The nurse notes that a client with Parkinson's disease has a flat facial expression, speaks softly, and shows little emotion. Which non-motor symptom does this suggest?

Rationale:

A. Baclofen is a centrally acting skeletal muscle relaxant that targets the GABA-B receptors in the spinal cord, inhibiting excitatory neurotransmission. By reducing the frequency and severity of muscle spasms, stiffness, and hypertonicity, it helps improve mobility, ADLs, and overall comfort in patients with MS. This demonstrates correct understanding of the therapeutic purpose of the medication.

B. Both baclofen and alcohol are CNS depressants, which can lead to additive effects such as excessive drowsiness, dizziness, hypotension, or impaired coordination, increasing the risk of falls or accidents. Avoiding alcohol ensures patient safety, especially during initiation or dose adjustments.

C. Stopping baclofen abruptly is dangerous. Sudden discontinuation can cause rebound spasticity, severe muscle rigidity, hallucinations, seizures, fever, and even life-threatening complications. Safe discontinuation requires a gradual tapering schedule under medical supervision. This statement indicates the patient does not understand the importance of safe medication management and the physiologic consequences of sudden withdrawal.

D. Drowsiness, fatigue, and generalized weakness are common CNS-related adverse effects of baclofen, particularly at the start of therapy or after dose increases. Educating patients about these effects helps them anticipate changes, avoid risky activities (e.g., driving or operating machinery), and adhere to the regimen while monitoring tolerance.

Rationale:

A. Clients with MS often have gait disturbances, weakness, or balance issues. Long or rapid strides increase the risk of tripping and falling. Safe ambulation requires small, deliberate steps and possibly the use of assistive devices, rather than encouraging faster movement.

B. Poor lighting increases fall risk because clients may misjudge distances or fail to see obstacles. MS patients benefit from bright, evenly distributed lighting to enhance visibility, particularly in hallways, stairs, and bathrooms. Dim lighting is unsafe.

C. Eliminating obstacles such as clutter, loose rugs, or cords reduces tripping hazards and is a primary fall-prevention strategy for clients with MS. Ensuring clear, wide pathways and secure flooring promotes safety and independence at home.

D. Assistive devices like canes, walkers, or gait belts provide stability and support, reducing fall risk. Advising a client to avoid them is unsafe and counterproductive. Proper training on device use and placement is essential for safe mobility.