(Test Bank) Pharmacology for Nurses: A Pathophysiologic Approach

Adams, 5

Nursing

Test Bank

5th Edition

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Test Bank for Pharmacology for Nurses: A Pathophysiologic Approach, The downloadable file consists of 151 pages, and the total size of the file is 0.94 MB. Purchase now only for highly discounted price.

Author(s): Adams

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Pharm Nuero ASN TB. Adams, Pharmacology for Nurse s: A Pathophysiologic Approach , 5/E Chapter 20 Question 1 Type: MCMA Several senior citizens have asked the nurse to do a presentation on degenerative diseases. What does the nurse plan to teach as the most common degenerative diseases? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Amyotrophic lateral sclerosis 2. Multiple sclerosis 3. Alzheimer's disease 4. Huntington's chorea 5. Parkinson 's disease Correct Answer: 3,5 Rationale 1 : Amyotrophic lateral sclerosis is not as common as other diseases. Rationale 2 : Multiple sclerosis is not as common as other diseases. Rationale 3 : Alzheimer's disease is one of the most common diseases of the cen tral nervous system. Rationale 4 : Huntington's chorea is not as common as other diseases. Rationale 5 : Parkinson's disease is one of the most common diseases of the central nervous system. Global Rationale: Alzheimer's disease and Parkinson's disease are the two most common diseases of the central nervous system. Multiple sclerosis is not as common as Alzheimer's disease and Parkinson's disease. Huntington's chorea is not as common as Alzheimer's disease and Parkinson's disease. Amyotrophic lateral scleros is is not as common as Alzheimer's disease and Parkinson's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and p rocesses. Formatted: Font: 26 pt, Highlight Formatted: Font: 26 pt AACN Essentials Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Compe tencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-1 Identify the most common degenerative diseases of the central nervous system. MNL Lea rning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 282 Question 2 Type: MCSA The patient is diagnosed with Parkinson's disease. The patient's wife asks the nurse how taking medic ine will help her husband. What is the best response by the nurse? 1. "The medications will help prevent muscle wasting in your husband." 2. "The medications will boost your husband's appetite and energy." 3. "The medications will balance serotonin and ace tylcholine in your husband's brain." 4. "The medications will help your husband to eat and walk." Correct Answer: 4 Rationale 1 : Medications do not prevent muscle wasting. Rationale 2 : Medications do not boost appetite or energy. Rationale 3 : The medicat ions help restore balance between dopamine, not serotonin, and acetylcholine. Rationale 4 : The goal of pharmacotherapy for Parkinson's disease is to increase the ability of the patient to perform activities of daily living (ADLs) such as walking, eating, d ressing, and bathing. Global Rationale: The goal of pharmacotherapy for Parkinson's disease is to increase the ability of the patient to perform activities of daily living (ADLs) such as walking, eating, dressing, and bathing. Medications do not prevent m uscle wasting. Medications do not boost appetite or energy. The medications help restore balance between dopamine, not serotonin, and acetylcholine. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parent eral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: I ntegration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholine in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 283 Question 3 Type: MCMA The nurse plans to teach a class about Alzheimer's disease to a caregiv er's support group. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Depression and aggressive behavior are common with the disease. 2. Alzheimer's disease accounts for about 50% of all dementias. 3. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 4. Chronic inflammation of the brain may be a cause of the disease. 5. Memory difficult ies are an early symptom of the disease. Correct Answer: 1,4,5 Rationale 1 : Depression and aggressive behavior are common symptoms of the disease. Rationale 2 : Alzheimer's disease accounts for about 70% of all dementias. Rationale 3 : The acetylcholineste rase inhibitors, not the glutamergic inhibitors, are the most widely used class of drugs for treating the disease. Rationale 4 : It is suspected that chronic inflammation and excess free radicals may cause neuron damage and contribute to the disease. Ratio nale 5 : Memory difficulties are an early symptom of Alzheimer's disease. Global Rationale: Memory difficulties are an early symptom of Alzheimer's disease. It is suspected that chronic inflammation and excess free radicals may cause neuron damage and cont ribute to the disease. Depression and aggressive behavior are common symptoms of the disease. Alzheimer's disease accounts for about 70% of all dementias. The acetylcholinesterase inhibitors, not the glutamergic inhibitors, are the most widely used class o f drugs for treating the disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Compete ncies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome : 20-5 Describe symptoms of Alzheimer’s disease and explain theories about why these symptoms develop. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287 Question 4 Type: MCSA The nurse plans care for a patient with Parkinson's disease. What will the best plan by the nurse include? 1. Monitor the patient for the ability to chew and swallow. 2. Check peripheral circulation for thrombophlebitis. 3. Monitor the patient for psychotic symptoms. 4. Limit exercise to decrease the possibility of fractures. Correct Answer: 1 Rationale 1 : In Parkinson's disease, muscle function is lost, and the patient's ability to chew and swallow to prevent aspiration becomes a safet y issue. Rationale 2 : Thrombophlebitis is not related to Parkinson's disease. Rationale 3 : Psychosis is possible; however , this is not the primary concern. Rationale 4 : Activity is important to maintain as much muscle tone as possible and should not be l imited. Global Rationale: In Parkinson's disease, muscle function is lost, and the patient's ability to chew and swallow to prevent aspiration becomes a safety issue. Psychosis is possible; however , this is not the primary concern. Activity is important t o maintain as much muscle tone as possible and should not be limited. Thrombophlebitis is not related to Parkinson's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A .1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing an d other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Park inson’s disease. Page Number: 282 Question 5 Type: MCSA The patient receives levodopa -carbidopa (Sinemet ). The nurse has completed medication education and determines that learning has occurred when the patient makes which statement? 1. "I need to increa se my daily intake of protein." 2. "I must increase the fiber in my diet." 3. "I need to check my pulse before taking the medication." 4. "I must avoid carbohydrates in my diet." Correct Answer: 2 Rationale 1 : There isn't any need to increase the daily int ake of protein , and a high protein diet may interfere with absorption . Rationale 2 : Fiber will help prevent constipation, which is a side effect of levodopa -carbidopa (Sinemet ). Rationale 3 There isn't any need to check the pulse prior to the medication. Rationale 4 : There isn't any need to avoid carbohydrates . Global Rationale: Fiber will help prevent constipation, which is a side effect of levodopa -carbidopa (Sinemet). There isn't any need to check the pulse prior to the medication. There isn't any nee d to avoid carbohydrates. There isn't any need to increase the daily intake of protein. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care pro vided and needed at each transition in care. AACN Essentials Competencies: IX.8 Imple ment evidence -based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-4 Describe the nurse’s role in the pharmacologic management of Parkinson’s dis ease and Alzheimer’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 284 Question 6 Type: MCSA The nurse prepares to administer benztropine (Cogent in) to the patient. The nurse holds the dose and notifies the physician based on which assessment finding? 1. A respiratory rate of 14 2. A pulse of 112 3. Blood pressure of 88/60 mmHg 4. A temperature of 100.2°F Correct Answer: 2 Rationale 1 : A respirator y rate of 14 is a normal finding. Rationale 2 : Benztropine (Cogentin) can cause tachycardia. Rationale 3 : Initial hypotension may occur, but this is uncommon. Rationale 4 : An elevated temperature is not related to benztropine (Cogentin). Global Rational e: Benztropine (Cogentin) can cause tachycardia. Initial hypotension may occur, but this is uncommon. An elevated temperature is not related to benztropine (Cogentin). A respiratory rate of 14 is a normal finding. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflect s an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Inte gration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanis ms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 288 Question 7 Type: MCSA The patient receives aspirin, a multivitamin, and an antihistamine every day. What is the best instruction by the nurse prior to administering levodopa, carbidopa , and entacapone (Stalevo) ? 1. "You should not take the aspirin with your levodopa, carbidopa , and entacapone (Stal evo)." 2. "You should not take the antihistamine with your levodopa, carbidopa , and entacapone (Stalevo) ." 3. "You should not take the multivitamin with your levodopa, carbidopa , and entacapone (Stalevo) ." 4. "These medications are safe to take with levodo pa, carbidopa , and entacapone (Stalevo) ." Correct Answer: 3 Rationale 1 : There isn't any contraindication to the use of aspirin and levodopa, carbidopa , and entacapone (Stalevo) . Rationale 2 : There isn't any contraindication to the use of an antihistamine and levodopa, carbidopa . and entacapone (Stalevo) . Rationale 3 : Vitamin B 6 will decrease the effects of levodopa, carbidopa , and entacapone (Stalevo) , so the patient should not take a multivitamin while receiving levodopa, carbidopa , and entacapone (Stale vo). Rationale 4 : One of these medications will decrease the effects of levodopa, carbidopa , and entacapone (Stalevo). Global Rationale: Vitamin B 6 will decrease the effects of levodopa, carbidopa , and entacapone (Stalevo), so the patient should not take a multivitamin while receiving levodopa, carbidopa , and entacapone (Stalevo). There isn't any contraindication to the use of aspirin and levodopa, carbidopa , and entacapone (Stalevo). There isn't any contraindication to the use of an antihistamine and levo dopa, carbidopa , and entacapone (Stalevo). