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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000425749.73429.51
Feature Articles

CE Test 2.5 Hours: Perioperative Medication Withholding in Patients with Parkinson's Disease: A Retrospective Electronic Health Records Review

Contrada, Emily

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Continued Education
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TEST INSTRUCTIONS

* To take the test online, go to our secure Web site at www.nursingcenter.com/ce/ajn.

* To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

* Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to: Lippincott Williams and Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is January 31, 2015.

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* Send in together two or more tests from any nursing journal published by Lippincott, Williams and Wilkins (LWW), and deduct $0.95 from the price of each test.

* We also offer CE accounts for hospitals and other health care facilities online at www.nursingcenter.com. Call 1-800-787-8985 for details.

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PROVIDER ACCREDITATION

LWW, publisher of AJN, will award the number of contact hours indicated for each continuing nursing education activity. LWW is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center (ANCC).

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LWW is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. Your certificate is valid in all states.

The ANCC's accreditation status of the LWW Department of Continuing Education refers to its continuing nursing educational activities only and does not imply Commission on Accreditation approval or endorsement of any commercial product.

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CE TEST QUESTIONS

GENERAL PURPOSE:

To present the details of a study done to measure the perioperative duration of carbidopa-levodopa withholding, to record the time of day that surgeries were performed on patients with Parkinson's disease, and to record perioperative exacerbations of Parkinson's disease symptoms.

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LEARNING OBJECTIVES:

After reading this article and taking this test, you will be able to

* review the background information helpful in understanding the need for the authors’ study of the impact of perioperative medication withdrawal on patients with Parkinson's disease.

* summarize the characteristics of the authors’ sample population, the results of their study, and the implications for practice.

1. A mood disorder commonly associated with Parkinson's disease is

a. mania.

b. confusion.

c. catatonia

d. irritability.

2. A motor symptom commonly seen in Parkinson's disease is

a. bradykinesia.

b. hyperreflexia.

c. limb flaccidity.

d. hemiparesis.

3. The National Parkinson Foundation reports that, in the United States, the number of people with Parkinson's disease is about

a. 0.5 to 1 million.

b. 1 to 1.5 million.

c. 1.5 to 2 million.

d. 2 to 2.5 million.

4. About how many new cases are diagnosed each year in this country?

a. 20,000 to 30,000

b. 30,000 to 40,000

c. 40,000 to 50,000

d. 50,000 to 60,000

5. What is the average age (in years) at diagnosis?

a. 50

b. 55

c. 60

d. 65

6. Adding carbidopa to levodopa reduces the peripheral conversion of levodopa to dopamine, thus also reducing peripheral dopamine adverse effects, which include

a. nausea.

b. joint pain.

c. candidiasis.

d. pupil constriction.

7. A concern with perioperative withholding of carbidopa-levodopa in patients with Parkinson's disease is that the drug

a. interferes with blood glucose testing results.

b. tends to worsen depression.

c. has an especially short half-life.

d. must be taken with high-protein meals.

8. In the study sample, the type of surgery most commonly performed was

a. ophthalmic.

b. genitourinary.

c. orthopedic.

d. gastrointestinal.

9. In the study sample, the most common comorbidity category was

a. neurologic–non-Parkinson's disease.

b. endocrine.

c. respiratory.

d. cardiovascular.

10. In the study sample, the most common individual comorbidity was

a. hypertension.

b. diabetes mellitus.

c. coronary artery disease.

d. gastroesophageal reflux disease.

11. The median time of medication withholding for the 89 surgical events included in the study sample was

a. 11.38 hours.

b. 12.35 hours.

c. 16.75 hours.

d. 20.59 hours.

12. The mean surgical start times for the entire sample and for only the outpatient procedures were similar, occurring

a. in the early morning.

b. just before noon.

c. in the early afternoon.

d. just before evening.

13. What percentage of the 32 inpatient records analyzed contained a nursing or progress note referencing Parkinson's disease symptoms or symptom management?

a. 28%

b. 37%

c. 45%

d. 56%

14. Of the following broad categories into which such notes fell, which had the most notations?

a. increased tremors, shakiness, or both

b. symptom management complicated by pain, pain medications, or both

c. increased agitation, confusion, or both

d. antiparkinson medications received inconsistently or not at all

15. What percentage of the 32 inpatient procedures had medication withholding times of more than 30 hours?

a. 18%

b. 28%

c. 38%

d. 48%

16. Preoperatively, patients with Parkinson's disease can take carbidopa-levodopa and other antiparkinson medications with a sip of water until

a. the early evening before surgery.

b. the midnight before surgery.

c. 2 to 3 hours before surgery.

d. shortly before the initiation of anesthesia.

17. Many surgical patients with Parkinson's disease can safely resume taking carbidopa-levodopa and other antiparkinson medications

a. in the postanesthesia recovery unit.

b. 12 hours after surgery.

c. 24 hours after surgery.

d. 36 hours after surgery.

18. One recommendation for improving symptom management in surgical patients who have Parkinson's disease is to

a. administer antiparkinson medications intravenously.

b. shorten the duration of their NPO status.

c. schedule the surgery as early in the day as possible.

d. make sure their medications are available at home.

© 2013 Lippincott Williams & Wilkins, Inc.

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