Osteoarthritis & Parkinson's Disease In Class Assignment
Which condition or action represents a modifiable risk factor for prevention of osteoarthritis? A)Obesity B)Hypertension C)Cigarette Smoking D)Walking as exercise
Answer: A Obesity Obesity increases the stress on weight-bearing joints and contributes to the development of degenerative joint disease
The client with Parkinson's disease has been taking a combination carbidopa-levodopa drug (Sinemet) for 3 years. Which of the following side effects should the nurse be alert for in this client as a result of this medication? •A) Constipation •B) Abnormal movements •C) Malabsorption syndrome •D) Increased resting heart rate
Answer: B Abnormal Movements •Rationale: Following 3 or more years of treatment, about one third of clients develop involuntary movements that are thought to be treatment-related.
Which statement regarding the pathophysiology of Parkinson's disease is true? •A) Alteration in neuronal signals from the basal ganglia cause dopamine levels to increase. •B) Degeneration of the substantia nigra leads to a decrease in dopamine levels. •C) Cerebellar levels of acetylcholine rise, inhibiting voluntary movement. •D) The cerebral cortex fails to use available acetylcholine.
Answer: B Degeneration of the substantia nigra leads to a decrease in dopamine levels. Rationale: •Parkinson's disease (PD) is believed to be caused by a genetic defect in chromosome 4. PD is caused by widespread degeneration of the substantia nigra, which leads to a decrease in dopamine. As dopamine levels decrease, the individual loses the ability to refine voluntary movements.
Which physical change in the client with osteoarthritis indicates disease advancement? •A) The hands are involved •B) The hip shows subluxation •C) Hip involvement is bilateral •D) The client is older than 65 years
Answer: B The hip shows subluxation •Rationale: Partial joint dislocation or subluxation is an indication of progressive disease in which the repair processes stimulated by the continuing damage are unable to keep pace with the rapid degeneration. Severely damaged joints do not keep the proximal and distal bones in anatomic alignment.
Which joints are most frequently affected by arthritis? •A) Jaw and Ankles •B) Neck and Wrists •C) Hips and Knees •D) Elbows and Shoulders
Answer: C Hips and KNEES •Rationale: Degenerative joint disease is known as the "wear and tear" consequences of joint use. Weight-bearing joints are most commonly affected by degenerative joint disease.
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.) The client has hand tremors at rest. The client does not remember what he ate for breakfast. The client's facial expression shows no emotion. The client has slurred speech. The client's blood pressure increases when the client stands up.
Correct! The client has hand tremors at rest. Correct! The client does not remember what he ate for breakfast. Correct! The client's facial expression shows no emotion. Correct! 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.
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? "You need to start getting out." "Can I ask why you aren't going out of the house?" "Tell your family to come and take you out of the house." "Getting out of the house will help you to feel less depressed."
Correct! "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.
A client newly diagnosed with Parkinson disease asks the nurse, "What does dopamine do in the brain?" Which is the most appropriate response? "Dopamine enhances the action of acetylcholine." "Dopamine stimulates the neurons to transmit sensory and motor impulses." "Dopamine causes spinal cord neurons to transmit impulses." "Dopamine helps maintain coordinated motor movement."
Correct! "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.
A client diagnosed with osteoarthritis asks the nurse, "If I am losing the cartilage in my knees, why do my knees look larger?" Which response should the nurse give? "Your knees have developed contractures, increasing the size of the knees." "The muscle mass is increasing as a result of the exercises you must do." "Sometimes inflammation increases the size of your knees or fluid buildup occurs." "Although the cartilage is destroyed, you may be building up more bone in the knee."
Correct! "Sometimes inflammation increases the size of your knees or fluid buildup occurs." Rationale: Inflammation causes swelling of the knee joint, which makes the joint appear larger. Joint effusion or fluid buildup may also occur. An increase in bone or muscle tissue does not occur in osteoarthritis. Flexion contractures may develop with osteoarthritis of the knee joint, but this will not result in an increase in the size of the joint.
The nurse is teaching a class about the joints commonly affected by osteoarthritis (OA). Which joints should the nurse include? Ankles, feet, and spine Hands, knees, and hips Neck, shoulder, and ankles Knees, Feet, and Spine
Correct! Hands, knees, and hips Rationale: Hands, knees, and hips are the most commonly affected joints of OA. Feet, spine, neck, shoulders, and ankles are not the most common locations
After performing a physical assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis (OA). Which finding supports the nurse's suspicion? (Select all that apply.) Joint stiffness Reduced joint flexibility Leg tremors Crepitation
Correct! Joint stiffness Correct! Joint tenderness Correct! Reduced joint flexibility Correct! Crepitation Rationale: Manifestations of OA include crackling sounds, or crepitation, with joint movement; joint stiffness and tenderness; and reduced joint flexibility. Leg tremors can be associated with multiple sclerosis or Parkinson disease.
Which is a common risk factor for osteoarthritis? (Select all that apply.) Activities affecting weight-bearing joints Autoimmune disorder Obesity Overuse of joints from sports or strenuous activities Ingestion of large amounts of purine
Correct! Obesity Correct! Overuse of joints from sports or strenuous activities Correct! Activities affecting weight-bearing joints Rationale: Common risk factors for osteoarthritis include obesity, overuse of joints from sports injuries or strenuous activities, and activities affecting weight-bearing joints. Rheumatoid arthritis is thought to be an autoimmune disorder. Ingestion of large amounts of purines is a risk factor for gout.
Which is the main pathology of Parkinson disease that causes changes in muscular and sensory function? Presence of Lewy bodies. Reduction of dopamine in the brain. Reduction of acetylcholine in the brain. Genetic predisposition.
Correct! 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
Which clinical manifestation would be required to confirm the diagnosis of Parkinson disease? Rigidity only Bradykinesia only Tremor at rest and flaccidity Tremors at rest and bradykinesia
Correct! 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.
A client diagnosed with localized idiopathic osteoarthritis (OA) asks the nurse what this means. Which response by the nurse provides the most accurate information? "Idiopathic OA, as compared with secondary OA, is caused by some kind of underlying condition." "Idiopathic describes OA overall while localized indicates that it affects one body joint only." "Idiopathic refers to the fact that the OA has already progressed significantly in one or two joints." "Idiopathic OA has no identifiable cause; when it is localized, it only affects one or two joints."
Correct! "Idiopathic OA has no identifiable cause; when it is localized, it only affects one or two joints." Rationale: There are two types of OA, idiopathic and secondary. Idiopathic OA has no identifiable cause and can be further subdivided as localized or generalized, with localized indicating that the OA only affects one or two joints, so stating that it has no identifiable cause and is limited to one or two joints would be the most accurate response. Idiopathic OA is not due to an underlying condition. Idiopathic refers to cause, not progression of the disease. Idiopathic is not a term used in general for OA, nor does the term localized indicate that affected joints are either in the upper or lower torso.
