Neuro Part II
The nurse is preparing to administer the client's first dosage of trihexyphenidyl. What should the nurse tell the client about the dosage? A) "The initial dose is usually 1 to 2 mg and then dosage is gradually increased." B) "The initial dose is usually 6 mg to establish serum levels and then 1 mg is taken daily." C) "Generally, a 5-mg dose is taken orally twice a day starting with first dose." D) "You'll probably need to take 1 to 2 mg orally every day starting with first dosage.
A) "The initial dose is usually 1 to 2 mg and then dosage is gradually increased."
What clients should the nurse recognize as having a health problem that could result in muscle spasm? Select all that apply. A) A client who overstretched a muscle during a vigorous workout B) A client who sustained an accidental gunshot injury to his leg C) A client who tore a leg tendon in a soccer game D) A school-aged client who fractured their radius on the playground E) An older adult client with Parkinson disease
A) A client who overstretched a muscle during a vigorous workout C) A client who tore a leg tendon in a soccer game
The nurse is caring for a client who is having a pump placed to deliver intrathecal baclofen and another client who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? Select all that apply. A) Acute pain related to GI effects of drug B) Risk for injury related to central nervous system (CNS) effects C) Disturbed body image related to muscle pain D) Disturbed thought processes related to CNS effects E) Deficient knowledge related to procedure
A) Acute pain related to GI effects of drug B) Risk for injury related to central nervous system (CNS) effects D) Disturbed thought processes related to CNS effects
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? A) Adding carbidopa to the client's medication regimen B) Addition of vitamin B6 to the client's medication regimen C) Substitution of diphenhydramine for levodopa D) Temporary change in levodopa route from oral to intravenous
A) Adding carbidopa to the client's medication regimen
The nurse is planning the care of a client diagnosed with Parkinson disease. What is the main purpose of this client's medication therapy? A) Adjust the balance of neurotransmitters in the client's CNS. B) Make the catechol-O-methyltransferase (COMT) inhibitors work better. C) Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists. D) Increase the actions of acetylcholine in the brain.
A) Adjust the balance of neurotransmitters in the client's CNS.
A client has developed drug-induced Parkinson disease following prolonged treatment with metoclopramide. The nurse should anticipate the use of what drug that is also classified as an antiviral? A) Amantadine B) Entacapone C) Diphenhydramine D) Ropinirole
A) Amantadine
The nurse is caring for a client with Parkinson's disease who has severe dysphagia. What drug would be available for parenteral administration? A) Apomorphine B) Bromocriptine C) Levodopa D) Ropinirole
A) Apomorphine
A nurse is providing discharge teaching for a client who will be going home on cyclobenzaprine prescribed for acute musculoskeletal pain. What health education should the nurse provide? A) Avoid drinking any alcohol until the completion of treatment B) Take the medication in the morning to avoid nighttime awakenings because of diuresis C) Avoid taking acetaminophen concurrently with cyclobenzaprine D) Avoid any supplements that contain vitamin B6
A) Avoid drinking any alcohol until the completion of treatment
6. A female client has been experiencing increased muscle spasticity since being diagnosed with multiple sclerosis. What drug is most likely to meet this client's needs? A) Baclofen B) Cyclobenzaprine C) Metaxalone D) Orphenadrine
A) Baclofen
A client is newly diagnosed with Parkinson disease. What aspects of this client's health history rules out the safe and effective use of an anticholinergic drug? Select all that apply. A) Benign prostatic hypertrophy B) Macular degeneration C) Chronic bowel obstructions D) Atrial fibrillation E) Psoriasis
A) Benign prostatic hypertrophy C) Chronic bowel obstructions
The nurse is caring for a client who has a disorder of muscle contraction and relaxation. The nurse should prioritize the assessment of what laboratory value? A) Calcium B) Chloride C) Magnesium D) Potassium
A) Calcium
A client has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases? A) Dantrolene B) Baclofen C) Carisoprodol D) Botulinum toxin type B
A) Dantrolene
A client has been prescribed benztropine as drug therapy for Parkinson disease. What assessment finding would suggest a therapeutic effect to the nurse? A) Decreased rigidity and tremors B) Increased level of consciousness C) Increased motivation and muscle strength D) Absence of seizure activity
A) Decreased rigidity and tremors
The nurse is giving discharge instructions to a client who just had Botox A injections around their eyes. The nurse should caution the client about what potential adverse effects? Select all that apply. A) Development of respiratory infections B) Flu-like symptoms C) Droopy eyelids D) Blurred vision or diplopia E) Muscle spasms
A) Development of respiratory infections B) Flu-like symptoms C) Droopy eyelids
The nurse is reviewing the medication administration record (MAR) of a client with Parkinson's disease. The nurse reads that the client is prescribed Stalevo t.i.d. Stalevo is a combination of drugs? Select all that apply. A) Entacapone B) Selegiline C) Carbidopa D) Levodopa E) Benztropine
A) Entacapone C) Carbidopa D) Levodopa
A client comes to the clinic to receive a Botox injection in their forehead. The client has adult acne across their forehead. What is the nurse's priority action? A) Hold the injection and consult the healthcare provider. B) Cleanse the area well with an antibacterial soap. C) Apply a topical antibiotic after administering the Botox. D) Provide client information about post-Botox injection care.
