Parkinsons

Motor symptoms of Parkinson's

-tremor (predominant at rest) -rigidity (resistance to passive movement) -bradykinesia (slowness in initiating voluntary movement; reductions in passive movements) -posture abnormalities (stooped) -gait abnormalities (shuffling steps, difficulty turning, increased risk of falls)

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.

4. Fetal tissue transplantation has shown some success in PD, but it is an experimental and highly controversial procedure.

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training

A, C, D, E Rationale: Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training (such as with resistance bands), and range-of-motion exercises. Use of shoes with non-slip soles is advised.

Risk Factors

Age is the primary risk factor for developing PD. The average age of onset is 60 years, and the risk increases with advancing age.

The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.

C) The client was able to feed himself and had no weight change in 1 week. The finding that the client was able to feed himself and had no weight change in 1 week is indicative of an improvement in nutritional status. The client filling out the menu card does not indicate that the client actually consumed any of the meal. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.

Diagnostic Tests for PD

DaTscan, involves the injection of radioactive Ioflupane I-123, which binds to dopamine transporters (DaT) in the brain. Does not rule out other dopamine degenerative disorders. MRI or CT scan to rule out other causes because PD patients will show up as normal

Nonpharmacologic Therapy for PD

Exercise is the most important nonpharmacologic therapy for patients with PD. Nonpharmacologic therapies are important because, in spite of regular medication usage, patients with PD still develop progressively worsening symptoms. Medications have limited effectiveness over time and frequently produce side effects. Goal is to prevent/delay disability.

Prevention

However, several prevention techniques have been suggested by experts, including consuming a healthy diet that is high in fruits and vegetables, avoiding herbicides and pesticides, and consuming moderate amounts of caffeine and green tea.

aspiration pneumonia

Individuals with PD who have difficulty swallowing may aspirate foods that have a thin consistency, such as juice or broth. Products to thicken liquids to prevent aspiration should be used, and the nurse should stress the need for adequate hydration. Aspiration can lead to life-threatening complications, including pneumonia.

treatment for Head and neck motor deficits

Levodopa Dopamine- or levodopa-modifying drugs DBS Speech therapy- for difficulty chewing and swallowing, and speech deficits Providing soft foods

Treatments for limb and trunk motor deficits

Levodopa Dopamine- or levodopa-modifying drugs Deep brain stimulation (DBS) Walking and balance training Exercise program Physical therapy Modification of the environment to reduce the risk of falls Mobility devices

Treatment for Cognitive effects

Rivastigmine-used to treat dementia in people with Parkinson's disease Promoting reorientation Providing support to caregivers

Nonmotor symptoms of Parkinson's

Slowed thinking, Depression, anxiety, fatigue, pain, constipation, sleep problems, short-term memory loss, impotence, short-term memory impairment, sleep problems

Key term: Bradykinesia

Slowness of movement. One of the cardinal manifestations of Parkinson's

Parkinson disease (PD)

a progressive neurologic disorder that primarily affects movement. characterized initially by unilateral hand tremor, but progresses to include bilateral tremor, rigidity, bradykinesia, and postural instability.

Collaboration of care for PD

care/treatment is designed to help control symptoms and teach the patient how to live with the disease. Nursing care should also include support for the caregiver, especially as the disease progresses.

bradykinesia

slow movements

retropulsion

the tendency to topple backward when bumped or when rising, standing, or turning

"pill-rolling"

the thumb and fingers gently rub together

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."

A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." In some individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing whether the client's mother was exposed to toxins or if that was the cause for her disease. Men are at higher risk for PD, with 50% more men than women developing the disease, but this does not eliminate the client's risk of having the disease, especially given her mother's diagnosis.

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."

A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." Rationale: In some individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing whether the client's mother was exposed to toxins or if that was the cause for her disease. Men are at higher risk for PD, with 50% more men than women developing the disease, but this does not eliminate the client's risk of having the disease, especially given her mother's diagnosis.

The nurse observed a client with PD frequently wiping their mouth with a handkerchief. After the nurse requested a prescription for an anticholinergic medication from the HCP, the client asked, "I feel better, why do I need another medication?" Which response by the nurse is correct? A) "It will help reduce tremors and uncontrolled drooling." B) "It helps dopamine work better." C) "The HCP thinks it will help your symptoms." D) "It will make you feel better."

A) "It will help reduce tremors and uncontrolled drooling." Rationale: The client stated that they are feeling better. It is levodopa and not an anticholinergic that will make dopamine work better. Stating that the healthcare provider thinks it will help with the​ client's symptoms will be an incomplete answer. To give a complete​ response, the nurse would state that an anticholinergic reduces tremors and uncontrolled drooling.

