3220 Exam 2
Levidopa is always...
given with carbidopa improves motor function
Patient exhibiting symptoms of middle-stage alzheimers, spouse is concerned...
Educate them that this is a normal progression of the disease
Moderate Stage of Alzheimer's
*agitation suspicion paranoia delusions *wandering *no ADLs
How much tylenol can you take with alcohol?
2 grams/day
How long does it take for PD meds to kick in?
2-3 months may need to go on a sterioid
Motrin dose
800 mg / 4 times per day
A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what? A) Limit intake of acetaminophen to less than 2000 mg/day. B) Avoid taking acetaminophen for pain. C) Take acetaminophen with food to reduce the risk of liver damage. D) Avoid taking any pain reliever other than acetaminophen.
A
After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A) Respiratory rate B) Heart rate C) Pain level D) Constipation
A
A patient reports having taken morphine for the past 6 months. Which medication, if ordered by the physician, should the nurse question? A) Promethazine [Phenergan] B) Pentazocine [Talwin] C) Methylnaltrexone [Relistor] D) Dextromethorphan [Delsym]
B
A patient is concerned about developing AD. What should the nurse include in the teaching plan? A) Estrogen replacement therapy improves cognitive functioning. B) No solid evidence supports the use of drugs to prevent AD. C) Naproxen taken daily after the age of 50 years decreases the risk of AD. D) Daily doses of ginkgo biloba can prevent cognitive decline.
B
A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what? A) Renal toxicity B) Bleeding C) Stroke symptoms D) Dysrhythmias
B
A patient taking levodopa/carbidopa [Sinemet] for Parkinson disease experiences frequent "on-off" episodes (ie, the abrupt loss of effect). Which action by the nurse is best? A) Administer the medication when the patient has an empty stomach. B) Instruct the patient to avoid high-protein foods. C) Have the patient increase the intake of vitamin B6. D) Discontinue the drug for 10 days (for a "drug holiday").
B
A patient with rheumatoid arthritis is prescribed methotrexate [Rheumatrex]. The nurse will expect to observe therapeutic effects with this drug in which time period? A) 3 to 7 days B) 3 to 6 weeks C) 3 to 4 months D) 1 to 2 years
B
The nurse is caring for a patient who is receiving pramipexole [Mirapex]. The nurse is most concerned if the patient makes which statement? A) "I take this pill even when I feel good." B) "Sometimes I just fall asleep without warning." C) "The pills make me sleepy, so I take a nap in the afternoon." D) "I have noticed that this medicine makes me constipated."
B
The nurse prepares to administer a cholinesterase inhibitor to a patient with AD. Which medication, if ordered by the healthcare provider, should the nurse question? A) Famotidine [Pepcid] B) Amitriptyline [Elavil] C)Memantine [Namenda] D) Levothyroxine [Synthroid]
B
The nurse prepares to administer memantine [Namenda] to a patient with severe AD. The nurse should assess what before administering of the medication? A) Hemoglobin and hematocrit B) Blood urea nitrogen and serum creatinine C) Aspartate aminotransferase and alanine aminotransferase D) Erythrocyte sedimentation rate and neutrophil count
B
Which statement about enteracept does the nurse identify as true? A. The patient should stop taking the drug if redness appears at the injection site. B. Enteracept can cause liver injury. C. Live vaccines can be administered with enteracept. D. Enteracept is used to treat CNS demyelinating disorders.
B
A patient with rheumatoid arthritis has been taking high-dose aspirin and complains of gastric upset and pain. What does the nurse anticipate will be prescribed for this patient? A) Taking a lower dose of aspirin B) Biweekly injections of methotrexate [Rheumatrex] C) Obtaining a prescription for celecoxib [Celebrex] D) Daily drug therapy with prednisone
C
An older patient with skin cancer and hypertension is prescribed levodopa/carbidopa [Sinemet] to treat Parkinson disease. Which action by the nurse is best? A) Give the medication if the patient's blood pressure is normal. B) Administer the medication as prescribed. C) Ask the patient about the type of skin cancer. D) Hold the medication if the patient is more than 65 years old.
