Alterations in Cognition and Sensing Review (Multiple Sclerosis & PD)

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. a. Fluid overload b. Dysphagia d. Choking e. Constipation f. Anorexia

b. Dysphagia d. Choking e. Constipation Explanation: Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Fluid overload and anorexia are not specifically related to Parkinson's disease.

Students are reviewing information about the stages of pressure ulcer development. They demonstrate understanding when they identify which stage as characterized by a full-thickness wound? Select all that apply. a. Deep tissue injury b. Stage I c. Stage II d. Stage III e. Stage IV

d. Stage III e. Stage IV Explanation: Stages III and IV pressure ulcers are considered full-thickness wounds. Deep tissue injury is a localized area of discolored, purple, intact skin or blood-filled blister caused by underlying soft tissue damage from pressure or shear. Stage I ulcer is characterized by erythema. Stage II pressure ulcer is a partial-thickness wound.

What nursing intervention will best help the client with Huntington disease to increase nutrition? Select all that apply. a. Eliminate foods high in fat b. Increase high carbohydrate foods c. Maintain a pureed diet d. Use Relaxation techniques e. Take phenothiazine prior to meals

d. Use Relaxation techniques e. Take phenothiazine prior to meals Explanation: Talking to the client before meals will help to promote relaxation, and phenothiazines help to calm some clients. Eliminating foods high in fat, increasing carbohydrates, and pureeing food will not assist in relaxing muscles during choreiform movements. The nurse should wait for the client to chew and swallow, which can be a slow process.

A nurse is assessing a client with Parkinson's disease. Which of the following would the nurse expect to find? a. Gait with the body leaning backward b. Continuous tremors c. Muscle flaccidity d. Slowing of activity

d. Slowing of activity Explanation: Clients with Parkinson's disease typically manifest bradykinesia (slowing of all active movement), a propulsive, forward leaning gait, tremors that disappear with active movement, and muscle rigidity.

The nurse is assessing a male client with multiple sclerosis (MS). What education would the nurse provide to assist the client in managing this disease? Select all that apply. a. Avoidance of hot temperatures b. Treatment of any episodes of depression c. Effective treatment of anemia d. Recommend bone mineral density testing e. Participation in occupational therapy

a. Avoidance of hot temperatures b. Treatment of any episodes of depression c. Effective treatment of anemia e. Participation in occupational therapy Explanation: Multiple sclerosis (MS) is an immune-mediated, progressive demyelinating disease of the central nervous system (CNS). Fatigue affects most people with MS and is often the most disabling symptom. Heat, depression, anemia, deconditioning, and medication may contribute to fatigue. Avoiding high temperatures, effective treatment of depression and anemia, a change in medication, as well as occupational and physical therapy may help manage fatigue. Pain is another common symptom of MS. Bone mineral testing is recommended for women with MS who are perimenopausal. This group of clients are likely to have pain related to osteoporosis.

The nurse is caring for a client who is hospitalized with an exacerbation of MS. To ensure the client's safety, what nursing action should be performed? a. Ensure that suction apparatus is set up at the bedside. b. Pad the client's bed rails. c. Maintain bed rest whenever possible. d. Provide several small meals each day.

a. Ensure that suction apparatus is set up at the bedside. Explanation: Because of the client's risk of aspiration, it is important to have a suction apparatus at hand. Bed rest should be generally be minimized, not maximized, and there is no need to pad the client's bed rails or to provide multiple small meals.

Which of the following are disease-modifying agents used in the treatment of multiple sclerosis (MS)? Select all that apply. a. Interferon beta-1a (Rebif) b. Interferon beta-1b (Betaseron) c. Interferon beta-1a (Avonex) d. Glatiramer acetate (Copaxone) e. Tizanidine (Zanaflex)

a. Interferon beta-1a (Rebif) b. Interferon beta-1b (Betaseron) c. Interferon beta-1a (Avonex) d. Glatiramer acetate (Copaxone) Explanation: Disease-modifying agents include Rebif, Betaseron, Avonex, and Copaxone. Zanaflex is a benzodiazepine used to treat spasticity in the treatment of MS.

A nurse is teaching a family about skin care for a bedridden client. What interventions should be included with the family teaching? Select all that apply. a. Keep the skin clean and dry using mild soap. b. Change the client's position frequently . c. Encourage a high-protein diet with supplements. d. Gently massage the skin around the pressure areas. e. Rub moisturizing lotion over the pressure areas.

a. Keep the skin clean and dry using mild soap. b. Change the client's position frequently . c. Encourage a high-protein diet with supplements. d. Gently massage the skin around the pressure areas. Explanation: Keeping the skin clean and dry with the use of mild soaps, changing the client's position frequently, encouraging a high-protein diet, and gently massaging the skin around the pressure areas are important for skin care. The nurse should rub lotion around, not directly over, pressure areas to avoid skin breakdown.

