A nurse is assessing a client on long-term Levodopa therapy. Which findings would the nurse identify as adverse effects of the medication? SELECT ALL THAT APPLY

Rationale: A. Levodopa, especially with long-term use or higher doses, can cross the blood-brain barrier and affect neurotransmitter balance, leading to cognitive changes, including confusion and disorientation. This is a well-documented adverse effect in Parkinson’s patients. B. Alterations in central dopamine levels due to Levodopa therapy can impact mood regulation, potentially resulting in depression or worsening pre-existing mood disorders. Monitoring mental health is essential during long-term therapy. C. Levodopa does not typically increase appetite. Common side effects are neurological or psychiatric, and gastrointestinal effects may include nausea or vomiting, not increased appetite. This option is not associated with adverse effects of the medication. D. Long-term or high-dose Levodopa can cause psychiatric effects, including hallucinations, vivid dreams, or paranoia, particularly in older adults. These adverse effects reflect excessive dopaminergic stimulation in the CNS. E. Patients on Levodopa may experience insomnia, restless sleep, or sudden sleep attacks, particularly when dosing schedules are not optimized. Sleep disturbances are a recognized CNS-related adverse effect of chronic therapy.