Parkinson's Disease Practice Questions

The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? 1. Masklike facies and shuffling gait 2. Difficulty swallowing and immobility 3. Pill rolling of fingers and flat affect 4. Lack of arm swing and bradykinesia

2 1. Masklike facies is responsible for lack of expression and is part of the motor manifestations of Parkinson's disease but is not related to the symptoms listed. Shuffling is also a motor deficit and does pose a risk for falling, but fever and patchy infiltrates on a chest x-ray do not result from a gait problem. They are manifestations of a pulmonary complication. 2. Difficulty swallowing places the client at risk for aspiration. Immobility predisposes the client to pneumonia. Both clinical manifestations place the client at risk for pulmonary complications. 3. Pill rolling of fingers and flat affect do not have an impact on the development of pulmonary complications. 4. Arm swing and bradykinesia are motor deficits.

The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion? 1. The client should discuss feelings about being placed on a ventilator. 2. The client may have rapid mood swings and become easily upset. 3. Pill-rolling tremors will become worse when the medication is wearing off. 4. The client may automatically start to repeat what another person says.

2 1. This is information that should be discussed when filling out an advance directive form. A ventilator is used to treat a physiological problem. 2. These are psychosocial manifestations of PD. These should be discussed in the support meeting.* 3. The reduction in the unintentional pill-rolling movement of the hands is controlled at times by the medication; this is a physiological problem. 4. Echolalia is a speech deficit in which the client automatically repeats the words or sentences of another person; this is a physiological problem.

The nurse is caring for clients on a medical-surgical floor. Which client should be assessed first? 1. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.

3 1. A headache of "2" on a 1-to-10 scale is a mild headache. 2. A spinal cord injury at T10 involves deficits at approximately the waist area. Inability to move the toes would be expected. 3. Body image is a concern for clients diagnosed with PD. This client is the one client who is not experiencing expected sequelae of the disease.* 4. This client is getting better; "resolving" indicates an improvement in the client's clinical manifestations.

The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an antiparkinsonian drug. Which statement is the *scientific rationale* for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

3 1. Carbidopa is never given alone. Carbidopa is given together with levodopa to help the levodopa cross the blood-brain barrier. 2. Levodopa is a form of dopamine given orally to clients diagnosed with PD. 3. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in the periphery, thereby making more levodopa available to the central nervous system. Sinemet is the most effective treatment for PD.* 4. Carbidopa does not cross the blood-brain barrier.

Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability 2. Depression 3. Memory deficits 4. Paranoia

3 1. Emotional lability is a psychosocial problem, not a cognitive one. 2. Depression is a psychosocial problem. 3. Memory deficits are cognitive impairments. The client may also develop a dementia.* 4. Paranoia is a psychosocial problem.

The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an *understanding* of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends."

3 1. The emotions of a person diagnosed with PD are labile. The client has rapid mood swings and is easily upset. 2. Hallucinations are a sign that the client is experiencing drug toxicity. 3. Scheduling appointments late in the morning gives the client a chance to complete ADLs without pressure and allows the medications time to give the best benefits.* 4. The client should take the prescribed medications at the same time each day to provide a continuous drug level.

The nurse researcher is working with clients diagnosed with Parkinson's disease. Which is an example of an *experimental* therapy? 1. Sterotactic pallidotomy/thalamotomy 2. Dopamine receptor agonist medication 3. Physical therapy for muscle strengthening 4. Fetal tissue transplantation

4 1. A stereotactic pallidotomy and/or thalamotomy are surgeries that use CT or MRI scans to localize specific areas of the brain in which to produce lesions in groups of brain cells through electrical stimulation or thermocoagulation. These procedures are done when medication has failed to control tremors. 2. Dopamine receptor agonists are medications that activate the dopamine receptors in the striatum of the brain. 3. Physical therapy is a standard therapy used to improve the quality of life for clients diagnosed with PD. 4. Fetal tissue transplantation has shown some success in PD, but it is an experimental and highly controversial procedure.*

The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? 1. Consult the occupational therapist for adaptive appliances for eating. 2. Request a low-fat, low-sodium diet from the dietary department. 3. Provide three (3) meals per day that include nuts and whole-grain breads. 4. Offer six (6) meals per day with a soft consistency.

