Chapter 20: Drugs for Parkinson's Disease and Alzheimer Disease

Which comment to the nurse indicates more teaching is needed for a patient taking carbidopa/levodopa? A) "I know I need to take this drug once a day" B) "I know I shouldn't stop taking this drug abruptly" C) "I understand my urine may become dark and discolored" D) "I know it may take a few weeks or months to control my symptoms"

A) "I know I need to take this drug once a day" Carbidopa/levodopa has a short half-life and must be taken 3-4 times a day to maintain therapeutic levels.

What would the nurse teach a patient who is taking anticholinergic therapy for Parkinson's disease? (Select all that apply) A) avoid alcohol, cigarettes, and caffeine B) relieve dry mouth with hard candy or ice chips C) use sunglasses to reduce photophobia D) urinate 2 hours after taking the drug E) receive routine eye examinations

A) avoid alcohol, cigarettes, and caffeine B) relieve dry mouth with hard candy or ice chips C) use sunglasses to reduce photophobia E) receive routine eye examinations

The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa. What information does the nurse use as a basis for the teaching plan? A) carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier B) carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain C) giving both drugs together minimizes side effects D) carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain

A) carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.

The patient is scheduled to begin treatment with carbidopa-levodopa. A family member tells the nurse that the patient has a history of undergoing treatment for narrow-angle glaucoma. What is the highest priority action on the part of the nurse? A) contact the health care provider with this information B) reassure the family that this will not affect the patient's treatment C) contact the pharmacist since the dosage will need to be decreased D) contact the pharmacist since the dosage will need to be increased

A) contact the health care provider with this information Glaucoma is known to be a contraindication to use of carbidopa-levodopa as it could increase intraocular pressure. Adjusting the dosage will not change this fact.

A patient is taking rivastigmine to improve cognitive function. What should the nurse teach the patient/family member to do? (Select all that apply) A) rise slowly to avoid dizziness B) remove obstacles from pathways to avoid injury C) closely follow the drug dosing schedule D) have frequent checks for hypertension E) receive regular liver function tests

A) rise slowly to avoid dizziness B) remove obstacles from pathways to avoid injury C) closely follow the drug dosing schedule

The patient asks the nurse to explain the difference between carbidopa-levodopa and ropinirole. The nurse's best response is based on understanding that: A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa B) carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson disease C) both drugs have the same pharmacodynamic and side effect profiles D) carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine

A) ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. Because the drug itself is not dopamine, there are fewer side effects related to peripheral dopamine levels than are noted with carbidopa-levodopa.

The health care provider is considering placing the patient on memantine. The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse anticipates which adjustment in drug therapy? A) the dosage of the drug will be reduced B) a different drug will be ordered instead C) the dosage of the drug will be increased D) all drug therapy will be stopped

A) the dosage of the drug will be reduced The reduction in kidney function may lead the health care provider to choose to reduce the dosage of the medication to prevent toxicity from developing.

The nurse should teach the patient's family to administer the rivastigmine: A) without food B) with meals C) at 3:00 am and 3:00 pm D) when the patient is acting most confused

A) without food Food decreases the absorption rate of rivastigmine.

Which is a nursing intervention for a patient taking carbidopa-levodopa for Parkinson's disease? A) encourage the patient to adhere to a high-protein diet B) inform the patient that perspiration may be dark and may stain clothing C) advise the patient that glucose levels should be checked with urine testing D) warn the patient that it may take 4 to 5 days before symptoms are controlled

B) inform the patient that perspiration may be dark and may stain clothing

Which of the following assessment findings could the nurse see in a patient with Parkinson's disease? (Select all that apply) A) an abrupt onset of symptoms B) muscle rigidity C) involuntary tremors D) bradykinesia E) bilateral muscle weakness

B) muscle rigidity C) involuntary tremors D) bradykinesia

A patient has been taking benztropine. Which outcome assessment helps the nurse verify therapeutic effects of this medication? A) patient is unable to talk B) patient has had a decrease in tremors C) patient can sit up unassisted D) patient has an increased heart rate

B) patient has had a decrease in tremors Certain anticholinergic drugs, such as benztropine and trihexyphenidyl HCl, help reduce the rigidity and tremors characteristic of parkinsonism. They should not result in the patient being unable to talk or increasing the heart rate. They will be unlikely to allow the patient to sit up unassisted when the patient has been previously unable to do so.

