Chapter 23: Neurodegenerative Disorders

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. The greatest risk for injury for a client with progressed Parkinson’s disease is: a. falls. b. suicide. c. bleeding ulcers. d. respiratory arrest.

ANS: A

If the client becomes off-balance, self-correction is very slow, so falls are common. While the client is monitored for depression, suicide is not a common risk for injury. Bleeding ulcers and respiratory arrest are not generally recognized as caused by this disease.

DIF: Cognitive Level: Applying REF: p. 302

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Immediate reversal of all symptoms of Parkinson’s Disease after administration of levodopa b. Dramatic improvement of symptoms of Parkinson’s Disease after administration of levodopa c. Dramatic improvement in gait only after administration of levodopa d. Dramatic improvement in tremor only after administration of levodopa

2. An older adult with suspected Parkinson’s Disease has a “challenge test” performed in order to confirm the diagnosis. The nurse understands that a “challenge test” will demonstrate which of the following?

ANS: B

A diagnosis of Parkinson’s disease is confirmed by a “challenge test” when symptoms improve dramatically after the administration of the medication levodopa.

DIF: Cognitive Level: Understanding REF: p. 301

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Administer with meals only b. Administer first thing in the morning only c. Administer on an empty stomach, 30-60 minutes before or 45-60 minutes after a meal d. Administer with a full 8 ounces of water and have the patient sit upright for thirty minutes after

3. A nurse is caring for an older adult with Parkinson’s Disease. The patient is receiving the medication levodopa-carbidopa. The nurse understands that in order to maximize effectiveness, the administration schedule for this medication should adhere to which of the following?

ANS: C

To maximize effectiveness, levodopa-carbidopa must be taken on an empty stomach (30-60 minutes before or 45-60 minutes after a meal).

DIF: Cognitive Level: Understanding REF: p. 302

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation

4. While the older African American is at the highest risk for developing Alzheimer’s disease, the nurse demonstrates an understanding of this disease process’s risk factors when assessing this population’s: a. weight and elimination patterns. b. heart rate and capillary refill status. c. blood pressure and serum lipid levels. d. muscle strength and reflex times.

ANS: C

Researchers found distinct ethnic and racial differences among persons with AD. They may have identified a gene placing African Americans at about twice the risk for developing AD than their white American counterparts. It is possible that additional risk factors are a part of this, specifically, a higher rate of cardiovascular disease. There is no current research to support a relationship between the other options and the development of AD.

DIF: Cognitive Level: Understanding REF: pp. 302–303

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation

Multiple Response

1. An older adult is diagnosed with Alzheimer’s Disease. The nurse knows that this diagnosis is made on the presence of which of the following? (Select all that apply.)

a. A decline from a previous level of functioning b. Fluctuation of symptoms over the course of a 24-hour period c. An insidious onset d. A gradual decline in cognitive abilities e. The cognitive changes worsen in the evening hours

ANS: A, C, D

A diagnosis of a NCD due to AD requires (1) a decline from a previous level of functioning, (2) an insidious onset, and (3) a gradual decline in cognitive abilities. It is important to note that the changes are “greater than expected for the person’s age and educational background” and these changes can be documented with standardized neuropsychological testing. Options B and D are indicative of delirium.

DIF: Cognitive Level: Understanding REF: p. 303

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Rigidity b. Resting tremor c. Bradykinesia d. Orthostatic hypotension e. Progressive decline in cognitive function

2. A diagnosis of Parkinson’s disease is made based on the presence of which of the following symptoms? (Select all that apply.)

ANS: A, B, C

A diagnosis of Parkinson’s Disease is made based on the presence of the following symptoms: resting tremor, rigidity, bradykinesia, asymmetric onset, as well as a positive response to levodopa. Neither orthostatic hypotension nor progressive decline in cognitive function is one of the diagnostic criteria for PD.

DIF: Cognitive Level: Understanding REF: p. 302, Box 23-7

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. Maintain blood pressure within normal limits b. Smoking cessation c. Maintain control of blood sugar (hemoglobin A 1C ≤7) d. Eliminate fats from the diet e. Maintain ideal body weight

3. An older patient is concerned that her neighbor was recently diagnosed with Alzheimer’s Disease and asks a nurse what can be done to decrease the risk of Alzheimer’s Disease. The nurse includes which of the following in the response to the patient? (Select all that apply.)

ANS: A, B, C

Recommendations to decrease risk of neurocognitive disorders include maintaining blood pressure within normal limits, maintaining low-density lipoprotein cholesterol ≤100, maintaining hemoglobin A 1C ≤7, taking aspirin (81 mg enteric coated) for persons with risk for heart disease and without contraindications, maintaining optimal control of heart failure, and smoking cessation. Eliminating fats from the diet is not recommended. Although maintaining ideal body weight is important to prevent many other chronic illnesses, it is not cited as a factor to decrease the risk of neurocognitive disorders.

DIF: Cognitive Level: Understanding REF: p. 305, Box 23-11

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. individuals with LB develop motor symptoms, and individuals with AD do not. b. individuals with AD display impairments in judgment whereas individuals with LB do not. c. the use of traditional antipsychotic medication is contraindicated for individuals with LB. d. LB usually occurs in individuals under age 60, and AD occurs in individuals only over age 60. e. individuals with LB develop language symptoms, and individuals with AD do not.

4. Differences in the presentation of patients with Neurocognitive Disorder (NCD) Alzheimer’s Disease (AD) and NCD Lewy bodies (LB) are: (Select all that apply.)

ANS: A, C

Both AD and LB rarely occur to persons under the age of 60. Both are characterized by impairments in memory, thinking, language, judgment, and behavior. A distinct difference in the two is that persons with LB will eventually develop motor symptoms, and the use of traditional (typical) antipsychotics (e.g., Haldol) is always contraindicated.

DIF: Cognitive Level: Understanding REF: p. 299

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. depression. b. delirium. c. osteoporosis. d. rheumatoid arthritis. e. medication side effects.

5. An older adult is referred to a geriatric nurse practitioner because of changes in memory and reports by family members that “there is something different about her.” The nurse practitioner evaluates the older adult for potentially reversible causes for the changes, which include: (Select all that apply.)

ANS: A, B, E

Reversible dementia-like conditions include depression, delirium, thyroid disorders, vitamin deficiencies (especially vitamin D), and excessive alcohol intake, as well as side effects from medications. There is no evidence that rheumatoid arthritis or osteoporosis has a dementia-like condition associated with them.

DIF: Cognitive Level: Remembering REF: p. 300, Box 23-4

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation a. A deficiency of the neurotransmitter dopamine b. An inability of the neurons to absorb dopamine c. A reduction of dopamine receptors d. An accumulation of Lewy Bodies, especially in the basal ganglia e. The presence of neurofibrillary tangles and amyloid plaques in the brain

6. A nurse understands that the pathophysiology of Parkinson’s Disease includes which of the following? (Select all that apply.)

ANS: A, C, D

Parkinson’s Disease is the result of a deficiency of the neurotransmitter dopamine, a reduction of dopamine receptors, and the accumulation of Lewy Bodies, especially in the basal ganglia. The presence of neurofibrillary tangles and amyloid plaques in the brain is seen in Alzheimer’s Disease.

DIF: Cognitive Level: Understanding REF: p. 301

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Adaptation