Review Neurodegenerative Diseases: Alzheimer's disease, Parkinson's disease

Pathophysiology of the Nervous System > Pathophysiology

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Neurodegenerative Diseases: Alzheimer's disease, Parkinson's disease

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Total Questions : 8

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Question 1:

A nurse is caring for a client who has Alzheimer's disease (AD). The client's family asks the nurse about the cause and progression of the disease. Which of the following statements should the nurse make?

A. "AD is caused by a buildup of amyloid plaques and neurofibrillary tangles in the brain that impair nerve function and communication." B. "AD is caused by a deficiency of dopamine in the brain that affects movement and cognition." C. "AD is caused by an autoimmune disorder that attacks the myelin sheath of the nerve cells in the brain and spinal cord." D. "AD is caused by a viral infection that destroys the neurons in the brain and causes inflammation and swelling."

Answer and Explanation

Choice A:

This is a correct answer. The nurse should explain to the client's family that AD is caused by a buildup of abnormal protein deposits called amyloid plaques and twisted fibers called neurofibrillary tangles in the brain that impair nerve function and communication. These changes lead to progressive loss of memory, language, reasoning, judgment, and other cognitive abilities.

Choice B:

This is an incorrect answer. The nurse should not tell the client's family that AD is caused by a deficiency of dopamine in the brain that affects movement and cognition. This is not the cause of AD, but rather Parkinson's disease (PD), which is another neurodegenerative disorder that affects the basal ganglia and causes tremors, rigidity, bradykinesia, and postural instability.

Choice C:

This is an incorrect answer. The nurse should not tell the client's family that AD is caused by an autoimmune disorder that attacks the myelin sheath of the nerve cells in the brain and spinal cord. This is not the cause of AD, but rather multiple sclerosis (MS), which is another neurodegenerative disorder that causes demyelination and inflammation of the central nervous system (CNS) and leads to sensory, motor, and cognitive impairments.

Choice D:

This is an incorrect answer. The nurse should not tell the client's family that AD is caused by a viral infection that destroys the neurons in the brain and causes inflammation and swelling. This is not the cause of AD, but rather encephalitis, which is an acute inflammatory condition of the brain that can be caused by various viruses or bacteria and can result in neurological deficits or death.

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Question 2:

A nurse is assessing a client who has Parkinson's disease (PD). Which of the following findings should the nurse expect? (Select all that apply.)

A. Resting tremor B. Muscle rigidity C. Bradykinesia D. Postural instability E. Nuchal rigidity

Answer and Explanation

Choice A:

This is a correct answer. Resting tremor is a common symptom of PD, which occurs when the affected limb or body part shakes involuntarily at rest and stops with voluntary movement or sleep. Resting tremor usually affects one side of the body first and then progresses to both sides. It typically involves the hand, arm, leg, jaw, or tongue.

Choice B:

This is a correct answer. Muscle rigidity is another common symptom of PD, which occurs when there is increased resistance to passive movement of the joints due to sustained muscle contraction. Muscle rigidity can cause stiffness, pain, reduced range of motion, and difficulty initiating movement.

Choice C:

This is a correct answer. Bradykinesia is another common symptom of PD, which occurs when there is slowness or paucity of movement due to impaired initiation or execution of movement. Bradykinesia can affect various aspects of motor function, such as facial expression, speech, swallowing, gait, writing, dressing, and self-care.

Choice D:

This is a correct answer. Postural instability is another common symptom of PD, which occurs when there is impaired balance or coordination due to reduced postural reflexes or sensory feedback. Postural instability can cause falls, difficulty turning or changing direction, stooped posture, shuffling steps, or freezing episodes.

Choice E:

This is an incorrect answer. Nuchal rigidity is not a common symptom of PD, but rather a sign of meningitis or subarachnoid hemorrhage. Nuchal rigidity occurs when there is stiffness or pain in the neck when flexing or extending it due to inflammation or irritation of the meninges or subarachnoid space.

