Deck 21: Pharmacotherapy of Degenerative Diseases of the Central Nervous System

Question 1

When assessing a client for the typical signs and symptoms of Parkinson disease,which clinical manifestations would the nurse expect to find?

A)Tremors,a masklike facial expression,and a rigid posture
B)Shuffling gait,confusion,and postural instability
C)Tremors and hyperkinesia
D)A masklike expression and generalized muscle weakness

Answer 1

Tremors,a masklike facial expression,and a rigid posture

Question 2

The nurse suspects a client is developing Parkinson disease.Which early sign did the nurse most likely assess in this client?

A)Rigid posture
B)Shuffling gait
C)Masklike face
D)Tremors

Answer 2

Tremors

Question 3

The family member of a client with Parkinson disease notifies the nurse that the client is demonstrating extrapyramidal symptoms.Which instruction by the nurse to the family is the most appropriate?

A)Increase the dosage of the antiparkinson drugs.
B)Transport the client to the emergency department immediately.
C)Make an appointment when convenient for the client and health care provider for an evaluation.
D)Give diphenhydramine (Benadryl)25 mg immediately by mouth.

Answer 3

Transport the client to the emergency department immediately.

Question 4

The nurse is planning a presentation on degenerative diseases.Which two most common degenerative diseases will the nurse include in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Amyotrophic lateral sclerosis
B)Multiple sclerosis
C)Alzheimer disease
D)Huntington chorea
E)Parkinson disease

Question 5

What will the nurse include when teaching a caregivers' support group about Alzheimer disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Glutamatergic inhibitors are the most common class of drugs for treating Alzheimer disease.
B)Depression and aggressive behavior are common with the disease.
C)Memory difficulties are an early symptom of the disease.
D)Chronic inflammation of the brain can be a cause of the disease.
E)Pharmacologic therapies are given to help improve memory in Alzheimer disease.

Question 6

During the nurse's assessment of a client with known Parkinson disease,the onset of which finding would be cause for concern?

A)Masklike expression
B)"Pill-rolling" motion of the fingers
C)Confusion
D)Frequent falls

Question 7

The nurse is explaining to a client the imbalance of neurotransmitters in Parkinson disease.How will the nurse describe the relationship between acetylcholine and dopamine in the area of the brain that affects balance,posture,and involuntary muscle movement?

A)Dopamine stimulates while acetylcholine inhibits this region.
B)Both dopamine and acetylcholine inhibit this region of the brain.
C)Both dopamine and acetylcholine stimulate this region of the brain.
D)Dopamine inhibits and acetylcholine stimulates this region.

Question 8

A client is prescribed a dopaminergic agent for management of symptoms related to Parkinson disease.When teaching the client and family about the medication management,which time frame will the nurse include regarding when the medication should be recognizable?

A)Within 1 week
B)Within 2 to 3 days
C)Within 24 hours
D)Within 2 to 3 weeks

Question 9

A client with Parkinson disease asks the nurse why dopamine is not given as a neurotransmitter replacement.Which response by the nurse is the most appropriate?

A)"The risk for hypertension is too high with dopamine; therefore,more frequent cardiac monitoring would be required."
B)"Exogenous dopamine cannot cross the blood-brain barrier and would be of little use."
C)"Exogenous dopamine must be administered via intravenous infusion,which usually requires a central line and continuous cardiac monitoring."
D)"In older clients,the effects of dopamine on urinary function can pose an unacceptable risk for renal failure."

Question 10

A client has been diagnosed with Alzheimer disease.What is the most accurate medication education the nurse can give to the client's spouse?

A)"Symptoms should begin to improve in a few days."
B)"The medication has side effects that require periodic breaks from treatment."
C)"There is no cure.The medication might help with symptoms for a period of time."
D)"Symptoms will improve as long as the medication is taken daily at the same time."

Question 11

A client is diagnosed with secondary Parkinson disease.What is associated with the development of this type of Parkinson disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Traumatic brain injury
B)Family history of the disorder
C)Brain tumor
D)Toxins
E)Encephalitis

Question 12

When teaching a community course on health problems that the older adult client might encounter,the nurse describes a disorder that is characterized by confusion,progressive memory loss,and the inability to think clearly.Which disease process is the nurse describing?

A)Alzheimer disease
B)Parkinson disease
C)Schizophrenia
D)Huntington chorea

Question 13

A client with memory loss and difficulty completing routine tasks questions if these symptoms are related to Alzheimer disease.For what additional symptoms will the nurse assess to determine if the client is experiencing Alzheimer disease?

