Specific Neurodegenerative Disorders
8 The nurse is providing education to a patient taking carbidopa-levodopa. Which statement by the nurse correctly explains why the patient should take this medication with low-protein foods? "A high-protein diet will increase renal excretion of carbidopa-levodopa." "Low-protein foods accelerate the transportation of this medication to the CNS." "Alow-protein diet will help prevent gastrointestinal distress from the medication." "High-protein foods interfere with transportation of this medication to the central nervous system."
"High-protein foods interfere with transportation of this medication to the central nervous system." High-protein foods interfere with the transportation of the medication to the central nervous system. Patients taking carbidopa-levodopa should limit their intake of dietary protein.
A family member states, "My father complains of an upset stomach after taking rivastigmine." Which would be an appropriate response by the nurse? "We may need to decrease his dose." "Make sure he takes the medication with food." "Make sure he takes the medication without food." "We may need to reduce the frequency of his dosing to once daily."
"Make sure he takes the medication with food." Administering rivastigmine with food enhances absorption and reduces GI effects.
Which information related to rivastigmine should the nurse teach Mrs. Hill? "Weight gain can occur." "Avoid grapefruit products." "Take ibuprofen 30 minutes before a meal to prevent GI upset." "Rise slowly from sitting or lying positions, as orthostatic hypotension can occur."
"Rise slowly from sitting or lying positions, as orthostatic hypotension can occur." Orthostatic hypotension is a potential side effect of rivastigmine.
During patient discharge, a family member states to the nurse, "My mother's Alzheimer's disease can be cured." How should the nurse respond? "The disease cannot be slowed." "You are likely to develop this disease." "Everyone over 65 develops some level of this disease." "The symptoms may be treated, but the disease itself cannot be cured."
"The symptoms may be treated, but the disease itself cannot be cured." There are many physiologic symptoms of Alzheimer's disease that can be treated with medication, but there is no cure for the disease.
A patient who is currently taking an antihypertensive drug for renal artery stenosis has also been prescribed carbidopa-levodopa for the beginning stages of Parkinson's disease. The patient states, "I'm applying for a job where I would be operating a backhoe." What teaching should the nurse provide for the patient? "Perform exercises for lumbar support while sitting." "Your tremors will stop, so you will be able to operate a backhoe." "These medications stimulate your central nervous system, so you will be able to operate heavy machinery." "These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery."
"These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery." Taking an antihypertensive in combination with carbidopa-levodopa can result in hypotension. Patients using both medications should use caution when operating heavy machinery.
Which instruction is most important for the nurse to include when teaching a patient who has been prescribed sustained-released carbidopa-levodopa? "Take this medication with food." "Take this medication with low-protein foods." "Watch for adverse effects such as dizziness and drowsiness." "Inform the health care provider when you can walk without shuffling."
"Watch for adverse effects such as dizziness and drowsiness." Adverse effects of carbidopa-levodopa include dizziness and drowsiness, which can lead to orthostatic hypotension and falls. Safety is the highest priority.
The duration of action for transdermal rivastigmine is 24 hours. Use numbers only.
24
4 A nurse administers oral carbidopa-levodopa to a patient who has tremors from Parkinson's disease. What duration of action does the nurse expect to see for this medication? 1 hour 3 hours 5 hours 8 hours
5 hours The duration of action of carbidopa-levodopa is 5 hours.
Match the drug class with the mechanism of action. Affect dopamine content of the brain Stimulate dopamine receptors of nerve cells in the brain Inhibit activity of acetylcholine Inhibit activity of monoamine oxidase
Affect dopamine content of the brain Dopaminergics Stimulate dopamine receptors of nerve cells in the brain Dopamine agonists Inhibit activity of acetylcholine Anticholinergics Inhibit activity of monoamine oxidase MAO-B inhibitors
7 A nurse is providing a teaching plan for a patient who is taking carbidopa-levodopa and selegiline, an MAOI. Which foods should the nurse tell the patient to avoid? Honey, beer, and apples There will be no food and drug interactions if honey, beer, and apples are ingested. Boiled peanuts and hot dogs There will be no food and drug interactions if boiled peanuts and hot dogs are ingested. Grapefruit juice and tomatoes There will be no food and drug interactions if grapefruit juice and tomatoes are ingested. Correct Aged cheeses, red wines, and bananas Foods high in tyramine such as aged cheeses, red wines, and bananas should be avoided to prevent hypertensive crisis.
Aged cheeses, red wines, and bananas Foods high in tyramine such as aged cheeses, red wines, and bananas should be avoided to prevent hypertensive crisis.
