Chapter 23: Drugs for Alzheimers and Parkinsons Disease Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 23: Drugs for Alzheimers and Parkinsons Disease

Test Bank

MULTIPLE CHOICE

1. Which is the common underlying pathophysiology of both Alzheimers disease and Parkinsons disease?
a. Both are neurodegenerative diseases.
b. Both are forms of dementia.
c. Both involve interrupted transmission of nerve impulses.
d. Both are primarily caused and directly related to environmental factors.
ANS: C
Alzheimers disease is a form of dementia. Parkinsons disease is a neurodegenerative disease. Both illnesses involve interrupted nerve impulse transmissions.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 411 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which symptom is often the earliest to occur in a patient with Alzheimers disease?
a. Difficulty solving simple math problems
b. Problems performing simple tasks
c. Mild forgetfulness
d. Inability to read
ANS: C
Alzheimers disease symptoms begin very slowly. In the early stage, the first symptom is mild forgetfulness, which is sometimes confused with age-related memory changes.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 412 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

3. For which patient does the nurse watch most closely for symptoms of Alzheimers disease?
a. 45-year-old with Down syndrome
b. 50-year-old with a whiplash injury
c. 60-year-old with hypertension
d. 75-year-old with a smoking history
ANS: D
Age is the greatest risk factor for development of Alzheimers disease. A patient with Down syndrome has an increased risk by age 50 to 60 years. Whiplash and head injuries, hypertension, smoking, and high cholesterol all increase the risk for Alzheimers disease.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Psychosocial Integrity

4. Which statement made by a patient with Alzheimers disease indicates to the nurse the need for additional teaching?
a. When I have been taking donepezil for 6 weeks I should regain my memories.
b. The only way to be sure that I have Alzheimers disease is by autopsy after I die.
c. Even with medication, eventually I will need total care to prevent complications.
d. The rivastigmine I am taking will slow down the progression of my symptoms.
ANS: A
No drug has been developed that will protect neurons from the changes that occur with Alzheimers disease. Drug treatments can temporarily slow the progression of symptoms in some patients. The drugs do not cure the disease and a patient should not expect to regain lost function. The only way to definitively diagnose this illness is by seeing the plaques and tangles in the brain on autopsy after death.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

5. A newly admitted patient with Alzheimers disease who has been prescribed memantine (Namenda) has developed the symptoms of vomiting, drooling, heart rate of 56 beats per minute, and muscle weakness. What is the nurses best action?
a. Contact the prescriber and ask for an order for an as-needed antiemetic drug.
b. Place the patient on a heart monitor and check the heart rate every 2 hours.
c. Hold the drug dose and contact the prescriber immediately.
d. Give the drug exactly as ordered.
ANS: C
Symptoms of drug overdose for memantine include upset stomach, vomiting, drooling, sweating, slow heart rate, difficulty breathing, muscle weakness, and seizures. The drug dose should be held and the prescriber notified immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

6. Which strategy best supports safe medication administration for patients with Alzheimers disease?
a. Include the patients care provider when teaching about the patients drugs.
b. Provide written guidelines about each drug to the patient.
c. Create a chart listing the drugs, dosages, and times they should be taken.
d. Suggest that the patient set up the drugs each week in labeled boxes.
ANS: A
Because patients with Alzheimers disease have difficulty with memory and cognition, the nurse should always include the person providing care in the home when doing any teaching about the disease, including drugs and dosages.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

7. A patient with Alzheimers disease is prescribed rivastigmine (Exelon). What action does the nurse take to prevent a common side effect?
a. Give the drug with a full glass of water.
b. Administer the drug with meals twice a day.
c. Assess the patients level of consciousness.
d. Keep an accurate record of all patient food intake.
ANS: B
Both rivastigmine and galantamine (Reminyl) commonly cause the side effect of GI upset. The nurse should give these drugs with food twice a day to minimize this side effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

8. What is the most important precaution for the nurse to teach a patient who is prescribed transdermal rivastigmine (Exelon)?
a. Always remove old patches daily and apply the new patch to a different site.
b. Report any difficulty starting the urinary stream to your prescriber immediately.
c. Place the patch on the neck or forehead so that the drug reaches the brain more quickly.
d. For best drug absorption, hold a warm wet washcloth over the patch for 5 minutes after applying it.
ANS: A
As for any drug delivered by transdermal patch, the old patch should be removed before applying the new one to prevent a drug overdose. The patches can irritate the skin and should not be replaced in the same position as the previous patch. Rotating sites prevents skin irritation and breakdown. Applying the patch closer to the brain does not increase brain absorption of the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

