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.)

Choice A reason:

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 reason:

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 reason:

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 reason:

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.

Choice A reason:

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 reason:

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 reason:

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 reason:

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.