AH3 Exam 3: EOL/Parkinsons NCLEX

The hospice care nurse is planning the care of an elderly client diagnosed with end-stage renal disease. Which interventions should be included in the plan of care? Select all that apply. 1. Discuss financial concerns. 2. Assess any comorbid conditions. 3. Monitor increased visual or auditory abilities. 4. Note any spiritual distress. 5. Encourage euphoria at the time of death.

1. Discuss financial concerns. 2. Assess any comorbid conditions. 3. Monitor increased visual or auditory abilities. 4. Note any spiritual distress. Rationale: 1. The elderly are frequently on fixed incomes, and financial concerns are important for the nurse to address. A social services referral may be needed. 2. The elderly may have many comorbid conditions, which affect the type and amount of medications the client can tolerate and the client's quality of life. 4. The client may feel some spiritual distress at the terminal diagnosis. Even if the client possesses a strong faith, the unknown can be frightening.

The HCP has notified the family of a client in a persistent vegetative state on a ventilator of the need to "pull the plug." The client does not have an AD or a durable power of attorney for health care, and the family does not want their loved one removed from the ventilator. Which action should the nurse implement? 1. Refer the case to the hospital ethics committee. 2. Tell the family they must do what the HCP orders. 3. Follow the HCP's order and "pull the plug." 4. Determine why the client did not complete an AD.

1. Refer the case to the hospital ethics committee. Rationale: The ethics committee is composed of health-care workers and laypeople from the community to objectively review the situation and make a recommendation which is fair to both the client and health-care system. The family has the right to be present and discuss their feelings.

The client tells the nurse, "Every time I come in the hospital you hand me one of these advance directives (AD). Why should I fill one of these out?" Which statement by the nurse is most appropriate? 1. "You must fill out this form because Medicare laws require it." 2. "An AD lets you participate in decisions about your health care." 3. "This paper will ensure no one can override your decisions." 4. "It is part of the hospital admission packet and I have to give it to you."

2. "An AD lets you participate in decisions about your health care." Rationale: 1. Advance directives (AD) are not legally required. It is a standard of the Joint Commission, and any facility which accepts federal funds must ask and offer the AD. 2. ADs allow the client to make personal health-care decisions about end-of-life issues, including cardiopulmonary resuscitation (CPR), ventilators, feeding tubes, and other issues concerning the client's death. 3. This is not a legal document guaranteed to stand up in a court of law; therefore, the client should make sure all family members know the client's wishes. 4. It is part of the hospital admission requirements, but it is not the reason why the client should complete an AD.

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. Difficulty swallowing and immobility. Rationale: 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.

The nurse is orienting to a hospice organization. Which statement does not indicate a right of the terminal client? The right to: 1. Be treated with respect and dignity. 2. Have particulars of the death withheld. 3. Receive optimal and effective pain management. 4. Receive holistic and compassionate care.

2. Have particulars of the death withheld. Rationale: The client has the right to discuss his or her feelings and direct his or her care. Withholding information would be lying to the client.

The client has just signed an AD at the bedside. Which intervention should the nurse implement first? 1. Notify the client's health-care provider about the AD. 2. Instruct the client to discuss the AD with significant others. 3. Place a copy of the advance directive in the client's chart. 4. Give the original advance directive to the client.

2. Instruct the client to discuss the AD with significant others. Rationale: This is the most important intervention because the legality of the document is sometimes not honored if the family members disagree and demand other action. If the client's family is aware of the client's wishes, then the health-care team can support and honor the client's final wishes.

The nurse is discussing placing the client diagnosed with chronic obstructive pulmonary disease (COPD) in hospice care. Which prognosis must be determined to place the client in hospice care? 1. The client is doing well but could benefit from the added care by hospice. 2. The client has a life expectancy of six (6) months or less. 3. The client will live for about one (1) to two (2) more years. 4. The client has about eight (8) weeks to live and needs pain control.

2. The client has a life expectancy of six (6) months or less. Rationale: The HCP must think that, without life-prolonging treatment, the client has a life expectancy of six (6) months or less. The client may continue receiving hospice care if the client lives longer.

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. The client may have rapid mood swings and become easily upset. Rationale: These are psychosocial manifestations of PD. These should be discussed in the support meeting.

Which situation would cause the nurse to question the validity of an AD when caring for the elderly client? 1. The client's child insists the client make his or her own decisions. 2. The nurse observes the wife making the husband sign the AD. 3. A nurse encouraged the client to think about end-of-life decisions. 4. A friend witnesses the client's signature on the AD form.

2. The nurse observes the wife making the husband sign the AD. Rationale: This is coercion and is illegal when signing an AD. The AD must be signed by the client's own free will; an AD signed under duress may not be valid.