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior

A) Dyskinesia Rationale: With increasing doses and long-term exposure, levodopa usually causes dyskinesia, which may become less tolerable for the client than the symptoms of PD. Insomnia and hypertension are not side effects of levodopa. Compulsive behavior is a side effect of dopamine antagonists, not levodopa.

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior

A) Dyskinesia With increasing doses and long-term exposure, levodopa usually causes dyskinesia, which may become less tolerable for the client than the symptoms of PD. Insomnia and hypertension are not side effects of levodopa. Compulsive behavior is a side effect of dopamine antagonists, not levodopa.

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training

A) Low-intensity treadmill training C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training (such as with resistance bands), and range-of-motion exercises. Use of shoes with non-slip soles is advised.

A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis

A) Parkinson Disease Rationale: Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, suggesting a diagnosis of Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebrovascular accident.

A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis

A) Parkinson disease Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, suggesting a diagnosis of Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebrovascular accident.

Which is the main pathology of Parkinson disease that causes changes in muscular and sensory function? A) Reduction of dopamine in the brain B) Presence of Lewy bodies C) Genetic predisposition D) Reduction of acetylcholine in the brain

A) 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 type of therapy is used to manage problems with eating and swallowing? A) Speech B) Nutritional C) Occupational D) Physical

A) Speech Rationale: Speech therapy is used to manage problems with eating and swallowing. Occupational therapy is used to maintain​ self-care activities, not specifically eating and swallowing. Physical therapy is used to improve coordination of balance and gait. There is no nutritional therapy needed for a client with Parkinson disease.

Which health promotion activity should be the focus of teaching for a client with PD? SATA A) Promoting independence B) Participating in occupational therapy C) Improving balance D) Avoiding exercise E) Preventing injury from falls

A, B, C, E Rationale: The focus of teaching for the client with PD should be on improving​ balance, preventing​ falls, promoting​ independence, and participating in​ physical, occupational, and speech therapy. Clients should be taught to participate in exercise to optimize​ mobility, not avoid it.

The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease (PD)? SATA A) The client doesn't remember what he ate for breakfast B) The client's facial expression shows no emotion C) The client's BP increases when the client stands up D) The client has hand tremors at rest E) The client has slurred speech

A, B, D, E 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.

The nurse is assessing a client with PD. Which factor should the nurse include in the assessment? SATA A) Bowel changes B) Dizziness when sitting C) Cognitive deficits D) Response to medication E) Difficulty waking

A, C, D Rationale: While assessing the current​ condition, the nurse should ask about bowel​ changes, as clients with PD face problems with​ peristalsis, which contributes to constipation. The client may also have cognitive deficits such as memory​ loss, slowed​ thinking, and​ confusion, which eventually progress to dementia. Another aspect that needs to be assessed is responses to​ medication, especially for​ "on-off" or​ "wearing off" effects that indicate that medication is losing its effectiveness. Clients with PD have difficult falling and staying​ asleep, so difficulty in waking up is not related. Postural hypotension is common in Parkinson​ disease, resulting in blood pressure that drops when the client stands​ up, not while sitting.

The healthcare provider of an older adult client with advancing Parkinson disease suggested that the client start an exercise regime. Which exercise should the nurse​ recommend? A. T'ai chi B. Running C. Weight lifting D. Football

Answer: ​Rationale: For a client with Parkinson​ disease, an exercise regime that promotes balance and walking is the best.​ So, the nurse may recommend​ t'ai chi. Considering the​ client's age,​ football, running, and weight lifting may be too strenuous.

The nurse is performing passive range of motion exercises for a client with Parkinson disease. Which nursing goal does this intervention​ address? (Select all that​ apply.) A. The client will remain free from injury. B. The client will participate in speech therapy for swallowing and verbal communication. C. The client will demonstrate normal bowel elimination patterns. D. The client will participate in occupational therapy to integrate assistive devices for​ self-care. E. The client will participate in physical therapy to improve walking and balance.

Answer: A, E ​Rationale: Physical​ therapy, including passive range of motion​ (ROM) exercises, will improve the​ client's walking and balance. This in turn helps prevent injury from falls. Assistive devices related to occupational therapy are different from those related to physical therapy. The occupational therapist would teach about devices that facilitate activities of daily​ living, such as button hooks and communication boards. Passive ROM exercises are not related to speech therapy or promoting normal bowel elimination patterns.