A) Hold the injection and consult the healthcare provider.
A client is newly diagnosed with Parkinson disease, and levodopa has been prescribed. What health education should the nurse provide? A) Identifying foods and supplements high in vitamin B6 B) The need for weekly laboratory blood work for the first 6 weeks C) The fact that adverse effects will subside when the body adjusts to the drug D) Matching doses to the daily severity of symptoms
A) Identifying foods and supplements high in vitamin B6
An older adult client was diagnosed with Parkinson disease 2 years ago, and the client's symptoms have gradually worsened. What nursing diagnoses are likely to apply to this client? Select all that apply. A) Impaired physical mobility related to extrapyramidal symptoms B) Risk for autonomic dysreflexia related to CNS disruptions C) Disturbed thought processes related to low dopamine levels D) Self-care deficit: dressing/grooming related to ataxia E) Acute pain related to nociceptor stimulation
A) Impaired physical mobility related to extrapyramidal symptoms D) Self-care deficit: dressing/grooming related to ataxia
The nurse is explaining the therapeutic effects of levodopa to a client with Parkinson disease. What characteristics of levodopa and dopamine should the nurse describe? Select all that apply. A) Levodopa is a precursor of dopamine B) Levodopa crosses the blood-brain barrier C) Levodopa is converted to dopamine D) Levodopa stimulates the brain to synthesize dopamine E) Dopamine reverts levodopa for metabolism
A) Levodopa is a precursor of dopamine B) Levodopa crosses the blood-brain barrier C) Levodopa is converted to dopamine
The nurse admits a child diagnosed with tetanus after stepping on some old barbed wire fencing. What medication should the nurse expect to administer? A) Methocarbamol B) Baclofen C) Dantrolene D) Cyclobenzaprine
A) Methocarbamol
A client with a spinal cord injury has developed central spasticity, and the care provider wishes to administer a muscle relaxant intrathecally. What is the nurse's best action? A) Prepare to administer baclofen. B) Contact the care provider to question the treatment plan. C) Ensure that the client has patent venous access. D) Prepare to administer carisoprodol.
A) Prepare to administer baclofen.
The nurse is observing a client who is labeling the numbers on a drawing of a clock during a neurologic assessment. What should the nurse recognize that the client is using when making precise, intentional movements such as handwriting? A) Pyramidal tract B) Substantia nigra C) Broca's area D) Extrapyramidal tract
A) Pyramidal tract
The nurse is speaking to a group at the senior citizen's center about Parkinson disease. What should the nurse explain is importance to avoiding when taking an anticholinergic medication? A) Strenuous exercise in high environmental temperatures B) Salt substitutes and foods high in potassium C) Foods high in vitamin K such as dark green, leafy vegetables D) Over-the-counter medications containing acetaminophen
A) Strenuous exercise in high environmental temperatures
A client with a complex health history has developed severe spasticity. What aspect of the client's status would contraindicate the safe and effective use of dantrolene? A) The client has a history of fatty liver disease. B) The client has type 2 diabetes and takes oral antihyperglycemics. C) The client has asthma and occasionally uses an inhaled corticosteroid. D) The client requires partial assistance with activities of daily living.
A) The client has a history of fatty liver disease.
An older adult client began treatment for Parkinson's disease several months ago and the nurse is assessing the client. What assessment finding should suggest that the client's medications are becoming less effective? A) The client has begun drooling while they eat B) The client is increasingly impatient with their spouse and children C) The client has lost interest in their favorite foods D) The client's neutrophil count is gradually declining
A) The client has begun drooling while they eat
The nurse provides client teaching about chlorzoxazone in preparation for the client's discharge to home. The nurse determines that the client understands potential adverse effects when the client makes what statement? A) "This drug can cause diarrhea, so I'll adjust my diet accordingly." B) "My urine might change color when I take this drug." C) "My skin may turn yellow but that will go away once my body adjusts to the drug." D) "After I take a pill it might take 2 to 3 hours before I feel the effects."
