The nurse assists a client with Parkinson's disease (PD) to ambulate in the hallway. The client appears to "freeze" and then carefully lifts one leg and steps forward. The client tells the nurse of pretending to step over a crack on the floor. How should the nurse respond?

Plan to assess the client's cognition after returning to his room.

Confirm that this is an effective technique to help with ambulation.

Reorient the client to his present location and circumstances.

Assist the client to a carpeted area where he can walk more easily.

Answer and Explanation

The Correct Answer is B

A.   While assessing cognition is important for understanding the client’s overall functioning, the immediate issue of "freezing" during ambulation is more related to motor symptoms rather than cognitive impairment. "Freezing" in Parkinson's disease is a common motor symptom where the client feels as if their feet are glued to the floor.
B.   The technique of pretending to step over an imaginary object (like a crack) is known to be a helpful strategy for managing "freezing" in Parkinson's disease. This technique provides a cognitive cue that can help the client initiate movement and overcome the freezing episodes. Confirming that this is an effective technique acknowledges the client's strategy and supports their efforts to improve mobility.

C.   Reorienting the client to their location and circumstances can be helpful in situations where confusion or disorientation is an issue. However, in the case of "freezing" during ambulation, this response does not directly address the motor symptoms associated with Parkinson's disease. The problem here is more about movement initiation rather than orientation.
D.   Moving to a carpeted area might help with traction and reduce the risk of slipping, but it does not directly address the issue of "freezing" episodes. The freezing phenomenon in Parkinson's disease is related to motor control rather than the type of flooring. While providing a safer walking environment is beneficial, it doesn’t target the underlying motor symptoms as directly as addressing the client’s technique.

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Correct Answer is A

Explanation

A. This instruction is particularly relevant for a client with gouty arthritis. Gout is a type of arthritis caused by elevated levels of uric acid in the blood, which can form crystals in the joints and cause severe pain and inflammation. Red meat and certain seafood are high in purines, which can increase uric acid levels and exacerbate gout symptoms.
B. This instruction might not be suitable for someone with hypertension, as many salt substitutes contain potassium. For a person with high blood pressure, excessive potassium can be harmful, especially if they are on certain medications or have kidney issues.
C. This advice may not be appropriate given the client's current inability to bear weight due to severe ankle pain. Limiting mobility equipment could lead to further physical complications. The focus should be on managing pain and inflammation to improve mobility rather than restricting the use of equipment.
D. While wrapping joints with an elastic bandage can help reduce swelling, it should be done with caution. Over-wrapping can lead to decreased circulation or additional pain. In cases of severe pain and swelling, other treatments such as rest, elevation, and ice may be more appropriate.

A. Place an indwelling urinary catheter and measure strict Intake and output. B. Initiate bilateral intermittent sequential pneumatic compression devices. C. Administer aspirin to prevent further det formation and platelet dumping. D. Obtain a focused history to determine recent bleeding and use of anticoagulants.

Correct Answer is D

Explanation

A. Monitoring intake and output can be important for overall fluid management, it is not the most urgent intervention for a client presenting with symptoms suggestive of a stroke or other acute neurological event. The immediate concern should be to evaluate and manage the neurological symptoms rather than focusing on urinary output at this stage.
B. Bilateral intermittent sequential pneumatic compression devices are used to prevent deep vein thrombosis (DVT) in immobile patients. This is not directly relevant to the acute neurological symptoms described and does not address the immediate need for evaluating the cause of the sudden headache and facial droop.
C. While aspirin may be used in some cases to prevent further clot formation in patients with certain types of strokes, administering it without a clear diagnosis and without ruling out contraindications could be harmful. The client needs immediate diagnostic evaluation to determine if a stroke or another condition is present before starting any medication like aspirin.
D. Obtaining a focused history is crucial in the context of sudden onset neurological symptoms. This includes assessing for recent bleeding, trauma, or the use of anticoagulants, which can help in diagnosing and managing conditions like stroke. Understanding the client's medication history and any recent bleeding events is important for guiding appropriate treatment and ensuring safe management.

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The nurse assists a client with Parkinson's disease (PD) to ambulate in the hallway. The client appears to "freeze" and then carefully lifts one leg and steps forward. The client tells the nurse of pretending to step over a crack on the floor. How should the nurse respond?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Correct Answer is D

Explanation

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