What baseline labs should be obtained for a patient who has been prescribed carbidopa-levodopa? Select all that apply. CBC LFT BMP Kidney profile Prolactin level Pregnancy test
CBC Baseline labs for a patient who has been prescribed carbidopa-levodopa include CBC. LFT Baseline labs for a patient who has been prescribed carbidopa-levodopa include LFT. Prolactin level Baseline labs for a patient who has been prescribed carbidopa-levodopa include prolactin level. Pregnancy test Baseline labs for a patient who has been prescribed carbidopa-levodopa include a pregnancy test.
16 The nurse is preparing to administer rivastigmine to a patient who has been admitted with worsening symptoms of Alzheimer's disease. The order states to administer 8 mg bid, and the pharmacy sends four 2-mg tablets for the am dose. What should the nurse do first? Administer the medication Call the pharmacy to ask for one 8 mg tablet Call the health care provider for an order change Ask a family member what dosage the patient takes at home
Call the health care provider for an order change The maximum dose of rivastigmine is 6 mg bid.
3 Which statement about the mechanism of action of carbidopa is true? Carbidopa has no therapeutic effect on its own. Carbidopa works by crossing the blood-brain barrier. Carbidopa aids in the breakdown of levodopa in the peripheral tissues. Due to periphery loss of the medication, only 2% of carbidopa taken is available to the brain.
Carbidopa has no therapeutic effect on its own. Carbidopa has no therapeutic effect of its own; it is used to enhance the effects of levodopa.
Which statement correctly explains the action of carbidopa-levodopa? Carbidopa decreases symptoms of parkinsonism. Carbidopa inhibits the breakdown of dopamine at the synapses in the brain. Carbidopa inhibits the catechol-o-methyltransferase (COMT) enzyme, increasing the concentration of levodopa. Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain.
Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain. With the use of carbidopa, less levodopa is needed. Carbidopa has no therapeutic effect of its own.
2 Which statement about carbidopa-levodopa is correct? Carbidopa-levodopa should not be taken with food. Carbidopa-levodopa should not be stopped abruptly. High-protein foods should be consumed with every meal. A decrease in the symptoms of Parkinson's disease occurs within a week of starting medication treatment.
Carbidopa-levodopa should not be stopped abruptly. Discontinuing use of carbidopa-levodopa abruptly can result in rebound parkinsonism.
What potential side effect of carbidopa-levodopa should the nurse teach the patient and family to report to the health care provider? GI upset Seizures Dyskinesia Elevated temperature
Dyskinesia Dyskinesia (involuntary muscle movement) may occur with high levodopa dosages and should be reported.
5 Which nursing diagnosis is highest priority for a nurse who is caring for a patient taking carbidopa-levodopa for Parkinson's disease? Risk for activity intolerance related to tremors Impaired physical mobility related to dizziness Body image disturbance related to shuffling gait Knowledge deficit related to effects of medication
Impaired physical mobility related to dizziness Impaired physical mobility related to dizziness is the highest priority. Patients are at higher risk for falls when they are dizzy.
To evaluate the effectiveness of dopaminergic agents, the nurse should assess for which condition? Weight loss Correction of shuffling gait Increase in drooling and sweating Improvement in balance, gait, and mobility
Improvement in balance, gait, and mobility The effectiveness of dopaminergic agents is evaluated by their control of parkinsonism symptoms. An improvement in balance, gait, and mobility indicates controlled parkinsonism symptoms.
15 A nurse is evaluating the effectiveness of an Alzheimer patient's drug regimen. Which assessment finding by the nurse would indicate that the medicine is effective? Increase in wandering Absence of side effects No increase in ALT and AST Improvement in mental status
Improvement in mental status Ongoing evaluation of controlled Alzheimer's disease symptoms helps determine if an increase in dosage or change in medication is needed. An improvement in mental status from the baseline assessment indicates the medication is having a therapeutic effect.
Which statement best explains the therapeutic effect of rivastigmine? Improves memory Restores damaged neurons Improves oxygenation in the brain Increases antioxidants in the brain
Improves memory Rivastigmine improves memory in patients with mild to moderate Alzheimer's disease.
6 A patient has been taking carbidopa-levodopa for many years. During assessment, the nurse finds that the patient presents with hand tremors, drooling, and a mask-like facial expression. What action by the health care provider should the nurse anticipate? Increase in medication dosage Decrease in medication dosage Discontinuation of the medication Discussion of medication compliance
Increase in medication dosage Ongoing evaluation of controlled Parkinson's disease symptoms helps the health care provider determine if an increase in dosage or change in medication is needed. After many years of use, carbidopa-levodopa may lose its overall effectiveness.
The nurse is caring for a patient who has a history of COPD and a new diagnosis of Alzheimer's disease. The nurse knows that theophylline and rivastigmine have what effect on the patient when given together? Increase potassium levels Decrease blood glucose levels Increase the risk for theophylline toxicity Increase the risk for rivastigmine toxicity
Increase the risk for theophylline toxicity Rivastigmine can increase the effects of theophylline and increase the patient's risk for theophylline toxicity.
