Parkinson's
A patient with Parkinson's disease is scheduled for stereotactic pallidotomy. What are the steps in the correct order of their occurrence during the procedure? 1. Give intravenous sedation. 2. Perform magnetic resonance imaging. 3. Place a stereotactic head frame. 4. Pass electric stimulation through the electrode. 5. Insert an electrode into the target area.
ANS: 2, 3, 1, 5, 4 The first step to be performed in stereotactic pallidotomy is to perform magnetic resonance imaging to identify the target area. The second step is to place a stereotactic head frame on the patient. Then intravenous sedation should be given as the third step. In the fourth step, an electrode should be inserted into the target area. Finally, electric stimulation should be passed through the electrode to access the patient's reaction for reduction of tremor and rigidity.
21. A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? a. "Allow the client to be as independent as possible with activities." b. "Assist the client with frequent and meticulous oral care." c. "Assess the client's ability to eat and swallow before each meal." d. "Schedule appointments early in the morning to ensure rest in the afternoon."
ANS: A Clients with Parkinson disease do not move as quickly and can have functional problems. The client should be encouraged to be as independent as possible and provided time to perform activities without rushing. Although oral care is important for all clients, instructing the UAP to provide frequent and meticulous oral is not a priority for this client. This statement would be a priority if the client was immune-compromised or NPO. The nurse should assess the client's ability to eat and swallow; this should not be delegated. Appointments and activities should not be scheduled early in the morning because this may cause the client to be rushed and discourage the client from wanting to participate in activities of daily living.
Which stage of the disease does the nurse expect to find in a patient with Parkinson's disease who has a masklike face and bilateral limb involvement? A. Mild stage B. Initial stage C. Severe stage D. Moderate stage
ANS: A There are five stages in Parkinson's disease. Symptoms of a masklike face and bilateral limb involvement are seen in the mild stage of Parkinson's disease. The initial stage includes manifestations such as unilateral limb involvement and minimal weakness. Akinesia and rigidity are noticed in the severe stage of Parkinson's disease. Postural instability and increased gait disturbances are manifestations of the moderate stage.
A patient with Parkinson's disease is undergoing a stereotactic pallidotomy. The patient has no reduction of tremor and rigidity on receiving a mild electrical stimulation on the target area within pallidum. Which intervention would be beneficial in this situation? A. Repositioning the probe B. Monitoring the patient for 1 hour C. Making a burr hole into the cranium D. Making a lesion to destroy the tissue
ANS: A Stereotactic pallidotomy is the option when drugs cannot effectively manage the symptoms of Parkinson's disease. In this surgery, the target area within the pallidum receives a mild electrical stimulation when an electrode or cylindrical rod is inserted into it. If the patient shows no response in reduction for tremor and rigidity, then the probe is repositioned. The patient is monitored for 1 hour in the postanesthesia care unit once the surgery is performed. A lesion is made for the tissue destruction once the probe is positioned at the ideal location. A burr hole is made into the cranium for the insertion of the electrode into the target area.
A patient with Parkinson's disease (PD) has bilateral limb involvement, masklike face, and slow, shuffling gait. Which stage of Parkinson's disease does the nurse suspect in this patient? A. Mild stage B. Initial stage C. Severe disability D. Moderate disease
ANS: A The diagnosed manifestations in the patient such as bilateral limb involvement, masklike face, and slow, shuffling gait are the key features of the mild stage of PD. The initial stage includes manifestations such as unilateral limb involvement and hand and arm trembling in the patient. The severe disability stage of PD includes akinesia and rigidity in the patient. The postural instability and increased gait disturbances are considered as manifestations of the moderate disease stage of PD.
Which psychosocial symptoms of Parkinson's disease does the nurse recognize? Select all that apply. A. Mania B. Dysarthria C. Depression D. Hypophonia E. Impaired cognition F. Sleep disturbances
ANS: C,E,F Depression, paranoia, impaired cognition, and sleep disturbances are psychosocial symptoms of Parkinson's disease. Dysarthria and hypophonia are speech-related symptoms of Parkinson's disease. Mania is not a symptom of Parkinson's disease.
