Nokea
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.
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A client is prescribed carbidopa/levodopa. The nurse understands that this drug should be administered cautiously to clients with which condition? Select all that apply.
- A. Hyperthyroidism
- B. Seizure disorder
- C. Renal disease
- D. Asthma
- E. Peptic ulcer disease
Correct Answer: C,D,E
Rationale: Carbidopa/levodopa (Sinemet) is used cautiously in clients with cardiovascular or pulmonary disease (asthma), peptic ulcer disease, renal or hepatic disease, and psychosis.
The nurse understands the need for cautious administration of the prescribed entacapone to a client with which of the following? Select all that apply.
- A. Hypotension
- B. Renal dysfunction
- C. Hepatic dysfunction
- D. Diabetes
- E. Hypertension
Correct Answer: A,B,C,E
Rationale: The nurse should cautiously administer entacapone (Comtan) to clients with hypotension, hypertension, and decreased hepatic or renal function.
A nurse is caring for a 55-year-old client with Parkinson's disease who is prescribed entacapone. The nurse would monitor this client for which adverse reaction?
- A. Increased hand tremor
- B. Constipation
- C. Urinary retention
- D. Dyskinesia
Correct Answer: D
Rationale: The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hypersinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs.
After teaching a group of nursing students issues and problems commonly associated with antiparkinson drug therapy, the instructor determines that the teaching was successful when the students identify which nursing diagnosis as common? Select all that apply.
- A. Risk for Injury
- B. Risk for Infection
- C. Diarrhea
- D. Impaired Physical Mobility
- E. Imbalanced Nutrition: More Than Body Requirements
Correct Answer: A,D
Rationale: Common drug therapy-related nursing diagnoses include Risk for Injury, Constipation, Impaired Physical Mobility, Imbalanced Nutrition: Less Than Body Requirements, and Disturbed Sleep Pattern.
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.