The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease (PD)? (Select all that apply)

Choice A reason: Hand tremors at rest are a hallmark symptom of Parkinson disease, resulting from the degeneration of dopaminergic neurons in the substantia nigra, which disrupts basal ganglia function. This leads to rhythmic, involuntary movements, typically unilateral at onset, occurring when the limb is relaxed. These tremors are a primary motor symptom, distinguishing PD from other neurological conditions. Choice B reason: Slurred speech, or dysarthria, in Parkinson disease arises from impaired motor control of speech muscles due to dopamine depletion in the basal ganglia. This affects articulation, causing soft, monotone, or slurred speech. It is a common motor symptom in PD, reflecting the disease's impact on coordinated muscle movements required for clear speech production. Choice C reason: A lack of facial expression, known as masked facies, is a classic Parkinson disease symptom caused by bradykinesia and rigidity from dopamine deficiency. The basal ganglia's impaired signaling reduces spontaneous facial movements, resulting in a flat, emotionless appearance. This motor symptom significantly affects social interaction and is a key diagnostic feature of PD. Choice D reason: Memory impairment, such as forgetting what was eaten for breakfast, is not a primary feature of Parkinson disease. While cognitive decline may occur in advanced stages or in related conditions like dementia with Lewy bodies, it is not a core diagnostic criterion. PD primarily affects motor functions due to dopaminergic neuron loss, not memory. Choice E reason: Increased blood pressure upon standing, or orthostatic hypertension, is not associated with Parkinson disease. Orthostatic hypotension is more common in PD due to autonomic dysfunction from dopamine depletion, causing blood pressure to drop upon standing. Increased blood pressure suggests other conditions, not PD's typical autonomic or motor symptoms.