A)Muscle weakness and vision changes
B)Tremors,muscle rigidity,and abnormal gait
C)Confusion and difficulty with communication
D)Involuntary muscle spasms and confusion

Question 14

When explaining the pathophysiology of Parkinson disease to a client,the nurse would explain that it is a degenerative disorder of the nervous system caused by the death of neurons that produce which substance?

A)Acetylcholine
B)Serotonin
C)Norepinephrine
D)Dopamine

Question 15

The nurse explains to the family of a client with Alzheimer disease that memory loss and confusion occur because of the disease's effect on which neurotransmitter?

A)Serotonin
B)Acetylcholine
C)Dopamine
D)Gamma-aminobutyric acid (GABA)

Question 16

The spouse of a client with Parkinson disease asks how taking medication will help with symptoms.What is the nurse's best response?

A)"Medication will balance serotonin and acetylcholine in your spouse's brain."
B)"Medication will prevent muscle wasting in your spouse."
C)"Medication will boost your spouse's energy and appetite."
D)"The medication will facilitate your spouse's ability to walk,dress,and eat."

Question 17

The nurse is concerned that a client is experiencing symptoms of Parkinson disease.Which assessment findings would indicate the client might have idiopathic or primary Parkinson disease?

A)Tremors and bradykinesia
B)Ocular diplopia and ptosis
C)Progression and severity of fatigue
D)Spasticity and paresis

Question 18

Which assessment finding would indicate to the nurse that a client might have secondary Parkinson disease?

A)Confusion and difficulty performing activities of daily living
B)Nonintentional tremor and history of a brain injury
C)Progressive memory loss and history of fatigue
D)Involuntary muscle spasm and history of a motor vehicle accident

Question 19

Which assessment finding in a client with Alzheimer disease would the nurse directly attribute to the disease's effect on acetylcholine?

A)Darkened urine
B)Inability to retain new information
C)Muscle cramps
D)Vomiting and diarrhea

Question 20

The nurse is determining if a client is experiencing symptoms of Alzheimer disease or Huntington chorea.Which assessment finding would indicate the client might have Huntington chorea rather than Alzheimer disease?

A)Confusion
B)Difficulty completing tasks
C)Involuntary muscle spasm
D)Memory loss

Question 21

Prior to administering donepezil (Aricept)to a client diagnosed with Alzheimer disease,the nurse notes that the client is prescribed medications that will react with this drug.Which medications interact with donepezil (Aricept)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Phenytoin (Dilantin)
B)Rifampin
C)Quinidine
D)Penicillin
E)Aspirin

Question 22

The nurse provides instruction to a client who is prescribed levodopa/carbidopa (Parcopa).Which client statement indicates that learning has occurred?

A)"I need to increase my daily intake of protein."
B)"I must avoid eating leafy green vegetables in my diet."
C)"I need to check my pulse before I take this medication."
D)"I must avoid foods such as beef,whole-grain cereals,and multivitamins."

Question 23

The nurse is providing care to a client who is diagnosed with multiple sclerosis.When teaching the client about the medication therapy,which goals will the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Modifying the progression of the disease
B)Treating acute exacerbations
C)Managing symptoms
D)Curing the disease
E)Remyelinating nerve fibers.

Question 24

A client takes an aspirin,a multivitamin,and an antihistamine every day.What is the most important instruction by the nurse when the client is prescribed levodopa/carbidopa (Parcopa)?

A)"You should not take the multivitamin with your levodopa/carbidopa (Parcopa)."
B)"You should not take the antihistamine with your levodopa/carbidopa (Parcopa)."
C)"You should not take the aspirin with your levodopa/carbidopa (Parcopa)."
D)"These medications are safe to take with levodopa/carbidopa (Parcopa)."

Question 25

A client with amyotrophic lateral sclerosis is prescribed riluzole (Rilutek).What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)It reduces the degeneration of neurons.
B)It should be taken every 12 hours on an empty stomach.
C)The client should avoid high-fat meals before or after taking the medication.
D)Headache and dizziness are common reactions to this medication.
E)Paralytic ileus is a life-threatening adverse effect of this medication.

Question 26

The nurse is caring for a client in the middle phase of Alzheimer disease.Which symptoms is the client most likely to demonstrate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Inability to remember eating breakfast
B)Stating that the year is 1950
C)Staring at bath basin and not sure what to do with a washcloth
D)Weight loss
E)Inability to walk

Question 27

A client is diagnosed with multiple sclerosis.Which symptoms will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Muscle weakness
B)Difficulty maintaining balance
C)Atrophy of the hands and legs
D)Slow shuffling gait
E)Progressive chorea

Question 28

The nurse is teaching a class for caregivers of clients with Alzheimer disease.The nurse determines that learning has occurred when a caregiver makes which statement?