9. For which patient must the drug donepezil (Aricept) for Alzheimers disease be avoided?
a. 54-year-old woman with early onset Alzheimers disease
b. 67-year-old man who also takes drugs for type 2 diabetes
c. 72-year-old woman who is 20 lb underweight
d. 72-year old man who is unable to sit or stand
ANS: C
Donepezil suppresses appetite and causes weight loss. In a person who is underweight, the usual dosage can lead to toxicity. In addition, some Alzheimers patients forget to eat and are already underweight. Weighing less than an ideal body weight increases the risk for many complications of old age and poor health.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 415 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

10. Which statement is true about how drugs for Parkinsons disease work?
a. Dopaminergic drugs decrease the amount of dopamine activity in the brain.
b. COMT inhibitors allow a larger amount of levodopa to reach the brain, which lowers the brains dopamine levels.
c. MAO-B inhibitors facilitate the enzyme monoamine oxidase B that breaks down dopamine in the brain.
d. Anticholinergic drugs block cholinergic nerve impulses to minimize tremors and rigidity.
ANS: D
Dopaminergic drugs increase the amount of dopamine activity in the brain. COMT (catechol-o-methyltransferase) inhibitors allow a larger amount of levodopa to reach the brain, which increases the brains dopamine levels. MAO-B inhibitors inhibit the enzyme monoamine oxidase B that breaks down dopamine in the brain. Anticholinergic drugs are effective against tremors and rigidity by blocking cholinergic nerve impulses that help control the muscles of the arms, legs, and body.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 418 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

11. A patient with Parkinsons disease who has been prescribed entacapone (Comtan) tells the nurse about muscle aches, weakness, and having dark cola-colored urine. What is the nurses best action?
a. Send a urine specimen to the laboratory for urinalysis.
b. Help the patient back to bed and instruct him or her to rest.
c. Tell the patient that these are expected side effects of the drug.
d. Hold the drug and notify the prescriber immediately.
ANS: D
Entacapone is a COMT inhibitor. These drugs can cause the adverse effect of rhabdomyolysis, a serious and potentially fatal effect involving destruction or degeneration of skeletal muscle. Signs and symptoms of rhabdomyolysis include muscle aches, muscle weakness, and dark cola-colored urine. The nurse must hold the drug and notify the prescriber immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

12. Which blood laboratory test result is most important for the nurse to check before administering the first prescribed dose of carbadopa-levodopa (Sinemet) to a patient?
a. International normalized ratio (INR)
b. Blood urea nitrogen (BUN) level
c. White blood cell (WBC) count
d. Lactate dehydrogenase (LDH)
ANS: C
Carbidopa-levodopa can suppress bone marrow activity and reduce the circulating levels of WBCs (neutropenia), greatly increasing the risk for infection. More patients with Parkinsons disease are older adults and may already have some age-related decrease in immune function. Neutropenia and infection are more likely when the patients WBC count is low before treatment with the drug is started.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

13. For which adverse effect does the nurse monitor in a patient with Parkinsons disease after administering ropinirole (Requip)?
a. Neuroleptic malignant syndrome
b. Depression with suicidal tendencies
c. Central nervous system depression
d. Narcolepsy or sleep attacks
ANS: D
An adverse effect of ropinirole, a dopaminergic/dopamine antagonist drug, is episodes of falling asleep suddenly (narcolepsy). Neuroleptic malignant syndrome is an adverse effect of COMT inhibitors. Depression with suicidal tendencies is an adverse effect of carbidopa-levodopa (Sinemet). Central nervous system depression is an adverse effect of apomorphine (Apokyn) and can include respiratory depression, coma, and cardiac arrest.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

14. A patient with Parkinsons disease informs the nurse that the stiffness and slowness of movements associated with the illness have become worse. What does the nurse teach the patient about this change?
a. These changes are normal and expected as your disease progresses.
b. You will need to use a walker at all times to avoid falls and accidents.
c. Whenever your symptoms worsen, contact your prescriber right away.
d. If your prescriber increases your drug dosage these functions will improve.
ANS: C
Patients should be taught to immediately notify their prescriber if symptoms of Parkinsons disease (e.g., shaking, stiffness, or slowness of movement) become worse.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