The nurse administered donepezil to a patient. Which finding indicates that the medication is therapeutic? A) the patient is relaxed B) the patient has increased cognition C) the patient is awake D) the patient has urinated

B) the patient has increased cognition Donepezil is used to treat Alzheimer disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A) dysphagia B) increased libido C) agranulocytosis D) urinary retention

C) agranulocytosis This term describes a dangerous decrease in white blood cell (WBC) count which can be life-threatening because the patient's immune system cannot fight off infection.

A patient is taking rivastigmine. The nurse should teach the patient and family which information about rivastigmine? A) hepatotoxicity may occur B) the initial dose is 6 mg three times a day C) gastrointestinal distress is a common side effect D) weight gain may be a side effect

C) gastrointestinal distress is a common side effect

The patient has been started on donepezil. The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? A) reassure the family member that this is an expected side effect of the medication B) instruct the family member not to administer any further doses of the drug C) notify the health care provider; the patient may need to be taken off the drug D) instruct the family member to call if the patient continues to exhibit fainting episodes

C) notify the health care provider; the patient may need to be taken off the drug Donezepil is known to cause slow heartbeat and fainting. The health care provider should be notified because the patient may need to be taken off the medication. It is beyond the nurse's scope to take the patient off a drug.

A nurse at an adult day care center notes that many patients are on rivastigmine (Exelon). The nurse knows that the function of this medication is to: A) increase physical mobility B) cure Alzheimer disease C) slow the progression of symptoms of Alzheimer disease D) restore full memory to the patients

C) slow the progression of symptoms of Alzheimer disease

A patient has been diagnosed with Alzheimer disease. The patient's daughter asks the nurse what the cause of Alzheimer disease is. The best response by the nurse is "The cause of Alzheimer disease is A) a virus" B) a cancer" C) unknown" D) normal aging"

C) unknown"

The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient? A) "do not drink milk while on this medication" B) "increase your intake of fatty foods while on this therapy" C) "do not eat carbohydrates with this medication" D) "increase your intake of fluids while on this medication"

D) "increase your intake of fluids while on this medication" The patient should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation. There is no need to restrict milk or carbohydrates or to increase the intake of fatty foods.

A patient with Parkinson's disease is being treated with carbidopa/levodopa. The daughter asks the nurse why he needs both agents. The nurse responds: A) "the two medicines together are doubly effective" B) "this combination has fewer side effects" C) "you'll tolerate this better than a single-agent medication" D) "the carbidopa helps the levodopa reach the brain"

D) "the carbidopa helps the levodopa reach the brain"

The patient is currently on a treatment regimen that includes selegiline therapy. What information is most important for the nurse to teach the patient about this medication? A) "this medication will cure your disease" B) "this medication is used when other drugs do not work" C) "this medication blocks breakdown of dopamine" D) "you will need to restrict your intake of certain foods and drinks"

D) "you will need to restrict your intake of certain foods and drinks" This medication may inhibit monoamine oxidase (MAO)-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine, and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the patient.

The patient has begun treatment with ropinirole and complains to the nurse of feeling excessively drowsy. What does this symptom indicate to the nurse? A) an anaphylactic reaction to the medication B) an overdosage of the medication C) an insufficient dosage of the medication D) an expected side effect of the medication

D) an expected side effect of the medication Drowsiness at frequent intervals is known to be a side effect of the medication. Drowsiness is not indicative of an anaphylactic reaction, overdosage, or underdosage.

A patient is receiving carbidopa-levodopa for Parkinson's disease. What should the nurse know about this drug? A) carbidopa-levodopa may lead to hypertension B) carbidopa-levodopa may lead to excessive salivation C) dopaminergic and anticholinergic therapy may lead to drowsiness and sedation D) dopaminergics and anticholinergics are contraindicated in patients with glaucoma

D) dopaminergics and anticholinergics are contraindicated in patients with glaucoma

Before administering carbidopa/levodopa for the treatment of Parkinson's disease, it is most important for the nurse to assess the patient for a history of: A) pulmonary disease B) diabetes mellitus C) allergy to penicillin D) glaucoma

D) glaucoma Carbidopa/levodopa is contraindicated in patients with narrow-angle glaucoma.

The nurse has initiated teaching for a family member of a patient with Alzheimer disease. The nurse realizes more teaching is needed if the family member makes which statement? A) as the disease gets worse, the memory loss will get worse B) there are several theories about the cause of the disease C) personality changes and hostility may occur D) it may take several medications to cure the disease

D) it may take several medications to cure the disease At this point in time, there is no cure for Alzheimer disease.