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16Qw/exp *LOOK OVER* Ch 20 Drugs for Degenerative Diseases of Nervous System
Terms in this set (16)
The family member caring for a client with Parkinson's disease at home notifies the nurse that the client is demonstrating extrapyramidal symptoms. The nurse should instruct the caregiver to:
a. Give diphenhydramine (Benadryl) 25 mg p.o.
b. Transport the client to the Emergency Department.
c. Increase dosage of antiparkinsonism drugs.
d. Make an appointment with the health care provider for evaluation.
Answer: b. Transport the client to the Emergency Department.
Rationale: The symptoms can cause severe muscle spasms and can be life-threatening without intervention. The client should be transported to the Emergency Department. Diphenhydramine must be given parenterally for effective treatment.
The client asks what can be expected from drug therapy for treatment of parkinsonism. The best response by the nurse would be:
a. That a cure can be expected within six months.
b. That symptoms can be reduced, and the ability to perform ADLs can be improved.
c. That disease progression will be stopped.
d. That EPS will be prevented
Answer: b. That symptoms can be reduced, and the ability to perform ADLs can be improved.
Rationale: Pharmacotherapy does not cure the disease, but it does improve the client's ability to perform normal activities, such as eating, bathing, and walking. The symptoms are often reversed if medications are taken long-term.
Levodopa (Laradopa) is prescribed for a client with Parkinson's disease. The nurse's discharge teaching should include: (Select all that apply.)
a. Monitor the blood pressure every two hours for the first two weeks.
b. Expect the urine color to be orange.
c. Report the development of diarrhea.
d. Report to the lab for a follow-up of liver and renal function tests.
e. Avoid taking the medication with high-protein meals
Answer: d. Report to the lab for a follow-up of liver and renal function tests.; e. Avoid taking the medication with high-protein meals.
Rationale: A decrease in kidney and liver function could slow the metabolism and excretion of the drug, leading to overdose and toxicity. Protein decreases the absorption of levodopa. Blood pressure needs to be closely monitored when the dose is adjusted. It might cause urine and sweat to darken in color. It does not cause diarrhea.
The nurse provides nutritional counseling for a client receiving levodopa. The client should be encouraged to:
a. Lower the intake of simple carbohydrates.
b. Increase vitamin B6 intake.
c. Avoid foods such as ham, sweet potatoes, and oatmeal.
d. Decrease intake of dairy products
Answer: c. Avoid foods such as ham, sweet potatoes, and oatmeal.
Rationale: Ham, sweet potatoes, and oatmeal are high in pyridoxine (vitamin B6). Pyridoxine reduces the effects of levodopa.
A client receiving an anticholinergic drug for treatment of Parkinson's disease complains of dry mouth. Nursing intervention should include advising the client to:
a. Take the drug with food or milk.
b. Chew sugarless gum, and suck on sugarless hard candy.
c. Use mouthwash before taking the drug.
d. Rinse mouth with warm water
Answer: b. Chew sugarless gum, and suck on sugarless hard candy.
Rationale: Frequent drinking of cool liquids, sucking on hard candy or ice chips, and chewing sugarless gum can add moisture to the mucous membranes.
A client has been started on benztropine (Cogentin) for relief of parkinsonian symptoms. Which of the following statements made by the client best indicates that the drug is producing a therapeutic effect?
a. "My hands aren't as shaky as they used to be."
b. "I feel so calm and relaxed."
c. "I can tie my shoes now without difficulty."
d. "That annoying lip smacking is much less frequent."
Answer: a. "My hands aren't as shaky as they used to be."
Rationale: Cogentin blocks excess cholinergic stimulation and helps to suppress tremors. It does not affect symptoms of tardive dyskinesia, such as lip smacking. It does not affect mood.
Donepezil (Aricept) is prescribed for a client with Alzheimer's disease. The nurse determines that the medication is having positive effects when what is observed?
a. Absence of wandering
b. Decreased progression of memory loss
c. Increase in "pin rolling"
d. Regaining the ability to drive a car
Answer: b. Decreased progression of memory loss
Rationale: Aricept is effective in the early stages of Alzheimer's disease. It might slow or decrease progression of symptoms, but it will not reverse behaviors that are lost.
The lab results of a client treated for Alzheimer's disease reveals increased liver function tests. The nurse recognizes that the drug most likely to cause this side effect is:
a. Rivastigmine tartrate (Exelon).
b. Donepezil (Aricept).
c. Tacrine (Cognex).
d. Galantamine (Reminyl).
Answer: c. Tacrine (Cognex).
Rationale: Acetylcholinesterase inhibitors used for treatment of Alzheimer's disease cause a variety of side effects. Elevated liver enzymes are specifically associated with tacrine (Cognex) use.
A client with Alzheimer's disease has been receiving medication therapy for several months. The nurse should teach the client and caregiver to report signs of overdose, which include:
a. Bradycardia and muscle weakness.
b. Tachycardia and hypertension.
c. Abdominal pain and dry mouth.
d. Emotional withdrawal and tachypnea
Answer: a. Bradycardia and muscle weakness.
