A nurse is providing discharge teaching to a client who has Parkinson's disease. Which of the following instructions should the nurse include? (Select All that Apply.)

Take small bites of food.

Liquids should be thickened.

Sit slightly forward when eating.

Chew food thoroughly before swallowing.

Avoid having conversations while eating.

Answer and Explanation

Correct Answer : A,C,D

A. Take small bites of food: Taking small bites of food is important for clients with Parkinson's disease to reduce the risk of choking and aspiration. It allows better control of swallowing and reduces the likelihood of difficulty swallowing, which is common in Parkinson’s disease due to dysphagia (swallowing difficulty).
B. Liquids should be thickened: While thickening liquids is often recommended for clients with swallowing difficulties, it is not universally required for all Parkinson's patients. It would depend on the specific swallowing assessment and the client’s condition. Therefore, this is not an essential recommendation for every client.
C. Sit slightly forward when eating: Sitting slightly forward helps clients with Parkinson's disease improve their swallowing and reduce the risk of aspiration. This posture encourages a safer swallowing reflex and reduces the likelihood of food or liquids going into the airway.
D. Chew food thoroughly before swallowing: Thoroughly chewing food is vital for clients with Parkinson’s disease because it reduces the risk of choking and aspiration. This allows the food to break down into smaller pieces, making it easier to swallow and less likely to cause blockages in the throat.
E. Avoid having conversations while eating: While it is important to focus on eating to prevent choking, there is no strict guideline that clients with Parkinson’s must avoid conversation entirely. Talking while eating may be challenging for some, but it is not universally harmful. However, the client should be reminded to focus on swallowing to prevent aspiration.

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Correct Answer is C

Explanation

A. "You have many dangerously low blood sugar levels. A hemoglobin A1C of 9% indicates chronic hyperglycemia, not hypoglycemia. This test reflects an average blood glucose level over the past 2 to 3 months, and a high value suggests consistently elevated blood glucose, not frequent lows.
B. "Your blood sugar is too high after meals." While postprandial glucose spikes may contribute to an elevated A1C, the A1C reflects overall glycemic control, not just after meals. This statement is too narrow and doesn’t fully address the long-term trend that a 9% A1C represents.
C. "Your average blood sugar is high." This is the most accurate statement. A hemoglobin A1C of 9% correlates with an estimated average blood glucose level of approximately 212 mg/dL, which is well above the recommended target. It reflects poor long-term blood sugar control.
D. "Your blood sugar is very unstable." An A1C of 9% does not measure variability in blood sugar; it reflects a sustained elevation in average glucose. Blood sugar instability would be better evaluated with continuous glucose monitoring or frequent blood glucose checks, not A1C.

A. Malignant brain tumors often originate from another part of the body. B. Primary CNS tumors commonly spread to other parts of the body. C. Most CNS tumors are spinal tumors. D. Ependymomas are primarily brain tumors.

Correct Answer is D

Explanation

A. Malignant brain tumors often originate from another part of the body: While malignant brain tumors can spread from other body parts (metastatic tumors), primary brain tumors, such as gliomas or meningiomas, originate in the brain itself. Malignant brain tumors that metastasize to the brain are relatively less common.
B. Primary CNS tumors commonly spread to other parts of the body: Primary central nervous system (CNS) tumors generally do not spread to other parts of the body. Most CNS tumors are localized, and their spread is usually restricted to the surrounding neural tissue, not to distant organs.
C. Most CNS tumors are spinal tumors: Most central nervous system (CNS) tumors are actually brain tumors, not spinal tumors. Brain tumors are more common in adults, while spinal tumors are rarer in comparison.
D. Ependymomas are primarily brain tumors: Ependymomas are a type of tumor that originates from the ependymal cells in the central nervous system. While they can occur in both the brain and spinal cord, they are more frequently found in the brain, especially in the ventricles. Thus, ependymomas are primarily considered brain tumors.

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A nurse is providing discharge teaching to a client who has Parkinson's disease. Which of the following instructions should the nurse include? (Select All that Apply.)

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