Parkinson’s Disease (20 Questions)

1. M. Tremblay, 72 years old, has been living with Parkinson’s disease for 8 years. He is admitted for pneumonia. You are preparing his morning medications.
Medical Order: Levodopa-Carbidopa (Sinemet) 100/25 mg PO at 08:00, 12:00, 16:00, and 20:00.

It is currently 08:15 and you are busy with another patient.

Question:
Why is strict adherence to the exact administration time critical for this specific patient? *

To prevent the development of antibiotic resistance.

To avoid the "On-Off" phenomenon where the patient becomes immobile if the drug levels drop.

To prevent severe hypotension and bradycardia associated with peak dose.

To ensure the medication is taken on an empty stomach for better absorption.

2. Mme Gagnon, 78 years old, is eating her lunch sitting in a chair. You notice that she is drooling slightly and requires a long time to chew. When she swallows, she coughs weakly.

Question:
Which nursing intervention is most appropriate to improve swallowing safety? *

Encourage her to tilt her head back (extension) to help gravity move the food down.

Offer thin liquids (water or tea) to wash down the solid food.

Instruct her to tuck her chin down towards her chest when swallowing.

Purée all foods and feed her rapidly to prevent fatigue.

3. M. Roy is walking down the hallway with his walker. Suddenly, he stops in the doorway of his room. He looks distressed and says, "My feet are stuck to the floor! I can't move them!" He is trying to push forward but his upper body is leaning dangerously.

Question:
What is the best technique to help M. Roy overcome this "freezing" episode? *

Go behind him and push his wheelchair to force him forward.

Tell him to imagine a line on the floor in front of him and try to step over it.

Grab his arms and pull him forward towards you.

Tell him to focus on his destination and hurry up before he falls.

4. Mme Lefebvre has been taking high doses of Levodopa for 10 years. During your assessment, you notice she is making uncontrollable writhing, snake-like movements with her neck and arms. She is not distressed by them, but her family is concerned she is having a seizure.

Question:
How do you interpret these movements? *

She is having a focal seizure; call the physician immediately.

She is having an allergic reaction to the medication.

Her Parkinson’s disease is worsening, and she needs a higher dose of medication.

She is exhibiting dyskinesia, a common side effect of long-term Levodopa therapy.

5. M. Cloutier, 65 years old, complains of severe abdominal bloating and states he hasn't had a bowel movement in 5 days.
Medical History: Parkinson's Disease, Hypertension.

Question:
Aside from medication side effects, what is the physiological reason for this issue in Parkinson's patients, and what is the first-line intervention? *

It is caused by liver failure; restrict fluid intake.

It is caused by anxiety; administer Lorazepam.

It is caused by decreased autonomic nervous system function; increase fluid and fiber intake.

It is caused by H. pylori infection; prepare for antibiotics.

6. You are admitting Mme Poirier for a fractured wrist. During the admission assessment, you manipulate her unaffected arm to check range of motion. You feel a rhythmic interruption of the movement, similar to a ratchet or a gear clicking.

Question:
How do you document this specific finding? *

Flaccidity.

Spasticity.

Cogwheel Rigidity.

Intention Tremor.

7. M. Fortin rings the bell for assistance to the bathroom. He sits up on the side of the bed. You check his blood pressure: lying down it was 130/80 mmHg; sitting up it is 100/60 mmHg. He says he feels lightheaded.

Medical Order: Selegiline (MAO-B Inhibitor) 5 mg PO daily.

Question:
What is the most appropriate instruction to give M. Fortin? *

"Stand up quickly to stimulate your heart rate."

"Stop taking your blood pressure medication immediately."

"Hold your breath while standing up to increase pressure."

"Sit on the edge of the bed for 2 minutes and pump your ankles before standing."

8. M. Dubé is preparing for discharge. He has a stooped posture and a shuffling gait (festination). You are teaching him how to prevent falls at home.

Question:
Which specific instruction helps counteract the "festinating" gait (tendency to accelerate forward)? *

"Wear thick, rubber-soled shoes that grip the carpet firmly."

"Look at your feet while you walk to see where you are going."

"Consciously lift your toes and look up ahead, not down at the ground."

"Keep your arms tight against your sides for balance."

9. Mme Caron is sitting in the dayroom. You ask her how her pain is. She moves her lips, but her voice is a barely audible whisper. Her face appears expressionless (masked facies).

Question:
What is the best strategy to improve communication? *

Assume she has no pain since she isn't complaining loudly.

Use a family member to interpret everything she says.

Speak loudly to her because she is likely hard of hearing.

Remind her to take a deep breath before speaking and enunciate words loudly.

10. Mme Lambert brings her husband, M. Lambert, to the clinic. She reports that he has started accusing her of having an affair and claims to see strangers in the living room at night. M. Lambert has been on Dopamine Agonists for 3 years.