A patient with Parkinson disease is successfully being treated with carbidopa/levodopa. Over the past few days, the patient states symptoms occur well before it is time for the next dose of medication. Which alterations does the nurse anticipate the health care provider will make to the drug regimen? Select all that apply. A. Drug holiday B. Change in drug choice C. Reduction in drug dosage D. Addition of a second drug E. Change in dose frequency F. Change in administration route
ANS: A,B,C,E The provider will likely consider a reduction in dosage, a change of drug, a change of dose frequency, or a drug holiday, especially since Sinemet is a levodopa drug. The addition of a second drug is not indicated at this time until the other options have been tried. A change in administration route will not affect the present outcomes.
What teachings should the nurse provide for a patient with Parkinson's disease (PD) to help the patient manage the condition? Select all that apply. A. Practice yoga and tai-chi. B. Avoid driving automobiles. C. Perform strenuous exercise. D. Avoid sleeping during the daytime. E. Concentrate on the feet while walking.
ANS: A,B,D Exercises such as yoga and tai-chi may help elevate the mood and improve mobility. PD patients may fall asleep while driving an automobile. A patient with PD may find it difficult to sleep at night if he or she sleeps during the day. The patient should not perform strenuous exercise because it can lead to overexertion of the muscles. The patient should be reminded not to concentrate on the feet while walking to prevent falls.
Which statements by a student nurse regarding the drugs used to treat Parkinson's disease indicate effective learning? Select all that apply. A. "Benztropine should be avoided in older patients." B. "Apomorphine can be taken with cheese and red wine." C. "Entacapone should not be taken with cheese and red wine." D. "Apomorphine causes orthostatic hypotension and drowsiness."
ANS: A,C,D Anticholinergic drugs such as benztropine should be avoided in older patients because they can cause side effects such as acute confusion, urinary retention, constipation, dry mouth, and blurred vision. Monamine oxidase type B (MAO-B ) inhibitors (MAOIs) such as entacapone and rasagiline mesylate should not be taken with food and beverages that contain tyramine to prevent severe headache and life-threatening hypertension. Dopamine agonists such as apomorphine and pramipexole are associated with adverse effects such as orthostatic (postural) hypotension, hallucinations, and sleeplessness. Sinemet should be given before meals to increase absorption and transport across the blood-brain barrier. Apomorphine should not be taken with cheese and red wine to avoid severe headaches and life-threatening hypertension.
The registered nurse is teaching a nursing student about sleep patterns associated with Parkinson's disease (PD). Which statement of the nursing student indicates a need for further teaching by the nurse? A. "I will assess the sleeping habits of the patient." B. "I will inform the patient that driving is not dangerous." C. "I will provide a good sleep environment for the patient." D. "I will attempt to keep the patient awake during the day."
ANS: B PD causes sleepiness and dizziness, so a patient with PD should avoid driving. Patients with PD tend not to sleep well at night because of the drug therapy and the disease itself, so the patient's sleep habits should be assessed. Providing a good sleep environment may prevent insomnia and prevent deterioration caused by the condition. Taking frequent naps during the day may make the patient restless at night and keep the patient awake; therefore, the nurse should try to keep the patient awake during the day instead.
A patient has Parkinson disease (PD). Which nursing intervention best protects the patient from injury? A. Discouraging the patient from activity B. Monitoring the patient's sleep patterns C. Encouraging the patient to watch the feet when walking D. Suggesting that the patient obtain assistance in performing activities of daily living (ADLs)
ANS: B Patients with PD tend to not sleep well at night because of drug therapy and the disease itself. Some patients nap for short periods during the day and may not be aware that they have done so. This sleep misperception could put the patient at risk for injury (e.g., falling asleep while driving). Active and passive range-of-motion exercises, muscle stretching, and activity are important to keep the patient with PD mobile and flexible. The patient with PD should avoid watching his or her feet when walking to prevent falls and should be encouraged to participate as much as possible in self-management, including ADLs. Occupational and physical therapists can provide training in ADLs and the use of adaptive devices, as needed, to facilitate independence.
