Exam 1: Parkinson's Disease Questions

A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce? 1. Increase in acetylcholine production 2. Regeneration of injured thalamic cells 3. Improvement in myelination of neurons 4. Replacement of a neurotransmitter in the brain

4 rationale: Carbidopa-levodopa is used because levodopa is the precursor of dopamine. It is converted to dopamine in the brain cells, where it is stored until needed by axon terminals; it functions as a neurotransmitter. Regeneration of injured thalamic cells is not an action of this drug; neurons do not regenerate. Increase in acetylcholine production and improvement in myelination of neurons are not actions of this drug.

Carbidopa/levodopa is prescribed for a client with Parkinson disease. What will the nurse teach the client about this medication? 1. "Take this medication between meals." 2. "Blood levels of the drug should be monitored weekly." 3. "It can cause happy feelings followed by feelings of depression." 4. "You may experience dizziness when moving from sitting to standing."

4 rationale: Carbidopa/levodopa is a metabolic precursor of dopamine; it reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension. Carbidopa/levodopa should be administered with food to minimize gastric irritation. Although periodic tests to evaluate hepatic, renal, and cardiovascular status are required for prolonged therapy, whether these tests should be done on a weekly basis has not been established. Carbidopa/levodopa may produce either happiness or depression, but no established pattern of such responses exists.

Which monoamine oxidase inhibitor is used to treat Parkinson disease? 1. Selegiline 2. Phenelzine 3. Isocarboxazid 4. Tranylcypromine

1 rationale: Selegiline is a monoamine oxidase-B inhibitor used to treat Parkinson disease. Phenelzine, isocarboxazid, and tranylcypromine are nonselective inhibitors of both type A and B used in the treatment of depression.

A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client? 1. Change to a standing position slowly. 2. Take the medication between meals. 3. Perform self-blood glucose monitoring. 4. Withhold the next dose if nausea occurs.

1 rationale: A common side effect of selegiline is dizziness. Safety precautions are necessary to prevent falls caused by orthostatic hypotension. Taking the medication with food or milk limits gastrointestinal irritation. Monitoring blood glucose levels is not necessary. Nausea is a common side effect of selegiline; the medication should not be withheld without the healthcare provider's supervision. Abrupt withdrawal may precipitate a parkinsonian crisis.

Discharge planning for an ambulatory client with Parkinson disease (PD) includes recommending equipment for home use that will help with activities of daily living. To foster independence, the nurse should promote the use of which equipment? 1. a raised toilet seat 2. side rails for the bed 3. a trapeze above the bed 4. crutches for ambulation

1 rationale: A raised toilet seat will reduce strain on the back muscles and make it easier for the client to rise from the seat without injury. The client is not bedridden and will not need side rails for the bed or a trapeze above the bed. Clients with Parkinson disease have poor balance and a propulsive gait, which makes it unsafe to use crutches.

Selegiline is prescribed for a client with Parkinson disease who is having an inadequate response to levodopa therapy. What information does the nurse include when teaching the client about the addition of this drug to the regimen? 1. Primary healthcare provider should be contacted immediately if a severe headache occurs. 2. Therapeutic blood level of the drug should be monitored each month. 3. Dosage of the drug can be adjusted daily depending on the client's response that day. 4. Side effects of levodopa will decrease when the selegiline and levodopa are taken concurrently.

1 rationale: A severe headache is a sign of a monoamine oxidase inhibitor-induced hypertensive crisis and should be reported to the healthcare provider immediately. Monthly blood tests are unnecessary, but routine medical evaluations of the client should be scheduled. Adjusting the dose of the drug daily is unsafe; the recommended daily dose of the drug should be taken as prescribed. The side effects of levodopa will increase, not decrease, when these two drugs are taken concurrently.

A nurse is assessing four clients with musculoskeletal disorders. Which client does the nurse suspect of having Parkinson disease? 1. Client A 2. Client B 3. Client C 4. Client D

1 rationale: Festinating gait, when the neck, trunk, and knees flex when the body is rigid, in client A indicates Parkinson disease. A leg-length discrepancy of more than one inch due to arthritis or fracture may lead to the short-leg gait in client B. Neurogenic disorders such as cerebral palsy and hemiplegia may lead to the spastic gait in client C, which is manifested by jerky, uncoordinated, and cross-knee movement. Neurogenic disorders such as peroneal nerve injury and paralyzed dorsiflexor muscles may lead to the steppage gait in client D; this is manifested by increased hip and knee flexion to clear the foot from the floor and foot-dropping while walking.

