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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.”
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.
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
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
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.”
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?
A An alpha-adrenergic antagonist medication
B Discussing amantadine with the prescriber
C Increasing the salt and water intake
D Taking a drug holiday
A nursing student wants to know why a patient who has been taking levodopa (Dopar) for years will now receive levodopa/carbidopa (Sinemet). The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
A “Carbidopa increases the availability of levodopa in the central nervous system.”
B “Carbidopa reduces the incidence of nausea and vomiting.”
C “Combination products reduce peripheral cardiovascular side effects.”D “Combination products cause fewer dyskinesias and decreased psychosis.”
A nurse is teaching a group of nurses about Parkinson’s medications. The nurse is correct to state that one side effect associated with pramipexole (Mirapex) that is less likely to occur with other dopamine agonists is:
A sleep attacks.
C hallucinations.D dyskinesias.
A nursing student wants to know how carbidopa can be effective for treating Parkinson’s disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
A can be taken with high-protein meals.
B does not cross the blood-brain barrier.
C has dopamine-like effects of its own.D reduces abrupt loss of effect
A 25-year-old patient has been newly diagnosed with Parkinson’s disease, and the prescriber is considering using pramipexole (Mirapex). Before beginning therapy with this drug, the nurse will ask the patient about:
A any history of alcohol abuse or compulsive behaviors.
B any previous history of hypertension.
C difficulty falling asleep or staying asleep.whether any family members have experienced psychoses
A hospitalized patient with Parkinson’s disease who is receiving apomorphine to treat “off” episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient’s provider?
A Levodopa (Dopar)
B Ondansetron (Zofran)
C Prochlorperazine (Compazine)
D Trimethobenzamide (Tigan)
A patient with Parkinson’s disease is taking levodopa/carbidopa (Sinemet). The prescriber orders bromocriptine (Parlodel) to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:
A adding an antipsychotic medication.
B changing from bromocriptine to cabergoline (Dostinex).
C reducing the dose of bromocriptine.D reducing the dose of levodopa/carbidopa
A nurse is caring for an older adult man who has Alzheimer’s disease (AD). The patient’s daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?
A Family history and female gender are both known to increase the risk.
B Genetic testing can provide a definitive measure of the risk.
C Patients with the apolipoprotein E2 gene (ApoE2) are more likely to develop the disease.D Some biologic markers can be measured, but none is known to increase the risk.
The spouse of a patient who acts confused and forgetful wants to know if there is a test to determine whether the patient has Alzheimer’s disease. Which response by the nurse is correct?
A “A diagnosis is made by administering medications and observing for potential improvement in symptoms.”
B “The diagnosis is based on a patient’s age, family history, serum apolipoproteins, and genetic testing.”
C “Magnetic resonance imaging to demonstrate brain atrophy is the definitive test to determine Alzheimer’s disease.”
D “Proposed diagnostic criteria include measures of cognitive function and the presence of one known biomarker.”
An older adult patient with Alzheimer’s disease is admitted to the hospital. The patient’s spouse reports that the patient is often confused and gets lost walking to the store, which is 3 blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?
A Notify the provider of this patient’s worsening symptoms.
B Prepare the patient’s spouse for impending death from Alzheimer’s disease.
C Request an increase in the medication dose to treat the exacerbation in symptoms.
D Tell the spouse that this is an expected progression of the disease.
An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil (Aricept) 10 mg once daily for 6 months. The patient’s symptoms have begun to worsen, and the patient’s spouse asks if the medication dose can be increased. What will the nurse tell the spouse?
A The dose can be increased, because the patient has been taking the drug for longer than 3 months.
B The dose can be increased to twice daily dosing instead of once daily dosing.
C The increase in symptoms is the result of hepatotoxicity from the medication’s side effects.
D The patient must take the drug for longer than 1 year before the dose can be increased.
A patient will begin taking a cholinesterase inhibitor for early Alzheimer’s disease. The nurse is teaching the patient’s spouse about the medication. Which statement by the spouse indicates a need for further teaching?
A “Gastrointestinal symptoms are common with this medication.”
B “People taking this drug should not take antihistamines.”
C “This drug helps neurons that aren’t already damaged to function better.”
D “This drug significantly slows the progression of the disease.”