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. "I will schedule appointments late in the morning after his morning bath." Rationale: 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.

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. Carbidopa makes more levodopa available to the brain. Rationale: 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.

The client with an AD tells the nurse, "I have changed my mind about my AD. I really want everything possible done if I am near death since I have a grandchild." Which action should the nurse implement? 1. Notify the health information systems department to talk to the client. 2. Remove the AD from the client's chart and shred the document. 3. Inform the client he or she has the right to revoke the AD at any time. 4. Explain this document cannot be changed once it is signed.

3. Inform the client he or she has the right to revoke the AD at any time. Rationale: The client must be informed the AD can be rescinded or revoked at any time for any reason verbally, in writing, or by destroying his or her own AD. The nurse cannot destroy the client's AD, but the client can destroy his or her own.

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

3. Memory deficits. Rationale: 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 male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent and the client's wife tells the nurse, "Help him please. Do something. I am not ready to let him go." Which action should the nurse take? 1. Ask the wife if she would like to revoke her husband's AD. 2. Leave the wife at the bedside and notify the hospital chaplain. 3. Sit with the wife at the bedside and encourage her to say good-bye. 4. Request the client to tell the wife he is ready to die, and don't do anything.

3. Sit with the wife at the bedside and encourage her to say good-bye. Rationale: At the time of death, loved ones become scared and find it difficult to say good-bye. The nurse should support the client's decision and acknowledge the wife's psychological state. Research states hearing is the last sense to go, and talking to the dying client is therapeutic for the client and the family.

The hospice care nurse is conducting a spiritual care assessment. Which statement is the scientific rationale for this intervention? 1. The client will ask all of his or her spiritual questions and get answers. 2. The nurse is able to explain to the client how death will affect the spirit. 3. Spirituality provides a sense of meaning and purpose for many clients. 4. The nurse is the expert when assisting the client with spiritual matters.

3. Spirituality provides a sense of meaning and purpose for many clients. Rationale: Clients facing death may wish to find meaning and purpose in life through a higher power. This gives the clients hope, even if the life on earth will be temporary.

In which client situation would the AD be consulted and used in decision making? 1. The client diagnosed with Guillain-Barré who is on a ventilator. 2. The client with a C6 spinal cord injury in the rehabilitation unit. 3. The client in end-stage renal disease who is in a comatose state. 4. The client diagnosed with cancer who has Down syndrome.

3. The client in end-stage renal disease who is in a comatose state. Rationale: The client must have lost decision-making capacity as a result of a condition which is not reversible or must be in a condition specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD.

The nurse is moving to another state which is part of the multistate licensure compact. Which information regarding ADs should the nurse be aware of when practicing nursing in other states? 1. The laws regarding ADs are the same in all the states. 2. Advance directives can be transferred from state to state. 3. A significant other can sign a loved one's advance directive. 4. Advance directives are state regulated, not federally regulated.

4. Advance directives are state regulated, not federally regulated. Rationale: The state determines the definition of terms and requirements for an AD; individual states are responsible for specific legal requirements for ADs.

The client asks the nurse, "When will the durable power of attorney for health care take effect?" On which scientific rationale would the nurse base the response? 1. It goes into effect when the client needs someone to make financial decisions. 2. It will be effective when the client is under general anesthesia during surgery. 3. The client must say it is all right for it to become effective and enforced. 4. It becomes valid only when the clients cannot make their own decisions.

4. It becomes valid only when the clients cannot make their own decisions. Rationale: The client must have lost decision-making capacity as a result of a condition which is not reversible or must be in a condition which is specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD.

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. Masklike facies and a shuffling gait. Rationale: 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.

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. Offer six (6) meals per day with a soft consistency. Rationale: 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. The client will be able to carry out activities of daily living. Rationale: 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 presenting an in-service discussing do not resuscitate (DNR) orders and advance directives. Which statement should the nurse discuss with the class? 1. Advance directives must be notarized by a notary public. 2. The client must use an attorney to complete the advanced directive. 3. Once the DNR is written, it can be used for every hospital admission. 4. The health-care provider must write the DNR order in the client's chart.

4. The health-care provider must write the DNR order in the client's chart. Rationale: The HCP writes the DNR order in the client's chart, and the client completes the AD.

The client diagnosed with end-stage congestive heart failure and type 2 diabetes is receiving hospice care. Which action by the nurse demonstrates an understanding of the client's condition? 1. The nurse monitors the blood glucose four (4) times a day. 2. The nurse keeps the client on a strict fluid restriction. 3. The nurse limits the visitors the client can receive. 4. The nurse brings the client a small piece of cake.

