Chapter 15: Disorders of Motor Function

Which individual is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? A 57-year-old female who developed rhabdomyolysis and ischemic injury after a tourniquet application A 20-year-old female who had nerves transected during surgery to remove a tumor from her mandible. A 26-year-old male who suffered a bone-depth laceration to his shoulder during a knife attack A 32-year-old male who had his forearm partially crushed by gears during an industrial accident

A 32-year-old male who had his forearm partially crushed by gears during an industrial accident

Which principle best explains symptoms of amyotrophic lateral sclerosis (ALS), including dysphagia, muscle weakness and spasticity, and dysphonia? ALS is caused by lack of dopamine in the body. ALS is caused by disruption to the cerebellum. ALS is caused by muscular necrosis. ALS is caused by both an upper motor neuron and lower motor neuron disturbance.

ALS is caused by both an upper motor neuron and lower motor neuron disturbance.

Reflex activity involves which neurons? Interneurons Efferent neurons Afferent neurons All of the above

All of the above

A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her: Bowels Bladder Perineal musculature Arms

Arms

Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease? Lack of sweating Paresthesia Bradykinesia Hypotonia

Bradykinesia

Neurotoxins such as the botulism organism can produce paralysis by what mechanism? Demyelination of multiple peripheral nerves By blocking release of acetylcholine Loss of acetylcholine receptors Causing a recessive gene defect on the X chromosome

By blocking release of acetylcholine

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? Guillain-Barré syndrome Myasthenia gravis Phalen maneuver Carpal tunnel syndrome

Carpal tunnel syndrome

An older adult has had a recent decrease in coordination, with gait being described as wide-based, unsteady, and lacking in fluidity, although the client's muscle tone appears normal. This client requires further assessment for which condition that is involved with coordination of movement? Muscle atrophy Impaired spinal reflexes Lower motor neuron lesions Cerebellar disorder

Cerebellar disorder

A client had an arm cast fitted after suffering a right humeral fracture in a hockey game. The client reported a loss of sensation in the right hand, but sensation returned upon removal of the cast. Which was the most likely cause of the client's loss of sensation? Inhibition of the musculocutaneous nerve to protect the humerus Inflammation of the musculocutaneous nerve Severing of the musculocutaneous nerve followed by regeneration Compression lesion of the musculocutaneous nerve

Compression lesion of the musculocutaneous nerve

Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD). Creatine kinase Rheumatoid factor Amylase levels Serum glucose

Creatine kinase

Which statement best describes the pathophysiology of Parkinson disease? Failure of the cerebral cortex, which does not allow the use of acetylcholine Degeneration of the nigrostriatal dopamine system Increase in the number of dopamine receptors by an alternate basal ganglion Rise in acetylcholine levels, causing an inhibition of voluntary movement

Degeneration of the nigrostriatal dopamine system

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance? Dopamine Acetylcholine Serotonin Adenosine

Dopamine

A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide? Give the client some orange juice and sugar. Disimpact the stool from the anal vault. Insert an indwelling catheter. Elevate the head of the bed.

Elevate the head of the bed.

Loss of coordinated movement and balance is likely due to damage to which physical structure? Cranial nerves Peripheral neurons Pyramidal structures Extrapyramidal structures

Extrapyramidal structures Disorders affecting the extrapyramidal system include involuntary movement, muscle rigidity, and immobility without paralysis.

An individual affected by a basal-ganglia associated movement disorder is affected by dyskinesias. Which assessment correlates with dyskinesia? Rapid initiation of controlled movements Grimacing and lip pursing Stooped posturing Tremors of hands

Grimacing and lip pursing

A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which food? Unrefrigerated meat Fresh fish Home-grown and canned vegetables Dairy products

Home-grown and canned vegetables

Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration? Anticonvulsants Antibiotics Antidepressants Immunomodulators

Immunomodulators

Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS? Long-term corticosteroid administration Mitoxantrone, an antineoplastic agent Interferon-β, a cytokine injection Baclofen, a muscle relaxer

Interferon-β, a cytokine injection

Which neuron connects sensory and motor neurons? Interneurons Cranial nerves Efferent neurons Afferent neurons

Interneurons

A client has been diagnosed with Guillain-Barré syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client? Maintenance of the client's airway Inserting a Foley catheter Restarting the IV when it infiltrates Assessing distal peripheral pulses

Maintenance of the client's airway

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. What disease falls into this category? Myasthenia gravis Multiple sclerosis Becker muscular dystrophy Duchenne muscular dystrophy

Myasthenia gravis

Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability? Guillain-Barré syndrome Parkinson disease Muscular dystrophy Myasthenia gravis

Myasthenia gravis

Which peripheral nerve injury will likely result in cellular death with little chance of regeneration? Cutting injury where slow-regeneration axonal branches are located Incomplete amputation where tubular implants are used to fill in the gaps of nerves Nerve fibers destroyed close to the neuronal cell body Crushing injury where the nerve is traumatized but not severed

Nerve fibers destroyed close to the neuronal cell body

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: Manifestations of another disease process Normal manifestations of Parkinson disease Signs of clinical improvement Signs of clinical deterioration

Normal manifestations of Parkinson disease The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement.

