Nokea
A client with Parkinson's disease is undergoing treatment in a health care facility. Which of the following nursing interventions should the nurse perform as part of the client's ongoing assessment?
- A. Assess the client for ability to perform the daily activities.
- B. Observe the current mental condition of the client.
- C. Observe the client for various neuromuscular signs.
- D. Prepare a baseline for future evaluations of the client's drug therapy.
Correct Answer: C
Rationale: The nurse should evaluate the client's response to drug therapy by observing the client for various neuromuscular signs to compare these observations with the data obtained during the initial physical assessment. The nurse should assess the clients ability to perform daily activities and observe the client's current mental condition before the drug is administered to the client as part of the preadministration assessment. During the preadministration assessment, before starting the drug therapy, the nurse also performs a physical assessment of the client to provide a baseline for future evaluations of drug therapy.
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A nurse is assigned to care for a 40-year-old client with a hepatic injury that has occurred due to the administration of tolcapone. Which of the following interventions should the nurse perform when caring for this client?
- A. Monitor the client for signs of tactile hallucinations.
- B. Monitor the client for signs of dystonic movements.
- C. Perform regular blood tests of the client.
- D. Perform serum transaminase level testing every day.
Correct Answer: C
Rationale: A serious and potentially fatal adverse reaction to tolcapone is hepatic injury. The nurse should, therefore, perform regular blood testing to monitor liver function of the client as prescribed. The testing of serum transaminase levels may be ordered at frequent intervals such as every 2 weeks for the first year and every 8 weeks thereafter. The nurse need not perform serum transaminase level testing every day. The nurse should monitor for signs of dystonic movements when caring for a client receiving carbidopa and levodopa, not tolcapone. The nurse should monitor for signs of tactile hallucinations when caring for an elderly client receiving tolcapone.
A nurse is caring for a 70-year-old client undergoing antiparkinsonism drug therapy. The client is prescribed pramipexole by the physician. The nurse should monitor the client's condition for the development of which of the following adverse reactions associated with the use of this drug?
- A. Blurred vision
- B. Memory loss
- C. Visual hallucinations
- D. Muscular rigidity
Correct Answer: C
Rationale: The nurse should monitor the elderly client who is administered a dopamine receptor antagonist for signs of visual, auditory, or tactile hallucinations. Hallucinations occur more often in older adults than in younger adults receiving the antiparkinsonism drugs, especially when taking the dopamine receptor agonists. The incidence of hallucinations appears to increase with age. The nurse need not monitor the clients condition for signs of blurred vision, memory loss, and muscular rigidity as these conditions are not known to occur in elderly clients due to the use of dopamine receptor agonists.
After administering tolcapone (Tasmar) to a client, the nurse would be alert for which of the following as a possible adverse reaction? Select all that apply.
- A. Orthostatic hypotension
- B. Renal failure
- C. Dyskinesia
- D. Dry mouth
- E. Anorexia
Correct Answer: A,C,E
Rationale: Adverse reactions associated with tolcapone (Tasmar) include orthostatic hypotension, dyskinesia, sleep disorders, dystonia, excessive dreaming, somnolence, dizziness, nausea, anorexia, muscle cramps, and liver failure.
A nurse is assigned to care for a client who is to receive a cholinergic blocking drug. The nurse obtains the history from the client. Which of the following would alert the nurse to the need for cautious administration?
- A. The client has a decreased liver function.
- B. The client has a history of hallucinations or psychosis.
- C. The client has a cardiovascular disease.
- D. The client has a pulmonary disease.
Correct Answer: A
Rationale: It is important for the nurse to know if the client has decreased liver or kidney function so that the cholinergic blocking drug can be administered cautiously in the client. Other conditions in clients that require cautious use include tachycardia, cardiac arrhythmias, hypertension, hypotension, tendency toward urinary retention, and obstructive disease of the urinary system or gastrointestinal tract. The cholinergic blocking drugs are given with caution to older adults. The nurse should use dopamine receptor agonist drugs with caution in clients with a history of hallucinations or psychosis or cardiovascular disease. The nurse should use dopaminergic drugs with caution in clients with pulmonary diseases.
After teaching the family of a client with Parkinson's disease about possible adverse reactions, the nurse determines that the teaching was successful when the family states they will withhold the drug if the client experiences which of the following? Select all that apply.
- A. Facial grimacing
- B. Exaggerated chewing motions
- C. Protruding tongue
- D. Constipation
- E. Lack of appetite
Correct Answer: A,B,C
Rationale: The nurse should teach the client and family how to describe movements and to be alert for those such as facial grimacing, protruding tongue, exaggerated chewing motions and head movements, and jerking movements of the arms and legs. If these occur, the client should not take the next drug dose and should notify the primary health care provider immediately.