4 1. Adaptive appliances will not help the client's shaking movements and are not used for clients with Parkinson's disease. 2. Clients with Parkinson's disease are placed on high-calorie, high-protein, soft or liquid diets. Supplemental feedings may also be ordered. If liquids are ordered because of difficulty chewing, then the liquids should be thickened to a honey or pudding consistency. 3. Nuts and whole-grain food would require extensive chewing before swallowing and would not be good for the client. Three large meals would get cold before the client can consume the meal, and one half or more of the food would be wasted. 4. The client's energy levels will not sustain eating for long periods. Offering frequent and easy-to-chew (soft) meals of small proportions is the preferred dietary plan.*

The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.

4 1. Akinesia is lack of movement. The goal in treating PD is to maintain mobility. 2. This could be a goal for a problem of noncompliance with the treatment regimen, but not a goal for treating the disease process. 3. This might be a goal for a psychosocial problem of social isolation. 4. The major goal of treating PD is to maintain the ability to function. Clients diagnosed with PD experience slow, jerky movements and have difficulty performing routine daily tasks.*

The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data *support* this diagnosis? 1. Crackles in the upper lung fields and jugular vein distention 2. Muscle weakness in the upper extremities and ptosis 3. Exaggerated arm swinging and scanning speech 4. Masklike facies and a shuffling gait

4 1. Crackles and jugular vein distention indicate heart failure, not PD. 2. Upper extremity weakness and ptosis are clinical manifestations of myasthenia gravis. 3. The client has very little arm swing, and scanning speech is a clinical manifestation of multiple sclerosis. 4. Masklike facies and a shuffling gait are two clinical manifestations of PD

Which clinical manifestation would be required to confirm the diagnosis of Parkinson​ disease? A. Tremors at rest and bradykinesia B. Bradykinesia only C. Rigidity only D. Tremor at rest and flaccidity

A ​Rationale: A diagnosis of Parkinson disease requires the presence of two of the three cardinal​ manifestations: tremor,​ rigidity, and bradykinesia. Tremors at rest and bradykinesia are two of the cardinal signs. Bradykinesia alone would not be diagnostic. Tremors at rest are a cardinal​ sign, but flaccidity is not. Rigidity is a cardinal​ sign, but rigidity alone is not diagnostic.

A client with Parkinson's disease asks the nurse to explain to his nephew "what the doctor said the pallidotomy would do." The nurse's best response includes stating that the main goal for the client after pallidotomy is improved: A. Functional ability B. Emotional stress C. Alertness D. Appetite

A The goal of a pallidotomy is to improve functional ability for the client with Parkinson's disease. This is a priority. The pallidotomy creates lesions in the globus pallidus to control extrapyramidal disorders that affect control of movement and gait. If functional ability is improved by the pallidotomy, the client may experience a secondary response of an improved emotional response, but this is not the primary goal of the surgical procedure. The procedure will not improve alertness or appetite.

What is the primary goal collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? A. To maintain joint flexibility B. To build muscle strength C. To improve muscle endurance D. To reduce ataxia

A The primary goal of physical therapy and nursing interventions is to maintain joint flexibility and muscle strength. Parkinson's disease involves a degeneration of dopamine-producing neurons; therefore, it would be an unrealistic goal to attempt to build muscles or increase endurance. The decrease in dopamine neurotransmitters results in ataxia secondary to extrapyramidal motor system effects. Attempts to reduce ataxia through physical therapy would not be effective

The healthcare provider of an older adult client with advancing Parkinson disease suggested that the client start an exercise regime. Which exercise should the nurse​ recommend? A. T'ai chi B. Running C. Weight lifting D. Football

A ​Rationale: For a client with Parkinson​ disease, an exercise regime that promotes balance and walking is the best.​ So, the nurse may recommend​ t'ai chi. Considering the​ client's age,​ football, running, and weight lifting may be too strenuous.

The healthcare provider is assessing a patient with a diagnosis of Parkinson disease (PD). Which of the following findings would the healthcare provider anticipate? Select all that apply. A. Kyphosis B. Depression C. Daytime sleepiness D. Bradykinesia E. Exophthalamos F. Receptive aphasia

A, B, C, D

Which recommendation should the nurse make to the client with Parkinson disease​ (PD) to improve gait and​ balance? Select all that​ apply A. Looking ahead instead of down B. Not moving too quickly C. Not using an assistive device D. Standing straight E. Placing the heel on the ground before the toes

A, B, D, E Rationale: For improving gait and balance in the client with​ PD, the nurse may recommend walking technique that includes standing​ straight, not moving too​ quickly, looking ahead and not​ down, and placing the heel on the ground before the toes. The client may use assistive devices to improve balance and gait.

