Final - ALS, MS, Parkinson's

A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia

A. CORRECT: Areas of loss of skin sensation are a finding in a client who has MS. B. CORRECT: Nystagmus is a finding in a client who has MS. E. CORRECT: Ataxia occurs in the client who has MS as muscle weakness develops and there is loss of coordination.

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information would the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives

ANS: C Glatiramer acetate (Copaxone) is administered by self-injection. Oral contraceptives are an appropriate choice for birth control while taking Copaxone. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.

A nurse is teaching about levodopa with a family member of a client who has Parkinson's. Which of the following pieces of information should the nurse include? a. "A full therapeutic response may take several months to happen." b. "The medication should be taken with high-protein foods." c. "A full therapeutic response might cause vivid dreams." d. "The medication is given at the onset of mild symptoms."

Answer: A

A nurse is providing teaching to the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following pieces of information should the nurse include in the teaching? a. "Crush the medication and mix it in food." b. "Administer the medication 1 hour before bed time." c. "Expect your child to have cloudy urine while taking this medication." d. "Weight your child twice per week while on this medication."

Answer: D The parent should weight the child 2-3x per week to monitor for weight loss. Administer 30 min before meal on empty stomach. Common side effects include insomnia, weight loss, anorexia, and tachycardia.

A nurse is caring for several clients in an extended care facility. Which of the following clients is the highest priority to observe during meals? A. A client who has decreased vision B. A client who has Parkinson's disease C. A client who has poor dentition D. A client who has anorexia

B. CORRECT: A client who has Parkinson's disease is at risk for aspiration. Due to this safety risk, this client is the highest priority to observe during meals.

A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include? A. Recommend a community support group. B. Integrate a daily exercise routine. C. Provide a walker for ambulation. D. Perform ADLs for the client.

C. CORRECT: The client should use a walker for ambulation in stage III of Parkinson's disease because movement slows down significantly and gait disturbances occur.

A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. "This medication will help you with your tremors." B. "This medication will help you with your bladder function." C. "This medication can cause your skin to bruise easily." D. "This medication can cause you to experience dizziness."

D. CORRECT: Baclofen is an antispasmodic medication that is given to clients who have MS to treat muscle spasms. An adverse effect of this medication is drowsiness, as well as dizziness. Instruct the client to monitor for these findings, as they can lead to impaired safety. The client should be instructed not to discontinue baclofen abruptly.

A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating. B. Complete passive range‑of‑motion exercises daily. C. Place the client on a low‑protein, low‑calorie diet. D. Give the client extra time to perform activities.

D. CORRECT: Bradykinesia is abnormally slowed movement and is seen in clients who have PD. The client should be given extra time to perform activities and should be encouraged to remain active.

A nurse in the post‑anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should expect a prescription for which of the following medications? A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium

A. CORRECT: Neostigmine is a cholinesterase inhibitor used to reverse the effects of nondepolarizing neuromuscular blockers. B. Naloxone is used to reverse the effects of opioids. C. Dantrolene acts on skeletal muscles to reduce metabolic activity and treat malignant hyperthermia. D. Vecuronium is an intermediate‑acting nondepolarizing neuromuscular blocker.

Which action would the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a. Teach the patient how to self-catheterize. b. Encourage decreased evening fluid intake. c. Suggest the use of adult incontinence briefs. d. Assist the patient to the commode every 2 hours.

ANS: A The patient may need to intermittently self-catheterize when urinary retention is not relieved by other means. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.

A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which interventions would the nurse include in the plan of care? (Select all that apply.) a. Provide an elevated toilet seat. b. Cut patient's food into small pieces. c. Serve high-protein foods at each meal. d. Place an armchair at the patient's bedside. e. Observe for sudden exacerbation of symptoms.

ANS: A, B, D Because the patient with Parkinson's disease has difficulty chewing, food would be cut into small pieces. An armchair would be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa; limiting protein intake to the evening meal can decrease this problem. Parkinson's disease is a steadily progressive disease without acute exacerbations.

