Neuro- Chapter 21

9) When assessing a client for the typical signs and symptoms of Parkinson's disease, which clinical manifestations would the nurse expect to find? 1. Tremors, a masklike facial expression, and a rigid posture 2. Shuffling gait, confusion, and postural instability 3. Tremors and hyperkinesia 4. A masklike expression and generalized muscle weakness

Answer: 1 Explanation: The classic symptoms of Parkinson's disease are tremors, muscle rigidity, bradykinesia, and postural instability.

2) When teaching a community course on health problems that the older adult client might encounter, the nurse describes a disorder that is characterized by progressive memory loss, confusion, and the inability to think clearly. Which disease process is the nurse describing? 1. Alzheimer's disease 2. Parkinson's disease 3. Schizophrenia 4. Huntington's chorea

Answer: 1 Explanation: Alzheimer's disease is a degenerative disorder characterized by progressive memory loss, confusion, and inability to think or communicate clearly and effectively.

26) The nurse is planning care for a client with Parkinson's disease. What intervention is important for the nurse to include? 1. Monitor the client's ability to chew and eat. 2. Teach the client to limit exercise to decrease the risk for fractures. 3. Assess peripheral circulation for presence of thrombophlebitis. 4. Monitor the client for development of psychotic symptoms.

Answer: 1 Explanation: In Parkinson's disease, muscle function is lost, and the client's ability to chew and swallow is impaired, increasing the risk of aspiration.

22) A client with Parkinson's disease develops depression. What education would the nurse provide to the client's family? 1. "Depression is a common problem with Parkinson's disease." 2. "Depression is very easy to treat, and a wide variety of medications are available." 3. "Eventually anyone who has a brain disease will develop depression." 4. "The depression is most likely a side effect of the medications taken to treat the symptoms."

Answer: 1 Explanation: Over half of the clients with Parkinson's disease present with clinical depression.

6) The nurse is concerned that a client is experiencing symptoms of Parkinson's disease. Which assessment findings would indicate the client might have idiopathic or primary Parkinson's disease? 1. Tremors and bradykinesia 2. Ocular diplopia and ptosis 3. Progression and severity of fatigue 4. Spasticity and paresis

Answer: 1 Explanation: Tremors and bradykinesia are present with idiopathic or primary Parkinson's disease.

25) A client takes an aspirin, a multivitamin, and an antihistamine every day. What is the most important instruction by the nurse when the client is prescribed levodopa/carbidopa (Parcopa)? 1. "You should not take the multivitamin with your levodopa/carbidopa (Parcopa)." 2. "You should not take the antihistamine with your levodopa/carbidopa (Parcopa)." 3. "You should not take the aspirin with your levodopa/carbidopa (Parcopa)." 4. "These medications are safe to take with levodopa/carbidopa (Parcopa)."

Answer: 1 Explanation: Vitamin B6 will decrease the effects of levodopa/carbidopa (Parcopa), so a multivitamin should not be taken with the medication.

39) Prior to administering donepezil (Aricept) to a client diagnosed with Alzheimer's disease, the nurse notes that the client is prescribed medications that will react with this drug. Which medications interact with donepezil (Aricept)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Phenytoin (Dilantin) 2. Rifampin 3. Quinidine 4. Penicillin 5. Aspirin

Answer: 1, 2, 3 Explanation: Decreased effects of donepezil (Aricept) will occur with concurrent administration of phenytoin (Dilantin). Decreased effects of donepezil (Aricept) will occur with concurrent administration of rifampin. Metabolism of donepezil (Aricept) may be inhibited by quinidine.

32) A client with Parkinson's disease is experiencing an increase in bradykinesia. What will the client demonstrate with this manifestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walking 4. Stooped posture 5. Lack of facial expression

Answer: 1, 2, 3 Explanation: Slow speech is a manifestation of bradykinesia. Difficulty chewing is a manifestation of bradykinesia. Shuffling the feet when walking is a manifestation of bradykinesia.

36) A client tells the nurse about using "different" drugs to treat the symptoms associated with mild Alzheimer's disease. For which drugs should the nurse assess the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vitamins 2. NSAIDs 3. Ginkgo biloba 4. Estrogen 5. Antihistamines

Answer: 1, 2, 3, 4 Explanation: Several agents, including vitamins, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including NSAIDs, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including ginkgo biloba, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including estrogen, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease.

40) Prior to administering galantamine (Reminyl) to a client with Alzheimer's disease, the nurse reviews the client's medical history for which disease processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Respiratory disorders 2. Liver dysfunction 3. Kidney failure 4. Atrial fibrillation 5. Arthritis

Answer: 1, 2, 3, 4 Explanation: This medication should be used cautiously in those with respiratory disease. This medication is not recommended for use in those with hepatic dysfunction. This medication is not recommended for use in those with renal dysfunction. This medication is to be used cautiously in those with cardiac conduction disorders.