4. The nurse brings the client a small piece of cake. Rationale: The client may have diabetes, but the client is also terminal, and allowing some food for pleasure is understanding of the client's life expectancy.

A middle-aged female client tells the nurse that she is noticing a slight tremor of her left hand when at rest. The client is concerned that she has Parkinson disease, as her mother had the illness and passed away because of respiratory failure. What should the nurse respond to this client? A) "Having a first-degree relative with the illness can increase your chance of developing it as well." B) "You should not worry, as it has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably do not have it, as your mother was probably exposed to a toxin that caused the disease."

A) "Having a first-degree relative with the illness can increase your chance of developing it as well." Rationale: In a few individuals, PD is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client that it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing if the client's mother was exposed to toxins or if that was the cause for the disease. Parkinson disease occurs equally in males and females. Two percent of adults over age 65 have the diagnosis.

The nurse is caring for the family of a terminally ill client. The family members have been tearful and sad since the diagnosis was given. What is the best nursing diagnosis for this family? A) Anticipatory Grieving B) Hopelessness C) Complicated Grieving D) Caregiver Role Strain

A) Anticipatory Grieving Rationale: Grieving prior to the actual loss is termed anticipatory grieving. There are no assessment findings in the question that indicate complicated grieving or hopelessness. This reaction is typical of family members, so there is no indication that the family is exhibiting caregiver role strain.

The nurse is taking care of a client with terminal lung cancer who is showing signs of imminent death. What changes should the nurse expect the client to exhibit? Select all that apply. A) Decreased blood pressure B) Initial increased heart rate followed by bradycardia C) An increase in the volume of Korotkoff's sounds D) Diaphoresis E) An increase in cardiac output

A) Decreased blood pressure B) Initial increased heart rate followed by bradycardia D) Diaphoresis Rationale: The heart rate might initially increase as hypoxia develops; then the heart rate and blood pressure decrease, resulting in decreased cardiac output. Peripheral circulation decreases, leading to diaphoresis; clammy, cool skin; and changes in skin coloring. A change in pulse pressure and a decrease in the volume of Korotkoff's sounds indicate imminent death. The heart rate and blood pressure decrease, resulting in decreased cardiac output, which is a sign of imminent death.

The wife of a patient with end-stage COPD tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients. She is also concerned that, even if he were eligible for hospice care, they couldn't afford it, they'd have medical personnel constantly underfoot, and her husband would have to switch physicians. How should the nurse respond? Select all that apply. A) Inform her that a diagnosis of cancer is not required for hospice care. B) Inform her that hospice care is very expensive. C) Tell her that, even if her husband receives hospice care, he can remain under the care of his current physician. D) Tell her that, even though her husband has end-stage COPD, he is not eligible for hospice care. E) Inform her that all hospice programs provide 24/7 care.

A) Inform her that a diagnosis of cancer is not required for hospice care. C) Tell her that, even if her husband receives hospice care, he can remain under the care of his current physician. Rationale: In addition to clients who are diagnosed with cancer, a variety of clients qualify for hospice care. Hospice reinforces the client-primary physician relationship by advocating office or home visits. Hospice care is often less expensive than conventional care in the last 6 months of life. Hospice teams visit clients intermittently, although they are available 24/7 for support and care.

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for a 65-year-old client with Parkinson disease. Which interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range of motion E) High-intensity treadmill training

A) Low-intensity treadmill training C) Use of resistance bands D) Active and passive range of motion E) High-intensity treadmill training Rationale: Research studies have shown improvements on the 6-minute walk test of individuals with Parkinson disease after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.

A client with Parkinson disease tells the nurse that it is 1950 and he is late for work. What action should the nurse take at this time? A) Orient the client, provide a calendar, and place a clock in the room. B) Ask the client what life is like in 1950. C) Medicate for confusion. D) Apply restraints so the client will not attempt to get out of bed to go to work.

A) Orient the client, provide a calendar, and place a clock in the room. Rationale: Clients with Parkinson disease may demonstrate confusion and disorientation. This is what the client is demonstrating. The nurse should orient the client, provide a calendar, and place a clock in the room to assist with ongoing orientation. The nurse should not medicate the client for confusion or apply restraints. The nurse should not feed into the confusion by asking what life is like in 1950.

A client complains of a right-hand tremor, increasing weakness, and muscles feeling tight. The nurse notes the client has poor voice volume and facial muscles do not move easily. What do these assessment findings suggest to the nurse? A) Parkinson disease B) Spinal cord injury C) Cerebral vascular accident D) Multiple sclerosis

A) Parkinson disease Rationale: Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, indicating Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebral vascular accident.

