In formulating the nursing care plan for a client diagnosed with Parkinson's disease, which nursing problem has the highest priority?
Impaired physical mobility relative to muscle rigidity.
Risk for aspiration relative to muscle weakness.
Risk for constipation relative to immobility.
Self-care deficit relative to motor disturbance.
The Correct Answer is B
Choice A rationale: Impaired physical mobility is a significant concern in Parkinson's disease due to bradykinesia and tremors. However, it does not pose an immediate threat to life when compared to potential airway and respiratory complications.
Choice B rationale: Aspiration is the highest priority according to the ABC (Airway, Breathing, Circulation) framework. Parkinson's causes dysphagia and impaired laryngeal reflexes, making silent aspiration and subsequent pneumonia a life-threatening risk for the client.
Choice C rationale: Constipation is common due to decreased GI motility and side effects of dopaminergic medications. While it causes discomfort and potential impaction, it is a physiological need that ranks lower than respiratory safety.
Choice D rationale: Self-care deficits in hygiene and dressing affect the client's quality of life and independence. In the hierarchy of care, these functional limitations are addressed only after the client's physical safety and airway are secured.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is choiced. Ask the parents to explain what they understand about the child’s diagnosis.
Choice A rationale:
While it is important to support the parents’ decisions, this choice does not address the need for the parents to have accurate information about the condition and its potential complications.
Choice B rationale:
This statement is incorrect.Delaying surgery for hypospadias can lead to complications such as urinary problems, infections, and issues with sexual function later in life.
Choice C rationale:
This is misleading.Hypospadias does not typically resolve on its own, and waiting can result in complications that may require more complex surgical interventions.
Choice D rationale:
This choice is correct because it encourages the parents to share their understanding of the diagnosis, allowing the nurse to provide accurate information and address any misconceptions.This approach ensures that the parents make an informed decision based on a clear understanding of the condition and its implications.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale:
Verapamil is a calcium channel blocker and is expected to decrease heart rate by inhibiting calcium influx into cardiac cells, particularly in the SA (sinoatrial) node, where it can slow down the heart's electrical impulses.
Choice B rationale:
Increased contractility is not an expected outcome of verapamil use. In fact, verapamil's main action is to decrease myocardial contractility, making it useful for treating conditions like angina and atrial fibrillation.
Choice C rationale:
Verapamil is known to dilate coronary arteries, which can improve blood flow to the heart muscle and relieve symptoms of angina.
Choice D rationale:
Reduced blood pressure is an expected outcome of verapamil use due to its vasodilatory effects on peripheral blood vessels. This can be beneficial in treating hypertension and angina.
Choice E rationale:
Relieved chest pain is an expected outcome of verapamil use, particularly in the case of variant angina (Prinzmetal's angina), as it helps to relax coronary arteries and reduce coronary artery spasm, which is a common cause of chest pain in this condition.
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