B) "My urine might change color when I take this drug."
A client attends a "Botox Party" and is injected with botulinum toxin type A to decrease frown lines between their eyebrows. Later that evening, the client is admitted to the emergency department and is distraught because they cannot move their eyebrows. What does the nurse explain the toxin causes? A) "The toxin causes muscle death, which smooths wrinkles in the area." B) "The toxin causes muscle paralysis, preventing movement and relieving wrinkles." C) "The drug is a toxin to nerves in the area." D) "The drug is a permanent muscle relaxant and the muscles will never move again."
B) "The toxin causes muscle paralysis, preventing movement and relieving wrinkles."
After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm? A) Physical therapy for the affected muscle B) Application of heat to the affected region C) Deep tissue massage D) Administration of a nonsteroidal anti-inflammatory drug
B) Application of heat to the affected region
The nurse is caring for a client who has Parkinson disease and whose symptoms are worsening. The healthcare provider has added selegiline to the client's drug regimen. What is the nurse's priority assessment after this drug is administered? A) Apical heart rate B) Blood pressure C) Urine output and urine character D) Monitoring for hemorrhage
B) Blood pressure
A client with muscle spasticity has begun taking baclofen. What recent assessment findings should the nurse attribute to possible adverse effects? Select all that apply. A) Heart rate 61 beats/min, regular rhythm. B) Blood pressure 103/59 mm Hg. C) Client reports frequent urges to void. D) Client reports lightheadedness transitioning from lying to sitting. E) Most recent laboratory blood results suggest leukopenia.
B) Blood pressure 103/59 mm Hg. C) Client reports frequent urges to void. D) Client reports lightheadedness transitioning from lying to sitting.
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? A) Bromocriptine B) Carbidopa C) Amantadine D) Trihexyphenidyl
B) Carbidopa
A 10-year-old client has been prescribed an antiparkinsonian drug due to changes in movement. Which treatment should the nurse expect as the first choice for this child? A) Benztropine B) Diphenhydramine C) Trihexyphenidyl D) Electroconvulsive therapy (ECT)
B) Diphenhydramine
A client has a long-standing diagnosis of Parkinson disease and has been taking Sinemet for 2 years. The nurse has observed that the client is experiencing less and less benefit from the Sinemet in recent months. What drug may reverse this trend? A) Pramipexole B) Entacapone C) Ropinirole D) Amantadine
B) Entacapone
When caring for a client taking dantrolene, for what adverse effects should the nurse monitor the client? Select all that apply. A) Bradycardia B) Jaundice C) Urinary retention D) Fatigue E) Drowsiness
B) Jaundice D) Fatigue E) Drowsiness
The nurse is teaching a new client with Parkinson disease about levodopa (L-dopa). What should the nurse instruct the client to avoid using concurrently with L-dopa? A) Over-the-counter calcium carbonate tablets B) Multivitamin-mineral preparations C) Foods that are high in tyramines D) Topical corticosteroid ointments
B) Multivitamin-mineral preparations
What are the simplest nerve pathways in the body? A) Arc reflexes B) Spinal reflexes C) Afferent nerve reflexes D) Spindle gamma loop
B) Spinal reflexes
The nurse provides client teaching about use of levodopa for treatment of Parkinson disease. What statement by the client would indicate a good understanding of levodopa? A) "I'll know within about a year whether this drug has cured my Parkinson disease." B) "I should avoid exercising while taking this drug so that I don't get injured." C) "I should take this drug with food to avoid an upset stomach." D) "I will take multivitamins to ensure that I have good nutrition."
C) "I should take this drug with food to avoid an upset stomach."
When describing Parkinson disease to a client with a new diagnosis, what statement made by the nurse would be accurate? A) "Parkinson disease can be cured if medication is taken regularly as prescribed." B) "Degeneration of the neurons can be halted if medications are begun as early as possible." C) "Symptom management through drug therapy is the current mainstay of treatment." D) "Surgery has become the most effective intervention for Parkinson disease over the past decade."
C) "Symptom management through drug therapy is the current mainstay of treatment."
A client with Parkinson disease has been prescribed apomorphine to treat the client's episodes of hypomobility. What should the nurse teach the client regarding administration of the drug? A) "The drug will likely be injected intramuscularly three times a day in a range of 1.0 to 1.5 mL." B) "The drug will probably be prescribed intravenously, 50 mg every third day." C) "The drug will probably be injected three times a day with a dosage range of 2 to 6 mg." D) "The drug is usually taken orally, 20 mg three times a day."
C) "The drug will probably be injected three times a day with a dosage range of 2 to 6 mg."