A nurse is preparing to administer a medication to a client who has absence seizures. The nurse should expect to administer which of the following medications to the client? (Select all that apply.) A. Phenytoin B. Ethosuximide C. Gabapentin D. Carbamazepine E. Valproic acid F. Lamotrigine

B. CORRECT: The only mechanism of action of ethosuximide is to treat a client who has absence seizures. E. CORRECT: Valproic acid has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures. F. CORRECT: Lamotrigine has a therapeutic effect when treating a client who has absence seizures and all other forms of seizures.

Which information about a patient with multiple sclerosis (MS) indicates that the nurse would consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient reports pain with neck flexion. b. The patient walks a mile each day for exercise. c. The patient has epilepsy controlled by medication. d. The patient has the relapsing-remitting form of MS.

ANS: B Dalfampridine use may cause seizures, especially at higher doses, so it would be important to evaluate the risk of triggering seizures in someone known to have epilepsy. The other information will not impact whether the dalfampridine would be administered.

A nurse is reviewing a new prescription for oxcarbazepine with a client who has partial seizures. Which of the following instructions should the nurse include? (Select all that apply.) A. "Use caution if given a prescription for a diuretic medication." B. "Consider using an alternate form of contraception if you are using oral contraceptives." C. "Chew gum to increase saliva production." D. "Avoid driving until you see how the medication affects you." E. "Notify your provider if you develop a skin rash."

A. CORRECT: Diuretic medications are administered with caution because of the high risk for hyponatremia when taking oxcarbazepine. B. CORRECT: An alternate form of contraception is recommended for clients taking oral contraceptives because oxcarbazepine decreases oral contraceptive levels. D. CORRECT: The client should avoid driving if CNS effects of dizziness, drowsiness, and double vision develop. E. CORRECT: The client should notify the provider if a skin rash occurs because life‑threatening skin disorders can develop.

A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include? A. Rise slowly when standing. B. Expect urine to become dark‑colored. C. Avoid foods containing tyramine. D. Report any skin discoloration.

A. CORRECT: Orthostatic hypotension is a common adverse effect of bromocriptine, a dopamine receptor agonist. Therefore, rising slowly when standing up will decrease the risk of dizziness and lightheadedness.

A nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Hallucinations B. Increased salivation C. Diarrhea D. Discoloration of urine

A. CORRECT: Pramipexole can cause hallucinations within 9 months of the initial dose and might require discontinuation. B. Increased salivation is an adverse effect of cholinesterase inhibitors. Dry mouth is an adverse effect of pramipexole. C. Constipation is an adverse effect of pramipexole. D. Discoloration of urine is an adverse effect of COMT inhibitors and not an adverse effect of pramipexole

Which action would the nurse include in completing a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS)? a. Assess for the presence of chest pain. b. Inquire about urinary tract problems. c. Inspect the skin for rashes or discoloration. d. Ask the patient about any increase in libido.

ANS: B Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.

A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. Increase intake of protein‑rich foods. B. Expect muscle twitching to occur. C. Take this medication with food. D. Anticipate relief of manifestations in 24 hr.

A. The client should avoid protein‑rich foods, which can result in decreased therapeutic effects of levodopa. B. The client should monitor and report muscle twitching which can indicate toxicity. C. CORRECT: The client should take this medication with food to reduce GI effects. D. The client should anticipate relief of manifestations to take several weeks to months.

A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which action would the nurse include in the plan of care? a. Observe for agitation and paranoia. b. Assist with active range of motion (ROM). c. Give muscle relaxants as needed to reduce spasms. d. Use simple words and phrases to explain procedures.

ANS: B ALS causes progressive muscle weakness. Assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.

A patient with Parkinson's disease (PD) has bradykinesia. Which action would the nurse include in the plan of care? a. Instruct the patient in activities that can be done while lying or sitting. b. Suggest that the patient use the arms of the chair to help push up to standing. c. Have the patient take small steps in a straight line directly in front of the feet. d. Teach the patient to keep the feet in contact with the floor and slide them forward.

ANS: B Pushing down on the arms of the chair and placing the back legs of the chair on small (2-inch) blocks help the individual with PD to stand. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wider base of support, rather than stepping directly forward, will help with balance. The patient should lift the feet and avoid a shuffling gait.