A client is admitted to the hospital with the diagnosis of Parkinson disease. What medication does the nurse expect the healthcare provider to prescribe to relieve the client's physiologic responses to this disease? 1. carbidopa-levodopa 2. isocarboxazid 3. selegiline 4. dopamine 5. pyridoxine (vitamin B 6)

1 rationale: Levodopa crosses the blood-brain barrier and converts to dopamine, a substance depleted in Parkinson disease. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of psychological symptoms associated with severe depression, not physiologic symptoms of Parkinson disease. Dopamine is not given because it does not cross the blood-brain barrier. Pyridoxine can reverse the effects of some antiparkinsonian medications and is contraindicated.

When helping a client with Parkinson disease to ambulate, what instructions should the nurse give the client? 1. Avoid leaning forward. 2. Hesitate between steps. 3. Rest when tremors are experienced. 4. Keep arms close to the center of gravity.

1 rationale: The client with Parkinson disease often has a stooped posture because of the tendency of the head and neck to be drawn down; this shift away from the center of gravity causes instability. Hesitation is part of the disease; clients may use a marching rhythm to help maintain a more fluid gait. The tremors of Parkinson disease occur at rest (resting tremors). The client must consciously attempt to maintain a natural arm swing for balance.

A male client with dementia due to Parkinson disease has been placed in a nursing home. His wife appears tired and angry on her first visit with her husband. As she is leaving she says to the unit nurse in a sarcastic tone, "Let's see what you can do with him." What is the most therapeutic response by the nurse? 1. "It sounds like it's been difficult for you." 2. "I don't understand what you mean by that comment." 3. "I have experience caring for clients like your husband." 4. "It's too bad you didn't realize that you needed help to care for him."

1 rationale: The response "It sounds like it has been difficult for you" recognizes the problems faced by the caregiver without a hint of blame; it opens the channel of communication. The response "I don't understand what you mean by that comment" avoids the caregiver's concerns. "I have experience caring for clients like your husband" and "It's too bad you didn't realize that you needed help to care for him" are hostile responses that will put the caregiver on the defensive.

An elderly adult with Parkinson's disease falls while going to the bathroom and gets injured. The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system? 1. The nurse should document the incident in the occurrence report tool. 2. The nurse should provide information in the medical record about the occurrence. 3. The nurse should document in the client's medical report that an occurrence report has been filed. 4. The nurse should document in the client's medical report that the primary healthcare provider has been contacted.

1 rationale: To alert the risk management system and to prevent the recurrence of such occurrences, the nurse should document the incident in the occurrence report tool. The nurse should provide information in the medical record about the occurrence; however, this will not alert the risk management system. The nurse should not document in the client's medical report that an occurrence report has been filed because this will alert all healthcare team members. The nurse should document in the client's medical report that the primary healthcare provider has been contacted because it might be useful in defending a lawsuit, but this action will not be a beneficial way to alert the risk management system.

A client is admitted to the hospital with a diagnosis of Parkinson disease. Which common signs of Parkinson disease does the nurse expect to identify when completing a nursing admission history and physical? Select all that apply. 1. muscle rigidity 2. blank facial expression 3. leaning toward the affected side 4. intention tremors with movement 5. hyperextension of the affected extremity

1, 2 rationale: With Parkinson disease muscle rigidity occurs as a result of an imbalance between excitatory and inhibitory messages in the basal ganglia. With Parkinson disease there is a lack of neural control of fine-motor movements, resulting in a characteristic masklike face. Leaning toward an affected side is unrelated to Parkinson disease; this often is associated with a brain attack (CVA). Movement usually abolishes tremors; these are known as nonintention tremors. Hyperextension of the affected extremities does not occur with Parkinson disease; both arms fall rigidly to the sides and do not swing with a regular rhythm when walking, producing a shuffling gait.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply. 1. vomiting 2. anorexia 3. slow heart rate 4. changes in mood 5. peripheral edema

1, 2, 4 rationale: Nausea and vomiting may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of nausea and vomiting. Changes in affect, mood, and behavior are related to toxic effects of the drug. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.