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across li fespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-9 For each of the drug classes l isted in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacothera py of Parkinson’s disease. Page Number: 286 Question 8 Type: MCSA An older adult receives levodopa, carbidopa , and entacapone (Stalevo) . The nurse is primarily concerned about which problem with this patient? 1. Hypertension 2. Diarrhea 3. Muscle twitchi ng 4. Dark urine Correct Answer: 3 Rationale 1 : Hypotension, not hypertension , is possible with levodopa, carbidopa , and entacapone (Stalevo) . Rationale 2 : Constipation, not diarrhea, is a side effect of levodopa, carbidopa , and entacapone (Stalevo) . Rationale 3 : Muscle twitching may indicate toxicity. Rationale 4 : Dark urine is a normal finding associated with this medication. Global Rationale: Muscle twitching may indicate toxicity. Constipation, not diarrhea, is a side effect of levodopa, carbidopa , and entacapone (Stalevo). Dark urine is a normal finding associated with this medication. Hypotension, not hypertension , is possible with levodopa, carbidopa , and entacapone (Stalevo). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human gr owth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nurs ing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, an d important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 286 Question 9 Type: MCSA The patient receives levodopa and carbidopa (Sinemet ). What will the best teaching by the nurse include as relates to this medication? 1. Avoid drinking caffeinated beverages. 2. Take the medication with meals. 3. Take the medication on an empty stomach. 4. Take the medication with a protein food. Correct A nswer: 3 Rationale 1 : There isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet). Rationale 2 : Levodopa and carbidopa (Sinemet) should not be taken with meals; this will decrease absorption. Rationale 3 : Levodopa and ca rbidopa (Sinemet) should be taken on an empty stomach for better absorption. Rationale 4 : Levodopa and carbidopa (Sinemet) should not be taken with a protein food; this will decrease absorption. Global Rationale: Levodopa and carbidopa (Sinemet) should b e taken on an empty stomach for better absorption. Levodopa and carbidopa (Sinemet) should not be taken with meals; this will decrease absorption. Levodopa and carbidopa (Sinemet) should not be taken with a protein food; this will decrease absorption. Ther e isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient -centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, m edical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts : Nursing Process: Implementation Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacother apy, safe drug administration, and client education. Page Number: 295 Question 10 Type: MCSA The patient has been diagnosed with Alzheimer's disease. What is the best medication education the nurse gives to the patient's husband? 1. "The medication may h elp her symptoms for a little while." 2. "The medication has serious side effects if used for a long time." 3. "Her symptoms will improve as long as she takes the medication." 4. "Her symptoms should begin improving in a few days." Correct Answer: 1 Ration ale 1 : Medications will only slow the progression of the disease. Rationale 2 : The medications are usually not used over a long period of time. Rationale 3 : Improvement with medication usually only lasts a matter of months. Rationale 4 : It takes a minimu m of 1 to 4 weeks to begin to see improvement. Global Rationale: Medications will only slow the progression of the disease. Improvement with medication usually lasts only a matter of months. It takes a minimum of 1 to 4 weeks to begin to see improvement. The medications do not have serious side effects and are usually not used over a long period of time. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demon strate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-5 Describe symptoms of Alzheimer’s disease and explain theories about why these symptoms develop. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 11 Type: MCSA The nurse is teaching a class for caregivers of patients with Alzheimer's disease. The nurse determines that learning has occurred when the care givers make which statement? 1. “Antianxiety drugs are not effective when the patient’s anxiety is due to Alzheimer’s disease ." 2. "No new drugs are being developed for Alzheimer’s disease.” 3. "Some health care providers think vitamin E and nonsteroidal a nti-inflammatory medications may help control Alzheimer’s symptoms ." 