NUR 239 EXAM 5 QUESTIONS AND ANSWERS | NUR 239
STUDY GUIDE & PRACTICE TEST 2026/2027
off time phenomenon - correct answer ✔✔-fluctuations in med effectiveness
-periods of day when med is not working well
-increase in Sx when drug concentrations are low
-occurs in advanced Parkinson’s disease
-as a nurse we need to give meds on time for consistent drug levels
-precise schedule that differs from facility schedule
-delay of 5 mins is a problem
overview of therapeutic outcomes for Parkinson’s med - correct answer ✔✔-absence of tremors
-decreased rigidity
-decreased stiffness
-increased ability to perform ADLs
-improvement in other Sx
COMT - correct answer ✔✔enzyme that metabolizes dopamine in brain and some peripheral levodopa
cardinal signs of parkinson's - correct answer ✔✔-1st tremor: upper extremities at rest, possibly lower
later on
*pill rolling: increases w stress, decreases w purposeful mvmnt and sleep
-rigidity (akinesia): stiffness, mask like expression
-bradykinesia: inability to move, "freeze in place"
other signs of parkinson's - correct answer ✔✔-early: loss of smell, constipation, sleep disorders
-postural instability: leans forward (stooped posture), risk for falls
-gait: slow to start, small shuffling steps, difficulty stopping, starting, turning
-decreased blinking, arm swing w walking
-speech: slurred, soft speaking voice
-ANS Sx: drooling, dysphagia, constipation, sweating
-later cognitive abilities: decreased emotions, dementia, depression, anorexia, sleep disturbances, sexual
difficulty
pathophysiology of parkinson's disease - correct answer ✔✔-chronic progressive degenerative
neurologic condition: neurons are destroyed
-affects dopamine neurons of substantia nigra
-degeneration of nigrostriatal pathway: decrease of dopamine
-leads to gradual destruction of pigmented cells in substantia nigra that produce dopamine
*Lewy bodies: abn neurons that destroy DNA, mitochondria
*dopamine deficiency in basal ganglia prevents cells from performing normal function in CNS
*inability to inhibit unwanted mvmnts
diagnosis/trmnt of parkinson's - correct answer ✔✔-individualized
, -neurologist consult
-based on age/Hx/S&S
-CT or MI to r/o tumors, etc
-DaTScan: IV injection radioactive tracer that detects smaller signal in brain of those who have PD;
PetScan: visualize dopamine neurons
-goal of trmnt: relieve Sx and keep functional, support groups, education, exercise, nutrition, meds,
phys/speech therapy, neurosurgery in extreme cases
-medication classes: increase dopamine, block acetylcholine
-meds do not stop progression of disease: relieves Sx, increases ability to do ADLs
parkinson's disease clinical manifestations - correct answer ✔✔-wide base of support, unsteady gait,
lack of fluid mvmnts, resting tremors, involuntary mvmnts, rigidity
-rolls fingers like rolling a marble in hand (pill rolling)
-bradykinesia
-freeze in place, "feet are glued to floor", esp at doorways
-leans forward to maintain center of gravity
-small shuffling steps
-med must be given on time
-monitor effectiveness of meds and for any AEs
hypoxemia - correct answer ✔✔-decreased O2 concentration in blood (an O2 sat of 85% or less)
-prolonged hypoxemia leads to hypoxia: decreased tissue oxygenation
-acute hypoxia: decreased LOC, impaired judgement, mood changes, restlessness, irritability, confusion,
lethargy, coma, increased HR and BP, dysrhythmias, central cyanosis, diaphoresis, cool extremities
-chronic hypoxia: pulmonary vessel vasoconstriction, polycythemia
atelectasis - correct answer ✔✔PARTIAL OR COMPLETE COLLAPSE OF THE LUNG
-high alveolar pressure can decrease perfusion by squeezing capillaries
-local area of lung
-collapse of sm number of alveoli results in reduced gas exchange or an obstruction of bronchioles that
inhibits full inflation of alveoli
-due to compression of alveoli (mass/tumor)
-most common cause: sedation during surgery (resp rate decreases and depth is shallow)
-predisposes pt to pneumonia
-kery nursing implications: prevention!, turn, cough, deep breathing, use IS, early ambulation, pain
control
hypercapnia - correct answer ✔✔-elevated PaCO2: decrease in O2/CO2 exchange, rising CO2 level
results in resp acidosis
-causes: hypoventilation, neuromuscular diseases, chest wall deformities
-Sx: increased resp rate, SOB, HA, confusion, lethargy, N/V
pleuritis - correct answer ✔✔inflammation of pleural lining
pleural effusion - correct answer ✔✔fluid in pleural cavity
pneumothorax - correct answer ✔✔air in pleural cavity
