PD Practice Questions
The nurse is conducting a physical assessment for a patient using the Unified Parkinson's Disease Rating Scale (UPDRS). Which statement should the nurse recognize as defining the purpose of this tool? Used to rate patients in multiple areas Used to rule out PD Used to diagnose Parkinson disease (PD) Used to determine appropriate treatment
Used to rate patients in multiple areas The Unified Parkinson's Disease Rating Scale (UPDRS) rates patients with Parkinson disease (PD) in 42 different areas in the categories of mentation, behavior and mood, activities of daily living, motor examination, and complications of therapy. The UPDRS is not used to diagnose or rule out PD, and it does not determine which treatment is most appropriate for the patient.
A patient with Parkinson disease (PD) is having trouble swallowing and is referred to a speech therapist. The patient asks, "Why do I need to see a speech therapist?" Which answer from the nurse is appropriate? "A speech therapist will help you to focus on activities of daily living." "A speech therapist will help you with strategies to facilitate eating." "A speech therapist will help you pick the right foods." "A speech therapist will help you to cope in a home environment."
"A speech therapist will help you with strategies to facilitate eating." A speech therapist will develop a plan of care to help the patient implement strategies to facilitate eating. A physical therapist focuses more on mobility, and an occupational therapist focuses more on activities of daily living. A dietitian focuses on implementation of the proper diet for the patient, not on the mechanics of eating.
The son of a patient with Parkinson disease (PD) is concerned that he might be at risk too. He asks the nurse about the risk factors for Parkinson disease. Which statement by the nurse is accurate? "Parkinson disease affects city dwellers more than it does those in rural areas." "Age is the primary risk factor for Parkinson disease." "Late-onset Parkinson disease is more likely to have a genetic link." "Parkinson disease affects women more often than it does men."
"Age is the primary risk factor for Parkinson disease." The primary risk factor of Parkinson disease (PD) is age, with average age of onset being 60 years. Fifty percent more men than women develop PD. Individuals who live in rural areas are at higher risk for PD. Early-onset or juvenile PD patients are more likely to have a genetic mutation than are those with late-onset PD.
A patient with Parkinson disease states that, since the decrease in the dose of levodopa, they are not able to walk properly. Which response by the nurse is most appropriate? "I'll make a note of this in your record so we can see if it improves." "Make sure to tell your healthcare provider at your next appointment." "I'll report that to the healthcare provider today and let you know of any changes." "The healthcare provider prescribed the dosage, and you should just keep taking it."
"I'll report that to the healthcare provider today and let you know of any changes." The patient's concern needs to be addressed, and the nurse would report this concern to the healthcare provider for dosage evaluation at that time. The nurse will also need to record the subjective comment, but the nursing plan needs to include notification of the healthcare provider as well. Asking the patient with Parkinson disease (PD) to wait to tell the healthcare provider is not a correct response and could prolong intervention. The patient should not be told to simply keep the same dose; their concerns are valid and need to be addressed with the healthcare provider.
A patient is recently diagnosed with Parkinson disease (PD). Upset with this diagnosis, the patient asks the nurse, "How did this happen?" Which statement by the nurse represents the cause of PD? "The cause of Parkinson disease is unknown." "There are many causes of Parkinson disease. You need to research it on the internet." "Parkinson disease is caused by toxins in your environment." "I think you should ask your doctor that question."
"The cause of Parkinson disease is unknown." The cause of Parkinson disease (PD) is unknown. Many researchers believe it results from a combination of genetic susceptibility or an exposure to environmental factors and toxins, and some cases of PD appear to be hereditary. Most cases of PD are sporadic, which means the disease occurs randomly, with no apparent genetic link. Researching on the internet or conferring with the doctor might help to understand about the disease but not about its cause.
The nurse is teaching an older adult patient with Parkinson disease (PD) and their spouse about placement of a deep brain stimulator. Which statement by the patient's spouse indicates a need for further instruction? "The device makes electrical impulses to stimulate the brain." "This device helps block a chemical in my spouse's brain." "This device means that my spouse won't have to take medication anymore." "The device does not cure Parkinson disease."
