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

A) Expresses that they cannot get enough air to breathe: While this statement suggests respiratory distress, it is not as objective an assessment finding as a respiratory rate of 7 breaths/minute. Objective measurements are typically more reliable indicators for initiating interventions.
B) Respiratory rate of 7 breaths/minute: A respiratory rate of 7 breaths/minute is indicative of respiratory depression, which is a potential side effect of opioid analgesics like morphine sulfate. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Administering a prescribed PRN dose of naloxone is appropriate to counteract the respiratory depression and prevent further complications.
C) Bilateral wheezing on auscultation: Wheezing is more commonly associated with bronchoconstriction or airway obstruction rather than opioid-induced respiratory depression. Naloxone is not indicated for wheezing unless there is concurrent opioid-induced respiratory depression.
D) Pulse oximeter reading of 89% on room air: While a pulse oximeter reading of 89% indicates hypoxemia, it may not be solely due to opioid-induced respiratory depression. Other factors, such as hypoventilation, ventilation-perfusion (V/Q) mismatch, or lung disease, could contribute to decreased oxygen saturation. Administering naloxone solely based on pulse oximetry readings may not address the underlying cause adequately. It is essential to assess the client comprehensively, considering clinical signs and symptoms along with objective data.

A. Advise the client to move slowly and cautiously when rising and walking. B. Monitor intake and output every 8 hours. C. Ensure the client knows to stop baclofen before using other antispasmodics. D. Evaluate muscle strength every 4 hours.

Correct Answer is A

Explanation

A) Advise the client to move slowly and cautiously when rising and walking: This intervention is essential because baclofen, a muscle relaxant, can cause dizziness, drowsiness, and muscle weakness as side effects. Instructing the client to move slowly and cautiously can help prevent falls and injuries due to these potential side effects.
B) Monitor intake and output every 8 hours: Monitoring intake and output is not directly related to the administration of baclofen. While it is essential to monitor fluid balance in some situations, it is not specifically indicated in this case.
C) Ensure the client knows to stop baclofen before using other antispasmodics: While it is important to avoid concurrent use of multiple antispasmodic medications without proper medical supervision, stopping baclofen abruptly without medical guidance can lead to withdrawal symptoms. Therefore, this intervention is not appropriate without further clarification from the healthcare provider.
D) Evaluate muscle strength every 4 hours: While monitoring muscle strength is essential for clients receiving muscle relaxants, such as baclofen, evaluating it every 4 hours may not be necessary unless there are specific concerns or as directed by the healthcare provider. Monitoring for signs of muscle weakness or adverse effects should be ongoing but may not require such frequent assessments.

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