Question 1

Students are learning about the actions of drugs used to treat Parkinson's disease. Carbidopa-Levodopa (Sinemet) is the prototype for this classification. What statement by a student indicates understanding of the mechanism of action of this drug?

A) "Sinemet acts by acts by blocking excess cholinergic stimulation of neurons in the corpus striatum. It is used for relief of parkinsonism symptoms."
B) "Sinemet restores the neurotransmitter dopamine in extrapyramidal areas of the brain, thus relieving some Parkinson's symptoms."
C) " This drug acts by intensifying the effect of acetylcholine at the cholinergic receptor."
D) " Sinemet works by slowing the progression of parkinsonism by focusing on modifying the abnormal immune response.

"Sinemet restores the neurotransmitter dopamine in extrapyramidal areas of the brain, thus relieving some Parkinson's symptoms."

Accepted Answer

Rationale 1. This would be the effect of an anti-cholinergic, also used to treat Parkinson's disease.
Rationale 2. This is the mechanism of action of Carbidopa-Levodopa (Sinement).
Rationale 3. This is the action of a drug used to treat Alzheimers.
Rationale 4. This is the action of drugs used to treat multiple sclerosis.

Question 2

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?&#10;A) &#34;The risk for hypertension is too high with dopamine; therefore, more frequent cardiac monitoring would be required.&#34;&#10;B) &#34;Exogenous dopamine cannot cross the blood-brain barrier and would be of little use.&#34;&#10;C) &#34;Exogenous dopamine must be administered via intravenous infusion, which usually requires a central line and continuous cardiac monitoring.&#34;&#10;D) &#34;In older clients, the effects of dopamine on urinary function can pose an unacceptable risk for renal failure.&#34;&#10;

Accepted Answer

Rationale 1: This is not the reason dopamine is not given to a client with Parkinson disease. Dopamine can be given to raise blood pressure.
Rationale 2: Dopamine does not cross the blood-brain barrier. Levodopa is the precursor of dopamine and does cross the blood-brain barrier, where the enzyme dopa decarboxylase converts it to dopamine.
Rationale 3: Dopamine is only given intravenously, but that is not the reason it is not prescribed for clients with Parkinson disease.
Rationale 4: Dopamine receptors are located in the kidney, although improvement in renal function is based on dopamine's effect on increasing cardiac output. This is not the reason dopamine is not given to a client with Parkinson disease.

Question 3

A client is being started on Donepezil (Aricept) for early stage Alzheimers disease. The nurse is completing her teaching to the client and her family. Why does the nurse stress to the client and family not to stop taking this medication abruptly?

A) Severe muscle weakness has been documented in clients after discontinuing Aricept.
B) Other medications cannot be started for 6-8 weeks following Aricept's discontinuation.
C) Stopping Aricept abruptly has been known to cause seizures
D) Once discontinued, improvement in condition may be lost permanently.

Once discontinued, improvement in condition may be lost permanently.

Accepted Answer

Rationale 1. There is no evidence to support severe muscle weakness after discontinuing this drug.
Rationale 2. There are no restrictions on staring other medications after discontinuing Aricept.
Rationale 3. There is no evidence of seizure activity after Aricept is discontinued..
Rationale 4 The nurse must stress that stopping Aricept may result in reversal of any improvement in the client's condition. There is no guarantee that if the drug is restarted that the client will regain what he lost.

Question 4

The nurse is teaching a class for clients who recently have been diagnosed with epilepsy. Which statements by the client indicates understanding of the content taught?&#10;A) &#34;Epilepsy can be caused by a head injury.&#34;&#10;B) &#34;With some cases of epilepsy, the cause is never determined.&#34;&#10;C) &#34;Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy.&#34;&#10;D) &#34;Eating disorders like anorexia nervosa increase the risk for developing epilepsy.&#34;&#10;E) &#34;A stroke, or brain attack, could increase the risk for developing epilepsy.&#34;&#10;

Accepted Answer

Rationale 1: Head trauma is a known cause of seizures.
Rationale 2: Epilepsy is a disorder where seizures occur on a chronic basis. In some cases, the exact etiology cannot be identified.
Rationale 3: Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.
Rationale 4: There is no known correlation with anorexia nervosa and the development of epilepsy.
Rationale 5: Changes in cerebral perfusion such as hypotension, strokes or brain attacks, and shock can be causes of seizures.

Question 5

The client who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this client?&#10;A) &#34;Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication.&#34;&#10;B) &#34;Thankfully, most modern antiepileptic medications will not interfere with your getting pregnant.&#34;&#10;C) &#34;Your current antiepileptic medication should not be used when you are pregnant.&#34;&#10;D) &#34;Folic acid supplementation is important for you.&#34;&#10;E) &#34;You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy.&#34;&#10;

Accepted Answer

Rationale 1: Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant clients.
Rationale 2: Women who have epilepsy have a reduced fertility rate, and some do not ovulate.
Rationale 3: Valproic acid (Depakote) is pregnancy category D.
Rationale 4: Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency.
Rationale 5: Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this client, but should provide information to the client and then support the client's choice.

Question 6

The client tells the nurse that she has been prescribed phenytoin (Dilantin) for 2 years and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?&#10;A) &#34;This is the best medication for you; we can add another medication to decrease the side effects associated with phenytoin (Dilantin).&#34;&#10;B) &#34;You should not stop the medication abruptly, as you can experience withdrawal seizures.&#34;&#10;C) &#34;You have probably been on the medication long enough; I'll let your doctor know you are stopping it.&#34;&#10;D) &#34;Side effects are a problem, but they are not as bad as the seizures you were having.&#34;&#10;

Accepted Answer

Rationale 1: There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin).
Rationale 2: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6-12 weeks.
Rationale 3: The nurse does not know if the client has been on the medication long enough, and the client must be informed of the consequences of abruptly stopping the medication.
Rationale 4: Telling a client that medication side effects are not as bad as seizures is an inappropriate and nontherapeutic response that does not address the client's concerns.
.

Question 7

The nurse is talking with a client who was just prescribed phenytoin. Which client statement should the nurse immediately discuss with the client's health care provider?&#10;A) &#34;Did I mention that I used to take phenobarbital for my seizures?&#34;&#10;B) &#34;I forgot to tell the doctor that I am taking TCAs for depression.&#34;&#10;C) &#34;I have lactose intolerance, so I can't drink milk.&#34;&#10;D) &#34;My husband and I plan to have a baby in a couple of years.&#34;&#10;E) &#34;My husband and I are leading a 20-mile bicycle tour this weekend.&#10;

Accepted Answer

Rationale 1: There is no indication that previous phenobarbital use is problematic with the use of phenytoin.
Rationale 2: Phenytoin can cause seizures when taken with tricyclic antidepressants.
Rationale 3: There is no indication that inability to drink milk is problematic with the use of phenytoin.
Rationale 4: Phenytoin is pregnancy category D, the client should be cautioned about becoming pregnant while on this medication. Encourage her to make an appointment to discuss this with her physician when the time is right.
Rationale 5: The most common adverse effects of phenytoin include dizziness, ataxia, and fatigue. It is advisable to avoid hazardous activities until the effect of the medication is known.

Question 8

The nurse is planning educational sessions for a client regarding the use of a newly prescribed antiepileptic drug (AED). Which topics should be included in these sessions?&#10;A) The client should take the medication at the same time every day.&#10;B) If the client forgets a dose of medication, wait until the next dose is due and take both doses together.&#10;C) The client should take an additional dose of medication upon experiencing a seizure aura.&#10;D) If the client experiences side effects of the medication, the client should skip the next dose to see if the side effects lessen.&#10;E) The client should avoid using dietary supplements containing kava when on this medication.&#10;

Accepted Answer

Rationale 1: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day.
Rationale 2: The client should take the dose as soon as it is remembered but should not take two doses at the same time or close together.
Rationale 3: Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure.
Rationale 4: The client should never abruptly discontinue taking these medications and should not skip doses.
Rationale 5: Kava interferes with many AEDs, often adding to their sedative effects.

Question 9

What client education should the nurse include in her care plan that will help to reduce complications from anti seizure drugs?&#10;A) Have blood tests drawn as ordered.&#10;B) Do not engage in hazardous activity until effect of drug is known&#10;C) Do not drive or operate heavy machinery while on anti-seizure medications.&#10;D) Monitor weight and report fluctuations of >5 pounds to physician.&#10;E) Report any unusual bleeding to physician.&#10;

Accepted Answer

Rationale 1 Having scheduled lab work will monitor therapeutic levels of some drugs (Phenytoin)and will assess for liver and renal function which can be affected by some of these drugs.
Rationale 2 Until the effects of the drug are known, driving or engaging in hazardous activities should be avoided.
Rationale 3. Once the effects of the drug are known, and seizures have been controlled for a period of time, there is no reason to avoid driving or operate heavy machinery while on these drugs.
Rationale 4. There is no reason to monitor weight gain or loss while on these drugs.
Rationale 5. Some drugs can affect levels of vitamin K and may alter the normal coagulation times.

Question 10

The nurse has been instructing the parents of a child with cerebral palsy about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions?

A) "At some point, our child may require surgery to correct this spasticity."
B) "As long as we continue our child's medications, the spasticity can be controlled."
C) "Our physical therapy sessions should focus on flexing our child's muscles."
D) "We should repeat the exercises several times with each muscle group."
E) "It is best to give our child a rest from physical therapy by skipping 2 days a week."

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Accepted Answer

Rationale 1: Surgery is sometime necessary in these cases, so this statement reflects accurate knowledge.
Rationale 2: Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching.
Rationale 3: The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching.
Rationale 4: Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge.
Rationale 5: Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching.

Deck 9: Pharmacotherapy of Degenerative Diseases of the Nervous System