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.