Neuro and MS drugs 复制

The nurse is caring for a client who is prescribed baclofen (Lioresal). The client asks the nurse if there are any adverse effects for the medication. Which list of adverse effects is most appropriate for the nurse to share with this client? 1. Drowsiness, dizziness, weakness, and fatigue 2. Sleepiness, increased appetite, renal failure, and constipation 3. Dizziness, mental awakeness, decreased appetite, and diarrhea 4. Insomnia, decreased energy, diarrhea, and headaches

1 Rationale 1: Drowsiness, dizziness, weakness, and fatigue are common adverse effects of baclofen.

The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse? 1. "Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose." 2. "Because phenytoin (Dilantin) can cause blood-thinning in some patients." 3. "Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests." 4. "Because phenytoin (Dilantin) can deplete your system of potassium."

1 Rationale 1: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity.

Mitoxantrone is prescribed for a 24-year-old woman with worsening relapsing-remitting multiple sclerosis. In preparing a teaching plan for this patient, which question should the nurse ask? 1. "How are you managing contraception?" 2. "Have you ever experienced an eating disorder?" 3. "Do you experience spotting between menstrual periods?" 4. "How severe was facial acne for you during adolescence?"

1. Avoid pregnancy due to its teratogenic effect.

A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen (Lioresal) to help manage spasticity. How will the baclofen interfere with rehabilitation activities? 1. By producing drowsiness, lethargy, and blurred vision 2. By causing gastrointestinal distress 3. By increasing pain associated with activities 4. By impairing coordinated movements

1. These are SE of baclofen. A The central nervous system effects of baclofen include drowsiness and lethargy, which might diminish the effectiveness of rehabilitation activities.

A patient with multiple sclerosis is started on a treatment regimen with mitoxantrone. Which nursing diagnosis would have the highest priority to add to the plan of care? 1. Risk for sleep pattern disturbance related to irritability 2. Risk for infection related to depressed production of neutrophils 3. Impaired urinary elimination related to blue-green urine 4. Disturbed sensory perception, auditory, related to ototoxicity

2

The primary use of entacapone in treating Parkinson's disease is to: 1. protect the liver from damage from levodopa or carbidopa. 2. inhibit decarboxylase enzymes, which are used to metabolize levodopa. 3. inhibit COMT and prolong the half-life of levodopa in the blood. 4. bind to dopamine receptors, causing their activation.

3

A patient with Parkinson's disease who is taking levodopa experiences dizziness when getting out of bed. The nurse should instruct the patient to: 1. try to sleep sitting up. 2. use a potassium supplement. 3. decrease the levodopa dose. 4. try increasing salt and water in the diet.

4

A patient with myasthenia gravis is administered pyridostigmine (Mestinon) for the first time. She asks the nurse the reason why she has been changed to this medication. Which of the following is the nurse's best response? A) "Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow." B) "Pyridostigmine (Mestinon) can be taken every other day." C) "Pyridostigmine (Mestinon) is a faster-release form of cholinergic agent." D) "Pyridostigmine (Mestinon) is taken one time per day for better control."

A Feedback: Pyridostigmine is a slow-release form that is taken at bedtime and allows the patient the ability to swallow in the morning. Pyridostigmine is usually taken two times per day, not every other day. Pyridostigmine is a slow-release form, not a fast-release form. Pyridostigmine is taken two times per day, not one time per day.

A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? a. "Avoid consuming foods that are high in tyramine." b. "This drug will prevent the need to take levodopa." c. "You may have red wine with dinner on occasion." d. "You will not have serious drug interactions with this drug."

ANS: A Selegiline (Eldepryl) inhibits monoamine oxidase-B, and it has similar adverse reactions to other monoamine oxidase inhibitors. Patients should be cautioned against consuming foods containing tyramine because of the risk of hypertensive crisis. Red wine is high in tyramine. Use of this drug may delay, but will not prevent, the need for levodopa. Severe adverse drug interactions may occur between this drug and tricyclic antidepressants.

A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet) and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss: a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone. b. adding the DA-releasing agent amantadine to the regimen. c. giving a direct-acting dopamine agonist. d. shortening the dosing interval of levodopa/carbidopa.