7) A client is diagnosed with secondary Parkinson's disease. What is associated with the development of this type of Parkinson's disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Traumatic brain injury 2. Family history of the disorder 3. Brain tumor 4. Toxins 5. Encephalitis

Answer: 1, 3, 4, 5 Explanation: Traumatic brain injury is a finding associated with development of secondary Parkinson's disease. Brain tumor is a finding associated with development of secondary Parkinson's disease. Exposure to toxins is a finding associated with development of secondary Parkinson's disease. A brain infection is a finding associated with development of secondary Parkinson's disease.

16) Which assessment finding in a client with Alzheimer's disease would the nurse directly attribute to the disease's effect on acetylcholine? 1. Darkened urine 2. Inability to retain new information 3. Muscle cramps 4. Vomiting and diarrhea

Answer: 2 Explanation: Acetylcholine functions within the hippocampus (an area of the brain responsible for learning and memory) and in other portions of the cerebral cortex. The inability to recall information is among the early symptoms of the disease.

15) The nurse explains to the family of a client with Alzheimer's disease that memory loss and confusion occur because of the disease's effect on which neurotransmitter? 1. Serotonin 2. Acetylcholine 3. Dopamine 4. Gamma aminobutyric acid (GABA)

Answer: 2 Explanation: Clients with Alzheimer's disease experience a dramatic loss of their ability to perform tasks that require acetylcholine as a neurotransmitter.

21) The nurse is teaching a class for caregivers of clients with Alzheimer's disease. The nurse determines that learning has occurred when a caregiver makes which statement? 1. "There are effective drugs, but they cannot be used over a long period of time." 2. "There are drugs that will help to decrease the symptoms for a period of time." 3. "There aren't any drugs that are effective in treating this disease." 4. "There are drugs that can control the symptoms for many years."

Answer: 2 Explanation: Current medications will only decrease symptoms for a short period of time.

13) A client with Parkinson's disease asks the nurse why dopamine is not given as a neurotransmitter replacement. Which response by the nurse is the most appropriate? 1. "The risk for hypertension is too high with dopamine; therefore, more frequent cardiac monitoring would be required." 2. "Exogenous dopamine cannot cross the blood—brain barrier and would be of little use." 3. "Exogenous dopamine must be administered via intravenous infusion, which usually requires a central line and continuous cardiac monitoring." 4. "In older clients, the effects of dopamine on urinary function can pose an unacceptable risk for renal failure."

Answer: 2 Explanation: Dopamine does not cross the blood—brain barrier. Levodopa is the precursor of dopamine and does cross the blood—brain barrier, where the enzyme dopa decarboxylase converts it to dopamine.

19) The family member of a client with Parkinson's disease notifies the nurse that the client is demonstrating extrapyramidal symptoms. Which instruction by the nurse to the family is the most appropriate? 1. Increase the dosage of the antiparkinson drugs. 2. Transport the client to the emergency department immediately. 3. Make an appointment when convenient for the client and healthcare provider for an evaluation. 4. Give diphenhydramine (Benadryl) 25 mg immediately by mouth.

Answer: 2 Explanation: Extrapyramidal symptoms can be life threatening without intervention. The client should be transported immediately to the emergency department.

5) Which assessment finding would indicate to the nurse that a client might have secondary Parkinson's disease? 1. Confusion and difficulty performing activities of daily living 2. Nonintentional tremor and history of a brain injury 3. Progressive memory loss and history of fatigue 4. Involuntary muscle spasm and history of a motor vehicle crash

Answer: 2 Explanation: History of a brain injury and nonintentional tremor are classic signs associated with secondary Parkinson's disease.

3) A client with memory loss and difficulty completing routine tasks questions if these symptoms are related to Alzheimer's disease. For what additional symptoms will the nurse assess to determine if the client is experiencing Alzheimer's disease? 1. Muscle weakness and vision changes 2. Tremors, muscle rigidity, and abnormal gait 3. Confusion and difficulty with communication 4. Involuntary muscle spasms and confusion

Answer: 3 Explanation: Alzheimer's disease is a degenerative disorder characterized by progressive memory loss, confusion, and inability to think or communicate effectively.

10) During the nurse's assessment of a client with known Parkinson's disease, the onset of which finding would be cause for concern? 1. Masklike expression 2. "Pill-rolling" motion of the fingers 3. Confusion 4. Frequent falls

Answer: 3 Explanation: Confusion is not a sign typically seen in clients with Parkinson's disease and would alert the nurse that further investigation into the cause of the confusion is warranted. Page Ref: 306

18) A client has been diagnosed with Alzheimer's disease. What is the most accurate medication education the nurse can give to the client's spouse? 1. "Symptoms should begin to improve in a few days." 2. "The medication has side effects that require periodic breaks from treatment." 3. "There is no cure. The medication might help with symptoms for a period of time." 4. "Symptoms will improve as long as the medication is taken daily at the same time."

Answer: 3 Explanation: Medications can slow the progression of the disease, but there is no cure. Improvement with medication usually lasts only a matter of months, and it takes 1 to 4 weeks to observe medication effectiveness.

