Question 1

When assessing the past medication history of a patient with a new diagnosis of Parkinson's disease,which of the following is a concern for the patient who will be taking levodopa-carbidopa (Sinemet)?&#10;A)Glaucoma&#10;B)Seizure disorder&#10;C)Bladder difficulties&#10;D)Benign prostatic hypertrophy

Accepted Answer

Glaucoma is a contraindication to the use of levodopa-carbidopa.
Seizure disorder is a contraindication to the use of dopaminergic drugs.Bladder difficulties and benign prostatic hypertrophy are contraindications for anticholinergic drugs.

Question 2

A patient has been newly diagnosed with Parkinson's disease and given a prescription for levodopa-carbidopa (Sinemet).She comments,however,that her friend was given a prescription for "plain levodopa." What should the nurse explain to this patient about her prescription?

A)Levodopa alone cannot cross the blood-brain barrier.
B)Really no difference exists in the two prescriptions.
C)The combination drug is more efficient in increasing the dopamine level in the brain.
D)Concerns about drug-food interactions with levodopa therapy do not exist with the combination therapy.

Accepted Answer

The addition of carbidopa allows for more of the levodopa to reach the site of action without being broken down;thus,lower doses of levodopa are needed,and the combination is more efficient in increasing the dopamine level in the brain.
Dopamine,not levodopa,cannot cross the blood-brain barrier.Drug-food interactions with levodopa therapy alone are not a concern.If a substance interacts with levodopa it will also interact with the drug combination of levodopa-carbidopa because the drug levodopa is the common component in both.

Question 3

Which of the following statements is true of amantadine (Symmetrel)therapy?&#10;A)It increases the production of dopamine in the basal ganglia.&#10;B)It works by eliciting the release of dopamine from nerve endings.&#10;C)It is most effective in the later stages of Parkinson's disease.&#10;D)It is considered a long-term therapy for Parkinson's disease.

Accepted Answer

Amantadine works by eliciting the release of dopamine from nerve endings,not by increasing the production of dopamine in the basal ganglia.
Amantadine is most effective in the earlier stages of Parkinson's disease and is usually effective for only 6 to 12 months because,as the disease progresses,the population of functioning nerves diminishes.

Question 4

A patient taking a levodopa preparation for the first time calls the clinic to report a dark discoloration of his urine.Which of the following statements is true in this situation?&#10;A)The discoloration of urine is a harmless effect of the drug.&#10;B)The patient has taken this drug with red wine or cheese.&#10;C)The patient is having an allergic reaction to the drug.&#10;D)The patient has most likely taken extra drug doses.

Accepted Answer

Levodopa preparations may darken the patient's urine and sweat.

Question 5

During drug therapy for Parkinson's disease,the nurse monitors for dyskinesia.Which of the following describes the manifestation of dyskinesia?&#10;A)Rigid,tense muscles&#10;B)Involuntary movements&#10;C)Limp extremities with weak muscle tone&#10;D)Confusion and altered mental status

Accepted Answer

Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson's disease.

Question 6

Which of the following nursing diagnoses is appropriate for patients taking anticholinergic drugs?&#10;A)Diarrhea&#10;B)Urinary retention&#10;C)Risk for infection&#10;D)Ineffective tissue perfusion

Accepted Answer

Patients receiving anticholinergic drugs are at risk for urinary retention.

Question 7

Which of the following statements describes an advantage of the catechol ortho-methyltransferase (COMT)inhibitors during the treatment of Parkinson's disease?&#10;A)They have a shorter duration of action.&#10;B)They cause less gastrointestinal distress.&#10;C)They have a slower onset than traditional Parkinson's disease drugs.&#10;D)They are associated with fewer &#34;wearing-off&#34; effects and have prolonged therapeutic benefits.

Accepted Answer

COMT inhibitors are associated with fewer "wearing-off" effects and have prolonged therapeutic benefits.
COMT inhibitors have a longer duration of action and a quicker onset than traditional drugs.COMT inhibitors also have gastrointestinal adverse effects.

Question 8

When a patient is taking an anticholinergic,such as benztropine,as part of the treatment for Parkinson's disease,what important information should the nurse include in the teaching plan?&#10;A)Avoid vitamin B&#8326; supplements and vitamin-fortified foods.&#10;B)Discontinue the medication immediately if adverse effects occur.&#10;C)Take the medication on an empty stomach to enhance absorption.&#10;D)Take the medication at bedtime to prevent drowsiness during the day.

Accepted Answer

Anticholinergics should be taken at bedtime to prevent drowsiness during the day.
Vitamin B₆ interferes with dopaminergics,not anticholinergics.Anticholinergics should not be discontinued suddenly and should be taken with or after meals to minimize gastrointestinal upset.

Question 9

A patient has been treated with antiparkinsonian medications for 3 months.What therapeutic responses should the nurse look for when assessing this patient?&#10;A)Decreased appetite&#10;B)Gradual development of cogwheel rigidity&#10;C)Occurrence of adverse effects such as confusion, anxiety, irritability, and headache&#10;D)Improved mental status and an improved ability to think clearly and to perform activities of daily living

Accepted Answer

Therapeutic responses to the antiparkinsonian drugs include improved mental status and an increased ability to concentrate,to think clearly,and to perform activities of daily living (ADLs).
Antiparkinsonian drugs result in an increase in appetite,less intense parkinsonism manifestations,and an improved sense of well-being.

Question 10

A patient has been taking selegiline (Anipril)for a month and says he understands the "cheese effect" that the doctor explained to him.When the nurse questions him about it,he tells her (correctly)that the cheese effect results in which of the following?

A)Hypotension
B)Hypertension
C)Urinary discomfort
D)Gastrointestinal upset

Accepted Answer

The cheese effect causes severe hypertension.This is a major adverse effect of monoamine oxidase inhibitors (MAOIs)because they interact with tyramine-containing foods (cheese,red wine,beer,and yogourt).

Deck 15: Antiparkinsonian Drugs