ANS: A This patient is describing abrupt loss of effect, or the "off" phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect.

A client is prescribed a monoamine oxidase inhibitor for the treatment of his Parkinson's disease. The nurse anticipates that this drug is: a. amantadine. b. selegiline. c. benztropine mesylate. d. bromocriptine mesylate.

ANS: B Feedback A Incorrect: This is an antiviral agent. B Correct: Selegiline inhibits monoamine oxidase. C Incorrect: This is an anticholinergic agent. D Incorrect: This is not an MAO inhibitor.

A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet). The prescriber orders bromocriptine (Parlodel) to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss: a. adding an antipsychotic medication. b. changing from bromocriptine to cabergoline (Dostinex). c. reducing the dose of bromocriptine. d. reducing the dose of levodopa/carbidopa.

ANS: C Bromocriptine is used to treat levodopa-induced dyskinesias and has dose-dependent psychologic side effects. The nurse should suggest reducing the dose of this drug to minimize these side effects. Adding an antipsychotic medication is not indicated. Cabergoline is not approved for this use. Reducing the dose of levodopa/carbidopa is not indicated.

A nurse is caring for a 55-year-old client with Parkinson's disease who is prescribed entacapone. The nurse would monitor this client for which adverse reaction? A) Increased hand tremor B) Constipation C) Urinary retention D) Dyskinesia

Ans: D Feedback: The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hyperkinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs.

The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects? What is the name of this drug? A) Bromocriptine B) Carbidopa

B Feedback: Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues, thereby leading to higher levels crossing the blood-brain barrier.

The patient received a preoperative dose of lorazepam (Ativan) 20 minutes ago. Which safety precaution should the nurse take? a. Monitor respiratory status. b. Raise the bed rails. c. Elevate the head of the bed 30 degrees. d. Take seizure precautions.

B Raising the bed rails is a safety precaution against the dizziness and hypotension caused by this drug.

The nurse prepares to administer benztropine (Cogentin) to the patient. The nurse holds the dose and notifies the physician based on which assessment finding? 1. A respiratory rate of 14 2. A pulse of 112 3. Blood pressure of 88/60 mmHg 4. A temperature of 100.2°F

Rationale 2: Benztropine (Cogentin) can cause tachycardia.

The patient receives levodopa-carbidopa (Sinemet). The nurse has completed medication education and determines that learning has occurred when the patient makes which statement? 1. "I need to increase my daily intake of protein." 2. "I must increase the fiber in my diet." 3. "I need to check my pulse before taking the medication." 4. "I must avoid carbohydrates in my diet."

Rationale 2: Fiber will help prevent constipation, which is a side effect of levodopa-carbidopa (Sinemet). fiber will help prevent constipation, which is a side effect of levodopa-carbidopa (Sinemet). There isn't any need to check the pulse prior to the medicat

A client diagnosed with Parkinson disease has been prescribed levodopa-carbidopa (Sinemet). Which data indicates the medication has been effective? 1. The client has muscle rigidity. 2. The client has bradykinesia. 3. The client is able to walk without stumbling. 4. The client has tremors.

Rationale 3: The client's ability to walk upright without stumbling would indicate levodopa-carbidopa (Sinemet) is working. The client's ability to walk without stumbling would indicate Sinemet is working. Tremors, muscle rigidity, bradykinesia, and postural instability are signs or symptoms of Parkinson.

Prior to administering benztropine (Cogentin) to a client, the nurse assesses adverse effects of previous doses and decides to withhold the current dose. Which clinical manifestation would warrant the nurse holding the dose of the medication? 1. A respiratory rate of 14 2. A blood pressure reading of 88/60 mmHg 3. A temperature of 100.2°F 4. Distant bowel sounds

ationale 4: Paralytic ileus is the only identified life-threatening adverse reaction with this medication. Distant bowel sounds could be an indication of developing paralytic ileus.

