Chapter 64: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

A) Edrophonium

What intervention should the nurse suggest to help a client with multiple sclerosis avoid urinary incontinence?

A) Establish a regular voiding schedule.

What assessment findings would the nurse expect to find with a client with progressive myasthenia gravis?

A) Muscle weakness, difficulty swallowing, double vision, and difficulty speaking

The nurse assesses for euphoria in a client with multiple sclerosis. What characteristic clinical manifestation is the nurse looking for?

A) an exaggerated sense of well-being

A client with multiple sclerosis is starting a bowel retraining program. Which strategy is not appropriate?

A) limiting fluid intake to 1,000 mL/day

What is an initial sign of Parkinson's disease?

A) tremor

7. Medication to counteract Tensilon side effects

Ans: Atropine (AtroPen)

11. Purpose of plasmapheresis in Guillain-Barre' syndrome

Ans: Decrease in antibodies attacking peripheral nerve myelin

6. Expected outcome of baclofen for multiple sclerosis

Ans: Decreased muscle spasms in the lower extremities

8. Additional assessment data for myasthenia gravis diagnosis

Ans: Generalized weakness of the extremities

10. Clinical manifestation of bulbar muscle weakness in Guillain-Barre'

Ans: Inability to clear secretions

1. Assessment finding expected for bacterial meningitis

Ans: Neck flexion produces flexion of knees and hips

5. Priority nursing intervention for Guillain-Barre' syndrome

Ans: Using the incentive spirometer as prescribed

9. Assessment parameter to confirm myasthenia gravis diagnosis

Ans: Visual screening using the Snellen chart

3. Deteriorating status in Guillain-Barré syndrome

Ans: Vital capacity of 11 mL/kg

2. Trigeminal neuralgia trigger to avoid

Ans: Washing his face

An expected nursing intervention for a patient diagnosed with Bell's palsy would be which of the following?

Applying a protective eye shield

What is the primary manifestation of Guillain-Barré Syndrome?

Ascending Weakness

When teaching a client about levodopa-carbidopa therapy for Parkinson's disease, what instruction should the nurse include?

B) 'Be aware that your urine may appear darker than usual.'

Which client statement about advance directives indicates a need for further instruction for a client with advanced Parkinson's disease?

B) 'I don't really need to sign anything. I'm depending on my physician to tell my family what to do if something bad happens.'

When developing a long term care plan for the client with multiple sclerosis, the nurse should teach the client to prevent:

B) contractures.

What is an expected outcome for a client with Parkinson's disease who has had a pallidotomy?

B) improved functional ability

A client with multiple sclerosis lives with her daughter and granddaughter. What measure would be most beneficial for the client's condition?

B) regular exercise

What is the common early sign of Multiple Sclerosis?

Blurred Vision

Typical signs and symptoms of MS

Blurred vision, intention tremor, urinary hesitancy

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?

C) Ineffective airway clearance

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to:

C) rest in an air-conditioned room.

Which symptom is not present in cholinergic crisis when distinguishing it from myasthenic crisis?

D) Improved muscle strength after I.V. administration of edrophonium chloride.

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?

D) Respiratory acidosis

The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson's disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. The nurse should:

D) explain how to overcome a freezing gait by telling the client to march in place.

The primary nursing goal for a client with myasthenia gravis is to:

D) maintain respiratory function.

A client with Parkinson's disease is prescribed levodopa therapy. Improvement in which area indicates effective therapy?

D) muscle rigidity

Which goal is the most realistic for a client diagnosed with Parkinson's disease?

D) to maintain optimal body function

What is the expected outcome of plasmapheresis in Guillain-Barré Syndrome treatment?

Decrease in Antibodies Attacking Peripheral Nerve Myelin

Primary manifestations in a patient with MS

Difficulties with coordination, spasticity of extremities, loss of coordination

A patient with trigeminal neuralgia is taking Tegretol (carbamazepine) to alleviate pain associated with this disorder. It is important to teach the patient that which of the following side effects may occur from taking this medication?

Drowsiness

What is the characteristic symptom of Bell's Palsy?

Facial Paralysis

Clinical manifestations of Bell's palsy

Facial paralysis

Appropriate care schedule for myasthenia gravis patient

In the morning, with frequent rest periods

Which of the following nursing interventions would be included in the care plan for a patient admitted with MS?

Instruct the patient on daily muscle stretching.

What basic information will the nurse caring for a patient recently diagnosed with multiple sclerosis (MS) provide to him?

It is a degenerative disease of the nervous system.

Cause of myasthenia gravis

Lower motor neuron lesion at myoneural junction

A patient with Guillain-Barre' has had arterial blood gases (ABGs) drawn. Which of the following ABG values indicates that the patient's status is deteriorating?

PaCO2 60

When examining a patient with Guillain-Barre' syndrome, the nurse would expect to assess which of the following clinical manifestations?

Paresthesias of the hands and feet

The nurse would expect to document which of the following in a patient with myasthenia gravis undergoing a Tensilon test?

Positive Tensilon test

What is the primary finding on MRI for Multiple Sclerosis?

Presence of Multiple Plaques

The nurse assessing a patient with multiple sclerosis understands that due to the pathophysiology of this disease process which of the following is the expected primary finding on the MRI?

Presence of multiple plaques

Fatigue management for MS patient

Rest in an air-conditioned room

The nurse recognizes that corticosteroid therapy, when used in the treatment of Guillain-Barre' syndrome, reduces the inflammation and edema associated with this neuromuscular disorder. It is most important for the nurse to monitor which of the following lab values for the patient on corticosteroid therapy?

Serum glucose

Medication information for carbamazepine (Tegretol)

Taken with meals, gradually increased for pain relief

Symptoms in a patient with multiple sclerosis

Vision changes such as diplopia, nystagmus, blurred vision

Clinical manifestation of Guillain-Barré syndrome

Vocal paralysis, dysphagia

When assessing a patient with myasthenia gravis, the nurse would be correct in questioning the patient regarding which of the following clinical manifestations?

Weakness associated with fatigue

A client has an exacerbation of multiple sclerosis. The physician orders dantrolene, 25 mg P.O. daily. Which assessment finding indicates the medication is effective?

d) Reduced muscle spasticity