Adams4e Tif Ch20

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 20Question 1Type: 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: 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 sclerosis is not as common as Alzheimer's disease and Parkinson's disease.




Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-1

Question 2Type: MCSA

The patient is diagnosed with Parkinson's disease. The patient's wife asks the nurse how taking medicine 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 acetylcholine in your husband's brain."

4. "The medications will help your husband to eat and walk."

Correct Answer: 4

Rationale 1: 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 muscle wasting. Medications do not boost appetite or energy. The medications 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, dressing, and bathing. Medications do not


prevent muscle wasting. Medications do not boost appetite or energy. The medications help restore balance between dopamine, not serotonin, and acetylcholine.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 20-3

Question 3Type: MCMA

The nurse plans to teach a class about Alzheimer's disease to a caregiver's support group. What will the best plan by the nurse include?



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 difficulties are an early symptom of the disease.

Correct Answer: 1,4,5

Rationale 1: 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 contributes 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 of drugs for treating the disease.


Rationale 3: 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 contributes to the disease. Depression and Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

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 of drugs for treating the disease.



Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-6


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 safety issue. Psychosis is possible; however this is not the primary concern. Activity is important to maintain as much muscle tone as possible, and should not be limited. Thrombophlebitis is not related to Parkinson's disease.

Rationale 2: 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 to maintain as much muscle tone as possible, and should not be limited. Thrombophlebitis is not related to Parkinson's disease.



Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-2


The patient receives levodopa (Larodopa). The nurse has completed medication education and determines that learning has occurred when the patient makes which statement?

1. "I need to increase 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 yellow vegetables in my diet."

Correct Answer: 2

Rationale 1: Fiber will help prevent constipation, which is a side effect of levodopa (Larodopa). There isn't any need to check the pulse prior to the medication. There isn't any need to avoid yellow vegetables. There isn't any need to increase the daily intake of protein.





Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 20-5


The nurse prepares to administer benztropine (Cogentin) 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 102

3. Blood pressure of 88/60 mmHg

4. A temperature of 100.2°F

Correct Answer: 2

Rationale 1: 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.




Global Rationale:

Cognitive Level: AnalyzingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-9


The patient receives aspirin, a multivitamin, and an antihistamine every day. What is the best instruction by the nurse prior to administering levodopa (Larodopa)?

1. "You should not take the aspirin with your levodopa (Larodopa)."

2. "You should not take the antihistamine with your levodopa (Larodopa)."

3. "You should not take the multivitamin with your levodopa (Larodopa)."

4. "These medications are safe to take with levodopa (Larodopa)."

Correct Answer: 3

Rationale 1: Vitamin B6 will decrease the effects of levodopa (Larodopa), so the patient should not take a multivitamin while receiving levodopa (Larodopa). Vitamin B6 will decrease the effects of levodopa (Larodopa), so the patient should not a take a multivitamin while receiving levodopa (Larodopa). There isn't any contraindication to the use of aspirin and levodopa (Larodopa). There isn't any contraindication to the use of an antihistamine and levodopa (Larodopa).




Global Rationale:


Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 20-5


The elderly patient receives levodopa (Larodopa). The nurse is primarily concerned about which problem with this patient?

1. Hypertension

2. Diarrhea

3. Muscle twitching

4. Dark urine

Correct Answer: 3

Rationale 1: Muscle twitching may indicate toxicity. Constipation, not diarrhea, is a side effect of levodopa (Larodopa). Dark urine is a normal finding associated with this medication. Hypotension, not hypertension is possible with levodopa (Larodopa).




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-5



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 Answer: 3

Rationale 1: Levodopa and carbidopa (Sinemet) should be 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. There isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet).




Global Rationale:




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 help 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

Rationale 1: Medications will only slow the progression of the disease. Improvement with medication usually only lasts 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.




Global Rationale:



The nurse is teaching a class for caregivers of patients with Alzheimer's disease. The nurse determines that learning has occurred when the caregivers make which statement?

1. “There aren't any drugs that are effective in treating this disease."

2. "There are effective drugs, but they cannot be used over a long period."


3. "There are drugs that will help decrease symptoms for a little while."

4. "There are drugs that can control symptoms for many years."

Correct Answer: 3

Rationale 1: Current medications will only decrease symptoms for a little while. There are drugs that will decrease symptoms for a short period of time. Drugs will not control symptoms for many years. The drugs for treatment of Alzheimer's disease are no more dangerous than other drugs used for a long period of time.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 20-8


The patient has Parkinson's disease, 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 available."

3. "This is a common problem with Parkinson's disease."

4. "This is a result of the medications taken for control of symptoms."

Correct Answer: 3


Rationale 1: Depression is common with any chronic, debilitating disease. 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 with the patient.