The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene? A) A man who is taking a cardiac glycoside B) A man who is taking an antipsychotic drug C) A woman who is on hormone replacement therapy D) A woman who is taking a loop diuretic
C) A woman who is on hormone replacement therapy
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? A) Monitoring of laboratory results for blood dyscrasias B) Focused respiratory assessment C) Assessment of the client's bowel pattern D) Monitoring of prothrombin time and international normalized ratio (INR)
C) Assessment of the client's bowel pattern
The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen? A) The client's dose of baclofen should be gradually withdrawn over 4 to 6 weeks to prevent rebound spasticity. B) "The client will be prescribed alternate doses of baclofen and carisoprodol over 10 days to prevent symptoms of baclofen withdrawal." C) Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations. D) "Carisoprodol will be administered while continuing baclofen until the carisoprodol level is established.
C) Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations.
When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa may be reduced. What does the reduction in the dosage of L-dopa cause? A) Heightened levels of sedation B) Prolonged effect of medications C) Decreased adverse effects D) Decreased effectiveness of symptom control
C) Decreased adverse effects
The nurse is caring for a client who has Parkinson disease. What should the nurse anticipate for this client? A) Excessive gamma-aminobutyric acid (GABA) levels B) Hypoxia in the corpus striatum C) Deficient levels of dopamine D) Hypertrophy of the substantia nigra
C) Deficient levels of dopamine
The nurse is caring for a client diagnosed with Parkinson disease who has been prescribed an anticholinergic drug. What factor most likely prompted the primary care provider to prescribe this drug? A) The client has exhibited adverse effects of medications. B) The client has developed psychological dependence on dopaminergics. C) Levodopa has not caused a sufficient therapeutic response. D) The client's disease has been deemed incurable.
C) Levodopa has not caused a sufficient therapeutic response.
An older adult with lumbar pain has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize? A) Chronic confusion related to CNS depression B) Diarrhea related to GI stimulation C) Risk for falls related to CNS depression D) Risk for deficient fluid volume related to vomiting and diaphoresis
C) Risk for falls related to CNS depression
The nurse is caring for an older adult client who has been diagnosed with Parkinson disease and who will soon begin drug therapy. What nursing action will best promote safe and effective drug therapy? A) Teaching the family to best match medication doses to the daily severity of the client's symptoms B) Detailed education about the need for outpatient blood pressure monitoring C) Thorough client and family teaching, supplemented with written materials D) Reassurance that many of the client's symptoms may be normal age-related changes rather than pathologic changes
C) Thorough client and family teaching, supplemented with written materials
An order is written for a drug that is an adjunctive therapy for Parkinson disease. The nurse reviews the order before administering the drug. What prescription should the nurse question? A) Levodopa 0.5 to 1 g/d orally in two divided doses B) Amantadine 200 mg orally b.i.d. C) Tolcapone 400 mg orally t.i.d. D) Selegiline 10 mg/d orally
C) Tolcapone 400 mg orally t.i.d.
A 31-year-old female client has been taking dantrolene for several years with good effect. The client has presented to the clinic because she has just had a positive home pregnancy test. In addition to referring the client to her primary care provider, the nurse should provide what teaching? A) "Your provider will likely want to discontinue the drug for the rest of your first trimester, since that when organs are forming." B) "Dantrolene is in pregnancy category A, which means it's been shown safe to use in pregnancy." C) "Your provider will likely choose an alternative muscle relaxant since dantrolene has been linked to spontaneous abortion." D) "You and your care provider will have to carefully consider whether it will be safe for you to continue taking dantrolene."
D) "You and your care provider will have to carefully consider whether it will be safe for you to continue taking dantrolene."
The nurse is preparing to administer a hospital client's scheduled dose of baclofen 20 mg PO. Prior to administering the medication, the nurse has performed an assessment which indicated the client's blood pressure is 151/98 mm Hg. What is the nurse's best action? A) Withhold the scheduled dose of baclofen and document the assessment findings. B) Contact the care provider immediately. C) Withhold the medication and reassess the client in 30 to 60 minutes. D) Administer the medication as prescribed.
D) Administer the medication as prescribed.
