A client recently diagnosed with Parkinson's disease receives a new prescription for carbidopa-levodopa, a dopaminergic drug. To reduce the client's risk for injury, which instruction should the nurse provide?

Obtain a hospital bed with side rails and an over-bed trapeze.

Place small rugs on smooth surfaces such as tile or wood floors.

Use caution when changing from a sitting to a standing position.

Ambulate using a four point cane or a walker with wheels.

Answer and Explanation

The Correct Answer is C

Choice A reason: Obtaining a hospital bed with side rails and an over-bed trapeze is not a necessary instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. A hospital bed may be helpful for patients with severe mobility impairment or bedridden status, but not for all patients with Parkinson's disease.

Choice B reason: Placing small rugs on smooth surfaces such as tile or wood floors is an incorrect instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. Small rugs can pose a tripping hazard and increase the risk of falls, especially for patients with impaired balance or coordination.

Choice C reason: Using caution when changing from a sitting to a standing position is a correct instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. Carbidopa-levodopa can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. This can cause dizziness, fainting, or falls. Patients should change positions slowly and carefully, and use support if needed.

Choice D reason: Ambulating using a four point cane or a walker with wheels is not a specific instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. The type of assistive device that is appropriate for each patient depends on their individual needs and abilities. Some patients may not need any device, while others may need different types of canes, walkers, or wheelchairs.

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Correct Answer is []

Explanation

Potential Condition:Methemoglobinemia

Methemoglobinemia is a condition in which the hemoglobin in the blood is unable to bind oxygen effectively, resulting in tissue hypoxia. It can be caused by exposure to certain drugs or chemicals, such as nitrates, benzocaine, or dapsone. Some symptoms of methemoglobinemia include cyanosis, headache, fatigue, dyspnea, and tachycardia. In severe cases, it can lead to seizures, coma, and death.

Actions to Take:

Draw blood for a complete blood count
administer methylene blue

A complete blood count (CBC) can help diagnose methemoglobinemia by measuring the level of methemoglobin in the blood. A normal level is less than 1%, while a level above 15% can cause symptoms. A level above 30% can be life-threatening. Methylene blue is a medication that can reduce methemoglobin back to normal hemoglobin and restore oxygen delivery to the tissues. It is given intravenously at a dose of 1-2 mg/kg over 5 minutes.

Parameters to Monitor:

Methemoglobin level
heart rate and rhythm

The methemoglobin level is the most important parameter to monitor in methemoglobinemia, as it indicates the severity of the condition and the response to treatment. The goal is to lower the level below 10% or until symptoms resolve. The heart rate and rhythm are also important to monitor, as methemoglobinemia can cause tachycardia and dysrhythmias due to hypoxia and acidosis. The goal is to maintain a normal sinus rhythm and a heart rate within the normal range for the client’s age and condition.

A. Seizures B. Nausea C. Orthostatic hypotension D. Sedation E. Euphoria F. Itching G. Urinary retention

Correct Answer is ["B","C","D"]

Explanation

Choice A reason:

Seizures are not a common side effect of morphine, and they are unlikely to contribute to this client's fall risk. Seizures can occur in rare cases of morphine overdose, hypersensitivity, or withdrawal, but they are not expected in a client who is receiving a continuous and monitored dose of morphine. Therefore, choice A is incorrect.

Choice B reason:

Nausea is a common side effect of morphine, and it can contribute to this client's fall risk. Nausea can cause the client to feel dizzy, weak, or unsteady, and it can also impair the client's appetite and hydration status. Nausea can also trigger vomiting, which can increase the risk of aspiration or dehydration. Therefore, choice B is correct.

Choice C reason:

Orthostatic hypotension is a common side effect of morphine, and it can contribute to this client's fall risk. Orthostatic hypotension is a sudden drop in blood pressure that occurs when the client changes position from lying to sitting or standing. Orthostatic hypotension can cause the client to feel faint, dizzy, or lightheaded, and it can also increase the risk of syncope (loss of consciousness) or cardiac arrhythmias. Therefore, choice C is correct.

Choice D reason:

Sedation is a common side effect of morphine, and it can contribute to this client's fall risk. Sedation can cause the client to feel sleepy, drowsy, or confused, and it can also impair the client's alertness and coordination. Sedation can also reduce the client's ability to respond to stimuli or alarms, and it can increase the risk of respiratory depression or coma. Therefore, choice D is correct.

Choice E reason:

Euphoria is a common side effect of morphine, and it can contribute to this client's fall risk. Euphoria is a feeling of intense happiness or well-being that is induced by the activation of opioid receptors in the brain. Euphoria can cause the client to feel overconfident, impulsive, or reckless, and it can also impair the client's judgment and perception of reality. Euphoria can also increase the risk of psychological dependence or addiction. Therefore, choice E is correct.

Choice F reason:

Itching is a common side effect of morphine, and it can contribute to this client's fall risk. Itching is caused by the release of histamine from mast cells in response to the stimulation of opioid receptors in the skin. Itching can cause the client to scratch excessively, which can damage the skin and increase the risk of infection. Itching can also distract the client from other sensations or warnings, and it can reduce the client's comfort and quality of life. Therefore, choice F is correct.

Choice G reason:

Urinary retention is a common side effect of morphine, and it can contribute to this client's fall risk. Urinary retention is the inability to empty the bladder completely or voluntarily due to the inhibition of bladder contraction by opioid receptors in the urinary tract. Urinary retention can cause the client to feel pain, discomfort, or urgency in the lower abdomen, and it can also increase the risk of urinary tract infection or kidney damage. Urinary retention can also prompt the client to attempt to get out of bed without assistance or supervision, which can increase the risk of falling. Therefore, choice G is correct.

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A client recently diagnosed with Parkinson's disease receives a new prescription for carbidopa-levodopa, a dopaminergic drug. To reduce the client's risk for injury, which instruction should the nurse provide?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data Exhibits Review H and P, and nurse’s note. Identify from the choices below which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

Correct Answer is []

Explanation

Patient Data Exhibits The charge nurse places a fall precautions sign on the client's door. What side effects of morphine could contribute to this client's fall risk? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

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