Question 1

A client complains of a right-hand tremor,increasing weakness,and muscles feeling tight.The nurse notes the client has poor voice volume and facial muscles do not move easily.Based on this data,which diagnosis does the nurse anticipate?
A) Parkinson disease
B) Spinal cord injury
C) Cerebral vascular accident
D) Multiple sclerosis

Accepted Answer

A) Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, indicating Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebral vascular accident.
B) Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, indicating Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebral vascular accident.
C) Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, indicating Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebral vascular accident.
D) Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, indicating Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebral vascular accident.

Question 2

A client is evaluated for Parkinson disease (PD).Which findings on the Unified Parkinson Disease Rating Scale (UPDRS)would suggest a positive finding for PD? Select all that apply.
A) Diarrhea
B) Dystonia
C) Retropulsion
D) Hyperphonia
E) Festination

Accepted Answer

A) The UPDRS rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.
B) The UPDRS rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.
C) The UPDRS rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.
D) The UPDRS rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.
E) The UPDRS rates the client in 42 different areas of function. Positive findings for PD are retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run) and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.

Question 3

A client with osteoarthritis of the knees and hips returns for a 3-month follow-up with the provider.The nurse calculates that the client's BMI is now 22.The reports starting a water aerobics and step aerobics program three times per week.The client is also using hot packs for edema for 20 minutes and cold packs for pain for 40 minutes daily.After evaluating the client's actions,the nurse plans which follow-up interventions? Select all that apply.
A) Reinforce the correct use of hot packs.
B) Educate on low-impact exercise modes.
C) Explain the risk of injury using cold packs.
D) Counsel on continued weight loss.
E) Congratulate on starting water aerobics.

Accepted Answer

A) Congratulate the client on starting water exercise. Also congratulate on weight loss. A BMI of 22 is ideal. Do not encourage continued weight loss. Educate the client that using cold packs for over 30 minutes may cause skin injury. Reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Educate on the negative effect that high-impact step aerobics may have on the joints.
B) Congratulate the client on starting water exercise. Also congratulate on weight loss. A BMI of 22 is ideal. Do not encourage continued weight loss. Educate the client that using cold packs for over 30 minutes may cause skin injury. Reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Educate on the negative effect that high-impact step aerobics may have on the joints.
C) Congratulate the client on starting water exercise. Also congratulate on weight loss. A BMI of 22 is ideal. Do not encourage continued weight loss. Educate the client that using cold packs for over 30 minutes may cause skin injury. Reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Educate on the negative effect that high-impact step aerobics may have on the joints.
D) Congratulate the client on starting water exercise. Also congratulate on weight loss. A BMI of 22 is ideal. Do not encourage continued weight loss. Educate the client that using cold packs for over 30 minutes may cause skin injury. Reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Educate on the negative effect that high-impact step aerobics may have on the joints.
E) Congratulate the client on starting water exercise. Also congratulate on weight loss. A BMI of 22 is ideal. Do not encourage continued weight loss. Educate the client that using cold packs for over 30 minutes may cause skin injury. Reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Educate on the negative effect that high-impact step aerobics may have on the joints.

Question 4

A client admitted 3 days prior with an injury to the thoracic area of the spinal cord tells the nurse,"I'm getting worse.It's harder to breathe." Based on this data,which does the nurse suspect?
A) The client has atelectasis.
B) The extent of injury cannot yet be determined.
C) The client is improving.
D) The client is developing pneumonia.

Accepted Answer

A) With a spinal cord injury, there is an area of ischemia and edema. Because edema extends from the level of injury for two cord segments above and below the affected level, the extent of injury cannot be determined for up to 1 week. The client's complaint of it being harder to breathe could be evidence that extent of injury is becoming more obvious but will not be totally determined for a few more days. The client's complaint of it being harder to breathe may or may not indicate pneumonia or atelectasis. The complaint is not evidence that the client is improving.
B) With a spinal cord injury, there is an area of ischemia and edema. Because edema extends from the level of injury for two cord segments above and below the affected level, the extent of injury cannot be determined for up to 1 week. The client's complaint of it being harder to breathe could be evidence that extent of injury is becoming more obvious but will not be totally determined for a few more days. The client's complaint of it being harder to breathe may or may not indicate pneumonia or atelectasis. The complaint is not evidence that the client is improving.
C) With a spinal cord injury, there is an area of ischemia and edema. Because edema extends from the level of injury for two cord segments above and below the affected level, the extent of injury cannot be determined for up to 1 week. The client's complaint of it being harder to breathe could be evidence that extent of injury is becoming more obvious but will not be totally determined for a few more days. The client's complaint of it being harder to breathe may or may not indicate pneumonia or atelectasis. The complaint is not evidence that the client is improving.
D) With a spinal cord injury, there is an area of ischemia and edema. Because edema extends from the level of injury for two cord segments above and below the affected level, the extent of injury cannot be determined for up to 1 week. The client's complaint of it being harder to breathe could be evidence that extent of injury is becoming more obvious but will not be totally determined for a few more days. The client's complaint of it being harder to breathe may or may not indicate pneumonia or atelectasis. The complaint is not evidence that the client is improving.