A competent elderly client has a living will that expresses the client's desire to avoid resuscitation and heroic life support measures. The family members are not supportive of this directive and plan to contest the living will. Which nursing action is the most appropriate? A) Place the document on the chart. B) Contact the Social Services department. C) Explain to the client that the conflict could invalidate the document. D) Notify the hospital attorney.

A) Place the document on the chart. Rationale: The client is competent. The wishes of the client must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department or the unit supervisor will need to be contacted. There is no need to notify the hospital attorney at this time. A lack of support by the family, or a plan to contest, does not invalidate the document legally.

A client with gastric cancer receives morphine every 3 hours but is still experiencing​ pain, despite the last dose 1.5 hours ago. What should the nurse​ do? A. Administer a fentanyl lozenge for breakthrough per a standing order. B. Return in an hour to administer the next dose of medicine. C. Administer the next dose of morphine a little early. D. Provide a gentle massage to help relieve discomfort until the next dose.

A. Administer a fentanyl lozenge for breakthrough per a standing order. Rationale: Breakthrough pain is a common problem in clients with severe cancer pain. Clients will need a continuous medication for pain in addition to a​ fast-acting medication for breakthrough pain. A massage may not be effective against cancer breakthrough​ pain, and​ it's inappropriate to make the client wait another hour before giving another dose of pain medicine. The nurse should not administer the morphine earlier than it is ordered

A terminally ill client has a dry mouth and refuses to take any food or fluids by mouth. Which intervention should the nurse implement for this​ client? A. Apply moist sponges to the mouth and lips. B. Place a nasogastric tube to administer artificial feeding. C. Administer intravenous fluids to maintain hydration level. D. Feed the client ice chips or popsicles.

A. Apply moist sponges to the mouth and lips. Rationale: Application of moist sponges to the mouth and lips can help relieve dry mouth in clients who are refusing to eat or drink. Administration of intravenous fluids or a nasogastric tube may be possible interventions but require an order from the healthcare provider and may be refused by the client or the healthcare proxy. Attempting to feed the client ice chips or popsicles after refusal of taking in other foods or liquids is insensitive to the wishes of the client.

The nurse notes that several terminally ill pediatric clients do not have advanced care planning. The nurse should recognize that which are the top three barriers that hinder the completion of this​ planning? (Select all that​ apply.) A. Differences in understanding of the​ child's prognosis between clinicians and parents B. Lack of parent readiness to discuss the need for palliative care C. Lack of financial means D. Lack of formal pediatric palliative care training by the healthcare provider E. Unrealistic parent expectations

A. Differences in understanding of the​ child's prognosis between clinicians and parents B. Lack of parent readiness to discuss the need for palliative care E. Unrealistic parent expectations ​Rationale: The top three barriers to advanced care planning for children are unrealistic parental​ expectations, differences in understanding of the​ child's prognosis between clinicians and​ parents, and lack of parent readiness to discuss the need for palliative care. Lack of financial means and lack of formal pediatric palliative care training are other barriers for care but are not among the top three.

The nurse cares for a client who is approaching the end of life. Which sign indicates that the client is nearing​ death? (Select all that​ apply.) A. Increase in sleeping B. Increase in confusion C. Apneic periods D. Restlessness E. Periods of intense hunger

A. Increase in sleeping B. Increase in confusion C. Apneic periods D. Restlessness ​Rationale: Signs that indicate a person is nearing death include increased​ confusion, increased periods of​ sleep, apneic​ periods, and restlessness. There is a​ decreased, not an​ increased, need for food at this time.

The nurse observes a client who is approaching end of life. For which reason should the nurse realize this​ client's blood pressure is beginning to​ decrease? A. Increasing confusion B. Decreasing body temperature C. ​Warm, clammy skin D. Rapid heart rate

A. Increasing confusion Rationale: Signs and symptoms of hypotension include​ confusion, cool​ skin, irregular​ pulse, blurry​ vision, and dizziness. Rapid heart​ rate, decreasing body​ temperature, and clammy skin are not indicative of hypotension.

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. Loss of perspiration B. Dry mouth C. Drooling D. Rigidity E. Tremors

A. Loss of perspiration B. Dry mouth 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.

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

A. Not moving too quickly B. Looking ahead instead of down D. Standing straight E. Placing the heel on the ground before the toes ​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.

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

A. Preventing injury from falls B. Promoting independence C. Participating in occupational therapy E. Improving balance 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 is the main pathology of Parkinson disease that causes changes in muscular and sensory​ function? A. Reduction of dopamine in the brain B. Genetic predisposition C. Presence of Lewy bodies D. Reduction of acetylcholine in the brain

A. Reduction of dopamine in the brain 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 15-​25% of​ cases, it is a risk factor rather than a cause of PD manifestations.