4. "All of the drugs used for Alzheimer’s disease are from the same drug class. ." Correct Answer: 3 Rationale 1 : There are antianxiety drugs that will treat anxiety associated with Alzhei mer’s disease. Rationale 2 : New drugs are being used and are in development. Rationale 3 : Vitamin E and NSAIDS may be effective in slowing progression of Alzheimer’s disease. Rationale 4 : Drugs to treat Alzheimer’s disease come from different classes. Global Rationale: Vitamin E and NSAIDS may be effective in slowing progression of Alzheimer’s disease. There are antianxiety drugs that will treat anxiety associated with Alzheimer’s disease. New drugs are being used and are in development. Drugs to treat Alz heimer’s disease come from different classes. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and proces ses. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-6 Explain the goals of phar macotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 288 Question 12 Type: MCSA The patient has multiple sclerosis and develops depression. What is the best education the nurse can give the patient's family? 1. "Anytime someone has a brain disease, depression will result." 2. "Depression is very easy to treat with medications we have ava ilable." 3. "This is a common problem with chronic debilitating disease s but requires close monitoring ." 4. "This is a result of the medications taken for control of symptoms." Correct Answer: 3 Rationale 1 : Patients with a neurological illness do not alwa ys develop depression. Rationale 2 : Depression is treatable with medications, but this does not help the family to understand what is happening with the patient. Rationale 3 : Depression is common with any chronic, debilitating disease , but may also be ass ociated with medications. Close monitoring is required. Rationale 4 : The medications are not the cause of the depression. Global Rationale: Depression is common with any chronic, debilitating disease , but may also be associated with medications. Close mon itoring is required. . The medications are not the cause of the depression. Patients with a neurological illness do not always develop depression. Depression is treatable with medications, but this does not help the family to understand what is happening wi th the patient. Cognitive Level: Applying Client Need: Psychological Integrity Client Need Sub: QSEN Competencies: I.B.3 Provide patient -centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmaco therapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number : 295 Question 13 Type: MCSA The patient receives trih exyphenidyl (Artane) for Parkinson's disease. Which assessment data will the nurse report to the physician? 1. Dry mouth 2. Anorexia 3. Hypertension 4. Urinary retention Correct Answer: 4 Rationale 1 : Dry mouth is a common side effect of trihexyphenidyl (A rtane) that does not need reporting. Rationale 2 : Anorexia is not a side effect of trihexyphenidyl (Artane). Rationale 3 : Hypertension is not a side effect of trihexyphenidyl (Artane). Rationale 4 : Urinary retention is a serious side effect that must be reported to the physician. Global Rationale: Urinary retention is a serious side effect that must be reported to the physician. Dry mouth is a common side effect of trihexyphenidyl (Artane) that does not need reporting. Hypertension is not a side effect o f trihexyphenidyl (Artane). Anorexia is not a side effect of trihexyphenidyl (Artane). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care pro vided and needed at each transition in care. AACN Essentials Competencies: IX.8 Imple ment evidence -based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-4 Describe the nurse’s role in the pharmacologic management of Parkinson’s dise ase and Alzheimer’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 287 Question 14 Type: MCSA The patient receives donepezil (Aricept) as treatmen t for Alzheimer's disease. Which laboratory test(s) will the nurse primarily assess? 1. Serum amylase levels 2. Complete blood count 3. Pulmonary function tests 4. Liver function tests Correct Answer: 4 Rationale 1 : Donepezil (Aricept) does not affect panc reatic function; so monitoring of serum amylase levels is not required. Rationale 2 : Donepezil (Aricept) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required. Rationale 3 : Donepezil (Aricept) does not affect pulmonary function; so monitoring of pulmonary function tests is not required. Rationale 4 : Donepezil (Aricept) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Global Rationale: Donepezil (Aricept) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Donepezil (Aricept) does not affect pulmonary function; so monitoring of pulmonary function tests is not required. Donepezil (Aricept) does not affect pancreatic function; so monitoring of serum amylase levels is not required. Donepezil (Aricept) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required. Cognitive Level: Analyzing Client Need: Physiological Integ rity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowled ge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, prim ary action, and important adverse effects. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 15 Type: MCSA Which degenerative disease of the cent ral nervous system is the most common? 