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Question 3:

A nurse is educating a client who has Alzheimer's disease (AD) and their caregiver about the medication donepezil. The client asks the nurse, "How will this medication help me?" How should the nurse respond?

A. "This medication will slow down the progression of your disease and improve your memory and thinking." B. "This medication will increase the level of dopamine in your brain and reduce your tremors and rigidity." C. "This medication will prevent the inflammation and swelling in your brain and reduce your headaches and confusion." D. "This medication will enhance the transmission of nerve impulses in your brain and improve your mood and behavior."

Answer and Explanation

Choice A:

This is a correct answer. The nurse should explain to the client that donepezil is a cholinesterase inhibitor that works by increasing the level of acetylcholine in the brain, which is a neurotransmitter that is involved in memory, learning, and cognition. Donepezil can slow down the progression of AD and improve the client's memory and thinking abilities.

Choice B:

This is an incorrect answer. The nurse should not tell the client that donepezil will increase the level of dopamine in the brain and reduce their tremors and rigidity. This is not the mechanism or effect of donepezil, but rather levodopa or carbidopa, which are medications used to treat Parkinson's disease (PD). PD is caused by a deficiency of dopamine in the brain, which affects movement and cognition.

Choice C:

This is an incorrect answer. The nurse should not tell the client that donepezil will prevent the inflammation and swelling in their brain and reduce their headaches and confusion. This is not the mechanism or effect of donepezil, but rather corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), which are medications used to treat encephalitis or meningitis. Encephalitis or meningitis are inflammatory conditions of the brain or meninges that can be caused by various viruses or bacteria.

Choice D:

This is an incorrect answer. The nurse should not tell the client that donepezil will enhance the transmission of nerve impulses in their brain and improve their mood and behavior. This is not the mechanism or effect of donepezil, but rather antidepressants or mood stabilizers, which are medications used to treat depression or bipolar disorder. Depression or bipolar disorder are mood disorders that affect the levels of serotonin, norepinephrine, or dopamine in the brain.

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Question 4:

A nurse is planning care for a client who has Parkinson's disease (PD) and experiences freezing episodes. Which of the following interventions should the nurse include in the plan of care?

A. Instruct the client to lift their feet and take big steps when walking B. Instruct the client to use a walker or cane for support and stability C. Instruct the client to focus on an object or a line on the floor ahead of them D. Instruct the client to hum or sing a song while walking

Answer and Explanation

Choice A:

This is an incorrect answer. Instructing the client to lift their feet and take big steps when walking is not an effective intervention for a client who has PD and experiences freezing episodes. Freezing episodes are sudden and brief periods of inability to move or initiate movement, especially when starting to walk, turning, or crossing a threshold. Lifting the feet and taking big steps may be difficult or impossible for the client during a freezing episode and may increase the risk of falls or injuries.

Choice B:

This is an incorrect answer. Instructing the client to use a walker or cane for support and stability is not an effective intervention for a client who has PD and experiences freezing episodes. A walker or cane may actually trigger or worsen freezing episodes by creating a visual cue that interferes with the initiation of movement. A walker or cane may also reduce the client's confidence and independence in walking.

Choice C:

This is a correct answer. Instructing the client to focus on an object or a line on the floor ahead of them is an effective intervention for a client who has PD and experiences freezing episodes. Focusing on an external cue can help the client overcome the internal blockage that prevents them from moving or initiating movement. Focusing on an object or a line can also help the client maintain their balance and direction while walking.

Choice D:

This is an incorrect answer. Instructing the client to hum or sing a song while walking is not an effective intervention for a client who has PD and experiences freezing episodes. Humming or singing a song may distract the client from their walking and cause them to lose their rhythm or coordination. Humming or singing a song may also increase the risk of aspiration or choking if the client has dysphagia, which is difficulty swallowing due to impaired muscle control in PD.

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Question 5:

A nurse is evaluating the effectiveness of the education provided to a client who has Alzheimer's disease (AD) and their caregiver about the medication memantine. Which of the following statements by the caregiver indicates a need for further teaching?

