A nurse is caring for a client with Parkinson's disease who recently had deep brain stimulation. Which outcome indicates the treatment is effective?

Rationale:

A. Difficulty falling asleep (sleep-onset insomnia) and frequent nighttime awakenings (sleep-maintenance insomnia) are common non-motor symptoms of Parkinson’s disease. Sleep disturbances may result from dopaminergic dysfunction, nocturia, restless legs, pain, or medication side effects, and can significantly affect quality of life, cognition, and daytime functioning. Assessing and addressing sleep hygiene, medication timing, and environmental factors is essential for managing this symptom.

B. Anxiety may coexist with sleep disturbances but is not the primary cause of difficulty falling asleep and frequent awakenings in this scenario. Anxiety typically presents as excessive worry, restlessness, or tension, rather than isolated nocturnal sleep disruption.

C. Excessive daytime sleepiness (EDS) is a related non-motor symptom, often secondary to poor nighttime sleep or as a side effect of dopaminergic medications. However, the client’s current complaint focuses on nocturnal insomnia, not daytime somnolence.

D. Hallucinations, such as visual or auditory perceptions without external stimuli, are non-motor symptoms of PD, often associated with advanced disease or medication side effects. They do not explain difficulty initiating or maintaining sleep.

Rationale:
A. This is correct understanding. Glyburide, a sulfonylurea, can interact with alcohol to cause severe hypoglycemia or a disulfiram-like reaction. Complete avoidance of alcohol is recommended, so this statement shows proper comprehension.

B. Alcohol can enhance the hypoglycemic effects of glyburide, leading to symptoms such as dizziness, lightheadedness, or fainting. The client recognizing this risk demonstrates understanding of medication-alcohol interactions.

C. Alcohol can potentiate the blood-glucose-lowering effects of glyburide by inhibiting gluconeogenesis, increasing the risk of hypoglycemia. This statement shows the client understands the potential danger.

D. Even small amounts of alcohol can precipitate hypoglycemia in clients taking glyburide, particularly if alcohol is consumed without food. This statement indicates a misunderstanding of the risks, so the nurse should provide further teaching to emphasize complete avoidance of alcohol while on sulfonylureas.