A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures

b

A patient with Parkinson's disease has been prescribed entacapone (Comtan). The patient asks how this medication works. Which of the following responses is most appropriate? A) "Entacapone is best given parenterally to relieve symptoms." B) "Entacapone inhibits COMT to metabolize dopamine in the brain." C) "It increases the metabolism of levodopa (L-dopa) in the bloodstream." D) "It is excreted in the urine, and your renal function is adequate."

b

A client is actively experiencing status epilepticus. Which prescribed medication does the nurse prepare to administer? a. Atropine b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Morphine sulfate

b Initially, intravenous lorazepam is administered to stop motor movements. This is followed by the administration of phenytoin. Atropine and morphine are not administered for seizure activity.

A patient is prescribed amantadine (Symmetrel). Which of the following statements indicates the patient has understood the patient teaching? A) "This drug is also used to decrease my drooling." B) "This drug is excreted in my stool and urine." C) "This drug will improve my tremors in 1-5 days." D) "This drug is effective when it is given long term."

c

Which of the following statements is true about dopamine replacement in the treatment of Parkinson's disease? a. administer IV dopamine b. administer IV levodopa c. administer oral levodopa d. administer oral dopamine

c. Since dopamine cannot get through the blood-brain barrier and get into the brain, it must be given in the form of levodopa, which, once past the blood-brain barrier, converts into dopamine.

A patient with Parkinson's disease has been achieving good symptom control with levodopa but complains that symptoms begin to return before it is time for the next dose. One potential remedy for this "wearing off" phenomenon is to: 1. take levodopa at shorter dosing intervals. 2. give a drug that decreases levodopa's half-life. 3. take levodopa at longer dosing intervals. 4. increase the dose to increase receptor binding.

1

The client being evaluated for a possible diagnosis of myasthenia gravis (MG) describes having a diagnostic test that involved an injection that resulted in a 5-minute period of markedly improved muscle strength. The nurse recognizes the client's report as describing a(n): 1. Tensilon test. 2. Computed tomography (CT) scan. 3. Nerve stimulation study. 4. Analysis of antiacetylcholine receptor antibodies.

1. Tensilon test. Rationale: The Tensilon test produces a 5-minute increase in muscle strength. A computed tomography (CT) scan would not result in improved muscle strength. The nerve stimulation study and the analysis of antiacetylcholine receptor antibodies are tests that can be done to help diagnose MG, but do not require a drug injection.

A patient with Parkinson's disease says, "I always take my other medications with my bacon and eggs each morning. Can I take the levodopa at this time, too?" Select the nurse's best response. 1. "You can take the levodopa at breakfast if it helps you to remember to take it." 2. "You should take all of your medications together to enhance efficacy." 3. "You should take the levodopa at least 1 hour before you eat your breakfast." 4. "You should never take this medication with food, as it will increase its side effects."

3

The nurse is assisting in the care of a client who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium (Tensilon). Evaluation of the results indicates that the test is positive. Which of the following would be the expected response noted by the nurse? 1. Joint pain for the next 15 minutes 2. A decrease in muscle strength within 1 to 3 minutes 3. An increase in muscle strength within 1 to 3 minutes 4. Feelings of faintness or dizziness for 5 to 10 minutes

3 Rationale: Edrophonium (Tensilon) is a short-acting acetylcholinesterase inhibitor used to diagnose myasthenia gravis. An increase in muscle strength should be seen in 1 to 3 minutes following the test dose if the client does have the disease. If no response occurs, another dose is given over the next 2 minutes and muscle strength is tested again. If no increase in muscle strength occurs with this higher dose, the muscle weakness is not caused by myasthenia gravis. Clients who receive injections of this medication commonly demonstrate a drop of blood pressure, feel faint and dizzy, and are flushed.

The client with myasthenia gravis becomes increasingly weaker. The physician injects a dose of edrophonium (Tensilon) to determine whether the client is experiencing a myasthenic crisis or a cholinergic crisis. The nurse expects that the client will have which of the following reactions if the client is in cholinergic crisis? 1. No change in the condition 2. Complaints of muscle spasms 3. An improvement of the weakness 4. A temporary worsening of the condition

4 Rationale: An edrophonium (Tensilon) injection makes the client in cholinergic crisis temporarily worse. An improvement of the condition ("an improvement of the weakness") indicates myasthenic crisis. The other two options are unrelated to the test.

