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The nurse is teaching a patient with Parkinson's disease preventive measures to reduce the risk of a fall. Which of the following instructions should the nurse include in the teaching session?
- A. Point the toes downward when stepping.
- B. Take two steps backward and three steps forward.
- C. Rock from front to back when walking.
- D. Drop rice kernels and step over them.
Correct Answer: D
Rationale: Patients who are at risk for falling and tend to freeze while walking are at risk of falling. Have the patient learn to drop rice kernels and focus on stepping over them to help prevent falls. Other measures include: pointing the toes upward, take one step backwards and two steps forward, and, rock from side to side, rather than from front to back.
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The nurse is caring for a patient who is diagnosed with early Huntington's disease (HD). Which of the following information should the nurse include in the teaching plan for the patient, partner, and children?
- A. Use of levodopa-carbidopa to help reduce HD symptoms
- B. Need to take prophylactic antibiotics to decrease the risk for pneumonia.
- C. Lifestyle changes such as increased exercise that delay disease progression.
- D. Availability of genetic testing to determine the HD risk for the patient's children.
Correct Answer: D
Rationale: Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing. Sinemet will increase symptoms of HD given that HD involves an increase in dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective treatments or lifestyle changes that delay the progression of symptoms in HD.
The nurse is caring for a patient with myasthenia gravis who has had a thymectomy and receives the usual dose of pyridostigmine. An hour later, the patient has nausea and severe abdominal cramps. Which of the following actions should the nurse take first?
- A. Auscultate the patient's bowel sounds.
- B. Notify the patient's health care provider.
- C. Administer the prescribed PRN antiemetic drug.
- D. Give the scheduled dose of prednisone.
Correct Answer: B
Rationale: The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
The nurse assesses a patient in the health clinic who has symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. Which of the following prescriptions would the nurse anticipate?
- A. Oral corticosteroids
- B. Antiparkinsonian drugs
- C. Electroencephalogram (EEG) testing
- D. Magnetic resonance imaging (MRI)
Correct Answer: B
Rationale: The diagnosis of Parkinson's is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. This patient has symptoms of tremor and bradykinesia; the next anticipated step will be treatment with medications. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
The health care provider is considering the use of sumatriptan for a patient with migraine headaches. Which of the following information obtained by the nurse is most important to report to the health care provider?
- A. The patient has at least 1-2 cups of coffee daily.
- B. The patient has had migraine headaches for 30 years.
- C. The patient has a history of a recent acute myocardial infarction.
- D. The patient has been taking topiramate for 2 months.
Correct Answer: C
Rationale: The triptans cause coronary artery vasoconstriction and should be avoided in patients with coronary artery disease. The other information will be reported to the health care provider, but none of it is an indication that sumatriptan would be an inappropriate treatment.
The nurse is caring for a patient with Parkinson's disease who has decreased tongue mobility and an inability to move the facial muscles. Which of the following nursing diagnoses is of highest priority?
- A. Activity intolerance related to immobility
- B. Toileting self-care deficit related to impaired mobility
- C. Ineffective health management related to difficulty managing complex treatment regimen
- D. Imbalanced nutrition: less than body requirements related to insufficient dietary intake
Correct Answer: D
Rationale: The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses also may be appropriate for a patient with Parkinson's disease, but the data do not indicate they are current problems for this patient.