Question 5

A client with chronic hip pain is diagnosed with osteoarthritis.Which instruction regarding home safety is the most appropriate for the nurse to provide to this client?
A) Walk up and down the steps at home as much as possible.
B) Rest in a recliner.
C) Place scatter rugs in high-traffic areas.
D) Install grab bars in the bathroom near the commode and in the shower.

Accepted Answer

A) The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should be instructed to sit in a straight-back chair, avoid slumping, and avoid the use of a recliner.
B) The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should be instructed to sit in a straight-back chair, avoid slumping, and avoid the use of a recliner.
C) The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should be instructed to sit in a straight-back chair, avoid slumping, and avoid the use of a recliner.
D) The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should be instructed to sit in a straight-back chair, avoid slumping, and avoid the use of a recliner.

Question 6

An adolescent is brought into the emergency department (ED)with injuries sustained from a motor vehicle crash.What should the nurse ensure while caring for this client?
A) An adequate urine output
B) Stable blood pressure
C) Stabilization of the neck and spinal cord
D) Intravenous access line

Accepted Answer

A) The danger of death from a spinal cord injury is greatest when there is damage to or transection of the upper cervical region. All people who have sustained trauma to the spine should be treated as though they have a spinal cord injury by stabilizing the neck and spinal cord. Assessment of urine output can be delayed. Assessing blood pressure is an intervention for all clients brought into the Emergency Department. An intravenous access line is necessary, but the stabilization of the neck and spinal cord is of first priority.
B) The danger of death from a spinal cord injury is greatest when there is damage to or transection of the upper cervical region. All people who have sustained trauma to the spine should be treated as though they have a spinal cord injury by stabilizing the neck and spinal cord. Assessment of urine output can be delayed. Assessing blood pressure is an intervention for all clients brought into the Emergency Department. An intravenous access line is necessary, but the stabilization of the neck and spinal cord is of first priority.
C) The danger of death from a spinal cord injury is greatest when there is damage to or transection of the upper cervical region. All people who have sustained trauma to the spine should be treated as though they have a spinal cord injury by stabilizing the neck and spinal cord. Assessment of urine output can be delayed. Assessing blood pressure is an intervention for all clients brought into the Emergency Department. An intravenous access line is necessary, but the stabilization of the neck and spinal cord is of first priority.
D) The danger of death from a spinal cord injury is greatest when there is damage to or transection of the upper cervical region. All people who have sustained trauma to the spine should be treated as though they have a spinal cord injury by stabilizing the neck and spinal cord. Assessment of urine output can be delayed. Assessing blood pressure is an intervention for all clients brought into the Emergency Department. An intravenous access line is necessary, but the stabilization of the neck and spinal cord is of first priority.

Question 7

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD).Which interventions are supported by research? Select all that apply.
A) Low-intensity treadmill training
B) Walking barefoot indoors
C) Use of resistance bands
D) Active and passive range of motion
E) High-intensity treadmill training

Accepted Answer

A) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.
B) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.
C) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.
D) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.
E) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training, and range of motion. Use of shoes with non-slip soles is advised.

Question 8

The nurse completes teaching for a young adult client diagnosed with Parkinson disease (PD).Which client statement indicates teaching has been effective?
A) "I could have prevented PD with diet and exercise."
B) "I probably have a genetic mutation that caused PD."
C) "My brain has too much of a chemical called dopamine."
D) "Most people get PD when they are my age."

