MED SURG FINAL ATI EXAM QUESTION AND ANSWERS.
Deep brain stimulation
● An electrode is implanted in the thalamus.
● A current is delivered through a small pulse generator
implanted under the skin of the upper chest. Electrical
stimulation from DBS impulses decreases tremors and
involunta...
Deep brain stimulation ● An electrode is implanted in the thalamus. ● A current is delivered through a small pulse generator implanted under the skin of the upper chest. Electrical stimulation from DBS impulses decreases tremors and involuntary movements, and can decrease medications required to control PD. NURSING ACTIONS: Monitor for infection, brain hemorrhage, or stroke-like symptoms. INTERPROFESSIONAL CARE ● Because PD is a degenerative neurological disorder, long-term treatment and care must be accommodated. ● During the later stages of the disorder, the client needs referrals to and support from disciplines such as speech therapists, occupational therapists, physical therapists, and social service/case management. COMPLICATIONS Aspiration pneumonia As PD advances in severity, alterations in chewing and swallowing worsen, increasing the risk for aspiration. NURSING ACTIONS ● Use swallowing precautions to decrease the risk for aspiration. ● Develop individual dietary plan based on the speech therapist’s recommendations. ● Have a nurse in attendance when the client is eating. ● Encourage the client to eat slowly and chew thoroughly before swallowing. ● Feed the client in an upright position and have suction equipment on standby. ● Evaluate need for enteral feedings to maintain weight and prevent aspiration as PD progresses. Altered cognition (dementia, memory deficits) Clients in advanced stages of PD can exhibit altered cognition in the form of dementia and memory loss. NURSING ACTIONS ● Acknowledge the client’s feelings. ● Provide for a safe environment. ● Develop a comprehensive plan of care with the family, client, and interprofessional team. Application Exercises 1. A nurse is caring for a client who displays signs of stage III Parkinson’s disease. Which of the following actions should the nurse include in the plan of care? A. Recommend a community support group. B. Integrate a daily exercise routine. C. Provide a walker for ambulation. D. Perform ADLs for the client. 2. A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson’s disease. Which actions should the nurse include in the plan of care? (Select all that apply.) A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Place the client in Fowler’s position to eat. E. Offer nutritional supplements between meals. 3. A nurse is reinforcing teaching with a client who has Parkinson’s disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include in the teaching? A. Rise slowly when standing. B. Expect urine to become dark-
colored. C. Avoid foods containing tyramine. D. Report any skin discoloration. 4. A nurse is assessing a client for manifestations of Parkinson’s disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression MED SURG FINAL ATI EXAM QUESTION AND ANSWERS. 5. A nurse is caring for a client who has Parkinson’s disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating. B. Complete passive range-of-motion exercises daily. C. Place the client on a low-protein, low-calorie diet. D. Give the client extra time to perform activities. RN ADULT MEDICAL SURGICAL NURSING CHAPTER 7 PARKINSON’S DISEASE 43 Application Exercises Key 1. A. The client/family should be involved in a community support group at the onset of the disease process to enhance coping mechanisms. B. The client should perform daily exercises with the onset of the disease process to promote mobility and independence for as long as possible. C. CORRECT: The client should use a walker for ambulation in stage III of Parkinson’s disease because movement slows down significantly and gait disturbances occur. D. The client loses ability to perform ADLs during stage V of Parkinson’s disease and is dependent on others for care at that time. During earlier stages, the client should be encouraged to remain as independent as possible. NCLEX® Connection: Safety and Infection Control, Accident/Error/Injury Prevention 2. A. The nurse should plan to provide small frequent meals during the day to maintain adequate nutrition. B. CORRECT: The nurse should record the client’s diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration. C. The nurse should document the client’s weight weekly to identify weight loss and intervene to maintain the client’s weight. D. The nurse should ensure that the client is sitting upright for meals rather than in a supported Fowler’s position, where the client’s head is elevated to 45 to 60°. E. CORRECT: The nurse should offer nutritional supplements between meals to maintain the client’s weight. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 3. A. CORRECT: Orthostatic hypotension is a common adverse effect of bromocriptine, a dopamine receptor agonist. Therefore, rising slowly when standing up will decrease the risk of dizziness and lightheadedness. B. The client should expect urine to turn dark when taking entacapone, a COMT inhibitor. Dark urine is not an expected finding when taking bromocriptine. C. The client should avoid tyramine in the diet when taking selegiline, a monoamine type B inhibitor. However, bromocriptine does not interact with foods that contain tyramine. D. Skin discoloration is an adverse effect of amantadine, an anti-viral medication. However it is not an adverse effect of bromocriptine. NCLEX® Connection: Pharmacological and Parenteral Therapies, Adverse Effects/Contraindications/Side Effects/Interactions 4. A. Decreased vision is not an expected finding in a client who has PD. B. CORRECT: The client who has PD can manifest pill-rolling tremors of the fingers due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. C. CORRECT: The client who has PD can manifest shuffling gait because of overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. D. CORRECT: The client who has PD can manifest drooling because of overstimulation of the basal ganglia by acetylcholine, making the controlled movement of swallowing secretions difficult. E. Bilateral ankle edema is not an expected finding in a client who has PD, but can be an adverse effect of certain medications used for treatment. F. CORRECT: The client who has PD can manifest a lack of facial expressions due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. NCLEX® Connection: Physiological Adaptation, Pathophysiology 5. A. The client who has PD develops a propulsive gait and tends to walk increasingly rapidly. The client should be reminded to stop occasionally when walking to prevent a propulsive gait and decrease the risk for falls. B. The nurse should encourage active, not passive, range-of-motion exercises to promote mobility in the client who has PD and is displaying bradykinesia. C. The client who has PD often requires high-calorie, high-protein supplements between meals in order to maintain adequate weight. D. CORRECT: Bradykinesia is abnormally slowed movement and is seen in clients who have PD. The client should be given extra time to perform activities and should be encouraged to remain active. NCLEX® Connection: Reduction of Risk Potential, System Specific Assessments 44 CHAPTER 7 PARKINSON’S DISEASE CONTENT MASTERY SERIES Using the ATI Active Learning Template: System Disorder ALTERATION IN HEALTH (DIAGNOSIS): Parkinson’s disease is a debilitating condition that progresses to complete dependent care. The disease involves a decrease in dopamine production and an increase in secretion of acetylcholine, causing resting tremor, slowed movement, and muscular rigidity. COMPLICATIONS ● Aspiration due to pharyngeal muscle involvement making swallowing difficult ● Orthostatic hypotension, slow movement, and muscle rigidity ● Change in speech pattern: slow, monotonous speech ● Altered emotional changes that can include depression and fear NURSING CARE ● Add thickener to liquids to prevent aspiration. ● Consult with a dietitian about appropriate diet. ● Encourage periods of rest between activities. ● Allow adequate time to rise slowly from a sitting to standing position. ● Encourage slower speech when expressing thoughts. ● Observe for signs of depression and dementia. NCLEX® Connection: Physiological Adaptation, Illness Management PRACTICE Answer A nurse is preparing a plan of care for a client who has a new diagnosis of Parkinson’s disease. What should the nurse include in the plan of care? Use the ATI Active Learning Template: System Disorder to complete this item. ALTERATION IN HEALTH (DIAGNOSIS): Define Parkinson’s disease. COMPLICATIONS: Identify four. NURSING CARE: Describe six nursing actions. PRACTICE Active Learning Scenario
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