A nurse is caring for a client with Parkinson disease. Which clinical indicators does the nurse expect to find upon assessment? Select all that apply. 1. resting tremors 2. flattened affect 3. muscle flaccidity 4. tonic-clonic seizures 5. slow voluntary movements

1, 2, 5 rationale: Resting (nonintention) tremors, commonly accompanied by pill-rolling movements of the thumb against the fingers, are associated with destruction of the neurons of the basal ganglia and substantia nigra. Destruction of the neurons of the basal ganglia and substantia nigra results in decreased muscle tone. The masklike appearance, unblinking eyes, and monotonous speech patterns can be interpreted as a flat affect. Slow voluntary movements (bradykinesia) are associated with this disorder. Muscle flaccidity is not associated with Parkinson disease. Rigidity is caused by sustained muscle contractions. Movement is jerky in quality (cogwheel rigidity). Tonic-clonic seizures are not associated with Parkinson disease.

A nurse is performing the history and physical examination of a client with Parkinson disease. Which assessments identified by the nurse support this diagnosis? Select all that apply. 1. nonintention temors 2. frequent bouts of diarrhea 3. masklike facial expression 4. hyperextension of the neck 5. rigidity to passive movement

1, 3, 5 rationale: Nonintention tremors associated with Parkinson disease result from degeneration of the dopaminergic pathways and excess cholinergic activity in the feedback circuit. A masklike facial expression results from nigral and basal ganglial depletion of dopamine, an inhibitory neurotransmitter. Cogwheel rigidity is increased resistance to passive motion and is a classic sign of Parkinson. Constipation, not diarrhea, is a common problem because of a weakness of muscles used in defecation. The tendency is for the head and neck to be drawn forward, not hyperextended, because of loss of basal ganglial control.

Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply. 1. nausea 2. lethargy 3. bradycardia 4. polycythemia 5. emotional changes

1, 5 rationale: Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects that may occur, not lethargy. Tachycardia and palpitations, not bradycardia, occur. Anemia and leukopenia, not polycythemia, are adverse reactions.

A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? 1. eat food high in tyramine 2. ensure that an opioid is not taken currently 3. take the medication in the morning and evening 4. monitor for signs of hypoglycemia and hyperglycemia

2 rationale: Selegiline concurrently used with an opioid analgesic can result in a fatal reaction (e.g., excitation, rigidity, hypertension, hypotension, coma). Foods high in tyramine (e.g., cheese, wine, beer, pickled products) should be avoided, not encouraged. When foods high in tyramine are broken down, they release specific biogenic amines. When the breakdown of these biogenic amines is inhibited by monoamine oxidase inhibitors, such as selegiline, pressor substances accumulate in the body, causing a quick increase in blood pressure to excessively high levels, precipitating intracranial bleeding and death. It is recommended that this medication be taken at breakfast and lunch, so its effects are more apparent while the client is awake; it should not be taken in the evening or at bedtime. Selegiline does not influence serum glucose levels. It can produce false-positive or false-negative results for glycosuria.

The nurse is caring for a client with Parkinson disease. Which is a priority nursing concern? 1. Decreased physical mobility related to stooped posture 2. Risk for injury related to gait disturbances 3. Impaired skin related to drooling 4. Pain related to headache

2 rationale: The client with Parkinson disease may fall because of gait disturbances. Decreased mobility and impaired skin are problems but not the priority. Pain is usually not a manifestation of Parkinson disease.

A nurse is interviewing a client with a tentative diagnosis of Parkinson disease. What should the nurse expect the client to report about how the onset of symptoms occurred? 1. suddenly 2. gradually 3. overnight 4. irregularly

2 rationale: The onset of this disease is not sudden, but insidious, with a prolonged course and gradual progression. The onset is slow and gradual. The onset is not irregular; there is a gradual, regular progression of symptoms.

A nurse identifies that a client exhibits the characteristic gait associated with Parkinson disease. When recording on the client's record, what term does the nurse use to document this gait? 1. ataxic 2. shuffling 3. scissoring 4. asymmetric

2 rationale: With a shuffling gait the steps are short and dragging; this is seen with basal ganglia defects. Ataxia is a staggering gait often associated with cerebellar damage. Scissoring is associated with bilateral spastic paresis of the legs. An asymmetric gait is associated with weakness of or pain in one lower extremity.

A nurse is caring for a client with Parkinson's disease. The nurse notes that the client belongs to a distinct culture and is estranged from family members. Which nursing activities display the use of evidence-based practice, as per the 21st century competencies of the Institute of Medicine? Select all that apply. 1. The nurse administers the medications on time to manage the client's condition. 2. The nurse refers to several journals to understand the client's cultural practices of the client. 3. The nurse collaborates with an interpreter to teach the client about medical procedures. 4. The nurse evaluates data about the incidence of Parkinson's disease in the client's community. 5. The nurse customizes the care plan based on extensive research about the client's culture.

