A nurse is caring for a 68-year-old male client on a medical-surgical unit.

A nurse is providing client teaching on the newly prescribed medication. Which of the following statements made by the client indicate an understanding of the teaching?

“I might have low blood pressure when I get out of bed.”

“I may experience a return of my symptoms in between doses of my medication.”

“I should eat a diet high in protein.”

“I should take this medication on an empty stomach.”

“My symptoms should resolve in a couple of days after starting this medication.”

Answer and Explanation

Correct Answer : A,B,D

Choice A rationale: Orthostatic hypotension is a common side effect of carbidopa-levodopa due to its vasodilatory effects and impact on the autonomic nervous system. Patients may experience dizziness or lightheadedness when standing up quickly, caused by a drop in blood pressure. Normal blood pressure ranges around 120/80 mm Hg, and sudden decreases can lead to falls, especially in Parkinson’s disease patients who already have balance issues.

Choice B rationale: Wearing-off phenomenon is common with carbidopa-levodopa therapy. This occurs when medication effects diminish before the next dose, causing symptom recurrence such as bradykinesia and tremor. The medication has a relatively short half-life, and patients often report fluctuation in symptom control, especially as disease progresses. Understanding this helps manage expectations and medication timing.

Choice C rationale: High-protein diets can interfere with the absorption of levodopa, as dietary amino acids compete with levodopa for transport across the intestinal mucosa and the blood-brain barrier. Patients are typically advised to moderate protein intake during dosing times to maximize medication effectiveness, rather than increase protein consumption.

Choice D rationale: Levodopa is best absorbed on an empty stomach because food, particularly proteins, delays gastric emptying and competes with levodopa for absorption. Taking the medication 30 minutes before or 1 hour after meals improves bioavailability and symptom control. This knowledge helps optimize medication efficacy.

Choice E rationale: Parkinson’s symptoms usually do not resolve within days of starting carbidopa-levodopa. It often takes weeks to months for optimal symptom control and dose adjustments. Patients should understand that this medication manages symptoms but is not a cure and requires ongoing therapy.

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Correct Answer is C

Explanation

Choice A rationale

Administering diclofenac at bedtime does not specifically mitigate its gastrointestinal side effects. NSAIDs like diclofenac can cause gastric irritation and ulceration by inhibiting cyclooxygenase-1 (COX-1), which produces prostaglandins essential for gastric mucosal protection. Time of administration is less critical than co-administration with food or protective agents.

Choice B rationale

Antacids can interfere with the absorption of some medications, but specifically for diclofenac, avoiding concomitant administration is not a standard recommendation to mitigate adverse effects. In fact, antacids can sometimes be used to alleviate gastric distress associated with NSAIDs, although they do not prevent direct mucosal damage.

Choice C rationale

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric mucosa, potentially causing dyspepsia, nausea, and ulceration. Administering the medication with food or milk helps to buffer the gastric acid and physically protect the stomach lining, thereby reducing the direct irritant effect on the gastrointestinal tract and enhancing tolerability.

Choice D rationale

Diclofenac is typically formulated as an enteric-coated tablet or delayed-release capsule to protect the stomach from irritation and ensure targeted drug release in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach, increasing gastric irritation, and potentially reducing therapeutic efficacy.

A. Aspartate aminotransferase (AST). B. Fibrin split products. C. BUN. D. Glucose.

Correct Answer is D

Explanation

Choice A rationale

Aspartate aminotransferase (AST) is an enzyme primarily found in the liver, heart, and muscle. Elevated levels can indicate hepatocellular damage or cardiac muscle injury. While some medications can affect liver function, AST is not a primary monitoring parameter for methylprednisolone, which is a corticosteroid, unless specific hepatotoxicity is suspected or pre-existing liver conditions exist. Normal AST levels are typically 10-40 U/L.

Choice B rationale

Fibrin split products (FSPs) are indicators of fibrinolysis, the breakdown of fibrin clots. Elevated FSPs suggest active clotting and subsequent clot degradation, often seen in disseminated intravascular coagulation (DIC). Methylprednisolone, a corticosteroid, does not directly impact fibrinolysis or coagulation to warrant routine monitoring of FSPs as a primary concern. This test is not routinely indicated.

Choice C rationale

Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from the waste product urea. Elevated BUN can indicate kidney dysfunction or dehydration. While corticosteroids can influence fluid balance, BUN is not a specific or primary laboratory value monitored for the direct effects of methylprednisolone therapy unless a pre-existing renal impairment is present. Normal BUN levels are typically 7-20 mg/dL.

Choice D rationale

Methylprednisolone, a glucocorticoid, significantly impacts carbohydrate metabolism by promoting gluconeogenesis and glycogenolysis, leading to increased blood glucose levels. This can induce hyperglycemia and even steroid-induced diabetes, particularly in predisposed individuals. Therefore, close monitoring of blood glucose is crucial to prevent and manage this common adverse effect. Normal fasting glucose is typically 70-99 mg/dL.

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A nurse is caring for a 68-year-old male client on a medical-surgical unit. A nurse is providing client teaching on the newly prescribed medication. Which of the following statements made by the client indicate an understanding of the teaching?

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A nurse is caring for a 68-year-old male client on a medical-surgical unit.

A nurse is providing client teaching on the newly prescribed medication. Which of the following statements made by the client indicate an understanding of the teaching?