Chapter 21: Drugs for Parkinson's Disease

Chapter 21: Drugs for Parkinson’s Disease

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse is providing patient education for a 71-year-old patient and the spouse. The patient has taken levodopa (Dopar) for Parkinson’s disease for 2 weeks but reports no improvement in the symptoms. The nurse should tell the patient

a.	“Stop the drug. If you have not noticed any effects within 2 weeks, the prescriber may need to change your drug regime.”
b.	“It may take several months for a response to occur. Continue the medication as prescribed.”
c.	“Double the dose to see whether an effect occurs. Finding the correct dose takes many adjustments.”
d.	“Another agent will need to be added to the regimen to manage your symptoms.”

 

 

ANS:   B

Full therapeutic response with levodopa may take several months to develop. Patients should not expect immediate improvement. They should be informed that beneficial effects are likely to increase steadily over the first few months.

The drug should not be discontinued, because 2 weeks is not enough time to determine its efficacy.

The dose should not be doubled without a prescriber’s order and only if it is indicated.

Another agent should not be added until the effectiveness of the levodopa is determined.

 

DIF:    Cognitive Level: Application             REF:    pp. 184-185

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. A patient with Parkinson’s disease has been achieving effective symptom control with levodopa (Dopar) but complains that the symptoms begin to return before it is time for the next dose. “The drug just wears off,” he states. The nurse should anticipate that the prescriber will order the patient to

a.	take the levodopa at shorter dosing intervals.
b.	start taking a drug that reduces levodopa’s half-life.
c.	take levodopa at longer dosing intervals.
d.	increase the dose to increase receptor binding.

 

 

ANS:   A

Gradual loss (wearing off) develops near the end of the dosing interval and simply indicates that drug levels have declined to a subtherapeutic value. Wearing off can be minimized by shortening the dosing interval.

Giving a drug that prolongs levodopa’s plasma half-life and giving a direct-acting dopamine agonist would be effective; giving a drug that reduces levodopa’s half-life would not.

Levodopa should be taken at shorter dosing intervals, not longer ones.

Increasing the dose does not increase receptor binding. The availability of receptor binding makes a difference, and as does the drug’s affinity for the receptor.

 

DIF:    Cognitive Level: Application             REF:    pp. 184-185

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient with Parkinson’s disease says, “I always take my other medications with my bacon and eggs each morning. Can I take the levodopa (Dopar) at this time too?” The nurse’s best response would be

a.	“You can take the levodopa at breakfast if it helps you to remember to take it.”
b.	“You should take all of your medications together to enhance efficacy.”
c.	“You should take the levodopa at least 1 hour before you eat your breakfast.”
d.	“You should never take this medication with food, because that would increase its side effects.”

 

 

ANS:   C

Meals with a high protein content, such as bacon and eggs, can reduce therapeutic responses to levodopa by significantly reducing both the amount of levodopa absorbed and the amount transported into the brain. A high-protein meal could trigger an abrupt loss of effect. The patient should be instructed to take the medication 1 hour prior to breakfast.

Taking the medication at breakfast would not be indicated for a patient who eats a breakfast high in protein.

Taking all the medications together can potentiate or negate the effects of medications, resulting in toxicity and/or drug-to-drug interactions.

Taking the medication with food would reduce absorption, not increase it.

 

DIF:    Cognitive Level: Application             REF:    pp. 188-189

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A nurse checks on a patient with Parkinson’s disease who recently began taking levodopa (Dopar). She finds the patient trying to get out of bed. The patient tells the nurse that every time she gets out of bed, she gets dizzy and light-headed. The nurse explains that this symptom is known as orthostatic hypotension, and she should instruct the patient to

a.	maintain bed rest for at least 2 weeks.
b.	sleep on her left side to improve her circulation.
c.	lie down and put her feet up on pillows.
d.	try increasing the salt and water in her diet.

 

 

ANS:   D

Postural hypotension is common early in treatment. Hypotension can be reduced by increasing the intake of salt and water.

Postural hypotension can be easily treated with dietary changes, as well as by instructing the patient to rise slowly from lying to sitting to standing position. She does not need 2 weeks of bed rest.

Although sleeping on her left side may improve her circulation, it is not related to postural hypotension.

Lying down with the feet up is a more appropriate intervention for hypertension.

 

DIF:    Cognitive Level: Application             REF:    p. 185

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies