N256 NeuroProtection 2/3

A nurse is caring for a client who has been diagnosed with Parkinson's disease. The client does not understand how the medication, carbidopa-levodopa, is going to help the condition. What is the correct response by the nurse?

"Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." (The pathophysiology of Parkinson's disease is the lack of dopamine and the excess of acetylcholine, which cause the symptoms of muscle rigidity, tremors at rest, akinesia or bradykinesia, and postural instability. Carbidopa-levodopa (Sinemet) increases the activity of dopamine and decreases the excessive amount of acetylcholine, which causes improved nerve impulse control and decreases the symptoms exhibited.)

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." (Anticholinergic drugs decrease sweating and may cause heat stroke. The client should be instructed to avoid high environmental temperatures. Anticholinergic agents will decrease mental alertness. Pseudoephedrine will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.)

A client has been placed on the drug bethanical. The client asks a nurse to explain how the drug bethanechol works. What would be a correct response?

"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine." (Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine.)

Which drug is classified as a cholinergic blocking drug used to treat parkinsonism?

Benztropine

The client is receiving a cholinergic agonist. Which assessment finding in a client warrants immediate action by the nurse?

Blood pressure decreased from 110/90 mm Hg to 80/50 mm Hg (A client receiving a cholinergic agonist is at risk for hypotension and bradycardia. Increased urination is a therapeutic effect of the medication and is not cause for immediate concern.)

A nurse is caring for a 59-year-old client with Parkinson's disease. What would indicate to the nurse that the client is experiencing an adverse reaction related to the drug carbidopa-levodopa?

Blurred vision (Blurred vision may indicate that the drug is causing increased intraocular pressure, which should be reported to the provider immediately)

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 is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client?

Cholinergic crisis (Overdose of cholinergic agonists can lead to cholinergic crisis. Symptoms of cholinergic crisis are those associated with excessive stimulation of the parasympathetic nervous system, including increased sweating, salivation, gastric secretions, and respiratory secretions. If not treated quickly, cholinergic crisis can lead to respiratory failure.)

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 (The nurse should assess for confusion and disorientation when caring for this elderly patient undergoing anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring.)

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

The nuring instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?

Degeneration of cholinergic pathways (Acetylcholine is the transmitter in the cholinergic neuropathway. People with early Alzheimer's disease experience degeneration of these cholinergic neuropathways. As a result, the client has problems with memory and thinking. The cholinesterase inhibitors act to increase the level of acetylcholine in the central nervous system by inhibiting its breakdown and slowing neural destruction.)

Clients with Parkinson's disease experience a deterioration in intellectual functioning along with incoordination of unconscious muscle movement.

False (Parkinson's disease does not affect a person's intellectual functioning)

The client is a 67-year-old with AD. When treating a client with Alzheimer's disease, it is important to involve which group of people?

Family members and caregivers

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

Levodopa (Because levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma (because it increases intraocular pressure).)

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. (Levodopa restores dopamine levels and, in combination with carbidopa, decreases the peripheral breakdown of levodopa and allows more to reach the brain.)

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

Levodopa.

A nurse is reviewing a client's history for conditions that would contraindicate the use of anticholinergics for Parkinson's disease. Which would cause the nurse to be concerned?

Myasthenia gravis (Anticholinergics are contraindicated for clients with myasthenia gravis, which could be exacerbated by the blocking of acetylcholine receptor sites at the neuromuscular synapses.)

The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs?

Parasympathetic nervous system

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

After teaching an in-service program about nervous system conditions, the nurse determines that the teaching was successful when the group identifies which condition or disease as a group of symptoms involving motor movement characterized by tremors, rigidity, and bradykinesia?

Parkinsonism

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 (The client has blurred vision and ataxia (muscular incoordination), placing the client at risk for falls and injury.)

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

Suspicious skin lesions (Levodopa is contraindicated in clients with suspicious skin lesions because the drug is associated with the development of melanoma. Cautious use is recommended for clients with myocardial infarction, bronchial asthma, and peptic ulcer disease, as these conditions could be exacerbated by dopamine receptor stimulation.)

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?

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

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 has been taking Aricept for several months. The family feels that she is better and wants to stop the medication. What would be an important teaching point?

This medication is a treatment, not a cure. If you stop it, she will lose any benefits that she has gained.

Dopaminergic agents can exacerbate cardiovascular disease due to dopamine receptor stimulation.

True

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

True

The client is ordered betanechol subcutaneously. After giving the client the injection of bethanechol, the nurse should make sure that what is available?

Urinal, bed pan, and call light (Bethanechol subcutaneous injections are used to relax the bladder so a client with urinary retention can void. After giving a client a subcutaneous injection, the client will usually need to void within about 15 minutes, so it is important the client has a way to easily void.)

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

Vitamin B6 (Vitamin B6 interacts with levodopa decreasing its effectiveness. St. John's wort is not known to interact with levodopa)

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. (To avoid urinary retention associated with the administration of an anticholinergic agent, the client should be instructed to void before taking the medication. The client should be instructed to avoid the use of over-the-counter sleep aids. The client should avoid high environmental temperatures. The client should avoid strenuous activity and should not enroll in an exercise class.)

The nursing student correctly identifies the transmitter in the cholinergic neuropathways that appears insufficient in clients with Alzheimer's disease is which?

acetylcholine.

A 78-year-old man is admitted to the emergency department (ED) with bradycardia resulting from overdose of donepezil. The nurse knows that the ED is likely to order which medication?

atropine (Atropine is a specific antidote to cholinergic drugs and may be used to treat overdose.)

Myasthenia gravis is best understood by the nurse as being what type of disorder?

autoimmune (Myasthenia gravis is a neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the post-synaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine.)

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

decrease salivation, spasticity, and tremors. (Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. They are used primarily in people who have minimal symptoms or who cannot tolerate levodopa, or in combination with other antiparkinson drugs.)

A client is diagnosed with Alzheimer's disease. The nurse should anticipate administering which medication?

donepezil

Common side effects of anticholinergics include:

dry mouth, urinary retention, constipation, and increased pulse rate. (Anticholinergic drugs may cause blurred vision, dry mouth, tachycardia, and urinary retention. They also decrease sweating and may cause fever or heatstroke.)

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. (Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.)

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.

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 (Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma)

The three major features of Parkinson's include:

rigidity, bradykinesia, and tremors.

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." (The plasma half-life of both carbidopa-levodopa and carbidopa alone is roughly 1 to 2 hours, and the duration of action of a dose is 5 hours. Consequently, most patients must take the drug several times daily.)

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

"The carbidopa allows a lower dose of levodopa to be used." (When levodopa is used in combination with carbodopa, the enzyme dopa is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal tract and in peripheral tissues. Because the 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 side effects.)

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." (The optimal dose is the lowest one that allows the client to function adequately. Optimal dosage may not be established for 6 to 8 weeks with levodopa.)

What may parkinsonism result from? (Select all that apply.)

-Drugs -Encephalitis (Parkinsonism may result from the use of certain drugs, head injuries, and encephalitis.)

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 (Anticholinergic medications have the following adverse reactions: dry mouth, blurred vision, dizziness, mild nausea, and nervousness. Fever, bradycardia, and increased salivation are not common adverse reactions to anticholinergic medications.)

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 (Carbidopa/levodopa (Sinemet) is contraindicated in clients who have known hypersensitivity to the drug, narrow angle glaucoma, or use MAOI antidepressants.)

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

-Nervousness -Dysphagia -Flushing (Possible adverse effects of dopaminergic therapy include nervousness, dysphagia, flushing, hypotension, and urinary retention.)

The nurse should be cautious and closely monitor clients receiving carbidopa/levodopa (Sinemet) with which medical conditions? (Select all that apply.)

-Renal Disease -Asthma -Peptic ulcer disease (Carbidopa/levodopa (Sinemet) is used cautiously in clients with cardiovascular or pulmonary disease (asthma), peptic ulcer disease, renal or hepatic disease, and psychosis.)

The nurse is admitting a client who has just been diagnosed with Parkinson's disease. The nurse assesses this client for which symptoms that are considered most characteristic of this disease? (Select all that apply.)

-Resting tremor -Bradykinesia -Rigidity -Postural instability (Classic symptoms of Parkinson's disease include resting tremor, bradykinesia, rigidity, and postural instability.)

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.)

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

A health care provider prescribes 10 mg of donepezil hydrochloride per day to a client with dementia of Alzheimer's disease. Donepezil tablets are available as 10-mg tablets. How many tablets should the nurse have to administer to the client per day?

1 tablet

The client is in early stage of Alzheimer's disease and is ordered Aricept 5 mg PO daily. The drug comes in 10 mg tablets. How much will the nurse give this client each day?

1/2 tablet

A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter?

Acetylcholine

When preparing to administer a cholinergic drug, the nurse understands that which is responsible for activating the primary neurotransmitter in the parasympathetic nervous system?

Acetylcholinesterase (Acetylcholinesterase is the enzyme responsible for activating acetylcholine, the primary neurotransmitter in the parasympathetic nervous system.)

When describing the action of levodopa, which would the nurse include?

Acts like replacement therapy (Levodopa is a precursor of dopamine that crosses the blood-brain barrier, where it is converted to dopamine, acting like a replacement therapy.)

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 (Agitation would be noted due to the blocking of central acetylcholine receptors. Constipation, reduced sweating, and dry mouth may be noted as well.)

A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent?

Atropine