"This device means that my spouse won't have to take medication anymore." Patients who have a deep brain stimulator placed may still need low doses of medication, as the stimulator does not completely control the manifestations. The stimulator does not cure Parkinson disease (PD), but it will help control tremors in patients who are not receiving sufficient control with medications. The deep brain stimulator creates electrical impulses that stimulate the brain in specific areas. The impulses block the effects of acetylcholine that cause the tremors.
The caregiver of a patient with Parkinson disease tells the nurse that, as the patient's disability increases, they exhibit more fear, anxiety, and depression. Which response by the nurse is appropriate? "You should tell the patient that they need to get over these fears." "The patient has no reason to be fearful with you there." "Don't worry about it as it is quite expected." "You can help to overcome these barriers by listening to the patient's fears."
"You can help to overcome these barriers by listening to the patient's fears." The caregiver of a patient with Parkinson disease can help to overcome these barriers by listening to the patient's fears, helping the patient reach out to a support group, coordinating mobility training, and helping to celebrate the patient's little victories. Not addressing the core reasons for the patient's feelings would not be supportive.
A child has early-onset Parkinson disease (PD). Which information should the nurse communicate to the parents? "Your child will have a lower instance of dystonia." "Your child will have a slower disease progression and a lower rate of dementia." "Your child will have a higher rate of dementia." "Your child will have a faster rate of disease progression."
"Your child will have a slower disease progression and a lower rate of dementia." Patients with early-onset Parkinson disease (PD) have a slower disease progression and a lower rate of dementia. They are more likely to have dystonias at the onset and dyskinesias.
The nurse is assessing the home routine of a patient who was recently diagnosed with Parkinson disease (PD) to help improve activities of daily living (ADLs). Which activity should the nurse consider most important in the assessment? Ability to prepare meals Ability to go to a gym Availability of a gardener Availability of a housekeeper
Ability to prepare meals For patients with Parkinson disease (PD), performing activities of daily living (ADLs) becomes a burden. These include preparing meals, performing hygiene tasks, and maintaining the house. Understanding about the patient's household responsibilities is important, but the availability of a housekeeper or a gardener, or whether the patient has the ability to go to a gym does not assess the patient's ability to perform ADLs.
The nurse is caring for a older adult patient with Parkinson disease (PD). The nurse notices the patient has tremors. Which other manifestation should the nurse expect to observe? Hand tremors only with movement Constant blinking of eyes Loud voice Bradykinesia
Bradykinesia Two of the three symptoms of tremor, rigidity, and bradykinesia are required for a diagnosis of Parkinson disease (PD). Postural hypotension, not hypertension, is a common manifestation in patients with PD. This is caused by damage to the autonomic nervous system. Tremors at rest, not only at movement, are very common in PD and are easy to identify. Tremors may occur in the hands, face, neck, lips, tongue, and jaw. Bradykinesia associated with PD causes the person to blink less frequently, not more frequently, and also causes the sufferer to speak in a voice that is softer (hypophonia), not louder.
The nurse is assessing a patient who has been recently diagnosed with Parkinson disease (PD). Which finding should the nurse expect in the patient? Excessive sleeping Choking Diarrhea Rapid thought processes
Choking The patient with Parkinson disease (PD) has difficulty swallowing and tremors that interfere with eating. This can lead to choking, malnutrition, and weight loss. Patients with PD typically have difficulty sleeping from loss of dopamine, a neurotransmitter that helps to regulate sleep. Patients with PD tend to have constipation as a result of limited physical mobility due to rigidity. Cognitive deficits usually begin with slowed thinking.
