ch 28 pharm

8. The nurse understands the need for cautious administration of the prescribed entacapone to a client with which of the following? Select all that apply. A) Hypotension B) Renal dysfunction C) Hepatic dysfunction D) Diabetes E) Hypertension

Ans: A, B, C, E Feedback: The nurse should cautiously administer entacapone (Comtan) to clients with hypotension, hypertension, and decreased hepatic or renal function.

2. A group of students are reviewing antiparkinson drugs. They demonstrate understanding when they identify which of the following as classified as dopaminergic drugs? Select all that apply. A) Amantadine (Symmetrel) B) Bromocriptine (Parlodel) C) Biperiden (Akineton) D) Carbidopa (Lodosyn) E) Benztropine (Cogentin)

Ans: A, B, D Feedback: Amantadine (Symmetrel), bromocriptine (Parlodel), and carbidopa (Lodosyn) are classified as dopaminergic drugs. Biperiden and benztropine are cholinergic blocking drugs used to treat Parkinson's disease.

13. A client tells the nurse that he takes the drug Stalevo. The nurse understands that this drug is a combination of which of the following? Select all that apply. A) Benztropine B) Levodopa C) Carbidopa D) Tolcapone E) Entacapone

Ans: B, C, E Feedback: Stalevo is a brand-name combination product that contains carbidopa, levodopa, and entacapone.

15. 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.

17. A nurse is caring for a 70-year-old client who is receiving anticholinergic drug therapy for Parkinson's disease. The nurse would be alert for the development of which of the following in this client? A) Confusion and disorientation B) Choreiform movements C) Suicidal tendencies D) Psychotic episodes

Ans: A Feedback: The nurse should assess for confusion and disorientation when caring for this elderly client receiving anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.

5. A client is prescribed carbidopa/levodopa. The nurse understands that this drug should be administered cautiously to clients with which condition? Select all that apply. A) Hyperthyroidism B) Seizure disorder C) Renal disease D) Asthma E) Peptic ulcer disease

Ans: C, D, E Feedback: Carbidopa/levodopa (Sinemet) is used cautiously in clients with cardiovascular or pulmonary disease (asthma), peptic ulcer disease, renal or hepatic disease, and psychosis.

22. A nurse is caring for a client who has received carbidopa/levodopa. After administration of the first dose of the drug, the client has developed gastrointestinal disturbances. Which of the following nursing interventions would be most appropriate? A) Administer the next drug dose with milk. B) Withhold the next drug dose. C) Observe for alterations in blood pressure. D) Administer the next drug dose with meals.

Ans: D Feedback: The nurse should administer the next drug dose with meals to manage gastrointestinal disturbances in a client who has been administered antiparkinsonism drugs. Withholding the next drug dose, administering the next drug dose with milk, or observing alterations in the client's blood pressure are not appropriate interventions when caring for a client who is experiencing GI disturbances with the first dose of antiparkinsonism drugs.

1. A nursing instructor is describing parkinsonism to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as a possible cause? Select all that apply. A) Drugs B) Stroke C) Myocardial infarction D) Encephalitis E) Epilepsy

Ans: A, D Feedback: Parkinsonism may result from the use of certain drugs, head injuries, and encephalitis.

12. When reviewing the medication records of several clients, the nurse notes documentation of nonergot dopamine receptor agonists. Which of the following would the nurse most likely note? Select all that apply. A) Pramipexole (Mirapex) B) Entacapone (Comtan) C) Amantadine (Symmetrel) D) Ropinirole (Requip) E) Benztropine (Cogentin)

Ans: A, D Feedback: Pramipexole (Mirapex) and ropinirole (Requip) are nonergot dopamine receptor agonists.

20. A nurse is assigned to care for a client who is to receive a cholinergic blocking drug. The nurse obtains the history from the client. Which of the following would alert the nurse to the need for cautious administration? A) The client has a decreased liver function. B) The client has a history of hallucinations or psychosis. C) The client has a cardiovascular disease. D) The client has a pulmonary disease.