1. Amyotrophic lateral sclerosis (ALS) 2. Alzheimer’s 3. Multiple sclerosis (MS) 4. Huntington’s chorea Correct Answer: 2 Rationale 1 : ALS is not the most common disease. Rationale 2 : Parkinson’s and Alzheimer’s disea ses are the most common degenerative diseases of the central nervous system. Rationale 3 : MS is not the most common disease. Rationale 4 : Huntington’s chorea is not the most common disease. Global Rationale: Parkinson’s and Alzheimer’s diseases are the m ost common degenerative diseases of the central nervous system. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and pr ocesses. AACN Essentials Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Compet encies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-1 Identify the most common degenerative diseases of the central nervous system. MNL Le arning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 282 Question 16 Type: MCSA Heat sensitivity , spascity , and visual impairment are symptoms most likely associated with which di sorder? 1. Parkinson’s disease 2. Multiple sclerosis (MS) 3. Alzheimer’s disease (AD) 4. Amyotrophic lateral sclerosis (ALS) Correct Answer: 2 Rationale 1 : Parkinson’s disease has several symptoms, including muscle stiffness, pill -rolling activity, and bradykinesia. Rationale 2 : Patients with multiple sclerosis often have fatigue, heat -sensitivity, spasticity, and visual impairment. Rationale 3 : Patients with AD have memory issues. Rationale 4 : Patient with ALS have progressive muscle weakness which event ually involves the respiratory muscles. Global Rationale: Patients with multiple sclerosis often have fatigue, heat -sensitivity, spasticity, and visual impairment. Parkinson’s disease has several symptoms, including muscle stiffness, pill -rolling activity, and bradykinesia. Patients with AD have memory issues. Patient with ALS have progressive muscle weakness which eventually involves the respiratory muscles. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological A daptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integr ation of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-7 Describe the signs and basis for development of multiple sclerosis symptoms . MNL Learning Outcome: 3.3.3 Examine etiology , pathophysiology, clinical manifestations, and pharmacotherapy of multiple sclerosis. Page Number: 282 Question 17 Type: MCSA Pharmacotherapy for Parkinson’s disease is intended to 1. increase the amount of dopamine and reduce the amount of acetylcholine . 2. increase the amount of dopamine and acetylcholine. 3. reduce the amount of dopamine and increase the amount of acetylcholine. 4. reduce the amount of dopamine and acetylcholine. Correct Answer: 1 Rationale 1 : Parkinson’s disease results in the death o f neurons that produce dopamine. The balance is restored by increasing the levels of dopamine or by inhibiting the excitatory actions of acetylcholine. Rationale 2 : Parkinson’s disease results in the death of neurons that produce dopamine. Due to the imba lance, dopamine is provided (levodopa), and anticholinergics can be administered as well. Acetylcholine is not increased. Rationale 3 : Dopamine is not reduced. Rationale 4 : Dopamine is not reduced. Global Rationale: Parkinson’s disease results in the dea th of neurons that produce dopamine. The balance is restored by increasing the levels of dopamine or by inhibiting the excitatory actions of acetylcholine. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacologica l and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge an d Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholi ne in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 284 Question 18 Type: MCSA From a pharmacology standpoint, which statement best explains wh y levodopa is superior to dopamine? 1. It crosses the blood –brain barrier. 2. It has fewer adverse effects. 3. It has less risk for addiction. 4. It can be administered orally. Correct Answer: 1 Rationale 1 : Levodopa can cross the blood –brain barrier, but dopamine cannot. Levodopa administration leads directly to dopamine synthesis. Rationale 2 : Levodopa does not have fewer side effects. Rationale 3 : There is no risk for addiction from either substance. Rationale 4 : Route of administration is not a factor. Global Rationale: Levodopa can cross the blood –brain barrier, but dopamine cannot. Levodopa administration leads directly to dopamine synthesis. Levodopa does not have fewer side effects. There is no risk for addiction from either substance. Route of admi nistration is not a factor. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essen tials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholine in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of P arkinson’s disease. Page Number: 284 Question 19 Type: MCSA Which statement best explains why structural changes occur within the brains of people with Alzheimer’s disease? 1. Increased acetylcholine levels 2. Increases in blood pressure and cholesterol levels 3. Chronic inflammation and oxidative cellular damage 4. Cerebral bleeding and associated hypoxia Correct Answer: 3 Rationale 1 : There is no increase of acetylcholine levels. Rationale 2 : Blood pressure and cholesterol levels are not implicated. Rationale 3 : Alzheimer’s disease is characterized by amyloid plaques and neurofibrillary tangles that most likely occur from chronic inflammation or oxidative cellular damage. Rationale 4 : Cerebral bleeding and associated hypoxia are not implicated. Global Rationale: Alzheimer’s disease is characterized by amyloid plaques and neurofibrillary tangles that most likely occur from chronic inflammation or oxidative cellular damage. There is no increase of acetylcholine levels. Blood pressure and cholesterol level s are not implicated. Cerebral bleeding and associated hypoxia are not implicated. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient -centere d care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursi ng Process: Assessment Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe d rug administration, and client education. Page Number: 287 Question 20 Type: MCSA Which drug would most likely be an initial treatment for a patient with Alzheimer’s disease? 1. Levodopa (Larodopa) 2. Haloperidol (Haldol) 3. Benztropine mesylate (Cogenti n) 4. Donepezil hydrochloride (Aricept) Correct Answer: 4 Rationale 1 : Levodopa (Larodopa) is used for Parkinson’s disease. Rationale 2 : Haloperidol (Haldol) can be used in some cases of Alzheimer’s disease, but due to its adverse effects it is not freque ntly used. Rationale 3 : Benztropine mesylate (Cogentin) is used for Parkinson’s disease. Rationale 4 : Donepezil hydrochloride (Aricept) is an acetylcholinesterase inhibitor and the most frequently used drug for Alzheimer’s disease. Global Rationale: Donepezil hydrochloride (Aricept) is an acetylcholinesterase inhibitor and the most frequently used drug for Alzheimer’s disease. Levodopa (Larodopa) and benztropine mesylate (Cogentin) are used for Parkinson’s disease. Haloperidol (Haldol) can be used in som e cases of Alzheimer’s disease, but due to its adverse effects it is not frequently used. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate kn owledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing ma nagement across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Lear ning Outcome: 20-6 Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 21 Type: MCSA Which statement is the most accurate regarding acetylcholinesterase inhibitors when used for Alzheimer's disease? 1. They reverse the structural damage within the brain. 2. They increase synthesis of acetylcholine. 3. They increase enzymatic breakdown, leading to increased neuronal production. 4. They intensify the effect of acetylcholine at the receptor. Correct Answer: 4 Rationale 1 : Currently no drugs can reverse the structural damages associated with Alzheimer’s d isease. Rationale 2 : They do not increase acetylcholine synthesis or enzymatic breakdown. Rationale 3 : They do not increase enzymatic breakdown. Rationale 4 : Acetylcholinesterase inhibitors intensify the effect of acetylcholine at the receptor. Global Rationale: Acetylcholinesterase inhibitors intensify the effect of acetylcholine at the receptor. They do not increase acetylcholine synthesis or enzymatic breakdown. Currently no drugs can reverse the structural damages associated with Alzheimer’s disease . Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Im plement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare set tings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287 Question 22 Type: MCMA What will the nurse include when teaching a care givers' support group about Alzheimer's disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 2. Depression and aggressive behavior are common with the disease. 3. Memory difficulties are an early symptom of the disease. 4. Chronic inflammation of the brain can be a cause of the disease. 5. Pharmacologic therapies are given to help improve memory in Alzheimer's disease. Correct Answer: 2,3,4,5 Rationale 1 : Glutamergic inhibitors are not the most common class of drugs for treating Alzheimer's disease. Rationale 2 : Depression and aggressive behavior are common symptoms of the dise ase. Rationale 3 : Memory difficulties are an early symptom of Alzheimer's disease. Rationale 4 : It is suspected that chronic inflammation and excess free radicals can cause neuron damage and contribute to the disease. Rationale 5 : The acetylcholinesterase inhibitors are the most widely used class of drugs for treating the disease. These drugs work by increasing the availability of acetylcholine. Acetylcholine is involved in cognition, memory, and learning. Global Rationale: Depression and aggressive behavio r are common symptoms of the disease. Memory difficulties are an early symptom of Alzheimer's disease. It is suspected that chronic inflammation and excess free radicals can cause neuron damage and contribute to the disease. The acetylcholinesterase inhibi tors are the most widely used class of drugs for treating the disease. These drugs work by increasing the availability of acetylcholine. Acetylcholine is involved in cognition, memory, and learning. Glutamergic inhibitors are not the most common class of d rugs for treating Alzheimer's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AAC N Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across l ifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287–288 Question 23 Type: MCMA A patient is diagnosed with multiple sclerosis. What symptoms will the nurse most likely assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Muscle weakness 2. Difficulty maintaining balance 