Monitoring of a patient on gabapentin to treat seizures includes: 1. Routine therapeutic drug levels every 3 to 4 months 2. Assessing for dermatologic reactions, including Steven's Johnson 3. Routine serum electrolytes, especially in hot weather 4. Recording seizure frequency, duration, and severity Logged

4.

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline (Eldepryl) with carbidopa-levodopa (Sinemet) to the medication regime should result in which purpose? A) Slows the progression of the disease B) Replaces dopamine C) Relieves symptoms of dyskinesia D) Prevents side effects from Sinemet

A Feedback: Selegiline (Eldepryl) increases dopaminergic activity and slows the progression of the disease. Carbidopa-levodopa (Sinemet) is a dopamine replacement drug. Anticholinergic drugs (such as Cogentin) are used to reduce the symptoms of dyskinesia and other side effects.

A patient taking entacapone (Comtan) for Parkinson's disease informs the nurse that his urine is now brownish-orange in color. What is the nurse's best action? a. Explain that this is an expected side effect and is not harmful. b. Collect a urine sample and send it to the laboratory for urinalysis. c. Hold the drug and immediately notify the prescriber. d. Instruct the patient to increase his intake of fluids.

A Entacapone may discolor a patient's urine brownish-orange. This is an expected side effect and is not harmful.

The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order? a. Adrenocorticotropic hormone (ACTH) b. Cyclophosphamide (Cytoxan) c. Glatiramer acetate (Copaxone) d. Interferon-B (IFN-B)

ANS: A ACTH is given to treat an acute attack of MS. Glatiramer acetate and interferon are used for remission-exacerbation states. Cyclophosphamide is given for chronic, progressive symptoms.

The nurse is caring for a patient who has a seizure disorder. The nurse notes that the patient has reddened gums that bleed when oral care is given. The nurse recognizes this finding as a. an adverse effect of the phenytoin. b. a drug interaction with aspirin. c. a symptom of hepatotoxicity. d. a sign of poor self-care.

ANS: A Hydantoins commonly cause gingival hyperplasia, which causes overgrowth of reddened gum tissue that bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack of self-care.

A client with myasthenia gravis demonstrates diplopia, ptosis, and dysphagia. The client is ordered to receive pyridostigmine bromide (Mestinon). What would indicate a positive outcome? a. Increase in the ability to sleep b. Decrease in muscle weakness c. Increase in hemiparesis d. Decrease in metabolic rate

ANS: B A decrease in weakness would indicate a positive response.

A nurse is providing patient education for a 71-year-old patient and the spouse. The patient has taken levodopa (Dopar) for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. The nurse should tell the patient a. "Stop the drug. If you have not noticed any effects within 2 weeks, the prescriber may need to change your drug regime." b. "It may take several months for a response to occur. Continue the medication as prescribed." c. "Double the dose to see whether an effect occurs. Finding the correct dose takes many adjustments." d. "Another agent will need to be added to the regimen to manage your symptoms."

ANS: B Full therapeutic response with levodopa may take several months to develop. Patients should not expect immediate improvement. They should be informed that beneficial effects are likely to increase steadily over the first few months.

The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon). The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing. What action will the nurse perform next? a. Contact the provider to request an order for atropine sulfate. b. Contact the provider to request an order for edrophonium chloride (Tensilon). c. Report signs of cholinergic crisis to the provider. d. Report signs of myasthenic crisis to the provider.

ANS: B Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia. Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor. When given, if the symptoms are alleviated, the cause is myasthenic crisis; if symptoms worsen, it is cholinergic crisis. Since patients can have similar symptoms, the nurse cannot report one or the other to the provider without more information.

A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patient's urine. Which action will the nurse take? a. Ask the provider to order a serum drug level. b. Reassure the patient that this is a harmless side effect. c. Report possible thrombocytopenia to the provider. d. Request an order for a urinalysis and creatinine clearance.

ANS: B Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient. It is not necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia.

A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take? a. Start fluids via a large-bore catheter. b. Turn the client's head to the side. c. Administer IV push diazepam. d. Prepare to intubate the client.

ANS: B The nurse should turn the client's head to the side to prevent aspiration and allow drainage of secretions. Anticonvulsants are administered on a routine basis if a seizure is sustained. If the seizure is sustained (status epilepticus), the client must be intubated and should be administered oxygen, 0.9% sodium chloride, and IV push lorazepam or diazepam.