A patient was hospitalized and diagnosed with Parkinson's disease (PD). Which medication is prescribed to the patient as a continuous transdermal patch to maintain the consistent level of dopamine? A. Sinemet B. Rotigotine C. Amantadine D. Rivastigmine
ANS: B Rotigotine is a dopamine agonist that is available as a continuous transdermal patch to maintain a consistent level of dopamine. It acts by stimulating the dopamine receptors in the brain. Sinemet is the combination of levodopa and carbidopa. It is provided to patients with severe symptoms and is available in both immediate release (IR) and controlled-release (CR) form. Rivastigmine is a cholinesterase inhibitor and is administered only when patients with PD have dementia. Amantadine is an antiviral drug and has anti-Parkinson actions.
The nurse is preparing to administer Sinemet to a client whose highest blood pressure is 88/50 while lying in bed. What is the nurse's priority action at this time? A. Instruct the client to get out of bed slowly. B. Withhold the drug until contacting the primary health care provider. C. Ask the client about the presence of hallucinations. D. Take the client's apical pulse and temperature.
ANS: B The client should not get out of bed because the systolic blood pressure will likely drop and the patient may become dizzy or perhaps have syncope (A). While Sinemet can cause hallucinations, it can also cause severe hypotension. Therefore, the priority action is for the nurse to withhold the drug until contacting the primary health care provider at this time, or choice B. Taking the pulse and temperature may be performed, but are not the priority action in response to a very low blood pressure
The nurse is providing care for a patient diagnosed with Parkinson Disease (PD). Which stage of PD is characterized by bilateral limb involvement with a masklike face and a slow, shuffling gait? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4
ANS: B There are five stages of PD. Stage 2 (mild stage) is characterized by bilateral limb involvement, a masklike face, and a slow, shuffling gait. Stage 1 (initial stage) is characterized by unilateral limb involvement, minimal weakness, and hand and arm trembling. Stage 3 (moderate disease) is characterized by postural instability and increased gait disturbances. Stage 4 (severe disability) is characterized by akinesia and rigidity. The fifth stage is characterized by complete ADL dependence.
A patient with severe symptoms of Parkinson's disease is prescribed sinemet. Which instruction does the nurse include while teaching the patient's family about the drug administration? A. "Give the drug after the meals." B. "Give the drug before sleeping." C. "Give the drug before the meals." D. "Give the drug after waking up in the morning."
ANS: C Sinemet may be the initial drug of choice for the patient with severe symptoms of Parkinson disease. The patient who is prescribed sinemet must take the drug before meals to increase absorption and transport across the blood-brain barrier. The other instructions such as taking the drug before sleeping, after meals, or after waking up in the morning may not be beneficial for administration of sinemet.
A patient newly diagnosed with Parkinson's disease is being discharged. Which instruction is best for the nurse to provide to the patient's spouse? A. Speak loudly for better understanding. B. Complete activities of daily living for the patient. C. Provide high-calorie, high-carbohydrate foods to maintain the patient's weight. D. Administer medications promptly on schedule to maintain therapeutic drug levels.
ANS: D Administering medications promptly on schedule is a correct statement. The patient should be encouraged to do as much as possible on his own. Slow speech rather than loud speech, and small, frequent meals are more effective for the patient with Parkinson's disease.
10. After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates she correctly understands changes associated with this disease? a. "His masklike face makes it difficult to communicate, so I will use a white board." b. "He should not socialize outside of the house due to uncontrollable drooling." c. "This disease is associated with anxiety causing increased perspiration." d. "He may have trouble chewing, so I will offer bite-sized portions."