Rationale: An overdose of drugs to treat Alzheimer's disease could occur if they are taken improperly, or if decreased liver or renal function occurs. Symptoms of overdose include severe nausea/vomiting, sweating, salivation, hypotension, bradycardia, convulsions, and increased muscle weakness, including respiratory muscles.
During the initial treatment with levodopa for clients with Parkinson's disease, nursing interventions should include:
a. Monitoring for suicidal ideation.
b. Observing for EPS.
c. Providing safety to prevent falls.
d. Increasing foods high in vitamin B6, such as bananas and liver
Answer: c. Providing safety to prevent falls.
Rationale: Orthostatic hypotension is likely during early treatment. Clients should be protected from falls. Suicidal ideation is monitored when clients are first started on antidepressants. EPS occurs with some antipsychotic medications. Bananas and liver are high in vitamin B6 and will decrease absorption of levodopa.
Which of the following client statements indicates that the levodopa/carbidopa (Sinemet) is effective?
a. "I'm sleeping a lot more, especially during the day."
b. "My appetite has improved."
c. "I'm able to shower by myself."
d. "My skin doesn't itch anymore."
Answer: c. "I'm able to shower myself"
Rationale: Becoming more independent in ADLs shows an improvement in physical abilities. Options a, b, and d are incorrect. Drowsiness is a common adverse effect of anti-Parkinson's medications. Anorexia or loss of appetite is also a common adverse effect and skin itching is not related to medication use.
The client asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of parkinsonism. What is the best response by the nurse?
a. "A cure can be expected within 6 months."
b. "Symptoms can be reduced and the ability to perform ADLs can be improved."
c. "Disease progression will be stopped."
d. "EPS will be prevented."
Answer: b. Symptoms can be reduced and the ability to perform ADLs can be improved.
Rationale: Pharmacotherapy does not cure or stop the disease process but does improve client's ability to perform normal activities such as eating, bathing and walking. Options a, c, and d are incorrect. Drug therapy in Parkinson's disease does not cure or halt progression of the disease. Depending on the drug therapy, EPS may be an adverse effect.
Levodopa (Larodopa) is prescribed for a client with Parkinson's disease. At discharge, which of the following teaching points should the nurse include?
a. Monitor blood pressure every 2 hours for the first 2 weeks.
b. Report development of diarrhea.
c. Take the pill on an empty stomach or 2 hours after a meal containing protein.
d. If tremors seem to worsen, take a double dose for two doses and call the provider
Answer: c. Take the pill on an empty stomach or 2 hours after a meal containing protein.
Rationale: Taking dopamine replacement drugs such as levodopa (Larodopa) with meals containing protein significantly impairs absorption. The drug should be taken on an empty stomach or 2 or more hours after a meal containing protein. Options a, b, and d are incorrect. Although the client should be taught to rise gradually from lying or sitting to standing, the client does not need to monitor blood pressure every 2 hours. Diarrhea should be reported bur is unrelated to the effects of levodopa, and other causes should be explored. An increase in tremors should be evaluated and the dose of the drug should not be independently increased.
The nurse discusses the disease process of multiple sclerosis with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included?
a. Drink extra fluids while this drug is given.
b. Local injection site irritation is a common affect.
c. Take the drug with plenty of water and remain in an upright position for at least 30 minutes.
d. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.
Answer: b. Local injection site irritation is a common affect.
Rationale: Glatiramer acetate (Copaxone) is given by injection and often causes injection site irritation. Options a, c, and d are incorrect. Extra fluids do not need to be included and the drug is not given orally. It does not deplete vitamin C from the body.
A client who has not responded well to other drug therapy for Alzheimer's disease is placed on tacrine (Cognex). Which of the following are major disadvantages to the use of tacrine? (Select all that apply)
a. It must be administered four times per day.
b. It causes weight gain.
c. It may cause vision difficulties.
d. it may cause serious hepatic damage.
e. It may be purchased over the counter
a. It must be administered four times a day.
d. It may cause serious hepatic damage.
Rationale: It is difficult to remember to take a drug four times a day; as the client's cognitive function declines, it may be increasingly difficult to administer it. Serious liver damage is a possibility with tacrine, which decreases its usefulness. Options b,c, and e are incorrect. Tacring may cause weight loss, rather than gain, and it does not cause vision difficulties. Tacrine is available by prescription only.
An early sign(s) of levodopa toxocity is (are) which of the following?
a. Orthostatic hypotension
c. Spasmodic eye winking and muscle twitching
d. Nausea, vomiting and diarrhea
Answer: c. Spasmodic eye winking and muscle twitching.
Rationale: Blepharospasm (spasmodic eye winking) and muscle twitching are early signs of potential overdose or toxicity. Options a, b, and d are incorrect. Orthostatic hypotension is a common adverse effect of both Parkinson's disease and many drugs used to treat the condition but is not a symptom of over-dosage or toxicity. Drooling, nausea, vomiting, and diarrhea are also not symptoms of overdose or toxicity.
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