A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response would the nurse provide? a. MS symptoms will be worse after the pregnancy. b. Symptoms of MS may improve during pregnancy. c. Women with MS frequently have premature labor. d. MS is associated with an increased risk for congenital defects.

ANS: B Some women with MS have remission or an improvement in symptoms during pregnancy. Symptoms of MS may improve during pregnancy. There is no increased risk for congenital defects in infants born of mothers with MS. Onset of labor is not affected by MS. MS symptoms will not worsen after pregnancy.

A 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor. Which topic would the nurse anticipate explaining to the patient? a. Oral corticosteroids b. Dopaminergic drugs c. Magnetic resonance imaging (MRI) d. Electroencephalogram (EEG) testing

ANS: B The clinical diagnosis of Parkinson's is made when tremor, rigidity, akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when dopaminergic drugs are administered. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.

After change-of-shift report on the neurology unit, which patient would the nurse assess first? a. Patient with Bell's palsy who has herpes vesicles in front of the ear. b. Patient with neurosyphilis who has tabes dorsalis and decreased deep tendon reflexes. c. Patient with Guillain-Barré syndrome who is drooling and having difficulty swallowing. d. Patient with an abscess caused by injectable drug use who needs tetanus immune globulin.

ANS: C The patient with Guillain-Barré syndrome who has drooling and difficulty swallowing indicates that the nurse would rapidly assess for respiratory distress. The information about the other patients is consistent with their diagnoses and does not indicate any immediate need for assessment or intervention.

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which assessment finding would indicate to the nurse that a change in the medication or dosage may be needed? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement

ANS: D Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.

Which patient problem would the nurse identify as of highest priority for a patient who has Parkinson's disease and is unable to move the facial muscles? a. Activity intolerance b. Negative self-image c. Musculoskeletal problem d. Nutritionally compromised

ANS: D The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson's disease, but the data do not indicate that they are current problems for this patient.

A nurse is caring for a client who has multiple sclerosis and is receiving interferon beta-1a. The nurse should identify that which of the client statements indicate a potential adverse effects of this medication? a. My body aches all over b. I have abdominal cramping c. My hair seems to be thinning d. It hurts when I urinate

Answer: A Adverse effects include flu like symptoms such as general body and muscle aches.

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions? a. Watch for urinary retention as a side effect. b. Stop taking the medication if diarrhea occurs. c. Restrict fluid intake while taking this medication. d. Notify the primary health care provider if fatigue occurs.

Answer: A Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention. The client should not restrict fluid intake. Constipation, rather than diarrhea, is an adverse effect of baclofen. Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary to notify the primary health care provider if fatigue occurs.

A nurse is preparing to administer dantrolene to a client who has muscle spasticity. Which of the following findings from the client's medical record should the nurse identify as a contraindication to the administration of this medication? a. history of cirrhosis b. history of multiple sclerosis c. history of cerebral palsy d. history of malignant hyperthermia

Answer: A Dantrolene is contraindicated for clients who has active liver disease because it is hepatotoxic and can cause liver failure. Liver function tests are monitored for clients throughput the treatment with this medication.

Which nursing intervention is a priority for a patient with multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Answer: A Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.

A patient's eyes jerk while the patient looks to the left. The nurse records this finding as a. nystagmus b. CN VI palsy c. ophthalmic dyskinesia d. oculocephalic response

Answer: A Nystagmus is defined as fine, rapid jerking movements of the eyes.

A nurse is providing teaching to a client with a seizure disorder who has a new prescription for carbamazepine. Which of the following statements should the nurse include in the teaching? a. This medication will decrease the effectiveness of oral contraceptives. b. Once you are seizure-free for a month, you will be able to stop taking it. c. You can cut the dose in half if GI upset occurs. d. This medication might initially increase the frequency of your seizures.

Answer: A Take medication even if no seizure activity. Take with meals to avoid GI stress.

A nurse is caring for a client with OCD who has been taking fluoxetine for 3 months. The client states, "This medication isn't working. I want to stop taking it." Which of the following responses should the nurse make? a. It is best to discontinue medication slowly over 1-2 months. b. If the medication hasn't helped you in 3 months, it's not going to. c. You will likely gain weight if you stop taking the medication. d. This medication is the only treatment available for your condition.