STUDY GUIDE & PRACTICE TEST 2026/2027
off time phenomenon - correct answer ✔✔-fluctuations in med effectiveness
-periods of day when med is not working well
-increase in Sx when drug concentrations are low
-occurs in advanced Parkinson’s disease
-as a nurse we need to give meds on time for consistent drug levels
-precise schedule that differs from facility schedule
-delay of 5 mins is a problem
overview of therapeutic outcomes for Parkinson’s med - correct answer ✔✔-absence of tremors
-decreased rigidity
-decreased stiffness
-increased ability to perform ADLs
-improvement in other Sx
COMT - correct answer ✔✔enzyme that metabolizes dopamine in brain and some peripheral levodopa
cardinal signs of parkinson's - correct answer ✔✔-1st tremor: upper extremities at rest, possibly lower
later on
*pill rolling: increases w stress, decreases w purposeful mvmnt and sleep
-rigidity (akinesia): stiffness, mask like expression
-bradykinesia: inability to move, "freeze in place"
other signs of parkinson's - correct answer ✔✔-early: loss of smell, constipation, sleep disorders
-postural instability: leans forward (stooped posture), risk for falls
-gait: slow to start, small shuffling steps, difficulty stopping, starting, turning
-decreased blinking, arm swing w walking
-speech: slurred, soft speaking voice
-ANS Sx: drooling, dysphagia, constipation, sweating
-later cognitive abilities: decreased emotions, dementia, depression, anorexia, sleep disturbances, sexual
difficulty
pathophysiology of parkinson's disease - correct answer ✔✔-chronic progressive degenerative
neurologic condition: neurons are destroyed
-affects dopamine neurons of substantia nigra
-degeneration of nigrostriatal pathway: decrease of dopamine
-leads to gradual destruction of pigmented cells in substantia nigra that produce dopamine
*Lewy bodies: abn neurons that destroy DNA, mitochondria
*dopamine deficiency in basal ganglia prevents cells from performing normal function in CNS
*inability to inhibit unwanted mvmnts
diagnosis/trmnt of parkinson's - correct answer ✔✔-individualized
, -neurologist consult
-based on age/Hx/S&S
-CT or MI to r/o tumors, etc
-DaTScan: IV injection radioactive tracer that detects smaller signal in brain of those who have PD;
PetScan: visualize dopamine neurons
-goal of trmnt: relieve Sx and keep functional, support groups, education, exercise, nutrition, meds,
phys/speech therapy, neurosurgery in extreme cases
-medication classes: increase dopamine, block acetylcholine
-meds do not stop progression of disease: relieves Sx, increases ability to do ADLs
parkinson's disease clinical manifestations - correct answer ✔✔-wide base of support, unsteady gait,
lack of fluid mvmnts, resting tremors, involuntary mvmnts, rigidity
-rolls fingers like rolling a marble in hand (pill rolling)
-bradykinesia
-freeze in place, "feet are glued to floor", esp at doorways
-leans forward to maintain center of gravity
-small shuffling steps
-med must be given on time
-monitor effectiveness of meds and for any AEs
hypoxemia - correct answer ✔✔-decreased O2 concentration in blood (an O2 sat of 85% or less)
-prolonged hypoxemia leads to hypoxia: decreased tissue oxygenation
-acute hypoxia: decreased LOC, impaired judgement, mood changes, restlessness, irritability, confusion,
lethargy, coma, increased HR and BP, dysrhythmias, central cyanosis, diaphoresis, cool extremities
-chronic hypoxia: pulmonary vessel vasoconstriction, polycythemia
atelectasis - correct answer ✔✔PARTIAL OR COMPLETE COLLAPSE OF THE LUNG
-high alveolar pressure can decrease perfusion by squeezing capillaries
-local area of lung
-collapse of sm number of alveoli results in reduced gas exchange or an obstruction of bronchioles that
inhibits full inflation of alveoli
-due to compression of alveoli (mass/tumor)
-most common cause: sedation during surgery (resp rate decreases and depth is shallow)
-predisposes pt to pneumonia
-kery nursing implications: prevention!, turn, cough, deep breathing, use IS, early ambulation, pain
control
hypercapnia - correct answer ✔✔-elevated PaCO2: decrease in O2/CO2 exchange, rising CO2 level
results in resp acidosis
-causes: hypoventilation, neuromuscular diseases, chest wall deformities
-Sx: increased resp rate, SOB, HA, confusion, lethargy, N/V
pleuritis - correct answer ✔✔inflammation of pleural lining
pleural effusion - correct answer ✔✔fluid in pleural cavity
pneumothorax - correct answer ✔✔air in pleural cavity
