the client with parkinsons disease

7/14/2019 The Client With Parkinsons Disease

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The Client with Parkinsons Disease; Multiple Sclerosis; Unconscious Patient

1. Which of the following is an initial sign of Parkinson's disease?1. Rigidity.2. Tremor.3. Bradykinesia.4. Akinesia.

2. The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease.Which of the following topics that the nurse plans to discuss is the most important?1. Maintaining a balanced nutritional diet.2. Enhancing the immune system.3. Maintaining a safe environment.4. Engaging in diversional activity.

3. The nurse observes that a client's upper arm tremors disappear as he unbuttons his shirt.Which statement best guides the nurse's analysis of these observations about the client'stremors?

1. The tremors are probably psychological and can be controlled at will.2. The tremors sometimes disappear with purposeful and voluntary movements.

3. The tremors disappear when the client's attention is diverted by some activity.4. There is no explanation for the observation; it is probably a chance occurrence.4. When does the nurse encourage a client with Parkinson's disease to schedule the most

demanding physical activities to minimize the effects of hypokinesia?1. Early in the morning, when the client's energy level is high.2. To coincide with the peak action of drug therapy.3. Immediately after a rest period.4. When family members will be available.

5. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson'sdisease?

1. To cure the disease.2. To stop progression of the disease.3. To begin preparations for terminal care.4. To maintain optimal body function.

6. What is the primary goal collaboratively established by the client with Parkinson's disease,nurse, and physical therapist?

1. To maintain joint flexibility.2. To build muscle strength.3. To improve muscle endurance.4. To reduce ataxia.

7. A client with Parkinson's disease is prescribed levodopa (l-dopa) therapy. Improvement inwhich of the following indicates effective therapy?

1. Mood.2. Muscle rigidity.3. Appetite.4. Alertness.

8. A client is being switched from levodopa to carbidopa-levodopa (Sinemet). The nurseshould monitor for which of the following possible complications during medication changesand dosage adjustment?

1. Euphoria.2. Jaundice.3. Vital sign fluctuation.4. Symptoms of diabetes.



9. A new medication regimen is ordered for a client with Parkinson's disease. At which timewould the nurse make certain that the medication is taken?

1. At bedtime.2. All at one time.3. Two hours before mealtime.4. At the time scheduled.

10.A client with Parkinson's disease needs a long time to complete her morning hygiene, but

she becomes annoyed when the nurse offers assistance and refuses all help. Whichstatement is the nurse's best initial response in this situation?1. Tell the client firmly that she needs assistance and help her with her care.2. Praise the client for her desire to be independent and give her extra time and

encouragement.3. Tell the client that she is being unrealistic about her abilities and must accept the

fact that she needs help.4. Suggest to the client that if she insists on self-care, she should at least modify her

routine.11.A client with Parkinson's disease asks the nurse to explain to his nephew "what the doctor

said the pallidotomy would do." What is the nurse's best response? The main goal for theclient after pallidotomy is improved

1. functional ability.2. emotional stress.3. alertness.4. appetite.

12.Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)?1. Double vision.2. Sudden bursts of energy.3. Weakness in the extremities.4. Muscle tremors.

13.A client with MS is receiving baclofen (Lioresal). The nurse determines that the drug iseffective when it achieves which of the following?

1. Induces sleep.2. Stimulates the client's appetite.3. Relieves muscular spasticity.4. Reduces the urine bacterial count.

14.A client has had MS for 15 years and has received various drug therapies. What is theprimary reason why the nurse has found it difficult to evaluate the effectiveness of the drugsthat the client has used? Clients with MS

1. exhibit intolerance to many drugs.2. experience spontaneous remissions from time to time.3. require multiple drugs simultaneously.4. endure long periods of exacerbation before the illness responds to a particular drug.

15.When the nurse talks with a client with MS who has slurred speech, which nursingintervention is contraindicated?

1. Encouraging the client to speak slowly.2. Encouraging the client to speak distinctly.3. Asking the client to repeat indistinguishable words.4. Asking the client to speak louder when tired.

16.The right hand of a client with MS trembles severely whenever she attempts a voluntaryaction. She spills her coffee twice at lunch and cannot get her dress fastened securely.Which is the best legal documentation in nursing notes of the chart for this clientassessment?



1. "Has an intention tremor of the right hand."2. "Right-hand tremor worsens with purposeful acts."3. "Needs assistance with dressing and eating due to severe trembling and

clumsiness."4. "Slight shaking of right hand increases to severe tremor when client tries to button

her clothes or drink from a cup."17.A client with MS is experiencing bowel incontinence and is starting a bowel retraining

program. Which strategy is inappropriate?1. Eating a diet high in fiber.2. Setting a regular time for elimination3. Using an elevated toilet seat.4. Limiting fluid intake to 1,000 mL/day.

18.Which of the following is an inappropriate outcome to establish with a client who has MS?1. The client will develop joint mobility.2. The client will develop muscle strength.3. The client will develop cognition.4. The client will develop mood elevation.

19.The nurse is preparing a client with MS for discharge from the hospital to home. Which of the following instructions is appropriate?

1. "You will need to accept the necessity for a quiet and inactive lifestyle."2. "Keep active, use stress reduction strategies, and avoid fatigue."3. "Follow good health habits to change the course of the disease."4. "Practice using the mechanical aids that you will need when future disabilities arise."

20.Which of the following is inappropriate for the nurse to include in the discharge plan for aclient with MS who has an impaired peripheral sensation?

