Chapter 21: Drugs Treating Parkinson Disease and Other Movement Disorders
Which drug is classified as a cholinergic blocking drug used to treat parkinsonism? Benztropine (Cogentin) Entacapone (Comtan) Apomorphine (Apokyn) Carbidopa (Lodosyn)
Benztropine (Cogentin)
A client has been diagnosed with liver failure. The nurse knows that which of the following class of medications is contraindicated for this client? ACE inhibitors Beta blockers COMT inhibitors Anticholinergics
COMT inhibitors
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? Gamma-aminobutyric acid (GABA) Serotonin Acetylcholine Dopamine
Dopamine
The nurse is providing care for a client with Parkinson's disease. Which of the lient's medications will most directly affect catecholamine-O-methyl transferase (COMT) function? Benztropine Entacapone Diphenhydramine Selegiline
Entacapone
Which drug is classified as a catechol-O-methyltransferase (COMT) inhibitor? Entacapone (Comtan) Biperiden (Akineton) Carbidopa (Lodosyn) Benztropine (Cogentin)
Entacapone (Comtan)
Clients with Parkinson's disease experience a deterioration in intellectual functioning along with incoordination of unconscious muscle movement. False True
False
A client is newly diagnosed with Parkinson's disease and levodopa (Dopar) has been prescribed. What health education should the nurse provide? The need for weekly laboratory blood work for the first six weeks The fact that adverse effects will subside when the body adjusts to the drug Identifying foods and supplements high in vitamin B6 Matching doses to the daily severity of symptoms
Identifying foods and supplements high in vitamin B6
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.) Altered Bowel Movements: Diarrhea Imbalanced Nutrition: Less than Body Requirements Risk for Injury Altered Bowel Movements: Constipation Imbalanced Nutrition: More than Body Requirements
Imbalanced Nutrition: Less than Body Requirements Altered Bowel Movements: Constipation Risk for Injury
The nurse provides drug teaching to a client who has Parkinson's disease and who has been prescribed amantadine. How should the nurse describe the action of this drug? It stimulates the natural release of dopamine It acts on effector cells in the same manner as dopamine It binds directly with postsynaptic dopamine receptors It acts a direct precursor of dopamine synthesis
It stimulates the natural release of dopamine
For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated? Neurontin Amantadine Levodopa Dilantin
Levodopa
A patient who suffers from Parkinson's disease is being treated with levodopa (L-dopa). Which disorder will result in the discontinuation of levodopa (L-dopa) based on a disease-related contraindication? Narrow-angle glaucoma Normal-tension glaucoma Human immune deficiency virus Human papillomavirus
Narrow-angle glaucoma
A 60-year-old male patient has developed a tremor of the right hand with a pill rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from? Degenerative joint disease Parkinson's disease Seizure disorder Amyotrophic lateral sclerosis
Parkinson's disease
A nurse is caring for a patient who has been prescribed diphenhydramine for the treatment of allergies. The nurse observes that the patient has developed diplopia and the patient reports blurred vision. What nursing intervention should the nurse perform when caring for this patient? Provide eye protection to the patient. Provide proper assistance with ambulation. Instruct the patient to avoid direct sunlight. Instruct the patient to place a cool cloth over eyes.
Provide proper assistance with ambulation.
A nurse should counsel patients receiving levodopa to avoid foods high in which vitamin as it reduces the effect of levodopa? Cyanocobalamin (vitamin B12) Ascorbic acid (vitamin C) Phylloquinone (vitamin K1) Pyridoxine (vitamin B6)
Pyridoxine (vitamin B6)
The nurse should be cautious and closely monitor clients receiving carbidopa/levodopa (Sinemet) with which medical conditions? (Select all that apply.) Renal disease Seizure disorder Asthma Peptic ulcer disease Hyperthyroidism
Renal disease Asthma Peptic ulcer disease
The physician prescribed riluzole to Mr. Tom, a 63-year-old man who was diagnosed with amyotrophic lateral sclerosis one month ago. You are teaching him the importance of taking the medication as prescribed. What is the main reason the physician prescribed this medication? Riluzole is given to increase respiratory function in the patient. Riluzole reverses the progression of the disease. Riluzole is given to slow the progression of the disease. Riluzole is the only drug shown to provide a cure for the disease.
Riluzole is given to slow the progression of the disease.
The physician has prescribed selegiline (Eldepryl), an MAOI. You are providing patient teaching to Mr. Jones about this medication. Which statement by the patient would indicate the need for additional teaching? Selegiline can cause a change in my blood pressure, so I should change positions slowly. Selegiline will increase the breakdown of dopamine in the tissues. Selegiline inhibits monoamine oxidase type B, which breaks down dopamine. Selegiline is given in conjunction with carbidopa-levodopa.
Selegiline will increase the breakdown of dopamine in the tissues.