A patient with advanced Parkinson's disease who takes levodopa (Dopar) has been taking bromocriptine (Parlodel) for several weeks. Which of the following findings should most concern the nurse? a. Increased urine output b. Nightmares and agitation c. A consistent increase in respirations d. Swelling and redness in the feet

ANS: C A consistent increase in respirations should most concern the nurse, because bromocriptine can cause pulmonary infiltrates.

A patient with advanced Parkinson's disease who takes levodopa (Dopar) has been taking bromocriptine (Parlodel) for several weeks. Which of the following findings should most concern the nurse? a. Increased urine output b. Nightmares and agitation c. A consistent increase in respirations d. Swelling and redness in the feet

ANS: C A consistent increase in respirations should most concern the nurse, because bromocriptine can cause pulmonary infiltrates. Bromocriptine does not cause an increase in urine output. Nightmares and agitation may occur, but the increase in respirations should cause the most concern, because pulmonary infiltrates may lead to congestive heart failure. Swelling and redness in the feet are important but rare side effects They are not as notable as a consistent increase in respirations.

A nurse is providing patient education for a patient who is to gradually discontinue baclofen (Lioresal). The nurse advises the patient to avoid abrupt discontinuation of the medication to prevent which adverse effect? a. Weakness b. Fatigue c. Seizures d. Respiratory depression

ANS: C Abrupt discontinuation (or withdrawal) from baclofen has been associated with adverse reactions such as visual hallucinations, paranoid ideation, and seizures. Central nervous system effects may cause weakness and fatigue but not as a result of abrupt discontinuation. Respiratory depression is a result of overdose, not abrupt discontinuation of the baclofen.

A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen (Lioresal) but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects? a. Weakness and dizziness b. Fatigue and drowsiness c. Seizures and hallucinations d. Respiratory depression and coma

ANS: C Abrupt discontinuation of baclofen is associated with visual hallucinations, paranoid ideation, and seizures. Central nervous system effects of baclofen include weakness, dizziness, fatigue, and drowsiness. Respiratory depression is a result of overdose of baclofen.

A patient diagnosed with multiple sclerosis has been admitted to your unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What would you include as an expected outcome of this medication? A) Reduction in the appearance of new lesions on the MRI B) Decreased muscle spasms in the lower extremities C) Increased muscle strength in the upper extremities D) Limits severity and duration of exacerbations

Ans: B Feedback: Baclofen, a GABA agonist, is the medication of choice in treating spasms. It can be administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions on the MRI. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa (Sinemet) for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider? a. Taking a lower dose on an empty stomach b. Taking an increased dose along with a high-protein snack c. Taking a lower dose with a low-protein snack d. Taking dopamine in addition to levodopa/carbidopa

ANS: C Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla.

When teaching the client prescribed bromocriptine mesylate, the nurse should include which of the following instructions? a. "This will prevent your breasts from being engorged." b. "It's OK to let your baby suckle intermittently." c. "If your breasts get full, just take a hot shower to relieve the discomfort." d. "Rise slowly from a sitting or lying position."

ANS: D Feedback A Incorrect: Engorgement can still occur. B Incorrect: This will stimulate milk production. C Incorrect: This will stimulate milk letdown and further milk production. D Correct: An adverse effect of this drug is hypotension.

A health-care provider administers edrophonium (Tensilon) to a school-age child with new onset of muscle weakness. The child is able to hold her eyes open for the duration of the drug's half-life. Which information does the nurse plan to teach the child and parents? A. Muscle weakness will progress in an ascending fashion. B. Pain control will be an important aspect of the child's care. C. This disease is a result of a previous viral infection. D. Weakness and fatigue will probably be worse during the day.

ANS: D A positive result to a Tensilon test is diagnostic for myasthenia gravis, an autoimmune disease uncommon in children. Muscle weakness is the main symptom, and the weakness is particularly pronounced in muscles used for eye movement, chewing, swallowing, and breathing. Weakness is usually worse during the day or during times of stress. It is not painful, muscle weakness does not progress in ascending fashion as in Guillain-Barré syndrome, and the cause is unknown.