Answer: A Taper off slowly to reduce withdrawal manifestations. It takes several months to peak and therapy should be continued for a year before discontinuation. Adverse effect of medication is weight gain. This is not the only form of treatment for OCD.

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? a. Amantadine b. Bupropion c. Phenelzine d. Hydroxyzine

Answer: A The client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy.

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? a. amantadine b. bupropion c. phenelzine d. hydroxyzine

Answer: A The client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy.

A nurse is teaching the family of a client who has Alzheimer's disease about donepezil. Which of the following statements should the nurse include in the teaching? a. "Donepezil can improve cognitive functioning during the earlier stages of the disease." b. "Cures the disease process if started at the first recognition of dementia." c. "Provides long-term reversal of memory loss in the last phase of the disease." d. "Accelerates the breakdown of acetylcholine within the client's brain."

Answer: A Used to treat mild to severe Alzheimer's manifestations. It does NOT prevent the progression, it is intended to prolong the client's ability to function in the early stages of the disease.

Stimulation of the parasympathetic nervous system results in (SATA) a. constriction of the bronchi b. dilation of skin blood vessels c. increased secretions of insulin d. increased blood glucose levels e. relaxation of the urinary sphincters

Answer: A B C E Stimulation of the parasympathetic nervous system results in pupil constriction, decreased heart rate, increased saliva secretion, and relaxation of the urinary sphincter with stimulation of urination. Stimulation of the sympathetic nervous system results in increased blood glucose levels.

A nurse is providing discharge teaching to a client who has been hospitalized for major depressive disorders and has a prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? a. "I will take it in the morning because I'll likely have trouble falling asleep if I take it in the evening." b. "I will move slowly when I stand up because it can cause my blood pressure to decrease." c. "I can drink a glass of beer or wine with my evening meal because amitriptyline doesn't interact with alcohol." d. "I will avoid foods that are high in fiber because it can cause diarrhea."

Answer: B Amitriptyline can cause orthostatic hypotension. The nurse should instruct the client to take precautions to prevent an injury due to a fall while taking amitriptyline.

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primary therapeutic response to the medication? a. decreased nausea b. decreased muscle spasms c. increased muscle tone and strength d. increased range of motion of all extremities

Answer: B Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases or with multiple sclerosis. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is an incorrect option.

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs? a. Shuffling gait b. Inability to urinate c. Decreased appetite d. Irregular bowel movements

Answer: B Benztropine mesylate is an anticholinergic, which causes urinary retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. The remaining options are unrelated to the use of this medication.

A nurse is caring for a client who is taking selegiline. The nurse should monitor the client for which of the following adverse effects of selegiline and notify the provider if it occurs? a. Bruising b. Drowsiness c. Coughing d. Constipation

Answer: B Drowsiness can be an adverse effect of selegiline and a manifestation of serotonin syndrome, it should be reported IMMEDIATELY.

A nurse is updating the plan of care for a client who has major depression and a new prescription for amitriptyline. The nurse should plan to monitor the client for which of the following effects? a. Hypertension b. Drowsiness c. Panic attacks d. Diarrhea

Answer: B Drowsiness is an expected side effect of this medication and other tricyclic antidepressants. Sedation is most likely to be present during the first weeks of treatment with amitriptyline and can increase the risk of falls.

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which finding, if noted during the nursing assessment, would indicate that the client is experiencing a side/adverse effect of this medication? a. headache b. drowsiness c. urinary retention d. increased salivation

Answer: B Incoordination and drowsiness are common side/adverse effects of diazepam. The remaining options are unrelated to the use of this medication.

A nurse is providing teaching about baclofen to the guardian of a toddler who has cerebral palsy. Which of the following adverse effects should the nurse include? a. Bradycardia b. Muscle weakness c. Diarrhea d. Dry skin

Answer: B Muscle weakness is a common side effect of baclofen, other common adverse effects include dizziness, drowsiness, and nausea.

A nurse is reviewing the medical record of a client who is requesting a prescription for sildenafil citrate. Which of the following data in the client record should the nurse identify as a contraindication to the use of this medication? a. Diabetes mellitus b. Current use of isosorbide to treat heart failure. c. Eyeglasses for presbyopia d. Osteoarthritis

Answer: B Nitrates such as isosorbide and nitroglycerin is a contraindication for sildenafil, a medication that treats erectile dysfunction. Taking it concurrently with nitrates can cause life-threatening hypotension.