The use of levodopa may interfere with which of the following test? (Choose one) Test for nitrites in the urine Test for leukocytes in the urine Tests for ketones in the urine Test for protein in the urine
Tests for ketones in the urine
A patient has Parkinson's disease. Apomorphine (Apokyn), a dopamine agonist, has been prescribed for periods of hypomobility. What should be discussed with the patient regarding administration of the drug? The drug will be administered subcutaneously 3 times a day with a dosage range of 1-6 mg. The drug will be injected intramuscularly 3 times a day in a range of 1.0-1.5 mL. The drug will be given intravenously, 50 mg every third day. The drug is taken orally, 20 mg 3 times a day.
The drug will be administered subcutaneously 3 times a day with a dosage range of 1-6 mg.
Dopaminergic agents can exacerbate cardiovascular disease due to dopamine receptor stimulation. True False
True
Levodopa is used as treatment for Parkinson's disease primarily acting as a replacement neurotransmitter. True False
True
A home health nurse is visiting an older adult client with Parkinson's disease. What should the nurse assess this man for related to common adverse effects? Jaundice Increased dopamine activity Urinary retention Skin lesions
Urinary retention
A client is taking levodopa. What should the nurse caution the client to avoid? St. John's wort Vitamin B6 Aged cheese Analgesics
Vitamin B6
The symptoms of parkinsonism are caused by the depletion of dopamine in the: central nervous system. smooth muscle. peripheral nervous system. skeletal muscle.
central nervous system.
A patient with Parkinson's disease has been prescribed entacapone (Comtan). The patient asks how this medication works. Which response is most appropriate? "It is excreted in the urine, and your renal function is adequate." "Entacapone is best given parenterally to relieve symptoms." "Entacapone inhibits COMT to metabolize dopamine in the brain." "It increases the metabolism of levodopa (L-dopa) in the bloodstream."
"Entacapone inhibits COMT to metabolize dopamine in the brain."
A nurse is treating a patient who has been started on amantadine. What statement by the patient would indicate the need for additional teaching? "I'll stop taking this drug after a couple of weeks." "This drug is not effective for long-term treatment." "This drug can accumulate if one has decreased renal function." "My tremors and rigidity will improve about 3 weeks after I begin taking this drug."
"My tremors and rigidity will improve about 3 weeks after I begin taking this drug."
A patient is prescribed amantadine (Symmetrel). Which of the following statements indicates the patient has understood the patient teaching? "This drug is also used to decrease my drooling." "This drug is excreted in my stool and urine." "This drug will improve my tremors in 1-5 days." "This drug is effective when it is given long term."
"This drug will improve my tremors in 1-5 days."
What type of medication is given in conjunction with levodopa/carbidopa to lower the dosage of levodopa and provide more effective relief of symptoms? Acetylcholine derivatives A dopamine agonist Tricyclic antidepressants An anticholinergics agent
A dopamine agonist
A client is taking tolcapone for Parkinson's disease. What blood test will the nurse perform often on this client? Chemistry panel CBC ALT CRP
ALT
A client is newly diagnosed with parkinsonism and has been prescribed levodopa. After several weeks, no appreciable reduction in symptoms has been noted. The nurse should anticipate what change in the client's medication regimen? Adding carbidopa to the client's medication regimen Temporary change in levodopa route from oral to intravenous Addition of vitamin B6 to the client's medication regimen Substitution of diphenhydramine for levodopa
Adding carbidopa to the client's medication regimen
A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient? Administer the next drug dose with meals. Administer the next drug dose with milk. Observe alterations in blood pressure. Withhold the next dose of the drug.
Administer the next drug dose with meals.
A client has developed drug induced Parkinson's disease following prolonged treatment with metoclopramide. The nurse should anticipate the use of what drug that is also classified as an antiviral? Ropinirole (Requip) Amantadine (Symmetrel) Entacapone (Comatan) Diphenhydramine (Benadryl)
Amantadine (Symmetrel)
A client, newly diagnosed with Parkinson's disease, has been prescribed an anticholinergic drug. What assessment should the nurse perform when monitoring for adverse effects of anticholinergic agents used for the treatment of Parkinson's disease? Monitoring of prothrombin time and international normalized ratio (INR) Focused respiratory assessment Monitoring of laboratory results for blood dyscrasias Assessment of the client's bowel pattern
Assessment of the client's bowel pattern Anticholinergics often cause decreased bowel motility, resulting in constipation.
The nurse provides client teaching about use of levodopa for treatment of Parkinson's disease. What statement by the client would indicate a good understanding of levodopa? "I'll know within about a year and then stopwhether this drug has cured my Parkinson's disease." "I should take this drug with food to avoid an upset stomach." "I will take multivitamins to ensure that I have good nutrition." "I should avoid exercising while taking this drug so that I don't get injured."
"I should take this drug with food to avoid an upset stomach."
A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease? "It is characterized by abnormalities in behavior." "It is characterized by joint pliancy." "It is characterized abnormalities in posture." "It is an acute disorder."
"It is characterized abnormalities in posture."