A patient experiences severe muscle weakness, and the provider orders edrophonium bromide (Tensilon). The patient begins to show improved muscle strength within a few minutes after administration of this drug. The nurse anticipates the provider will order which drug? a. Atropine sulfate b. Edrophonium bromide (Tensilon) c. Intravenous immune globulin (IVIG) d. Pyridostigmine HCl (Mestinon)

ANS: D In this case, edrophonium is used to diagnose myasthenia gravis. Since symptoms improved with the AChE inhibitor, the patient will benefit from a longer-acting AChE inhibitor such as pyridostigmine. Atropine is given for AChE inhibitor overdose. Edrophonium is very short-acting, so it will not be used for treatment. IVIG is used when other AChE inhibitors fail.

The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects? What is the name of this drug? A) Bromocriptine B) Carbidopa C) Amantadine D) Trihexyphenidyl

B Feedback: Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues, thereby leading to higher levels crossing the blood-brain barrier.

The nurse has a patient who is receiving selegiline (Carbex, Eldepryl). What is the nurse's priority assessment? A) Irregular heart rate B) Elevated blood pressure C) Decreased urinary output D) Gingival hyperplasia

B Feedback: The excessive stimulation of the sympathetic nervous system can cause severe hypertension and stroke so it is important for the nurse to assess blood pressure. Gingival hyperplasia is an adverse effect of phenytoin (Dilantin). Irregular heart rate and decreased urinary output are not adverse effects of selegiline.

A patient with multiple sclerosis is admitted to the unit for an acute exacerbation and is given interferon beta-1a (Avonex). What questions related to adverse effects should the nurse include in the physical assessment? a. "Are you experiencing any gastrointestinal upset or diarrhea?" b. "Do you have a headache, chills, or muscle aches?" c. "Are you having any swelling in your legs or shortness of breath?" d. "Do you have or have you experienced any ringing in your ears?"

B Assessment of the patient should include assessing for flulike symptoms, which often are adverse effects associated with interferon beta-1a. Interferon beta-1a does not have the adverse effect of gastrointestinal symptoms. Swelling in the legs and shortness of breath may indicate cardiotoxicity, which is seen most often with mitoxantrone, not interferon beta-1a. Tinnitus is not an adverse effect of interferon beta-1a.

A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action? a. Increasing the dose of amantadine [Sym-metrel] b. Interrupting treatment with amantadine for several weeks c. Ordering renal function tests d. Ordering another anticholinergic medication

B When amantadine is added to therapy to treat dyskinesias associated with levodopa, it often loses effectiveness after several months. If the effects diminish, they can be restored by either increasing the dosage or by interrupting treatment for several weeks. The maximum dosage of amantadine is 400 mg/day, so it is incorrect to increase the dose. Altered renal function would result in drug toxicity, not ineffectiveness of the drug. It is not necessary to order another drug until determining whether the effectiveness can be restored.

A client with myasthenia gravis is receiving pyridostigmine (Mestinon). Which medications should the nurse question prior to administering to this client? Standard Text: Select all that apply. 1. Decadron 2. Ibuprofen 3. Warfarin 4. NPH insulin 5. Lidocaine

Correct Answer: 1,2,5 Rationale 1: Cholinergic drugs increase gastric acid secretion and should be used with caution with corticosteroids such as Decadron. Rationale 2: Cholinergic drugs increase gastric acid secretion and should be used with caution with nonsteroidal anti-inflammatory drugs such as ibuprofen. Rationale 5: Drugs that interfere with neuromuscular transmission such as lidocaine should be used with caution in the client with myasthenia gravis because severe muscular weakness may result.

A patient has been diagnosed with a brain tumor, which has caused partial seizure activity. The patient is being treated with gabapentin (Neurontin). After administering the medication, the nurse should assess the patient because of the potential for what adverse effect? A) Tetany B) Hypersensitivity C) Paradoxical seizures D) CNS depression

D Feedback: The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. The drug has not been noted to cause tetany, hypersensitivity reactions, or paradoxical seizures.

A nurse is providing education to the other nurses on the unit on how to differentiate between a myasthenic crisis and a cholinergic crisis. To show that they understand the difference, the nurses could state that they should a. ask the patient about occupation and family history. b. assess serum levels of the cholinesterase inhibitors. c. assess the patient about muscle weakness. d. administer edrophonium (Tensilon) and monitor the response.

