MSN Exam for Parkinson’s Disease

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Text Mode – Text version of the exam

1) 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

1. You will need a cane for support
2. Walk erect with eyes on horizon
3. I’ll get you a wheelchair
4. Don’t force yourself to walk

2) Nurse Carol is assessing a client with Parkinson’s disease. The nurse recognize bradykinesia when the client exhibits:

1. Intentional tremor
2. Paralysis of limbs
3. Muscle spasm
4. Lack of spontaneous movement

3) 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?

1. Parkinson’s disease
2. Multiple sclerosis
3. Huntington’s disease
4. Creutzfeldt-Jakob’s disease

4) 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?

1. Increase dopamine availability
2. Activates dopaminergic receptors in the basal ganglia
3. Decrease acetylcholine availability
4. Release dopamine and other catecholamine from neurological storage sites

5) A shuffling gait is typically associated with the patient who has:

1. Parkinson’s disease
2. Multiple sclerosis
3. Raynaud’s disease
4. Myasthenia gravis

6) 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?

1. Disturbed vision
2. Forgetfulness
3. Mask like facial expression
4. Muscle atrophy

7) 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?

1. Vitamin C rich food
2. Vitamin E rich food
3. Thiamine rich food
4. Vitamin B6 rich food

8) 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).

1. Check for orthostatic changes in pulse and bloods pressure.
2. Monitor for improvement in tremor after levodopa (L-dopa) is given.
3. Remind the patient to allow adequate time for meals.
4. Monitor for abnormal involuntary jerky movements of extremities.
5. Assist the patient with prescribed strengthening exercises.
6. Adapt the patient’s preferred activities to his level of function.

9) Which of the following is the most common cause of dementia among elderly persons?

1. Parkinson’s disease
2. Multiple sclerosis
3. Amyotrophic lateral sclerosis
4. Alzheimer’s disease

10) The nurse should instruct the patient with Parkinson’s disease to avoid which of the following?

1. Walking in an indoor shopping mall
2. Sitting on the deck on a cool summer evening
3. Walking to the car on a cold winter day
4. Sitting on the beach in the sun on a summer day

11) 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?

1. The NA assists the patient to ambulate to the bathroom and back to bed.
2. The NA reminds the patient not to look at his feet when he is walking.
3. The NA performs the patient’s complete bath and oral care.
4. The NA sets up the patient’s tray and encourages patient to feed himself.

12) 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?

1. Multiple sclerosis
2. Parkinson’s disease
3. Huntington’s disease
4. Creutzfeldt-Jakob’s disease

13) 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:

1. Periodically lie prone without a neck pillow
2. Sleep only in dorsal recumbent position
3. Rest in supine position with his head elevated
4. Sleep on either side but keep his back straight

14) 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

1. Injurious chemical substances
2. Hereditary factors
3. Death of brain cells due to old age
4. Impairment of dopamine producing cells in the brain

15) 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?

1. Eat solid food
2. Give liquids with meals
3. Feed the client
4. Sit in an upright position to eat

16) 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?

1. Cerebrovascular accident (CVA)
2. Meningitis
3. Seizure disorder
4. Parkinson’s disease

17) 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?

1. Dykinesia
2. Glaucoma
3. Hypotension
4. Respiratory depression

18) Levodopa is ordered for a client with Parkinson’s disease. Before starting the medication, the nurse should know that:

1. Levodopa is inadequately absorbed if given with meals.
2. Levodopa may cause the side effects of orthostatic hypotension
3. Levodopa must be monitored by weekly laboratory tests.
4. Levodopa causes an initial euphoria followed by depression.

19) 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?

1. Pancytopenia
2. Peptic ulcer
3. Postural hypotension
4. Weight loss

20) 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:

1. Take a warm bath
2. Hold an object
3. Practice deep breathing
4. Take diazepam as needed

Answers and Rationales

1. A. You will need a cane for support .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.
2. D. Lack of spontaneous movement . Bradykinesia is slowing down from the initiation and execution of movement.
3. A. Parkinson’s disease. In some patients, Parkinson’s disease can be controlled; however, it cannot be cured.
4. A. Increase dopamine availability. 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.
5. A. Parkinson’s disease . 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.
6. C. Mask like facial expression. 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.
7. D. Vitamin B6 rich food . Vitamin b6 or pyridoxine is avoided in patients taking levodopa because levodopa increases vitamin b6 availability leading to toxicity.
8. 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. 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
9. D. Alzheimer’s disease. 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.
10. D. Sitting on the beach in the sun on a summer day . 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.
11. C. The NA performs the patient’s complete bath and oral care. 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
12. A. Multiple sclerosis . The cause of MS is not known and the disease affects twice as many women as men.
13. A. Periodically lie prone without a neck pillow. 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.
14. D. Impairment of dopamine producing cells in the brain. Dopamine producing cells in the basal ganglia mysteriously deteriorates due to unknown cause.
15. D. Sit in an upright position to eat . Client with Parkinson’s disease are at a high risk for aspiration and undernutrition. Sitting upright promotes more effective swallowing.
16. B. Meningitis. 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.
17. C. Hypotension . Hypotension, dizziness and lethargy are side effects of anti parkinson drugs like levodopa and carbidopa.
18. B. Levodopa may cause the side effects of orthostatic hypotension. Levodopa is the metabolic precursor of dopamine. It reduces sympathetic outflow by limiting vasoconstriction, which may result in orthostatic hypotension.
19. C. Postural hypotension
20. B. Hold an object . 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.