Exemplar 13.F - Parkinson's Disease

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."

A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." In some individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client 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 whether the client's mother was exposed to toxins or if that was the cause for her disease. Men are at higher risk for PD, with 50% more men than women developing the disease, but this does not eliminate the client's risk of having the disease, especially given her mother's diagnosis.

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior

A) Dyskinesia With increasing doses and long-term exposure, levodopa usually causes dyskinesia, which may become less tolerable for the client than the symptoms of PD. Insomnia and hypertension are not side effects of levodopa. Compulsive behavior is a side effect of dopamine antagonists, not levodopa.

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following 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 exercises E) High-intensity treadmill training

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

A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis

A) Parkinson disease 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, suggesting a diagnosis of Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebrovascular accident.

The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."

B) "I probably have a genetic mutation that caused my PD." Early-onset PD is likely due to a genetic mutation. Increasing age is a risk factor for the disease, and diagnosis as a young adult is uncommon. PD is associated with decreased dopamine levels in the brain, not an excess of dopamine. Although consuming a healthy, pesticide-free diet is recommended, dietary intake has not been definitively linked to development of PD.

The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."

B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." Levodopa/carbidopa is a medication that boosts dopamine levels in clients with PD. This medication commonly causes orthostatic hypotension, so clients must take care when changing positions from lying to standing. Clients should also avoid eating protein-rich meals when taking this medication, as a high-protein diet may interfere with levodopa absorption from the GI tract. There is no medication that is known to cure Parkinson disease. Care must be taken if clients are also taking medications to lower their 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 be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B) Dystonia C) Retropulsion E) Festination The UPDRS rates clients in 42 different areas of function. Positive findings for PD include 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 (PD) 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 nursing 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 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 or Anxiety at this time.

A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity

B) Unilateral tremors Motor symptoms associated with PD usually begin unilaterally, not bilaterally. For most clients, the earliest motor symptom is tremors; rigidity usually develops later in the course of the disease.

The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."

C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." Clients with early-onset PD generally have a slower disease progression and a lower rate of dementia than clients who develop the disease later in life. The effect of PD medication on the efficacy of birth control pills is not known, so clients should be urged to consider other forms of contraception. Many women with PD have successfully carried healthy babies to full term.

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.

C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. Levodopa is a natural chemical that can cross the blood—brain barrier and be converted directly to dopamine in the brain. Levodopa can also be converted to dopamine outside the brain, which leads to the most common side effects of nausea and orthostatic hypotension. Therefore, levodopa is almost always given in combination with carbidopa, which prevents levodopa from converting to dopamine until it reaches the brain.

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. 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 that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.

C) Consult with speech therapy for exercises to aid the client with speech and language. 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 the client 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, so it may not be appropriate for the nurse to suggest that the client and spouse communicate via writing.

The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques

C) Instructing the spouse to ambulate the client at least four times a day Because exercise fosters not just mobility but also independence and self-esteem, the intervention that would be most appropriate is for the nurse 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 would not support physical mobility. Reviewing the medication administration schedule would not support physical mobility.

Which of the following is NOT a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling

C) Malignant hypertension Malignant hypertension is not a clinical manifestation of PD; orthostatic hypotension is more commonly associated with this disease. All of the other conditions listed here (restless leg syndrome, cogwheel rigidity, and pill-rolling) are frequently observed in clients with PD.

The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself 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 himself and had no weight change in 1 week. The finding that the client was able to feed himself and had no weight change in 1 week is indicative of an improvement in nutritional status. The client filling out the menu card does not indicate that the client actually consumed any of the meal. 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.