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? A. "Tell your family to come and take you out of the​ house." B. "Can I ask why you​ aren't going out of the​ house?" C. "You need to start getting​ out." D. ​"Getting out of the house will help you to feel less​ depressed."

Answer: B ​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 with Parkinson disease​ (PD) complains of increased tremor while eating. Which action should the nurse​ recommend? A. Having someone feed them B. Liquefying all meals and drinking them through a straw C. Holding a piece of bread in the other hand while eating D. Using their nondominant hand to eat

Answer: B ​Rationale: Holding a piece of bread in the opposite hand or purposeful movement will decrease tremors while eating. The client should be encouraged to eat independently for as long as possible. Using the nondominant hand may lack coordination. As the client with PD is prone to​ choking, liquefying all meals would not be recommended.

Which is the main pathology of Parkinson disease that causes changes in muscular and sensory​ function? A. Reduction of acetylcholine in the brain B. Reduction of dopamine in the brain C. Genetic predisposition D. Presence of Lewy bodies

Answer: B ​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 15dash​25% of​ cases, it is a risk factor rather than a cause of PD manifestations.

An older adult client with Parkinson disease uses a​ walker, speaks in a slurred manner with poor​ articulation, but tries to speak louder to accommodate for this impairment. The client​ states, "I catch my daughter looking at me angrily​ sometimes, but she​ doesn't say​ anything." Which nursing diagnosis is the priority​? A. Communication: Verbal, Impaired B. Caregiver Role Strain C. ​Falls, Risk for D. Nutrition, Imbalanced: Less than Body Requirements

Answer: B ​Rationale: The client is making accommodations for preventing falls by using a walker. Being the primary​ caregiver, the​ client's daughter assists the client in feeding so imbalanced nutrition is not a risk. The client is also practicing speech by speaking louder. It is the​ caregiver's role strain that is the major risk for this client.​

The nurse is assessing a client with Parkinson disease​ (PD). Which factor should the nurse include in the​ assessment? (Select all that​ apply.) A. Difficulty waking B. Response to medication C. Cognitive deficits D. Dizziness when sitting E. Bowel changes

Answer: B, C, E ​Rationale: While assessing the current​ condition, the nurse should ask about bowel​ changes, as clients with PD face problems with​ peristalsis, which contributes to constipation. The client may also have cognitive deficits such as memory​ loss, slowed​ thinking, and​ confusion, which eventually progress to dementia. Another aspect that needs to be assessed is responses to​ medication, especially for​ "on-off" or​ "wearing off" effects that indicate that medication is losing its effectiveness. Clients with PD have difficult falling and staying​ asleep, so difficulty in waking up is not related. Postural hypotension is common in Parkinson​ disease, resulting in blood pressure that drops when the client stands​ up, not while sitting.

Which symptom for a client with Parkinson disease​ (PD) is due to the lack of automatic muscle​ movement? A. Diminished voice volume B. Reduced ability to swallow C. Alterations in sleep pattern D. Diminished physical mobility

Answer: C ​Rationale: Alterations in sleep pattern may occur due to lack of automatic muscle movement in a client with Parkinson disease. Reducing strenuous activities near​ bedtime, limiting intake of​ caffeine, and providing a glass of milk before bedtime are all examples of interventions that directly address issues with sleep pattern. Reduced ability to​ swallow, diminished voice​ volume, and diminished physical mobility are all related to dysfunction of voluntary muscle movement.

Which type of therapy is used to manage problems with eating and​ swallowing? A. Physical B. Occupational C. Speech D. Nutritional

Answer: C ​Rationale: Speech therapy is used to manage problems with eating and swallowing. Occupational therapy is used to maintain​ self-care activities, not specifically eating and swallowing. Physical therapy is used to improve coordination of balance and gait. There is no nutritional therapy needed for a client with Parkinson disease.

The daughter of an older adult client with advancing Parkinson disease tells the nurse that they need to dress their mother each​ morning, because the mother is​ "not fast​ enough." Which is the most appropriate response from the​ nurse? A. "It is important for you to get to work on​ time." B. "Can you let her dress​ herself? C. "It is best for you to let your mother dress herself for as long as she​ can." D. "That is really quite​ normal."

Answer: C ​Rationale: The nurse should tell the caregiver​ that, by allowing independence in​ dressing, the client will have an improved sense of​ well-being and lessened depression. Asking​ closed-ended questions or just remarking that it is normal will not support the​ client's needs.

