1.
The nurse is assessing a patient and notes a Brudzinski’s sign and Kernig’s sign. These are two classic signs of which of the following disorders?
Correct Answer
B. Meningitis
Explanation
A positive response to one or both tests indicates meningeal irritation that is present with meningitis. Brudzinski’s and Kernig’s signs don’t occur in CVA, seizure disorder, or Parkinson’s disease.
2.
The nurse should instruct the patient with Parkinson’s disease to avoid which of the following?
Correct Answer
D. Sitting on the beach in the sun on a summer day
Explanation
The patient with Parkinson’s disease may be hypersensitive to heat, which increases the risk of hyperthermia, and he should be instructed to avoid sun exposure during hot weather.
3.
The nurse is teaching a client with Parkinson’s disease ways to prevent curvatures of the spine associated with the disease. To prevent spinal flexion, the nurse should tell the client to:
Correct Answer
A. Periodically lie prone without a neck pillow
Explanation
Periodically lying in a prone position without a pillow will help prevent the flexion of the spine that occurs with Parkinson’s disease. Answers B and C flex the spine; therefore, they are incorrect. Answer D is not realistic because of position changes during sleep; therefore, it is incorrect.
4.
A shuffling gait is typically associated with the patient who has:
Correct Answer
A. Parkinson’s disease
Explanation
A shuffling gait from the musculoskeletal rigidity of the patient with Parkinson’s disease is common. Patients experiencing a stroke usually exhibit loss of voluntary control over motor movements associated with generalized weakness; a shuffling gait is usually not observed in stroke patient.
5.
Which of the following diseases is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?
Correct Answer
A. Multiple sclerosis
Explanation
The cause of MS is not known and the disease affects twice as many women as men.
6.
Which of the following diseases is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain?
Correct Answer
A. Parkinson’s disease
Explanation
In some patients, Parkinson’s disease can be controlled; however, it cannot be cured.
7.
Mr. Perkson has a parkinson’s disease and he finds the resting tremor he is experiencing in his right hand very frustrating. The nurse advises him to:
Correct Answer
B. Hold an object
Explanation
The resting or non-intentional tremor may be controlled with purposeful movement such as holding an object. A warm bath, deep breathing and diazepam will promote relaxation but are not specific interventions for tremor.
8.
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.Which of the following is a characteristic of a patient with advanced Parkinson’s disease?
Correct Answer
C. Mask like facial expression
Explanation
Parkinson's disease does not affect the cognitive ability of a person. It is a disorder due to the depletion of the neurotransmitter dopamine which is needed for inhibitory control of muscular contractions. Client will exhibit mask like facial expression, Cog wheel rigidity, Bradykinesia, Shuffling gait etc. Muscle atrophy does not occur in parkinson's disease nor visual disturbances.
9.
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment. The onset of Parkinson’s disease is between 50-60 years old. This disorder is caused by
Correct Answer
D. Impairment of dopamine producing cells in the brain
Explanation
Dopamine producing cells in the basal ganglia mysteriously deteriorates due to unknown cause.
10.
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.The patient was prescribed with levodopa. What is the action of this drug?
Correct Answer
A. Increase dopamine availability
Explanation
Levodopa is an altered form of dopamine. It is metabolized by the body and then converted into dopamine for brain's use thus increasing dopamine availability. Dopamine is not given directly because of its inability to cross the BBB.
11.
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.You are discussing with the dietician what food to avoid with patients taking levodopa?
Correct Answer
D. Vitamin B6 rich food
Explanation
Vitamin b6 or pyridoxine is avoided in patients taking levodopa because levodopa increases vitamin b6 availability leading to toxicity.
12.
SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse is going to make an initial assessment.One day, the patient complained of difficulty in walking. Your response would be
Correct Answer
A. You will need a cane for support
Explanation
Telling the client to walk erect neglects the clients complain of difficulty walking. Wheelchair is as much as possible not used to still enhance the client's motor function using a cane. Telling the client not to force himself walk is non therapeutic. The client wants to talk and we should help her walk using devices such as cane to provide support and prevent injuries.