The nurse is planning care for a client with a terminal illness who is nearing the end of life. Which action should the nurse take to ensure the client receives the highest quality of​ care? (Select all that​ apply.) A. Remind the healthcare provider to discuss symptom management with the client and family. B. Explain interventions to the client and family before performing. C. Stay with the client until intravenous pain medication takes effect. D. Suggest that family members return home to get rest. E. Offer family members a quiet area to express emotions.

A. Remind the healthcare provider to discuss symptom management with the client and family. B. Explain interventions to the client and family before performing. C. Stay with the client until intravenous pain medication takes effect. E. Offer family members a quiet area to express emotions. ​Rationale: Nurses play an important role in providing quality​ end-of-life care to clients and their families by facilitating communication among​ clients, families, and​ providers; providing emotional​ support; and treating clients and their families with respect. The nurse should offer family members a quiet area to express​ emotions, explain interventions before performing​ them, stay with the client until pain medication takes​ effect, and remind the healthcare provider to talk with the family and client about symptom management. While it is important for family members to receive adequate​ rest, the nurse would not suggest they return home to do this. If rest is​ needed, the family can be provided with a quiet place to recharge.

The adult daughter of a client who is nearing death questions the quality of care being provided to the client. What should the nurse do to support the​ daughter's needs during the dying​ process? A. Respond to the​ daughter's concerns. B. Ask the healthcare provider to talk with the daughter. C. Suggest that the daughter go home to get some rest. D. Permit the daughter to spend uninterrupted time with the client.

A. Respond to the​ daughter's concerns. Rationale: The nurse needs to support the family through the grieving process. To do​ this, the nurse should respond to the​ daughter's concerns. Suggesting that the daughter go home to get some rest does not address the​ daughter's concerns about quality of care. The nurse can talk to the daughter about the quality of care and does not need to contact the healthcare provider. Permitting the daughter to spend uninterrupted time with the client might exacerbate the feeling that care is less than optimal.

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

A. Response to medication B. Cognitive deficits C. Bowel changes ​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.

The nurse wants to help with a terminally ill​ client's discomfort. Which complementary and alternative therapy should the nurse consider for this​ client? (Select all that​ apply.) A. Simple touch B. Yoga C. Massage D. Biofeedback E. Acupressure

A. Simple touch C. Massage ​Rationale: The interventions of massage and simple touch have been found effective to reduce pain and improve mood in the client nearing the end of life.​ Yoga, biofeedback, and acupressure are not identified as complementary and alternative therapies used during​ end-of-life nursing care.

The hospital administrator is expanding the palliative care area in a major metropolitan city hospital. When planning for this care​ area, which member of the healthcare team should the administrator realize is most likely to notice subtle changes in the​ client's condition and communicate them to the rest of the​ team? A. The nurse B. The social worker C. The spiritual advisor D. The healthcare provider

A. The nurse Rationale: Nurses interact with clients most​ frequently, so they are responsible for communicating changes to the rest of the healthcare and collaborative team. The nurse must be vigilant to these changes and ensure appropriate and timely communication with the healthcare​ provider, family​ members, social​ workers, psychologists, or spiritual advisors.

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

A. Tremors at rest and bradykinesia ​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.

The nurse is caring for a pediatric client with a terminal illness. When should palliative care be initiated for this​ child? A. Upon diagnosis with a​ life-threatening illness B. As death approaches C. When officially diagnosed as terminal D. At the time the parents are prepared

A. Upon diagnosis with a​ life-threatening illness Rationale: Palliative care is best initiated when a child is first diagnosed with a​ life-threatening illness. This ensures that appropriate and rational care planning can occur early in the course of the​ child's disease when there​ isn't a crisis. Waiting until the child is diagnosed as terminal or death is imminent may cause conflict down the line. The parents may never decide that they are ready for palliative​ care, which can also cause conflict or poor care planning.

The nurse completes teaching for a 22-year-old client diagnosed with Parkinson disease (PD). Which client statement indicates teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused PD." C) "My brain has too much of a chemical called dopamine." D) "Most people get PD when they are my age."

B) "I probably have a genetic mutation that caused PD." Rationale: Early-onset Parkinson disease is likely due to a genetic mutation. Increasing age is a risk factor for PD; age 22 is uncommon. In PD there is a deficit of available dopamine. Although a healthy diet avoiding pesticides is recommended, it is not a proven causative agent.

The nurse instructs a client with Parkinson disease about carbidopa-levodopa (Sinemet). Which client statement indicates that teaching has been effective? A) "I will take the medication with my meals." B) "I will sit up for several minutes to gain my balance before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "This medication will cure my Parkinson disease in time."