A)"There are effective drugs,but they cannot be used over a long period of time."
B)"There are drugs that will help to decrease the symptoms for a period of time."
C)"There aren't any drugs that are effective in treating this disease."
D)"There are drugs that can control the symptoms for many years."

Question 29

A client who is prescribed benztropine (Cogentin)tells the nurse about plans for a Caribbean cruise.What should the nurse include during client teaching?

A)"Take a multivitamin every day to keep you healthy."
B)"If you miss a dose,take the next dose at its regularly scheduled time."
C)"Limit your activity while on the cruise."
D)"Avoid alcohol."

Question 30

A client with Parkinson disease develops depression.What education would the nurse provide to the client's family?

A)"Depression is a common problem with Parkinson disease."
B)"Depression is very easy to treat,and a wide variety of medications are available."
C)"Eventually anyone who has a brain disease will develop depression."
D)"The depression is most likely a side effect of the medications taken to treat the symptoms."

Question 31

The client is prescribed tacrine (Cognex)as treatment for Alzheimer disease.Which laboratory test would the nurse monitor?

A)Liver function tests
B)Renal function tests
C)Serum amylase levels
D)Complete blood count

Question 32

Prior to administering benztropine (Cogentin)to a client,the nurse assesses adverse effects of previous doses and decides to withhold the current dose.Which clinical manifestation would warrant the nurse holding the dose of the medication?

A)A respiratory rate of 14
B)A blood pressure reading of 88/60 mmHg
C)A temperature of 100.2°F
D)Distant bowel sounds

Question 33

A client with Parkinson disease is experiencing an increase in bradykinesia.What will the client demonstrate with this manifestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Slow speech
B)Difficulty chewing
C)Shuffling the feet when walking
D)Stooped posture
E)Lack of facial expression

Question 34

The spouse of a client with Alzheimer disease tells the nurse that the health care provider said that a cause of the disorder is brain damage.The spouse wants to know what type of brain damage could have occurred to the client.What possible causes of brain damage can the nurse explain to the spouse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Environmental exposure
B)Nutritional imbalances
C)Exposure to viruses
D)Acetylcholine deficiency
E)Defect in chromosome 14

Question 35

The nurse is explaining to a client with Parkinson disease the steps in which the neurotransmitter dopamine functions to impact motor movement.In which order will the nurse explain these steps? Standard Text: Click on the down arrow for each response in the right column and select the correct choice from the list.Response

A)The substantia nigra produces dopamine.
B)Dopamine travels to the corpus striatum.
C)The dopamine is released.
D)The dopamine finds receptors.
E)The dopamine slows impulses down spinal neurons.
F)Coordinated unconscious muscle movement occurs.

Question 36

The nurse observes a client with Parkinson disease having difficulty controlling hand movements.What did the nurse observe in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Pill rolling
B)Tremor
C)Stooped posture
D)Lack of arm swing
E)Difficulty bending the arms

Question 37

During a health history the nurse is concerned that a client is at risk for developing secondary Parkinson disease because of which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client has a history of concussions.
B)The client was treated for meningitis while in college.
C)The client worked as a crop duster after the war.
D)The client waited tables at a local restaurant.
E)The client scuba dives during vacations.

Question 38

An older client is receiving levodopa/carbidopa (Parcopa).Which side effect of the medication would cause the nurse the most concern?

A)Hypertension
B)Dark urine
C)Urinary retention
D)Diarrhea

Question 39

The nurse is planning care for a client with Parkinson disease.What intervention is important for the nurse to include?

A)Monitor the client's ability to chew and eat.
B)Teach the client to limit exercise to decrease the risk for fractures.
C)Assess peripheral circulation for presence of thrombophlebitis.
D)Monitor the client for development of psychotic symptoms.

Question 40

A client tells the nurse about using "different" drugs to treat the symptoms associated with mild Alzheimer disease.For which drugs should the nurse assess the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Vitamins
B)NSAIDs
C)Ginkgo biloba
D)Estrogen
E)Antihistamines

Question 41

Prior to administering galantamine (Reminyl)to a client with Alzheimer disease,the nurse reviews the client's medical history for which disease processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Respiratory disorders
B)Liver dysfunction
C)Kidney failure
D)Atrial fibrillation
E)Arthritis

Question 42

Which strategies can the nurse teach the family of a client with Alzheimer disease to ensure an adequate nutritional and fluid intake? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Weigh the client once a week.
B)Assist the client with eating.
C)Offer fluids on a regular basis.
D)Permit the client to feed self.
E)Provide finger foods.