15. A patient taking entacapone (Comtan) for Parkinsons disease informs the nurse that his urine is now brownish-orange in color. What is the nurses best action?
a. Explain that this is an expected side effect and is not harmful.
b. Collect a urine sample and send it to the laboratory for urinalysis.
c. Hold the drug and immediately notify the prescriber.
d. Instruct the patient to increase his intake of fluids.
ANS: A
Entacapone may discolor a patients urine brownish-orange. This is an expected side effect and is not harmful.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. What safety precaution must the nurse teach a patient with Parkinsons disease who is prescribed benztropine (Cogentin)?
a. Always dress warmly and avoid extended exposure to cold weather.
b. Stay indoors in an air-conditioned setting during hot weather.
c. Change positions slowly to avoid dizziness or light-headedness.
d. Avoid alcohol intake because drowsiness is associated with this drug.
ANS: B
Benztropine is an anticholinergic drug. These drugs cause decreased perspiration, leading to increased risk for overheating during hot weather. Patients should be taught to stay indoors, preferably in an air-conditioned environment, to avoid this side effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

17. A patient who has been prescribed carbidopa-levodopa (Sinemet) informs the nurse that a dark spot on his arm is getting larger. What is the nurses best action?
a. Measure the size of the spot and document the finding.
b. Inform the patient that this is an expected side effect of the drug.
c. Administer the drug as ordered by the prescriber.
d. Hold the drug and contact the prescriber about this change.
ANS: D
Carbidopa-levodopa can activate malignant melanoma. Patients should be instructed to report any changes in skin lesions immediately to their prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

18. Why is bromocriptine (Parlodel) not recommended for women who are breastfeeding?
a. It stops the production of milk.
b. It enters the milk and slows infant growth.
c. It enters the milk and causes symptoms of Parkinsons disease in the infant.
d. It is a pregnancy category C drug and has been found to cause birth defects in animals.
ANS: A
Bromocriptine suppresses the secretion and release of prolactin from the pituitary gland. Without secretion of this important hormone, lactation with milk production does not occur.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 421 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

19. A patient is prescribed entacapone (Comtan) 800 mg per day. The drug is available in 200-mg tablets. How many tablets does the nurse give?
a. 2
b. 4
c. 6
d. 8
ANS: B
Have 200 mg/1 tablet, Want 800 mg/X tablets; 800/200 = 4 tablets.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. Which information must be included when documenting a patients seizure? (Select all that apply.)
a. Time of seizure onset
b. Total duration of the seizure
c. Patients ability to swallow during seizure
d. Incontinence during seizure
e. Patient orientation after seizure
ANS: A, B, D, E
When a patient has a seizure, documentation should include time of seizure onset, time of seizure termination, total duration of seizure, and characteristics of the seizure (e.g., location of tonic or clonic movement, pupil changes, cyanosis, incontinence, and patient orientation level after the seizure). While it is a good idea to assess swallowing ability after a seizure, during the seizure is not the time to do this.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 414 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which are major symptoms of Parkinsons disease? (Select all that apply.)
a. Bradycardia
b. Rigidity
c. Abnormal gait
d. Tremor at rest
e. Lack of facial expression
ANS: B, C, D
The four major symptoms of Parkinsons disease are tremor at rest, rigidity, bradykinesia (slow movements and difficulty starting movements), and abnormal gait. Lack of facial expression is a symptom of this illness, but not a major symptom.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 416 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

3. What are the goals of treatment for Parkinsons disease? (Select all that apply.)
a. Help the patient to maintain a high quality of life.
b. Reduce side effects of drug therapy.
c. Regain as much function as possible.
d. Minimize the patients disability.
e. Prolong the patients life span.
ANS: A, B, D
The goals of treatment for Parkinsons disease are to minimize disability, reduce possible side effects of drug therapy, and help the patient maintain a high quality of life. There is no cure for this illness, which is progressive. Drugs can help slow the progression and control the symptoms.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 417 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

4. A patient has been prescribed rasagiline (Azilect). Which foods must the nurse teach the patient to avoid? (Select all that apply.)
a. Green leafy vegetables
b. Aged cheeses
c. Sour cream
d. Fresh apples and pears
e. Soy sauce
ANS: B, C, E
Rasagiline is an MAO-B inhibitor. Patients must be taught to avoid foods with tyramine, an amino acid that can cause a hypertensive crisis when patients are taking these drugs. Examples of such foods are aged cheeses, sour cream, and soy sauce (see Box 23-2 in the text).

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 421 TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

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