Chapter 23: Drugs for Neurologic Disorders: Parkinsonism and Alzheimers Disease Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 23: Drugs for Neurologic Disorders: Parkinsonism and Alzheimers Disease

Test Bank

MULTIPLE CHOICE

1. The client has been prescribed carbidopa-levodopa (Sinemet). The highest priority instruction for the client is to avoid eating:

a.

oranges.

b.

lima beans.

c.

spinach.

d.

watermelon.

ANS: B

Pyridoxine increases dopa decarboxylase action, which metabolizes levodopa in the peripheral nervous system to dopamine. Food rich in pyridoxine, such as lima beans, should be avoided.

DIF: Cognitive Level: Application REF: p. 325

TOP: Nursing Process: Teaching/Learning

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

2. In parkinsonism, what is the neurotransmitter that is in excess, causing excitation and movement disorders?

a.

Acetylcholine

b.

Norepinephrine

c.

Epinephrine

d.

Dopamine

ANS: A

Acetylcholine is the chemical that is in excess amounts in clients with Parkinsons disease, owing to low dopamine.

DIF: Cognitive Level: Comprehension REF: p. 320

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A client is admitted with the diagnosis of Parkinsons disease. The nurse is vigilant for which symptom?

a.

Gastrointestinal upset

b.

Inability to remember name

c.

Bradykinesia

d.

Disorientation

ANS: C

Bradykinesia, or slow voluntary movement, is characteristic of this disorder.

DIF: Cognitive Level: Application REF: p. 320

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

4. A client is diagnosed with parkinsonism. He is ordered to receive levodopa (L-dopa) 750 mg qid. What side effects should the nurse watch for?

a.

Cardiac dysrhythmias, behavioral changes, and orthostatic hypotension

b.

Increased urination, increased libido, and muscle weakness

c.

Hypotension, anorexia, and dyspnea

d.

Decreased libido, hypertension, and palpitations

ANS: A

These are side effects associated with this medication.

DIF: Cognitive Level: Application REF: p. 321

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The client with ________ would not be a candidate for treatment with Sinemet.

a.

narrow-angle glaucoma

b.

gastrointestinal distention

c.

bradycardia

d.

urinary frequency

ANS: A

Sinemet may increase intraocular pressure.

DIF: Cognitive Level: Comprehension REF: p. 324

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. What antiviral drug is used to decrease parkinsonism symptoms?

a.

Amantadine (Symmetrel)

b.

Pergolide (Permax)

c.

Bromocriptine (Parlodel)

d.

Selegiline (Eldepryl)

ANS: A

Amantadine (Symmetrel), found to decrease the symptoms of parkinsonism, is also an antiviral agent.

DIF: Cognitive Level: Comprehension REF: p. 323

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A client is diagnosed with Alzheimers disease. In developing a teaching plan for the clients family members, the nurse bases the plan on the idea that Alzheimers disease is a(n):

a.

curable dementia-type illness.

b.

form of mental illness.

c.

chronic, progressive condition.

d.

acute, treatable disease.

ANS: C

Alzheimers disease is a chronic progressive neurodegenerative condition.

DIF: Cognitive Level: Comprehension REF: p. 320

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology

8. Tacrine (Cognex) has a short half-life. The nurse would anticipate that this medication would be ordered how often?

a.

Every other day

b.

Daily

c.

bid

d.

qid

ANS: D

Medications with short half-lives require more frequent dosing; therefore they are given four times a day.

DIF: Cognitive Level: Application REF: p. 328

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. Tacrine (Cognex) is ordered for a client. Because of its most life-threatening adverse reaction, the nurse is aware that which levels should be frequently evaluated?

a.

Liver enzymes

b.

BUN and creatinine levels

c.

White blood cell count

d.

Serum albumin levels

ANS: A

This medication is very hepatotoxic; therefore, liver enzymes should be periodically monitored.

DIF: Cognitive Level: Analysis REF: p. 328

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. Which is a realistic goal regarding medication for the client with advanced Alzheimers disease?

a.

The client will demonstrate independent medication administration behaviors throughout the course of the disease.

b.

