4f - Parkinson's Disease

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.* 2. This client has had an unusual occurrence (fall) and now has a potential complication (a fracture). The experienced nurse should take care of this client. 3. These vital signs indicate increased intracranial pressure. The more experienced nurse should care for this client. 4. This could indicate a worsening of the tumor. This client is at risk for seizures and herniation of the brainstem. The more experienced nurse should 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.* 2. Unlicensed assistive personnel can turn and position clients with pressure ulcers. The nurse should assist in this at least once during the shift to assess the wound area. 3. The UAP can assist the client to the bathroom every two (2) hours and document the results of the attempt. 4. The UAP can obtain the vital signs on a stable client.

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.

1. A headache of "2" on a 1-to-10 scale is a mild headache. 2. A spinal cord injury at T10 involves deficits at approximately the waist area. Inability to move the toes would be expected. *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.* 4. This client is getting better; "resolving" indicates an improvement in the client's clinical manifestations.

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

1. A stereotactic pallidotomy and/or thalamotomy are surgeries that use CT or MRI scans to localize specific areas of the brain in which to produce lesions in groups of brain cells through electrical stimulation or thermocoagulation. These procedures are done when medication has failed to control tremors. 2. Dopamine receptor agonists are medications that activate the dopamine receptors in the striatum of the brain. 3. Physical therapy is a standard therapy used to improve the quality of life for clients diagnosed with PD. *4. Fetal tissue transplantation has shown some success in PD, but it is an experimental and highly controversial procedure.*

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.

1. Adaptive appliances will not help the client's shaking movements and are not used for clients with Parkinson's disease. 2. Clients with Parkinson's disease are placed on high-calorie, high-protein, soft or liquid diets. Supplemental feedings may also be ordered. If liquids are ordered because of difficulty chewing, then the liquids should be thickened to a honey or pudding consistency. 3. Nuts and whole-grain food would require extensive chewing before swallowing and would not be good for the client. Three large meals would get cold before the client can consume the meal, and one half or more of the food would be wasted. *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.

1. Akinesia is lack of movement. The goal in treating PD is to maintain mobility. 2. This could be a goal for a problem of noncompliance with the treatment regimen, but not a goal for treating the disease process. 3. This might be a goal for a psychosocial problem of social isolation. *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.*

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.

1. Carbidopa is never given alone. Carbidopa is given together with levodopa to help the levodopa cross the blood-brain barrier. 2. Levodopa is a form of dopamine given orally to clients diagnosed with PD. *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.* 4. Carbidopa does not cross the blood-brain barrier.

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

1. Crackles and jugular vein distention indicate heart failure, not PD. 2. Upper extremity weakness and ptosis are clinical manifestations of myasthenia gravis. 3. The client has very little arm swing, and scanning speech is a clinical manifestation of multiple sclerosis. *4. Masklike facies and a shuffling gait are two clinical manifestations of PD.*

82. Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability 2. Depression 3. Memory deficits 4. Paranoia

1. Emotional lability is a psychosocial problem, not a cognitive one. 2. Depression is a psychosocial problem. *3. Memory deficits are cognitive impairments. The client may also develop a dementia.* 4. Paranoia is a psychosocial problem.

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

1. Masklike facies is responsible for lack of expression and is part of the motor manifestations of Parkinson's disease but is not related to the symptoms listed. Shuffling is also a motor deficit and does pose a risk for falling, but fever and patchy infiltrates on a chest x-ray do not result from a gait problem. They are manifestations of a pulmonary complication. *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.* 3. Pill rolling of fingers and flat affect do not have an impact on the development of pulmonary complications. 4. Arm swing and bradykinesia are motor deficits.

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."

1. The emotions of a person diagnosed with PD are labile. The client has rapid mood swings and is easily upset. 2. Hallucinations are a sign that the client is experiencing drug toxicity. *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.* 4. The client should take the prescribed medications at the same time each day to provide a continuous drug level.

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.

1. This is information that should be discussed when filling out an advance directive form. A ventilator is used to treat a physiological problem. *2. These are psychosocial manifestations of PD. These should be discussed in the support meeting.* 3. The reduction in the unintentional pill-rolling movement of the hands is controlled at times by the medication; this is a physiological problem. 4. Echolalia is a speech deficit in which the client automatically repeats the words or sentences of another person; this is a physiological problem.