Central Nervous System (CNS)

NURS3523 PharmacologyCNS/PNS DisordersDate: April 9, 2014Pei-Ying Chuang, PhD, MSN, RN1

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Parkinsons Disease (PD)Alzheimers Disease (AD)Multiple Sclerosis (MS)EpilepsyMuscle Spasm and Spasticity2Topics2

3PD ExercisePatient has taken levodopa (Dopar) for Parkinsons disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

A. Another agent will be needed to manage your symptoms. B. Double the dose to see whether an effect occurs. C. It may take several months for a response to occur. D. The prescriber may need to change your drug regimen. 3

4ExerciseNurse provides teaching for a patient who is newly diagnosed with Parkinsons 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. 4

5ExercisePatient has been diagnosed with Parkinsons 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. 5

6ExercisePatient with Parkinsons 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. 6

7AD ExerciseNurse is caring for an older adult man who has Alzheimers disease (AD). The patients 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. 7

8ExerciseThe spouse of a patient who acts confused and forgetful wants to know if there is a test to determine whether the patient has Alzheimers 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 patients age, family history, serum apolipoproteins, and genetic testing. C. Magnetic resonance imaging to demonstrate brain atrophy is the definitive test to determine Alzheimers disease. D. Proposed diagnostic criteria include measures of cognitive function and the presence of one known biomarker. 8

9ExerciseAn older adult patient with Alzheimers disease is admitted to the hospital. The patients 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 patients worsening symptoms. B. Prepare the patients spouse for impending death from Alzheimers 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. 9

10ExerciseAn 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 patients symptoms have begun to worsen, and the patients 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. Correct 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 medications side effects. D. The patient must take the drug for longer than 1 year before the dose can be increased. 10

11MS ExerciseA 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. 11

12ExerciseA 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. Correct 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. 12

13ExerciseA 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 13

14ExerciseA 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?

Acetaminophen or ibuprofen Asking the provider to order a complete blood count (CBC) C. Coming to the clinic for evaluation for leukoencephalopathy D. Discontinuing the drug immediately 14

15Seizure ExerciseA 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?

Tonic-clonic Petit mal C. Myoclonic D. Atonic 15

16ExerciseA 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. 16

17ExerciseA nurse is discussing partial versus generalized seizures with a group of nursing students. Which statement by a student indicates understanding of the teaching?

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. 17

18ExerciseA 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?

Even with an accurate diagnosis of my seizures, it may be difficult to find an effective drug. 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. D. When drug levels are maintained at therapeutic levels, I can expect to be seizure free. 18

19Muscle Relaxant ExerciseA 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 D. Respiratory depression and coma 19

20ExerciseA 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. 20

21ExerciseA 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?

Preparing to support respirations Administering an antidote to baclofen C. Administering diazepam to prevent seizures D. Obtaining an electrocardiogram 21

22ExerciseA patient has localized muscle spasms after an injury. The prescriber has ordered tizanidine (Zanaflex) to alleviate the spasms. When obtaining the patients 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 hyperthermia D. Occasional use of alcohol 22