2, 3, 4, 5 rationale: The nurse displays the use of evidence-based practice by referring to journals in order to understand the cultural practices of the client. The nurse displays the use of the Institute of Medicine's competencies by integrating research with clinical practice and client values. The nurse should also conduct further research by evaluating data about the incidence of the disease in the client's community. The nurse should collaborate with an interpreter to initiate effective communication with the client. These actions will help the nurse to understand the client's situation better. The nurse should integrate the results of the research with the client's care plan to provide customized care. The nurse provides patient-centered care by administering medications on time.

A client on antipsychotic drug therapy develops parkinsonism. Which drugs would be beneficial for the client? Select all that apply 1. levodopa 2. benztropine 3. amantadine 4. bromocriptine 5. diphenydramine

2, 3, 5 rationale: Benztropine is a centrally-acting anticholinergic drug that can be used to treat symptoms of parkinsonism associated with antipsychotic drugs. Amantadine is also used to treat antipsychotic-induced parkinsonism. Diphenhydramine is another centrally-acting anticholinergic drug that can be used to treat symptoms of antipsychotic-induced parkinsonism. Levodopa and direct dopamine agonists such as bromocriptine should be avoided in antipsychotic-induced Parkinsonism because these drugs activate dopamine receptors, which might counteract the beneficial effects of antipsychotic treatment.

What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa? 1. Multivitamins should be taken daily. 2. Alcohol consumption should be in moderation. 3. The medication should be taken with meals. 4. A high-protein diet should be followed.

3 rationale: Carbidopa-levodopa should be taken with meals to reduce the nausea and vomiting that commonly are caused by this drug. Multivitamins are contraindicated; vitamins may contain pyridoxine (vitamin B 6), which diminishes the effects of levodopa. Moderate amounts of alcohol will antagonize the drug's effects; a rare, occasional drink is not harmful. A high-protein diet is contraindicated. Sinemet contains levodopa, an amino acid that may increase blood urea nitrogen levels. Also, some proteins contain pyridoxine, which increases peripheral metabolism of levodopa, decreasing the amount of levodopa crossing the blood-brain barrier.

A nurse is caring for two clients. One has Parkinson disease, and the other has myasthenia gravis. For which common complication associated with both disorders should the nurse assess these clients? 1. cogwheel gait 2. impaired cognition 3. difficulty swallowing 4. nonintention tremors

3 rationale: Difficulty swallowing (dysphagia) is a manifestation of both neurologic disorders. With Parkinson disease there is a progressive loss of spontaneity of movement, including swallowing, related to degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain. With myasthenia gravis there is a decreased number of acetylcholine (Ach) receptor sites at the neuromuscular junction, which interferes with muscle contraction, impairing muscles involved in chewing, swallowing, speaking, and breathing. A cogwheel gait is associated with Parkinson disease, not myasthenia gravis. Impaired cognition is associated with Parkinson disease, not myasthenia gravis. Nonintention tremors are associated with Parkinson disease, not myasthenia gravis. The nonintention tremors associated with Parkinson disease result from the loss of the inhibitory influence of dopamine in the basal ganglia, which interferes with the feedback circuit within the cerebral cortex.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? 1. blocks the effects of acetylcholine 2. increases the production of dopamine 3. restores the dopamine levels in the brain 4. promotes the production of acetylcholine

3 rationale: Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

nurse determines that a client exhibits the characteristic gait associated with Parkinson disease. How should the nurse describe this gait when documenting on the client's progress report? 1. spastic 2. steppage 3. shuffling 4. scissoring

3 rationale: Steps are short and dragging (shuffling); this is seen with defects of the basal ganglia. Spastic gait, short steps with dragging of foot, is associated with neurogenic causes like cerebral palsy. Steppage gait is when foot slaps down and is associated with peroneal nerve injury or paralyzed dorsiflexor muscles. Scissoring gait is associated with bilateral spastic paresis of the legs as occurs in cerebral palsy or hemiplegia.

A nurse is educating the caregivers of an elderly adult with advanced Parkinson's disease about continuing care. What information should the nurse provide? Select all that apply. 1. "Home care is a type of continuing care in which the primary objectives are health promotion and education." 2. "Continuing care is necessary for clients who are recovering from an acute or chronic illness or disability." 3. "Adult day care centers are ideal for clients whose caregivers have to be away from home during the day." 4. "Hospice care is a continuing care system that allows clients to live at home with comfort, independence, and dignity." 5. "Nursing centers provide 24-hour custodial care in order to help residents achieve and maintain their highest level of functioning."

