1538 Passpoint
A client has asked the nurse about the expected course of Ménière disease. The nurse should give the client which information?
"Control of the episodes is usually possible, but a cute is not yet available."
When the client prescribed entacapone asks the nurse to describe exactly how this medication works, what response is most appropriate?
"Entacapone inhibits COMT so that dopamine is active for a longer time."
The nurse educates a client diagnosed with Parkinson disease and family about managing the chronic condition and important aspects about the prescribed medications. Which client statement indicates the need for further clarification?
"I will have my family journal about any facial grimacing, protruding tongue, exaggerated chewing, head movements and report it at the next visit to my health care provider."
After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old has been diagnosed with Parkinson's disease and will soon begin treatment with carbidopa-levodopa. Which statement indicates that the client 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 client asks the nurse to explain the development of Parkinson disease (PD). Which response will the nurse provide the client?
"It is caused by low levels of dopamine that are not available to counteract the effects of acetylcholine."
The nurse is educating a client diagnosed with Parkinson 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."
An older adult has encouraged their spouse to visit their health care provider, stating their concern that the spouse may have Parkinson disease. Which description of the spouse's health and function is most suggestive of Parkinson disease?
"Lately they seem to move far more slowly than they ever have in the past."
A client with Parkinson disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The client reports that they have been achieving relief for the past few weeks by using over-the-counter laxatives. How should the nurse respond?
"Let's explore other options, because laxatives can have side effects and create dependency."
A group of students are differentiating the various classifications of drugs used to treat Parkinson disease. The instructor determines the session is successful when the students correctly choose which drugs as belonging to the dopaminergic classification? Select all that apply.
- Amantadine - Bromocriptine - Carbidopa
Which are classified as dopaminergic drugs? (Select all that apply.)
- Amantadine (Symmetrel) - Bromocriptine (Parlodel) - Carbidopa (Lodosyn)
A nurse is investigating for the potential source of the Parkinson-like signs a client is suddenly exhibiting. Which potential medications should the nurse question in the client's medical record? Select all that apply.
- Antidepressants - Conventional antipsychotics - Lithium
The nurse has administered carbidopa/levodopa to a client. Which findings should the nurse prioritize on the ongoing assessment? Select all that apply.
- Choreiform movements - dry mouth - anorexia
A 58-year-old construction worker fell from a 25-foot scaffolding and incurred a closed head injury as a result. As their intracranial pressure continues to increase, the potential of herniation also increases. If the brain herniates, which of the following are potential consequences? Choose all correct options.
- Death - Permanent neurologic dysfunction - Impaired cellular activity - Seizures
When describing the possible adverse effect(s) associated with trihexyphenidyl therapy, what would the nurse include? Select all that apply.
- Delirium - Agitation - Blurred vision
The client diagnosed with Parkinson disease has been prescribed levodopa. What action(s) should the nurse include in the care plan? Select all that apply.
- Discuss falls precaution strategies. - Monitor for urine retention. - Monitor for cardia arrhythmias. - Monitor for dysphagia. - Discuss strategies to support adequate nutrition.
A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply.
- Dysphagia - Choking - Constipation
A nurse is reviewing the medication record of several clients with Parkinson disease. The nurse identifies which drug if included in the client's record as being classified as a catechol-O-methyltransferase (COMT) inhibitor drug? Select all that apply.
- Entacapone - Tolcapone
Which are classified as catechol-O-methyltransferase (COMT) inhibitor drugs? (Select all that apply.)
- Entacapone (Comtan) - Tolcapone (Tasmar)
The nurse is conducting a preadministration assessment of a client prescribed entacapone. The nurse determines caution is warranted after discovering which disorders listed in the client's past history? Select all that apply.
- Hypotension - Renal dysfunction - Hepatic dysfunction - Hypertension
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 is questioning the recent prescription of Stalevo. The nurse explains it is a combination drug consisting of which medications? Select all that apply.
- Levodopa - Carbidopa - Entacapone
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
Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply.
- Tremor - Rigidity - Bradykinesia - Postural instability
The nurse is providing education for a client who has been prescribed phenytoin. What adverse reactions should the nurse discuss in the teaching? Select all that apply.
- ataxia - nausea - lethargy - gingival hyperplasia
A nurse is caring for a client with Parkinson's. Which factor(s) in the client's history that could have triggered the onset of Parkinson's? Select all that apply.
- certain drugs - head trauma - encephalitis
A 41-year-old client diagnosed with multiple sclerosis (MS) is sharing their story with members of an MS support group made up of people recently diagnosed. Which aspect(s) of their condition should the client warn others to expect at some point in the progression of the disease? Select all that apply.
- debilitating fatigue - progressive loss of visual acuity - loss of mental acuity
The nurse is providing education to a client who has been prescribed anticholinergic drug therapy. What adverse effects will the nurse mention during teaching? Select all that apply.
- dry mouth - blurred vision - urinary retention
The nurse is preparing to administer a new drug to a client currently prescribed carbidopa/levodopa, which can decrease its effects. Which medication(s) will require the nurse to monitor for decreased carbidopa/levodopa effectiveness? Select all that apply.
- phenytoin - amitriptyline - pyridoxine
A client with Parkinson disease is having difficulty swallowing and is unable to continue taking prescribed oral medications. Which medication(s) would the nurse anticipate being prescribed for this client? Select all that apply.
- rotigotine - apomorphine
A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range?
12 mcg/mL
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 their 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 being evaluated in the clinic for a potential diagnosis of Parkinson's disease. What initial symptom observed by the nurse indicates the correlation between the symptoms and the disease process?
A resting tremor of the fingers and thumb of that hand
The client is reporting GI disturbances after receiving the first dose of carbidopa/levodopa for Parkinson disease. Which action should the nurse prioritize for this client?