B) "I will sit up for several minutes to gain my balance before going from lying down to standing up." Rationale: Carbidopa-levodopa is a medication that replaces the dopamine that is lacking in clients with Parkinson disease. This medication is likely to cause orthostatic hypotension, so the client must take care when changing positions from lying to standing. The medication should be taken 1 hour before or 2 hours after meals to promote absorption of the medication. There is no medication known to cure Parkinson disease. Care must be taken if the client is also taking medications to lower the blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.

A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would suggest a positive finding for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B) Dystonia C) Retropulsion E) Festination Rationale: The Unified Parkinson Disease Rating Scale (UPDRS) rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.

A client with Parkinson disease ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety

B) Impaired Physical Mobility Rationale: The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping and Anxiety at this time.

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. "Can you let her dress​ herself? B. "It is best for you to let your mother dress herself for as long as she​ can." C. "That is really quite​ normal." D. "It is important for you to get to work on​ time."

B. "It is best for you to let your mother dress herself for as long as she​ can." 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.

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

B. Alterations in sleep pattern ​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.

The nurse has been asked to serve as a point person for a family with a child who is dying in the PICU. Which function should the nurse prepare to perform in this​ role? A. Address the emotional and informational needs of the family. B. Develop a trusting relationship with the parents. C. Organize care​ before, during, and after death. D. Articulate the​ family's wishes to the healthcare team.

B. Develop a trusting relationship with the parents. Rationale: The point person will develop a trusting and unique relationship with the parents while their child is in the PICU. The family advocate will help to articulate the​ family's wishes to the healthcare team. The family supporter will address the emotional and informational needs of the family. The​ end-of-life coordinator will organize care​ before, during, and after death.

Which recommendation should the nurse make to a client with Parkinson disease who reports​ constipation? (Select all that​ apply.) A. Decreasing fluid intake B. Increasing fluid intake C. Decreasing fiber intake D. Increasing fiber intake E. Limiting exercise

B. Increasing fluid intake D. Increasing fiber intake ​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.

The nurse prepares an educational program on palliative care for a group of oncology nurses. For which age group should the nurse emphasize that palliative care is often​ neglected? A. Older adults B. Infants C. Adolescents D. Children

B. Infants ​Rationale: Palliative care tends to be neglected in infants and very young​ children, though they should receive this type of care in the same way that adults do. Nurses are more likely to identify​ children, adolescents,​ adults, and older adults as potential candidates for palliative care.

The spouse of a terminally ill client who has just passed away sits at the​ bedside, holds the​ client's hand, and cries softly. What action should the nurse take to support the spouse at this​ time? (Select all that​ apply.) A. Remind the spouse that the client will need to be moved in a short while. B. Provide the spouse with water and tissues. C. Ask if there is anyone that should be contacted at this time. D. Ask if the spouse would like to talk with someone about the​ client's death. E. Ask if there is a particular funeral home that should be contacted.

B. Provide the spouse with water and tissues. C. Ask if there is anyone that should be contacted at this time. D. Ask if the spouse would like to talk with someone about the​ client's death. E. Ask if there is a particular funeral home that should be contacted ​Rationale: Considerations for the family at the end of life include assisting the family to cope with the​ client's health status. Interventions should focus on providing the family with emotional support and referring the family to funeral​ homes, grief​ counseling, and support groups if appropriate. The nurse should provide the spouse with water and tissues to help meet physical needs. Asking if there is anyone that should be contacted helps to meet the​ spouse's psychosocial needs. Asking about a funeral home or if the spouse would like to talk with someone about the​ client's death helps meet the​ spouse's grieving needs. Reminding the spouse that the client will need to be moved does not support any of the​ spouse's needs at this time.

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

B. Speech 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.

A client has not been told about dying but anticipates that death is near. In which state of awareness is this​ client? A. Open B. Suspected C. Closed D. Mutual pretense

B. Suspected Rationale: In suspected​ awareness, no one directly tells the client about the​ condition, but the client begins to suspect that death is near. In open​ awareness, the​ client, family, and healthcare team know about the​ client's impending death and discuss it openly. In closed​ awareness, the client is unaware of impending​ death, even though the healthcare team and family are aware. In mutual pretense​ awareness, the​ client, family, and healthcare team all know that the​ client's condition is​ terminal, but no one discusses it.

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 participate in speech therapy for swallowing and verbal communication. B. The client will remain free from injury. 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.

B. The client will remain free from injury. E. The client will participate in physical therapy to improve walking and balance. 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 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's blood pressure increases when the client stands up. B. The​ client's facial expression shows no emotion. C. The client has hand tremors at rest. D. The client does not remember what he ate for breakfast. E. The client has slurred speech.