Ans: A Feedback: It is important for the nurse to know if the client has decreased liver or kidney function so that the cholinergic blocking drug can be administered cautiously in the client. Other conditions in clients that require cautious use include tachycardia, cardiac arrhythmias, hypertension, hypotension, tendency toward urinary retention, and obstructive disease of the urinary system or gastrointestinal tract. The cholinergic blocking drugs are given with caution to older adults. The nurse should use dopamine receptor agonist drugs with caution in clients with a history of hallucinations or psychosis or cardiovascular disease. The nurse should use dopaminergic drugs with caution in clients with pulmonary diseases.

21. A nurse is caring for a client who requires antiparkinson drug therapy. The nurse confirms that which of the following conditions is absent because it would contraindicate the use of the COMT inhibitor? A) Pregnancy B) Achalasia C) Peptic ulcers D) Glaucoma

Ans: A Feedback: The nurse should confirm that the client is not pregnant or lactating and that the client does not have a hypersensitivity to the drug to ensure that the use of COMT inhibitors is not contraindicated. Achalasia, peptic ulcers, and glaucoma are not conditions that are contraindications to the use of COMT inhibitors. The use of cholinergic blocking drugs is contraindicated in clients with achalasia, peptic ulcers, and glaucoma.

16. A nurse is caring for a client who has been prescribed amantadine for the treatment of the influenza A virus. After administration of the drug, the client complains of dry mouth. Which of the following instructions should the nurse offer the client to help relieve dry mouth? A) Instruct the client to take ice chips frequently. B) Encourage the client to take small, frequent meals. C) Instruct the client to avoid protein-rich foods. D) Stop the use of the antiparkinsonism drug by the client.

Ans: A Feedback: The nurse should instruct the client to suck on ice chips or hard candy (if allowed). The nurse should also instruct the client to take frequent sips of water throughout the day and between meals. The nurse encourages the client to have small, frequent meals when the client experiences a GI disturbance and not when the client complains of dry mouth. The nurse also need not instruct the client to avoid protein-rich foods because this will not reduce the client's discomfort due to dry mouth. The nurse should stop the use of the antiparkinsonism drug when the client complains of severe nausea or vomiting and not when the client is experiencing dry mouth. If dry mouth is so severe that there is difficulty in swallowing or speaking, or if loss of appetite and weight loss occur, the dosage of the antiparkinsonism drug may be reduced but not stopped completely.

10. A client is prescribed ropinirole (Requip). The nurse would anticipate an increase in dopamine agonist effects if which of the following medications are initiated? Select all that apply. A) Ranitidine (Zantac) B) Verapamil (Calan) C) Estradiol (Estrace) D) Perphenazine (Trilafon) E) Lisinopril (Prinivil)

Ans: A, B, C Feedback: A client taking ropinirole (Requip) will have increased dopamine agonist effects if ranitidine, verapamil, or estrogens such as estradiol are initiated.

24. A nurse is reviewing the medical record of a client who is exhibiting Parkinson-like adverse reactions due to drug therapy. Which drugs might the nurse note in the client's record? Select all that apply. A) Antidepressants B) Conventional antipsychotics C) Lithium D) Opioids E) NSAIDs

Ans: A, B, C Feedback: Drugs such as antidepressants, antiemetics, first-generation antipsychotics, lithium, and stimulants can cause symptoms similar to Parkinson's disease. Opioids and NSAIDs are not associated with Parkinson-like symptoms.

27. After teaching the family of a client with Parkinson's disease about possible adverse reactions, the nurse determines that the teaching was successful when the family states they will withhold the drug if the client experiences which of the following? Select all that apply. A) Facial grimacing B) Exaggerated chewing motions C) Protruding tongue D) Constipation E) Lack of appetite

Ans: A, B, C Feedback: The nurse should teach the client and family how to describe movements and to be alert for those such as facial grimacing, protruding tongue, exaggerated chewing motions and head movements, and jerking movements of the arms and legs. If these occur, the client should not take the next drug dose and should notify the primary health care provider immediately.