Administer the next drug dose with meals.
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?
Amyotrophic lateral sclerosis
When is Parkinson's disease usually diagnosed?
Around 60 years of age
An older adult client diagnosed with Parkinson 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
The nurse is assessing a client for the effectiveness of the antiparkinson drug. If the nurse determines the client has improvement in these movements, which factor will the nurse point out has improved?
Bradykinesia
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
The nurse is assessing motor strength in a client with a head injury. Which is the best way to determine motor strength for this client?
Compare equality of hand grasps.
A 70-year-old client with Parkinson disease is prescribed an anticholinergic drug. Which finding on assessment should the nurse prioritize?
Confusion and disorientation
Regarding the pathophysiology of Parkinson disease, which statement is true?
Degeneration of the nigrostriatal dopamine neurons occurs.
A client is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level?
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?
Dopamine
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?
Dopamine nigrostriatal system
The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease?
Drugs administered may cause a wide variety of adverse effects.
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?
Dyskinesia
A nurse has administered entacapone to a 55-year-old client with Parkinson disease. Which adverse reaction should the nurse prioritize?
Dyskinesia
The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa for 7 years. For what common side effect should the nurse assess this client?
Dyskinesia
The nurse is planning the care for a client who has had a posterior fossa (infratentorial) craniotomy. What should the nurse avoid when positioning the client?
Elevating the head of the bed to 30 degrees.
The nurse instructs the parent of a young school-age child with a seizure disorder who takes an AED to be alert for what signs and symptoms?
Excessive sedation and interference with learning and social development
The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. What should the nurse do?
Explain how to overcome a freezing gait by telling the client to march in place.
The underlying causative problem in Parkinsonism is:
Failure of dopamine release
A client has experienced a seizure in which they became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize?
Generalized seizure
A nurse is caring for a client who suffered a stroke. The family reports that the nurse on the previous shift failed to administer medications properly or maintain client privacy. What is the best action by the nurse?
Inform the charge nurse of the family's concerns.
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.
A client begins tolcapone therapy, and the 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
A client is prescribed selegiline. The nurse is aware that which analgesic should not be given to the client?
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
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?
Monitoring blood pressure
Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction?
Myasthenia gravis
Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability?
Myasthenia gravis
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
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
Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding?
Paralysis
The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain?
Parkinson disease
Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?
Parkinson disease
Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells?
Parkinson disease
A client is admitted to the hospital for management of an extrapyramidal disorder. Included in the health care provider's admitting orders are the medications levodopa, benztropine, and selegiline. The nurse knows that most likely, the client has a diagnosis of:
Parkinson 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 appropriate?
Provide proper assistance with ambulation.
Which nursing diagnosis would be most important for a nurse to include in the plan of care for a client who is receiving an antiseizure agent and experiencing common adverse effects?
Risk for injury
A client with Parkinson disease is undergoing a swallowing assessment because the client has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method?
Semisolid food with thick liquids
A family brings their parent to their health care provider for a checkup. Since their last visit, they note their parent has developed a tremor in their hands and feet. They also roll their fingers like they have a marble in their hand. The health care provider suspects the onset of Parkinson disease when they note which abnormality in the client's gait?
Slow to start walking and has difficulty when asked to "stop" suddenly
A client is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed?
Status epilepticus
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
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?
The client's Sinemet was likely less effective than in the past
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 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 client is diagnosed with Parkinson's disease and is having difficulty performing their activities of daily living. The 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 is taking levodopa. What should the nurse caution the client to avoid?
Vitamin B6
A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?
When the client is resting
The nurse is caring for client who has been living with Parkinson disease for the past 10 years and is being treated with levodopa-carbidopa. The client often leaves the unit with family for extended periods. What should the nurse prioritize when teaching the client?
Your medication needs to be taken at equal intervals to reduce symptom fluctuation.
The nurse is assessing the client with Parkinson disease. Which finding is expected?
a stiff, masklike facial expression
A client has had a cerebrovascular accident, which has affected the left side of the client's brain. The nurse should assess the client for which symptom?
aphasia
A nurse is caring for a 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
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 client should be aware that the adverse effects of centrally acting anticholinergic drugs include:
confusion
The nurse is teaching a client who has had cataract surgery how to decrease intraocular pressure. What should the nurse instruct the client to avoid?
coughing
Common side effects of anticholinergics include:
dry mouth, urinary retention, constipation, and increased pulse rate.
A client with a complex medical history has been diagnosed with Parkinson's disease. The client's current medication regimen includes omeprazole, ranitidine, multivitamins, albuterol and ipratropium. Before the client begins treatment with levodopa, the nurse should:
ensure the multivitamin is discontinued by the provider.
Loss of coordinated movement, muscle rigidity, and immobility without paralysis is likely due to damage to:
extrapyramidal tracts.
A client undergoes cerebral angiography for evaluation after an intracranial computed tomography scan revealed a subarachnoid hemorrhage. Afterward, the nurse checks frequently for signs and symptoms of complications associated with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a clot?
hemiplegia, seizures, and decreased level of consciousness (LOC)
The geriatrician providing care for a 74-year-old client with a diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the likely focus of the pharmacologic treatment of the client's health problem?
increasing the functional ability of the underactive dopaminergic system
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.
An older adult with Parkinson's disease being treated with carbidopa-levodopa begins experiencing auditory and visual hallucinations. What does the nurse identify as the appropriate action to discuss with the health care provider?
reducing the dose of the medication
The nurse is assessing a client with Parkinson disease. Which is an initial sign of Parkinson disease?
tremor
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client?
use of anticonvulsant medications
