patho exam 7

The unique clinical presentation of a 3 month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?

"Have you ever given your child any honey or honey-containing products?"

A 22 year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

What best explains symptoms of ALS including dysphagia, muscle weakness and spasticity, and dysphonia?

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

Reflex activity involves which of the following?

All of the above

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:

An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve

Which one of the following is a manifestation of a serious condition that causes new-onset back pain in persons 50 years of age or older?

Aortic aneurysm

A patient who has experienced a spinal cord injury has an ipsilateral loss of voluntary motor function and a contralateral loss of pain and temperature sensation. Based on these symptoms, which classification of spinal cord injury does the patient have?

Brown Sequard

The signs and symptoms produced by disorders of the motor system are useful in finding the disorder. What signs and symptoms would the nurse assess when looking for a disorder of the motor system? (Select all that apply.)

Bulk

Neurotoxins such as the botulism organism can produce paralysis by what mechanism?

By blocking release of acetylcholine

Loss of diaphragm control would most likely occur with a spinal injury at which level?

C1-2

A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column?

Cannot breathe on own, needs ventilator assistance

A client is experiencing pain, tingling, and numbness of the thumb and first, second, third, and half of the fourth digits of the hand. She states that she has pain in the wrist and hand, which worsens at night, and she has noticed that they have become clumsy. The nurse recognizes these manifestations as:

Carpal tunnel syndrome

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

Carpal tunnel syndrome

The nurse assesses the client with Huntington's disease demonstrating irregular wriggling and writhing movements. The client is also having facial grimacing, raising the eyebrows, and rolling the eyes. How would the nurse document this finding?

Chorea

Bowel dysfunction is one of the most difficult problems to deal with after a spinal cord injury. After a spinal cord injury, most people experience constipation. Why does this occur?

Defecation reflex is lost

Regarding the pathophysiology of Parkinson disease, which of the following statements is true?

Degeneration of the nigrostriatal dopamine neurons occurs.

Select the statement that best describes the pathophysiology of Parkinson disease.

Degeneration of the nigrostriatal dopamine system occurs.

Peripheral neuropathy occurs most commonly with which one of the following disorders?

Diabetes

The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions?

Disuse atrophy

Loss of coordinated movement and balance is likely due to damage to which of the following?

Extrapyramidal structures

Loss of coordinated movement, muscle rigidity, and immobility without paralysis is likely due to damage to which of the following?

Extrapyramidal tracks

The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement?

Frontal cortex

In which of the following does the highest level of motor function occur?

Frontal cortex of the brain

During a late night study session, a pathophysiology student reaches out to turn the page the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action?

Frontal lobe

Which of the following organs found in muscle tendons transmits information about muscle tension or force of contraction at the junction of the muscle and the tendon that attaches to the bone?

Golgi tendon

When initially assessing a client with verbalization of back pain, the nurse would be most concerned for rapid assessment for which client?

Gradual onset of back pain with history of intravenous drug use

A 60 year-old male office worker presents to a clinic complaining of new-onset of lower back pain that has been worsening over the last six weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)?

His onset of pain has been gradual and he has no prior history of lower back problems.

A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which of the following?

Home-grown and canned vegetables

The geriatrician providing care for a 74 year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem?

Increasing the functional ability of the underactive dopaminergic system.

The nurse should anticipate they will need to teach the newly diagnosed multiple sclerosis patient how to give injections if they are prescribed which medication to modify the course of the disease by reducing exacerbations?

Interferon-beta.

Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS?

Interferon-β, a cytokine injection

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron that causes muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

Interneuron

Which of the following neurons connect sensory and motor neurons?

Interneurons

A client has developed spinal shock. The most important assessment for the nurse to perform would be:

Loss of tendon reflexes

A client has been diagnosed with Guillain-Barre 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

A client sustained a spinal cord injury and is immediately brought to the emergency department. The client asks the physician if there is any medication he can get to possibly help him, regardless of risks. The physician assesses the client and determines the most important medication to administer would be:

Methylprednisone

What role do the basal ganglia play in cognition?

Monitor sensory information coming into the brain and apply it to information stored in the memory

Muscular dystrophy is characterized by what pathophysiologic changes?

Muscular necrosis, with replacement with fat and connective tissue

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

Myelinated neurons found in the central nervous system are covered by which of the following cells?