What nursing intervention will best assist the client with chorea? a. Monitor the client on bed rest b. Assist the client with walking hourly c. Keep an oral airway at the bedside d. Administer pain medications every 4 hours

a. Monitor the client on bed rest Explanation: Chorea is a rapid, jerky, involuntary, purposeless movement of the extremities that interferes with walking, sitting, and activities of daily living. It can involve facial muscles. For safety reasons, the client should be monitored on bed rest.

A client with Huntington disease has just been admitted to a long-term care facility. The charge nurse is creating a care plan for this client. Nutritional management for a client with Huntington disease should be informed by what principle? a. The client is likely to have an increased appetite. b. The client is likely to require enzyme supplements. c. The client will likely require a clear liquid diet. d. The client will benefit from a low-protein diet.

a. The client is likely to have an increased appetite. Explanation: Due to the continuous involuntary movements, clients will have a ravenous appetite. Despite this ravenous appetite, clients usually become emaciated and exhausted. As the disease progresses, clients experience difficulty in swallowing and thin liquids should be avoided. Protein will not be limited with this disease. Enzyme supplements are not normally required.

A nurse is performing range-of-motion exercises and moves the patient's hand sideways so that the little finger moves toward the forearm. The nurse is performing which of the following? a. Ulnar deviation b. Supination c. Thumb opposition d. Wrist flexion

a. Ulnar deviation Explanation: Moving the hand sideways so that the side of the hand with the little finger moves toward the forearm reflects ulnar deviation. Supination occurs when the elbow is at the waist, the arm is bent at a 90-degree angle, and the hand is turned so that the palm is facing up. Thumb opposition occurs when the thumb moves out and around to touch the little finger. Wrist flexion occurs when the wrist is bent so that the palm is toward the forearm.

A nurse is developing a teaching plan for a patient with urinary incontinence who will be performing intermittent self-catheterization. Which of the following would be most important for the nurse to emphasize? a. Maintaining sterility of the equipment b. Following a regular emptying schedule c. Cleaning the client's used catheters with water and allowing to air dry d. Using bladder distention to signal need for insertion

b. Following a regular emptying schedule Explanation: When intermittent self-catheterization is used, the nurse would emphasize regular emptying of the bladder rather than sterility. The catheter is inserted for the length of time it would take to empty the bladder. A regular schedule, not evidence of bladder distention, is used to guide the frequency of the procedure.

The nurse is evaluating whether a client's walker is the right height for the client. While the client's hands are on the hand grip, the nurse assesses the client's elbows. The nurse determines that the walker is at the right height when the client's elbows are in which position? a. 0-degree flexion b. 15-degree flexion c. 25-degree flexion d. 45-degree flexion

c. 25-degree flexion Explanation: When a walker is at the right height for a client, the client's elbows will be between 20 and 30 degrees flexion when the hands are resting on the hand grip.

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern? a. Take psyllium (Metamucil) daily. b. Take a laxative whenever bloating is experienced. c. Adopt a diet with moderate fiber intake. d. Adopt a high-fiber diet.

c. Adopt a diet with moderate fiber intake. Explanation: A regular bowel routine may be established by encouraging the patient to follow a regular time pattern, consciously increase fluid intake, and eat foods with moderate fiber content. Laxatives should be avoided. Psyllium (Metamucil), for example, decreases constipation but carries the risk of bowel obstruction (Karch, 2012).

A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS? a. Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes b. Flexor spasm, clonus, and negative Babinski reflex c. Blurred vision, intention tremor, and urinary hesitancy d. Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs

c. Blurred vision, intention tremor, and urinary hesitancy Explanation: Optic neuritis, leading to blurred vision, is a common early sign of MS, as is intention tremor (tremor when performing an activity). Nerve damage can cause urinary hesitancy. In MS, deep tendon reflexes are increased or hyperactive. A positive Babinski reflex is found in MS. Abdominal reflexes are absent with MS.

The nurse practitioner prescribes the medication of choice for an MS patient who is experiencing disabling episodes of muscles spasms, especially at night. Which of the following is the drug most likely prescribed in this scenario? a. Valium b. Zanaflex c. Lioresal d. Dantrium

c. Lioresal Explanation: Baclofen (Lioresal), a gamma-aminobutyric acid (GABA) agonist, is the medication of choice for treating spasticity. It can be administered orally or by intrathecal injection.

