A nurse is educating a client who has Alzheimer's disease (AD) and their caregiver about the medication donepezil. The client asks the nurse, "How will this medication help me?" How should the nurse respond?

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 caregiver does not need further teaching if they say that pramipexole will help reduce the symptoms of PD by stimulating dopamine receptors in the brain. Pramipexole is a dopamine agonist that works by mimicking the action of dopamine, which is a neurotransmitter that is deficient in PD and affects movement and cognition. Pramipexole can reduce tremors, rigidity, bradykinesia, and postural instability in clients who have PD.

Choice B reason:

This is an incorrect answer. The caregiver does not need further teaching if they say that pramipexole will help prevent the development of dyskinesia or involuntary movements in their loved one. Dyskinesia is a common side effect of levodopa-carbidopa, which is another medication used to treat PD. Pramipexole can delay or reduce the occurrence of dyskinesia by allowing lower doses of levodopa-carbidopa to be used.

Choice C reason:

This is an incorrect answer. The caregiver does not need further teaching if they say that pramipexole will help increase the duration and quality of sleep in their loved one. Sleep disturbances are common in clients who have PD, due to various factors such as nocturia, pain, restless legs syndrome, or anxiety. Pramipexole can improve sleep quality and quantity by reducing nighttime awakenings and increasing REM sleep.

Choice D reason:

This is a correct answer. The caregiver needs further teaching if they say that pramipexole will help improve the mood and motivation of their loved one. This is not the purpose or effect of pramipexole, but rather antidepressants or stimulants, which are medications used to treat depression or apathy, respectively. Depression or apathy are common neuropsychiatric symptoms of PD, which affect the levels of serotonin, norepinephrine, or dopamine in the brain.