The nurse is caring for a client with Parkinson disease​ (PD) who reports problems with stiffness and the ability to move. Which action by the nurse will address the​ client's mobility? A. Ask the client if they know about the medications to treat the stiffness B. Advise bedrest for muscle recovery C. Tell the client that this is part of the disease process that cannot be stopped D. Recommend a regular exercise routine and walking

Answer: D ​Rationale: The best way to promote mobility in the client with PD is to recommend the client ambulate daily and exercise on a regular basis. Bedrest would only make the stiffness worse. Although there are medications that can help with​ rigidity, it is outside of the​ nurse's scope of practice to recommend medication. Telling the client that this is just part of the disease process is not appropriate or therapeutic.

The nurse observed a client with Parkinson disease frequently wiping their mouth with a handkerchief. After the nurse requested a prescription for an anticholinergic medication from the healthcare​ provider, the client​ asked, "I feel​ better, why do I need another​ medication?" Which response by the nurse is​ correct? A. "It helps dopamine work​ better." B. ​"It will make you feel​ better." C. "The healthcare provider thinks it will help your​ symptoms." D. "It will help reduce tremors and uncontrolled​ drooling."

Answer: D ​Rationale: The client stated that they are feeling better. It is levodopa and not an anticholinergic that will make dopamine work better. Stating that the healthcare provider thinks it will help with the​ client's symptoms will be an incomplete answer. To give a complete​ response, the nurse would state that an anticholinergic reduces tremors and uncontrolled drooling.

Which recommendation should the nurse make to a client with Parkinson disease who reports​ constipation? (Select all that​ apply.) A. Decreasing fiber intake B. Limiting exercise C. Decreasing fluid intake D. Increasing fluid intake E. Increasing fiber intake

Answer: D, E ​Rationale: Increasing fluid and fiber intake is a known recommendation for the prevention of constipation. Decreasing the intake of fluids or fiber will not help to prevent constipation. Limiting exercise is not associated with constipation.

The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."

B) " I probably have a genetic mutation that caused my PD." Rationale: Early-onset PD is likely due to a genetic mutation. Increasing age is a risk factor for the disease, and diagnosis as a young adult is uncommon. PD is associated with decreased dopamine levels in the brain, not an excess of dopamine. Although consuming a healthy, pesticide-free diet is recommended, dietary intake has not been definitively linked to development of PD.

A client newly diagnosed with Parkinson's asks the nurse, "What does dopamine do in the brain?" Which is the most appropriate response? A) "Dopamine stimulates the neurons to transmit sensory and motor impulses." B) "Dopamine helps maintain coordinated motor movement." C) "Dopamine enhances the action of acetylcholine." D) "Dopamine causes spinal cord neurons to transmit impulses."

B) "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.

The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."

B) "I probably have a genetic mutation that caused my PD." Early-onset PD is likely due to a genetic mutation. Increasing age is a risk factor for the disease, and diagnosis as a young adult is uncommon. PD is associated with decreased dopamine levels in the brain, not an excess of dopamine. Although consuming a healthy, pesticide-free diet is recommended, dietary intake has not been definitively linked to development of PD.

The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."

B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." Levodopa/carbidopa is a medication that boosts dopamine levels in clients with PD. This medication commonly causes orthostatic hypotension, so clients must take care when changing positions from lying to standing. Clients should also avoid eating protein-rich meals when taking this medication, as a high-protein diet may interfere with levodopa absorption from the GI tract. There is no medication that is known to cure Parkinson disease. Care must be taken if clients are also taking medications to lower their blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.

The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."

B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." Rationale: Levodopa/carbidopa is a medication that boosts dopamine levels in clients with PD. This medication commonly causes orthostatic hypotension, so clients must take care when changing positions from lying to standing. Clients should also avoid eating protein-rich meals when taking this medication, as a high-protein diet may interfere with levodopa absorption from the GI tract. There is no medication that is known to cure Parkinson disease. Care must be taken if clients are also taking medications to lower their blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.

Which symptom for a client with PD is due to the lack of automatic muscle movement? A) Diminished deep voice volume B) Alterations in sleep pattern C) Reduced ability to swallow D) Diminished physical mobility

B) Alterations in sleep pattern Rationale: Alterations in sleep pattern may occur due to lack of automatic muscle movement in a client with Parkinson disease. Reducing strenuous activities near​ bedtime, limiting intake of​ caffeine, and providing a glass of milk before bedtime are all examples of interventions that directly address issues with sleep pattern. Reduced ability to​ swallow, diminished voice​ volume, and diminished physical mobility are all related to dysfunction of voluntary muscle movement.

A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B) Dystonia C) Retropulsion E) Festination The UPDRS rates clients in 42 different areas of function. Positive findings for PD include retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run), and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.

