parkinsons
t/f
parkinson is a cogntive disorder
f
motor function disease
fill in the blank
_____ drops and ______ stays the same
dopamine & acetylcholine
A client with a traumatic brain injury is becoming restless while emerging from a coma. Which nursing action is the priority?
A. Reorient the client frequently
B. Reduce environmental stimuli
C. Apply wrist restraints
D. Encourage the client to follow commands
B Restlessness from ICP → reduce environmental stimuli to prevent increased ICP.
A client with a head injury has clear fluid draining from the nose. What should the nurse do first?
A. Suction the nose
B. Test the drainage for glucose
C. Insert nasal packing
D. Apply warm compresses
Answer: B — Test the drainage for glucose
Rationale: Clear nasal drainage may be CSF. CSF is positive for glucose or halo sign. Do NOT suction, pack, or manipulate the nares.
A stroke patient arrives unconscious with drooling and gurgling respirations. What is the priority?
A. Apply compression devices
B. Suction saliva from the mouth
C. Obtain a full set of VS
D. Insert a nasogastric tube
Answer: B — Suction saliva from the mouth
Rationale: Airway is always #1. Unconscious stroke pts have ↓ gag reflex → high aspiration risk. Your notes indicate suctioning is priority for airway.
In the early stages of Parkinson’s disease, the patient typically has no memory issues but may experience difficulty speaking, and as the disease progresses, they may eventually lose their ability to speak.
Rationale:
Early Parkinson’s disease usually does not cause memory problems.
However, patients commonly have speech difficulties such as soft voice, slurred speech, or slowed speech.
As the disease progresses, they may eventually lose the ability to speak clearly or at all due to muscle rigidity and bradykinesia affecting the facial and throat muscles.
Early in the course of Parkinson’s disease, the nurse expects which clinical finding?
A. Symptoms begin bilaterally in both arms
B. Symptoms begin unilaterally on one side of the body
C. Symptoms begin in the lower extremities only
D. Symptoms begin with severe cognitive decline
B. Symptoms begin unilaterally on one side of the body
Rationale:
Parkinson’s disease typically starts with unilateral symptoms (like tremor or rigidity on one side). As the disease progresses, symptoms become bilateral.
A client with a head injury has clear drainage from the nose. What is the priority action?
A. Suction the nose
B. Test the drainage for glucose
C. Apply nasal packing
D. Tilt the head back
Answer: B — Test the drainage for glucose
Rationale: Clear nasal drainage after trauma may be CSF—testing for glucose/halo sign confirms it.
❌ Suctioning or packing can worsen leaking and increase ICP.
A TBI patient is becoming restless while emerging from a coma. What should the nurse do first?
A. Reorient the patient
B. Reduce environmental stimuli
C. Apply restraints
D. Administer pain meds
Answer: B — Reduce environmental stimuli
Rationale: Restlessness is an early sign of increasing ICP. Reducing stimulation prevents further pressure elevation.
(This is exactly what your ICP notes state.)
Before giving tPA, which must be verified FIRST?
A. NIHSS score
B. Blood glucose
C. Patient’s allergies
D. Weight
answer: B — Blood glucose
Rationale: Hypoglycemia mimics stroke → correct first.
A nurse is caring for a client newly diagnosed with Parkinson’s disease who asks, “How do these medications actually help me?” Which response by the nurse is most appropriate?
A. “These medications produce new dopamine to reverse the disease.”
B. “These medications help restore balance between dopamine and acetylcholine in your brain.”
C. “These medications only decrease acetylcholine and do not affect dopamine.”
D. “These medications prevent the progression of Parkinson’s disease.”
Correct Answer: B.
“These medications help restore balance between dopamine and acetylcholine in your brain.”
Rationale:
Parkinson’s meds do not create new dopamine → they help the brain use the dopamine it already has and/or suppress acetylcholine so the two are balanced.
Anticholinergics help decrease tremors by reducing excess acetylcholine.
