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Clinically isolated syndrome. This term refers to a single episode of neurological symptoms lasting at least 24 hours, without prior episodes. While some individuals with clinically isolated syndrome later develop MS, the presence of multiple episodes in the client’s history suggests an established MS diagnosis rather than an isolated event.

Primary progressive multiple sclerosis. This form of MS involves a gradual, continuous worsening of symptoms from the onset of the disease, without distinct relapses or remissions. The client’s history of symptom-free periods makes this diagnosis unlikely.

Secondary progressive multiple sclerosis. This type begins as relapsing-remitting MS but eventually transitions into a progressive form with a steady decline and fewer remissions. Since the client still experiences distinct remissions, the disease has not yet progressed to this stage.

Sporting accidents. While sports-related injuries, such as those from diving or contact sports, can cause spinal cord injuries (SCIs), they are more common in younger individuals. In older adults, decreased participation in high-risk sports makes this an unlikely primary cause of SCIs.

Gunshot wounds. Gunshot wounds can lead to penetrating spinal injuries, but they are not a leading cause of SCIs in individuals aged 65 years and older. SCIs due to violence-related incidents are more common in younger populations.

Motor vehicle accidents. Motor vehicle accidents (MVAs) are a leading cause of SCIs in younger adults but are less common than falls in older adults. Age-related changes, such as slower reaction times and decreased coordination, increase the risk of accidents, but falls remain the most frequent cause in this age group.

Examine the client for areas of skin breakdown. Skin breakdown can be a trigger for autonomic dysreflexia (AD) due to noxious stimuli, but assessing the skin is not the priority action. The immediate concern is to lower the client's blood pressure to prevent complications such as stroke or seizures.

Check the client for a fecal impaction. A fecal impaction is a common cause of AD, but the priority is to first lower the blood pressure before assessing for the trigger. Once the client is positioned appropriately, the nurse can assess for bowel or bladder distention as a potential cause.

Check the client’s bladder for distention. A distended bladder is the most common cause of AD, but assessment should be done after positioning the client upright. If urinary retention is identified as the trigger, the nurse should immediately catheterize the client to relieve the obstruction.

Piperacillin/tazobactam is a broad-spectrum antibiotic used to treat bacterial infections. It has no role in the management of Parkinson’s disease.

Levothyroxin is a synthetic thyroid hormone used to treat hypothyroidism by replacing thyroid hormones. It is not indicated for the treatment of Parkinson's disease and would not be relevant to the client's management plan as it does not impact dopamine levels or Parkinson’s symptoms.

Carbamazepine is an anticonvulsant and mood stabilizer used for conditions such as seizures and bipolar disorder, primarily used to treat epilepsy and certain types of nerve pain. It does not have a therapeutic effect in Parkinson’s disease.

Estrogen and progesterone. These hormones regulate the reproductive system and do not play a direct role in Parkinsonism. While some studies suggest estrogen may have a neuroprotective effect, an imbalance between estrogen and progesterone is not the primary defect in Parkinson’s disease.

An autosomal dominant genetic defect. Parkinson’s disease can have a genetic component, but idiopathic Parkinsonism occurs without a clear genetic cause. Most cases are sporadic and result from dopamine depletion, rather than an inherited genetic mutation.

Atherosclerosis and lack of blood supply. While vascular issues can contribute to stroke-related movement disorders, idiopathic Parkinsonism is caused by neurodegeneration, not blood flow problems. Atherosclerosis is not the primary cause of the dopamine-acetylcholine imbalance seen in Parkinsonism.

Whisper in one of the client's ears while occluding the other. This test assesses cranial nerve VIII (vestibulocochlear nerve), which is responsible for hearing and balance. It does not evaluate cranial nerve XI (spinal accessory nerve).

Have the client identify specific smells. Identifying specific smells such as coffee and lemon tests cranial nerve I (olfactory nerve), which is responsible for the sense of smell. Cranial nerve XI does not influence olfaction.

Check the client's visual acuity using a Snellen chart. The Snellen chart is used to assess cranial nerve II (optic nerve), which is responsible for vision. Cranial nerve XI does not play a role in vision or visual acuity.

T6-7. A thoracic spinal cord injury at T6-T7 results in paralysis of the lower extremities (paraplegia), making independent ambulation unlikely. Clients with mid-thoracic injuries require a wheelchair for mobility, though some may use braces for short-distance standing or walking with extensive support.

C7-8. A cervical spinal cord injury at C7-C8 leads to quadriplegia with partial upper limb function but no voluntary lower extremity movement. These clients rely on wheelchairs for mobility and cannot ambulate with braces.

T1-2. A T1-T2 injury results in complete lower extremity paralysis, preventing functional ambulation. Clients at this level typically use manual wheelchairs for mobility and retain full arm and hand function for self-care and wheelchair propulsion.