Parkinson's - HC3A Unit 3 Prep
84. The nurse is caring for clients on a medical-surgical floor. Which client should beassessed first? 1.The 65-year-old client diagnosed with seizures who is complaining of a headachethat is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot movehis toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying andworried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has aresolving 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.
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 alsodevelop a dementia.
The client diagnosed with Parkinson's disease is being discharged. Which statementmade 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 themorning gives the client a chance tocomplete ADLs without pressure andallows the medications time to give thebest benefits.
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 planof 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 notsustain eating for long periods.Offering frequent and easy-to-chew(soft) meals of small proportions is thepreferred dietary plan.
The nurse is planning the care for a client diagnosed with Parkinson's disease. Whichwould 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 tomaintain the ability to function. Clientsdiagnosed with PD experience slow,jerky movements and have difficultyperforming routine daily tasks.
You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.
A is the only incorrect statement
The healthcare provider is assessing a patient with a diagnosis of Parkinson disease (PD). Which of the following findings would the healthcare provider anticipate? Select all that apply. A. Kyphosis B. Depression C. Daytime sleepiness D. Bradykinesia E. Exophthalamos F. Receptive aphasia
A, B, C, D
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
A, B, D, E
A patient with a diagnosis of Parkinson disease (PD) has been prescribed levodopa. Which of the following statements will the healthcare provider include when teaching the patient about this medication? Select all that apply. A. "Let us know if you notice if the medication begins to lose its effectiveness." B. "If you experience nausea, you may take your medication with a high protein meal." C. "It may take a few months for you to experience the full effects of the medication." D. "Call our office if you notice the development of a tic or facial grimace."e. "This medication will reverse the disease process and give you a normal life."
A,C,D
7. You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."
A. "I will limit foods high in fiber like fruits and vegetables in my diet." (false) B. "I will be sure to drink 2 Liter of fluid per day." (true) C. "It is very common for me to experience diarrhea with this disease." (false) D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal." (true)
A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).
A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. (true) B. Use a cane with a laser point while walking (true). C. Have the husband try to push through the freeze ups. (false) D. Encourage the husband to consciously lift the legs while walking as with marching (true).
Which of the following might be seen in a patient who has been on long-term Levadopa therapy? A. Hypotension B. Hallucinations C. Respiratory distress D. Sleep alterations E. Confusion F. Depression
A. Hypotension B. Hallucinations D. Sleep alterations E. Confusion F. Depression
You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues
A. Increased Salivation (false) B. Loss of smell (true) C. Constipation (true) D. Tremors with purposeful movement (false) E. Shuffling of gait (true) F. Freezing of extremities (true) G. Euphoria (false) H. Coordination issues (true)
The nurse decides that learning has been effective when the patient with Parkinson's makes which of the following statements: A. I should report any burning when I void. B. I may feel depressed, but this should only be reported if it lasts more than 6 months. C. I am going to start Sinemet in the early stages of my disease process. D. It is best for me to watch my feet while I walk to maintain balance.
A. UTIs are a big concern with Parkinson's patients, so these symptoms should be reported. Depression is common and s/s of this should be reported immediately so an antidepressant can be started. Sinemet is reserved for patients with severe symptoms. Patients with Parkinson's benefit from watching the horizon while they walk.
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
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 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 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.
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: BRationale: 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 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.
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.
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:A 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.
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
B
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
B, D
While giving discharge instructions, the nurse instructs the family of a patient with Parkinson's to watch for all of the following complications EXCEPT: A. Constipation B. Hypertension C. Excessive sweating D. Depression
B. You more commonly see HYPOtension with Parkinson's patients, both with and withiut Sinemet therapy.
A patient diagnosed with Parkinson disease (PD) is prescribed levodopa. The medication therapy can be considered effective when the healthcare provider assesses improvement in which of the following? A. Appetite B. Hearing C. Urinary frequency D. Visual acuity
C
Which type of therapy is used to manage problems with eating and swallowing? A. Physical B. Occupational C. Speech
C
A patient who has been taking bromocriptine (Parlodel) and benztropine (Cogentin) for Parkinson's disease is experiencing a worsening of symptoms. The nurse will anticipate that patient may benefit from a. complete drug withdrawal for a few weeks. b. use of levodopa (L-dopa)-carbidopa (Sinemet). c. withdrawal of anticholinergic therapy. d. increasing the dose of bromocriptine.