The nurse observes a patient with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appopiate? a. provide the patient with diversion activities b. document the activity in the patients health record c. take the patients blood pressure sitting and standing d. ask the patient if they are feeling either anxious or depressed.

Answer: B Patients with Parkinson's disease are taught to rock from side to side to stimulate balance mechanisms and decrease akinesia.

The nurse teaches the wife of a client who is receiving levodopa/carbidopa to avoid pyridoxine medications. Which statement by the wife indicates an understanding of the instructions? a. "Vitamin B6 will change perspiration and urine to a dark color, which may stain clothing." b. "Vitamin B6 reverses the effectiveness of the medication, meaning a higher dose is needed." c. "The medication competes with vitamin B6 for absorption in the intestine, blocking absorption." d. "The two medications in combination will cause the blood sugar to drop, causing hypoglycemia."

Answer: B Pyridoxine (vitamin B6) reverses the therapeutic effects of levodopa. Dietary restrictions are not necessary, but ingredients of multivitamins should be assessed. Many multivitamins contain pyridoxine and should be avoided. Careful reading of over-the-counter vitamin labeling is necessary to avoid increasing pyridoxine in the diet. The statements in the remaining options are incorrect.

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). What strategy would prevent a common cause of death for patients with ALS? a. Reduce fat intake. b. Reduce the risk of aspiration. c. Decrease injury related to falls. d. Decrease pain secondary to muscle weakness.

Answer: B Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride. The nurse suspects that the client has which disorder? a. Diabetes mellitus b. Parkinson's disease c. Alzheimer's disease d. Coronary artery disease

Answer: B Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease.

A nurse is teaching about taking donepezil with a client who was recently diagnosed with early Alzheimer's disease. which of the following instructions should the nurse include in the teaching? a. "You should chew the medication thoroughly prior to swallowing." b. "You should take this medication late in the evening." c. "You should take this medication with food." d. "If you miss taking a dose for a day, take 2 doses the following day."

Answer: B Take whole, can be taken with or without food, if a dose is missed, resume normally don't double.

A nurse is providing teaching to a client who has a new prescription for sertraline. The client asks the nurse if he should continue to take St.John's wort for depression. Which of the following instructions should the nurse give the client? a. Take medication and herbal supplement together. b. Stop taking the herbal supplement while on this medication. c. Take the herbal supplement and the medication at least 2hr apart. d. Take an antiacid with both.

Answer: B Taking both increases risk of serotonin syndrome.

A nurse is teaching a client who has a new prescription for amitriptyline to treat depression. Which of the following client statements indicates an understanding of the teaching? a. "I should take this medication when I experience active symptoms." b. "I should take this medication before bedtime." c. "The medication may cause excess salivation." d. "I might experience weight loss while taking this medication."

Answer: B The nurse should instruct the client that an adverse effect of amitriptyline is sedation. The nurse should instruct the client to take the medication at bedtime to minimize sedation during waking hours while promoting sleep.

A client receiving therapy with carbidopa/levodopa is upset and tells the home health nurse that his urine has turned a darker color since he started taking this medication. The client wants to discontinue its use. In formulating a response to the client's concerns, the nurse interprets that this change is indicative of which condition? a. developing toxicity b. a harmless side effect of the medication c. a result of taking the medication with milk d. a signed of interaction with another medication

Answer: B With carbidopa/ levodopa therapy, a darkening of the urine or sweat may occur. The client should be reassured that this is a harmless effect of the medication, and its use should be continued. Darkened urine is not indicative of carbidopa/levodopa toxicity, the result of taking the medication with milk, or a sign of interaction with another medication.

A nurse is providing teaching to the parent of a school-aged child who has ADHD and a new prescription for methylphenidate IR. Which of the following information pieces should the nurse provide? a. "Have your child take medication once daily." b. "This medication might make your child gain weight." c. "Your child's growth might slow while using this medication." d. "Avoid giving your child food when taking this medication."

