No therapy is available that will stop the loss of neurons and the eventual decline of function in clients with Parkinson disease. As a result, nursing care should involve which interventions? a. Regular exercises to slow loss of function b. Supportive education as drugs fail and new therapy is needed c. Community and family support networking d. Discontinuation of drug therapy to test for a cure e. Special vitamin therapy to slow the loss of the neurons f. Explanations of the adjunctive drug therapy that may be used

b. Supportive education as drugs fail and new therapy is needed c. Community and family support networking f. Explanations of the adjunctive drug therapy that may be used

A patient taking levodopa and over-the-counter megavitamins might experience a. a cure from Parkinson disease. b. the return of Parkinson symptoms. c. improved health and well-being. d. a resistance to viral infections.

b. the return of Parkinson symptoms.

What are the classic symptoms associated with Parkinson's disease? Select all that apply.

bradykinesia muscle rigidity resting tremors

Parkinson disease reflects an imbalance between inhibitory and stimulating activity of nerves in the a. reticular activating system. b. cerebellum. c. basal ganglia. d. limbic system.

c. basal ganglia

Replacing dopamine in the brain would seem to be the best treatment for Parkinson disease. This is difficult because dopamine a. is broken down in gastric acid. b. is not available in drug form. c. cannot cross the blood-brain barrier. d. is used peripherally before reaching the brain.

c. cannot cross the blood-brain barrier.

A patient who has been diagnosed with Parkinson disease for many years and whose symptoms were controlled using Sinemet has started to exhibit increasing signs of the disease. Possible treatment might include a. an increased exercise program. b. adding iron to the person's diet. c. combination therapy with an anticholinergic drug. d. changes in diet to eliminate vitamin B6.

c. combination therapy with an anticholinergic drug.

The main underlying problem with Parkinson disease seems to be a decrease in the neurotransmitter a. acetylcholine. b. norepinephrine. c. dopamine. d. serotonin.

c. dopamine

A client has a diagnosis of Parkinson disease, and the health care provider will prescribe carbidopa-levodopa. Before drug therapy, the client should be carefully assessed for the presence of:

closed-angle glaucoma

A 72-year-old man should be aware that the adverse effects of centrally acting anticholinergic drugs include:

confusion.

.Parkinson disease is a progressive, chronic neurological disorder that is usually a. associated with severe head injury. b. associated with chronic diseases. c. associated with old age. d. known to affect people of all ages with no known cause.

d. known to affect people of all ages with no known cause.

Parkinson disease

debilitating disease characterized by progressive loss of coordination and function, which results from the degeneration of dopamine-producing cells in the substantia nigra

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

decrease salivation, spasticity, and tremors.

Bradykinesia

difficulty in performing intentional movements and extreme slowness and sluggishness; characteristic of Parkinson disease

Dopaminergic

drug that increases the effects of dopamine at receptor sites

Anticholinergic

drug that opposes the effects of acetylcholine at acetylcholine receptor sites

What is a common side effect of anticholinergic drug therapy? Select all that apply.

dry mouth blurred vision urinary retention

Common side effects of anticholinergics include:

dry mouth, urinary retention, constipation, and increased pulse rate.

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:

falls.

A client has developed symptoms of rigidity and bradykinesia. Which medication has been linked to the development of such symptomology?

haloperidol

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?

involuntary movements.

For a client diagnosed with both Parkinson's and narrow-angle glaucoma, what medication should cause the nurse concern?

levodopa

A client whose Parkinson's disease is being treated with tolcapone should concurrently take what drug?

levodopa/carbidopa

Corpus striatum

part of the brain that reacts with the substantia nigra to maintain a balance of suppression and stimulation

The three major features of Parkinson's include:

rigidity, bradykinesia, and tremors.