NURS 111 Parkinson's Disease Exam. Columbia University. Complete Solution.Medications
Leo was prescribed the antiparkinsonian medication
... [Show More] carbidopalevodopa (Sinemet) shortly after being
diagnosed with Parkinson's disease. Before starting the medication, the nurse in the healthcare
provider's office explained the action of Sinemet as part of medication teaching.
1.
Which statement explains the mechanism of action of Sinemet in the treatment of Parkinson's disease?
A) Sinemet counteracts the neurotransmitter acetylcholine and restores the natural balance of
neurotransmitters in the CNS.
INCORRECT
This is not the mechanism of action for Sinemet. Anticholinergics such as benztropine (Cogentin) are
used to block acetylcholine and restore neurotransmitter balance.
B) Sinemet inhibits dopamine breakdown, leading to increased amounts of dopamine available in
the CNS.
INCORRECT
This is not the mechanism of action for Sinemet. Monoamine oxidase (MAO) inhibitors, such as
selegiline (Eldepryl, Carbex), inhibit dopamine degradation (breakdown), thus making more dopamine
available in the CNS.
C) Sinemet causes a release of dopamine from neuronal storage sites and blocks reuptake of
dopamine.
INCORRECT
This is not the mechanism of action for Sinemet. Indirect acting dopaminergics, such as amantadine
(Symmetrel), cause the release of already present endogenous dopamine and prevent dopamine reuptake.
D) Sinemet is converted to dopamine and provides an exogenous form of dopamine replacement.
CORRECT
Sinemet, a combination of levodopa and carbidopa, provides an exogenous source of dopamine to the
CNS. Levodopa crosses the bloodbrain barrier and is converted to dopamine. Carbidopa does not
cross the bloodbrain barrier. Its role is to prevent the breakdown of levodopa in the periphery, allowing
more levodopa to cross the bloodbrain barrier. This in turn allows lower doses of levodopa to be used
and reduces the risk of side effects such as nausea and vomiting.
Correct answer(s): D
Nancy calls the healthcare provider's office and reports to the nurse that Leo has started seeing and
talking to people that have been dead for many years. In addition, he has developed jerky movements
of his head and has begun smacking his lips.
2.
How should the nurse respond?
A) Suggest that Nancy contact a psychiatrist as soon as possible.
INCORRECT
Leo’s behavior is not psychologically induced.
B) Advise Nancy to administer an extra dose of levodopa.
INCORRECT
An extra dose of levodopa will not correct these manifestations.
C) Explain that this is normal behavior as the disease progresses.
INCORRECT
These behaviors do not reflect the normal progression of Parkinson's disease.
D) Instruct Nancy to bring Leo to the healthcare provider's office now.
CORRECT
Hallucinations, delusions, and tardive dyskinesia are adverse effects of longterm levodopa therapy.
Therefore, Leo needs to be assessed by the healthcare provider.
Correct answer(s): D
Nancy brings Leo to the healthcare provider's office. After assessing Leo, the healthcare provider
informs Nancy that Leo is going to get progressively worse. Nancy starts crying and tells the healthcare
provider she just can't keep caring for Leo by herself. The healthcare provider writes a referral for home
health care.
Home Health Nurse Visit
During the initial visit with the home health nurse, Nancy expresses frustration, stating that it is getting
harder for her to understand what Leo is saying, although he can still communicate if she gives him
enough time. In addition, the nurse observes that Leo has a shuffling gait and has difficulty getting out
of the chair.
3.
In planning care, which nursing diagnosis is the priority?
A) Ineffective coping related to depression and dysfunction due to disease process.
INCORRECT
Psychosocial nursing diagnoses do not take priority over physiological problems.
B) Impaired verbal communication related to limited ability to move facial muscles.
INCORRECT
This nursing diagnosis is indicated for Leo, but it is of less priority than another diagnosis.
C) Impaired physical mobility related to muscle rigidity and motor weakness.
CORRECT
Impaired physical mobility is a priority since it impacts every aspect of Leo's ability to function safely,
and places him at risk for numerous complications of immobility.
D) Risk for constipation related to medication side effects and reduced activity.
INCORRECT [Show Less]