D The Tensilon test provides information as to whether a patient is experiencing a myasthenic crisis or a cholinergic crisis. If the patient's symptoms worsen with Tensilon, the individual most likely is overmedicated and experiencing a cholinergic crisis; the patient should then be given atropine as an antidote. If the patient's symptoms improve with the administration of Tensilon, the person most likely was undermedicated and is experiencing a myasthenic crisis. The occupational and family history will not provide information that can differentiate between the two crises. Serum levels of cholinesterase inhibitors would not provide information that can differentiate between the two crises. Assessing the patient for muscle weakness will not provide specific enough information to diffe-rentiate between the two crises.

The client is prescribed phenytoin (Dilantin) for treatment of a seizure disorder. What precautions or instructions should be taught to this client? A. "Do not take aspirin or aspirin-containing products while on this medication." B. "Avoid contact sports and heavy physical exercise while on this medication." C. "Avoid direct exposure to sunlight while on this medication." D. "Do not take warfarin (Coumadin) while on this medication."

D Warfarin inhibits the metabolism of phenytoin, increasing the half-life of phenytoin and the risk of toxic levels.

A client is taking carbamazepine (Tegretol). What type of seizure activity does the nurse anticipate this client has experienced? 1. Tonic-clonic seizure 2. Absence seizure 3. Simple partial seizure 4. Febrile seizure

Rationale 1:Carbamazepine (Tegretol) is the drug of choice for tonic-clonic and partial seizures because it produces fewer adverse effects than does phenytoin or phenobarbital.

A client with Parkinson disease who is receiving entacapone (Comtan) is to be given epinephrine for cardiopulmonary resuscitation. The nurse should be aware that entacapone (Comtan) causes an increased effect of epinephrine on the heart due to which action? 1. Stimulation of the enzyme COMT in the synaptic cleft 2. Inhibition of the enzyme COMT in the synaptic cleft 3. Increased reuptake of the enzyme COMT from the synaptic cleft 4. Excessive secretion of the enzyme COMT from the synaptic vesicles

Rationale 2: Entacapone (Comtan) causes inhibition of COMT in the synaptic cleft. This causes an increased effect of epinephrine on the heart and blood pressure.

A patient who takes benztropine (Cogentin) has developed constipation. What treatment should the nurse recommend? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Try drinking a glass of wine each evening." 2. "Take docusate (Colace) every evening." 3. "Increase your fluid intake." 4. "Taking a walk each day may help." 5. "Stop taking your medication until your bowel function normalizes."

Rationale 3: Increasing fluid intake is recommended to treat constipation. Rationale 4: Exercising is recommended to treat constipation.

The patient receives levodopa and carbidopa (Sinemet). What will the best teaching by the nurse include as relates to this medication? 1. Avoid drinking caffeinated beverages. 2. Take the medication with meals. 3. Take the medication on an empty stomach. 4. Take the medication with a protein food.

Rationale 3: Levodopa and carbidopa (Sinemet) should be taken on an empty stomach for better absorption. Levodopa and carbidopa (Sinemet) should be taken on an empty stomach for better absorption. Levodopa and carbidopa (Sinemet) should not be taken with meals; this will decrease absorption. Levodopa and carbidopa (Sinemet) should not be taken with a protein food; this will decrease absorption. There isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet).

An older adult receives levodopa, carbidopa, and entacapone (Stalevo). The nurse is primarily concerned about which problem with this patient? 1. Hypertension 2. Diarrhea 3. Muscle twitching 4. Dark urine

Rationale 3: Muscle twitching may indicate toxicity. Muscle twitching may indicate toxicity. Constipation, not diarrhea, is a side effect of levodopa, carbidopa, and entacapone (Stalevo). Dark urine is a normal finding associated with this medication. Hypotension, not hypertension, is possible with levodopa, carbidopa, and entacapone (Stalevo).

The patient receives aspirin, a multivitamin, and an antihistamine every day. What is the best instruction by the nurse prior to administering levodopa, carbidopa, and entacapone (Stalevo)? 1. "You should not take the aspirin with your levodopa, carbidopa, and entacapone (Stalevo)." 2. "You should not take the antihistamine with your levodopa, carbidopa, and entacapone (Stalevo)." 3. "You should not take the multivitamin with your levodopa, carbidopa, and entacapone (Stalevo)." 4. "These medications are safe to take with levodopa, carbidopa, and entacapone (Stalevo)."

Rationale 3: Vitamin B6 will decrease the effects of levodopa, carbidopa, and entacapone (Stalevo), so the patient should not take a multivitamin while receiving levodopa, carbidopa, and entacapone (Stalevo).

The client receives levodopa. Which foods can the nurse include in the dietary teaching for this client? (Select all that apply.) 1. Banana 2. Green, leafy vegetables 3. Citrus fruit 4. Chocolate 5. Fish

Rationale 3: Vitamin B6 will interfere with the effectiveness of levodopa. Citrus fruits may be included in the diet because they are low in vitamin B6. Rationale 4: Chocolate may be included in the diet because it is low in vitamin B6. Global Rationale: Vitamin B6 and protein will interfere with the effectiveness of levodopa. Citrus fruits and chocolatemay be included in the diet because they are low in vitamin B6. Banana and green, leafy vegetables should be avoided because they are high in vitamin B6. Fish should be avoided as it is high in protein.

The nurse is preparing to administer intravenous lorazepam (Ativan) to a client. Which nursing intervention is a priority following the parenteral administration of this medication? 1. Assess for drug interactions with other medications. 2. Instruct client to change positions slowly, especially from lying to standing. 3. Monitor for changes in respirations. 4. Assess for seizure activity.

Rationale 3: When providing this medication through the parenteral route, the client should be monitored for respiratory depression. When providing this medication through the parenteral route, the client should be monitored for respiratory depression. Assessing for drug interactions with other medications should be completed prior to administering the medication. Changing position slowly, especially from lying down to standing, helps to prevent dizziness and possible falls, especially in the older adult. However, this is not the priority intervention when administering the medication. Ativan is used for several off-label indications, including seizures. However, this is not the priority intervention when administering the medication.

An adult client, diagnosed with Parkinson disease, has been prescribed levodopa. What nursing observations would indicate that the medication is working? 1. Increased strength on affected side 2. Blood pressure changes from 180/90 to 140/80mmHg. 3. Urine output increases to 60 mL per hour. 4. Decrease in tremors in upper extremities

Rationale 4: Levodopa would decrease tremors in upper extremities. Global Rationale: Levodopa would decrease tremors in upper extremities. Decreased strength on affected side is symptom of a CVA, not of Parkinson disease. Levodopa does not decrease blood pressure. Levodopa does not increase urine output.

The nurse has completed medication education about pyridostigmine (Mestinon), an indirect cholinergic drug, for the patient with myasthenia gravis. The nurse determines that learning has occurred when the patient makes which statement? 1. "My heart may beat slower while I am on this drug." 2. "I will need to increase my fluid intake with this medication." 3. "I must take this medication immediately before eating a full meal." 4. "It is really important to take my medication on time."

Rationale 4: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed. Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed. Heart rate is typically increased by anticholinergic drugs. There is no reason to increase fluid intake with this drug. There is no reason this drug should be taken immediately prior to eating a full meal.

A patient is admitted to the emergency room with uncontrolled tonic-clonic seizures. What medication is administered intravenously to assist in reducing seizure activity? A) Lorazepam (Ativan) B) Phenytoin (Dilantin) C) Ethosuximide (Zarontin) D) Gabapentin (Neurontin)

a

A nurse is caring for a patient who is starting gabapentin therapy. During the initial assessment the patient informs the nurse that he takes antacids every day. The nurse will stress to the patient that gabapentin should be taken A) at least 1 hour before ingesting antacids. B) at least 2 hours after administering antacids. C) intravenously. D) with milk or food.

b

A patient with multiple sclerosis will be starting therapy with an immunosuppressant drug. The nurse expects that which drug will be used? a. Azathioprine (Imuran) b. Glatiramer acetate (Copaxone) c. Daclizumab (Zenapax) d. Sirolimus (Rapamune)

b