NCLEX Questions Parkinson Disease

NCLEX Questions Parkinson Disease ScienceMedicineNeurology SMathews926 Save Parkinson's Disease Practice Questi...29 terms martina_hughes Preview Parkinson's Disease NCLEX 12 terms babydoe20Preview Amyotrophic Lateral Sclerosis NCLE...12 terms Courtney_Cooper7 Preview Guillain 12 terms SM 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.)

• The client has hand tremors at rest.
• The client does not remember what he ate for breakfast.
• The​ client's blood pressure increases when the client stands up.
• The client has a slurred speech.
• 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 is the main pathology of Parkinson disease that causes changes in muscular and sensory​ function?

• Reduction of acetylcholine in the brain
• Reduction of dopamine in the brain
• Genetic predisposition
• 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.

Which clinical manifestation would be required to confirm the diagnosis of Parkinson​ disease?

• Tremors at rest and bradykinesia
• Bradykinesia only
• Rigidity only
• 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 symptom for a client with Parkinson disease​ (PD) is due to the lack of automatic muscle​ movement?

• Diminished voice volume
• Reduced ability to swallow
• Alterations in sleep pattern
• 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.A client newly diagnosed with Parkinson disease asks the​ nurse, "What does dopamine do in the​ brain?" Which is the most appropriate​ response?

• "Dopamine enhances the action of​ acetylcholine."
• "Dopamine causes spinal cord neurons to transmit​ impulses."
• "Dopamine stimulates the neurons to transmit sensory and motor​ impulses."
• "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 type of therapy is used to manage problems with eating and​ swallowing?

• Physical
• Occupational
• Speech
• 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.

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

• Caregiver Role Strain
• ​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 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?

• T'ai chi
• Running
• Weight lifting
• 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.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?

• "Tell your family to come and take you out of the​ house."
• "Can I ask why you​ aren't going out of the​ house?"
• "You need to start getting​ out."
• ​"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.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?

• "It is important for you to get to work on​ time."
• "Can you let her dress​ herself?
• "It is best for you to let your mother dress herself for as long as she​ can."
• "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.

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.)

• Drooling
• Dry mouth
• Rigidity
• 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.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?

• Parkinson disease affects both men and women at the same rate.
• Parkinson disease is the result of an infection.
• Parkinson disease is inherited in over​ 50% of those affected.
• 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.Which health promotion activity should be the focus of teaching for a client with Parkinson disease​ (PD)? (Select all that​ apply.)

• Participating in occupational therapy
• Improving balance
• Avoiding exercise
• Preventing injury from falls
• 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.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?

• "It helps dopamine work​ better."
• ​"It will make you feel​ better."
• "The healthcare provider thinks it will help your​ symptoms."
• "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.