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A 65-year-old patient with PD is experiencing moderate dyskinesias that are bothersome. The patient is on carbidopa/levodopa 25/100 mg two tablets at 7 AM and one tablet at 11 AM, 2 PM, 5 PM, 8 PM, and 11 PM. Which of the following is most appropriate:
- A. Add amantadine.
- B. Add entacapone.
- C. Add rasagiline.
- D. Add pramipexole.
Correct Answer: A
Rationale: Amantadine is effective in reducing dyskinesias in PD patients by modulating glutamate activity in the brain.
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Nurse Parker is overseeing the care of a patient with Parkinson's disease who has been consistently taking carbidopa/levodopa (Sinemet) for a year. She is attentively monitoring for any potential adverse reactions associated with this specific medication. Which adverse reaction should Nurse Parker be particularly vigilant about in monitoring this patient?
- A. The occurrence of dyskinesia.
- B. The emergence of respiratory depression.
- C. The onset of glaucoma.
- D. The development of a rash or other signs of an allergic reaction.
Correct Answer: A
Rationale: Dyskinesia, or involuntary movements, is a common adverse reaction to long-term levodopa therapy in PD patients.
Which of the following might indicate a problem with the patient's sensory system?
- A. Inability to feel light touch or pain in specific areas.
- B. Normal sensation throughout the body.
- C. Clear and accurate perception of temperature.
- D. Absence of tingling or numbness.
Correct Answer: A
Rationale: Inability to feel light touch or pain suggests sensory system dysfunction. Normal sensation, accurate temperature perception, and absence of tingling are expected findings.
To prevent strain on Mr. Tucker's back muscles, which nursing action is INAPPROPRIATE?
- A. To place him on bed pan, logroll using a turning sheet
- B. When lying on his side, flex upper leg and place a pillow between his knees
- C. When lying on his back, place pillows under entire length of his knees
- D. To turn him on his side, gently turn his shoulders and upper trunk first, prop with a pillow, then turn his pelvis and lower limbs
Correct Answer: D
Rationale: Turning the pelvis and lower limbs last can strain back muscles.
To assess the Glasgow Coma Scale (GCS), the nurse needs to evaluate:
- A. Eye opening, verbal response, and motor response.
- B. Heart rate, blood pressure, and temperature.
- C. Pupil size, reaction to light, and accommodation.
- D. Skin turgor, moisture, and temperature.
Correct Answer: A
Rationale: The Glasgow Coma Scale (GCS) assesses a patient's level of consciousness based on eye opening, verbal response, and motor response. It is a standardized tool used in neurological assessments.
The autonomic nervous system includes any of the following EXCEPT:
- A. hypothalamus
- B. paravertebral sympathetic trunk
- C. vagal nerve
- D. cerebral cortex
Correct Answer: D
Rationale: Cerebral cortex is the correct answer because the autonomic nervous system (ANS) primarily consists of the hypothalamus, brainstem, and peripheral nerves, which regulate involuntary bodily functions. The cerebral cortex, however, is involved in higher cognitive functions and voluntary motor control, and is not part of the ANS.