Correct Answer: B Rationale: After the dopamine receptor agonists begin to fail to relieve symptoms, the addition of L-dopa with carbidopa can be added to the regimen. Complete drug withdrawal will result in worsening of symptoms. Anticholinergic therapy should be continued to help maintain the balance between the actions of dopamine and acetylcholine. Increasing the dose of bromocriptine will increase the risk for toxic effects.
Coexisting dementia and depression are identified in a patient with Parkinson's disease. The nurse anticipates that the greatest improvement in the patient's condition will occur with administration of a. antipsychotic drugs. b. anticholinergic agents. c. dopaminergic agents and antidepressant drugs. d. selective serotonin reuptake inhibitor (SSRI) agents.
Correct Answer: C Rationale: Parkinson's disease and depression are both potentially reversible conditions, and the patient's symptoms that are caused by these two conditions will improve with appropriate treatment. Anticholinergic agents are likely to worsen the patient's condition because they will block the effect of acetylcholine at the synaptic cleft. There is no indication that the patient needs an antipsychotic agent at this time. A selective serotonin reuptake inhibitor (SSRI) may be effective for the depression, but it does not address the patient's other conditions.
A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. The nurse recognizes that these impairments commonly contribute to the nursing diagnosis of a. disuse syndrome related to loss of muscle control. b. self-care deficit related to bradykinesia and rigidity. c. impaired verbal communication related to difficulty articulating. d. impaired oral mucous membranes related to inability to swallow.
Correct Answer: C Rationale: The inability to use the tongue and facial muscles decreases the patient's ability to socialize or communicate needs. Disuse syndrome is not an appropriate nursing diagnosis because the patient is continuing to use the muscles as much as possible. There is no indication in the stem that the patient has a self-care deficit, bradykinesia, or rigidity. The oral mucous membranes will continue to be moist and should not be impaired by the patient's difficulty swallowing.
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."
D
As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks
D. Rubber sole shoes
Parkinson's is a progressive neurodegenerative disease that affects movement due to decreased
Dopamine
Parkinson's drug therapy: The main drugs are dopamine agonists which are most effective in what stage of _________________.
First 3-5 years of use
Muscle rigidity
Inability of muscles to relax normally
Primary risk factors of Parkinson's
Male Over 40 Family history
Parkinson's drug therapy: Dopamine agonist safety priority
Orthostatic hypotension
4 cardinal signs of Parkinson's disease: P M B A T
P- Postural instability M- Muscle rigidity B- Bradykinesia A- Akinesia T- Tremors
As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________.
Substantia nigra, dopamine
A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans
The answer is A. The patient should have a diet of soft foods that are easy to swallow and chew. Option A is the only option that meets that specification.
A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."
The answer is A. This medication is contraindicated for patients with glaucoma.
13. While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva
The answer is A. This medication is known to cause sudden drowsiness that can cause a person to randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc...to prevent injury.
While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity
The answer is B. This is known as cogwheel rigidity, and occurs when the arms are passively moved, which will cause them to jerk slightly.
A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.
The answer is C. All the other options are CORRECT about this medication. However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.
You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)
The answer is C. Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the "wearing off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.
A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling
The answer is C. This is known as bradykinesia.
15. A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply: A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish
The answers are B, D, and E. Rasagiline "Azilect" is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.
Secondary risk factors for Parkinson's
Traumatic brain injury Brain tumors or lesions
Parkinsons disease progresses in stages ranging from
hand tremling to complete ADL dependence
Parkinson's is a leading neurological disorders among
older adults
Primary concern with Parkinson's tx
to promote mobility
Postural instability
unstable when standing