B. The​ client's facial expression shows no emotion. C. The client has hand tremors at rest. D. The client does not remember what he ate for breakfast. E. The client has slurred speech. 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.

The nurse reviews data collected during an assessment of a terminally ill client. Which nursing diagnosis should the nurse select as this client nears​ death? (Select all that​ apply.) A. Fluid​ Volume: Deficient, Risk for B. Tissue​ Integrity, Impaired C. Comfort, Impaired D. Sleep​ Pattern, Disturbed E. Nutrition, Imbalanced: Less than Body Requirements

B. Tissue​ Integrity, Impaired C. Comfort, Impaired D. Sleep​ Pattern, Disturbed ​Rationale: The main objective for care as a patient nears death is comfort.​ Therefore, nursing diagnoses appropriate for a client nearing death include ​Comfort, Impaired; Tissue​ Integrity, Impaired​; and Sleep​ Pattern, Disturbed. While a client nearing death will have altered nutrition and fluid volume​ deficit, these would be considered manifestations and not necessarily client problems that the nurse would address at this stage.​ (NANDA-I ©​ 2014)

A client in significant pain from metastatic bone cancer begs the nurse to help him die. How should the nurse​ respond? A. "Let's talk about hospice​ care." B. ​"Euthanasia is​ illegal, but​ I'll have the pain management team come to see you​ immediately." C. ​"Let me get the appropriate paperwork for you to​ sign." D. ​"You must have your attorney get a court order and bring it to the hospital​ first."

B. ​"Euthanasia is​ illegal, but​ I'll have the pain management team come to see you​ immediately." Rationale: It is important for the nurse to address and appropriately manage the​ client's pain, even though active euthanasia is illegal in all 50 states. Signing paperwork or getting a court order will not help the client in this situation. Talking about hospice​ care, though it may be​ appropriate, dismisses the​ client's concern at this moment.

A spouse expresses frustration when trying to communicate with a client with Parkinson disease. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest the spouse obtain a hearing aid. C) Consult with Speech Therapy for exercises to aid with speech and language. D) Suggest communicating by writing.

C) Consult with Speech Therapy for exercises to aid with speech and language. Rationale: The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with Speech Therapy for exercises to aid with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write, because of hand tremors.

The nurse, planning care for a client with Parkinson disease, identifies which intervention as supporting mobility while providing the spouse with an activity that is beneficial for the client? A) Suggest the spouse use a blender to make foods easier for the client to swallow. B) Review the medication administration schedule with the spouse. C) Instruct the spouse to ambulate the client at least four times a day. D) Instruct the spouse on proper turning and repositioning techniques.

C) Instruct the spouse to ambulate the client at least four times a day. Rationale: Since exercise fosters independence and self-esteem, the intervention that would support physical mobility while providing the spouse with an activity beneficial for the client would be to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing will not support physical mobility. Reviewing the medication administration schedule will not support physical mobility.

The nurse is evaluating the care of a client with Parkinson disease. Which finding indicates an improvement in nutritional status? A) The client was observed providing morning self-care and dressing. B) The client coughs frequently when drinking fluids. C) The client was able to feed self and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.

C) The client was able to feed self and had no weight change in 1 week. Rationale: Evidence that interventions to improve the client's nutritional status were effective would be the client's self-feeding with no change in weight. Observing the client with morning self-care and dressing does not evaluate interventions to address nutritional status. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.

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. "You need to start getting​ out." C. "Can I ask why you​ aren't going out of the​ house?" D. "Getting out of the house will help you to feel less​ depressed."

C. "Can I ask why you​ aren't going out of the​ house?" 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.

An adolescent client with a terminal illness wishes to discontinue further treatment. Which action should the nurse take at this​ time? A. Explain that there is nothing that can be done until the teen turns 18. B. Contact the healthcare provider for a​ DNR/DNI order. C. Arrange a meeting between the​ teen, the​ parents, and the healthcare team. D. Give the consent form to the teen to sign.

C. Arrange a meeting between the​ teen, the​ parents, and the healthcare team. Rationale: Teens, especially teens with a chronic or terminal medical​ illness, have a strong desire for autonomy and are cognitively able to participate in their​ care, despite the law not allowing them to make formal decisions until they turn 18. The nurse should arrange a meeting between the​ teen, the​ parents, and the healthcare team to discuss the​ teen's feelings and wishes and the different options available.