The nurse is working with a client who has been prescribed tizanidine for the treatment of muscle spasticity. When monitoring the client's risk for injury, what assessment should the nurse prioritize? A) Assessment of bowel sounds and pattern of bowel movements B) Assessment for headaches following peak blood levels C) Assessment of the client's creatinine clearance rate D) Assessment of the client's blood pressure following administration
D) Assessment of the client's blood pressure following administration
The nurse has developed a plan of care for an older adult client newly diagnosed with Parkinson disease. What outcome is most likely to be appropriate for this client? A) Client will demonstrate a full return to independent activities of daily living with 2 weeks of starting treatment. B) Client will return to prediagnosis levels of fine motor skill within 48 hours of beginning treatment. C) Client will be oriented to person, place, and time within 48 hours of beginning treatment. D) Client will demonstrate the ability to ambulate the length of the hall within 1 week of starting medication
D) Client will demonstrate the ability to ambulate the length of the hall within 1 week of starting medication
The nurse is caring for a client who has just been prescribed cyclobenzaprine 100 mg PO t.i.d. What is the nurse's best action? A) Confirm the client's identity and administer the medication as prescribed. B) Contact the prescriber to confirm the route. C) Contact the prescriber to confirm the frequency. D) Contact the prescriber to confirm the dose.
D) Contact the prescriber to confirm the dose.
A client with advanced Parkinson disease has undergone diagnostic testing and diagnostic imaging. What are the results most likely to reveal? A) Decreased enzyme dopa decarboxylase levels B) Increased gamma-aminobutyric acid (GABA) C) Brain infarcts D) Degeneration of dopamine-producing nerve cells
D) Degeneration of dopamine-producing nerve cells
The client reports pain caused by muscle spasms in their back. The nurse assesses the client as being very anxious due to intense psychosocial stressors and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this client? A) Baclofen B) Botulinum toxin type B C) Dantrolene D) Diazepam
D) Diazepam
The nurse assesses a newly admitted client and finds the muscle tone in their left leg has sustained muscle contraction and that the client is unable to relax the muscle even when prompted. What is the nurse's most appropriate action? A) Administer phenytoin as prescribed. B) Administer diphenhydramine as prescribed C) Document the fact that the client has atonic muscles D) Document the presence of muscle spasticity
D) Document the presence of muscle spasticity
The nurse is assessing a client who was prescribed levodopa 1 week earlier. What change in the client's status would suggest the effectiveness of drug therapy? A) Stability of mood B) Slower chewing of food C) Improved attention span D) Improvement in handwriting
D) Improvement in handwriting
A client presents to the emergency department and states stepping on a rusty nail 2 days ago. Upon assessment, the client exhibits signs of muscle rigidity and contractions. The nurse should expect to administer which medication? A) Carisoprodol B) Cyclobenzaprine C) Metaxalone D) Methocarbamol
D) Methocarbamol
A client has been diagnosed with cerebral palsy accompanied by muscle spasticity. The nurse should identify what causative factor of this client's symptoms? A) Irreversible injury to muscle tissue B) Imbalances between neurotransmitter levels and the levels of enzymes that modulate their reuptake C) Inherited defects of the peripheral nervous system D) Nerve damage within the central nervous system
D) Nerve damage within the central nervous system
The nurse is caring for a client with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this client? A) Chlorzoxazone B) Carisoprodol C) Cyclobenzaprine D) Orphenadrine
D) Orphenadrine
The pediatric nurse is preparing to administer an antiparkinsonism drug to a 14-year-old client. What is the most likely indication for this use of antiparkinsonian drugs? A) Early onset of Parkinson disease B) Development of parkinsonian effects from recreational drug use C) Parkinsonian effects secondary to a connective tissue disorder D) Parkinsonian symptoms arising from adverse medication effects
D) Parkinsonian symptoms arising from adverse medication effects
The nurse is teaching a client newly-diagnosed with Parkinson disease about the appropriate use of levodopa-carbidopa (Sinemet). What should the nurse teach the client? A) Take the daily dose at bedtime to minimize sedative effects. B) Remain seated upright for 30 minutes after taking the medication, if possible. C) Use a moisturizing cream if a rash develops after beginning the medication. D) Take the drug three times each day, at the times that are specified.
D) Take the drug three times each day, at the times that are specified.
A home health nurse is visiting an older male adult client with Parkinson disease. The nurse should assess this client for which signs or symptoms related to common adverse effects? A) Skin lesions B) Increased dopamine activity C) Jaundice D) Urinary retention
D) Urinary retention
A client with Parkinsonism has been told that the levodopa prescribed is no longer controlling the disease. What drug should the nurse question if ordered as adjunctive therapy? A) Diphenhydramine B) Pramipexole C) Trihexyphenidyl D) Vitamin B6
D) Vitamin B6
General anesthetic has been administered to a surgical client, and the client has begun to exhibit signs and symptoms of malignant hyperthermia. The operating room nurse should prepare to assist with the administration of: A) orphenadrine. B) metaxalone. C) chlorzoxazone. D) dantrolene.
D) dantrolene.
