The nurse assesses a client who has Parkinson disease. Which signs and symptoms would the nurse recognize as a key feature of this disease? (Select all that apply.)

Choice A rationale A shuffling gait is a hallmark motor symptom resulting from the loss of dopaminergic neurons in the substantia nigra. This gait pattern is characterized by short, hesitant steps and a reduced lifting of the feet off the ground, often referred to as festination. This occurs because the basal ganglia can no longer effectively regulate the rhythm and amplitude of movement. It significantly increases the risk of tripping and falling, making gait assessment a priority for nursing safety interventions. Choice B rationale Bradykinesia refers to the generalized slowness of movement and is one of the cardinal features required for a clinical diagnosis. It affects all skeletal muscle groups, leading to difficulties in initiating movement and a reduction in spontaneous actions, such as blinking or swinging the arms while walking. This symptom is caused by the disruption of the motor pathways that coordinate complex voluntary movements. It often manifests as a mask like facial expression and significantly slows the performance of simple daily tasks. Choice C rationale Tremors at rest, often described as a pill rolling motion of the fingers, are a classic early sign of the disease. These rhythmic oscillations typically occur when the limb is supported and inactive, and they often diminish or disappear during purposeful voluntary movement or sleep. The tremor is a result of the imbalance between excitatory acetylcholine and inhibitory dopamine within the extrapyramidal system. While usually starting unilaterally, the tremor may eventually progress to involve both sides of the body. Choice D rationale Aphasia, which is the loss of the ability to understand or express speech due to brain damage, is not a standard feature of Parkinson disease. While patients may experience dysarthria, which is a physical difficulty in articulating words due to muscle weakness, or a soft, monotone voice known as hypophonia, the cognitive processing of language remains intact. Aphasia is more commonly associated with strokes or specific types of dementia that affect the language centers of the cerebral cortex, such as Broca's area. Choice E rationale Muscle rigidity is caused by increased muscle tone and a continuous resistance to passive movement in the joints. This can manifest as lead pipe rigidity, which is a constant resistance, or cogwheel rigidity, where the resistance is interrupted by small jerks. This stiffness is often painful and contributes to the characteristic stooped posture and decreased range of motion seen in affected individuals. It results from the sustained contraction of both agonist and antagonist muscles due to neurological dysfunction.