The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease (PD)? (Select all that apply)

The client has hand tremors at rest

The client has slurred speech

The client's facial expression shows no emotion

The client does not remember what he ate for breakfast

The client's blood pressure increases when the client stands up

Answer and Explanation

Correct Answer : A,B,C

Choice A reason: Hand tremors at rest are a hallmark symptom of Parkinson disease, resulting from the degeneration of dopaminergic neurons in the substantia nigra, which disrupts basal ganglia function. This leads to rhythmic, involuntary movements, typically unilateral at onset, occurring when the limb is relaxed. These tremors are a primary motor symptom, distinguishing PD from other neurological conditions.

Choice B reason: Slurred speech, or dysarthria, in Parkinson disease arises from impaired motor control of speech muscles due to dopamine depletion in the basal ganglia. This affects articulation, causing soft, monotone, or slurred speech. It is a common motor symptom in PD, reflecting the disease's impact on coordinated muscle movements required for clear speech production.

Choice C reason: A lack of facial expression, known as masked facies, is a classic Parkinson disease symptom caused by bradykinesia and rigidity from dopamine deficiency. The basal ganglia's impaired signaling reduces spontaneous facial movements, resulting in a flat, emotionless appearance. This motor symptom significantly affects social interaction and is a key diagnostic feature of PD.

Choice D reason: Memory impairment, such as forgetting what was eaten for breakfast, is not a primary feature of Parkinson disease. While cognitive decline may occur in advanced stages or in related conditions like dementia with Lewy bodies, it is not a core diagnostic criterion. PD primarily affects motor functions due to dopaminergic neuron loss, not memory.

Choice E reason: Increased blood pressure upon standing, or orthostatic hypertension, is not associated with Parkinson disease. Orthostatic hypotension is more common in PD due to autonomic dysfunction from dopamine depletion, causing blood pressure to drop upon standing. Increased blood pressure suggests other conditions, not PD's typical autonomic or motor symptoms.

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Correct Answer is C

Explanation

Choice A reason: Obstructive shock results from physical blockages, like pulmonary embolism, impeding blood flow. The client’s blood loss and decreasing blood pressure point to volume depletion, not obstruction, making this choice incorrect for the scenario of significant surgical blood loss.

Choice B reason: Septic shock is caused by systemic infection leading to vasodilation and hypotension. The client’s blood loss, not infection, is the cause of decreasing blood pressure, making septic shock irrelevant to this postoperative scenario, so this choice is incorrect.

Choice C reason: Hypovolemic shock occurs from significant blood or fluid loss, reducing circulating volume and causing hypotension. An 800 mL blood loss during surgery directly leads to this condition, as the heart struggles to maintain perfusion, making this the correct choice.

Choice D reason: Neurogenic shock results from spinal cord injury causing vasodilation due to loss of sympathetic tone. The client’s blood loss, not neurological injury, is the cause of hypotension, making this choice incorrect for the described postoperative condition.

A. A client who is vomiting B. A client who is taking a thiazide diuretic C. A client who has salicylate intoxication D. A client who has diarrhea

Correct Answer is ["C","D"]

Explanation

Choice A reason: Vomiting typically leads to metabolic alkalosis, not acidosis. It causes loss of hydrochloric acid from the stomach, reducing hydrogen ion concentration in the blood. This elevates blood pH above 7.45, as the body retains bicarbonate. The kidneys attempt to compensate by excreting excess bicarbonate, but this does not result in metabolic acidosis, making this choice incorrect.

Choice B reason: Thiazide diuretics increase sodium and water excretion, which can lead to mild metabolic alkalosis due to increased bicarbonate reabsorption in the kidneys. They do not cause a loss of bicarbonate or accumulation of acids, which are necessary for metabolic acidosis. Thus, this choice is incorrect as it does not contribute to an acidic blood state.

Choice C reason: Salicylate intoxication, such as from aspirin overdose, causes metabolic acidosis by increasing acid production. Salicylates stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis initially, but they also disrupt mitochondrial function, causing lactic acid accumulation. This lowers blood pH below 7.35, meeting the criteria for metabolic acidosis, making this choice correct.

Choice D reason: Diarrhea results in significant bicarbonate loss through the stool, as the intestines secrete bicarbonate to neutralize gastric acid. This loss reduces the blood’s buffering capacity, lowering pH below 7.35, indicative of metabolic acidosis. The body may attempt to compensate via hyperventilation to reduce CO2, but the primary issue is bicarbonate depletion, making this choice correct.

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The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease (PD)? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing postoperative care to a client who lost 800 mL of blood during surgery. The client’s blood pressure has been steadily decreasing over the past 2 hours. Which of the following categories of shock should the nurse recognize is occurring?

Correct Answer is C

Explanation

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Correct Answer is ["C","D"]

Explanation

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