Oligodendrocytes

A client who has experienced a spinal cord injury still has use of the arms and has impaired motor and sensory function of the trunk, legs, and pelvic organs. The injury would be classified as:

Paraplegia

After being thrown off the back of a bull, the bull rider can move their arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as being a:

Paraplegia.

Guillain-Barré syndrome is characterized by which of the following forms of neuron damage?

Polyneuropathy

Multiple sclerosis is characterized by what type of neuron damage?

Polyneuropathy

Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia?

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

The nurse is performing an assessment for a client suspected of having symptoms that correlate with carpal tunnel disorder. The client states he feels a tingling sensation that radiates into the palm of the hand when the nurse lightly percusses over the median nerve. How would the nurse document this finding?

Positive Tinel sign

A client has sustained an acute spinal cord injury in a fall from a tree stand during a hunting trip. The client will require surgical intervention for the unstable spinal cord. What does the nurse recognize is the goal of early surgical intervention for this client?

Provide internal skeletal stabilization.

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 of the following medical terms?

Pseudohypertrophy

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this?

Psychological manifestation due to involvement of white matter of cerebral cortex

Amyotrophic lateral sclerosis is considered a disease of the upper motor neurons. What is the most common clinical presentation of amyotrophic lateral sclerosis?

Rapidly progressive weakness and atrophy in distal muscles of both upper extremities

Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?

Reading

The transmission of impulses at the neuromuscular junction is mediated by which of the following actions?

Release of neurotransmitter acetylcholine from autonomic nerve endings

The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be:

Straight-leg test

A nurse caring for a spinal cord-injured patient knows that control of sweat gland activity and temperature regulation is managed by the direct action of which the following body systems?

Sympathetic nervous system

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction

A nurse is providing education to a client newly diagnosed with Guillain-Barre' syndrome. Which statement reflects accurate information about the course of the disease?

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 vestibular system

A 70 year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult?

Unsteady gait and difficulty speaking and swallowing

Which of the following project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS?

Upper motor neurons

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:

Ventilatory assessment and support

In myasthenia gravis, periods of stress can produce myasthenic crisis. When does myasthenic crisis occur?

When muscle weakness becomes severe enough to compromise ventilation

A nurse caring for a patient in myasthenic crisis identifies a priority concern as:

maintenance of airway and respiration.

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

• Tremor • Bradykinesia • Rigidity

The nurse is providing education to a patient recently diagnosed with multiple sclerosis. The nurse instructs the patient regarding which symptoms commonly occurring with multiple sclerosis? Select all that apply.

• Visual loss or blurring • Difficulty swallowing • Paresthesias of extremities

The health care provider is assessing a client for carpal tunnel syndrome. The health care provider performs light percussion over the median nerve at the wrist. This assessment is known as:

Tinel sign

When assessing the motor system, on which of the following will the nurse focus? Select all that apply.

• Body position • Presence of involuntary muscle movement • Muscle strength • Coordination

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult:

who had their forearm partially crushed by gears during an industrial accident.

A client presents to a health clinic complaining of several vague symptoms. As the history/physical continues, the health care provider clearly thinks the client may have myasthenia gravis. Which statements by the client would correlate with this diagnosis? Select all that apply.

• "Sometimes I have double vision." • "I have more energy in the morning but get worse as the day goes by." • "I feel like I don't have enough energy to chew my food sometimes.

Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)?

A 25 year old woman

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in their hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions?

I'm going to tap (percuss) over the median nerve in your wrist, tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?

The nurse is assessing a client diagnosed with myasthenia gravis (MG). The nurse would expect the assessment to include:

Inability to move eyes in multiple positions

The nurse expects that loss of respiratory effort occurs with a spinal injury at which of the following levels?

C1-3

The nurse is caring for a spinal cord injury client. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column?

C5

At what level of the cervical spine would a complete cord injury prevent flexion and extension of the fingers?

C8

An individual will experience problems with rapid muscular activities such as running as a result of damage to which of the following structures?

Cerebellum

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?

Elevate the head of the bed.

The basal ganglia play a role in coordinated movements. Part of the basal ganglia system is the striatum, which involves local cholinergic interneurons. What disease is thought to be related to the destruction of the cholinergic interneurons?

Myasthenia gravis

Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability?

Myasthenia gravis

Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration?

Nerve fibers destroyed close to the neuronal cell body

The brain stem contains gray matter that is made up of which of the following?

Neurons

Cerebellar tremor is exhibited by which symptom?

