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.”
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A urine output of 240 mL in a 12-hour period translates to 20 mL/hr, which is significantly below the normal physiological range of 30 mL/hr or greater. While low urine output can indicate dehydration, severe oliguria often points to acute kidney injury or severe hypovolemia, not solely dehydration. Normal urine output is generally considered to be 0.5-1 mL/kg/hr.
Choice B rationale
A BUN of 18 mg/dL falls within the normal range of 10 to 20 mg/dL. In dehydration, the kidneys reabsorb more water, leading to a disproportionate increase in BUN relative to creatinine due to increased urea concentration in the tubules, reflecting hypovolemia. A normal BUN value does not indicate dehydration.
Choice C rationale
A weight loss of 0.61 Kg (1.34 lb) in 24 hours is a significant and rapid reduction in body mass. This acute fluid deficit directly reflects a negative fluid balance, indicating a loss of body water. Each kilogram of weight loss approximates 1 liter of fluid loss, making this a clear indicator of dehydration due to fluid volume deficit.
Choice D rationale
A blood pressure of 100/70 mm Hg is within the normal range for many individuals, although it is on the lower side of normotension. While hypotension can be a late sign of severe dehydration, especially orthostatic hypotension, a reading of 100/70 mm Hg alone does not definitively confirm dehydration as the primary cause.
Correct Answer is A
Explanation
Choice A rationale
Allopurinol is a xanthine oxidase inhibitor. This enzyme is crucial in the purine catabolism pathway, converting xanthine and hypoxanthine into uric acid. By inhibiting xanthine oxidase, allopurinol effectively decreases the de novo synthesis of uric acid, thereby lowering serum uric acid levels. This reduction prevents the formation of uric acid crystals in joints and tissues, which are responsible for the painful manifestations of gout.
Choice B rationale
Tophus formation is a direct consequence of chronic hyperuricemia, where uric acid crystals accumulate in soft tissues, leading to palpable nodules. Allopurinol's primary mechanism of action is to reduce uric acid levels. By achieving this, it prevents further crystal deposition and can even lead to the regression of existing tophi over time. Therefore, it does not increase tophus formation.
Choice C rationale
Allopurinol's mechanism of action is specifically related to uric acid metabolism. It does not directly influence calcium homeostasis in the body. Calcium levels are primarily regulated by parathyroid hormone, calcitonin, and vitamin D, which are distinct physiological pathways unrelated to xanthine oxidase inhibition. Therefore, it does not lower calcium levels.
Choice D rationale
While allopurinol ultimately helps relieve joint inflammation in gout, it does so indirectly. Its primary action is to reduce uric acid production, which then prevents the formation of inflammatory uric acid crystals. The direct reduction of inflammation is typically achieved by anti-inflammatory drugs like NSAIDs or colchicine, which act on inflammatory mediators or pathways, not directly by allopurinol.
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