NURSING 6005 CHAPTER 21: DRUGS FOR PARKINSON’S DISEASE Test Bank

NURSING 6005 CHAPTER 21: DRUGS FOR PARKINSON’S DISEASE Test Bank MULTIPLE CHOICE 1. A patient has taken levodopa (Dopar) for Parkinson’s disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct? a. “Another agent will be needed to manage your symptoms.” b. “Double the dose to see whether an effect occurs.” c. “It may take several months for a response to occur.” d. “The prescriber may need to change your drug regimen.” ANS: C A full therapeutic response with levodopa may take several months to develop. Until the true effect of the dose is seen, it is not necessary to change to another drug, increase the dose, or change the drug regimen. DIF: Cognitive Level: Application REF: Levodopa | Use in Parkinson’s Disease TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A nurse provides teaching for a patient who is newly diagnosed with Parkinson’s disease. Which statement by the patient indicates understanding of the drug therapy for this disease? a. “A levodopa/carbidopa combination is used to improve motor function.” b. “There are several drugs available to treat dyskinesias.” c. “When ‘off’ times occur, I may need to increase my dose of levodopa.” d. “With adequate drug therapy, the disease progression may be slowed.” ANS: A Levodopa combined with carbidopa is the initial drug of choice to treat motor symptoms. Amantadine is the only drug recommended to treat dyskinesias. Entacapone and rasagiline are used to treat abrupt loss of effect, or “off” times. Drug therapy does not slow the progression of the disease. DIF: Cognitive Level: Application REF: Overview of Motor Symptom Management | Therapeutic Goal | Drugs Employed | Drug Selection TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A patient has been diagnosed with Parkinson’s disease (PD) and begins treatment with levodopa/carbidopa (Sinemet). After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to: a. add a dopamine agonist. b. discuss the “on-off” phenomenon. c. increase the dose of Sinemet. d. re-evaluate the diagnosis. ANS: D Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The “on-off” phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated. DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used for Motor Symptoms | Levodopa | Use in Parkinson’s Disease TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A patient with Parkinson’s disease is taking levodopa/carbidopa (Sinemet) and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss: a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone. b. adding the DA-releasing agent amantadine to the regimen. c. giving a direct-acting dopamine agonist. d. shortening the dosing interval of levodopa/carbidopa. ANS: A This patient is describing abrupt loss of effect, or the “off” phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect. DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used for Motor Symptoms | Levodopa | Use in Parkinson’s Disease | Table 21-2: Drugs for Motor Complications of Levodopa Therapy TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient newly diagnosed with Parkinson’s disease has been taking levodopa/carbidopa (Sinemet) for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider? a. Taking a lower dose on an empty stomach b. Taking an increased dose along with a high-protein snack c. Taking a lower dose with a low-protein snack d. Taking dopamine in addition to levodopa/carbidopa ANS: C Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla