Podcast
Questions and Answers
Which of these is a typical physical assessment finding in a client with Parkinson's disease?
Which of these is a typical physical assessment finding in a client with Parkinson's disease?
Which of the following is a primary nursing diagnosis for clients with Parkinson's disease, based on the provided information?
Which of the following is a primary nursing diagnosis for clients with Parkinson's disease, based on the provided information?
What is a typical type of tremor observed during a physical assessment of a client with Parkinson's disease?
What is a typical type of tremor observed during a physical assessment of a client with Parkinson's disease?
Besides mobility and cognition, what other common functional change is associated with Parkinson's disease, as suggested by the assessment section?
Besides mobility and cognition, what other common functional change is associated with Parkinson's disease, as suggested by the assessment section?
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What type of diagnostic testing is usually recommended as the primary diagnostic test for confirming Parkinson's Disease?
What type of diagnostic testing is usually recommended as the primary diagnostic test for confirming Parkinson's Disease?
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Which of the following is considered the only definitive diagnosis for Alzheimer's disease?
Which of the following is considered the only definitive diagnosis for Alzheimer's disease?
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Which of the following is NOT listed as an area of cognitive function to be assessed in individuals with suspected Alzheimer's disease?
Which of the following is NOT listed as an area of cognitive function to be assessed in individuals with suspected Alzheimer's disease?
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When assessing symptoms of Alzheimer's disease, what aspect of the symptoms is important to consider?
When assessing symptoms of Alzheimer's disease, what aspect of the symptoms is important to consider?
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Which of these is NOT a recommended lifestyle change to help maintain overall health and potentially slow progression of Alzheimer's disease?
Which of these is NOT a recommended lifestyle change to help maintain overall health and potentially slow progression of Alzheimer's disease?
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Besides the key cognitive areas, what assessment is also essential for a patient with possible Alzheimer's disease?
Besides the key cognitive areas, what assessment is also essential for a patient with possible Alzheimer's disease?
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Which of the following is a diagnostic procedure used in conjunction with clinical observation?
Which of the following is a diagnostic procedure used in conjunction with clinical observation?
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Which of the following brain imaging techniques is used to assess patients with suspected Alzheimer's disease?
Which of the following brain imaging techniques is used to assess patients with suspected Alzheimer's disease?
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Which symptom is specifically listed within physical assessments for patients with suspected Alzheimers?
Which symptom is specifically listed within physical assessments for patients with suspected Alzheimers?
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Which structures are primarily affected by meningitis?
Which structures are primarily affected by meningitis?
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What is a key assessment finding associated with meningitis?
What is a key assessment finding associated with meningitis?
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Which intervention is crucial in preventing meningitis?
Which intervention is crucial in preventing meningitis?
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What is a primary nursing action in managing a client with meningitis?
What is a primary nursing action in managing a client with meningitis?
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What class of medication is typically used in the treatment of bacterial meningitis?
What class of medication is typically used in the treatment of bacterial meningitis?
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A patient with suspected meningitis is exhibiting signs of increased ICP. What would be a high priority nursing assessment?
A patient with suspected meningitis is exhibiting signs of increased ICP. What would be a high priority nursing assessment?
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Which of the following is considered a type of meningitis?
Which of the following is considered a type of meningitis?
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In addition to neurological status, what other type of assessment should be performed in a patient with meningitis?
In addition to neurological status, what other type of assessment should be performed in a patient with meningitis?
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A patient with Alzheimer's disease is having difficulty with self-dressing; what is the most effective way to promote the patient's independence in this area?
A patient with Alzheimer's disease is having difficulty with self-dressing; what is the most effective way to promote the patient's independence in this area?
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In order to best support a client with Alzheimer’s disease remaining safely at home, which of the following would a nurse recommend to the family?
In order to best support a client with Alzheimer’s disease remaining safely at home, which of the following would a nurse recommend to the family?
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During a follow-up appointment, a patient with Alzheimer's is described as occasionally struggling to find the right words. Which term should the nurse use for this finding?
During a follow-up appointment, a patient with Alzheimer's is described as occasionally struggling to find the right words. Which term should the nurse use for this finding?
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If a client is experiencing agnosia, what would the nurse anticipate them having difficulty with?
If a client is experiencing agnosia, what would the nurse anticipate them having difficulty with?
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A client with Alzheimer’s disease is able to perform their ADLs but wants to remain in their home. What home adjustment does the nurse suggest to promote independence?
A client with Alzheimer’s disease is able to perform their ADLs but wants to remain in their home. What home adjustment does the nurse suggest to promote independence?
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What is the most appropriate nursing response when a wife expresses concern about her husband's care while she is out of town?
What is the most appropriate nursing response when a wife expresses concern about her husband's care while she is out of town?
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What best describes the condition of apraxia?
What best describes the condition of apraxia?
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In what situation should physical and chemical restraints be considered as an option?
In what situation should physical and chemical restraints be considered as an option?
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If a patient is referred to as having aphasia, what can the nurse expect to see in the patient’s communication abilities?
If a patient is referred to as having aphasia, what can the nurse expect to see in the patient’s communication abilities?
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A patient has resistance to passive movement in their lower extremities along with slightly limited movement. Which documentation term best describes this assessment?
A patient has resistance to passive movement in their lower extremities along with slightly limited movement. Which documentation term best describes this assessment?
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A family member of a patient with Alzheimer's is worried about the client wandering. The nurse advises the family not to install complex locks, why is this the case?
A family member of a patient with Alzheimer's is worried about the client wandering. The nurse advises the family not to install complex locks, why is this the case?
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What could be an adverse consequence of taking a person with Alzheimer's disease to varied locations for walks?
What could be an adverse consequence of taking a person with Alzheimer's disease to varied locations for walks?
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A patient with stage II (moderate) Alzheimer's is exhibiting symptoms and needs continuous supervision, is this client suitable to stay home alone?
A patient with stage II (moderate) Alzheimer's is exhibiting symptoms and needs continuous supervision, is this client suitable to stay home alone?
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Which of the following is a nontherapeutic approach to a client's wife who is seeking care for her spouse while she is out of town?
Which of the following is a nontherapeutic approach to a client's wife who is seeking care for her spouse while she is out of town?
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According to the context, what is the primary consideration when determining the need for supervision for a person with Alzheimer's?
According to the context, what is the primary consideration when determining the need for supervision for a person with Alzheimer's?
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What does the symptom 'cogwheel' rigidity typically describe?
What does the symptom 'cogwheel' rigidity typically describe?
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A client with suspected Parkinson's disease exhibits resistance to passive movement during an assessment. If the resistance varies with rhythmic interruptions, how should this finding be documented?
A client with suspected Parkinson's disease exhibits resistance to passive movement during an assessment. If the resistance varies with rhythmic interruptions, how should this finding be documented?
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A nurse is explaining the primary impact of Parkinson's disease to a family. What should the nurse emphasize about the disease's progression?
A nurse is explaining the primary impact of Parkinson's disease to a family. What should the nurse emphasize about the disease's progression?
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A client with Parkinson's disease experiences increasing difficulty with movement. Though other challenges may arise, which area is considered the primary expected outcome?
A client with Parkinson's disease experiences increasing difficulty with movement. Though other challenges may arise, which area is considered the primary expected outcome?
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A family reports that a client with Alzheimer's disease is showing increased paranoia. Which of these is an appropriate response by the nurse to this report?
A family reports that a client with Alzheimer's disease is showing increased paranoia. Which of these is an appropriate response by the nurse to this report?
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A client with Parkinson’s disease demonstrates a total resistance to movement of the extremeties. How should the nurse document this finding?
A client with Parkinson’s disease demonstrates a total resistance to movement of the extremeties. How should the nurse document this finding?
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When assessing a client with known Parkinson's disease, the nurse notes a mild resistance to movement. How should this be classified?
When assessing a client with known Parkinson's disease, the nurse notes a mild resistance to movement. How should this be classified?
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A nurse is educating a client's family about Parkinson's disease. Which of the following should the nurse emphasize as a common change that will arise over time?
A nurse is educating a client's family about Parkinson's disease. Which of the following should the nurse emphasize as a common change that will arise over time?
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A nurse is caring for a client with Alzheimer's disease who has become increasingly paranoid. What is the best initial nursing action?
A nurse is caring for a client with Alzheimer's disease who has become increasingly paranoid. What is the best initial nursing action?
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Study Notes
Chapter 39: Care of Patients with Problems of the Central Nervous System: The Brain
- Priority concepts include cognition and mobility
- Interrelated concept is pain and infection
Alzheimer's Disease
- Pathophysiology Overview: Most common type of dementia, characterized by neurofibrillary tangles, neuritic plaques, and beta-amyloid buildup in the brain, along with neurotransmitter abnormalities.
- Risk Factors: Age, gender, and genetics are factors.
- Incidence and Prevalence: Higher incidence and prevalence after age 65, can affect anyone older than 40, 5.7 million affected in the U.S. (over 65 years old)
- Health Promotion and Maintenance: No proven way to prevent Alzheimer's disease. Chronic health problems may contribute. Diet, exercise, and avoiding smoking/drinking may be helpful.
- Assessment: History (onset, duration, progression, symptoms), functional status, physical assessment, stages (attention, concentration, judgment, perception, learning memory, communication, and language). Information processing and psychosocial assessment, laboratory and imaging assessment (brain tissue examination at autopsy is the only definite diagnosis). Genetic testing, CT scans and MRI scans.
- Analysis: Decreased memory and cognition due to neuronal changes in the brain, potential for injury or falls due to wandering, potential for elder abuse by caregivers.
- Planning and Implementation: Managing memory and cognitive dysfunction, preventing injuries/falls, preventing elder abuse
- Care Coordination and Transition Management: Home care management (respite care, preparation for agitation), self-management education, teaching family about drug therapy, maintaining mobility, health care resources like Alzheimer's Association
Parkinson's Disease
- Pathophysiology Overview: Progressive neurodegenerative disorder with four main symptoms: tremor, muscle rigidity, bradykinesia, and postural instability.
- Risk Factors: Environmental and genetic factors, exposure to chemicals/metals, older than 40 years old, and familial tendency.
- Incidence and Prevalence: 60,000 new cases annually in people over 50, 1 million currently live with Parkinson's, and men are 50% more likely to be affected.
- Assessment: History (when symptoms started), physical assessment (resting tremors, rigidity assessment, facial expression, emotional changes, speech changes, and bowel/bladder changes) and laboratory/imaging assessment (no specific diagnostic tests may be done, such as CSF, MRI, or SPECT).
- Analysis: Decreased mobility (and potential self-care deficit) due to muscle rigidity, tremors, postural/gait changes, and impaired cognition from neurotransmitter changes.
- Planning and Implementation: Promoting mobility (nonsurgical/surgical management), managing cognitive dysfunction
- Care Coordination and Transition Management: Home care preparation, self-management education, health care resources
- Evaluation: Improving mobility to support self-care, reducing the chance of complications from impaired mobility, maintaining and assuring safety, and an overall acceptable quality of life
Migraine Headache
- Description: Recurrent, episodic attacks of head pain often with nausea, light sensitivity, sound sensitivity, and head movement sensitivity.
- Triggers: Some patients have food triggers.
- Severity and Types: With aura, without aura, and atypical
- Pain Management: Abortive therapy, NSAIDs, Triptan preparations, and combinations with ergotamine derivatives and isometheptene
Seizures and Epilepsy
- Seizure: Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons in the brain, which may cause changes in LOC, motor ability, or sensory ability.
- Epilepsy: Chronic disorder with repeated unprovoked seizure activity.
- Types of Seizures: Tonic-clonic, myoclonic, atonic (akinetic), Partial (focal or local), complex partial (psychomotor or temporal lobe).
- Seizures and Epilepsy: Etiology and Genetic Risk: Primary (genetics), secondary (underlying brain lesion, metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, high fever, stroke, head injury, substance abuse, heart disease)
- Seizures and Epilepsy: Interprofessional Collaborative Care: Assessment (number, timing, pattern of seizures, preictal phase, other medical history, EEG, CT, MRI, SPECT/PET), interventions (nonsurgical/surgical management)
- Seizure Management: Protect patient from injury, do not force anything into the mouth, position patient on side, remove objects, loosen restrictive clothing, do not restrain patient, record time of seizure onset and offset.
- Acute Seizure and Status Epilepticus Management: Medical emergency, IV-push lorazepam, diazepam (oral/rectal gel)
- Seizures and Epilepsy: Care Coordination and Transition Management: Compliance with AEDs, social services referral, balanced diet and rest, stress reduction.
Meningitis
- Pathophysiology Overview: Infection of the meninges (pia mater and arachnoid) of the brain and spinal cord, specifically
- Types: Viral (aseptic), bacterial
- Meningitis: Interprofessional Collaborative Care: Assessment (neurologic and neurovascular assessment, nuchal rigidity, increased ICP), Interventions (vaccination for prevention, accurate monitoring of neurologic status, broad-spectrum antibiotics, vascular assessment).
Case Studies - Answers
(See corresponding sections for details specific to each case study)
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Description
Test your knowledge on the physical assessments and nursing diagnoses related to Parkinson's disease and Alzheimer's disease. This quiz covers typical findings, diagnostic tests, and cognitive functions that are crucial for nurses working with these patients.