Accepted Answer

A) Early-onset Parkinson disease is likely due to a genetic mutation. Increasing age is a risk factor for PD; diagnosis for a young adult is uncommon. In PD there is a deficit of available dopamine. Although a healthy diet avoiding pesticides is recommended, it is not a proven causative agent.
B) Early-onset Parkinson disease is likely due to a genetic mutation. Increasing age is a risk factor for PD; diagnosis for a young adult is uncommon. In PD there is a deficit of available dopamine. Although a healthy diet avoiding pesticides is recommended, it is not a proven causative agent.
C) Early-onset Parkinson disease is likely due to a genetic mutation. Increasing age is a risk factor for PD; diagnosis for a young adult is uncommon. In PD there is a deficit of available dopamine. Although a healthy diet avoiding pesticides is recommended, it is not a proven causative agent.
D) Early-onset Parkinson disease is likely due to a genetic mutation. Increasing age is a risk factor for PD; diagnosis for a young adult is uncommon. In PD there is a deficit of available dopamine. Although a healthy diet avoiding pesticides is recommended, it is not a proven causative agent.

Question 9

The nurse is evaluating care provided to a client with osteoarthritis.Which client statement indicates to the nurse that interventions for osteoarthritis have been successful?
A) "I had to take early retirement and now stay at home all day and rest my legs."
B) "I am sleeping throughout the night and have not missed any work because of knee pain."
C) "I am moving from my two-story house into the first floor of my daughter's home so I won't have to walk steps anymore."
D) "I changed my work hours so now I work part time and have a nursing assistant who helps me bathe twice a week at home."

Accepted Answer

A) Expected outcomes for the care of the client with osteoarthritis include independence with activities of daily living, minimal lifestyle impact because of osteoarthritis, and controlled pain to allow for rest and sleep. Of the client statements provided, the one that would indicate the success of the interventions is the one about improved sleep and pain not interfering with work. The client who changed work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. The client who is moving in with a daughter is experiencing significant lifestyle impact. The client who retired early and stays at home all day and rests also has had a significant impact in lifestyle.
B) Expected outcomes for the care of the client with osteoarthritis include independence with activities of daily living, minimal lifestyle impact because of osteoarthritis, and controlled pain to allow for rest and sleep. Of the client statements provided, the one that would indicate the success of the interventions is the one about improved sleep and pain not interfering with work. The client who changed work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. The client who is moving in with a daughter is experiencing significant lifestyle impact. The client who retired early and stays at home all day and rests also has had a significant impact in lifestyle.
C) Expected outcomes for the care of the client with osteoarthritis include independence with activities of daily living, minimal lifestyle impact because of osteoarthritis, and controlled pain to allow for rest and sleep. Of the client statements provided, the one that would indicate the success of the interventions is the one about improved sleep and pain not interfering with work. The client who changed work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. The client who is moving in with a daughter is experiencing significant lifestyle impact. The client who retired early and stays at home all day and rests also has had a significant impact in lifestyle.
D) Expected outcomes for the care of the client with osteoarthritis include independence with activities of daily living, minimal lifestyle impact because of osteoarthritis, and controlled pain to allow for rest and sleep. Of the client statements provided, the one that would indicate the success of the interventions is the one about improved sleep and pain not interfering with work. The client who changed work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. The client who is moving in with a daughter is experiencing significant lifestyle impact. The client who retired early and stays at home all day and rests also has had a significant impact in lifestyle.

Question 10

Lab results are back on a client who has limiting joint pain.Synovial fluid analysis shows no uric acid crystals,bacteria,or blood.The client asks what conditions are possible cause(s)of this pain.What is the nurse's response? Select all that apply.
A) Osteoarthritis
B) Rheumatoid arthritis
C) Septic arthritis
D) Gout
E) Trauma