C
A patient with mild symptoms of AD is prescribed donepezil [Aricept]. Which statement made by the patient indicates the need for further teaching? A)"The drug will improve transmission by neurons in my brain." B) "I may experience an upset stomach while taking this drug." C) "I will take the drug every night at bedtime with a snack." D) "The drug will stop damage to the neurons in my brain."
D
Morphine (post-op)
Count respirations* Assess pain Offer fluids Monitor how big abdomen is* (looking for urinary retention)
A patient is prescribed the dopamine agonist pramipexole [Mirapex]. Which statement made by the patient indicates a need for further teaching? A) "The drug should be taken with food to prevent nausea." B) "I may experience hallucinations while taking this drug." C) "I should rise slowly to prevent dizziness and fainting." D) "This drug will stop the progression of Parkinson disease."
D
A postoperative patient who received an intravenous infusion of morphine has a respiratory rate of 8 breaths per minute and is lethargic. Which as-needed medication should the nurse administer to the patient? A) Methadone [Dolophine] B) Nalbuphine [Nubain] C) Tramadol [Ultram] D) Naloxone [Narcan]
D
Nonaspirin NSAIDs differ from aspirin in all but which way? A) They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline. B) They can suppress platelet aggregation, but they are not used to prevent MI and stroke. C) They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time. D) They are safe to use in children with chickenpox or influenza.
D
What is a treatment for someone with dysmenorrhea (aspirin didn't work)?
Ibuprofen (NSAID)
2 tests someone who takes methotrexate would need to have done
Kidney: creatine, DSF Liver: AST, ALT
If oxy isn't working
Move to fentanyl patch
Are any alzheimer's medications going to affect neurons or slow disease process?
No
Do PD medications stop progression of the disease?
No
Do levidopa/carbidopa have neuro protective events?
No
Is Narcan given neo?
No
Can Aroceft stop damage to nerves in the brain?
No (AD Med)
If someone has developed a tolerance to opioids, will they have the same analgesic effect?
No, it will decrease
COMT
PD medication
If giving someone an oral opioid, when must you assess for pain?
before administration and an hour after administration
If someone says, "this oxy is not working for me"
Recommend extended-release instead of increasing their dose of opioid
If a patient is on levidopa/carbidopa and their PD symptoms do not go away...
need to be re-diagnosed (that's how effective these meds are)
Early Stage of Alzheimer's
Short-term memory loss Can't remember stuff they just read Difficulty planning Difficulty organizing a checkbook
Cholinesterase inhibitors [Donepezil (Aricept), Galantamine (Razadyne/ER/Reminyl), Rivastigmine (Exelon)] have what side-effects?
Slow HR Cause lightheadedness
Benefits of Opioids (analgesics)
Suppress cough Bowel motility
Can methotrexate delay joint degeneration?
Yes
Do RA medications slow the progression of the disease?
Yes
Namenda
affects the kidneys (BUN, creatine) alzheimer's med
When can you increase the dose of aricept?
after they've been on it for 3 months
Levidopa/Carbidopa side-effects
agitation nightmares: notify provider lightheaded, dizzy hypotension: tell patient drink more fluid (increase Na)
Addiction
chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain
Long term use of glucocorticoids (prednisone)
diabetes, osteoporosis
How frequently must the patch be changed?
every day
2 risk factors for Alzheimer's
family history age
Final stage of Alzheimer's
loss of speach
If someone has N/V on levidopa/carbidopa, what do you recommend?
low-protein diet
If someone OD's on tylenol, what should you give them?
mucomyst
If someone has elevated creatine levels from taking aricept...
notify provider to get dose reduced
Side-effects of morphine
pupils pinpoint then dilate hypoxia
If a patient is on PD medications for a while and symptoms return...
reduce dose until symptoms go away, then bring it back up
Demerol side-effects
respiratory depression (so you have to check respiratory rate)
If someone is scheduled for surgery and they are taking any kind of aspirin...
stop taking it
Emancidine
treats PD, sometimes you have to stop treatment for several weeks
