3] Difficulty swallowing
Rationale: Difficulty swallowing [dysphagia] is a manifestation of both neurologic disorders. With Parkinson disease there is a progressive loss of spontaneity of movement, including swallowing, related to degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain. With myasthenia gravis there is a decreased number of acetylcholine [Ach] receptor sites at the neuromuscular junction, which interferes with muscle contraction, impairing muscles involved in chewing, swallowing, speaking, and breathing. A cogwheel gait is associated with Parkinson disease, not myasthenia gravis. Impaired cognition is associated with Parkinson disease, not myasthenia gravis. Nonintention tremors are associated with Parkinson disease, not myasthenia gravis. The nonintention tremors associated with Parkinson disease result from the loss of the inhibitory influence of dopamine in the basal ganglia, which interferes with the feedback circuit within the cerebral cortex.
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Terms in this set [44]
The daughter of a 75-year-old woman states to the parish nurse that she has noticed her mother rolling her fingers together on her right hand. The nurse observes the patient and determines she is "pill rolling," which is characteristic of Parkinson's disease. Which of the following factors contributes to the development of central nervous system symptom of "pill rolling?"
A. decrease firing of the sinoatrial node
B. conversion of angiotensin I to angiotensin II
C. increase in excitatory acetylcholine
D. influx of potassium through the cell membrane
C
A 65-year-old woman has been taking levodopa for several weeks for symptoms of Parkinson's disease. Which of the following symptoms indicates that she is not receiving an adequate dose for the treatment of her symptoms?
A. edema of the feet and ankles
B. widened QRS complex
C. static gait
D. increased intraocular pressure
C
The 56-year-old man is taking levodopa-carbidopa for Parkinson's disease. During the therapy, he becomes light-headed and dizzy. Which of the following is a potentially serious adverse effect of the drug treatment?
A. orthostatic hypotension
B.
diminished fluid volume
C. hematuria
D. jaundice
A
A 52-year-old man is taking selegiline for the treatment of Parkinson's disease. He consumes port wine cheese and crackers at a party. Which of the following symptoms does he develop?
A. ataxic gait
B. melena
C. cardiac dysrhythmia
D. hypertension
D
A 48-year-old man with severe akinesia develops severe symptoms of parkinsonism following the administration of his antiparkinson medications. This condition occurs only one to two times per month. Which of the following medications is the man's prescriber most likely to order?
A. bromocriptine mesylate
B. apomorphine hydrochloride
C. cabergoline
D. pramipexole dihydrochloride
B
A 35-year-old woman has begun to take tolcapone in addition to levodopa/carbidopa for Parkinson's disease. Which of the following is the priority nursing intervention?
A. arrange to assess the patient for hypertension early in the morning
B. evaluate the patient's ability care for herself
C. have the patient take levodopa/carbidopa 2 hours after tolcapone
D. instruct the patient to report tea-colored urine to the prescriber
D
A 76-year-old woman is taking levodopa-carbidopa-entacapone. Which of the following is the priority nursing intervention?
A. administering with a high-protein meal
B. administering with meals only
C. assessing for diarrhea
D. assessing for constipation
C
An elderly man begins taking levodopa-carbidopa-entacapone. Which of the following symptoms warrants a change in the dosage?
A.
dilated pupils
B. static gait
C. edema
D. nausea
B
As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________.
A. red nucleus, acetylcholine
B. leminisci, norepinephrine
C. substantia nigra, dopamine
D. tectum nigra, dopamine
C
True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease.
FALSE
Rationale: Parkinson's Disease most commonly affects patients in OLDER adulthood [60 or older], and there is currently no cure for the disease.
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
Rationale: This option is the only one that is INCORRECT. Tremors in Parkinson's Disease tend to occurs at rest and will actually improve with movement.
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
B
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
C
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
B,C,E,F H
Rationale: The answers are B, C, E, F, H. These are all signs and symptoms experienced with PD [they vary among patients]. There is NOT increased salivation [although drooling occurs...this is due to the decreased ability to swallow]. There are tremors at REST [not purposeful movement] along with depression rather the euphoria.
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."
B,D
Rationale: Constipation [not diarrhea] is a common symptom with Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetable and drinking 2 L of fluid per day [unless contraindicated]. In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine [hence decreasing it absorption].
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
A
Rationale: 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.
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
D
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,B,D
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
C
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
B,D,E
Rationale: The answers are B, D, 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.
A patient with suspected Parkinsons disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?