Accepted Answer

A) There are no specific joint fluid tests for osteoarthritis, making this a possible diagnosis. There is no report of any tests for rheumatoid arthritis, making this a possible diagnosis. Gout is caused by the collection of uric acid crystals in the joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection. The absence of bacteria makes sepsis unlikely. The absence of blood makes trauma unlikely.
B) There are no specific joint fluid tests for osteoarthritis, making this a possible diagnosis. There is no report of any tests for rheumatoid arthritis, making this a possible diagnosis. Gout is caused by the collection of uric acid crystals in the joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection. The absence of bacteria makes sepsis unlikely. The absence of blood makes trauma unlikely.
C) There are no specific joint fluid tests for osteoarthritis, making this a possible diagnosis. There is no report of any tests for rheumatoid arthritis, making this a possible diagnosis. Gout is caused by the collection of uric acid crystals in the joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection. The absence of bacteria makes sepsis unlikely. The absence of blood makes trauma unlikely.
D) There are no specific joint fluid tests for osteoarthritis, making this a possible diagnosis. There is no report of any tests for rheumatoid arthritis, making this a possible diagnosis. Gout is caused by the collection of uric acid crystals in the joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection. The absence of bacteria makes sepsis unlikely. The absence of blood makes trauma unlikely.
E) There are no specific joint fluid tests for osteoarthritis, making this a possible diagnosis. There is no report of any tests for rheumatoid arthritis, making this a possible diagnosis. Gout is caused by the collection of uric acid crystals in the joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection. The absence of bacteria makes sepsis unlikely. The absence of blood makes trauma unlikely.

Question 11

A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20-40-pound boxes.The nurse anticipates which recommendation from the multidisciplinary team?
A) Joint replacement surgery
B) Pharmacologic therapy
C) Refer for Disability application.
D) Intermittent use of a cane

Accepted Answer

A) Of these options, pharmacologic therapy would be the most likely intervention. Acetaminophen, non-steroidal anti-inflammatory, and joint injections are all possible options. Joint replacement is delayed as long as possible due to the artificial joint often requiring replacement within 15-20 years. There is not enough information to determine whether applying for Disability is appropriate at this time. A cane is not indicated at this time.
B) Of these options, pharmacologic therapy would be the most likely intervention. Acetaminophen, non-steroidal anti-inflammatory, and joint injections are all possible options. Joint replacement is delayed as long as possible due to the artificial joint often requiring replacement within 15-20 years. There is not enough information to determine whether applying for Disability is appropriate at this time. A cane is not indicated at this time.
C) Of these options, pharmacologic therapy would be the most likely intervention. Acetaminophen, non-steroidal anti-inflammatory, and joint injections are all possible options. Joint replacement is delayed as long as possible due to the artificial joint often requiring replacement within 15-20 years. There is not enough information to determine whether applying for Disability is appropriate at this time. A cane is not indicated at this time.
D) Of these options, pharmacologic therapy would be the most likely intervention. Acetaminophen, non-steroidal anti-inflammatory, and joint injections are all possible options. Joint replacement is delayed as long as possible due to the artificial joint often requiring replacement within 15-20 years. There is not enough information to determine whether applying for Disability is appropriate at this time. A cane is not indicated at this time.

Question 12

A client with Parkinson disease (PD)ambulates with a shuffling gait and leans slightly forward.When seated,the client conducts a conversation,reads,and is able to self-feed without assistance.Which diagnosis is a priority for this client?
A) Ineffective Coping
B) Impaired Physical Mobility
C) Imbalanced Nutrition: More than Body Requirements
D) Anxiety

Accepted Answer

A) The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping and Anxiety at this time.
B) The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping and Anxiety at this time.
C) The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping and Anxiety at this time.
D) The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping and Anxiety at this time.

Question 13

The nurse is evaluating the care of a client with Parkinson disease (PD).Which finding indicates an improvement in nutritional status?
A) The client was observed providing morning self-care and dressing.
B) The client coughs frequently when drinking fluids.
C) The client was able to feed self and had no weight change in 1 week.
D) The client had a 4-pound weight loss in 1 week.

Accepted Answer

A) Evidence that interventions to improve the client's nutritional status were effective would be the client's self-feeding with no change in weight. Observing the client with morning self-care and dressing does not evaluate interventions to address nutritional status. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.
B) Evidence that interventions to improve the client's nutritional status were effective would be the client's self-feeding with no change in weight. Observing the client with morning self-care and dressing does not evaluate interventions to address nutritional status. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.
C) Evidence that interventions to improve the client's nutritional status were effective would be the client's self-feeding with no change in weight. Observing the client with morning self-care and dressing does not evaluate interventions to address nutritional status. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.
D) Evidence that interventions to improve the client's nutritional status were effective would be the client's self-feeding with no change in weight. Observing the client with morning self-care and dressing does not evaluate interventions to address nutritional status. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.