13.
Nurse Carol is assessing a client with Parkinson’s disease. The nurse recognize bradykinesia when the client exhibits:
Correct Answer
D. Lack of spontaneous movement
Explanation
Bradykinesia is slowing down from the initiation and execution of movement.
14.
A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which action must you intervene?
Correct Answer
C. The NA performs the patient’s complete bath and oral care.
Explanation
The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this patient as independent and mobile as possible. Assisting the patient to ambulate, reminding the patient not to look at his feet (to prevent falls), and encouraging the patient to feed himself are all appropriate to goal of maintaining independence. Focus: Delegation/supervision
15.
All of these nursing activities are included in the care plan for a 78-year-old man with Parkinson’s disease who has been referred to your home health agency. Which ones will you delegate to a nursing assistant (NA)? (Choose all that apply).
Correct Answer(s)
A. Check for orthostatic changes in pulse and bloods pressure.
C. Remind the patient to allow adequate time for meals.
E. Assist the patient with prescribed strengthening exercises.
Explanation
NA education and scope of practice includes taking pulse and blood pressure measurements. In addition, NAs can reinforce previous teaching or skills taught by the RN or other disciplines, such as speech or physical therapists. Evaluation of patient response to medication and development and individualizing the plan of care require RN-level education and scope of practice. Focus: Delegation
16.
A nurse is assigned to care to a client with Parkinson’s disease. What interventions are important if the nurse wants to improve nutrition and promote effective swallowing of the client?
Correct Answer
D. Sit in an upright position to eat
Explanation
Client with Parkinson’s disease are at a high risk for aspiration and undernutrition. Sitting upright promotes more effective swallowing.
17.
A client has been placed on levodopa to treat Parkinson’s disease. Which of the following is a common side effects of levodopa that the nurse should include in the client’s teaching plan?
Correct Answer
C. Postural hypotension
Explanation
Postural hypotension is a common side effect of levodopa that the nurse should include in the client's teaching plan. Levodopa is a medication used to treat Parkinson's disease, but it can cause a drop in blood pressure when changing positions, leading to postural hypotension. This can result in dizziness, lightheadedness, and even fainting. It is important for the client to be aware of this side effect and take precautions such as rising slowly from a sitting or lying position to prevent falls or injuries.
18.
Which of the following is the most common cause of dementia among elderly persons?
Correct Answer
D. Alzheimer’s disease
Explanation
Alzheimer;s disease, sometimes known as senile dementia of the Alzheimer’s type or primary degenerative dementia, is an insidious; progressive, irreversible, and degenerative disease of the brain whose etiology is still unknown. Parkinson’s disease is a neurologic disorder caused by lesions in the extrapyramidial system and manifested by tremors, muscle rigidity, hypokinesis, dysphagia, and dysphonia. Multiple sclerosis, a progressive, degenerative disease involving demyelination of the nerve fibers, usually begins in young adulthood and is marked by periods of remission and exacerbation. Amyotrophic lateral sclerosis, a disease marked by progressive degeneration of the neurons, eventually results in atrophy of all the muscles; including those necessary for respiration.
19.
Levodopa is ordered for a client with Parkinson’s disease. Before starting the medication, the nurse should know that:
Correct Answer
B. Levodopa may cause the side effects of orthostatic hypotension
Explanation
Levodopa is the metabolic precursor of dopamine. It reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension.
20.
A nurse is caring for a client with Parkinson's disease who has been taking carbidopa/levodopa (Sinemet) for a year. Which of the following adverse reactions will the nurse monitor the client for?
Correct Answer
C. Hypotension
Explanation
Hypotension, dizziness and lethargy are side effects of anti parkinson drugs like levodopa and carbidopa.