Nokea
A nursing instructor is describing parkinsonism to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as a possible cause? Select all that apply.
- A. Drugs
- B. Stroke
- C. Myocardial infarction
- D. Encephalitis
- E. Epilepsy
Correct Answer: A,D
Rationale: Parkinsonism may result from the use of certain drugs, head injuries, and encephalitis.
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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 client is receiving carbidopa/levodopa (Sinemet). When assessing this client for possible adverse reactions, which of the following might the nurse note? Select all that apply.
- A. Choreiform movements
- B. Hyperglycemia
- C. Hypotension
- D. Dry mouth
- E. Anorexia
Correct Answer: A,D,E
Rationale: The most common adverse reactions associated with carbidopa/levodopa include anorexia, nausea, vomiting, abdominal pain, dysphagia, dry mouth, mental changes, headache, dizziness, increased hand tremor, and choreiform and dystonic movements.
A nurse is reviewing the medical record of a client who is exhibiting Parkinson-like adverse reactions due to drug therapy. Which drugs might the nurse note in the client's record? Select all that apply.
- A. Antidepressants
- B. Conventional antipsychotics
- C. Lithium
- D. Opioids
- E. NSAIDs
Correct Answer: A,B,C
Rationale: Drugs such as antidepressants, antiemetics, first-generation antipsychotics, lithium, and stimulants can cause symptoms similar to Parkinson's disease. Opioids and NSAIDs are not associated with Parkinson-like symptoms.
A nurse is caring for a client who has been prescribed pramipexole for the treatment of Parkinson's disease. From the client's medical records, the nurse understands that the client is taking verapamil. The nurse understands that the client is at increased risk for which effect from the interaction of the two drugs?
- A. Cardiac symptoms
- B. Agonist effectiveness
- C. Toxicity of both drugs
- D. Psychotic behavior
Correct Answer: B
Rationale: The nurse should assess for an increased risk of agonist effectiveness in the client. Increased risk of cardiac symptoms and increased risk of toxicity of both drugs are the effects of the interaction of COMT inhibitors with MAOI antidepressants and adrenergic drugs. Increased risk of psychotic behavior is the effect of the interaction of cholinergic blocking drugs with haloperidol.
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.