Answer: C Adverse effect of medication is growth suppression related to the appetite suppression associated with it. IR has a dosing schedule of 2-3x daily, sustained-release is taken once or twice daily.

A client began taking amantadine approximately 2 weeks ago. The nurse determines that the medication is having a therapeutic effect if the client exhibits which finding? a. decreased voiding b. decreased blood pressure c. decreased rigidity and akinesia d. decreased white blood cell count

Answer: C Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Urinary retention, hypotension, and leukopenia are adverse effects of the medication.

A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication? a. hearing examination b. glucose tolerance test c. electrocardiogram d. pulmonary function tests

Answer: C Amitriptyline can cause tachycardia and ECG changes. An older adult client is at risk for cardiovascular effects while using amitriptyline; therefore, an ECG should be performed prior to the start of therapy to obtain a baseline of the clients cardiovascular status.

Baclofen is prescribed for the client with multiple sclerosis. The nurse determines that the medication is having the intended effect if which finding is noted in the client? a. increased muscle tone b. increased range of motion c. decreased muscle spasms d. decreased local pain and tenderness

Answer: C Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and degree of muscle spasms in clients with multiple sclerosis, spinal cord injury, or other diseases. The other options are incorrect.

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care? a. history of falls b. use of assistive devices c. postural (orthostatic) vital signs d. degree of exhibited intention tremor

Answer: C Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem is exacerbated with the introduction of levodopa/carbidopa, which also can cause postural hypotension and increase the client's risk for falls. Although knowledge of the client's use of assistive devices and history of falls is helpful, neither of these options is the most important element of the assessment, based on the wording of this question. Clients with Parkinson's disease generally have resting tremor, not intention tremor.

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor? a. tachycardia b. rapid pulse c. bradycardia d. hypertension

Answer: C Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects. Options 1, 2, and 4 are not effects with administration of this medication.

The nurse conducts a home visit for a patient with Parkinson disease taking levodopa/carbidopa daily. The patient has stopped eating meals with his family and has lost 3 pounds since the last visit a week ago. What action will the nurse take? a. plan 6 small high-protein meals a day b. provide information on a high-fat ketogenic diet. c. evaluate their ability with eating, swallowing, and use of assistive devices d. collaborate with the HCP about every other day levodopa/carbidopa dosing

Answer: C Patients with Parkinson's disorder have trouble with the coordinated act of eating, often require assistive devices to eat, and have difficulty swallowing. Diet is of major concern as malnutrition can occur without adequate calories and nutrient intake. The uncoordinated movements and tremors and slow eating can be embarrassing for the patient who may be isolating from the family. The nurse must determine if physical difficulty with the act of eating is causing the weight loss or if depression or another organic cause is to blame. Identifying the root of the problem would start with assessing the patient's abilities. Ketogenic diets are for headaches. Protein makes levodopa less effective, so protein should be limited to the evening meal. Reducing levodopa/carbidopa dosing will increase the tremors and bradykinesia.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient would the nurse see first? a. 42 yr w/ multiple sclerosis who was admitted with sepsis b. 72 yr w/ Parkinson's disease who has aspiration pneumonia c. 38 yr w/ myasthenia gravis who declined prescribed medications d. 45 yr w/ amyotrophic lateral sclerosis who refuses enteral feedinds.

Answer: C Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will develop myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.

A nurse is providing teaching to a client who has chronic constipation and new prescription of psyllium. Which of the following instructions should the nurse provide? a. This medication is for short-term use only. b. You should eat low-residual diet while on this medication. c. Mix with water and follow with an additional glass of liquid. d. Adverse effects include stomach cramps and nausea that go away in time.

Answer: C Take with full glass of water or juice followed by an additional glass of liquid. It can be taken for long-term use. Do not take if abdominal pain, nausea, vomiting, or a fever occurs.

The nurse is caring for a client with Parkinson's disease. Which finding about gait should the nurse expect to note in the client? a. walking on the toes b. unsteady and staggering c. shuffling and propulsive d. broad-based and waddling

Answer: C The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping. An ataxic gait is unsteady and staggering. A dystrophic gait is broad-based and waddling. Walking on the toes can occur from shortened Achilles tendons.

