Parkinson's

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs? 1.Shuffling gait 2.Inability to urinate 3.Decreased appetite 4.Irregular bowel movements

2.Inability to urinate Rationale:Benztropine mesylate is an anticholinergic, which causes urinary retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. The remaining options are unrelated to the use of this medication. Test-Taking Strategy(ies):Focus on the subject and recall that benztropine mesylate is an anticholinergic and that these types of medications cause urinary retention. This will direct you to the correct option.

The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride. The nurse suspects that the client has which disorder? 1.Diabetes mellitus 2.Parkinson's disease 3.Alzheimer's disease 4.Coronary artery disease

2.Parkinson's disease Rationale:Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease Test-Taking Strategy(ies):Focus on the subject, uses for selegiline hydrochloride. Knowledge of the action and use of selegiline hydrochloride is required to answer this question. Recalling that this medication increases dopaminergic action and thinking about the pathophysiology associated with Parkinson's disease will direct you to the correct option. Remember that this medication is used to treat Parkinson's disease.

The nurse is preparing to ambulate a client with Parkinson's disease who has recently been started on levodopa/carbidopa. Before performing this activity with the client, the nurse should include which most important assessment in the client's plan of care? 1. History of falls 2. Use of assistive devices 3. Postural (orthostatic) vital signs 4. Degree of exhibited intention tremor

3. Postural (orthostatic) vital signs Rationale:Clients with Parkinson's disease are at risk for postural (orthostatic) hypotension from the disease. This problem is exacerbated with the introduction of levodopa/carbidopa, which also can cause postural hypotension and increase the client's risk for falls. Although knowledge of the client's use of assistive devices and history of falls is helpful, neither of these options is the most important element of the assessment, based on the wording of this question. Clients with Parkinson's disease generally have resting tremor, not intention tremor. Test-Taking Strategy(ies):Focus on the strategic words, most important. Postural hypotension presents the greatest safety risk to the client. Also, use the ABCs-airway, breathing, and circulation-when prioritizing. Checking postural vital signs is one way to assess circulation.

The nurse is caring for a client with Parkinson's disease. Which finding about gait should the nurse expect to note in the client? 1.Walking on the toes 2.Unsteady and staggering 3.Shuffling and propulsive 4.Broad-based and waddling

3.Shuffling and propulsive Rationale:The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping. An ataxic gait is unsteady and staggering. A dystrophic gait is broad-based and waddling. Walking on the toes can occur from shortened Achilles tendons. Test-Taking Strategy(ies):Focus on the subject, the parkinsonian gait. Recall that the client has difficulty in initiating movement and bradykinesia. The gait is difficult to start, but it accelerates once it has begun. This will assist in eliminating options 2 and 4. From the remaining choices, recall that the client with Parkinson's disease shuffles but does not walk on the toes.

A client with Parkinson's disease has begun therapy with levodopa/carbidopa. The nurse determines that the client understands the action of the medication if he or she verbalizes that results may not be apparent for how long? 1. 1 week 2. 24 hours 3. 2 to 3 days 4. 2 to 3 weeks

4. 2 to 3 weeks Rationale:Signs and symptoms of Parkinson's disease usually begin to resolve within 2 to 3 weeks of starting therapy, although in some clients marked improvement may not be seen for up to 6 months. The client needs to understand this concept to aid in compliance with medication therapy. Test-Taking Strategy(ies):Focus on the subject, client teaching for levodopa/carbidopa. To answer this question accurately, you need to know when this medication begins to produce the expected effects. For this question, it is best to select the time frame farthest from the initiation of therapy. Remember that this effect takes approximately 2 to 3 weeks.

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? 1."I can sit down to put on my pants and shoes." 2."I try to exercise every day and rest when I'm tired." 3."My son removed all loose rugs from my bedroom." 4."I don't need to use my walker to get to the bathroom."

4."I don't need to use my walker to get to the bathroom." Rationale:The client with Parkinson's disease should be instructed regarding safety measures in the home. The client should use her or his walker as support to get to the bathroom because of bradykinesia. The client should sit down to put on pants and shoes to prevent falling. The client should exercise every day in the morning when energy levels are highest. The client should have all loose rugs in the home removed to prevent falling. Test-Taking Strategy(ies):Note the strategic words, need for further teaching. These words indicate a negative event query and the need to select the incorrect client statement as the answer. Recall that clients with Parkinson's disease are at risk for falls.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? 1.Pruritus 2.Tachycardia 3.Hypertension 4.Impaired voluntary movements

4.Impaired voluntary movements Rationale:Dyskinesia and impaired voluntary movements may occur with high carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication. Test-Taking Strategy(ies):Focus on the subject, an adverse effect. Options 2 and 3 are comparable or alike and are cardiac-related options, so these options can be eliminated first. Next, focus on the client's diagnosis and select the correct option over option 1 because it relates to the neurological system.