Global Rationale:



The patient receives trihexyphenidyl (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: 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 of trihexyphenidyl (Artane). Anorexia is not a side effect of trihexyphenidyl (Artane).

Rationale 2: 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 of trihexyphenidyl (Artane). Anorexia is not a side effect of trihexyphenidyl (Artane).Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-5


The patient receives tacrine (Cognex) as treatment for Alzheimer's disease. Which laboratory test(s) will the nurse primarily assess?

1. Serum amylase levels

2. Complete blood count

3. Renal function tests

4. Liver function tests

Correct Answer: 4

Rationale 1: Tacrine (Cognex) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Tacrine (Cognex) does not affect renal function; so monitoring of renal function tests is not required. Tacrine (Cognex) does not affect pancreatic function; so monitoring of serum amylase levels is not required. Tacrine (Cognex) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required.


Rationale 3: Tacrine (Cognex) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Tacrine (Cognex) does not affect renal function; so monitoring of renal function tests is not required. Tacrine (Cognex) does not affect pancreatic function; so monitoring of serum amylase levels is Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

not required. Tacrine (Cognex) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-9


Which of the following degenerative diseases of the central nervous system is the most common?


2. Parkinson’s


4. Huntington’s chorea

Correct Answer: 2

Rationale 1: Parkinson’s and Alzheimer’s diseases are the most common degenerative diseases of the central nervous system.




Global Rationale:

Cognitive Level: RememberingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-1


Muscle stiffness, pill-rolling activity, and bradykinesia are symptoms most likely associated with which disorder?

1. Parkinson’s disease


3. Alzheimer’s disease


Correct Answer: 1

Rationale 1: Parkinson’s disease has several symptoms, including muscle stiffness, pill-rolling activity, and bradykinesia.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-2


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 of neurons that produce dopamine. Due to the imbalance, dopamine is provided (levodopa), and anticholinergics can be administered as well.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-3


From a pharmacology standpoint, which of the following best explains why 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, where dopamine cannot. Levodopa administration leads directly to dopamine synthesis.





Global Rationale:

Cognitive Level: RememberingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-9


Which of the following 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 oxidate cellular damage

4. Cerebral bleeding and associated hypoxia

Correct Answer: 3

Rationale 1: Alzheimer’s disease is characterized by amyloid plaques and neurofibrillary tangles that most likely occur from chronic inflammation or oxidative cellular damage.




Global Rationale:


Cognitive Level: RememberingClient Need: Psychosocial IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-5


Which of the following would most likely be an initial treatment for a patient with Alzheimer’s disease?

1. Levodopa (Larodopa)

2. Haloperidol (Haldol)

3. Benztropine mesylate (Cogentin)

4. Donepezil hydrochloride (Aricept)

Correct Answer: 4

Rationale 1: 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 some cases of Alzheimer’s disease, but due to its adverse effects is not frequently used.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Learning Outcome: 20-6


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: 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.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-8


What will the nurse include when teaching a caregivers' support group about Alzheimer's disease?




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 disease.

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:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-5


A patient is diagnosed with multiple sclerosis. What symptoms will the nurse most likely assess in this patient?



1. Muscle weaknessAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

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 manifestation 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 of multiple sclerosis.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-1


The nurse observes a patient with Parkinson's disease having difficulty controlling hand movements. What did the nurse observe in this patient?



1. Pill rolling

2. Tremor

3. Stooped posture

4. Lack of arm swing

5. Difficulty bending the armsAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Correct Answer: 1,2

Rationale 1: 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 tablet between two fingers.

Rationale 2: The hands develop a palsy-like continuous motion or shaking when at rest.

Rationale 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 the patient's ability to control hand movements.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Health Promotion and MaintenanceClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-3


A patient with Parkinson's disease is experiencing an increase in bradykinesia. What will the patient demonstrate with this manifestation?



1. Slow speech

2. Difficulty chewing

3. Shuffling the feet when walking

4. Stooped posture

5. Lack of facial expression


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 manifestation 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:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 20-3

Question 26Type: SEQThe nurse is explaining to a patient with Parkinson's disease the steps in which the neurotransmitter dopamine functions to impact motor movement. In which order will the nurse explain these steps?

Standard Text: Click and drag the options below to move them up or down.

Correct Answer: Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 20-4


The nurse, providing medications to a patient with multiple sclerosis, realizes that the goals of medication therapy for this patient include



1. modifying the progression of the disease.

2. treating acute exacerbations.

3. managing symptoms.


4. curing the disease.

5. remyelinating nerve fibers.


Rationale 1: This is a goal of pharmacologic therapy for multiple sclerosis.



Rationale 4: This is not a goal of pharmacologic therapy for multiple sclerosis.

Rationale 5: This is not a goal of pharmacologic therapy for multiple sclerosis.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 20-7


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Adams4e Tif Ch20