Deck 13: Antiparkinsonian Drugs

Question 1

Which symptom of Parkinson's disease has the highest priority for nursing intervention?

A) Tremor
B) Akathisia
C) Dysphagia
D) Tardive dyskinesia

Answer 1

Dysphagia

Question 2

The nurse caring for a patient receiving a dopaminergic drug should assess the individual for early symptoms of:

A) psychosis.
B) fluid imbalance.
C) tardive dyskinesia.
D) labile hypertension.

Answer 2

psychosis.

Question 3

A patient has taken perphenazine (Prolixin) for a year. The nurse observes lip smacking and grinding teeth. Which tool should the nurse use to complete the assessment?

A) AIMS
B) EPSE
C) SAD PERSONS
D) CAGE questionnaire

Answer 3

AIMS

Question 4

Which neurotransmitter is most affected by an anticholinergic drug?

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

Question 5

When developing a teaching plan for a patient receiving benztropine (Cogentin), a priority consideration for the nurse is:

A) anticholinergic drugs often cause blurred vision.
B) urinary frequency may impair the patient's concentration.
C) akathisia produced by the drug will make concentration difficult.
D) increased peristalsis might cause gastrointestinal distress and impair concentration.

Question 6

Of the patients the nurse will see at the mental health center, which one should be assessed most carefully for EPSEs?

A) 59-year-old man with severe mental illness for 20 years; takes olanzapine ( Zyprexa )
B) 18-year-old woman with a first episode of schizophrenia; takes haloperidol ( Haldol )
C) 26-year-old man with generalized anxiety disorder; takes lorazepam (Ativan)
D) 30-year-old woman with depression; takes amitriptyline ( Elavil )

Question 7

An older adult patient who takes trihexyphenidyl (Artane) for drug-induced parkinsonism begins taking diphenhydramine (Benadryl) for cold symptoms. The nurse should carefully monitor this patient for:

A) polyuria.
B) tachycardia.
C) constipation.
D) hypothermia.

Question 8

A patient who takes haloperidol (Haldol) for a diagnosis of schizophrenia has a dystonic reaction. Benztropine (Cogentin) 2 mg is given intramuscularly and then continued orally twice daily. Three days later, the patient has fever, disorientation, and tachycardia. Select the best analysis of this scenario.

A) Tardive dyskinesia has emerged.
B) Benztropine toxicity has developed.
C) Extrapyramidal symptoms have returned.
D) Dopaminergic benztropine effects have exacerbated the psychosis.

Question 9

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The patient says, "I couldn't sleep last night because I needed to pace." The nurse's communication to the health care provider would be to suggest:

A) prescribing an anticholinergic drug.
B) discontinuing the antipsychotic drug.
C) prescribing dopaminergic medication.
D) using an antihistamine at bedtime to promote sleep.

Question 10

An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and bradykinesia develop, so an anticholinergic is added to the drug regimen. Within 3 days the patient displays a marked cognitive deficit. Which medication is the most likely cause of the cognitive change?

A) Antihypertensive
B) Anticholinergic
C) Antipsychotic
D) Antidiabetic

Question 11

Patient teaching for a patient beginning an anticholinergic drug should include:

A) limiting fluid intake to 1000 ml/day.
B) limiting strenuous activity on hot days.
C) eating small, frequent meals to decrease nausea.
D) wearing adequate clothing to prevent hypothermia.

Question 12

Which patient receiving fluphenazine (Prolixin) should be monitored most closely for EPSEs?

A) 35-year-old man
B) 45-year-old woman
C) 74-year-old woman
D) Patient with a 5-year history of schizophrenia

Question 13

A psychiatric nurse should base care of patients diagnosed with Parkinson's disease and patients demonstrating extrapyramidal side effects (EPSEs) caused by antipsychotic drug therapy on the premise that symptoms:

A) are the same for both problems.
B) result from deficits in dopamine synthesis.
C) result from acetylcholine and dopamine imbalance.
D) are produced by neurodegeneration of the substantia nigra.

Question 14

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The nurse should use which term to document these findings?

A) Dystonia
B) Akathisia
C) Dyskinesia
D) Bradykinesia

Question 15

A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should administer which drug from the patient's PRN list?

A) Vitamin E
B) Carbidopa (Sinemet)
C) Benztropine (Cogentin)
D) Amantadine (Symmetrel)

Question 16

A patient began trihexyphenidyl (Artane) for treatment of drug-induced parkinsonism. Which finding demonstrates a positive response to the medication?

A) Blood pressure returns to patient's normal range.
B) Gait is steady with decreased rigidity.
C) Patient reports fewer feelings of depression.
D) Patient has tremors with voluntary movement.

Question 17

A patient diagnosed with Parkinson's disease begins levodopa therapy. The nurse understands that administration of levodopa will:

A) improve symptoms of Parkinson's disease by increasing dopamine in the CNS.
B) improve symptoms of Parkinson's disease by decreasing levels of GABA.
C) cause the patient to develop symptoms of depression and an unsteady gait.
D) lead to an increased risk of dysphagia.

Question 18

A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should assess this finding as:

A) akathisia.
B) nystagmus.
C) tardive dyskinesia.
D) an oculogyric crisis.

Question 19

Which medication from a patient's pharmacologic profile is most likely to precipitate neuroleptic malignant syndrome (NMS)?

A) Diphenhydramine (Benadryl)
B) Risperidone (Risperdal)
C) Haloperidol (Haldol)
D) Clozapine (Clozaril)

Question 20

Which statement by the nurse should be included in the teaching plan for patients receiving anticholinergic agents?

A) "Avoid eating foods high in tyramine."
B) "Do not abruptly stop taking the drug."
C) "Take oral medications on an empty stomach."
D) "Take a multivitamin and mineral supplement daily."

Question 21

When patients are treated with antipsychotic medications, a variety of side effects and adverse reactions may occur. Sequence the following list in order of intervention priority, beginning with the most urgent:

A) Akathisia
B) Dystonic reaction
C) NMS
D) Tardive dyskinesia