A client is being taught to go down stairs using a cane. What action would the nurse instruct the patient to do first? a. Place the cane on the lower step. b. Step down with the unaffected leg. c. Step down with the affected leg. d. Place cane and affected leg on step simultaneously.

c. Step down with the affected leg. Explanation: When using a cane to go down stairs, first the patient would step down with the affected leg, then place the cane, and then place the unaffected extremity on the down step. The affected leg and cane should not be used simultaneously.

A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? a. "You'll continue to experience progressive muscle weakness and sensory deficits." b. "You'll need to take edrophonium (Tensilon) to treat the disease." c. "The disease is a disorder of motor and sensory dysfunction." d. "This disease doesn't cause sensory impairment."

d. "This disease doesn't cause sensory impairment." Explanation: Myasthenia gravis affects motor function; therefore, the nurse should inform the client that sensory impairments won't occur. This disease is chronic; there's no cure. It can be managed with edrophonium in the diagnostic phase; however, this drug isn't used to treat the condition.

A nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by: a. genetic dysfunction. b. upper and lower motor neuron lesions. c. decreased conduction of impulses in an upper motor neuron lesion. d. a lower motor neuron lesion.

d. a lower motor neuron lesion. Explanation: Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower motor neuron lesion at the myoneural junction. It isn't a genetic disorder. A combined upper and lower motor neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the spinal cord would cause decreased conduction of impulses at an upper motor neuron.

The nurse is caring for a client with Parkinson disease (PD). Which finding in the client's medical record will cause the nurse to question giving a prescribed dose of benztropine mesylate? a. Hypotension b. Seizure disorder c. Type 2 diabetes d. Narrow-angle glaucoma

d. Narrow-angle glaucoma Explanation: Benztropine mesylate is an anticholinergic agent that is used to counteract the action of acetylcholine. This medication is contraindicated in clients with narrow-angle glaucoma. This medication is not contraindicated in hypotension, a seizure disorder, or type 2 diabetes.

A nurse is caring for a client diagnosed with Guillain-Barré syndrome. The client states, "It's getting harder to take a deep breath." Which action by the nurse is most appropriate? a. Call the physician and prepare for intubation. b. Explain the progression of the syndrome. c. Assess lung sounds. d. Encourage the client to cough.

a. Call the physician and prepare for intubation. Explanation: The progression of Guillain-Barré syndrome leads to neuromuscular respiratory failure in a large proportion of the people affected. Changes in vital capacity and negative inspiratory force are usually key indicators to be monitored for early intervention. The nurse should be alert to the earliest signs that a client may be heading toward respiratory failure. Explaining the progression of the syndrome will not change the potential need for mechanical ventilation due to respiratory failure. Because the respiratory failure is caused by neurologic changes, assessing the lung sounds, although appropriate, is not the highest priority . Encouraging the client to cough will not change the progression of the syndrome.

Which intervention has the highest priority when providing skin care to a bedridden client? a. Changing the client's position frequently b. Keeping the skin clean and dry without using harsh soaps c. Gently massaging the skin around the pressure areas d. Rubbing moisturizing lotion over the pressure areas

b. Keeping the skin clean and dry without using harsh soaps Explanation: Keeping the skin clean and dry is always the highest priority. Changing the client's position frequently and gently massaging the skin around the pressure areas are also important but only after the skin is cleaned. The nurse should rub lotion around, not directly over, pressure areas to avoid skin breakdown.

A nurse is preparing a teaching plan for a client diagnosed with amyotrophic lateral sclerosis (ALS) and his family about the disorder and changes that may occur. Which of the following would the nurse least likely include in the discussion? a. Spasticity b. Difficulty swallowing c. Loss of bladder control d. Speech difficulties

c. Loss of bladder control Explanation: With amyotrophic lateral sclerosis, the client typically develops spasticity, difficulty swallowing, and speech difficulties. Usually the function of the anal and bladder sphincters remain intact because the spinal nerves that control these muscles are not affected.

The nurse is preparing to provide care for a client diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what issue? a. Genetic dysfunction b. Upper and lower motor neuron lesions c. Decreased conduction of impulses in an upper motor neuron lesion d. A lower motor neuron lesion

d. A lower motor neuron lesion Explanation: Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower neuron lesion at the myoneural junction. It is not a genetic disorder. A combined upper and lower neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the spinal cord would cause decreased conduction of impulses at an upper motor neuron.