A client is requesting to sign a document that designates someone to make healthcare decisions in case they are not able to do it. Which document should the nurse recommend to this​ client? A. DNR order B. Durable power of attorney C. Healthcare proxy D. Living will

C. Healthcare proxy ​Rationale: A healthcare proxy designates an individual to make healthcare decisions in case the client is not able. A durable power of attorney allows the selected individual to make legal decision for the client. A living will describes the​ client's treatment preferences for​ life-prolonging treatment. A DNR order is also known as a​ do-not-resuscitate order and allows the healthcare team to withhold​ life-saving measures in the event of a cardiac or respiratory arrest.

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

C. Holding a piece of bread in the other hand while eating ​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.

A client with a terminal illness does not want to receive cardiopulmonary resuscitation. Which medical order should the nurse expect to be written for this​ client? A. Involuntary euthanasia B. Do-not-intubate (DNI) C. ​Do-not-resuscitate (DNR) D. Voluntary euthanasia

C. ​Do-not-resuscitate (DNR) Rationale: A​ do-not-resuscitate order​ (DNR) is a medical order that states the​ client's wishes to withhold cardiopulmonary resuscitation​ (CPR) in the event of respiratory or cardiac arrest. A​ do-not-intubate order​ (DNI) prohibits endotracheal intubation in the event of severe respiratory failure or respiratory arrest. Voluntary euthanasia occurs when the client or the​ client's family gives consent for the actions that will result in death for the client. Involuntary euthanasia is defined as euthanasia performed against the wishes of the client or the​ client's family.

The nurse is caring for a Catholic client who has suffered a massive cerebral hemorrhage and is not expected to survive. Which intervention is most appropriate? A) Discuss the need to cremate the client, as burial is not accepted in this faith. B) Make plans for the family to wash the body after death. C) Contact a rabbi so that the client can participate in prayer. D) Contact a priest to deliver the Sacrament of the Sick.

D) Contact a priest to deliver the Sacrament of the Sick. Rationale: In the Catholic faith, it is common to receive the Sacrament of the Sick from a priest in order to receive spiritual strength and prepare for death. Contacting a rabbi would be appropriate for a Jewish client, and making plans for the family to wash the body is appropriate for the Muslim faith. Cremation is not preferred over burial in the Catholic faith.

An older client with terminal lung cancer is not breathing well and has cold and mottled skin. The client has a living will and requests comfort measures only. What should the nurse do to help this client? A) Ask the family what they want to be done for the client. B) Withhold all care until the client dies. C) Contact the physician for orders to control the client's breathing. D) Provide the client with pain medication as ordered.

D) Provide the client with pain medication as ordered. Rationale: "Comfort measures only" indicates that the client does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide client comfort is intensified and maintained through the end stages of the client's life. Nursing care will include the administration of pain medication and providing personal hygiene and nutrition. Asking the family what they want to be done is inappropriate when a client has written a living will. Contacting the physician to intervene to control respiration is considered adding extraordinary measures and is inappropriate, as is going against the client's written wishes when a living will is present and in force.

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 causes spinal cord neurons to transmit​ impulses." B. ​"Dopamine stimulates the neurons to transmit sensory and motor​ impulses." C. ​"Dopamine enhances the action of​ acetylcholine." D. "Dopamine helps maintain coordinated motor​ movement."

D. "Dopamine helps maintain coordinated motor​ movement." 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 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 will make you feel​ better." B. "The healthcare provider thinks it will help your​ symptoms." C. ​"It helps dopamine work​ better." D. "It will help reduce tremors and uncontrolled​ drooling."

D. "It will help reduce tremors and uncontrolled​ drooling." 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.

The nurse notices that a client who is dying is refusing to visit with family. What should the nurse consider this client is​ demonstrating? A. Major depression B. Dysfunctional grieving C. Unresolved family problems D. Anticipatory grief

D. Anticipatory grief Rationale: Anticipatory grief can result in a dying person distancing themselves from family or friends in an attempt to minimize the pain of loss. This is not a sign of unresolved family​ problems, dysfunctional​ grieving, or major depression.

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. Falls, Risk for B. Communication: Verbal, Impaired C. Nutrition, Imbalanced: Less than Body Requirements D. Caregiver Role Strain

D. Caregiver Role Strain 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.​ (NANDA-I ©​ 2014)

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 is the result of an infection. B. Parkinson disease affects both men and women at the same rate. 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. Parkinson disease usually affects people older than the age of 60 years. Rationale: The cause of PD is not known. There is no evidence of an infection that causes Parkinson disease. It is inherited in only 15-​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 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. Tell the client that this is part of the disease process that cannot be stopped B. Ask the client if they know about the medications to treat the stiffness C. Advise bedrest for muscle recovery D. Recommend a regular exercise routine and walking

D. Recommend a regular exercise routine and walking 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.

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. Running B. Football C. Weight lifting D. T'ai chi

D. T'ai chi ​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.