A client taking Levodopa-Carbidopa reports sudden periods of immobility ("off" times). The nurse knows this effect is best described as:

On-off syndrome

Withdrawal syndrome

Rebound tremor

Acute dystonia

Answer and Explanation

The Correct Answer is A

Rationale:

A. On-off syndrome is a common complication of long-term Levodopa-Carbidopa therapy in Parkinson’s disease. Clients experience sudden, unpredictable fluctuations between periods of good mobility (“on” periods) and severe motor impairment or immobility (“off” periods). This occurs due to pulsatile dopaminergic stimulation and the short half-life of Levodopa, which leads to inconsistent dopamine receptor activation in the basal ganglia. Recognition and management (e.g., adjusting dosing schedules, using controlled-release formulations, or adding adjunct medications) are key to improving functional mobility.

B. Withdrawal syndrome refers to symptoms that occur after abrupt discontinuation of a medication, such as sudden worsening of Parkinsonian symptoms or life-threatening complications with drugs like baclofen. In this case, the client is still taking Levodopa, so this is not a withdrawal effect.

C. Rebound tremor refers to a temporary increase in tremor after a medication wears off or is rapidly discontinued. While related to motor fluctuations, it is not synonymous with the full immobility episodes seen in on-off syndrome. Rebound tremor is a specific component of motor fluctuation, not the broader phenomenon described here.

D. Acute dystonia involves sustained, involuntary muscle contractions causing abnormal postures, often occurring shortly after starting or increasing certain medications (e.g., antipsychotics). The client’s sudden “off” periods of immobility are not dystonic postures but generalized motor blockade, making dystonia an inappropriate description.

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Correct Answer is C

Explanation

Rationale:

A. Tremor in Parkinson’s disease is a classic motor symptom, often presenting as a resting tremor in the hands, fingers, or jaw. It occurs independently of posture and does not typically cause lightheadedness, dizziness, or syncope upon standing. While tremor can interfere with fine motor tasks, it is not related to autonomic dysfunction or blood pressure changes.

B. High blood pressure generally does not cause dizziness upon standing. In fact, hypertension may coexist with Parkinson’s disease but is not responsible for orthostatic symptoms. Dizziness related to blood pressure in PD is usually caused by hypotension (low blood pressure), not elevated blood pressure. Focusing on hypertension would misdirect treatment efforts in this scenario.

C. Orthostatic hypotension (OH) is a non-motor complication of PD, resulting from autonomic nervous system dysfunction. When a patient stands, blood pressure fails to adjust appropriately, leading to decreased cerebral perfusion. Symptoms include dizziness, lightheadedness, blurred vision, or syncope, which can cause falls and impair functional independence. OH can be exacerbated by dopaminergic therapy, dehydration, prolonged bed rest, and age-related vascular changes.

D. Bradykinesia refers to slowness of voluntary movements and affects gait, speech, facial expression, and fine motor activities. It is a motor symptom, not an autonomic one, and does not directly cause dizziness or lightheadedness when changing positions. While bradykinesia may contribute to falls due to slow reactions, the primary cause of postural dizziness in this scenario is OH.

A. Insert a nasogastric tube for feedings B. Use thick liquids C. Eat bites of steak and chew frequently D. Use thin liquids

Correct Answer is B

Explanation

Rationale:

A. NG tube placement is invasive and not routinely indicated for patients who can safely eat orally. It is only used if the patient cannot swallow safely or meet nutritional needs orally, not as a first-line aspiration prevention strategy. Unnecessary NG tubes can increase the risk of infection and discomfort.

B. Thickened liquids are easier to control in the mouth and reduce the risk of aspiration in patients with dysphagia, which is common in Parkinson’s disease due to impaired swallowing and delayed pharyngeal reflexes. Thickened liquids slow the flow of fluids, giving the patient more time to coordinate a safe swallow, and are considered a primary intervention for aspiration prevention.

C. Solid foods, particularly tough or dry meats, are difficult to chew and swallow for patients with Parkinson’s disease. Even with frequent chewing, these foods increase the risk of choking and aspiration. Modified diets with soft, moist foods are safer.

D. Thin liquids, such as water or juice, flow quickly and are harder to control during swallowing, which significantly increases the risk of aspiration in patients with dysphagia. Thin liquids should be avoided unless swallowing function is intact and closely monitored.

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A client taking Levodopa-Carbidopa reports sudden periods of immobility ("off" times). The nurse knows this effect is best described as:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with Parkinson's disease complains of feeling dizzy upon standing. Which non-motor complication is suspected?

Correct Answer is C

Explanation

Correct Answer is B

Explanation

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