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding? Hypotonia Involuntary movements Paralysis Muscle rigidity

Paralysis

A client who has experienced a spinal cord injury still has use of the arms but has impaired motor and sensory function of the trunk, legs, and pelvic organs. Which term best describes how this injury is classified? Tetraplegia Quadriplegia Paraplegia Brown-Séquard syndrome

Paraplegia

Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway? Alzheimer disease Truncal ataxia Parkinson disease Guillain-Barré syndrome

Parkinson disease

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? Guillain-Barré syndrome Huntington disease myasthenia gravis

Parkinson disease The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis. The other answers are incorrect.

Which structural change can contribute to mixed sensorimotor deficit? Increased brain mass and pressure Increased number of neurons Increased number of dendritic processes Polyneuropathies involving demyelination of peripheral nerves

Polyneuropathies involving demyelination of peripheral nerves

Multiple sclerosis is characterized by what type of neuron damage? Transneuropathy Aneuropathy Mononeuropathy Polyneuropathy

Polyneuropathy

Which treatment should take place immediately in a client experiencing autonomic dysreflexia? Position the client in upright position, and correct the initiating stimulus. Apply binders and support hose to shunt the blood to the main organs. Place the client in a supine position, and increase intravenous fluids. Increase the client's blood pressure to allow for adequate perfusion.

Position the client in upright position, and correct the initiating stimulus.

Throwing a ball or picking up a fork are movements controlled by which portion of the frontal lobe? Supplementary motor cortex Primary motor cortex Reflexive circuitry Premotor cortex

Premotor cortex

A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. What is the most accurate description? This drug: prevents the depolarizing effect of the neurotransmitters. produces paralysis of the larynx muscles by blocking acetylcholine release. will slow the decline in muscle strength and function. inhibits the peripheral metabolism of dopamine.

Produces paralysis of the larynx muscles by blocking acetylcholine release Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release.-Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD.- Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. -Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. -Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects

The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which medical term? Dysdiadochokinesia Chorea Fasciculations Pseudohypertrophy

Pseudohypertrophy Explanation: Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this? Depression over new diagnosis Psychological manifestation due to involvement of white matter of cerebral cortex A side effect of treatment Likely a preexisting mental illness

Psychological manifestation due to involvement of white matter of cerebral cortex Explanation:Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions

The transmission of impulses at the neuromuscular junction is mediated by which action? Release of neurotransmitter acetylcholine from autonomic nerve endings Nerve stimulation of the adrenal medulla Nerve origin in thoracolumbar spine Connection to paraspinal ganglion chain

Release of neurotransmitter acetylcholine from autonomic nerve endings

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client? Respiratory ventilation assessment and prevention of aspiration pneumonia Assessment of lower extremities to prevent deep vein thrombosis Ability to turn from side to side, thereby preventing skin breakdown Ability to empty bladder completely, thereby preventing autonomic dysreflexia

Respiratory ventilation assessment and prevention of aspiration pneumonia

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? Slow to start walking and has difficulty when asked to "stop" suddenly Takes large, exaggerated strides and swings arms/hands wildly Hyperactive leg motions like he just can't stand still Difficulty putting weight on soles of feet and tends to walk on tiptoes

Slow to start walking and has difficulty when asked to "stop" suddenly

A nurse is caring for a client experiencing muscle fasciculations. Fasciculations appear as: increased muscular resistance with range of motion. weakness and loss of movement. spontaneous contractions of muscle fibers presenting as twitching. rhythmic movements.

Spontaneous contractions of muscle fibers presenting as twitching

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Atherosclerotic destruction of circulation to the brain, resulting in lactic acid buildup that affects nerve transmission Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decreased motor response

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.

A nurse is providing education to a client newly diagnosed with Guillain-Barré syndrome. Which statement reflects accurate information about the course of the disease? Most clients do not sustain residual dysfunction from the disorder. It is an acute disorder that usually resolves after treatment with antibiotics. The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process. The client can expect prolonged isolation due to contagious viral nature of disorder.

The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process.

Coordinated muscular movement requires proper functioning of four areas of the nervous system. Which system controls posture and balance? The sensory system The motor system The cerebellar system The vestibular system

The vestibular system

A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply. Bradykinesia Tachycardia Tremor Rapid speech Rigidity

Tremor Rigidity Bradykinesia The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement. Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.

Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following? Severe spinal shock Vasospasms and hypertension Tachycardia and pale skin Lack of sweat above injury level

Vasospasms and hypertension Explanation:Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. Continued hypertension produces a baroreflex-mediated vagal slowing of the heart rate to bradycardic levels. There is an accompanying baroreflex-mediated vasodilation with flushed skin and profuse sweating above the level of injury.

A client diagnosed with early multiple sclerosis (MS) will likely demonstrate which manifestations? Select all that apply. Visual clouding Anxiety Bladder dysfunction Paresthesia Fatigue

Visual clouding Paresthesia Bladder dysfunction Fatigue Explanation:Visual disturbances, paresthesias, abnormal gait (ataxia), bladder and sexual dysfunction, vertigo, nystagmus, fatigue, and speech disturbances are early signs of MS. Anxiety and depression are often seen later as a result of the changes the disease causes.

Death caused by muscular dystrophy in early adulthood is usually due to: severe long bone fractures. severe skeletal muscle weakness. malnutrition. respiratory and cardiac muscle involvement.

respiratory and cardiac muscle involvement.

Death caused by muscular dystrophy in early adulthood is usually due to: severe skeletal muscle weakness. malnutrition. respiratory and cardiac muscle involvement. severe long bone fractures.

respiratory and cardiac muscle involvement.

The nurse has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be: emotional support. administration of antibiotics. ventilatory assessment and support. feeding the client.

ventilatory assessment and support.