The spouse of a patient with Alzheimer’s disease asks a nurse for more information about the rivastigmine (Exelon) transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?
A “Doses are lower but more steady with the transdermal patch.”
B “Reduced side effects occur with the transdermal patch.”
C “We only need to change the patch every 2 weeks.”
D “We should remove the old patch before applying the new one.”
A nurse is teaching a group of nursing students about the use of memantine (Namenda) for Alzheimer’s disease. Which statement by a student indicates understanding of the teaching?
A “Memantine is indicated for patients with mild to moderate Alzheimer’s disease.”
B “Memantine modulates the effects of glutamate to alter calcium influx into neurons.”
C “Memantine prevents calcium from leaving neurons, which improves their function.”
D “When used with donepezil, memantine increases the amount of calcium in neuronal cells.”
A nurse is caring for an older adult patient who has Alzheimer’s disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?
A Confusion and memory impairment
B Dizziness and headache
C Nausea, vomiting, and diarrheaD Slowed heart rate and lightheadedness
A patient is worried about the risk of developing Alzheimer’s disease, because both parents had the disease. The nurse will tell this patient that known risk factors include what? (Select all that apply.)
A Advanced age
C Family history
A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching?
A “I may need to take additional drugs at times of acute relapse.”
B “I will need to take medication indefinitely.”
C “If medication is begun early, permanent remission can be achieved.”
D “Some symptoms may need to be managed with symptom-specific drugs.”
A 28-year-old woman is seen in the clinic after a single episode of blurred and double vision, weakness, and clumsiness lasting several days. The patient asks the nurse if she has multiple sclerosis. The nurse will tell this patient that the provider will:
A await a second clinical attack to confirm the diagnosis.
B consider her symptoms diagnostic of multiple sclerosis.
C order a magnetic resonance imaging (MRI) scan now and another when a second clinical attack occurs.
D have a definitive diagnosis based on an MRI scan ordered today.
A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptom free. The nurse will tell the patient that this indicates what?
A Hope for long-term remission
B Temporary improvement
C Development of relapsing-remitting MS
D Development of secondary progressive MS
A patient is being treated with interferon beta-1a (Avonex) for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend?
A Acetaminophen or ibuprofen
B Asking the provider to order a complete blood count (CBC)
C Coming to the clinic for evaluation for leukoencephalopathy
D Discontinuing the drug immediately
A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests?
A “After the first year of treatment, I will need once yearly blood work.”
B “I will need to have lab tests done every 3 months for the first year.”
C “If my liver function tests are abnormal, I will need to stop using this drug.”“These lab tests will measure liver and bone marrow function.”
A patient administers interferon beta-1a SQ (Rebif) 22 mcg/0.5 mL three times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do?
A Apply ice to the injection site before and after the injection.
B Ask the provider to reduce the dose of interferon beta to 8.8 mcg/0.2 mL.
C Discuss using a prescription-strength hydrocortisone product with the provider.
D Take oral diphenhydramine (Benadryl).
A patient has received an initial dose of glatiramer acetate (Copaxone) for relapsing-remitting multiple sclerosis. The nurse notes that the patient appears flushed and anxious and has urticaria. The patient reports palpitations, chest pain, and a feeling of laryngeal constriction. What will the nurse do?
A Obtain an order for epinephrine to treat a hypersensitivity reaction.
B Prepare to provide cardiorespiratory support.
C Report a possible cardiotoxic episode to the provider.
D Stay with the patient until this self-limiting episode passes.
A nurse provides teaching to a patient who is about to receive a first dose of fingolimod (Gilenya). Which statement by the patient indicates a need for further teaching?
A “I may experience a rapid heart rate and palpitations with the first dose.”
B “I should report nausea, vomiting, poor appetite, and dark urine.”
C “I will need an ophthalmologic examination before beginning treatment.”
D “I will need to remain in an observation unit for 6 hours after the first dose.”
A patient is about to begin therapy with fingolimod (Gilenya) to treat multiple sclerosis. The nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?
A Advise the patient to avoid individuals with chickenpox.
B Give the VZV vaccine with the initial dose of fingolimod.
C Give the VZV vaccine and tell the patient to begin using fingolimod in 1 month.