1. Carefully test the temperature of bath water.2. Avoid kitchen activities because of the risk of injury.3. Avoid hot water bottles and heating pads.4. Inspect the skin daily for injury or pressure points.

21.Which intervention should the nurse suggest to help a client with MS avoid episodes of urinary incontinence?

1. . Limit fluid intake to 1,000 mL/day.2. Insert an indwelling urinary catheter 3. Establish a regular voiding schedule.4. Administer prophylactic antibiotics, as ordered

22.A client with MS lives with her daughter and 3-year-old granddaughter. The daughter asksthe nurse what she can do at home to help her mother. Which of the following measureswould be most beneficial?

1. Psychotherapy.2. Regular exercise.3. Day care for the granddaughter.4. Weekly visits by another person with MS.

23.A client is brought to the emergency department unconscious. An empty bottle of aspirinwas found in his car, and a drug overdose is suspected. Which of the following medicationsshould the nurse have available for further emergency treatment?

1. Vitamin K.2. Dextrose 50%.3. Activated charcoal powder.4. Sodium thiosulfate.



24.A number of clients have presented at the emergency department after a possiblebioterrorist act of arsenic overexposure. Which findings would the nurse most commonlyexpect to assess? Select all that apply.

1. Violent vomiting.2. Severe diarrhea.3. Abdominal pain4. Sensory neuropathy.

25.Which clinical manifestations would the nurse expect to assess in a client diagnosed with anoverdose of a cholinergic agent. Select all that apply.1. Dry mucous membranes.2. Urinary incontinence.3. CNS depression.4. Seizures.

26.The wife and sister of a client who had attempted suicide with an overdose are distraughtabout his comatose condition and the possibility that he took an intentional drug overdose.Which of the following would be an appropriate initial nursing intervention with this family?

1. Explain that because the client was found on hospital property, he was probablyasking for help and did not intentionally overdose.

2. Give the wife and sister a big hug and assure them that the client is in good hands.3. Encourage the wife and sister to express their feelings and concerns, and listen

carefully.4. Allow the wife and sister to help care for the client by rubbing his back when he is

turned.27.Which of the following is a priority during the first 24 hours of hospitalization for a comatose

client with suspected drug overdose?1. Educate regarding drug abuse.2. Minimize pain.3. Maintain intact skin.4. Increase caloric intake.

28.An unconscious intubated client does not have increased intracranial pressure. Whichnursing intervention would be essential?

1. Monitoring the oral temperature, keep the room temperature at 70°F (21.1°C), andplace the client on a cooling blanket if the client's temperature is higher than 101°F(38.3°C).

2. Cleaning the mouth carefully, apply a thin coat of petroleum jelly, and move theendotracheal tube to the opposite side daily.

3. Positioning the client in the supine position with the head to the side and slightlyelevated on two pillows

4. Turning the client with a draw sheet and placing a pillow behind the back and onebetween the legs.

29.An unconscious client has been positioned on one side. The nurse monitors which of thefollowing anatomic areas as a pressure point?

1. Sacrum.2. Occiput.3. Ankles.4. Heels.

30.The client is placed in a right side-lying position. Which of the following positions isincorrect?

1. The head is placed on a small pillow.2. The right leg is extended without pillow support.3. The left arm is rested on the mattress with the elbow flexed



4. The left leg is supported on a pillow with the knee flexed31.What is the intended outcome for the nursing intervention of performing passive range-of-

motion exercises on an unconscious client?1. Preservation of muscle mass.2. Prevention of bone demineralization.3. Increase in muscle tone.4. Maintenance of joint mobility.

32.When the nurse performs oral hygiene for an unconscious client, which nursing interventionis the priority?1. Keep a suction machine available.2. Place the client in a prone position.3. Wear sterile gloves while brushing the client's teeth.4. Use gauze wrapped around the fingers to clean the client's gums.

33.The nurse observes that the client's right eye does not close totally. Based on this finding,which nursing intervention is most appropriate?

1. Make sure the client wears eyeglasses at all times.2. Place an eye patch over the completely closed right eye.3. Instill artificial tears once every shift.4. Clean the eyelid with a clean washcloth every shift

34.Which symptom is an early indicator of hypoxia in the unconscious client?1. Cyanosis.2. Decreased respirations.3. Restlessness.4. Hypotension.

35.When administering intermittent enteral feeding to an unconscious client, the nurse should1. heat the formula in a microwave.2. place the client in a semi-Fowler's position.3. obtain a sterile gavage bag and tubing.4. weigh the client before administering the feeding

36.The client is to receive 200 mL of tube feeding every 4 hours. When the nurse checks for the client's gastric residual before administering the next scheduled feeding and obtains 40mL of gastric residual, what is the appropriate intervention?

1. Withhold the tube feeding and notify the physician.2. Dispose of the residual and continue with the feeding3. Delay feeding the client for 1 hour and then recheck the residual.4. Readminister the residual to the client and continue with the feeding.

37.Of the following nursing interventions for catheter care, which should have the highestpriority?

1. Cleaning the area around the urethral meatus.2. Clamping the catheter periodically to maintain muscle tone.3. Irrigating the catheter with several ounces of normal saline solution.4. Changing the location where the catheter is taped to the client's leg.

38.A client has been pronounced brain dead. Which findings would the nurse assess? Selectall that apply.

1. Decerebrate posturing.2. Dilated nonreactive pupils.3. Deep tendon reflexes.4. Absent corneal reflex.

the client with parkinsons disease

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