A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety

B) Impaired Physical Mobility Rationale: The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping or Anxiety at this time.

A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety

B) Impaired Physical Mobility The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping or Anxiety at this time.

The nurse is caring for a client with PD who reports problems with stiffness and the ability to move. Which action by the nurse will address the client's mobility? A) Advise bedrest for muscle recovery B) Recommend a regular exercise routine and walking C) Ask the client if they know about the medications to treat the stiffness D) Tell the client that this is part of the disease process that cannot be stopped.

B) Recommend a regular exercise routine and walking Rationale: The best way to promote mobility in the client with PD is to recommend the client ambulate daily and exercise on a regular basis. Bedrest would only make the stiffness worse. Although there are medications that can help with​ rigidity, it is outside of the​ nurse's scope of practice to recommend medication. Telling the client that this is just part of the disease process is not appropriate or therapeutic.

The HCP of an older adult with advancing Parkinson's suggested that the client start an exercise regime. Which exercise should the nurse recommend? A) Running B) T'ai chi C) Weight lifting D) Football

B) T'ai chi Rationale: For a client with Parkinson​ disease, an exercise regime that promotes balance and walking is the best.​ So, the nurse may recommend​ t'ai chi. Considering the​ client's age,​ football, running, and weight lifting may be too strenuous.

A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity

B) Unilateral tremors Motor symptoms associated with PD usually begin unilaterally, not bilaterally. For most clients, the earliest motor symptom is tremors; rigidity usually develops later in the course of the disease.

A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity

B) Unilateral tremors Rationale: Motor symptoms associated with PD usually begin unilaterally, not bilaterally. For most clients, the earliest motor symptom is tremors; rigidity usually develops later in the course of the disease.

Which recommendation should the nurse make to the client with PD to improve gait and balance? SATA A) Not using an assistive device B) Not moving too quickly C) Placing the heel on the ground before the toes D) Looking ahead instead of down E) Standing straight

B, C, D, E Rationale: For improving gait and balance in the client with​ PD, the nurse may recommend walking technique that includes standing​ straight, not moving too​ quickly, looking ahead and not​ down, and placing the heel on the ground before the toes. The client may use assistive devices to improve balance and gait.

A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B, C, E Rationale: The UPDRS rates clients in 42 different areas of function. Positive findings for PD include retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run), and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.

The nurse is performing passive ROM exercises for a client with PD. Which nursing goal does this intervention address? SATA A) The client will demonstrate normal bowel elimination patterns B) The client will participate in physical therapy to improve walking and balance C) The client will participate in speech therapy for swallowing and verbal communication D) The client will participate in occupational therapy to integrate assistive devices for self-care E) The client will remain free from injury

B, E Rationale: Physical​ therapy, including passive range of motion​ (ROM) exercises, will improve the​ client's walking and balance. This in turn helps prevent injury from falls. Assistive devices related to occupational therapy are different from those related to physical therapy. The occupational therapist would teach about devices that facilitate activities of daily​ living, such as button hooks and communication boards. Passive ROM exercises are not related to speech therapy or promoting normal bowel elimination patterns.

The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."

C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." Clients with early-onset PD generally have a slower disease progression and a lower rate of dementia than clients who develop the disease later in life. The effect of PD medication on the efficacy of birth control pills is not known, so clients should be urged to consider other forms of contraception. Many women with PD have successfully carried healthy babies to full term.

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.

C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. Levodopa is a natural chemical that can cross the blood—brain barrier and be converted directly to dopamine in the brain. Levodopa can also be converted to dopamine outside the brain, which leads to the most common side effects of nausea and orthostatic hypotension. Therefore, levodopa is almost always given in combination with carbidopa, which prevents levodopa from converting to dopamine until it reaches the brain.

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.

C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. Rationale: Levodopa is a natural chemical that can cross the blood—brain barrier and be converted directly to dopamine in the brain. Levodopa can also be converted to dopamine outside the brain, which leads to the most common side effects of nausea and orthostatic hypotension. Therefore, levodopa is almost always given in combination with carbidopa, which prevents levodopa from converting to dopamine until it reaches the brain.

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.

C) Consult with speech therapy for exercises to aid the client with speech and language Rationale: The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with speech therapy for exercises to aid the client with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write because of hand tremors, so it may not be appropriate for the nurse to suggest that the client and spouse communicate via writing.

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.

C) Consult with speech therapy for exercises to aid the client with speech and language. The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with speech therapy for exercises to aid the client with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write because of hand tremors, so it may not be appropriate for the nurse to suggest that the client and spouse communicate via writing.