A patient visits the healthcare facility to have tests related to diagnosis of Parkinson disease (PD) performed. Which diagnostic test should the nurse expect the health care provider to order? Hematocrit MRI DaTscan X-ray
DaTscan DaTscan is an imaging technique used for patients with symptoms of Parkinson disease (PD). It involves the injection of radioactive ioflupane I 123, which binds with dopamine transporters in the brain. This allows visualization of dopaminergic neurons using single photon emission computed tomography (SPECT). Patients with degeneration of dopamine neurons will show less uptake of ioflupane I 123. An MRI or other blood tests may be used to rule out other conditions.
Which type of therapy has been shown to improve the health-related quality of life (HRQOL) of the patient with Parkinson disease? Speech therapy Dance therapy Physical therapy Occupational therapy
Dance therapy Dance therapy has been shown to be safe and effective in improving the health-related quality of life (HRQOL) of patients with Parkinson disease. It can affect HRQOL in as little as 2 weeks and improve HRQOL in individuals with severe or end-stage neurologic disorders, with participants reporting significant improvements in symptoms of anxiety, stress, and depression. Speech therapy is effective in improving speech and swallowing. Occupational therapy is prescribed to improve activities of daily living. Physical therapy is recommended to improve strength, gait, and balance.
Which clinical therapy should the nurse expect to be ordered for a patient with Parkinson disease who has head and neck motor deficits? Mobility devices Exercise program Deep brain stimulation Atypical antipsychotics
Deep brain stimulation Deep brain stimulation can be used to treat motor deficits of the upper limbs, lower limbs, trunk, head, and neck. Atypical antipsychotics are sometimes ordered for sleep problems in Parkinson disease. An exercise program and mobility devices would be beneficial for upper limb, lower limb, and trunk motor deficits.
Which practice should the nurse recommend that a patient with Parkinson disease (PD) avoid? Fast walking Intentionally picking up feet instead of shuffling Stepping over an imaginary line Placing the heel on the floor first
Fast walking Walking fast can result in falling for a patient with Parkinson disease (PD). The nurse can teach techniques for proper walking, including intentionally picking up the feet while walking, instead of shuffling, and placing the heel on the floor first. The patient can also be taught tips to overcome freezing, such as stepping over an imaginary line.
The nurse is teaching a patient with Parkinson disease (PD) ways to help reduce tremors during eating. Which recommendation is appropriate? Having all meals blended and drinking them from a cup Being fed instead of eating independently Using a splint Holding a piece of bread in the opposite hand while eating
Holding a piece of bread in the opposite hand while eating To reduce tremors during eating, it can be recommended that the patient with Parkinson disease (PD) hold a piece of bread in the opposite hand or use purposeful movement. Wearing a splint does not reduce tremors. It is important for the patient to be as independent as possible for as long as possible. A patient with PD is at risk for choking and should only drink thickened liquids. Having all meals blended may decrease the patient's joy in eating and decrease appetite over the long term. previous
A patient was recently hospitalized for a pressure injury related to immobility caused by Parkinson disease. Which precaution can best prevent this from happening again? Immobility precautions Choking precautions Gait precautions Medication precautions
Immobility precautions Immobility precautions will help to prevent pressure injuries and other complications of immobility. Gait problem precautions, choking precautions, and medication precautions are also important, but they are not directly related to the prevention of pressure injury.
The caregiver of a patient with Parkinson disease is concerned about the patient's safety at home. Which modification should the nurse suggest? Lowering the back legs of chairs Widening the doorways Installing hand rails Adjusting the toilet handle
Installing hand rails Safety is an important consideration for all patients with Parkinson disease who are discharged home. Modifications such as installing hand rails for stability and elevating the back legs of chairs, not lowering them, would be appropriate modifications for safety that would be discussed. Elevated toilet seats, not adjusting the toilet handle, would be advised for safety. Unless the patient is wheelchair bound, widening of the doorways would not be an important consideration for the safety of the patient.