6. A nurse administering carbidopa/levodopa (Sinemet) to a client should monitor the client for decreased effects of carbidopa/levodopa when which of the following medications are initiated? Select all that apply. A) Phenytoin (Dilantin) B) Amitriptyline (Elavil) C) Zonisamide (Zonegran) D) Ibuprofen (Motrin) E) Meperidine (Demerol)

Ans: A, C Feedback: A nurse administering carbidopa/levodopa (Sinemet) to a client should monitor the client for decreased effects of carbidopa/levodopa (Sinemet) when anticonvulsants, like phenytoin and zonisamide, are initiated.

9. After administering tolcapone (Tasmar) to a client, the nurse would be alert for which of the following as a possible adverse reaction? Select all that apply. A) Orthostatic hypotension B) Renal failure C) Dyskinesia D) Dry mouth E) Anorexia

Ans: A, C, E Feedback: Adverse reactions associated with tolcapone (Tasmar) include orthostatic hypotension, dyskinesia, sleep disorders, dystonia, excessive dreaming, somnolence, dizziness, nausea, anorexia, muscle cramps, and liver failure.

7. The nurse would be alert for a client taking benztropine (Cogentin) to have increased anticholinergic effects if which of the following medications are also started? Select all that apply. A) Amantadine (Symmetrel) B) Quetiapine (Seroquel) C) Glycopyrrolate (Robinul) D) Perphenazine (Trilafon) E) Tiotropium (Spiriva)

Ans: A, D Feedback: A client taking benztropine (Cogentin) will have increased anticholinergic effects if amantadine or phenothiazines such as perphenazine are given together.

28. After teaching a group of nursing students issues and problems commonly associated with antiparkinson drug therapy, the instructor determines that the teaching was successful when the students identify which nursing diagnosis as common? Select all that apply. A) Risk for Injury B) Risk for Infection C) Diarrhea D) Impaired Physical Mobility E) Imbalanced Nutrition: More Than Body Requirements

Ans: A, D Feedback: Common drug therapy-related nursing diagnoses include Risk for Injury, Constipation, Impaired Physical Mobility, Imbalanced Nutrition: Less Than Body Requirements, and Disturbed Sleep Pattern.

25. A client is admitted to the health care facility with a diagnosis of Parkinson's disease. When assessing the client, which of the following would the nurse expect to find? Select all that apply. A) Slurred speech B) Erect posture C) Step-like gait D) Tremors E) Rapid, jerky movements

Ans: A, D Feedback: The cardinal signs of Parkinson's disease include tremors, rigidity, and slow movement (bradykinesia). Other symptoms of Parkinson's disease include slurred speech, a mask-like and emotionless appearance of the face, and difficulty chewing and swallowing. The patient assumes a rigid, bent-forward posture and the gait becomes unsteady and shuffled.

11. A client is receiving carbidopa/levodopa (Sinemet). When assessing this client for possible adverse reactions, which of the following might the nurse note? Select all that apply. A) Choreiform movements B) Hyperglycemia C) Hypotension D) Dry mouth E) Anorexia

Ans: A, D, E Feedback: The most common adverse reactions associated with carbidopa/levodopa include anorexia, nausea, vomiting, abdominal pain, dysphagia, dry mouth, mental changes, headache, dizziness, increased hand tremor, and choreiform and dystonic movements.

4. A nurse reviews a client's medical record for possible conditions that would contraindicate the use of carbidopa/levodopa (Sinemet). Which of the following would the nurse identify as a contraindication? Select all that apply. A) Narrow-angle glaucoma B) Renal disease C) Hepatic disease D) Diabetes E) Use of MAOI antidepressants

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

26. After administering an antiparkinson drug to a client, the nurse assesses the effectiveness of the drug. The nurse notes that the client's slow movements have improved. The nurse documents this as an improvement in which of the following? A) Akathisia B) Bradykinesia C) Achalasia D) Choreiform movements

Ans: B Feedback: Bradykinesia refers to the slow movements associated with Parkinson's disease. Akathisia refers to extreme restlessness and increased motor activity. Achalasia refers to the failure to relax, usually referring to the smooth muscle fibers of the GI tract. Choreiform movements refer to the involuntary muscular twitching of the limbs or facial muscles.

