Parkinsons
A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:
sleep attacks.
A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?
Slowed heart rate and lightheadedness
A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?
Advancing age and family history are known risk factors
A patient has taken levodopa [Dopar] for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?
"It may take several months for a response to occur."
A nurse provides teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease?
"A levodopa/carbidopa combination is used to improve motor function."
The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct?
"Drugs to treat Alzheimer's disease may slow the progression of memory loss."
A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?
"Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug."
A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
"I may need to try a lower dose of Sinemet to reduce my tics."
A nurse counsels a patient who is to begin taking phenytoin [Dilantin] for epilepsy. Which statement by the patient indicates understanding of the teaching?
"I should brush and floss my teeth regularly."
Notify the prescriber, and request an order to reduce the dose of phenobarbital.
"I should report any nausea, drowsiness, and headache to my provider."
A patient has begun taking phenobarbital after experiencing several seizures and is currently receiving 60 mg PO twice daily. After two weeks of therapy, the patient has a serum drug level of 30 mcg/mL and reports feeling drowsy much of the day. What will the nurse tell this patient?
"I will contact your provider to discuss changing your dosing to once daily to minimize the drowsiness."
The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson's disease. What will the nurse include in teaching?
"If you need to stop this drug, your provider will order a gradual withdrawal."
The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine [Exelon] transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?
"We only need to change the patch every 2 weeks."
A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?
"While some drugs show promise, there are no studies that have proven a neuroprotective effect."
patient is worried about the risk of developing Alzheimer's disease, because both parents had the disease. The nurse will tell this patient that known risk factors include what? (Select all that apply.)
Advanced age Family Hx
A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin [Dilantin] 100 mg three times daily and oxcarbazepine [Trileptal] 300 mg twice daily for several years. The patient's phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?
An increased dose of phenytoin
A patient who is taking oral contraceptives begins taking valproic acid [Depakote] for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?
Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
Combination products cause fewer dyskinesias and decreased psychosis."
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?
Contact the provider to report symptoms of a complex partial seizure.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?
Contact the provider to request an order for serum drug levels.
A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?
Febrile seizures are a type of generalized tonic-clonic seizure."
A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?
Increasing salt and water intake
A 20-kg child has been taking valproic acid [Depakote] for 1 week to treat a seizure disorder. The child is receiving 200 mg PO twice daily. The child's parents report no improvement in seizure activity. The nurse will anticipate that the provider will order which change in this child's drug regimen?
Increasing the dose of valproic acid to 300 mg PO twice daily
A patient who has a seizure disorder is admitted to the hospital after an increase in seizure frequency, and the prescriber orders carbamazepine [Tegretol] 100 mg twice daily to be added to the patient's medication regimen. The nurse reviewing the patient's medical history notes that the patient is already taking lamotrigine [Lamictal] 375 mg twice daily. The nurse will contact the provider to discuss which action?
Increasing the lamotrigine dose to 500 mg twice daily
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?
Interrupting treatment with amantadine for several weeks
A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching?
Memantine modulates the effects of glutamate to alter calcium influx into neurons."
A patient who has been taking phenobarbital for epilepsy begins taking valproic acid [Depakote] as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?
Notify the prescriber, and request an order to reduce the dose of phenobarbital.
A child who receives valproic acid [Depakote] begins taking lamotrigine [Lamictal] because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?
Rash
A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient?
Reducing the dose of memantine
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
She should consider a different form of birth control while taking phenytoin.
A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?
Taking a lower dose with a low-protein snack
An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?
Tell the spouse that this is an expected progression of the disease.
An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?
The dose can be increased, because the patient has been taking the drug for longer than 3 months.
A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?
The provider will withdraw the drug over a 6- to 12-week period.
A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?
This drug significantly slows the progression of the disease."
A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?
Tonic-clonic
A hospitalized patient with Parkinson's disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?
Trimethobenzamide [Tigan]
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:
administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:
any history of alcohol abuse or compulsive behaviors.
A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
does not cross the blood-brain barrier
A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
re-evaluate the diagnosis.
A child is diagnosed with absence seizures, and the prescriber orders ethosuximide [Zarontin]. When teaching the child's parents about dosage adjustments for this drug, the nurse will stress the importance of:
recording the number of seizures the child has each day.
A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:
reducing the dose of bromocriptine.