A patient is taking the decarboxylase inhibitor levodopa to help control the manifestations of Parkinson disease (PD). The patient is experiencing brief and sudden-onset periods of manifestations followed by a return to improved function. What is the cause of this sudden change in manifestations? Low-protein diet Low medication levels Long-term exposure to levodopa Medication withdrawal
Long-term exposure to levodopa The symptoms of Parkinson disease (PD) result from a lack of dopamine in the brain. Therefore, the best way to treat PD is to increase brain dopamine levels. The primary drug used for this purpose is levodopa, which is the mainstay of PD treatment. As the patient continues to take levodopa, its effectiveness diminishes. This causes the patient to experience an "on-off" effect characterized by a sudden lack of symptom control and unexpected dyskinesia. With increasing doses and long-term exposure, levodopa usually causes dyskinesia, which may become less tolerable for the patient than the symptoms of PD. A low-protein diet is recommended because a high-protein diet may interfere with levodopa absorption in the gastrointestinal tract.
Which result should the nurse expect of an MRI or a CT scan of the brain in a patient with Parkinson disease (PD)? Small tumors Brain shrinkage Normal Hemorrhage
Normal A patient with Parkinson disease (PD) is expected to have normal results on an MRI or a CT scan of the brain. Brain shrinkage, hemorrhage, or tumors would not be expected results.
The nurse is caring for a patient with Parkinson disease who is concerned about completing activities of daily living once they are discharged home. Which referral should the nurse request from the healthcare provider? Physical therapy Occupational therapy Social worker Care coordinator
Occupational therapy Occupational therapy focuses more on fine motor skills and upper body strength. These therapists also help the patient perform activities of daily living and work functions, allowing the patient to keep their job longer. Physical therapy focuses more on gross motor skills and muscle strength. A care coordinator ensures the patient receives appropriate services while in the hospital and that services are not duplicated. A social worker has many roles in the hospital that include being a liaison for the patient and family and referring the patient to appropriate services.
The nurse is caring for a 36-year-old female patient who was recently diagnosed with Parkinson disease (PD). The nurse knows which statement is true regarding "early-onset" PD? Patients with early-onset PD are known to have a higher incidence of dementia. Patients with early-onset PD have a higher mortality rate than late-onset PD. Patients with early-onset PD will not be able to carry a pregnancy to full term. Patients with early-onset PD typically have a slower progression of the disease.
Patients with early-onset PD typically have a slower progression of the disease. Patients with "early-onset" or "young-onset" Parkinson disease (PD) tend to have a slower disease progression and lower rate of dementia than late-onset PD. There is no evidence that patients with early-onset PD have a higher mortality rate than late-onset PD. Patients with early-onset PD may want to receive genetic counseling if they have any concerns before conception, but many PD patients have carried pregnancies to full term. Early-onset PD is often inherited, although it may be idiopathic.
The nurse is planning discharge for an older adult patient with Parkinson disease (PD). The patient is worried about being able to safely walk in their home. Which collaborative therapy should the nurse arrange for the patient to receive in their home? Occupational therapy Respiratory therapy Physical therapy Recreational therapy
Physical therapy Physical therapy focuses on mobility, and the therapist would teach strategies for making the home environment safe. Occupational therapy focuses more on activities of daily living and performing them in the home environment. Recreational therapists work with patients to restore motor, social, and cognitive functioning; build confidence; develop coping skills; and integrate skills learned in the treatment settings into community settings. Respiratory therapy would only be performed if the patient had a compromised breathing airway.
A patient with Parkinson disease (PD) is unable to communicate because of a soft voice and poor facial muscle strength. The nurse should request a referral to which member of the interdisciplinary team? Occupational therapist Respiratory therapist Speech therapist Physical therapist
Speech therapist A speech therapist will work with the patient to improve speech with exercises to strengthen the face, throat, and respiratory muscles. The speech therapist may recommend a communication board ("magic slate") to help the patient communicate their need to others. Respiratory therapists give breathing treatments and perform chest percussion to treat congestion in the lungs. The occupational therapist treats self-care deficits such as grooming and dressing. And the physical therapist treats coordination and ambulation problems, not difficulty of speech because of a soft voice and poor facial muscle strength.