EAQ 4510 Parkinson Summer 2020

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? A. Suddenly B. Gradually C. Overnight D. Irregularly

B. Gradually 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.

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

B. Risk for injury related to gait disturbances 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 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? A. Ataxic B. Shuffling C. Scissoring D. Asymmetric

B. Shuffling 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.

Which among the Five Rights of Delegation is the cornerstone of delegation? A. "Right person" B. "Right supervision" C. "Right circumstance" D. "Right communication and direction"

D. "Right communication and direction" Rationale: Among the Five Rights of Delegation, "right communication and direction" is the most important right of delegation. It is the most useful in maintaining the quality and safety outcomes, as it involves communication and direction. "Right person" is useful for understanding which person has the appropriate skills to perform the task. "Right supervision" involves monitoring the tasks that are performed with the goal of improving outcomes. "Right circumstance" seeks to ensure that the appropriate equipment and resources are available for the delegatee.

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. A. Resting tremors B. Flattened affect C. Muscle flaccidity D. Tonic-clonic seizures E. Slow voluntary movements

A, B, E 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.

Antipsychotic drugs can cause extrapyramidal side effects. Which responses does the nurse document as indicating pseudoparkinsonism? Select all that apply. A. Rigidity B. Tremors C. Mydriasis D. Photophobia E. Bradykinesia

A, B, E Rationale: Rigidity, tremors, and bradykinesia may occur because of the effect of the antipsychotic on the postsynaptic dopamine receptors in the brain. Mydriasis and photophobia are not side effects of antipsychotic drugs.

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? A. "It sounds like it's been difficult for you." B. "I don't understand what you mean by that comment." C. "I have experience caring for clients like your husband." D. "It's too bad you didn't realize that you needed help to care for him."

A. "It sounds like it's been difficult for you." 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.

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? A. A raised toilet seat B. Side rails for the bed C. A trapeze above the bed D. Crutches for ambulation

A. A raised toilet seat 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.

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

A. Avoid leaning forward. 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.

Which monoamine oxidase inhibitor is used to treat Parkinson disease? A. Selegiline B. Phenelzine C. Isocarboxazid D. Tranylcypromine

A. Selegiline 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 on antipsychotic drug therapy develops parkinsonism. Which drugs would be beneficial for the client? Select all that apply. A. Levodopa B. Benztropine C. Amantadine D. Bromocriptine E. Diphenhydramin

B, C, E 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.

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

D. Replacement of a neurotransmitter in the brain 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.

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. A. Nonintention tremors B. Frequent bouts of diarrhea C. Masklike facial expression D. Hyperextension of the neck E. Rigidity to passive movement

A, C, E 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.

Which questions related to decision making for delegation are appropriate according to the delegation right of "right circumstance"? Select all that apply. A. Is the task legally appropriate to delegate? B. Is the prospective delegatee a willing and able employee? C. Are the equipment and resources available to complete the task? D. Does the delegatee have appropriate supervision to complete the task? E. Is the task appropriate to delegate based on the institutional policies and procedures?

C & D Rationale: There are Five Rights of Delegation. Questions related to the equipment and resources available for carrying out the task allotted are appropriate for the delegation right "right circumstance." Asking about the required supervision needed for the delegatee to complete the task is appropriate for the delegation right "right circumstance." Questioning whether the task allotted is legal is appropriate for delegation right "right task." Checking whether the delegatee is an able person to perform the task would come under delegation right "right person." Checking whether the task is based on the policies and procedures of the institution comes under the delegation right "right task."

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? A. Disintegration of the myelin sheath B. Breakdown of upper and lower neurons C. Reduced acetylcholine receptors at synapses D. Degeneration of the neurons of the basal ganglia

D. Degeneration of the neurons of the basal ganglia 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.

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? A. The nurse should document the incident in the occurrence report tool. B. The nurse should provide information in the medical record about the occurrence. C. The nurse should document in the client's medical report that an occurrence report has been filed. D. The nurse should document in the client's medical report that the primary healthcare provider has been contacted.

A. The nurse should document the incident in the occurrence report tool. 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 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. A. "Home care is a type of continuing care in which the primary objectives are health promotion and education." B. "Continuing care is necessary for clients who are recovering from an acute or chronic illness or disability." C. "Adult day care centers are ideal for clients whose caregivers have to be away from home during the day." D. "Hospice care is a continuing care system that allows clients to live at home with comfort, independence, and dignity." E. "Nursing centers provide 24-hour custodial care in order to help residents achieve and maintain their highest level of functioning."

C, D, E 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 receiving an antipsychotic medication. When assessing the client for signs and symptoms of pseudoparkinsonism, the nurse will be alert for which complication? A. Drooling B. Blurred vision C. Muscle tremors D. Photosensitivity

C. Muscle tremors Rationale: Drug-induced parkinsonism presents with the classic triad of adaptations associated with Parkinson disease: rigidity, slowed movement (bradykinesia), and tremors. The anticholinergic effects of antipsychotic medication cause dry mouth, not drooling. Neither dry mouth nor drooling is related to pseudoparkinsonism. Blurred vision and photosensitivity are side effects of anticholinergic, not antipsychotic, medications.

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? A. Blocks the effects of acetylcholine B. Increases the production of dopamine C. Restores the dopamine levels in the brain D. Promotes the production of acetylcholine

C. Restores the dopamine levels in the brain 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.

What should the nurse include when teaching a client with severe Parkinson's Disease about carbidopa-levodopa? A. Multivitamins should be taken daily. B. Alcohol consumption should be moderate. C. The medication can be taken with meals. D. A high-protein diet should be followed.

C. The medication can be taken with meals. Rationale: Carbidopa-levodopa is often taken with meals to reduce the nausea and vomiting commonly associated with this drug. Although the best practice is to take carbidopa-levodopa on an empty stomach, this is often not feasible for many clients who suffer from gastrointestinal disturbances related to this medication. Multivitamins are contraindicated as they often contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. Moderate alcohol consumption can also antagonize the drug effect. A high-protein diet is contraindicated because levodopa is an amino acid that may increase blood urea nitrogen (BUN) levels. Additionally, some proteins contain pyridoxine, which diminishes the desired therapeutic effect by increasing peripheral levodopa metabolism and reducing the amount of bioavailable levodopa crossing the blood-brain barrier.