When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests would the nurse expect? SATA a. EEG b. ECG c. CT scan d. Carotid duplex scan e. Evoked response testing f. Cerebrospinal fluid analysis

Answer: C E F No definitive diagnostic test exists for MS. Along with history and physical examination, CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI are used to establish a diagnosis of MS. EEG, ECG, and carotid duplex scan are not used to diagnose MS.

A nurse is teaching about the adverse effects of baclofen with a client who has multiple sclerosis with spasms. Which of the following statements should the nurse identify as an indication that the client understands the teaching? a. Adverse effects include urinary frequency. b. I should increase my fiber intake to counteract the adverse effect of constipation. c. This medication can cause addiction. d. I should not stop taking this medication suddenly.

Answer: D Adverse effects associated with abrupt withdrawal of baclofen include visual hallucinations, paranoid ideations, and seizures.

A client began taking amantadine approximately 2 weeks ago. The client reports to the clinic for a follow-up evaluation. The nurse determines that the client is experiencing a side or adverse effect related to the use of this medication if which is noted? a. decreased rigidity b. decreased akinesia c. a blood pressure of 118/74 mm Hg d. client complaints of urinary retention

Answer: D Amantadine is an antiparkinson agent that potentiates the action of dopamine in the central nervous system. The expected effect of therapy is a decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension are all side and adverse effects of the medication.

A nurse is assessing a client who has been taking thioridazine hydrochloride for several days. The client reports hand tremors, drooling, and rigid extremities. Which of the following actions should the nurse take? a. reassure the client these are expected effects. b. administer diazepam c. encourage deep breathing and relaxation d. administer benztropine

Answer: D Client is experiencing extrapyramidal effects including pseudoparkinsonism. Benztropine counteracts these adverse effects. This should be reported to provider and prescription should be obtained to alleviate manifestations.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for baclofen PO. Which of the following pieces of information should the nurse include? a. You should take this on an empty stomach to increase absorption. b. You can stop taking it once your back spasms disappear. c. You can expect to experience urinary frequency when you first start taking it. d. You should change positions slowly while on this medication.

Answer: D Dizziness and hypotension are adverse effects of this medication. Baclofen should be taken with milk or food to minimize GI stress. Stopping medication abruptly can cause withdrawal reaction like hallucinations and increased spasticity. Urinary frequency is an adverse effect of medication and should be reported to provider.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? a. Pruritus b. Tachycardia c. Hypertension d. Impaired voluntary movements

Answer: D Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? a. pruritus b. tachycardia c. hypertension d. impaired voluntary movements

Answer: D Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which of the following therapeutic effects should the nurse identify for the client taking this medication? a. Reduced cancer-related bone pain b. Decreased anxiety and insomnia c. Decreased inflammatory response to cancer tumors d. Reduced cramping, aching, and burning neuropathic pain.

Answer: D Gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.

The nurse is caring for a client with an exacerbation of multiple sclerosis. Which medication(s) will the nurse expect to be prescribed to hasten recovery from the exacerbation? a. Carbamazepine and phenytoin by mouth b. Lioresal by mouth and diazepam intravenously c. Phenytoin intravenously, then tapered to oral route d. Methylprednisolone and cyclophosphamide intravenously

Answer: D Intravenous methylprednisolone or adrenocorticotropic hormone in combination with cyclophosphamide may be prescribed to accelerate recovery from an exacerbation of multiple sclerosis. Carbamazepine may be prescribed for trigeminal neuralgia, and phenytoin may be prescribed to control seizures. Lioresal and diazepam are used to treat muscle spasticity.

A nurse is providing teaching to a client who has a new prescription for amitriptyline. The nurse should teach the client that which of the following OTC medications can cause cardiac dysrhythmias when taken concurrently with amitriptyline? a. acetaminophen b. famotidine c. naproxen d. pseudoephendrine

Answer: D It interacts with tricyclic medications and is therefore contraindicated. Ingesting products containing ephedrine along with amitriptyline can cause cardiac dysrhythmias.

A nurse is providing teaching to the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following statements by the parent indicates an understanding of the teaching? a. "I should expect my child to gain weight while on this medication." b. "I should expect this medication to decrease my child's heart rate." c. "I should crush the medication and put it in food." d. "I should give this medication to my child 30 minutes before breakfast."