A female patient has been prescribed ropinirole (Requip). She states, "I don't know why they are giving me this medicine. I don't have restless leg syndrome." What is the nurse's best response in teaching this patient with newly diagnosed Parkinson's disease about ropinirole (Requip)? "You are mistaken; ropinirole is not used for restless leg syndrome." "Ropinirole is used for restless leg syndrome and migraines, not parkinsonism." "Your doctor must have written the prescription wrong. I will call her." "You are right about ropinirole, but it is also used in early Parkinson's disease."
"You are right about ropinirole, but it is also used in early Parkinson's disease."
A client has been taking levodopa (L-dopa) for the treatment of Parkinson's disease. What additional medication may decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects of levodopa? Bromocriptine Trihexyphenidyl Carbidopa Amantadine
Carbidopa
Which drug is classified as a dopaminergic agent that treats Parkinsonism by supplementing the amount of dopamine in the brain? Procyclidine (Kemadrin) Carbidopa (Lodosyn) Benztropine (Cogentin) Biperiden (Akineton)
Carbidopa (Lodosyn)
The nurse has developed a plan of care for an older adult client newly diagnosed with Parkinson's disease. What outcome is most likely to be appropriate for this client? Client will demonstrate a full return to independent activities of daily living with two weeks of starting treatment Client will return to pre-diagnosis levels of fine motor skill within 48 hours of beginning treatment Client will demonstrate the ability to ambulate the length of the hall within one week of starting medication Client will be oriented to person, place and time within 48 hours of beginning treatment
Client will demonstrate the ability to ambulate the length of the hall within one week of starting medication
A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what? Improved short term memory Improved level of intellectual functioning Decreased aggression Decreased tremors
Decreased tremors
A client with advanced Parkinson's disease has undergone diagnostic testing and diagnostic imaging. What are the results most likely to reveal? Increased gamma-aminobutyric acid (GABA) Brain infarcts Decreased enzyme dopa decarboxylase levels Degeneration of dopamine-producing nerve cells
Degeneration of dopamine-producing nerve cells
Which are classified as catechol-O-methyltransferase (COMT) inhibitor drugs? (Select all that apply.) Amantadine (Symmetrel) Biperiden (Akineton) Bromocriptine (Parlodel) Entacapone (Comtan) Tolcapone (Tasmar)
Entacapone (Comtan) Tolcapone (Tasmar)
A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client? Imbalanced nutrition: less than body requirements Impaired dentition Risk for injury Impaired skin integrity
Imbalanced nutrition: less than body requirements
The nurse is assessing a client who was prescribed levodopa one week earlier. What change in the client's status would suggest the effectiveness of drug therapy? Stability of mood Improved attention span Slower chewing of food Improvement in handwriting
Improvement in handwriting
The nurse should monitor a client closely for which of the following symptoms after an abrupt reduction in levodopa dose as neuroleptic malignant-like syndrome may occur? Select all that apply: Fever Urinary incontinence Muscular rigidity Mental status changes Hypotension
Muscular rigidity Fever Mental status changes
A patient with Parkinson's disease is undergoing treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment? Prepare a baseline for future evaluations of the patient's drug therapy. Assess the patient for ability to perform the daily activities. Observe the patient for various neuromuscular signs. Observe the current mental condition of the patient.
Observe the patient for various neuromuscular signs.
Which of the following are non-ergot dopamine receptor agonists? Select all that apply: Ropinirole (Requip) Pramipexole (Mirapex) Benztropine (Cogentin) Entacapone (Comtan) Amantadine (Symmetrel)
Pramipexole (Mirapex) Ropinirole (Requip)
The nurse is teaching a client newly-diagnosed with Parkinson's disease about the appropriate use of levodopa-carbidopa (Sinemet). What should the nurse teach the client? Take the drug three times each day, at the times that are specified Take the daily dose at bedtime to minimize sedative effects Use a moisturizing cream if a rash develops after beginning the medication Remain seated upright for 30 minutes after taking the medication, if possible
Take the drug three times each day, at the times that are specified
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 is obese and has usually led a sedentary lifestyle The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma The client has taken calcium and vitamin D supplements for many years to prevent osteoporosis The client had cataract surgery last year and has hypertension
The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma
The nurse is preparing to administer a client's scheduled dose of Sinemet. What is the nurse's rationale for administering levodopa with carbidopa? Carbidopa makes the blood-brain barrier temporarily permeable. The combination allows a lower dose of levodopa than if levodopa were administered alone. Carbidopa potentiates the action of levodopa to prevent nerve cell degeneration. Carbidopa prevents excessive amounts of levodopa from being excreted by the kidneys and in feces
The combination allows a lower dose of levodopa than if levodopa were administered alone.
A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in muscle rigidity, tremor at rest, and postural instability. What occurs in the neurons that causes these symptoms? There is a decrease in stimulation of the nigrostriatal neural tracts. There is an increased level of GABA at the striatum. There is an imbalance between dopamine and acetylcholine. There is an increase in dopamine in the terminal nerve endings.
There is an imbalance between dopamine and acetylcholine.
The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: excessive sedation. infection. falls. uncontrolled bleeding.
falls.