The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques

C) Instructing the spouse to ambulate the client at least four times a day Rationale: Because exercise fosters not just mobility but also independence and self-esteem, the intervention that would be most appropriate is for the nurse to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing would not support physical mobility. Reviewing the medication administration schedule would not support physical mobility.

Which of the following is NOT a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling

C) Malignant hypertension Malignant hypertension is not a clinical manifestation of PD; orthostatic hypotension is more commonly associated with this disease. All of the other conditions listed here (restless leg syndrome, cogwheel rigidity, and pill-rolling) are frequently observed in clients with PD.

Which of the following is not a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling

C) Malignant hypertension Rationale: Malignant hypertension is not a clinical manifestation of PD; orthostatic hypotension is more commonly associated with this disease. All of the other conditions listed here (restless leg syndrome, cogwheel rigidity, and pill-rolling) are frequently observed in clients with PD.

The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.

C) The client was able to feed himself and had no weight change in 1 week Rationale: The finding that the client was able to feed himself and had no weight change in 1 week is indicative of an improvement in nutritional status. The client filling out the menu card does not indicate that the client actually consumed any of the meal. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.

An older adult client was diagnosed with Parkinson's 3 months ago. Since the diagnosis, the client has not gone out of the house. Which statement by the nurse is most appropriate? A) "Tell your family to come and take you out of the house." B) "You need to start getting out." C) "Getting out of the house will help you to feel less depressed." D) "Can I ask why you aren't going out of the house?"

D) "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.

The daughter of an older adult client with advancing PD tells the nurse that they need to dress their mother each morning, because the mother is "not fast enough." Which is the most appropriate response from the nurse? A) "Can you let her dress herself?" B) "that is really quite normal." C) "It is important for you to get to work on time." D) "It is best for you to let your mother dress herself for as long as she can."

D) "It is best for you to let your mother dress herself for as long as she can." Rationale: The nurse should tell the caregiver​ that, by allowing independence in​ dressing, the client will have an improved sense of​ well-being and lessened depression. Asking​ closed-ended questions or just remarking that it is normal will not support the​ client's needs.

A client with PD complains of increased tremor while eating. Which action should the nurse recommend? A) Liquefying all meals and drinking them through a straw B) Having someone feed them C) Using their non-dominant hand to eat D) Holding a piece of bread in the other hand while eating

D) Holding a piece of bread in the other hand while eating Rationale: Holding a piece of bread in the opposite hand or purposeful movement will decrease tremors while eating. The client should be encouraged to eat independently for as long as possible. Using the nondominant hand may lack coordination. As the client with PD is prone to​ choking, liquefying all meals would not be recommended.

A nurse is preparing a presentation of PD for a health fair at a local community center. Which information should the nurse include in the presentation? A) PD is inherited in over 50% of those affected B) PD is the result of an infection C) PD affects both men and women at the same rate D) PD usually affects people older than the age of 60 years

D) PD usually affects people older than the age of 60 years Rationale: The cause of PD is not known. There is no evidence of an infection that causes Parkinson disease. It is inherited in only 15-​25% of cases. Parkinson disease affects men more than it does women. Parkinson disease is more common in people over 60 years of age. It can also occur in younger​ people, but this is less common.

Which clinical manifestation would be required to confirm the diagnosis of Parkinson disease? A) Bradykinesia only B) Rigidity only C) Tremor at rest and flaccidity D) Tremors at rest and bradykinesia

D) 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.

*Possible exam question* A client with PD is prescribed an anticholinergic agent to treat tremors and rigidity. the nurse should teach the client about which adverse effect they may experience from this medication? SATA A) Drooling B) Rigidity C) Tremors D) Loss of perspiration E) Dry mouth

D, E Rationale: Anticholinergic medications can cause a decrease in​ salivation, causing dry mouth. This medication decreases tremors and reduces rigidity by blocking acetylcholine. The client taking this medication will have problems with temperature control because the client will not be able to perspire to cool off.

Which recommendation should the nurse make to a client with Parkinson's who reports constipation? SATA A) Decreasing fluid intake B) Decreasing fiber intake C) Limiting exercise D) Increasing fluid intake E) Increasing fiber intake

D, E Rationale: Increasing fluid and fiber intake is a known recommendation for the prevention of constipation. Decreasing the intake of fluids or fiber will not help to prevent constipation. Limiting exercise is not associated with constipation.

How would you explain the importance of exercise to a patient with mild PD who is skeptical of its beneficial effects?

