Pharmacology Chapter 24

Narrow-angle glaucoma

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?

On-off phenomenon

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?

0.5

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?

There is an imbalance between dopamine and acetylcholine.

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?

confusion

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

The client's latest digital-rectal exam suggests prostatic hypertrophy

A 74-year-old client with Parkinson's disease currently takes Sinemet 100/25 mg PO t.i.d. and Cogentin 3 mg PO daily. What change in this client's health status would necessitate a change in the medication regimen?

"The carbidopa allows a lower dose of levodopa to be used."

A client asks the nurse why the client must take levodopa in combination with carbidopa. Which response by the nurse would be most appropriate?

levodopa/carbidopa

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?

closed-angle glaucoma.

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:

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

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?

Void before taking the medication.

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

Entacapone

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

Pyridoxine (vitamin B6)

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?

Vitamin B6

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

ALT

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

Monitoring blood pressure

A client with Parkinson's disease is experiencing fewer therapeutic benefits of carbidopa-levodopa in recent weeks so the provider has prescribed selegiline 5 mg PO b.i.d. In addition to assessing for therapeutic effects on the client's Parkinson's symptoms, the nurse should prioritize what assessment?

The client had a myocardial infarction ten months ago

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 is retaining urine and has required a urinary catheter

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?

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

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?

Liver transaminase enzymes

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?

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

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?

Evaluate the client for adverse reactions from the centrally acting anticholinergics

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?

Carbidopa

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?

With amantadine, excretion is primarily via the kidneys.

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?

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

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?

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

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?

Confusion and disorientation

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?

Provide proper assistance with ambulation.

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?

The patient is not lactating.

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?

"It is characterized by abnormalities in movement and posture."

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

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

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.)

Central nervous system

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?

10

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?

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

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?

Decrease in muscle rigidity Improved gait Reduction in tremors

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.

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

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?

Assess renal function

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?

Supplemental vitamins

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

The client's Sinemet was likely less effective than in the past

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

Levodopa

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

decrease salivation, spasticity, and tremors.

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

Dopamine

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?

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?

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

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?

levodopa

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?

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

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?

Entacapone

The nurse is providing care for a client with Parkinson's disease. Which of the client's medications will most directly affect catecholamine-O-methyl transferase (COMT) function?

Nervousness Dysphagia Flushing

The nurse should monitor a client receiving a dopaminergic agent for which adverse effects. Select all that apply.

rigidity, bradykinesia, and tremors.

The three major features of Parkinson's include:

Blurred vision

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

Catecholamine-O-methyl transferase

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

Around 60 years of age

When is Parkinson's disease usually diagnosed?

Suspicious skin lesions

When reviewing a client's history, which would the nurse identify as a contraindication to the use of levodopa?

"Entacapone inhibits COMT so that dopamine is active for a longer time."

When the client prescribed entacapone asks the nurse to describe exactly how this medication works, what response is most appropriate?

Monitoring cardiac status

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

St. John's wort

Which would a nurse identify as least likely to contribute to a decrease in the effectiveness of levodopa?