14. A nurse is caring for a client who has been prescribed pramipexole for the treatment of Parkinson's disease. From the client's medical records, the nurse understands that the client is taking verapamil. The nurse understands that the client is at increased risk for which effect from the interaction of the two drugs? A) Cardiac symptoms B) Agonist effectiveness C) Toxicity of both drugs D) Psychotic behavior

Ans: B Feedback: The nurse should assess for an increased risk of agonist effectiveness in the client. Increased risk of cardiac symptoms and increased risk of toxicity of both drugs are the effects of the interaction of COMT inhibitors with MAOI antidepressants and adrenergic drugs. Increased risk of psychotic behavior is the effect of the interaction of cholinergic blocking drugs with haloperidol.

18. A nurse is assigned to care for a 40-year-old client with a hepatic injury that has occurred due to the administration of tolcapone. Which of the following interventions should the nurse perform when caring for this client? A) Monitor the client for signs of tactile hallucinations. B) Monitor the client for signs of dystonic movements. C) Perform regular blood tests of the client. D) Perform serum transaminase level testing every day.

Ans: C Feedback: A serious and potentially fatal adverse reaction to tolcapone is hepatic injury. The nurse should, therefore, perform regular blood testing to monitor liver function of the client as prescribed. The testing of serum transaminase levels may be ordered at frequent intervals such as every 2 weeks for the first year and every 8 weeks thereafter. The nurse need not perform serum transaminase level testing every day. The nurse should monitor for signs of dystonic movements when caring for a client receiving carbidopa and levodopa, not tolcapone. The nurse should monitor for signs of tactile hallucinations when caring for an elderly client receiving tolcapone.

23. A client with Parkinson's disease is undergoing treatment in a health care facility. Which of the following nursing interventions should the nurse perform as part of the client's ongoing assessment? A) Assess the client for ability to perform the daily activities. B) Observe the current mental condition of the client. C) Observe the client for various neuromuscular signs. D) Prepare a baseline for future evaluations of the client's drug therapy.

Ans: C Feedback: The nurse should evaluate the client's response to drug therapy by observing the client for various neuromuscular signs to compare these observations with the data obtained during the initial physical assessment. The nurse should assess the client's ability to perform daily activities and observe the client's current mental condition before the drug is administered to the client as part of the preadministration assessment. During the preadministration assessment, before starting the drug therapy, the nurse also performs a physical assessment of the client to provide a baseline for future evaluations of drug therapy.

19. A nurse is caring for a 70-year-old client undergoing antiparkinsonism drug therapy. The client is prescribed pramipexole by the physician. The nurse should monitor the client's condition for the development of which of the following adverse reactions associated with the use of this drug? A) Blurred vision B) Memory loss C) Visual hallucinations D) Muscular rigidity

Ans: C Feedback: The nurse should monitor the elderly client who is administered a dopamine receptor antagonist for signs of visual, auditory, or tactile hallucinations. Hallucinations occur more often in older adults than in younger adults receiving the antiparkinsonism drugs, especially when taking the dopamine receptor agonists. The incidence of hallucinations appears to increase with age. The nurse need not monitor the client's condition for signs of blurred vision, memory loss, and muscular rigidity as these conditions are not known to occur in elderly clients due to the use of dopamine receptor agonists.

3. A nurse is reviewing the medication record of several clients with Parkinson's 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. A) Amantadine (Symmetrel) B) Bromocriptine (Parlodel) C) Biperiden (Akineton) D) Entacapone (Comtan) E) Tolcapone (Tasmar)

Ans: D, E Feedback: Entacapone (Comtan) and tolcapone (Tasmar) are classified as COMT inhibitors. Amantadine and bromocriptine are dopaminergic drugs. Biperiden is a cholinergic blocking drug.