A. "This medication will help reduce the amount of glutamate in my loved one's brain." B. "This medication will help improve my loved one's memory and attention span." C. "This medication will help prevent my loved one from having seizures or hallucinations." D. "This medication will help slow down the decline of my loved one's cognitive function."

Answer and Explanation

Choice A:

This is an incorrect answer. The caregiver does not need further teaching if they say that memantine will help reduce the amount of glutamate in their loved one's brain. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist that works by blocking the excessive stimulation of glutamate, which is a neurotransmitter that is involved in learning, memory, and cognition. Glutamate can be toxic to nerve cells if it accumulates in high levels in AD.

Choice B:

This is an incorrect answer. The caregiver does not need further teaching if they say that memantine will help improve their loved one's memory and attention span. Memantine can improve some aspects of cognitive function in clients who have moderate to severe AD by enhancing nerve communication and preventing nerve damage.

Choice C:

This is a correct answer. The caregiver needs further teaching if they say that memantine will help prevent their loved one from having seizures or hallucinations. This is not the purpose or effect of memantine, but rather anticonvulsants or antipsychotics, which are medications used to treat seizures or psychosis, respectively. Seizures or hallucinations are not common symptoms of AD, but rather complications that may occur in advanced stages of the disease.

Choice D:

This is an incorrect answer. The caregiver does not need further teaching if they say that memantine will help slow down the decline of their loved one's cognitive function. Memantine can slow down the progression of AD and delay the need for institutionalization by preserving some cognitive abilities and daily functioning.

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Question 6:

A nurse is caring for a client who has Parkinson's disease (PD) and is prescribed levodopa-carbidopa. Which of the following instructions should the nurse give to the client about taking this medication?

A. Take this medication with food to prevent nausea and vomiting B. Take this medication at the same time every day to maintain a steady level C. Take this medication with a glass of milk to enhance absorption D. Take this medication as needed when you have symptoms of PD

Answer and Explanation

Choice A:

This is an incorrect answer. The nurse should not instruct the client to take levodopa-carbidopa with food to prevent nausea and vomiting. This is not an effective way to prevent these side effects, as food, especially protein-rich food, can interfere with the absorption and effectiveness of levodopa-carbidopa. The nurse should advise the client to take levodopa-carbidopa on an empty stomach, at least 30 minutes before or 1 hour after meals.

Choice B:

This is a correct answer. The nurse should instruct the client to take levodopa-carbidopa at the same time every day to maintain a steady level. Levodopa-carbidopa is a combination medication that increases the level of dopamine in the brain, which is a neurotransmitter that is deficient in PD and affects movement and cognition. Levodopa-carbidopa should be taken at regular intervals to prevent fluctuations in dopamine levels and avoid "wearing-off" or "on-off" phenomena, which are periods of reduced or enhanced response to the medication.

Choice C:

This is an incorrect answer. The nurse should not instruct the client to take levodopa-carbidopa with a glass of milk to enhance absorption. This is not an effective way to enhance absorption, as milk, especially dairy products, can decrease the absorption and effectiveness of levodopa-carbidopa. The nurse should advise the client to avoid dairy products or limit their intake when taking levodopa-carbidopa.

Choice D:

This is an incorrect answer. The nurse should not instruct the client to take levodopa-carbidopa as needed when they have symptoms of PD. This is not an appropriate way to take levodopa-carbidopa, as it can cause erratic changes in dopamine levels and worsen the symptoms and progression of PD. The nurse should advise the client to take levodopa-carbidopa as prescribed by their provider and not to skip or adjust doses without consulting their provider.

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Question 7:

A nurse is evaluating the effectiveness of the education provided to a client who has Parkinson's disease (PD) and their caregiver about the medication pramipexole. Which of the following statements by the caregiver indicates a need for further teaching?

A. "This medication will help reduce the symptoms of PD by stimulating dopamine receptors in the brain." B. "This medication will help prevent the development of dyskinesia or involuntary movements in my loved one." C. "This medication will help increase the duration and quality of sleep in my loved one." D. "This medication will help improve the mood and motivation of my loved one."