A client with amyotrophic lateral sclerosis (ALS) has a nasal sound to speech. Which intervention will the nurse add to the client's plan of care? a. Give oral fluids with assistance. b. Suction the oropharynx as needed. c. Maintain oxygen 2 liters per nasal canula. d. Instruct to tuck the chin when swallowing.

a. Give oral fluids with assistance. Explanation: Clinical manifestations of amyotrophic lateral sclerosis (ALS) depend upon the location of the affected motor neurons. If the client has weakness in the muscles supplied by the cranial nerves, difficulty swallowing will occur. When the client ingests liquids, the soft palate and upper esophageal weakness cause the liquid to be regurgitated through the nose. It is necessary, therefore, for oral fluids to be given with assistance. Oropharyngeal suctioning is not indicated. Oxygen therapy would not be used because of the change in the speech tone. Tucking the chin when swallowing is not an intervention to help the client with ALS.

A client is admitted to the hospital with pneumonia. He has a history of Parkinson disease, which his family says is worsening. Which assessment should the nurse expect? a. Impaired speech b. Muscle flaccidity c. Pleasant and smiling demeanor d. Tremors in the fingers that increase with purposeful movement

a. Impaired speech Explanation: In Parkinson's disease, dysarthria, or impaired speech, results from a disturbance in muscle control. Muscle rigidity, not flaccidity, causes resistance to passive muscle stretching. The client may exhibit a masklike appearance rather than a pleasant and smiling demeanor. Tremors should decrease, not increase, with purposeful movement and sleep.

A family member of a client diagnosed with Huntington disease calls the clinic. The family member is requesting help from the Huntington Disease Society of America. What kind of help can this client and family receive from this organization? Select all that apply. a. Information about this disease b. Referrals c. Public education d. Individual assessments e. Appraisals of research studies

a. Information about this disease b. Referrals c. Public education Explanation: The Huntington Disease Society of America helps clients and families by providing information, referrals, family and public education, and support for research. It does not provide individual assessments or appraisals of individual research studies.

What interventions will best help the client with Huntington disease relieve anxiety and increase communication? Select all that apply. a. Use biofeedback. b. Consult with a speech therapist. c. Use an interpreter. d. Talk as little as possible. e. Always have family present.

a. Use biofeedback. b. Consult with a speech therapist. Explanation: Using biofeedback and relaxation therapy may help to decrease stress and help with communication. A speech therapist can help maintain and prolong communication abilities as well. An interpreter is not needed and the client should be encouraged to talk. Family presence is not essential, but the nurse should learn how the client expresses needs and wants, especially if the client is nonverbal.

A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? a. Vision changes b. Absent deep tendon reflexes c. Tremors at rest d. Flaccid muscles

a. Vision changes Explanation: Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of MS. Deep tendon reflexes may be increased or hyperactive — not absent. Babinski's reflex may be positive. Tremors at rest aren't characteristic of MS; however, intentional tremors (those occurring with purposeful voluntary movement) are common in clients with MS. Affected muscles are spastic, rather than flaccid.

A client with a neurologic deficit is feeling frustrated because it is very difficult to pronounce words since having a stroke. The client is struggling with: a. dysarthria. b. dysphasia. c. ataxia. d. dysphagia.

a. dysarthria. Explanation: Dysarthria is characterized by poor articulation of words due to muscle weakness or loss of muscle control. Dysphasia is characterized by the compromised ability to put words together meaningfully. Ataxia is a dysfunction of the parts of the nervous system that coordinate movement. Dysphagia is difficulty with swallowing.

A nurse is monitoring a client with Guillain-Barré syndrome. The nurse should assess the client for which responses? Select all that apply. a. respiratory distress b. increasing ICP c. seizure activity d. difficulty swallowing

a. respiratory distress d. difficulty swallowing Explanation: Respiratory muscles may become paralyzed, requiring endotracheal intubation and mechanical ventilation. If cranial nerve involvement develops, swallowing becomes difficult. Increasing ICP and seizure activity are not expected complications of Guillain-Barré syndrome.

Which anticholinergic agent is used to control tremor and rigidity in Parkinson disease? a. Bromocriptine mesylate b. Benztropine Mesylate c. Amantadine d. Levodopa

b. Benztropine Mesylate Explanation: Benztropine Mesylate is an anticholinergic agent used to control tremor and rigidity in Parkinson disease. Bromocriptine mesylate is a dopamine agonist. Amantadine is an antiviral agent. Levodopa is a dopaminergic.

A rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles is: a. Akathisia b. Chorea d. Dyskinesia e. Paresthesia

b. Chorea Explanation: Chorea is a rapid, jerky, involuntary, purposeless movement of the extremities of facial muscles, including facial grimacing. Akathisia is restlessness. Dyskinesia is impaired ability to execute voluntary movements. Paresthesia is a sensation of numbness, tingling, or a "pins and needles" sensation.

