Week 2 - Neuro
Which statements are true regarding the pathophysiology of Parkinson disease? Select all that apply. 1 At autopsy, the fibrils visible as Lewy bodies are caused by accumulation of alpha-synuclein accumulation. 2 There is a deficiency of acetylcholine and an overabundance of dopamine in the brains of people with Parkinson disease. 3 The neurons that release gamma-aminobutyric acid (GABA) are suppressed in people with Parkinson disease. 4 The underlying cause of motor symptoms is loss of dopaminergic neurons in the substantia nigra. 5 Parkinson disease typically becomes clinically recognizable when about 25% of the neurons in the substantia nigra have been lost.
1 At autopsy, the fibrils visible as Lewy bodies are caused by accumulation of alpha-synuclein accumulation. 4 The underlying cause of motor symptoms is loss of dopaminergic neurons in the substantia nigra. The underlying cause of the motor symptoms, such as tremor and postural instability, associated with Parkinson disease is the loss of dopaminergic neurons in the substantia nigra. The fibrils that are known as Lewy bodies result from the accumulation of alpha-synuclein, a potentially toxic protein synthesized by dopaminergic neurons. In people with Parkinson disease, the neurons that release GABA are overstimulated because the excitatory influence of acetylcholine, which stimulates the neurons that release GABA and goes unopposed by dopamine; this is what causes the motor symptoms associated with Parkinson disease. There is an overabundance of acetylcholine and a deficiency of dopamine in the striatum of individuals with Parkinson disease. Parkinson disease does not become clinically recognizable until 70-80% of the neurons in the substantia nigra have been lost.
What is the goal of pharmacologic therapy in the treatment of Parkinson's disease (PD)? 1 Balance cholinergic and dopaminergic activity in the brain 2 Increase the amount of acetylcholine at the presynaptic neurons 3 Reduce the amount of dopamine available in the substantia nigra 4 Block dopamine receptors in presynaptic and postsynaptic neurons
1 Balance cholinergic and dopaminergic activity in the brain PD results from a decrease in dopaminergic (inhibitory) activity leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.
A patient with tonic-clonic seizures is on phenytoin and is advised by the nurse to take folic acid supplements. What is the most likely reason for this advice? 1 It can help prevent gum overgrowth. 2 The patient is hoping to become pregnant soon. 3 It can combat the nystagmus and diplopia that may occur. 4 The patient can't eat green leafy vegetables while taking phenytoin.
1 It can help prevent gum overgrowth. Of patients who take phenytoin, 20% develop gingival hyperplasia and evidence suggests that supplemental folic acid (0.5 mg/day) may prevent gum overgrowth. Phenytoin is a teratogen and can cause cleft palate, heart malformations, and fetal hydantoin syndrome, so it is rarely used during pregnancy. There is no evidence that folic acid combats the nystagmus and diplopia that might occur with phenytoin use. There is no recommendation to avoid green leafy vegetables while taking phenytoin.
The nurse is caring for a patient hospitalized with an acute episode (relapse) of multiple sclerosis (MS). The nurse anticipates administering which medication first? 1 Methylprednisolone IV injection 2 Natalizumab intravenous (IV) infusion 3 Interferon beta-1a intramuscular injection 4 Glatiramer acetate subcutaneous injection
1 Methylprednisolone IV injection During an acute relapse episode of MS, the treatment of choice is a high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. Interferon beta-1a, natalizumab, and glatiramer acetate are disease-modifying drugs that are used in the long-term management of MS.
The nurse is reviewing the care of patients with Alzheimer's disease (AD). Which factors are associated with the pathophysiology of this disease? Select all that apply. 1 Neurofibrillary tangles and tau 2 Beta-amyloid and neuritic plaques 3 Autoimmune changes in the myelin sheath 4 Dilation and inflammation of cranial blood vessels 5 Neuronal degeneration and decreased acetylcholine 6 Firing of hyperexcitable neurons throughout the brain
1 Neurofibrillary tangles and tau 2 Beta-amyloid and neuritic plaques 5 Neuronal degeneration and decreased acetylcholine AD is characterized by neuronal degeneration, reduced cholinergic transmission, beta-amyloid and neuritic plaques, and neurofibrillary tangles and tau. Dilation and inflammation of cranial blood vessels are associated with migraine. Multiple sclerosis is characterized by autoimmune changes in the myelin sheath, and epilepsy is associated with hyperexcitability of neurons and the firing of those neurons throughout the brain.
