TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 21-25
Chapter 21: Drugs for Parkinson’s Disease
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.
DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used
for Motor Symptoms | Levodopa | Use in Parkinson’s Disease| Adverse
Effects TOP: Nursing Process: Evaluation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
6. A nurse is discussing motor symptoms with a patient with Parkinson’s disease who has
been taking levodopa/carbidopa (Sinemet) and who is now having regular tics. Which
statement by the patient indicates understanding of this symptom?
a. “I may need to try a lower dose of Sinemet to reduce my tics.”
b. “My provider may order clozapine to treat these tics.”
c. “These tics are an indication that my dose of Sinemet is too low.”
d. “This means I will have to have surgery to stop the symptoms.”
ANS: A
Levodopa can cause movement disorders. If they occur, a lower dose of levodopa
may be required to alleviate them. Clozapine is an antipsychotic used to treat
levodopa-induced psychoses. Movement disorders generally occur as the dose of
levodopa increases. Surgery is a last option for treating movement disorders, after
amantadine fails.
DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used
for Motor Symptoms | Levodopa | Use in Parkinson’s Disease| Adverse
Effects TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
7. A patient who has begun taking levodopa/carbidopa (Sinemet) reports feeling lightheaded
and dizzy, especially when standing up from a sitting position. What will the nurse
recommend?
CHAPTERS 21-25
Chapter 21: Drugs for Parkinson’s Disease
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.
DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used
for Motor Symptoms | Levodopa | Use in Parkinson’s Disease| Adverse
Effects TOP: Nursing Process: Evaluation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
6. A nurse is discussing motor symptoms with a patient with Parkinson’s disease who has
been taking levodopa/carbidopa (Sinemet) and who is now having regular tics. Which
statement by the patient indicates understanding of this symptom?
a. “I may need to try a lower dose of Sinemet to reduce my tics.”
b. “My provider may order clozapine to treat these tics.”
c. “These tics are an indication that my dose of Sinemet is too low.”
d. “This means I will have to have surgery to stop the symptoms.”
ANS: A
Levodopa can cause movement disorders. If they occur, a lower dose of levodopa
may be required to alleviate them. Clozapine is an antipsychotic used to treat
levodopa-induced psychoses. Movement disorders generally occur as the dose of
levodopa increases. Surgery is a last option for treating movement disorders, after
amantadine fails.
DIF: Cognitive Level: Application REF: Pharmacology of the Drugs Used
for Motor Symptoms | Levodopa | Use in Parkinson’s Disease| Adverse
Effects TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
7. A patient who has begun taking levodopa/carbidopa (Sinemet) reports feeling lightheaded
and dizzy, especially when standing up from a sitting position. What will the nurse
recommend?