The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease (PD)? Select all that​ apply A. The client has hand tremors at rest. B. The client does not remember what he ate for breakfast. C. The​ client's blood pressure increases when the client stands up. D. The client has a slurred speech. E. The​ client's facial expression shows no emotion.

A, B, D, E ​Rationale: PD causes slowed​ movements, including slurred speech. Tremors at rest are very common in PD and easy to identify. Tremors may occur in the​ hands, face,​ neck, lips,​ tongue, and jaw. PD causes a​ frozen, mask-like expression​ (lack of​ affect). The client will not have an expression that is consistent with the emotions the client is feeling. Memory loss occurs in Parkinson disease because of the loss of neurons and other changes in the brain. The client may develop dementia. Postural​ hypotension, not​ hypertension, is a common manifestation in clients with PD. This is caused by damage to the autonomic nervous system.

Which health promotion activity should be the focus of teaching for a client with Parkinson disease​ (PD)? Select all that​ apply A. Participating in occupational therapy B. Improving balance C. Avoiding exercise D. Preventing injury from falls E. Promoting independence

A, B, D, E ​Rationale: The focus of teaching for the client with PD should be on improving​ balance, preventing​ falls, promoting​ independence, and participating in​ physical, occupational, and speech therapy. Clients should be taught to participate in exercise to optimize​ mobility, not avoid it.

Which of the following might be seen in a patient who has been on long-term Levadopa therapy? Select All That Apply. A. Hypotension B. Hallucinations C. Respiratory distress D. Sleep alterations E. Confusion F. Depression

A, B, D, E, F

A patient with a diagnosis of Parkinson disease (PD) has been prescribed levodopa. Which of the following statements will the healthcare provider include when teaching the patient about this medication? Select all that apply. A. "Let us know if you notice if the medication begins to lose its effectiveness." B. "If you experience nausea, you may take your medication with a high protein meal." C. "It may take a few months for you to experience the full effects of the medication." D. "Call our office if you notice the development of a tic or facial grimace." E. "This medication will reverse the disease process and give you a normal life."

A, C, D Rationale: Levodopa can help diminish symptoms but it will not reverse the disease process. The patient should be informed that they should not expect improvement immediately. A gradual wearing off of the therapeutic effects is a common occurrence. An adverse effect of levodopa is the development of involuntary movements such as a tic or facial grimace. The patient should be advised to take the medication on an empty stomach because food in the stomach delays the absorption of levodopa. Proteins in the diet compete with levodopa for intestinal transport, thereby reducing the medication's therapeutic effects.

The nurse is performing passive range of motion exercises for a client with Parkinson disease. Which nursing goal does this intervention​ address? Select all that​ apply A. The client will remain free from injury. B. The client will participate in speech therapy for swallowing and verbal communication. C. The client will demonstrate normal bowel elimination patterns. D. The client will participate in occupational therapy to integrate assistive devices for​ self-care. E. The client will participate in physical therapy to improve walking and balance.

A, E ​Rationale: Physical​ therapy, including passive range of motion​ (ROM) exercises, will improve the​ client's walking and balance. This in turn helps prevent injury from falls. Assistive devices related to occupational therapy are different from those related to physical therapy. The occupational therapist would teach about devices that facilitate activities of daily​ living, such as button hooks and communication boards. Passive ROM exercises are not related to speech therapy or promoting normal bowel elimination patterns.

The nurse decides that learning has been effective when the patient with Parkinson's makes which of the following statements: A. I should report any burning when I void. B. I may feel depressed, but this should only be reported if it lasts more than 6 months. C. I am going to start Sinemet in the early stages of my disease process. D. It is best for me to watch my feet while I walk to maintain balance.

A. UTIs are a big concern with Parkinson's patients, so these symptoms should be reported. Depression is common and s/s of this should be reported immediately so an antidepressant can be started. Sinemet is reserved for patients with severe symptoms. Patients with Parkinson's benefit from watching the horizon while they walk.

At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? A. Early in the morning, when the client's energy level is high B. To coincide with the peak action of drug therapy C. Immediately after a rest period D. When family members will be available

B Demanding physical activity should be performed during the peak action of drug therapy. Clients should be encouraged to maintain independence in self-care activities to the greatest extent possible. Although some clients may have more energy in the morning or after rest, tremors are managed with drug therapy.