Question 14

A client with osteoarthritis tells the nurse about having difficulty walking to the bathroom first thing in the morning.Which nursing action would assist this client?
A) Suggest a family member provide the client with a bedpan.
B) Discuss the option of residing in an assisted-living facility.
C) Consult with Physical Therapy for an assistive walking device such as a walker or cane.
D) Suggest using a bedside commode at home.

Accepted Answer

A) Assistive devices are items used to maintain, increase, or improve function. The client states difficulty with walking in the morning to the bathroom. The best intervention to help this client would be to consult with Physical Therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.
B) Assistive devices are items used to maintain, increase, or improve function. The client states difficulty with walking in the morning to the bathroom. The best intervention to help this client would be to consult with Physical Therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.
C) Assistive devices are items used to maintain, increase, or improve function. The client states difficulty with walking in the morning to the bathroom. The best intervention to help this client would be to consult with Physical Therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.
D) Assistive devices are items used to maintain, increase, or improve function. The client states difficulty with walking in the morning to the bathroom. The best intervention to help this client would be to consult with Physical Therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.

Question 15

A spouse expresses frustration when trying to communicate with a client with Parkinson disease (PD).What can the nurse do to facilitate communication between the client and spouse?
A) Recommend that the client and spouse learn sign language.
B) Suggest the spouse obtain a hearing aid.
C) Consult with Speech Therapy for exercises to aid with speech and language.
D) Suggest communicating by writing.

Accepted Answer

A) The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with Speech Therapy for exercises to aid with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write, because of hand tremors.
B) The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with Speech Therapy for exercises to aid with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write, because of hand tremors.
C) The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with Speech Therapy for exercises to aid with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write, because of hand tremors.
D) The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with Speech Therapy for exercises to aid with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write, because of hand tremors.

Question 16

A school nurse is treating a school-age client who has fallen down a flight of stairs.The client is breathing but unconsciousness.After calling the ambulance,which is the priority action by the nurse?
A) Open the airway using the head tilt maneuver.
B) Try to rouse the client by gently shaking the shoulders.
C) Protect the client's neck and head from any movement.
D) Place the client on the side to prevent aspiration.

Accepted Answer

A) Guidelines for emergency care are avoiding flexing, extending, or rotating the neck; immobilization of the neck; securing the head; maintaining the client in the supine position; and transferring from the stretcher with backboard in place to the hospital bed. This client is unconscious, and the nurse must protect the neck from any (or any further) damage. If the client vomits, the nurse should utilize the log-roll technique to turn the client while keeping the head, neck, and spine in alignment. The client is breathing; however, if a change in respirations were to occur, the airway should be opened using the jaw thrust maneuver. Rousing the client by shaking could cause damage to the spinal cord.
B) Guidelines for emergency care are avoiding flexing, extending, or rotating the neck; immobilization of the neck; securing the head; maintaining the client in the supine position; and transferring from the stretcher with backboard in place to the hospital bed. This client is unconscious, and the nurse must protect the neck from any (or any further) damage. If the client vomits, the nurse should utilize the log-roll technique to turn the client while keeping the head, neck, and spine in alignment. The client is breathing; however, if a change in respirations were to occur, the airway should be opened using the jaw thrust maneuver. Rousing the client by shaking could cause damage to the spinal cord.
C) Guidelines for emergency care are avoiding flexing, extending, or rotating the neck; immobilization of the neck; securing the head; maintaining the client in the supine position; and transferring from the stretcher with backboard in place to the hospital bed. This client is unconscious, and the nurse must protect the neck from any (or any further) damage. If the client vomits, the nurse should utilize the log-roll technique to turn the client while keeping the head, neck, and spine in alignment. The client is breathing; however, if a change in respirations were to occur, the airway should be opened using the jaw thrust maneuver. Rousing the client by shaking could cause damage to the spinal cord.
D) Guidelines for emergency care are avoiding flexing, extending, or rotating the neck; immobilization of the neck; securing the head; maintaining the client in the supine position; and transferring from the stretcher with backboard in place to the hospital bed. This client is unconscious, and the nurse must protect the neck from any (or any further) damage. If the client vomits, the nurse should utilize the log-roll technique to turn the client while keeping the head, neck, and spine in alignment. The client is breathing; however, if a change in respirations were to occur, the airway should be opened using the jaw thrust maneuver. Rousing the client by shaking could cause damage to the spinal cord.

