Parkinson's NCLEX
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77. The charge nurse is making assignments. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. 2. The client diagnosed with Parkinson's disease who fell during the night and is complaining of difficulty walking. 3. The client diagnosed with a cerebrovascular accident whose vitals signs are P 60, R 14, and BP 198/68. 4. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes.
1. Headache and photophobia are expected clinical manifestations of meningitis. The new graduate could care for this client.
76. The nurse and the unlicensed assistive personnel (UAP) are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? 1. Feed the 69-year-old client diagnosed with Parkinson's disease who is having difficulty swallowing. 2. Turn and position the 89-year-old client diagnosed with a pressure ulcer secondary to Parkinson's disease. 3. Assist the 54-year-old client diagnosed with Parkinson's disease with toilet-training activities. 4. Obtain vital signs on a 72-year-old client diagnosed with pneumonia secondary to Parkinson's disease.
1. The nurse should not delegate feeding a client who is at risk for complications during feeding. This requires judgment that the UAP is not expected to possess.
73. 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 places the client at risk for aspiration. Immobility predisposes the client to pneumonia. Both clinical manifestations place the client at risk for pulmonary complications.
83. 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. These are psychosocial manifestations of PD. These should be discussed in the support meeting.
84. 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. 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.
74. 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 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.
82. Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia.
3. Memory deficits are cognitive impairments. The client may also develop a dementia.
80. 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. 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.
79. 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. Fetal tissue transplantation has shown some success in PD, but it is an experimental and highly controversial procedure.
81. 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 are two clinical manifestations of PD.
75. 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. 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.
78. 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 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.
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
Answer: 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.
30. An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson's disease? A) "Lately he seems to move far more slowly than he ever has in the past." B) "He often complains that his joints are terribly stiff when he wakes up in the morning." C) "He's forgotten the names of some people that we've known for years." D) "He's losing weight even though he has a ravenous appetite."
Ans: A Feedback: Parkinson's disease is characterized by bradykinesia. It does not manifest as memory loss, increased appetite, or joint stiffness.
33. The nurse caring for a patient diagnosed with Parkinson's disease has prepared a plan of care that would include what goal? A) Promoting effective communication B) Controlling diarrhea C) Preventing cognitive decline D) Managing choreiform movements
Ans: A Feedback: The goals for the patient may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Constipation is more likely than diarrhea and cognition largely remains intact. Choreiform movements are related to Huntington disease.
A patient with suspected Parkinson's disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? A) When the patient is resting B) When the patient is ambulating C) When the patient is preparing his or her meal tray to eat D) When the patient is participating in occupational therapy
Ans: A Feedback: The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the patient is not performing deliberate actions.
34. The nurse is caring for a patient diagnosed with Parkinson's disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? A) Use of a bedpan B) Use of a raised toilet seat C) Sitting quietly on the toilet every 2 hours D) Following the outlined bowel program
Ans: B Feedback: A raised toilet seat is useful, because the patient has difficulty in moving from a standing to a sitting position. A handicapped toilet is not high enough and will not aid in improving bowel elimination. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position; neither will following the outlined bowel program.
6. The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patient's ADLs, what goal should the nurse prioritize? A) Promoting the patient's recovery from the disease B) Maximizing the patient's level of function C) Ensuring the patient's adherence to treatment D) Fostering the family's participation in care
Ans: B Feedback: Priority for the care of the child with muscular dystrophy is the need to maximize the patient's level of function. Family participation is also important, but should be guided by this goal. Adherence is not a central goal, even though it is highly beneficial, and the disease is not curable.
5. The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect of Sinemet would the nurse assesses this patient? A) Pruritus B) Dyskinesia C) Lactose intolerance D) Diarrhea
Ans: B Feedback: Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.
8. A patient with Parkinson's disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patient's nutritional needs should be met by what method? A) Total parenteral nutrition (TPN) B) Provision of a low-residue diet C) Semisolid food with thick liquids D) Minced foods and a fluid restriction
Ans: C Feedback: A semisolid diet with thick liquids is easier for a patient with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the patient's nutritional status. The patient's status does not warrant TPN.
35. A patient with Parkinson's disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond? A) "It's important to drink plenty of fluids while you're taking laxatives." B) "Make sure that you supplement your laxatives with a nutritious diet." C) "Let's explore other options, because laxatives can have side effects and create dependency." D) "You should ideally be using herbal remedies rather than medications to promote bowel function."
Ans: C Feedback: Laxatives should be avoided in patients with Parkinson's disease due to the risk of adverse effects and dependence. Herbal bowel remedies are not necessarily less risky.
11. A patient has just been diagnosed with Parkinson's disease and the nurse is planning the patient's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patient's family? A) Risk for infection B) Impaired spontaneous ventilation C) Unilateral neglect D) Risk for injury
Ans: D Feedback: Individuals with Parkinson's disease face a significant risk for injury related to the effects of dyskinesia. Unilateral neglect is not characteristic of the disease, which affects both sides of the body. Parkinson's disease does not directly constitute a risk for infection or impaired respiration.
7. A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The physician suspects the patient has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to diagnose spinal cord compression from a tumor, the nurse will most likely prepare the patient for what test? A) Anterior-posterior x-ray B) Ultrasound C) Lumbar puncture D) MRI
Ans: D Feedback: The MRI scan is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.
32. A patient who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patient's medication regimen? A) The patient is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident. B) Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. C) The patient's temporary improvement in status is likely unrelated to levodopa-carbidopa. D) Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.
Ans: D Feedback: The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time. However, a "honeymoon period" of treatment is not known.
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."
Answer: 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 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
Answer: 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.
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
Answer: 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.
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.
Answer: 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
Answer: 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.
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.
Answer: 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.
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."
Answer: 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.
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
Answer: B 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 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
Answer: 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 15dash25% 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
Answer: 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
Answer: 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.
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
Answer: 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.
Which type of therapy is used to manage problems with eating and swallowing? A. Physical B. Occupational C. Speech D. Nutritional
Answer: 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."
Answer: 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.
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
Answer: 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.
Answer: 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 15dash25% 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."
Answer: 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
Answer: 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.
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
Answer: 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.