A client with Parkinson's disease is prescribed levodopa (L-dopa) therapy. Improvement in which of the following indicates effective therapy? A. Mood B. Muscle rigidity C. Appetite D. Alertness

B Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease.

A client with Parkinson's disease needs a long time to complete her morning hygiene, but she becomes annoyed when the nurse offers assistance and refuses all help. Which action is the nurse's best initial response in this situation? A. Tell the client firmly that she needs assistance and help her with her care B. Praise the client for her desire to be independent and give her extra time and encouragement C. Tell the client that she is being unrealistic about her abilities and must accept the fact that she needs help D. Suggest to the client that if she insists on selfcare, she should at least modify her routine

B Ongoing self-care is a major focus for clients with Parkinson's disease. The client should be given additional time as needed and praised for her efforts to remain independent. Firmly telling the client that she needs assistance will undermine her self-esteem and defeat her efforts to be independent. Telling the client that her perception is unrealistic does not foster hope in her ability to care for herself. Suggesting that the client modify her routine seems to put the hospital or the nurse's time schedule before the client's needs. This will only decrease the client's self-esteem and her desire to try to continue self-care, which is obviously important to her

A patient who has been taking bromocriptine (Parlodel) and benztropine (Cogentin) for Parkinson's disease is experiencing a worsening of symptoms. The nurse will anticipate that patient may benefit from a. complete drug withdrawal for a few weeks. b. use of levodopa (L-dopa)-carbidopa (Sinemet). c. withdrawal of anticholinergic therapy. d. increasing the dose of bromocriptine.

B Rationale: After the dopamine receptor agonists begin to fail to relieve symptoms, the addition of L-dopa with carbidopa can be added to the regimen. Complete drug withdrawal will result in worsening of symptoms. Anticholinergic therapy should be continued to help maintain the balance between the actions of dopamine and acetylcholine. Increasing the dose of bromocriptine will increase the risk for toxic effects

Which of the following is an initial sign of Parkinson's disease? A. Rigidity B. Tremor C. Bradykinesia D. Akinesia

B The first sign of Parkinson's disease is usually tremors. The client commonly is the first to notice this sign because the tremors may be minimal at first. Rigidity is the second sign, and bradykinesia is the third sign. Akinesia is a later stage of bradykinesia.

The nurse observes that a client's upper arm tremors disappear as he unbuttons his shirt. Which statement best guides the nurse's analysis of this observation about the client's tremors? A. The tremors are probably psychological and can be controlled at will B. The tremors sometimes disappear with purposeful and voluntary movements C. The tremors disappear when the client's attention is diverted by some activity D. There is no explanation for the observation; it is probably a chance occurrence

B Voluntary and purposeful movements often temporarily decrease or stop the tremors associated with Parkinson's disease. In some clients, however, tremors may increase with voluntary effort. Tremors associated with Parkinson's disease are not psychogenic but are related to an imbalance between dopamine and acetylcholine. Tremors cannot be reduced by distracting the client

An older adult client was diagnosed with Parkinson disease 3 months ago. Since the​ diagnosis, the client has not gone out of the house. Which statement by the nurse is most​ appropriate? A. "Tell your family to come and take you out of the​ house." B. "Can I ask why you​ aren't going out of the​ house?" C. "You need to start getting​ out." D. ​"Getting out of the house will help you to feel less​ depressed."

B ​Rationale: Asking an​ open-ended question and inquiring about the reason why the client is not going out of the house will encourage the client to discuss and share information. Advising the client about going​ out, telling the client that they will feel better by going​ out, or involving the family will not encourage the client to discuss the reason behind staying at home.

Which is the main pathology of Parkinson disease that causes changes in muscular and sensory​ function? A. Reduction of acetylcholine in the brain B. Reduction of dopamine in the brain C. Genetic predisposition D. Presence of Lewy bodies

B ​Rationale: The changes in muscular and sensory function in Parkinson disease​ (PD) are caused by a decreased amount of dopamine in the​ brain, which in turn​ increases, not​ reduces, the amount of acetylcholine. The presence of Lewy bodies​ (abnormal aggregates of​ proteins) in the neurons is a characteristic of​ PD, but it is unclear whether they are helpful or harmful. Although there is a genetic link in approximately 15dash​25% of​ cases, it is a risk factor rather than a cause of PD manifestations.

An older adult client with Parkinson disease uses a​ walker, speaks in a slurred manner with poor​ articulation, but tries to speak louder to accommodate for this impairment. The client​ states, "I catch my daughter looking at me angrily​ sometimes, but she​ doesn't say​ anything." Which nursing diagnosis is the priority​? A. Communication: Verbal, Impaired B. Caregiver Role Strain C. ​Falls, Risk for D. Nutrition, Imbalanced: Less than Body Requirements

B ​Rationale: The client is making accommodations for preventing falls by using a walker. Being the primary​ caregiver, the​ client's daughter assists the client in feeding so imbalanced nutrition is not a risk. The client is also practicing speech by speaking louder. It is the​ caregiver's role strain that is the major risk for this client.​

The nurse is assessing a client with Parkinson disease​ (PD). Which factor should the nurse include in the​ assessment? Select all that​ apply A. Difficulty waking B. Response to medication C. Cognitive deficits D. Dizziness when sitting E. Bowel changes

B, C, E ​Rationale: While assessing the current​ condition, the nurse should ask about bowel​ changes, as clients with PD face problems with​ peristalsis, which contributes to constipation. The client may also have cognitive deficits such as memory​ loss, slowed​ thinking, and​ confusion, which eventually progress to dementia. Another aspect that needs to be assessed is responses to​ medication, especially for​ "on-off" or​ "wearing off" effects that indicate that medication is losing its effectiveness. Clients with PD have difficult falling and staying​ asleep, so difficulty in waking up is not related. Postural hypotension is common in Parkinson​ disease, resulting in blood pressure that drops when the client stands​ up, not while sitting.

A client with Parkinson disease​ (PD) is prescribed an anticholinergic agent to treat tremors and rigidity. The nurse should teach the client about which adverse effect they may experience from this​ medication? Select all that​ apply A. Drooling B. Dry mouth C. Rigidity D. Loss of perspiration E.Tremors

B, D Rationale: Anticholinergic medications can cause a decrease in​ salivation, causing dry mouth. This medication decreases tremors and reduces rigidity by blocking acetylcholine. The client taking this medication will have problems with temperature control because the client will not be able to perspire to cool off.

While giving discharge instructions, the nurse instructs the family of a patient with Parkinson's to watch for all of the following complications EXCEPT: A. Constipation B. Hypertension C. Excessive sweating D. Depression

B. You more commonly see HYPOtension with Parkinson's patients, both with and without Sinemet therapy.

When planning care for a patient diagnosed with Parkinson disease (PD), which of these patient outcomes should receive priority in the patient's plan of care? A. Taking a daily walk around the neighborhood B. Working on a favorite hobby C. Toileting and bathing independently D. Taking a vitamin supplement each day

C

A patient diagnosed with Parkinson disease (PD) is prescribed levodopa. The medication therapy can be considered effective when the healthcare provider assesses improvement in which of the following? A. Appetite B. Hearing C. Urinary frequency D. Visual acuity

C Rationale: Autonomic nervous system dysfunction can cause urinary symptoms in patients, such as urinary frequency, urgency, and urge incontinence.

Coexisting dementia and depression are identified in a patient with Parkinson's disease. The nurse anticipates that the greatest improvement in the patient's condition will occur with administration of a. antipsychotic drugs. b. anticholinergic agents. c. dopaminergic agents and antidepressant drugs. d. selective serotonin reuptake inhibitor (SSRI) agents.

C Rationale: Parkinson's disease and depression are both potentially reversible conditions, and the patient's symptoms that are caused by these two conditions will improve with appropriate treatment. Anticholinergic agents are likely to worsen the patient's condition because they will block the effect of acetylcholine at the synaptic cleft. There is no indication that the patient needs an antipsychotic agent at this time. A selective serotonin reuptake inhibitor (SSRI) may be effective for the depression, but it does not address the patient's other conditions.

A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. The nurse recognizes that these impairments commonly contribute to the nursing diagnosis of a. disuse syndrome related to loss of muscle control. b. self-care deficit related to bradykinesia and rigidity. c. impaired verbal communication related to difficulty articulating. d. impaired oral mucous membranes related to inability to swallow.