3. Atrophy of the hands and legs 4. Slow shuffling gait 5. Progressive chorea Correct Answer: 1,2 Rationale 1 : Muscle weakness is a manifestation of multiple sclerosis. Rationale 2 : Difficulty maintaining balance is a manifes tation of multiple sclerosis. Rationale 3 : Atrophy of the hands and legs is not a manifestation of multiple sclerosis. Rationale 4 : A slow shuffling gait is not a manifestation of multiple sclerosis. Rationale 5 : Progressive chorea is not a manifestation o f multiple sclerosis. Global Rationale: Muscle weakness and difficulty maintaining balance are manifestations of multiple sclerosis. Atrophy of the hands and legs is not a manifestation of multiple sclerosis. A slow shuffling gait is not a manifestation of multiple sclerosis. Progressive chorea is not a manifestation of multiple sclerosis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scient ific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-7 Describe the signs and basis for development of multiple sclerosis symptoms. MNL Learning Outcome: 3.3.3 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of multipl e sclerosis. Page Number: 291 Question 24 Type: MCMA The nurse observes a patient with Parkinson's disease having difficulty controlling hand movements. What did the nurse observe in this patient? Note: Credit will be given only if all correct choices a nd no incorrect choices are selected. Standard Text: Select all that apply. 1. Pill rolling 2. Tremor 3. Stooped posture 4. Lack of arm swing 5. Difficulty bending the arms Correct Answer: 1,2 Rationale 1 : Pill rolling is a common behavior in progressive P arkinson's disease in which the patient rubs the thumb and forefinger together in a circular motion resembling the motion of rolling a tablet between two fingers. Rationale 2 : The hands develop a palsy -like continuous motion or shaking when at rest. Ration ale 3 : A stooped posture would not influence the patient's ability to control hand movements. Rationale 4 : A lack of arm swing does not influence the patient's ability to control hand movements. Rationale 5 : Difficulty bending the arms does not influence t he patient's ability to control hand movements. Global Rationale: Pill rolling is a common behavior in progressive Parkinson's disease in which the patient rubs the thumb and forefinger together in a circular motion resembling the motion of rolling a table t between two fingers. The hands develop a palsy -like continuous motion or shaking when at rest. A stooped posture, lack of arm swing, and difficulty bending the arms would not influence the patient's ability to control hand movements. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theo ry, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 282 Question 25 Type: MCMA A patient with Parkinson's disease is experiencing an increase in bradykinesia. What will the patient demonstrate with this manifestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walki ng 4. Stooped posture 5. Lack of facial expression Correct Answer: 1,2,3 Rationale 1 : Slow speech is a manifestation of bradykinesia. Rationale 2 : Difficulty chewing is a manifestation of bradykinesia. Rationale 3 : Shuffling the feet when walking is a mani festation of bradykinesia. Rationale 4 : Stooped posture is not a manifestation of bradykinesia. Rationale 5 : Lack of facial expression is not a manifestation of bradykinesia. Global Rationale: Slow speech, difficulty chewing, and a shuffling gait are manif estations of bradykinesia. Stooped posture and lack of facial expression are not manifestations of bradykinesia. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrat e knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disci plines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s dis ease. Page Number: 282 Question 26 Type: MCMA A patient with progressive multiple sclerosis will be started on alemtuzumab (Lemtrada). The nurse should ensure which interventions are completed prior to initiating this therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A varicella zoster vaccination is scheduled. 2. A complete blood count (CBC) has been drawn. 3. A serum creatinine has been drawn. 4. A skin exam has been completed. 5. An indwelling urinary catheter is placed. Correct Answer: 1,2,3,4 Rationale 1 : The patient should have a varicella zoster vaccination at least 6 weeks prior to beginning this therapy. Rationale 2 : A CBC should be obtained prior to treatment. Rationale 3 : A serum creatinine should be obtained prior to treatment. Rationale 4 : A skin examination is necessary prior to treatment to monitor for melanoma. Rationale 5 : There is no reason to place an indwelling urinary catheter. Global Rat ionale: The patient should have a varicella zoster vaccination at least 6 weeks prior to beginning this therapy. A CBC and a serum creatinine should be obtained prior to treatment. A skin examination is necessary prior to treatment to monitor for melanoma. There is no reason to place an indwelling urinary catheter. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific meth ods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient -centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health -illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning