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A nurse is caring for a 70-year-old client who is receiving anticholinergic drug therapy for Parkinson's disease. The nurse would be alert for the development of which of the following in this client?
- A. Confusion and disorientation
- B. Choreiform movements
- C. Suicidal tendencies
- D. Psychotic episodes
Correct Answer: A
Rationale: The nurse should assess for confusion and disorientation when caring for this elderly client receiving anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.
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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 client who has been prescribed amaritadine for the treatment of the influenza A virus. After administration of the drug, the client complains of dry mouth. Which of the following instructions should the nurse offer the client to help relieve dry mouth?
- A. Instruct the client to take ice chips frequently.
- B. Encourage the client to take small, frequent meals.
- C. Instruct the client to avoid protein-rich foods.
- D. Stop the use of the antiparkinsonism drug by the client.
Correct Answer: A
Rationale: The nurse should instruct the client to suck on ice chips or hard candy (if allowed). The nurse should also instruct the client to take frequent sips of water throughout the day and between meals. The nurse encourages the client to have small, frequent meals when the client experiences a GI disturbance and not when the client complains of dry mouth. The nurse also need not instruct the client to avoid protein-rich foods because this will not reduce the client's discomfort due to dry mouth. The nurse should stop the use of the antiparkinsonism drug when the client complains of severe nausea or vomiting and not when the client is experiencing dry mouth. If dry mouth is so severe that there is difficulty in swallowing or speaking, or if loss of appetite and weight loss occur, the dosage of the antiparkinsonism drug may be reduced but not stopped completely.
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.
A client tells the nurse that he takes the drug Stalevo. The nurse understands that this drug is a combination of which of the following? Select all that apply.
- A. Benztropine
- B. Levodopa
- C. Carbidopa
- D. Tolcapone
- E. Entacapone
Correct Answer: B,C,E
Rationale: Stalevo is a brand-name combination product that contains carbidopa, levodopa, and entacapone.
The nurse would be alert for a client taking benztropine (Cogentin) to have increased anticholinergic effects if which of the following medications are also started? Select all that apply.
- A. Amantadine (Symmetrel)
- B. Quetiapine (Seroquel)
- C. Glycopyrrolate (Robinul)
- D. Perphenazine (Trilafon)
- E. Tiotropium (Spiriva)
Correct Answer: A,D
Rationale: A client taking benztropine (Cogentin) will have increased anticholinergic effects if amantadine or phenothiazines such as perphenazine are given together.