The nurse is assessing a client who was recently diagnosed with Parkinson’s disease and is taking carbidopa-levodopa. The client is concerned that the medication is not working. Which intervention should the nurse implement first?

Ask if the client’s morning voids are dark colored.

Evaluate the client for signs of dyskinesia.

Determine if the client is taking the medication before meals.

Explore what the client means by the drug “is not working.”

Answer and Explanation

The Correct Answer is D

A) Ask if the client’s morning voids are dark colored:
This intervention pertains to monitoring for potential adverse effects of carbidopa-levodopa, such as urine discoloration due to the breakdown of levodopa into dopamine. However, it does not directly address the client’s concern about the medication not working. While assessing for adverse effects is important, it may not provide immediate insight into the effectiveness of the medication in managing Parkinson’s disease symptoms.

B) Evaluate the client for signs of dyskinesia:
Dyskinesia refers to involuntary, abnormal movements that can occur as a side effect of long-term treatment with carbidopa-levodopa. While assessing for dyskinesia is essential during the management of Parkinson’s disease, it does not directly address the client’s immediate concern about the medication’s efficacy. It would be more appropriate to address the client’s primary concern first before assessing for potential adverse effects.

C) Determine if the client is taking the medication before meals:
The timing of medication administration, particularly with carbidopa-levodopa, can affect its absorption and effectiveness. Taking the medication with or without food can influence its onset of action and duration of effect. However, this intervention assumes that the client may not be taking the medication correctly, which may not necessarily be the case. It’s important to first clarify the client’s perception of the medication’s effectiveness before addressing administration instructions.

D) Explore what the client means by the drug “is not working.”
This option is correct. The nurse should prioritize exploring the client’s perception of the medication’s efficacy. Understanding the client’s specific concerns, such as which symptoms are not adequately controlled or how they define “not working,” can provide valuable information for further assessment and intervention. By actively listening to the client’s perspective, the nurse can collaboratively address any misconceptions, adjust the treatment plan if necessary, and provide education or reassurance accordingly.

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Correct Answer is B

Explanation

Answer: B. Administer a second dose of naloxone.

Rationale:

A) Prepare to assist with chest tube insertion:
Chest tube insertion is not relevant in this situation. A chest tube is typically used for conditions like pneumothorax or pleural effusion, not opioid-induced respiratory depression. The immediate concern here is the opioid overdose and the need for further naloxone administration to reverse the opioid effects, not the placement of a chest tube.

B) Administer a second dose of naloxone:
Administering a second dose of naloxone is the most appropriate action. Naloxone is a short-acting opioid antagonist, and its effects can wear off before the opioids have fully cleared from the client’s system. Given that the client’s respiratory rate is severely depressed and the oxygen saturation is dangerously low, another dose of naloxone is necessary to reverse the opioid's effects and restore adequate breathing. Immediate action is required to prevent further hypoxia.

C) Determine Glasgow Coma Scale score:
While assessing the client’s level of consciousness using the Glasgow Coma Scale (GCS) is important, it is not the immediate priority in this situation. The client’s low respiratory rate and oxygen saturation indicate a critical need for immediate treatment to improve ventilation and oxygenation. Administering naloxone should take precedence over neurological assessment.

D) Initiate cardiopulmonary resuscitation (CPR):
While the client’s respiratory depression is severe, initiating CPR may not yet be necessary if the client still has a pulse. Administering naloxone can potentially reverse the respiratory depression and prevent the need for CPR. If the client's condition continues to decline despite naloxone administration, CPR may become necessary later, but the first step is to administer a second dose of naloxone to restore breathing.

A. Serum ammonia level of 30 pg/dl (17.62 μmol /dL). B. Serum glucose level of 120 mg/dL (6.7 mmol/L). C. Serum potassium level of 3.8 mEq/L (3.8 mmol/L). D. Hemoglobin level of 13.5 g/dL (135 g/L).

Correct Answer is C

Explanation

A) Serum ammonia level of 30 pg/dl (17.62 μmol /dL): Serum ammonia level is not directly affected by sodium polystyrene sulfonate administration. Ammonia levels are typically related to liver function and are not relevant in assessing the effectiveness of this medication for hyperkalemia.
B) Serum glucose level of 120 mg/dL (6.7 mmol/L): Serum glucose level is unrelated to the action of sodium polystyrene sulfonate. While hyperkalemia can sometimes lead to glucose metabolism abnormalities, the glucose level alone does not provide information about the medication's effectiveness.
C) Serum potassium level of 3.8 mEq/L (3.8 mmol/L): Sodium polystyrene sulfonate, also known as Kayexalate, is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, leading to potassium excretion through feces. A decrease in serum potassium level within the normal range indicates that the medication has been effective in lowering potassium levels, which is the intended therapeutic outcome in the context of treating hyperkalemia associated with acute kidney injury (AKI).
D) Hemoglobin level of 13.5 g/dL (135 g/L): Hemoglobin level is unrelated to the action of sodium polystyrene sulfonate. It reflects the oxygen-carrying capacity of red blood cells and is not directly influenced by potassium-lowering medications.

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The nurse is assessing a client who was recently diagnosed with Parkinson’s disease and is taking carbidopa-levodopa. The client is concerned that the medication is not working. Which intervention should the nurse implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

Correct Answer is B

Explanation

Rationale:

Correct Answer is C

Explanation

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