Question 17

A middle-aged client states to the nurse,"I have noticed a slight tremor of my left hand when at rest.I think I might have Parkinson disease because my mother had it and passed away because of respiratory failure." Which response by the nurse is the most appropriate?
A) "Having a close relative, such as your mother, with the illness can increase your chance of developing it as well."
B) "You should not worry, as it has a higher prevalence in males."
C) "It is unlikely that you have the same illness as your mother."
D) "You probably do not have it, as your mother was probably exposed to a toxin that caused the disease."

Accepted Answer

A) In a few individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client that it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing if the client's mother was exposed to toxins or if that was the cause for the disease. Parkinson disease occurs equally in males and females. Two percent of adults over age 65 have the diagnosis.
B) In a few individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client that it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing if the client's mother was exposed to toxins or if that was the cause for the disease. Parkinson disease occurs equally in males and females. Two percent of adults over age 65 have the diagnosis.
C) In a few individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client that it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing if the client's mother was exposed to toxins or if that was the cause for the disease. Parkinson disease occurs equally in males and females. Two percent of adults over age 65 have the diagnosis.
D) In a few individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client that it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing if the client's mother was exposed to toxins or if that was the cause for the disease. Parkinson disease occurs equally in males and females. Two percent of adults over age 65 have the diagnosis.

Question 18

The nurse instructs a client with Parkinson disease (PD)about carbidopa-levodopa (Sinemet).Which client statement indicates that teaching has been effective?
A) "I will take the medication with my meals."
B) "I will sit up for several minutes to gain my balance before going from lying down to standing up."
C) "This medication will not affect my blood pressure medications."
D) "This medication will cure my Parkinson disease in time."

Accepted Answer

A) Carbidopa-levodopa is a medication that replaces the dopamine that is lacking in clients with PD. This medication is likely to cause orthostatic hypotension, so the client must take care when changing positions from lying to standing. The medication should be taken 1 hour before or 2 hours after meals to promote absorption of the medication. There is no medication known to cure Parkinson disease. Care must be taken if the client is also taking medications to lower the blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.
B) Carbidopa-levodopa is a medication that replaces the dopamine that is lacking in clients with PD. This medication is likely to cause orthostatic hypotension, so the client must take care when changing positions from lying to standing. The medication should be taken 1 hour before or 2 hours after meals to promote absorption of the medication. There is no medication known to cure Parkinson disease. Care must be taken if the client is also taking medications to lower the blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.
C) Carbidopa-levodopa is a medication that replaces the dopamine that is lacking in clients with PD. This medication is likely to cause orthostatic hypotension, so the client must take care when changing positions from lying to standing. The medication should be taken 1 hour before or 2 hours after meals to promote absorption of the medication. There is no medication known to cure Parkinson disease. Care must be taken if the client is also taking medications to lower the blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.
D) Carbidopa-levodopa is a medication that replaces the dopamine that is lacking in clients with PD. This medication is likely to cause orthostatic hypotension, so the client must take care when changing positions from lying to standing. The medication should be taken 1 hour before or 2 hours after meals to promote absorption of the medication. There is no medication known to cure Parkinson disease. Care must be taken if the client is also taking medications to lower the blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.

Question 19

The nurse,planning care for a client with Parkinson disease (PD),identifies which intervention as supporting mobility while providing the spouse with an activity that is beneficial for the client?
A) Suggest that the spouse use a blender to make foods easier for the client to swallow.
B) Review the medication administration schedule with the spouse.
C) Instruct the spouse to ambulate the client at least four times a day.
D) Instruct the spouse on proper turning and repositioning techniques.

Accepted Answer

A) Since exercise fosters independence and self-esteem, the intervention that would support physical mobility while providing the spouse with an activity beneficial for the client would be to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing will not support physical mobility. Reviewing the medication administration schedule will not support physical mobility.
B) Since exercise fosters independence and self-esteem, the intervention that would support physical mobility while providing the spouse with an activity beneficial for the client would be to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing will not support physical mobility. Reviewing the medication administration schedule will not support physical mobility.
C) Since exercise fosters independence and self-esteem, the intervention that would support physical mobility while providing the spouse with an activity beneficial for the client would be to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing will not support physical mobility. Reviewing the medication administration schedule will not support physical mobility.
D) Since exercise fosters independence and self-esteem, the intervention that would support physical mobility while providing the spouse with an activity beneficial for the client would be to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing will not support physical mobility. Reviewing the medication administration schedule will not support physical mobility.