C Rationale: The inability to use the tongue and facial muscles decreases the patient's ability to socialize or communicate needs. Disuse syndrome is not an appropriate nursing diagnosis because the patient is continuing to use the muscles as much as possible. There is no indication in the stem that the patient has a self-care deficit, bradykinesia, or rigidity. The oral mucous membranes will continue to be moist and should not be impaired by the patient's difficulty swallowing

The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which of the following topics that the nurse plans to discuss is the most important? A. Maintaining a balanced nutritional diet B. Enhancing the immune system C. Maintaining a safe environment D.Engaging in diversional activity

C The primary focus is on maintaining a safe environment because the client with Parkinson's disease usually has a propulsive gait, characterized by a tendency to take increasingly quicker steps while walking. This type of gait commonly causes the client to fall or to have trouble stopping. The client should maintain a balanced diet, enhance the immune system, and enjoy diversional activities; however, safety is the primary concern.

A client is being switched from levodopa (L-dopa) to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? A. Euphoria B. Jaundice C. Vital sign fluctuation D. Signs and symptoms of diabetes

C Vital signs should be monitored, especially during periods of adjustment. Changes, such as orthostatic hypotension, cardiac irregularities, palpitations, and light-headedness, should be reported immediately. The client may actually experience suicidal or paranoid ideation instead of euphoria. The nurse should monitor the client for elevated liver enzyme levels, such as lactate dehydrogenase, aspartate amino- transferase, alanine aminotransferase, blood urea nitrogen, and alkaline phosphatase, but the client should not be jaundiced. The client should not experience signs and symptoms of diabetes or a low serum glucose level, but the nurse should check the hemoglobin and hematocrit levels

Which symptom for a client with Parkinson disease​ (PD) is due to the lack of automatic muscle​ movement? A. Diminished voice volume B. Reduced ability to swallow C. Alterations in sleep pattern D. Diminished physical mobility

C ​Rationale: Alterations in sleep pattern may occur due to lack of automatic muscle movement in a client with Parkinson disease. Reducing strenuous activities near​ bedtime, limiting intake of​ caffeine, and providing a glass of milk before bedtime are all examples of interventions that directly address issues with sleep pattern. Reduced ability to​ swallow, diminished voice​ volume, and diminished physical mobility are all related to dysfunction of voluntary muscle movement.

A client with Parkinson disease​ (PD) complains of increased tremor while eating. Which action should the nurse​ recommend? A. Having someone feed them B. Liquefying all meals and drinking them through a straw C. Holding a piece of bread in the other hand while eating D. Using their nondominant hand to eat

C ​Rationale: Holding a piece of bread in the opposite hand or purposeful movement will decrease tremors while eating. The client should be encouraged to eat independently for as long as possible. Using the nondominant hand may lack coordination. As the client with PD is prone to​ choking, liquefying all meals would not be recommended.

Which type of therapy is used to manage problems with eating and​ swallowing? A. Physical B. Occupational C. Speech D. Nutritional

C ​Rationale: Speech therapy is used to manage problems with eating and swallowing. Occupational therapy is used to maintain​ self-care activities, not specifically eating and swallowing. Physical therapy is used to improve coordination of balance and gait. There is no nutritional therapy needed for a client with Parkinson disease.

The daughter of an older adult client with advancing Parkinson disease tells the nurse that they need to dress their mother each​ morning, because the mother is​ "not fast​ enough." Which is the most appropriate response from the​ nurse? A. "It is important for you to get to work on​ time." B. "Can you let her dress​ herself? C. "It is best for you to let your mother dress herself for as long as she​ can." D. "That is really quite​ normal."

C ​Rationale: The nurse should tell the caregiver​ that, by allowing independence in​ dressing, the client will have an improved sense of​ well-being and lessened depression. Asking​ closed-ended questions or just remarking that it is normal will not support the​ client's needs.

A health care provider has ordered carbidopa- levodopa (Sinemet) four times per day for a client with Parkinson's disease. The client states that he wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply. A. Explain that the new prescription for Sinemet will treat his depression B. Encourage the client to discuss his feelings as the Sinemet is being administered C. Contact the health care provider before administering the Sinemet D. Determine if the client is on antidepressants or monoamine oxidase (MAO) inhibitors E. Determine if the client is at risk for suicide

C,D,E The nurse should contact the health care provider before administering Sinemet because this medication can cause further symptoms of depression. Suicide threats in clients with chronic illness should be taken seriously. The nurse should also determine if the client is on an MAO inhibitor because concurrent use with Sinemet can cause a hypertensive crisis. Sinemet is not a treatment for depression. Having the client discuss his feelings is appropriate when the prescription is finalized.