A] When the patient is resting
B] When the patient is ambulating
C] When the patient is preparing his or her meal tray to eat
D] When the patient is participating in occupational therapy
A
The clinic nurse caring for a patient with Parkinsons disease notes that the patient has been taking levodopa and carbidopa [Sinemet] for 7 years. For what common side effect of Sinemet would the nurse assesses this patient?
A] Pruritus
B] Dyskinesia
C] Lactose intolerance
D] Diarrhea
B
A patient with Parkinsons disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The patients nutritional needs should be met by what method?
A] Total parenteral nutrition [TPN]
B] Provision of a low-residue diet
C] Semisolid food with thick liquids
D] Minced foods and a fluid restriction
C
A patient has just been diagnosed with Parkinsons disease and the nurse is planning the patients subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patients family?
A] Risk for infection
B] Impaired spontaneous ventilation
C] Unilateral neglect
D] Risk for injury
D
An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinson's disease. Which of the wife's descriptions of her husbands health and function is most suggestive of Parkinson's disease?
A] Lately he seems to move far more slowly than he ever has in the past.
B] He often complains that his joints are terribly stiff when he wakes up in the morning.
C] He's forgotten the names of some people that we've known for years.
D] He's losing weight even though he has a ravenous appetite.
A
A patient who was diagnosed with Parkinsons disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patients medication regimen?
A] The patient is in a honeymoon period when adverse effects of levodopa-carbidopa are not yet evident.
B] Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment.
C]
The patients temporary improvement in status is likely unrelated to levodopa-carbidopa.
D] Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.
D
The nurse caring for a patient diagnosed with Parkinsons disease has prepared a plan of care that would include what goal?
A] Promoting effective communication
B] Controlling diarrhea
C] Preventing cognitive decline
D]
Managing choreiform movements
A
The nurse is caring for a patient diagnosed with Parkinson's disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination?
A] Use of a bedpan
B] Use of a raised
toilet seat
C] Sitting quietly on the toilet every 2 hours
D] Following the outlined bowel program
B
A patient with Parkinson's disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond?
A] It's important to drink plenty of fluids
while you're taking laxatives.
B] Make sure that you supplement your laxatives with a nutritious diet.
C] Let's explore other options, because laxatives can have side effects and create dependency.
D] You should ideally be using herbal remedies rather than medications to promote bowel function.
C
Carbidopa is used to decrease the _______ breakdown of levodopa and allow more of it to reach the brain.
peripheral
True or False
Pyridoxine [vitamin B6] promotes the breakdown of levodopa, reducing its effectiveness.
true
The correct balance of _______ and acetylcholine is important in regulating posture, muscle tone, and voluntary movement.
dopamine
True or False
The first symptoms of Parkinson's disease are often resting tremors that begin in the fingers and thumb of one hand [pin-rolling movements].
true
True or False
Thalamotomy and pallidotomy are successful ablative procedures used to relieve symptoms of Parkinson disease.
false
Parkinson disease is associated with decreased levels of _______ resulting from degeneration of these storage cells in the substantia nigra in the basal ganglia region of the brain.
dopamine
One of the most common features of Parkinson disease is _________.
bradykinesia
The pharmacologic agent ________________, which is converted to dopamine in the basal ganglia, is the most effective agent, and the mainstay of treatment, for Parkinson disease.
Levodopa
The client diagnosed with Parkinson's disease [PD] is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data?
1. Masklike facies and shuffling gait
2. Difficulty swallowing and
immobility
3. Pill rolling of fingers and flat affect
4. Lack of arm swing and bradykinesia
2
The client diagnosed with PD is being discharged on carbidopa/levodopa [Sinemet], an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications?
1. There will be fewer side effects with this combination than with carbidopa alone.
2. Dopamine D requires the presence
of both of these medications to work.
3. Carbidopa makes more levodopa available to the brain.
4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.
3
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 plan of 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 nurse is planning the care for a client diagnosed with Parkinson's disease. Which would 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 nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis?
1. Crackles in the upper
lung fields and jugular vein distention
2. Muscle weakness in the upper extremities and ptosis
3. Exaggerated arm swinging and scanning speech
4. Masklike facies and a shuffling gait
4
Which is a common cognitive problem associated with Parkinson's disease?
1. Emotional lability
2. Depression
3. Memory deficits
4. Paranoia
3
The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion?
1. The client should discuss feelings about being placed on a ventilator.
2. The client may have rapid mood swings and become easily upset.
3. Pill-rolling tremors will become worse when the medication is wearing off.
4. The client may automatically start to
repeat what another person says.
2
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