Which problem statement/nursing diagnosis is most appropriate for a person with Parkinson disease?
Risk for falls related to unsteady gait
Risk for impaired skin integrity related to tremor
Nutrition: less than body requirements related to nausea
Ineffective airway clearance related to drooling
The Correct Answer is A
A. Parkinson’s disease often causes motor symptoms such as rigidity and bradykinesia, leading to an unsteady gait and increased fall risk.
B. Tremors do not directly cause impaired skin integrity; immobility or pressure may be more relevant factors.
C. Nausea is not a primary symptom of Parkinson’s disease or its typical treatments.
D. Drooling occurs but is less immediately threatening than fall risk; ineffective airway clearance may develop but is not the most common nursing diagnosis early on.
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Related Questions
Correct Answer is B
Explanation
A. Assisting the child to be pulled up in bed is contraindicated because it can disrupt traction alignment.
B. Keeping the child’s feet firmly against the foot of the bed helps maintain proper traction and alignment of the limb.
C. The heel should be elevated off the footboard to prevent pressure ulcers.
D. High Fowler’s position is not recommended as it may increase pressure on the traction and cause discomfort.
Correct Answer is B
Explanation
A. MS is believed to be an autoimmune disorder where the immune system attacks the myelin sheath, but it is not simply a hypersensitivity reaction.
B. Current evidence suggests that a combination of environmental factors (such as viral infections, vitamin D deficiency) and genetic predisposition contribute to the development of MS.
C. Allergic responses to antiviral medications are not linked to causing MS.
D. MS is not caused by a bacterial infection of the myelin; it is an autoimmune demyelinating disease.
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