Answer: D Medication should be administered on an empty stomach. Methylphenidate is a stimulant medication that can cause anorexia and weight loss. The parent should weight the child 2-3x per week to monitor for weight loss. This medication can cause tachycardia and hypertension.

The nurse is assigned to care for a client with multiple sclerosis who is receiving an intravenous dose of methocarbamol. The nurse monitors the client knowing that which is an expected side effect? a. insomnia b. excitability c. hypertension d. dark green-colored urine

Answer: D Methocarbamol is a skeletal muscle relaxant. It may cause the urine to turn a brown, black, or dark green color, and the client needs to be told that this is a harmless effect. This medication can cause hypotension. Drowsiness and dizziness can also occur. Therefore, the remaining options are incorrect.

A patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action would the health care team take to promote adequate nutrition? a. Administer multivitamins every morning and with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Give the patient with a pureed diet that is high in potassium and low in sodium. d. Provide small, frequent meals throughout the day that are easy to chew and swallow.

Answer: D Nutrition support is a priority in the care of persons with PD. Patients may benefit from smaller, more frequent meals that are easy to chew and swallow. Multivitamins are not necessary at each meal. Vitamin and protein intake must be monitored to prevent interactions with medications. Introducing a minced or pureed diet is likely premature, and a low carbohydrate diet is not indicated.

The nurse in a long-term care facility is reviewing the primary health care provider's (PHCP's) prescriptions on an assigned client. The nurse notes that the PHCP prescribed ropinirole hydrochloride. The nurse determines that this medication has been prescribed to treat which condition in the client? a. depression b. diabetes mellitus c. coronary artery disease d. parkinsonian syndrome

Answer: D Ropinirole hydrochloride is a medication that is used to treat idiopathic parkinsonian syndrome. It normally is administered 3 times a day to treat the client. This medication is not used to treat depression, diabetes mellitus, or coronary artery disease.

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long? a. 1 week b. 24 hours c. 2-3 days d. 2-3 weeks

Answer: D Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. The client needs to understand this concept to aid in compliance with medication therapy.

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? a. "I can sit down to put on my pants and shoes." b. "My son removed all loose rugs from my bedroom." c. "I try to exercise every day and rest when I'm tired." d. "I don't need to use my walker to get to the bathroom."

Answer: D The client with Parkinson's disease should be instructed regarding safety measures in the home. The client should use his or her walker as support to get to the bathroom because of bradykinesia. The client should sit down to put on pants and shoes to prevent falling. The client should exercise every day in the morning when energy levels are highest. The client should have all loose rugs in the home removed to prevent falling.

A nurse is caring for a client who has Alzheimer's and a new prescription for donepezil. Which of the following actions should the nurse take? a. Monitor the liver function while taking this medication. b. Increase dosage of medication every 72 hr. c. Offer the client a PRN NSAID while taking this medication. d. Administer medication at bedtime.

Answer: D The nurse should administer this medication at bedtime to reduce the risk of injury due to bradycardia and syncope.

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids

B. CORRECT: Loss of cognitive function is a manifestation associated with MS. A. Fluctuations in blood pressure is a manifestation associated with amyotrophic lateral sclerosis. C. Ineffective cough is a manifestation associated with amyotrophic lateral sclerosis. D. Drooping eyelids is a manifestation associated with myasthenia gravis.

A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include? (Select all that apply.) A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Offer cold fluids such as milkshakes. E. Offer nutritional supplements between meals.

B. CORRECT: Record the client's diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration. D. CORRECT: Provide cold fluids such as milkshakes. Thick and cold fluids are tolerated easier by the client. E. CORRECT: Offer nutritional supplements between meals to maintain the client's weight.

A nurse is assessing a client for manifestations of Parkinson's disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill‑rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression

B. CORRECT: The client who has PD can manifest pill‑rolling tremors of the fingers due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. C. CORRECT: The client who has PD can manifest shuffling gait because of overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. D. CORRECT: The client who has PD can manifest drooling because of overstimulation of the basal ganglia by acetylcholine, making the controlled movement of swallowing secretions difficult. F. CORRECT: The client who has PD can manifest a lack of facial expressions due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult.