Question 1

The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson's disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)?&#10;A) Glaucoma&#10;B) Seizure disorder&#10;C) Liver failure&#10;D) Benign prostatic hyperplasia

Accepted Answer

Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with preexisting liver disease. The other conditions listed are not contraindications.

Question 2

A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation?

A) This is a harmless effect of the drug.
B) The patient has taken this drug along with red wine or cheese.
C) The patient is having an allergic reaction to the drug.
D) The ordered dose is too high for this patient.

Accepted Answer

COMT inhibitors, including entacapone, may darken a patient's urine and sweat.

Question 3

The prescriber writes this order, &#34;Give amantadine (Symmetrel) 100 mg per PEG tube twice a day.&#34; The medication is available in a liquid form with a concentration 50 mg/5 mL. How many milliliters will the nurse give with each dose?

Accepted Answer

10 mL&#10;50 mg : 5 mL :: 100 mg : x mL&#10;(50 &#215; x) = (5 &#215; 100); 50x = 500; x = 10 mL

Question 4

When assessing the medication history of a patient with a new diagnosis of Parkinson's disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.)

A) Angle-closure glaucoma
B) History of malignant melanoma
C) Hypertension
D) Benign prostatic hyperplasia
E) Concurrent use of monoamine oxidase inhibitors (MAOIs)

Accepted Answer

Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect.

Question 5

When treating patients with medications for Parkinson's disease, the nurse knows that the wearing-off phenomenon occurs for which reason?&#10;A) There are rapid swings in the patient's response to levodopa.&#10;B) The patient cannot tolerate the medications at times.&#10;C) The medications begin to lose effectiveness against Parkinson's disease.&#10;D) The patient's liver is no longer able to metabolize the drug.

Accepted Answer

The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.

Question 6

Amantadine (Symmetrel) is prescribed for a patient with Parkinson's disease. The nurse informs the patient that which common adverse effects can occur with this medication?&#10;A) Dyskinesias, drowsiness&#10;B) Dizziness, insomnia, nausea&#10;C) Peripheral edema, fatigue, syncope&#10;D) Heart palpitations, hypotension, urinary retention

Accepted Answer

Common adverse reactions associated with amantadine include dizziness, insomnia, and nausea. The other effects may occur with other antiparkinson drugs.

Question 7

When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan?&#10;A) Minimize the amount of fluid taken while on this drug.&#10;B) Discontinue the medication if adverse effects occur.&#10;C) Take the medication on an empty stomach to enhance absorption.&#10;D) Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

Accepted Answer

Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize gastrointestinal upset and must not be discontinued suddenly. The patient must drink at least 3000 mL per day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation.

Question 8

A patient has been taking selegiline (Eldepryl), 20 mg per day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful." What did the patient most likely experience?

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

Accepted Answer

At doses that exceed 10 mg per day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension.

Question 9

A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson's disease. The nurse recognizes that an advantage of this drug class is that it&#10;A) has a shorter duration of action.&#10;B) causes less gastrointestinal distress.&#10;C) has a slower onset than traditional Parkinson's disease drugs.&#10;D) is associated with fewer wearing-off effects.

Accepted Answer

COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa.

Question 10

While a patient is receiving drug therapy for Parkinson's disease, the nurse monitors for dyskinesia, which is manifested by which finding?&#10;A) Rigid, tense muscles&#10;B) Difficulty in performing voluntary 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. The other options are incorrect.

Question 11

A patient has been treated with antiparkinson 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) Newly developed dyskinesias&#10;D) Improved ability to perform activities of daily living

Accepted Answer

The answer of A patient has been treated with antiparkinson...

Question 12

The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?&#10;A) Diarrhea&#10;B) Urinary retention&#10;C) Risk for infection&#10;D) Sleep deprivation

Accepted Answer

The answer of The nurse is developing a care plan...

Question 13

A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact?

A) Carbidopa allows for larger doses of levodopa to be given.
B) Carbidopa prevents the breakdown of levodopa in the periphery.
C) There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
D) Carbidopa is the biologic precursor of dopamine and can penetrate into the CNS.

Accepted Answer

The answer of A patient has been given a prescription...

Deck 15: Antiparkinson Drugs