28) An older client is receiving levodopa/carbidopa (Parcopa). Which side effect of the medication would cause the nurse the most concern? 1. Hypertension 2. Dark urine 3. Urinary retention 4. Diarrhea

Answer: 3 Explanation: Urinary retention is related to the anticholinergic effects of the medication and must be reported to the healthcare provider.

1) The nurse is planning a presentation on degenerative diseases. Which two most common degenerative diseases will the nurse include in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amyotrophic lateral sclerosis 2. Multiple sclerosis 3. Alzheimer's disease 4. Huntington's chorea 5. Parkinson's disease

Answer: 3, 5 Explanation: Alzheimer's disease and Parkinson's disease are the two most common degenerative diseases of the central nervous system. Alzheimer's disease and Park

27) A client who is prescribed benztropine (Cogentin) tells the nurse about plans for a Caribbean cruise. What should the nurse include during client teaching? 1. "Take a multivitamin every day to keep you healthy." 2. "If you miss a dose, take the next dose at its regularly scheduled time." 3. "Limit your activity while on the cruise." 4. "Avoid alcohol."

Answer: 4 Explanation: Benztropine (Cogentin) interacts with alcohol and has an additive sedative effect.

12) The nurse is explaining to a client the imbalance of neurotransmitters in Parkinson's disease. How will the nurse describe the relationship between acetylcholine and dopamine in the area of the brain that affects balance, posture, and involuntary muscle movement? 1. Dopamine stimulates while acetylcholine inhibits this region. 2. Both dopamine and acetylcholine inhibit this region of the brain. 3. Both dopamine and acetylcholine stimulate this region of the brain. 4. Dopamine inhibits and acetylcholine stimulates this region.

Answer: 4 Explanation: Dopamine is supplied to the corpus striatum by dopamine-producing neurons in the substantia nigra. Control of unconscious muscle movement depends on the balance between dopamine and acetylcholine in the corpus striatum. Persons with Parkinson's disease have decreased levels of inhibitory dopamine and increased levels of stimulating acetylcholine.

20) A client is prescribed a dopaminergic agent for management of symptoms related to Parkinson's disease. When teaching the client and family about medication management, which time frame will the nurse include regarding when the medication's results should be observable? 1. Within 1 week 2. Within 2 to 3 days 3. Within 24 hours 4. Within 2 to 3 weeks

Answer: 4 Explanation: It can take up to 2 or 3 weeks to observe results in the client.

24) Prior to administering benztropine (Cogentin) to a client, the nurse assesses adverse effects of previous doses and decides to withhold the current dose. Which clinical manifestation would warrant the nurse withholding the dose of the medication? 1. A respiratory rate of 14 2. A blood pressure reading of 88/60 mmHg 3. A temperature of 100.2°F 4. Distant bowel sounds

Answer: 4 Explanation: Paralytic ileus is the only identified life-threatening adverse reaction with this medication. Distant bowel sounds could be an indication of developing paralytic ileus.

11) When explaining the pathophysiology of Parkinson's disease to a client, the nurse would explain that it is a degenerative disorder of the nervous system caused by the death of neurons that produce which substance? 1. Acetylcholine 2. Serotonin 3. Norepinephrine 4. Dopamine

Answer: 4 Explanation: Symptoms of Parkinson's disease develop due to the destruction of the dopamine-producing neurons located in the substantia nigra. These neurons supply dopamine to the corpus striatum, the region of the brain that controls unconscious muscle movement.

23) The nurse provides instruction to a client who is prescribed levodopa/carbidopa (Parcopa). Which client statement indicates that learning has occurred? 1. "I need to increase my daily intake of protein." 2. "I must avoid eating leafy green vegetables in my diet." 3. "I need to check my pulse before I take this medication." 4. "I must avoid foods such as beef, whole-grain cereals, and multivitamins."

Answer: 4 Explanation: The client should be instructed to avoid foods high in pyridoxine such as beef, whole-grain cereals, and multivitamins because they will decrease the effects of the medication

17) The spouse of a client with Parkinson's disease asks how taking medication will help with symptoms. What is the nurse's best response? 1. "Medication will balance serotonin and acetylcholine in your spouse's brain." 2. "Medication will prevent muscle wasting in your spouse." 3. "Medication will boost your spouse's energy and appetite." 4. "The medication will facilitate your spouse's ability to walk, dress, and eat."

Answer: 4 Explanation: The goal of pharmacotherapy for Parkinson's disease is to increase an individual's ability to perform activities of daily living, such as walking, dressing, eating, and bathing.

8) The nurse suspects a client is developing Parkinson's disease. Which early sign did the nurse most likely assess in this client? 1. Rigid posture 2. Shuffling gait 3. Masklike face 4. Tremors

Answer: 4 Explanation: Tremors are usually the first sign of Parkinson's disease, along with fatigue and moving more slowly.