In general, the nurse should describe studies that have been done with different exercise programs and explain the results, especially benefits that resulted from the exercise. The nurse may also describe his or her own observations about differences in patients before and after participating in an exercise program or differences in patients that do or do not participate in an exercise program (while keeping patient confidentiality). If the patient has a basic understanding of physiology, the nurse can describe how specific exercises help increase strength and balance for patients with Parkinson disease (PD) and how such improvements can increase the quality of life for the patient.

An older adult client with PD uses a walker, speaks in a slurred manner with poor articulation, but tries to speak louder to accommodate for this impairment. The client states, "I catch my daughter looking at me angrily sometimes, but she doesn't say anything." Which nursing diagnosis is the priority? A) Falls, Risk fo B) Communication: Verbal, Impaired C) Caregiver Role Strain D) Nutrition, Imbalanced: Less than Body Requirements

Note from Mary: Shit question alert C) Caregiver Role Strain Rationale: The client is making accommodations for preventing falls by using a walker. Being the primary​ caregiver, the​ client's daughter assists the client in feeding so imbalanced nutrition is not a risk. The client is also practicing speech by speaking louder. It is the​ caregiver's role strain that is the major risk for this client.​ (NANDA-I ©​ 2014)

Strategies to prevent complications associated with PD:

See a speech-language pathologist to prevent or treat swallowing and speech problems. Discuss medications with a physician or pharmacist to prevent drug-drug and food-drug interactions. Increase fiber and fluid intake to prevent constipation. Maintain balance to prevent falls: Do not pivot the body before the feet, do not lean or reach, do not carry things while walking, avoid walking backward, remove obstacles and throw rugs, install handrails, and install adequate lighting that is easy to turn on and off. Participate in a support group to increase social interaction and prevent depression. Participate in an exercise program to maintain muscle strength and improve mobility, flexibility, balance, posture, and emotional well-being (see Evidence-Based Practice feature). Be cautious when driving. PD can affect the patient's ability to drive safely because of changes in perception, mental clarity, tremor, and medication side effects. Consider taking public transportation or arrange for a safety assessment through the local DMV.

Strategies to Minimize Symptoms and Complications of PD for patients

Take medications on time, every time. Consume a varied and balanced diet; avoid high-protein meals because protein can decrease the transport of levodopa across the blood-brain barrier. Drink plenty of fluids, but avoid dehydrating fluids, such as coffee. Use a proper walking technique: Place the heel on the ground before the toe, stand up straight, look ahead instead of down, and do not move too quickly. Use an assistive device for balance if needed. Maintain a strong voice by taking a breath before speaking, expressing ideas in short sentences, speaking louder than necessary, reducing throat clearing and coughing, and resting the voice when it is tired. Stop smoking, and cut back on caffeine and alcohol consumption if they increase tremor or balance problems. Allow plenty of time for ADLs. Sit down to perform activities to conserve energy and use assistive devices such as items with large handles, footstools, and electric toothbrushes. See an OT for techniques to make ADLs easier. If bladder incontinence is a problem, try a regular schedule for going to the bathroom or use a protective pad for accidents. If pain is experienced during urination, a UTI may be present and should be treated by a physician. Practice good sleep hygiene.

What special considerations would you have when suggesting an exercise program for an older patient with severe bilateral tremor in his legs who requires a walker for ambulation?

The nurse may suggest an exercise program that reduces the risk of injury should the patient lose balance, such as using a stationary bike or using a harness to supplement balance and prevent falls when using a treadmill. The patient would also benefit from mild strength-training exercises for the legs, arms, and torso. Alexander techniques may also be beneficial for this patient.

Pathophysiology of parkinsons disease

decreased levels of dopamine **Manifestations** tremor rigidity bradykinesia - abnormally slow movements

Promote Independence

encouraging the patient to take adequate time to perform each task. The use of assistive devices is key to helping patients maintain their independence in performing ADLs. Assistive devices for cooking and eating include electric can openers, food processors, mixers, utensils with large handles, finger guards, sloped plates, and many others

Deep brain stimulation (DBS)

is a procedure in which a neurostimulator is implanted into the individual to send electrical signals to one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Complications of DBS include hemorrhage, infection, misplacement or dislodging of the leads, component failure, and stimulation-related adverse effects

Unified Parkinson's Disease Rating Scale (UPDRS)

rates patients in 42 different areas in the categories of mentation, behavior, and mood; ADLs; motor examination; and complications of therapy

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.

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.

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.

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.

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.

2. These are psychosocial manifestations of PD. These should be discussed in the support meeting.

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.

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.

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.

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.

