NUR 138 EVALUATION EXAM ACTUAL QUESTIONS AND
SOLUTIONS RATED A+
✔✔Nursing assessment: mobility - ✔✔Observation balance, gait, bearing weight, and
use of assistive devices. Observe for signs of pain. Ask about patient physical activity,
ability to preform ALDs, time spent sedentary, and nutritional habits. Ask patient about
history of onset, severity, timing, and symptoms, associated with limitations in mobility.
Physical exam: inspect and palpate bone, muscles, and joints for deformities,
tenderness, and pain. Inspect ROM and five P's of neurovascular assessment (pain,
pulses, pallor, paresthesia, paralysis/paresis
✔✔Independent Interventions: mobility - ✔✔Provide education- proper body mechanics
and posture. Teach about meds including safe administration, actions, side effects, and
precautions.
Promote comfort- provide positioning and proper padding to joints and bones, prevent
skin breakdown, use brace and splint
Prevent injury- encourage exercise and stretching, utilize braces, enviornmental
screening
Fostering independence-
Reduce social isolation- discuss relationship with family, help patient explore social
networks, discuss living arrangements
✔✔Parkinsons Disease (PD) - ✔✔Progressive neurological disease that primarily
affects movement. It usually is characterized by unilateral hand tremors, but progresses
to include bilateral tremors, rigidity, bradykinesia, and postural instability.
✔✔PD patho, etiology, risk factors - ✔✔Patho- Dopamine is a neurotransmitter that
regulates voluntary movement, reward-seeking, memory and learning, attention, sleep,
affect, ect. Loss of dopamine neurons result in abnormal nerve firing patterns leading to
impaired movement.
Etiology- cause is unknown. most cases of early onset PD is caused by genetic
mutation.
Risk factors- age is primary risk factor, 60 years and older. Men are at higher risk.
Prevention- Healthy diet that is high in fruits and veggies, avoiding herbicides, and
consuming moderate amounts of caffine and green tea, consuming nutritional
suppliments, may help prevent PD.
✔✔PD manifestation - ✔✔Two out of the three classic symptoms are required to
diagnose PD
Motor symptoms: often begin unilateral, tremor (rhythmic, involuntary movement of
extremites), pill-rolling, rigidity (resistance to movement), muscle weakness and
stiffness, limited ROM, joint pain, bradykinesia( slowed movement), hypophonia
, (lowered voice volume), shorter steps, difficulty eating, retropulsion (tendency to topple
backwards), small shuffling steps, festation(rapid small step, as if trying to run), freezing
Nonmotor symptoms: slowed thinking, confusion, memory loss, parkinsons dementia,
depression, fear, anxiety, fatigue, sleep disturbances, frequent wakening
✔✔PD: Collaborative Care - ✔✔Diagnostic Tests: DaTscans (substance injected into
the brain that binds to dopamine transporters), MRI, blood tests
Surgery: Deep brain stimulation,
Pharm: Levodopa, carvadopa, anticholoinergics, antidepressants
Nonpharm: exercise is the most important therapy, PT, OT, speech,
✔✔Levodopa - ✔✔MOA: Restores dopamine levels in the brain
Uses: parkisonism, PD, pain relief for shingles, bone pain
Considerations: cornerstone therapy for PD, effective dose must be titrated to avoid
adverse effects, long term high dose can cause dyskinesia, effectiveness goes down
over time, avoid high protein diets, can cause urine and sweat to be dark,
✔✔Nursing process: PD - ✔✔Assessment: observe gait, assess tremors, use of
assistive devices. history of brain disorders, trauma, enviornmental toxins, medications,
family history. Assess mentation, behavior and mood. Assess speech, swallowing,
handwriting, facial expression, tremors at rest, UPDRS
Diagnosis: risk for falls, impaired mobility, impaired swallowing, disturbed sleep pattern,
fear, constipation, self care deficit.
Planning: pt free from injury, demonstrates progressive improvement, participate in
therapies, get adequte sleep
Implementations: install handrails, remove floor hazards, ROM, high and low intensity
treadmill walking, frequent ambulaiton, PT, OT, provide emotional support, take adequte
time for ALDs, assistive devices, prepare soft foods, speech therapy, provide oral and
written information, promote independence
Evaluation: evaluate regularly using the UPDRS, assess emotional level
✔✔Stroke - ✔✔Also known as a cerebrovascular accident, is a condition in which
neurologic deficits result from sudden decrease in blood flow to a localized area of the
brain. They can be ischemic ( thrombus, emboli, or stenosis) or hemorrhagic( vessel
breaks open and spills blood into surrounding tissue)
SOLUTIONS RATED A+
✔✔Nursing assessment: mobility - ✔✔Observation balance, gait, bearing weight, and
use of assistive devices. Observe for signs of pain. Ask about patient physical activity,
ability to preform ALDs, time spent sedentary, and nutritional habits. Ask patient about
history of onset, severity, timing, and symptoms, associated with limitations in mobility.