3, 4, 5 rationale: Adult day care centers are ideal for providing continuing care to clients whose caregivers have to be away from home during the day. Hospice care is a type of continuing care that provides palliative care to clients within the comfort, dignity, and independence of their homes. Clients also go to nursing centers to receive continuing care. Nursing centers provide 24-hour custodial care. They help clients achieve and maintain their highest level of functioning. The primary objectives of providing restorative home care are health promotion and education. Clients recovering from chronic or acute illnesses or disabilities require restorative care. Continuing care is necessary for clients who are suffering from a terminal disease, who are disabled, or who were never functionally independent.

A client is diagnosed with stage 3 of Parkinson disease. Which clinical manifestations are found in the client? Select all that apply. 1. akinesia 2. masklike face 3. postural instability 4. unilateral limb involvement 5. increased gait disturbances

3, 5 rationale: Parkinson disease is a progressive neurodegenerative disease that is one of the most common neurologic disorders of older adults. Stage 3 of Parkinson disease is characterized by postural instability and increased gait disturbances. Akinesia is manifested in stage 4 of the disease. Clinical manifestation of stage 2 is "masklike" face. Unilateral limb involvement is seen in stage 1 of Parkinson disease.

A nurse is assessing a client with Parkinson disease. Which assessment finding indicates the presence of bradykinesia? 1. intentino tremor 2. muscle flaccidity 3. paralysis of the limbs 4. lack of spontaneous movement

4 rationale: Bradykinesia is a slowing down in the initiation and execution of movement. Tremors are more prominent at rest and are known as nonintention, not intention, tremors. Cogwheel rigidity, not flaccidity, occurs because the disorder causes sustained muscle contractions. The limbs are rigid and move with a jerky quality; the limbs are not paralyzed

A client with Parkinson disease reports problems with bowel elimination. Which instruction should the nurse share with the client? 1. eat a banana daily 2. decrease fluid intake 3. take cathartics regularly 4. increase residue in the diet

4 rationale: Increasing residue in the diet produces bulk, which stimulates defecation; the muscles used in defecation are weak in clients with Parkinson disease. Bananas are binding and will intensify the problem of constipation. Decreasing fluid intake will intensify the problem; fluids need to be increased to keep the stool soft. Cathartics are irritating to the intestinal mucosa, and their regular administration promotes dependence.

taking an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complains of some numbness in the left hand. What is the nurse's priority intervention? 1. Refer the client to the primary healthcare provider only if other neurologic deficits are present. 2. Ask the primary healthcare provider to increase the client's dosage of the anticholinergic medication. 3. Stress the importance of having the client call the primary healthcare provider as soon as possible. 4. Make arrangements immediately for further medical evaluation by the client's primary healthcare provider.

4 rationale: Numbness, a sensory deficit, is inconsistent with parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending brain attack (cerebrovascular accident, CVA). This symptom is not caused by parkinsonism; increasing the dosage of the anticholinergic medication will not be helpful. Stressing the importance of having the client call the primary healthcare provider as soon as possible can cause a delay in the client's receiving immediate medical attention.

A client is diagnosed with Parkinson disease and asks the nurse what causes the disease. On which underlying pathology does the nurse base a response? 1. disintegration of the myelin sheath 2. breakdown of upper and lower neurons 3. reduced acetylcholine receptors at synapses 4. degeneration of the neurons of the basal ganglia

4 rationale: Parkinson disease involves destruction of the neurons of the substantia nigra, reducing dopamine. The cause of this destruction is unknown. Disintegration of the myelin sheath is associated with multiple sclerosis. Breakdown of upper and lower motor neurons is associated with Lou Gehrig disease or amyotrophic lateral sclerosis. Reduced acetylcholine receptors at synapses are associated with myasthenia gravis.

A client with a history of parkinsonism recently developed rigidity, tremors, and signs of pneumonia. The client is hospitalized for treatment. What should the nursing plan of care include? 1. gait training in the physical therapy department daily 2. isometric exercises every 2 hours while awake 3. active range-of-motion exercises at least every 4 hours 4. passive range-of-motion exercises at least every 8 hours

4 rationale: Passive range-of-motion exercises at least every eight hours maintain the range of joint movement with a minimum of energy expenditure by the client. Ambulation may fatigue the client and does not provide sufficient movement of the upper extremities. Isometric exercises do not provide the joint movement necessary to prevent contractures. Active range-of-motion exercises at least every four hours increase the client's metabolic rate and need for oxygen; the client's ability to meet increased oxygen demand is decreased in the presence of pneumonia.