The nurse is observing a client using a cane to ambulate. Which of the following would require the nurse to intervene? a. Client advances the cane at the same time he moves the affected leg forward. b. Client keeps the cane fairly close to the body when ambulating. c. Client bears down on the cane when he begins to swing the unaffected leg. d. Client moves the arm and leg on the same side together at the same time.

d. Client moves the arm and leg on the same side together at the same time. Explanation: When using a cane, the client should move the opposite arm and leg together, advance the cane at the same time that the affected leg is moved forward, keep the cane fairly close to the body to prevent leaning, and bear down on the cane when the unaffected extremity begins the swing phase.

The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care? a. Raise the head of the client's bed about 30 degrees during meals. b. Encourage the use of liquids that are thin in consistency. c. Arrange for specialized utensils for the client to use when eating. d. Encourage the client to massage the facial and neck muscles before eating.

d. Encourage the client to massage the facial and neck muscles before eating. Explanation: The client is having difficulty swallowing, which is interfering with nutritional intake. Therefore, the nurse should encourage the client to massage the facial and neck muscles before meals, sit in an upright position during meals, consume a semisolid diet with thick rather than thin liquids (which are easier to swallow), and think through the swallowing sequence. Raising the head of the bed 30 degrees is not high enough. Using specialized utensils would be more appropriate for a nursing diagnosis of self-care deficit, feeding to foster a sense of greater independence and control with eating.

A client is at risk for pressure ulcers. Which of the following would be most appropriate to include in the plan of care? a. Massaging any reddened areas of the skin b. Having the client shift his or her weight every hour c. Placing the client in a semi-reclining position d. Lubricating the skin with a non-irritating lotion

d. Lubricating the skin with a non-irritating lotion Explanation: To help reduce the risk of pressure ulcers, the nurse should lubricate the skin with a bland lotion to keep it soft and pliable. Reddened areas should not be massaged because this could damage the capillaries and deep tissues. Clients should shift their weight every 15 to 20 minutes. The semi-reclining position should be avoided because it increases the shearing forces over the sacral area.

A nurse is assisting an 80-year-old patient out of bed for the first time after being on strict bedrest for several days. Which of the following would lead the nurse to suspect that the patient is experiencing orthostatic hypotension? a. Flushing b. Bradycardia c. Dry skin d. Nausea

d. Nausea Explanation: Orthostatic hypotension is manifested by a drop in blood pressure, pallor, diaphoresis, nausea, tachycardia, and dizziness.

Which are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. a. Pain b. Fatigue c. Spasticity d. Aphasia e. Depression f. Numbness

a. Pain b. Fatigue c. Spasticity e. Depression f. Numbness Explanation: The most commonly reported clinical manifestations of MS are pain, fatigue, spasticity, depression, numbness, weakness, difficulty with coordination, and loss of balance. Aphasia is not a commonly reported clinical manifestation.

The nurse is caring for a client with Bell's palsy. Which body system will the nurse identify as the priority for this client? a. Sensory b. Neurologic c. Integumentary d. Musculoskeletal

a. Sensory Explanation: The priority for nursing care of the client with Bell's palsy is protecting the eye from injury. The eyelid often will not close completely and the blink reflex is diminished, increasing the risk of injury from dust and foreign particles. Corneal irritation and ulcerations may occur. The condition is caused by unilateral inflammation of the 7th cranial nerve; however, the neurologic system is not at risk for additional injury or effects. The integumentary system is not affected by Bell's palsy. The facial muscles on the affected side will be paralyzed; however, this is the only area of the musculoskeletal status affected.

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? a. Slows the progression of the disease b. Replaces dopamine c. Relieves symptoms of dyskinesia d. Prevents side effects from carbidopa-levodopa

a. Slows the progression of the disease Explanation: Selegiline increases dopaminergic activity and slows the progression of the disease. Carbidopa-levodopa is a dopamine replacement drug. Anticholinergic drugs are used to reduce the symptoms of dyskinesia and other side effects.

The nursing instructor is teaching the senior nursing class about neuromuscular disorders. When talking about Multiple Sclerosis (MS) what diagnostic finding would the instructor list as being confirmatory of a diagnosis of MS? a. An elevated acetylcholine receptor antibody titer b. Episodes of muscle fasciculations c. IV administration of edrophonium d. Oligoclonal bands

d. Oligoclonal bands Explanation: Electrophoresis of the CSF, a technique for electrically separating and identifying proteins, demonstrates abnormal immunoglobulin G bands, described as oligoclonal bands. An elevated acetylcholine receptor antibody titer and IV administration of edrophonium are diagnostic of Myasthenia Gravis. Episodes of muscle fasciculations are characteristic of ALS.