Which intervention related to family members who are preparing to bring their mother with Alzheimer's disease home from the hospital would be the highest priority for the nurse? Explain to the family members the importance of routine liver function tests Determine the family members' ability to cope with the patient's Alzheimer's disease Provide the family members with contact information for an Alzheimer's disease support group Instruct the family members to remove obstacles from the patient's path to prevent falls and injuries if she should wander
Instruct the family members to remove obstacles from the patient's path to prevent falls and injuries if she should wander Instructing the family members to remove obstacles from the patient's path to prevent falls is the priority intervention; it will enable the family to provide a safe environment for the patient in the home.
Which statement about rivastigmine is correct? It is metabolized in the kidneys. It is contraindicated in patients with liver disease. It is contraindicated with concurrent use of NSAIDs. It is contraindicated in patients with Alzheimer's disease.
It is contraindicated in patients with liver disease. Rivastigmine is contraindicated in patients with liver disease due to risk of hepatotoxicity.
11 What correct statement should the nurse include in patient teaching related to carbidopa-levodopa and symptoms of dyskinesia? "Your dyskinesia will be cured by this medication." "Your dyskinesia will worsen with this medication." "It will take 3 to 5 days for your symptoms to be controlled." "It may take weeks or months before your symptoms are controlled."
It may take weeks or months before your symptoms are controlled." Symptoms may take weeks or months to be controlled in patients taking carbidopa-levodopa.
Which factor in a patient's health history is most important for the nurse to consider with regard to the patient's treatment plan? Acid reflux Liver disease Prostate cancer Basal cell carcinoma
Liver disease A cumulative drug effect of rivastigmine is likely to occur in an older adult patient with liver disease or dysfunction; therefore, rivastigmine would be contraindicated for this patient.
Which side effects should the nurse teach Mrs. Hill to expect while taking rivastigmine? Select all that apply. Nausea Diarrhea Anorexia Headache Tachycardia Hypertension
Nausea Nausea is a potential side effect of rivastigmine. Diarrhea Diarrhea is a potential side effect of rivastigmine. Anorexia Anorexia is a potential side effect of rivastigmine. Headache Headache is a potential side effect of rivastigmine.
12 What statement is correct about the pharmacokinetics of topical rivastigmine? Peak action is 4 hours Peak action is 24 hours Onset of action is 2 to 4 hours Onset of action is 0.5 to 1 hour
Onset of action is 0.5 to 1 hour The onset of action for topical rivastigmine is 30 minutes to 1 hour.
Which statement correctly explains the action of rivastigmine? Interferes with the breakdown of dopamine Breaks down acetylcholine in the neuron receptors Permits more acetylcholine in the neuron receptors Reverses clinical manifestations of Alzheimer's disease
Permits more acetylcholine in the neuron receptors Rivastigmine effectively penetrates the central nervous system (CNS) and increases cholinergic transmission. The result is improved cognitive function in patients with mild to moderate Alzheimer's disease.
When instructing patients and family members about rivastigmine, the nurse should teach that which adverse effect is considered life threatening and is a priority? Seizures Suicidal ideation Cataract development Orthostatic hypotension
Suicidal ideation Suicidal ideation is life threatening and requires immediate attention.
1 Which is a correct therapeutic goal for treatment of Parkinson's Disease? To cure Parkinson's disease To delay the progression of Parkinson's disease To improve the patient's ability to carry out activities of daily living To return the patient's ability to carry out activities of daily living to baseline
To improve the patient's ability to carry out activities of daily living A goal for all medication treatment plans used with Parkinson's disease is to improve the patient's ability to carry out activities of daily living.
Which route of administration for rivastigmine results in a peak concentration between 8 and 16 hours? Oral Intravenous Transdermal Subcutaneous
Transdermal Transdermal applications of rivastigmine peak between 8 and 16 hours.
What information should the nurse include in patient teaching for a patient taking extended-release carbidopa-levodopa? Select all that apply. "Report tremors to your health care provider." "Do not abruptly stop taking this medication." "You may continue to have symptoms for several weeks or months " "If this medication causes GI upset, you can crush the tablets and mix them with food." "You may experience discolored urine or dark perspiration while taking this medication."
"Do not abruptly stop taking this medication." An increase in parkinsonism symptoms can occur if carbidopa-levodopa is stopped abruptly; therefore, the patient should not abruptly stop taking the medication. "You may continue to have symptoms for several weeks or months " It may take weeks or months for a therapeutic goal of carbidopa-levodopa to be reached and for symptoms to be controlled. "You may experience discolored urine or dark perspiration while taking this medication." Discolored urine or dark perspiration may occur when a patient is taking carbidopa-levodopa.