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

3. Memory deficits are cognitive impairments. The client may also develop a dementia.

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."

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.

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.

4. Masklike facies and a shuffling gait are two clinical manifestations of PD.

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.

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.

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.

Develop an exercise program for a 67-year-old male patient with a gait speed of 1.2 m/s, stride length of 0.79 m, cadence of 115 steps/min, and 6-minute walk distance of 472 m.

A good exercise program should include both strength and aerobic exercises. Exercises may include light weights or gravity for resistance during strength training, range-of-motion exercises, and stretches to increase flexibility and balance. Exercise programs should include walking on a treadmill for 30-60 min at least three times a week, plus strength, balance, flexibility, stride length, etc. For walking, a good exercise program should focus on the following goals:

A client newly diagnosed with Parkinson disease asks the​ nurse, "What does dopamine do in the​ brain?" Which is the most appropriate​ response? A. "Dopamine enhances the action of​ acetylcholine." B. "Dopamine causes spinal cord neurons to transmit​ impulses." C. "Dopamine stimulates the neurons to transmit sensory and motor​ impulses." D. "Dopamine helps maintain coordinated motor​ movement."

Answer: ​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.

Which clinical manifestation would be required to confirm the diagnosis of Parkinson​ disease? A. Tremors at rest and bradykinesia B. Bradykinesia only C. Rigidity only D. Tremor at rest and flaccidity

Answer: A ​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.

Which recommendation should the nurse make to the client with Parkinson disease​ (PD) to improve gait and​ balance? (Select all that​ apply.) A. Looking ahead instead of down B. Not moving too quickly C. Not using an assistive device D. Standing straight E. Placing the heel on the ground before the toes

Answer: A, B, D, E Rationale: For improving gait and balance in the client with​ PD, the nurse may recommend walking technique that includes standing​ straight, not moving too​ quickly, looking ahead and not​ down, and placing the heel on the ground before the toes. The client may use assistive devices to improve balance and gait.

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.) A. The client has hand tremors at rest. B. The client does not remember what he ate for breakfast. C. The​ client's blood pressure increases when the client stands up. D. The client has a slurred speech. E. The​ client's facial expression shows no emotion.

Answer: A, B, D, E ​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.

Which health promotion activity should be the focus of teaching for a client with Parkinson disease​ (PD)? (Select all that​ apply.) A. Participating in occupational therapy B. Improving balance C. Avoiding exercise D. Preventing injury from falls E. Promoting independence

Answer: A, B, D, E ​Rationale: The focus of teaching for the client with PD should be on improving​ balance, preventing​ falls, promoting​ independence, and participating in​ physical, occupational, and speech therapy. Clients should be taught to participate in exercise to optimize​ mobility, not avoid it.

A nurse is preparing a presentation on Parkinson disease​ (PD) for a health fair at a local community center. Which information should the nurse include in the​ presentation? A. Parkinson disease affects both men and women at the same rate. B. Parkinson disease is the result of an infection. C. Parkinson disease is inherited in over​ 50% of those affected. D. Parkinson disease usually affects people older than the age of 60 years.

Answer: D ​Rationale: The cause of PD is not known. There is no evidence of an infection that causes Parkinson disease. It is inherited in only 15dash​25% of cases. Parkinson disease affects men more than it does women. Parkinson disease is more common in people over 60 years of age. It can also occur in younger​ people, but this is less common.

Multisystem Effects of Parkinson Disease

Bradykinesia, mask like blank expression, tremor, muscle rigidity

The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."

C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." Rationale: Clients with early-onset PD generally have a slower disease progression and a lower rate of dementia than clients who develop the disease later in life. The effect of PD medication on the efficacy of birth control pills is not known, so clients should be urged to consider other forms of contraception. Many women with PD have successfully carried healthy babies to full term.

The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques

C) Instructing the spouse to ambulate the client at least four times a day Because exercise fosters not just mobility but also independence and self-esteem, the intervention that would be most appropriate is for the nurse to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing would not support physical mobility. Reviewing the medication administration schedule would not support physical mobility.

A client with Parkinson disease​ (PD) is prescribed an anticholinergic agent to treat tremors and rigidity. The nurse should teach the client about which adverse effect they may experience from this​ medication? (Select all that​ apply.) A. Drooling B. Dry mouth C. Rigidity D. Loss of perspiration E.Tremors

​Answer: B, D Rationale: Anticholinergic medications can cause a decrease in​ salivation, causing dry mouth. This medication decreases tremors and reduces rigidity by blocking acetylcholine. The client taking this medication will have problems with temperature control because the client will not be able to perspire to cool off.