Question:
What is the likely cause of these symptoms? *

He is developing Alzheimer's disease in addition to Parkinson's.

He is experiencing medication-induced psychosis/hallucinations.

He has a urinary tract infection.

He is seeking attention due to depression.

11. M. Boucher, 69 years old, was admitted for emergency abdominal surgery. Due to his NPO status and postoperative nausea, his Levodopa-Carbidopa was withheld for 24 hours. He suddenly develops a fever of 39.5°C, extreme muscle rigidity, tachycardia (120 bpm), and altered level of consciousness.

Question:
What is the most probable cause of this deterioration? *

Septic shock related to the abdominal surgery.

An allergic reaction to the anesthetic agents.

Parkinsonism-Hyperpyrexia Syndrome.

A severe aspiration pneumonia.

12. Mme Dubois, 60 years old, reports that her medication "stops working" every evening after dinner. She takes her Sinemet (Levodopa) at 17:30 and eats dinner at 18:00. She typically eats a large steak or pork chop for dinner.

Question:
What dietary education is most relevant to resolve this issue? *

"You should crush your medication and sprinkle it on the meat to help it digest."

"You are likely allergic to red meat; switch to a vegetarian diet."

"Take a double dose of your medication with dinner to compensate for the heavy meal."

"High-protein meals can interfere with the absorption of Levodopa."

13. You are admitting M. Lavoie for an elective procedure. When you ask him to sign the consent form, he starts writing his name. The letters start at a normal size but progressively become tiny and illegible by the end of the signature.

Question:
What is the clinical term for this finding, and what does it indicate? *

Dysgraphia; it indicates a stroke in the parietal lobe.

Agnosia; he has forgotten how to write his name.

Micrographia; it is a common early motor symptom of Parkinson’s disease.

Presbyopia; he needs reading glasses to see the paper.

14. The wife of M. Beaulieu, 70 years old, pulls you aside. She is distressed and says, "Last night he hit me in the face while he was sleeping. He was screaming and fighting an attacker in his dream. He does this often. Is he becoming violent?"

Question:
How do you explain this symptom? *

It is REM Sleep Behavior Disorder (RBD).

He is having night terrors caused by deep psychological trauma.

He is likely having nocturnal seizures and needs an EEG.

He is angry at you subconsciously, and you should sleep in separate rooms.

15. Mme St-Jean is frustrated because she can no longer feed herself soup or drink coffee without spilling it due to her resting tremor. She feels embarrassed eating in the dining room.

Question:
What is the best intervention to promote independence and dignity? *

Assign a PCA (Personal Care Assistant) to feed her all meals.

Provide weighted utensils and a cup with a lid and straw.

Tell her to sit on her hands for 5 minutes before eating to stop the shaking.

Provide only solid foods (sandwiches) that do not require utensils.

16. M. Grenier, 74 years old, is admitted to the unit. He reports that he has "accidents" frequently because when he feels the urge to urinate, he cannot get to the bathroom fast enough due to his slow walking.

Question:
What is the most appropriate nursing plan? *

Insert an indwelling urinary catheter (Foley) to keep the skin dry.

Apply an adult incontinence brief (diaper) and tell him to use it.

Implement a timed voiding schedule (e.g., every 2 hours) to empty the bladder.

Restrict oral fluids to 500mL per day to reduce urine output.

17. While performing hygiene care for M. Martin, you notice his face, specifically the forehead and around the nose, is very oily with patches of red, scaly skin.

Question:
This is a common non-motor symptom of Parkinson's. What is the appropriate care? *

Apply heavy moisturizing cream to the dry patches.

Wash the area gently with mild soap and water twice daily.

Apply an antifungal powder.

Consult a dermatologist immediately for suspected skin cancer.

18. Mme Tessier has a Deep Brain Stimulator (DBS) implanted to control her symptoms. She is scheduled for a diagnostic test for back pain.

Question:
Which diagnostic test is generally contraindicated or requires strict safety protocols for a patient with a DBS? *

Chest X-ray.

CT Scan of the lumbar spine.

MRI (Magnetic Resonance Imaging).

Ultrasound of the abdomen.

19. The daughter of M. Parent tells you, "My father seems so depressed. He never smiles anymore, he stares blankly, and he doesn't blink often." M. Parent denies feeling sad and says he enjoys his visits, but his face remains immobile.

Question:
How do you interpret this finding? *

He is in denial about his depression and needs antidepressants.

He is exhibiting "Masked Facies" (Hypomimia.

He is catatonic.

He has lost his vision.

20. You are conducting discharge planning for Mme Lapierre, who has moderate Parkinson's disease with balance issues. She lives alone.

Question:
Which specific modification for the bathroom is most critical to prevent falls? *

Installing a raised toilet seat with armrails.

Replacing the bathtub with a Jacuzzi for muscle relaxation.

Placing fluffy bath mats to cushion a potential fall.

Lowering the mirror so she can see herself while sitting.