When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason?

There are rapid swings in the patient’s response to levodopa.

The patient cannot tolerate the medications at times.

The medications begin to lose effectiveness against Parkinson’s disease.

The patient’s liver is no longer able to metabolize the drug.

Answer and Explanation

The Correct Answer is A

Choice A reason: The wearing-off phenomenon in Parkinson’s occurs when levodopa’s effect diminishes before the next dose, causing symptom fluctuations. This results from progressive dopamine neuron loss, reducing storage capacity, and shorter levodopa half-life, leading to rapid swings in motor control as plasma levels fluctuate.
Choice B reason: Intolerance to medications may cause side effects (e.g., nausea), but the wearing-off phenomenon is due to disease progression and levodopa’s pharmacokinetics, not patient tolerance. Symptoms return as drug levels drop, not because of inability to tolerate the dose.
Choice C reason: Medications like levodopa remain effective, but wearing-off occurs due to shorter duration of action as Parkinson’s progresses, not loss of drug efficacy. Neuron loss reduces dopamine storage, causing symptoms to re-emerge between doses, not a failure of the drug itself.
Choice D reason: The liver metabolizes levodopa minimally; carbidopa prevents peripheral breakdown. Wearing-off is due to central nervous system changes (loss of dopamine neurons), not liver dysfunction, which does not significantly alter levodopa’s pharmacokinetics in Parkinson’s disease.

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Correct Answer is C

Explanation

Choice A reason: Phenytoin can be taken with or without food, as food does not significantly affect its absorption. Taking it on an empty stomach is not necessary and may cause gastrointestinal upset, making this an incorrect teaching point for long-term use.
Choice B reason: Insomnia is not a common side effect of phenytoin. Common neurological effects include dizziness, ataxia, or sedation due to its action on sodium channels, stabilizing neuronal membranes. Teaching about insomnia is irrelevant and does not address key management concerns.
Choice C reason: Phenytoin commonly causes gingival hyperplasia due to fibroblast proliferation in gum tissue. Regular gum massage and good oral hygiene can reduce this risk by promoting circulation and preventing tissue overgrowth, making this a critical teaching point for long-term use.
Choice D reason: Blood pressure monitoring is not a primary concern with phenytoin, which primarily affects the central nervous system and liver. While rare cardiovascular effects may occur, gingival hyperplasia and blood level monitoring are more significant for long-term management.

A. Remove the medical alert bracelet from the fractured arm. B. Immobilize the arm by splinting the fractured site. C. Place the client in a supine position with a warm blanket. D. Cover any open areas with a sterile dressing.

Correct Answer is B

Explanation

Choice A reason: Removing a medical alert bracelet is not a priority, as it does not address the fracture’s immediate needs. The bracelet provides critical information (e.g., diabetes status) for emergency care, and its removal could delay appropriate management of comorbidities.
Choice B reason: Immobilizing the fractured arm with a splint is the priority to prevent further tissue damage, reduce pain, and stabilize the fracture site. In diabetes, poor wound healing increases complication risks, making immediate immobilization critical to minimize movement and promote healing.
Choice C reason: Placing the client supine with a blanket addresses comfort but not the fracture’s urgent needs. Immobilization takes precedence to prevent bone displacement, which could complicate healing, especially in diabetes, where vascular issues impair recovery.
Choice D reason: Covering open areas with a sterile dressing is necessary for open fractures to prevent infection, but the question does not specify an open fracture. Immobilization is the first action for any fracture to ensure stability and reduce complications.

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When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason?

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Naxlex Comprehensive Predictor Exams

What would the nurse include when creating a teaching plan that includes the long-term administration of phenytoin (Dilantin)?

Correct Answer is C

Explanation

A nurse is caring for a client with diabetes mellitus who has fractured her arm. Which action would the nurse take first?

Correct Answer is B

Explanation

A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?

On entering the room of a child in Buck’s traction, the nurse makes all of the following observations. Which observation requires a nursing intervention?

What nursing action will significantly decrease the risk of serious complications for a child in Bryant’s traction?

A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?

The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply)

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the client’s understanding. Which statement by the client indicates a correct understanding of the teaching?

A nurse is providing education to a community women’s group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply)

A client is prescribed celecoxib for joint pain. What statement by the client indicates a need for further teaching?