Physical exam: inspect and palpate bone, muscles, and joints for deformities,
tenderness, and pain. Inspect ROM and five P's of neurovascular assessment (pain,
pulses, pallor, paresthesia, paralysis/paresis
✔✔Independent Interventions: mobility - ✔✔Provide education- proper body mechanics
and posture. Teach about meds including safe administration, actions, side effects, and
precautions.
Promote comfort- provide positioning and proper padding to joints and bones, prevent
skin breakdown, use brace and splint
Prevent injury- encourage exercise and stretching, utilize braces, enviornmental
screening
Fostering independence-
Reduce social isolation- discuss relationship with family, help patient explore social
networks, discuss living arrangements
✔✔Parkinsons Disease (PD) - ✔✔Progressive neurological disease that primarily
affects movement. It usually is characterized by unilateral hand tremors, but progresses
to include bilateral tremors, rigidity, bradykinesia, and postural instability.
✔✔PD patho, etiology, risk factors - ✔✔Patho- Dopamine is a neurotransmitter that
regulates voluntary movement, reward-seeking, memory and learning, attention, sleep,
affect, ect. Loss of dopamine neurons result in abnormal nerve firing patterns leading to
impaired movement.
Etiology- cause is unknown. most cases of early onset PD is caused by genetic
mutation.
Risk factors- age is primary risk factor, 60 years and older. Men are at higher risk.
Prevention- Healthy diet that is high in fruits and veggies, avoiding herbicides, and
consuming moderate amounts of caffine and green tea, consuming nutritional
suppliments, may help prevent PD.
✔✔PD manifestation - ✔✔Two out of the three classic symptoms are required to
diagnose PD
Motor symptoms: often begin unilateral, tremor (rhythmic, involuntary movement of
extremites), pill-rolling, rigidity (resistance to movement), muscle weakness and
stiffness, limited ROM, joint pain, bradykinesia( slowed movement), hypophonia
, (lowered voice volume), shorter steps, difficulty eating, retropulsion (tendency to topple
backwards), small shuffling steps, festation(rapid small step, as if trying to run), freezing
Nonmotor symptoms: slowed thinking, confusion, memory loss, parkinsons dementia,
depression, fear, anxiety, fatigue, sleep disturbances, frequent wakening
✔✔PD: Collaborative Care - ✔✔Diagnostic Tests: DaTscans (substance injected into
the brain that binds to dopamine transporters), MRI, blood tests
Surgery: Deep brain stimulation,
Pharm: Levodopa, carvadopa, anticholoinergics, antidepressants
Nonpharm: exercise is the most important therapy, PT, OT, speech,
✔✔Levodopa - ✔✔MOA: Restores dopamine levels in the brain
Uses: parkisonism, PD, pain relief for shingles, bone pain
Considerations: cornerstone therapy for PD, effective dose must be titrated to avoid
adverse effects, long term high dose can cause dyskinesia, effectiveness goes down
over time, avoid high protein diets, can cause urine and sweat to be dark,
✔✔Nursing process: PD - ✔✔Assessment: observe gait, assess tremors, use of
assistive devices. history of brain disorders, trauma, enviornmental toxins, medications,
family history. Assess mentation, behavior and mood. Assess speech, swallowing,
handwriting, facial expression, tremors at rest, UPDRS
Diagnosis: risk for falls, impaired mobility, impaired swallowing, disturbed sleep pattern,
fear, constipation, self care deficit.
Planning: pt free from injury, demonstrates progressive improvement, participate in
therapies, get adequte sleep
Implementations: install handrails, remove floor hazards, ROM, high and low intensity
treadmill walking, frequent ambulaiton, PT, OT, provide emotional support, take adequte
time for ALDs, assistive devices, prepare soft foods, speech therapy, provide oral and
written information, promote independence
Evaluation: evaluate regularly using the UPDRS, assess emotional level
✔✔Stroke - ✔✔Also known as a cerebrovascular accident, is a condition in which
neurologic deficits result from sudden decrease in blood flow to a localized area of the
brain. They can be ischemic ( thrombus, emboli, or stenosis) or hemorrhagic( vessel
breaks open and spills blood into surrounding tissue)