Which goal is the most realistic and appropriate for a client diagnosed with Parkinson's disease? A. To cure the disease B. To stop progression of the disease C. To begin preparations for terminal care D. To maintain optimal body function

D Helping the client function at his or her best is most appropriate and realistic. There is no known cure for Parkinson's disease. Parkinson's disease progresses in severity, and there is no known way to stop its progression. Many clients live for years with the disease, however, and it would not be appropriate to start planning terminal care at this time

A new medication regimen is ordered for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? A. At bedtime B. All at one time C. Two hours before mealtime D. At the time scheduled

D While the client is hospitalized for adjustment of medication, it is essential that the medications be administered exactly at the scheduled time, for accurate evaluation of effectiveness. For example, levodopa-carbidopa (Sinemet) is taken in divided doses over the day, not all at one time, for optimum effectiveness.

A client newly diagnosed with Parkinson disease asks the​ nurse, "What does dopamine do in the​ brain?" Which is the most appropriate​ response? A. "Dopamine enhances the action of​ acetylcholine." B. "Dopamine causes spinal cord neurons to transmit​ impulses." C. "Dopamine stimulates the neurons to transmit sensory and motor​ impulses." D. "Dopamine helps maintain coordinated motor​ movement."

D ​Rationale: Dopamine is responsible for coordination. It balances the neurotransmitter​ acetylcholine, which stimulates the neurons. Dopamine prevents this stimulation from becoming excessive. Dopamine provides regulation rather than stimulation. Dopamine regulates motor neuron impulses and balances acetylcholine. Dopamine only works on certain brain neurons located in the basal​ ganglia, not the spinal cord. Dopamine minimizes and balances the effects of acetylcholine and does not enhance it.

The nurse is caring for a client with Parkinson disease​ (PD) who reports problems with stiffness and the ability to move. Which action by the nurse will address the​ client's mobility? A. Ask the client if they know about the medications to treat the stiffness B. Advise bedrest for muscle recovery C. Tell the client that this is part of the disease process that cannot be stopped D. Recommend a regular exercise routine and walking

D ​Rationale: The best way to promote mobility in the client with PD is to recommend the client ambulate daily and exercise on a regular basis. Bedrest would only make the stiffness worse. Although there are medications that can help with​ rigidity, it is outside of the​ nurse's scope of practice to recommend medication. Telling the client that this is just part of the disease process is not appropriate or therapeutic.

A nurse is preparing a presentation on Parkinson disease​ (PD) for a health fair at a local community center. Which information should the nurse include in the​ presentation? A. Parkinson disease affects both men and women at the same rate. B. Parkinson disease is the result of an infection. C. Parkinson disease is inherited in over​ 50% of those affected. D. Parkinson disease usually affects people older than the age of 60 years.

D ​Rationale: The cause of PD is not known. There is no evidence of an infection that causes Parkinson disease. It is inherited in only 15dash​25% of cases. Parkinson disease affects men more than it does women. Parkinson disease is more common in people over 60 years of age. It can also occur in younger​ people, but this is less common.

The nurse observed a client with Parkinson disease frequently wiping their mouth with a handkerchief. After the nurse requested a prescription for an anticholinergic medication from the healthcare​ provider, the client​ asked, "I feel​ better, why do I need another​ medication?" Which response by the nurse is​ correct? A. "It helps dopamine work​ better." B. ​"It will make you feel​ better." C. "The healthcare provider thinks it will help your​ symptoms." D. "It will help reduce tremors and uncontrolled​ drooling."

D ​Rationale: The client stated that they are feeling better. It is levodopa and not an anticholinergic that will make dopamine work better. Stating that the healthcare provider thinks it will help with the​ client's symptoms will be an incomplete answer. To give a complete​ response, the nurse would state that an anticholinergic reduces tremors and uncontrolled drooling.

Which recommendation should the nurse make to a client with Parkinson disease who reports​ constipation? Select All That Apply A. Decreasing fiber intake B. Limiting exercise C. Decreasing fluid intake D. Increasing fluid intake E. Increasing fiber intake

D, E ​Rationale: Increasing fluid and fiber intake is a known recommendation for the prevention of constipation. Decreasing the intake of fluids or fiber will not help to prevent constipation. Limiting exercise is not associated with constipation.