The nurse in a long-term care facility is reviewing the primary health care provider's (PHCP's) prescriptions on an assigned client. The nurse notes that the PHCP prescribed ropinirole hydrochloride. The nurse determines that this medication has been prescribed to treat which condition in the client? 1.Depression 2.Diabetes mellitus 3.Coronary artery disease 4.Parkinsonian syndrome

4.Parkinsonian syndrome Rationale:Ropinirole hydrochloride is a medication that is used to treat idiopathic parkinsonian syndrome. It normally is administered 3 times a day to treat the client. This medication is not used to treat depression, diabetes mellitus, or coronary artery disease. Test-Taking Strategy(ies):Note the subject, the action and use of ropinirole hydrochloride. Knowledge of the action of ropinirole hydrochloride is required to answer this question. Remember that ropinirole is used to treat parkinsonian syndrome.

A nurse is teaching about levodopa with a family member of a client who has Parkinson's disease. Which of the following pieces of information should the nurse include? A. "A full therapeutic response may take several months to happen." B. "The medication should be taken with high-protein foods." C. "A full therapeutic response might cause vivid dreams." D. "The medication is given at the onset of mild symptoms."

A. "A full therapeutic response may take several months to happen." The nurse should inform the family member that although levodopa is the most effective medication for Parkinson's disease, a full therapeutic response might not occur for several months. Incorrect Answers: B. Amino acids compete with levodopa for intestinal absorption. Therefore, high-protein foods decrease the therapeutic effects of levodopa. C. Vivid dreams may occur with levodopa as an adverse effect, not as a therapeutic response. D. Mild symptoms of Parkinson's are usually treated with selegiline, an MAO-B inhibitor. Levodopa is generally prescribed for the management of more severe symptoms.

A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? A. Amantadine B. Bupropion C. Phenelzine D. Hydroxyzine

A. Amantadine This client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy.

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following disorders should the nurse identify as increasing the client's metabolic needs? (Select all that apply.) A. COPD B. Hypothyroidism C. Cancer D. Parkinson's disease E. Major burns

A. COPD C. Cancer D. Parkinson's disease E. Major burns Clients who have COPD develop hypermetabolism as a result of the increased amount of energy used to breathe. Cancer can cause a number of metabolic changes, including hypermetabolism as a result of the tumor growth. Clients who have Parkinson's disease develop hypermetabolism because they burn calories due to muscular rigidity. Finally, clients who have major burns develop severe metabolic stress, which includes hypermetabolism and hypercatabolism.

A nurse is providing teaching about degenerative complications to the partner of a client who has a new diagnosis of Parkinson's disease. Which of the following manifestations is the priority? A. Dysphagia B. Emotional Lability C. Impaired speech D. Self-care dependency

A. Dysphagia The nurse should apply the ABC priority-setting framework, which emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body's organs via the blood. An alteration in any of these areas can indicate a threat to life and should be the nurse's priority concern. When applying the ABC priority-setting framework, the airway is the priority because it must be open for oxygen exchange to occur. Breathing is the second priority framework because adequate ventilatory effort is essential for oxygen exchange to occur. Circulation is the third priority because the delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. Therefore, dysphagia is the priority manifestation because it can lead to aspiration. Incorrect Answers: B. The nurse should teach the partner of the client about emotional lability and depression associated with Parkinson's disease; however, another manifestation is the priority. C. The nurse should teach the partner of the client about the development of impaired speech associated with Parkinson's disease; however, another manifestation is the priority. D. The nurse should teach the partner of the client about the self-care dependency associated with Parkinson's disease; however, another manifestation is the priority.

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________. A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

C. substantia nigra, dopamine

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

The answer is A. The patient should have a diet of soft foods that are easy to swallow and chew. Option A is the only option that meets that specification.

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

The answer is A. This medication is contraindicated for patients with glaucoma.

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

The answer is A. This medication is known to cause sudden drowsiness that can cause a person to randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc...to prevent injury.

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

The answer is A. This option is the only one that is INCORRECT. Tremors in Parkinson's Disease tend to occurs at rest and will actually improve with movement.

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

The answer is B. This is known as cogwheel rigidity, and occurs when the arms are passively moved, which will cause them to jerk slightly.

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

The answer is C. All the other options are CORRECT about this medication. However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

The answer is C. Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the "wearing off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

The answer is C. This is known as bradykinesia.

As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

The answer is D. Rubber sole shoes can make walking difficulty, especially when the patient has a shuffling gait because these type of shoes tend to stick to the floor and can cause the patient to trip. It is best to wear low heel, smooth soles (not slick or hard).

True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease.

The answer is FALSE. Parkinson's Disease most commonly affects patients in OLDER adulthood (60 or older), and there is currently no cure for the disease.

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

The answers are A, B, D. These are correct teaching points on how to deal with freeze ups in Parkinson's Disease.

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

The answers are B and D. Constipation (not diarrhea) is a common symptom with Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetable and drinking 2 L of fluid per day (unless contraindicated). In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine (hence decreasing it absorption).

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

The answers are B, C, E, F, H. These are all signs and symptoms experienced with PD (they vary among patients). There is NOT increased salivation (although drooling occurs...this is due to the decreased ability to swallow. There are tremors at REST (not movement) along with depression rather the euphoria.

A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply: A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish

The answers are B, D, and E. Rasagiline "Azilect" is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.