Question 20

A client with Parkinson disease (PD)states to the nurse,"It is 1950 and I am late for work." What action should the nurse take at this time?
A) Orient the client, provide a calendar, and place a clock in the room.
B) Ask the client what life is like in 1950.
C) Medicate for confusion.
D) Apply restraints so the client will not attempt to get out of bed to go to work.

Accepted Answer

A) Clients with PD may demonstrate confusion and disorientation. This is what the client is demonstrating. The nurse should orient the client, provide a calendar, and place a clock in the room to assist with ongoing orientation. The nurse should not medicate the client for confusion or apply restraints. The nurse should not feed into the confusion by asking what life is like in 1950.
B) Clients with PD may demonstrate confusion and disorientation. This is what the client is demonstrating. The nurse should orient the client, provide a calendar, and place a clock in the room to assist with ongoing orientation. The nurse should not medicate the client for confusion or apply restraints. The nurse should not feed into the confusion by asking what life is like in 1950.
C) Clients with PD may demonstrate confusion and disorientation. This is what the client is demonstrating. The nurse should orient the client, provide a calendar, and place a clock in the room to assist with ongoing orientation. The nurse should not medicate the client for confusion or apply restraints. The nurse should not feed into the confusion by asking what life is like in 1950.
D) Clients with PD may demonstrate confusion and disorientation. This is what the client is demonstrating. The nurse should orient the client, provide a calendar, and place a clock in the room to assist with ongoing orientation. The nurse should not medicate the client for confusion or apply restraints. The nurse should not feed into the confusion by asking what life is like in 1950.

Quiz 13: Mobility

A client complains of a right-hand tremor,increasing weakness,and muscles feeling tight.The nurse notes the client has poor voice volume and facial muscles do not move easily.Based on this data,which diagnosis does the nurse anticipate?

A client is evaluated for Parkinson disease (PD) .Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would suggest a positive finding for PD? Select all that apply.

A client admitted 3 days prior with an injury to the thoracic area of the spinal cord tells the nurse,"I'm getting worse.It's harder to breathe." Based on this data,which does the nurse suspect?

A client with chronic hip pain is diagnosed with osteoarthritis.Which instruction regarding home safety is the most appropriate for the nurse to provide to this client?

An adolescent is brought into the emergency department (ED) with injuries sustained from a motor vehicle crash.What should the nurse ensure while caring for this client?

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD) .Which interventions are supported by research? Select all that apply.

The nurse completes teaching for a young adult client diagnosed with Parkinson disease (PD) .Which client statement indicates teaching has been effective?

The nurse is evaluating care provided to a client with osteoarthritis.Which client statement indicates to the nurse that interventions for osteoarthritis have been successful?

Lab results are back on a client who has limiting joint pain.Synovial fluid analysis shows no uric acid crystals,bacteria,or blood.The client asks what conditions are possible cause(s) of this pain.What is the nurse's response? Select all that apply.

A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20-40-pound boxes.The nurse anticipates which recommendation from the multidisciplinary team?

A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward.When seated,the client conducts a conversation,reads,and is able to self-feed without assistance.Which diagnosis is a priority for this client?

The nurse is evaluating the care of a client with Parkinson disease (PD) .Which finding indicates an improvement in nutritional status?

A client with osteoarthritis tells the nurse about having difficulty walking to the bathroom first thing in the morning.Which nursing action would assist this client?

A spouse expresses frustration when trying to communicate with a client with Parkinson disease (PD) .What can the nurse do to facilitate communication between the client and spouse?

A school nurse is treating a school-age client who has fallen down a flight of stairs.The client is breathing but unconsciousness.After calling the ambulance,which is the priority action by the nurse?

A middle-aged client states to the nurse,"I have noticed a slight tremor of my left hand when at rest.I think I might have Parkinson disease because my mother had it and passed away because of respiratory failure." Which response by the nurse is the most appropriate?

The nurse instructs a client with Parkinson disease (PD) about carbidopa-levodopa (Sinemet) .Which client statement indicates that teaching has been effective?

The nurse,planning care for a client with Parkinson disease (PD) ,identifies which intervention as supporting mobility while providing the spouse with an activity that is beneficial for the client?

A client with Parkinson disease (PD) states to the nurse,"It is 1950 and I am late for work." What action should the nurse take at this time?