D Obtain an order for a VZV antibody test.
A nurse provides teaching for a 25-year-old patient who will receive mitoxantrone (Novantrone) for worsening relapsing-remitting multiple sclerosis. Which statement by the patient indicates a need for further teaching?
A “I may experience cardiac side effects several years after receiving this drug.”
B “I should report fever, chills, cough, and hoarseness immediately.”
C “I will need an infusion of this medication once weekly.”
D “I will need a liver function test and a pregnancy test before each dose.”
Immunomodulator drugs have shown effectiveness for what? (Select all that apply.)
A Preventing the development of MS
B Primary progressive MS
C Progressive-relapsing MS
D Relapsing-remitting MS
E Secondary progressive MS
A patient shows loss of consciousness, jaw clenching, contraction and relaxation of muscle groups, and periods of cyanosis. The nurse correctly identifies this as which type of seizure?
B Petit mal
A nurse is assessing a patient who becomes motionless and seems to stare at the wall and then experiences about 60 seconds of lip smacking and hand wringing. What should the nurse do?
A Ask the patient about a history of absence seizures.
B Contact the provider to report symptoms of a complex partial seizure.
C Notify the provider that the patient has had a grand mal seizure.
D Request an order for intravenous diazepam (Valium) to treat status epilepticus.
A nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?
A “Febrile seizures are a type of generalized tonic-clonic seizure.”
B “Generalized seizures are characterized by convulsive activity.”
C “Partial seizures do not last as long as generalized seizures.”
D “Patients having partial seizures do not lose consciousness.”
A nurse provides teaching for a patient with a newly diagnosed partial complex seizure disorder who is about to begin therapy with antiepileptic drugs (AEDs). Which statement by the patient indicates understanding of the teaching?
A “Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug.”
B “I will soon know that the drugs are effective by being seizure free for several months.”
C “Serious side effects may occur, and if they do, I should stop taking the medication.”“When drug levels are maintained at therapeutic levels, I can expect to be seizure free.”
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?
A Ask the patient to complete a seizure frequency chart for the past few weeks.
B Contact the provider to request an order for serum drug levels.
C Reinforce the need to take the medications as prescribed.
D Request an order to increase the dose of the antiepileptic drug.
A patient with a form of epilepsy that may have spontaneous remission has been taking an AED for a year. The patient reports being seizure free for 6 months and asks the nurse when the drug can be discontinued. What will the nurse tell the patient?
A AEDs must be taken for life to maintain remission.
B Another AED will be substituted for the current AED.
C The provider will withdraw the drug over a 6- to 12-week period.
D The patient should stop taking the AED now and restart the drug if seizures recur.
A patient with a seizure disorder is admitted to the hospital and has a partial convulsive episode shortly after arriving on the unit. The patient has been taking phenytoin (Dilantin) 100 mg three times daily and oxcarbazepine (Trileptal) 300 mg twice daily for several years. The patient’s phenytoin level is 8.6 mcg/mL, and the oxcarbazepine level is 22 mcg/mL. The nurse contacts the provider to report these levels and the seizure. What will the nurse expect the provider to order?
A A decreased dose of oxcarbazepine
B Extended-release phenytoin
C An increased dose of phenytoin
D Once-daily dosing of oxcarbazepine
A nurse counsels a patient who is to begin taking phenytoin (Dilantin) for epilepsy. Which statement by the patient indicates understanding of the teaching?
A “I should brush and floss my teeth regularly.”
B “Once therapeutic blood levels are reached, they are easy to maintain.”
C “I can consume alcohol in moderation while taking this drug.”“Rashes are a common side effect but are not serious.”
A patient is to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
A She may need to increase her dose of phenytoin while taking oral contraceptives.
B She should consider a different form of birth control while taking phenytoin.
C She should remain on oral contraceptives, because phenytoin causes birth defects.She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin
A patient is admitted to the hospital for a new onset seizure disorder, and the prescriber orders carbamazepine (Tegretol). The nurse reviewing the patient’s medical history notes that the patient is taking warfarin. The nurse will contact the provider to discuss _____ dose.