Rhythmic movement of the finger or toe that worsens as a target is approached

While teaching a class of nursing students about spinal cord injury, the instructor mentions that male SCI clients will be able to have a sexual response if their injury is at which level on the spinal column?

S4

The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing mysasthenia crisis?

The client has a sudden onset of severe weakness.

The nurse asks the client to hold her left wrist in complete flexion for approximately 1 minute. The client states she feels tingling and numbness when she does this, pointing to the medial nerve. What does the nurse anticipate the client will be prepared for after this assessment?

The client will be prepared for further diagnostic tests such as an electromyogram (EMG).

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

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barre? syndrome in their medical history. The patient asks, "What is that?" How should the nursing student reply?

"A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles."

The parents of a 3 year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents?

"Your son will be prone to heart problems and decreased lung function because of this."

The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring?

Hyperoxygenate prior to suctioning.

A 47 year-old woman was diagnosed with amyotrophic lateral sclerosis three years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?

Assessment of swallowing ability and respiratory status.

Death caused by muscular dystrophy in early adulthood is usually due to which of the following?

Respiratory and cardiac muscle involvement

A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady, her speech is slurred, and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state?

Cerebellar damage caused by a cerebrovascular accident

Which of the following medications is used to treat acute attacks of multiple sclerosis (MS)?

Corticosteroids

Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).

Creatine kinase

Which of the following would be a symptom that is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)?

Respiratory muscle impairment

A client affected by postural hypotension will likely display what symptoms?

Dizziness and pallor when moved to upright position

The underlying causative problem in Parkinsonism is which of the following?

Failure of dopamine release

Bradykinesia occurring in Parkinson's disease places the Parkinson's client most at risk for which of the following?

Falls and injury

The nurse notes that the client is experiencing visible squirming and twitching movements that can be seen as flickers under the skin. The nurse would recognize this as:

Fasciculations

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:

Normal manifestations of Parkinson disease

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?

Parkinson disease

Which of the following diseases can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?

Parkinson's disease

The nurse is providing client education to a client newly diagnosed with Parkinson's disease. The nurse most accurately describes the disease progression:

Parkinson's is a chronic condition and treatment aims to manage symptoms.

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. Which is the most accurate description? This drug:

Produces paralysis of the larynx muscles by blocking acetylcholine release

A patient is asked to stand with feet together, eyes open and hands by the sides. Then the patient is asked to close their eyes while the nurse observes for a full minute. What assessment is the nurse performing?

Proprioception.

A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to:

Scan his bladder to make sure it is empty

Which of the following complications of spinal cord injury is the most preventable in a paraplegic patient?

Skin breakdown

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 of the following abnormalities in the client's gait?

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

A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion?

The client displays increased muscle tone.

Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply.

• Rapid deterioration of respiratory status • Flaccid paralysis of limbs • BP 90/62

A comprehensive assessment of motor function must include which of the following? Select all that apply.

• Spinal reflexes • Body position • Coordination • Muscle characteristics

A 41 year-old woman was diagnosed with multiple sclerosis (MS) seven years ago and is sharing her story with members of an MS support group, many of which have been diagnosed recently. Which of the following aspects of her health problem should the woman warn others to expect at some point in the progression of the disease? Select all that apply.

• Debilitating fatigue • Progressive loss of visual acuity • Loss of mental acuity

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.

• Depression • Inattentiveness • Forgetfulness

A client works as a data entry worker for a large company. The client goes to employee health with pain in the wrist/hand. The nurse suspects that it is carpal tunnel syndrome based on which of the following assessment findings? Select all that apply.

• Describes numbness/tingling in the thumb and first digit • Precision grip weakness in the affected hand • Pain interferes with sleeping

Herniated disks occur when the nucleus pulposus is compressed enough that it protrudes through the annulus fibrosus, putting pressure on the nerve root. This type of injury occurs most often in the cervical and lumbar region of the spine. What is an important assessment technique for a herniated disk in the lumbar region?

• Hip flexion test • CT scan • Straight-leg test

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Select all that apply.)

• Hypertension • Skin pallor • Piloerector response

An individual experiencing spinal cord damage (SCD) is at high risk for developing deep vein thrombosis (DVT) and pulmonary emboli (PE) caused by which of the following?

• Impaired mobility • Impaired vasomotor tone • Hypercoagulation of blood • Stasis of blood flow

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.

• Inattentiveness • Forgetfulness • Depression

Myasthenic crisis may be precipitated by which of the following? Select all that apply.

• Infection • Pregnancy • Surgery