No medication reverses or stops the progression of Parkinson’s.
what is the classic triad?
tremor
rigidity
bradykinesia
A patient with an epidural hematoma becomes alert briefly, then loses consciousness. What is this called?
A. Second-impact syndrome
B. Cushing’s cycle
C. Lucid interval
D. Glasgow reversal
Answer: C — Lucid interval
Rationale: Epidural hematomas have a classic pattern:
1️⃣ Loss of consciousness →
2️⃣ Lucid period →
3️⃣ Rapid deterioration (arterial bleed).
A patient with increased ICP shows irregular respirations, widening pulse pressure, and bradycardia. What does this indicate?
A. Hypovolemic shock
B. Onset of seizures
C. Cushing’s triad
D. Normal ICP fluctuations
Answer: C — Cushing’s triad
Rationale: This triad = increased ICP and impending brain herniation.
Immediate intervention is required.
An unconscious stroke patient is drooling and unable to manage secretions. What is the priority?
A. Administer tPA
B. Suction the mouth
C. Turn supine
D. Take VS
Answer: B — Suction the mouth
Rationale: Airway is always #1. Stroke pts often have ↓ gag reflex → high aspiration risk.
A nurse is caring for a client with Parkinson’s disease who reports difficulty initiating movement when walking. Which nursing instruction is the most appropriate to help improve gait and reduce freezing episodes?
A. “Take quick, short shuffling steps to keep your balance.”
B. “Look down at your feet while walking to prevent tripping.”
C. “Use visual cues, like stepping over imaginary lines, to start moving.”
D. “Avoid exaggerated movements because they increase your risk of falling.”
Correct Answer: C. “Use visual cues, like stepping over imaginary lines, to start moving.”
Rationale:
Parkinson’s patients often experience bradykinesia and freezing episodes, making it hard to initiate gait.
Visual cueing (stepping over a line or imaginary object) is one of the most effective strategies to start movement safely.
Looking forward toward the horizon also helps maintain posture and reduce fall risk — not down at the feet.
Shuffling increases fall risk.
Exaggerated, rhythmic movements (not avoiding them) actually help initiate gait.
A nurse is reviewing diagnostic information for a client suspected of having Parkinson’s disease. Which statement best reflects how Parkinson’s disease is confirmed?
A. A brain MRI can definitively diagnose Parkinson’s disease.
B. Diagnosis is based on genetic testing and cerebrospinal fluid analysis.
C. There is no specific diagnostic test; diagnosis is based on health history, clinical symptoms, and a positive response to antiparkinsonian medications such as carbidopa-levodopa.
D. Diagnosis is confirmed through a biopsy of brain tissue showing dopamine loss.
C. There is no specific diagnostic test; diagnosis is based on health history, clinical symptoms, and a positive response to antiparkinsonian medications such as carbidopa-levodopa.
Which technique helps a Parkinson’s patient overcome freezing episodes?
A. Walk quickly in short steps
B. Consciously step over imaginary lines
C. Swing arms widely
D. Bend forward while walking
Answer: B — Step over imaginary lines
Rationale: Parkinson’s ambulation improves with visual cues → stepping over lines, rhythmic stepping patterns, focusing forward.
Which findings indicate worsening ICP?
A. Restlessness
B. Decorticate posturing
C. Pupils 3 mm, brisk
D. Headache that improves when sitting up
E. Vomiting without nausea
Answers: A, B, E
Rationale:
Restlessness = early ICP increase.
Decorticate posture = moderate-severe ICP damage.
Projectile vomiting = late ICP sign.
Pupils 3 mm & brisk = normal. Sitting up improving headache is NOT ICP-related.
A traumatic brain injury patient has ICP of 28 mmHg. Which order should the nurse question?
A. Suction every hour
B. Stool softeners daily
C. Maintain PaCO₂ at 35 mmHg
D. HOB at 30 degrees
Answer: A — Suction every hour
Rationale: Suctioning increases ICP and must be minimized.
Stool softeners prevent straining (good), PaCO₂ ≈35 helps prevent vasodilation, HOB 30° optimizes venous return.