ANS: D Because chewing and swallowing can be problematic, small frequent meals and a supplement are better for meeting the client's nutritional needs. A masklike face and drooling are common in clients with Parkinson disease. The client should be encouraged to continue to socialize and communicate as normally as possible. The wife should understand that the client's masklike face can be misinterpreted and additional time may be needed for the client to communicate with her or others. Excessive perspiration is also common in clients with Parkinson disease and is associated with the autonomic nervous system's response.
11. A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this client's plan of care? a. Ambulate the client in the hallway twice a day. b. Ensure a fluid intake of at least 3 liters per day. c. Teach the client pursed-lip breathing techniques. d. Keep the head of the bed at 30 degrees or greater.
ANS: D Elevation of the head of the bed will help prevent aspiration. The other options will not prevent aspiration, which is the greatest respiratory complication of Parkinson disease, nor do these interventions address any of the complications of Parkinson disease. Ambulation in the hallway is usually implemented to prevent venous thrombosis. Increased fluid intake flushes out toxins from the client's blood. Pursed-lip breathing increases exhalation of carbon dioxide.
A patient with Parkinson's disease reports insomnia. Which drug does the nurse expect the health care provider to prescribe to aid in sleep? A. Baclofen B. Venlafaxine C. Atropine sulfate D. Zolpidem tartrate
ANS: D Insomnia in a patient with Parkinson's disease can be treated with a sleep aid like zolpidem tartrate. Baclofen can provide relief from muscle spasm. Sublingual atropine sulfate will reduce drooling in a patient with Parkinson's disease. Venlafaxine is a short-acting antidepressant drug to treat moderate to severe depression.
A patient with Parkinson's disease is prescribed rasagiline mesylate for relieving freezing episodes. Which instruction by the nurse would be appropriate while administering the drug? A. "Strictly avoid orange juice." B. "Strictly avoid coffee and tea" C. "Strictly avoid green leafy vegetables." D. "Strictly avoid foods with cheese or cheese products."
ANS: D Rasagiline mesylate is a mono amino oxidase type A inhibitor. The intake of cheese or cheese products should be strictly avoided with the drug under this category; if they are taken together, it may cause life-threatening hypertension. The inclusion of coffee/tea, orange juice, and green, leafy vegetables may not cause any interaction with this medication.
Which drug for Parkinson Disease (PD) is often the initial drug of choice and will be used by almost all PD patients at some point in the progression of the disease? A. Rotigotine (Neupro) B. Pramipexole (Mirapex) C. Apomorphine (Apokyn) D. Levodopa-carbidopa (Sinemet)
ANS: D The combination levodopa-carbidopa drug Sinemet is the initial drug of choice if the patient's presenting symptoms are severe or interfere with work or school. At some point, this medication is used by almost all PD patients. Rotigotine, pramipexole and apomorphine are dopamine agonists. None of these are the initial drug of choice for PD.
Which clinical findings helped the nurse conclude that a patient is in the moderate stage of Parkinson's disease (PD)? A. Akinesia and rigidity of limbs B. Bilateral limb movement and mask-like face C. Unilateral limb movement and minimal weakness D. Postural instability and increased gait disturbances
ANS: D The moderate stage of PD is characterized by manifestations such as postural instability and increased gait disturbances. Symptoms such as akinesia and rigidity of the limbs are observed in patients who are in severe disability stage (stage 4). A patient with symptoms such as bilateral limb movement, mask-like face, and a slow shuffling gait may be in the mild stage of PD. Symptoms such as unilateral limb movement and minimal weakness are seen in the initial stage of PD.
Which interventions may be needed in a patient with Parkinson's disease (PD) who has developed drug tolerance? A. Increasing the drug dosage B. Changing the route of administration C. Providing a drug holiday that lasts up to 20 days D. Changing the drug or its frequency of administration
ANS: D The treatment of PD drug toxicity or tolerance requires a change of medication or frequency of administration. An increase in the drug dosage may not provide additional benefits but may increase side effects. A change in the route of administration may not be helpful to prevent drug tolerance because the drug dosage would be the same. A drug holiday means the patient receives no drug therapy for PD. A drug holiday should last only for 10 days.
