You are taking care of an older female adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. What do you realize she is experiencing?

Choice A reason: Changing facial expression is not a likely action to be observed during the assessment, as PD causes reduced facial expression or mask-like face. The client may have difficulty blinking, smiling, or showing emotions.

Choice B reason: Frequent movement is not a likely action to be observed during the assessment, as PD causes slowed movement or bradykinesia. The client may have difficulty initiating, continuing, or completing movements.

Choice C reason: Resting hand tremors is a likely action to be observed during the assessment, as PD causes rhythmic shaking of the hands, fingers, or other body parts. The tremors usually occur when the affected limb is at rest and may decrease when the client is performing tasks.

Choice D reason: Fast movements is not a likely action to be observed during the assessment, as PD causes impaired movement or dyskinesia. The client may have involuntary, jerky, or twisting movements that are often unpredictable and uncontrollable.

Choice E reason: None of the above is not the correct answer, as there is one choice that is a likely action to be observed during the assessment.

Choice A reason: Performing all activities of daily living (ADLs) and then resting is not a good instruction for the older adult who has COPD, as it can cause fatigue, shortness of breath, and anxiety. The nurse would advise the older adult to pace themselves and prioritize the most important activities, and to take breaks between tasks.

Choice B reason: Bathing and eating slowly with periodic rest is a good instruction for the older adult who has COPD, as it can help conserve energy, prevent dyspnea, and improve digestion. The nurse would advise the older adult to use a shower chair or a handheld showerhead, to avoid hot water or steam, and to use a fan or an open window for ventilation. The nurse would also advise the older adult to eat small, frequent meals, to avoid foods that cause gas or bloating, and to drink fluids between meals rather than with them.

Choice C reason: Walking short distances without oxygen is not a safe instruction for the older adult who has COPD, as it can cause hypoxia, which is a low level of oxygen in the blood. The nurse would advise the older adult to use oxygen therapy as prescribed by their doctor, and to monitor their oxygen saturation with a pulse oximeter. The nurse would also advise the older adult to exercise regularly, but to start slowly and gradually increase the intensity and duration, and to stop if they feel dizzy, chest pain, or severe breathlessness.

Choice D reason: Bathing right after eating and then resting is not a helpful instruction for the older adult who has COPD, as it can cause indigestion, reflux, or aspiration. The nurse would advise the older adult to wait at least an hour after eating before bathing, and to avoid lying down right after eating or bathing. The nurse would also advise the older adult to elevate their head with pillows when resting or sleeping, and to avoid napping during the day.