Answer and Explanation

Choice A:

This is an incorrect answer. The caregiver does not need further teaching if they say that pramipexole will help reduce the symptoms of PD by stimulating dopamine receptors in the brain. Pramipexole is a dopamine agonist that works by mimicking the action of dopamine, which is a neurotransmitter that is deficient in PD and affects movement and cognition. Pramipexole can reduce tremors, rigidity, bradykinesia, and postural instability in clients who have PD.

Choice B:

This is an incorrect answer. The caregiver does not need further teaching if they say that pramipexole will help prevent the development of dyskinesia or involuntary movements in their loved one. Dyskinesia is a common side effect of levodopa-carbidopa, which is another medication used to treat PD. Pramipexole can delay or reduce the occurrence of dyskinesia by allowing lower doses of levodopa-carbidopa to be used.

Choice C:

This is an incorrect answer. The caregiver does not need further teaching if they say that pramipexole will help increase the duration and quality of sleep in their loved one. Sleep disturbances are common in clients who have PD, due to various factors such as nocturia, pain, restless legs syndrome, or anxiety. Pramipexole can improve sleep quality and quantity by reducing nighttime awakenings and increasing REM sleep.

Choice D:

This is a correct answer. The caregiver needs further teaching if they say that pramipexole will help improve the mood and motivation of their loved one. This is not the purpose or effect of pramipexole, but rather antidepressants or stimulants, which are medications used to treat depression or apathy, respectively. Depression or apathy are common neuropsychiatric symptoms of PD, which affect the levels of serotonin, norepinephrine, or dopamine in the brain.

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Question 8:

A nurse is providing education to a client who has Alzheimer's disease (AD) and their caregiver about non-pharmacological interventions to manage the disease. Which of the following information should the nurse include in the teaching? (Select all that apply.)

A. Maintain a consistent daily routine and environment B. Use memory aids such as calendars, clocks, or lists C. Engage in physical and mental activities that are enjoyable and stimulating D. Avoid social interactions that may cause stress or confusion E. Limit fluid intake and caffeine consumption

Answer and Explanation

Choice A:

This is a correct answer. The nurse should advise the client and their caregiver to maintain a consistent daily routine and environment, as this can help reduce anxiety, agitation, or disorientation in clients who have AD. AD is a progressive neurodegenerative disorder that affects memory, language, reasoning, judgment, and other cognitive abilities. Maintaining a consistent daily routine and environment can provide structure, familiarity, and security for the client.

Choice B:

This is a correct answer. The nurse should advise the client and their caregiver to use memory aids such as calendars, clocks, or lists, as this can help enhance memory and orientation in clients who have AD. Memory aids can provide cues or reminders for the client about important information such as dates, events, tasks, or names.

Choice C:

This is a correct answer. The nurse should advise the client and their caregiver to engage in physical and mental activities that are enjoyable and stimulating, as this can help preserve cognitive function and well-being in clients who have AD. Physical and mental activities can improve blood flow and oxygen delivery to the brain, stimulate neural connections, enhance mood and self-esteem, and prevent boredom and depression.

Choice D:

This is an incorrect answer. The nurse should not advise the client and their caregiver to avoid social interactions that may cause stress or confusion, as this can have negative effects on cognitive function and well-being in clients who have AD. Social interactions can provide emotional support, companionship, communication skills, and cognitive stimulation for the client. The nurse should encourage the client and their caregiver to maintain social contacts and participate in activities that are appropriate for the client's level of functioning and interest.

Choice E:

This is an incorrect answer. The nurse should not advise the client and their caregiver to limit fluid intake and caffeine consumption, as this can have negative effects on cognitive function and well-being in clients who have AD. Fluid intake and caffeine consumption are not directly related to the cause or progression of AD, and limiting them can cause dehydration, constipation, or headaches. The nurse should advise the client and their caregiver to ensure adequate hydration and nutrition for the client and avoid substances that may interfere with sleep quality or medication effectiveness, such as alcohol or nicotine.

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Neurodegenerative Diseases: Alzheimer's disease, Parkinson's disease

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