A nurse is teaching ambulation strategies to a client with Parkinson’s disease who experiences bradykinesia and difficulty initiating gait. Which interventions should the nurse recommend to improve safe ambulation?
Select all that apply.
A. Consciously step over imaginary or real lines on the floor
B. Walk with the head up, looking forward toward the horizon
C. Shuffle feet with short, rapid steps to maintain balance
D. Use rhythmic patterns such as “one step forward, two steps back” to initiate movement
E. Use deliberate, exaggerated arm swings while walking
F. Freeze in place until another person physically prompts movement
orrect Answers: A, B, D, E
Rationales:
A. Consciously step over imaginary or real lines on the floor
✔ This is a classic intervention for Parkinson’s — visual cues help overcome freezing and bradykinesia.
B. Walk with the head up, looking forward toward the horizon
✔ Prevents shuffling, improves posture, and reduces fall risk.
D. Use rhythmic patterns such as “one step forward, two steps back” to initiate movement
✔ Rhythmic, exaggerated steps help trigger the brain to start movement when bradykinesia causes freezing.
E. Use deliberate, exaggerated arm swings while walking
✔ Helps balance, improves gait rhythm, and reduces rigidity.
❌ Incorrect Options:
C. Shuffle feet with short, rapid steps to maintain balance
✘ Shuffling increases fall risk — Parkinson’s patients already tend to shuffle and must be taught NOT to.
F. Freeze in place until another person prompts movement
✘ The patient should use self-cueing strategies (visual lines, rhythmic steps) to initiate gait — not rely on others.
A nurse is assessing a client with Parkinson’s disease. Which findings should the nurse recognize as common complications of this condition?
Select all that apply.
A. Dysphagia requiring a swallow evaluation
B. Contractures of the extremities
C. Insomnia as a side effect of medications
D. Increased risk for falls
E. Urinary incontinence leading to UTIs
F. Skin breakdown due to impaired mobility
G. Hyperactive reflexes and muscle spasms
Correct Answers:
A, B, C, D, E, F
Rationales:
A. Dysphagia → Very common in Parkinson’s due to muscle rigidity; requires a swallow evaluation.
B. Contractures → Result from rigidity; hand-roll/towel helps prevent this.
C. Insomnia → A known complication and also a side effect of antiparkinsonian meds.
D. Falls → Classic complication due to shuffling gait, rigidity, poor balance.
E. Urinary incontinence & UTIs → Autonomic dysfunction can cause retention/incontinence → UTI risk.
F. Skin breakdown → Due to immobility, incontinence, and rigidity.
Incorrect Option:
G. Hyperactive reflexes and muscle spasms → Not typical of Parkinson’s; Parkinson’s causes bradykinesia, rigidity, and decreased movement, not hyperactive reflexes.
A patient presents with stroke symptoms but the CT scan is negative for hemorrhage. What is the next priority?
A. Start tPA infusion immediately
B. Perform a swallow evaluation
C. Begin permissive hypertension
D. Check the exact time last-known-well
Answer: D — Check last-known-well time
Rationale: tPA eligibility depends on the 4.5-hour window, so LKW must be confirmed before anything else.
A Parkinson’s patient is taking carbidopa/levodopa. Which statement indicates the patient needs more teaching?
A. “I will avoid taking this medication with high-protein meals.”
B. “It may take weeks for the medication to become fully effective.”
C. “I can stop the medication if I feel better.”
D. “I may experience nausea when starting this medication.”
Answer: C — “I can stop the medication if I feel better.”
Rationale: Suddenly stopping levodopa → neuroleptic malignant-like syndrome, life-threatening.
A patient with a high cervical SCI is being mechanically ventilated. Which finding requires IMMEDIATE intervention?
A. PaCO₂ of 50 mmHg
B. Respiratory rate of 16
C. SpO₂ of 94%
D. Weak cough reflex
Answer: A — PaCO₂ of 50 mmHg
Rationale: Rising CO₂ = hypoventilation → impending respiratory failure in cervical SCI.