A reducing the carbamazepine
B reducing the warfarin
C increasing the carbamazepineD increasing the warfarin
A patient who is taking oral contraceptives begins taking valproic acid (Depakote) for seizures. After a week of therapy with valproic acid, the patient tells the nurse that she is experiencing nausea. What will the nurse do?
A Ask the patient if she is taking the valproic acid with food, because taking the drug on an empty stomach can cause gastrointestinal side effects.
B Contact the provider to request an order for a blood ammonia level, because hyperammonemia can occur with valproic acid therapy.
C Suggest that the patient perform a home pregnancy test, because valproic acid can reduce the efficacy of oral contraceptives.
A child is diagnosed with absence seizures, and the prescriber orders ethosuximide (Zarontin). When teaching the child’s parents about dosage adjustments for this drug, the nurse will stress the importance of:
A frequent serum drug level monitoring.
B learning as much as possible about the disorder and its treatment.
C recording the number of seizures the child has each day.D reporting dizziness and drowsiness to the provider.
A patient who has been taking phenobarbital for epilepsy begins taking valproic acid (Depakote) as adjunct therapy. The nurse notes that the patient is very drowsy. What will the nurse do?
A Explain to the patient that tolerance to sedation eventually will develop.
B Notify the prescriber, and request an order to reduce the dose of phenobarbital.
C Notify the prescriber of the need to increase the dose of valproic acid.
D Request an order for liver function tests to monitor for hepatotoxicity.
A nurse is providing teaching to a patient newly diagnosed with partial seizures who will begin taking oxcarbazepine (Trileptal). The patient also takes furosemide (Lasix) and digoxin (Lanoxin). Which statement by the patient indicates understanding of the teaching?
A “I may need to increase my dose of Trileptal while taking these medications.”
B “I may develop a rash and itching, but these are not considered serious.”
C “I should report any nausea, drowsiness, and headache to my provider.”
D “I should use salt substitutes instead of real salt while taking these drugs.”
A child who receives valproic acid (Depakote) begins taking lamotrigine (Lamictal) because of an increase in the number of seizures. The nurse will observe this child closely for which symptom?
A nurse is completing a discharge plan for a 24-year-old patient who will begin taking phenytoin. Which information is important to teach this patient?
A She may stop taking the drug when she is seizure free for a year.
B Taking the medication will ensure that she no longer has seizures.
C She may need to discontinue the drug if serious side effects occur.
D She should be sure to use an effective contraceptive method.
A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen (Lioresal) but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects?
A Weakness and dizziness
B Fatigue and drowsiness
C Seizures and hallucinations Correct
D Respiratory depression and coma
A patient has localized muscle spasms after suffering a leg injury in sports. Treatment options for this patient will not include:
A analgesic anti-inflammatory drugs.
B chlorzoxazone (Paraflex).
C metaxalone (Skelaxin).
D whirlpool baths.
A nurse is caring for a patient receiving intrathecal baclofen (Lioresal). The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention?
A Preparing to support respirations
B Administering an antidote to baclofen
C Administering diazepam to prevent seizuresD Obtaining an electrocardiogram
A patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine (Zanaflex) to alleviate the spasms. When obtaining the patient’s health history, the nurse should be concerned about which of the following as a possible reason for considering another drug?
A Concomitant use of aspirin
B A history of hepatitis
C A history of malignant hyperthermiaD Occasional use of alcohol
Which patient should receive dantrolene (Dantrium) with caution?
A A 20-year-old woman with a spinal cord injury
B A 45-year-old man with a history of malignant hyperthermia
C A 55-year-old woman with multiple sclerosisD An 8-year-old child with cerebral palsy
A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen (Lioresal). Which statement by the parent indicates a need for further teaching?
A “I can expect my child to be more drowsy when receiving this medication.”
B “I should not notice any change in my child’s muscle strength.”
C “I will contact the provider if my child is constipated or cannot urinate.”
D “If my child has a seizure, I should stop giving the medication immediately.”
A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy?
A Baclofen (Lioresal
B Dantrolene (Dantrium)
C Diazepam (Valium)
D Metaxalone (Skelaxin)
A patient with multiple sclerosis needs pharmacologic treatment for spasticity in order to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity?
A Baclofen (Lioresal)
B Dantrolene (Dantrium)
C Diazepam (Valium)
D Metaxalone (Skelaxin)
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