With assistance, the client will receive medications at appropriate times throughout the course of the illness.

c.

The client will demonstrate progressive improvement in cognitive function for the next year.

d.

The client will report a decrease in memory loss by the next healthcare provider visit.

ANS: B

The only realistic goal for the client is that he or she would receive medication with the help of a caregiver.

DIF: Cognitive Level: Application REF: p. 328

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client is being treated with carbidopa/levodopa (Sinemet) as a treatment for Parkinsons disease. Which symptom indicates a positive response to the medication?

a.

Increase in ability to remember name and recent events

b.

Decrease in tremoring and bradykinesia

c.

Acceleration of random movements

d.

Decrease in metabolic rate and vital signs

ANS: B

Decreases in parkinsonian symptoms are positive responses to these medications.

DIF: Cognitive Level: Application REF: p. 326

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A client with Alzheimers disease receives tacrine (Cognex). Her son is commenting on his mothers condition. Which comment indicates an expected positive effect from this medication?

a.

My mother is less unstable on her feet.

b.

My mother is not deteriorating at this time.

c.

My mother seems to be cured of her Alzheimers.

d.

My mother is no longer at risk of the effects of Alzheimers.

ANS: B

This is a realistic answer to this question. Medications for Alzheimers disease slow the progression of the illness but do not cure or decrease the risk of the condition. Cognex does not have an effect on motor function.

DIF: Cognitive Level: Application REF: p. 328

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client with Parkinsons disease is receiving levodopa (L-dopa) to reduce symptoms. What would indicate the effectiveness of the medication?

a.

Increasing tremoring

b.

Decreasing pill-rolling

c.

Hyperactivity

d.

Bradykinesia

ANS: B

The only positive response to the medication would be decreased pill-rolling.

DIF: Cognitive Level: Application REF: p. 320

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The client has been placed on Tacrine. What is the best time for the nurse to administer the medication?

a.

8:00 PM

b.

12:30 PM

c.

2:00 PM

d.

5:30 PM

ANS: C

Food decreases the absorption of Tacrine, so it should not be taken near any mealtime.

DIF: Cognitive Level: Analysis REF: p. 328

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The client has been ordered treatment with Sinemet. He tells the nurse that he has previously been diagnosed and treated for malignant melanoma. What is the best response from the nurse?

a.

The medication does not have any effect on diseases such as malignant melanoma.

b.

The medication is contraindicated when you have had malignant melanoma.

c.

The medication will prevent a recurrence of malignant melanoma.

d.

The medication may lead to a recurrence of malignant melanoma.

ANS: B

Sinemet is contraindicated when the client has had malignant melanoma.

DIF: Cognitive Level: Analysis REF: p. 324

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The client has been started on Sinemet. She is also being treated with an MAO inhibitor medication. The nurse anticipates that which of the clients vital signs should be most closely monitored?

a.

Blood pressure

b.

Apical pulse

c.

Temperature

d.

Respirations

ANS: A

Hypertensive crisis may result when the client is on Sinemet and an MAO inhibitor drug.

DIF: Cognitive Level: Analysis REF: p. 324

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The client has been diagnosed with Alzheimers disease and needs to be started on an acetylcholinesterase inhibitor drug. He has preexisting liver disease. The nurse anticipates the he will most likely be ordered which drug?

a.

Aricept

b.

Hydergine

c.

Exelon

d.

Cognex

ANS: C

Exelon is not known to cause hepatotoxicity.

DIF: Cognitive Level: Analysis REF: p. 329

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A client is ordered to receive an anticholinergic to control the symptoms of Parkinsons disease. The nurse is teaching the client precautions about the medication class. What would be included in the treatment plan? (Select all that apply.)

a.

Use sunglasses to deal with photophobia.

b.

Drooling is a common side effect.

c.

Have routine eye examinations.

d.

Void before taking the medication.

e.

Anticholinergics have few interactions with other medications.

f.

Ensure adequate fiber in the diet.

ANS: A, C, D, F

These medications may cause photophobia, urinary retention, dry mouth, and constipation, and may have many interactions with other medications. They may exacerbate glaucoma.

DIF: Cognitive Level: Application REF: p. 321

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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