Which assessment is essential before a patient receives a second dose of mitoxantrone? Select all that apply. 1 Pregnancy test 2 Echocardiogram 3 Complete blood count 4 Ophthalmic examination 5 Magnetic resonance imaging (MRI) 6 T 3, T 4, and thyroid-stimulating hormone (TSH) levels
1 Pregnancy test 2 Echocardiogram 3 Complete blood count Mitoxantrone can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.
Which symptoms are associated with Parkinson's disease (PD)? Select all that apply. 1 Rigidity 2 Tremors 3 Seizures 4 Tachycardia 5 Bradykinesia
1 Rigidity 2 Tremors 5 Bradykinesia Bradykinesia, or slowing down of movements, is a prominent symptom of PD. Tremors occur because of involuntary contractions of the muscles. Rigidity occurs as a result of resistance to passive movement. Tachycardia and seizures are not symptoms of PD. Tachycardia may not be caused by the degeneration of the substantia nigra because this brain area does not regulate heart function. Seizures are not associated with depleting concentrations of dopamine.
What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? 1 "Do not take the medication if you have a fever. " 2 "Wait to see how you react to the medication before driving. " 3 "Lie in bed for at least an hour after taking any antiepileptic agent. " 4 "Take the antiepileptic agent with milk or juice to prevent stomach upset. "
2 "Wait to see how you react to the medication before driving. " Antiepileptic medications suppress the central nervous system, causing sedation. The patient should know how he or she responds to the medication before attempting tasks such as driving. The patient does not have to lie in bed for an hour after taking an antiepileptic. Several medications cannot be taken with milk or fruit juice as they may alter absorption of the medication, and the nurse should not instruct the patient to administer medication in this manner. A fever is not a contraindication to taking an antiepileptic agent.
The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. What statement should be included in the plan of care? 1 "You will only need to be on therapy for a few months." 2 "Your medication is chosen based on your type of seizure." 3 "You will be started on several drugs to control your seizures." 4 "Medication therapy is not essential to treat seizure disorders."
2 "Your medication is chosen based on your type of seizure." Medication therapy for seizures is matched to the type of seizure the patient exhibits. Single-drug therapy must fail before multiple-drug therapy is tried. Therapy, in most cases, is lifelong and essential for treating epilepsy.
The healthcare provider orders amantadine 100 mg by mouth (PO) daily. Amantadine 10 mg/mL syrup is available. How many milliliters will the nurse administer? 1 1 mL 2 10 mL 3 100 mL 4 0.1 mL
2 10 mL The available concentration of amantadine is 10 mg/mL. The ordered dose of 100 mg would equal 10 mL of syrup; 100 mg/10 = 10 mL.
Which inhibitory neurotransmitter is involved in Parkinson's disease (PD)? 1 Oxytocin 2 Dopamine 3 Adrenaline 4 Acetylcholine
2 Dopamine Dopamine is the inhibitory neurotransmitter involved in PD. The disease is characterized by low concentrations of dopamine. Acetylcholine is an excitatory neurotransmitter that counteracts the effects of dopamine. The adrenergic glands on the kidney release adrenaline. Oxytocin is released by the pituitary gland; it is a not a neurotransmitter.
The nurse is caring for a patient with Parkinson's disease who has been prescribed selegiline. The nurse instructs the patient to avoid wine and cheese. Which food-drug interaction is the nurse trying to prevent? 1 Hypertrophy 2 Hypertension 3 Hyperglycemia 4 Hyperthyroidism
2 Hypertension Selegiline is a selective monoamine oxidase inhibitor that, when taken with foods such as cheese or beer, can cause the "cheese effect." This effect is characterized by high blood pressure. Therefore, the patient taking selegiline should avoid eating cheese. Selegiline medication does not cause any type of organ enlargement or hypertrophy because it does not affect cell regulation and division. Hyperthyroidism is not seen in the cheese effect caused by selegiline because it does not alter thyroid hormone levels. Blood glucose is not affected by eating yogurt along with selegiline because it does not affect glucose regulation. Therefore, the food-drug interaction may not cause hyperglycemia.
A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? 1 An imbalance of dopamine and acetylcholine in the CNS 2 Inflammation and myelin destruction in the central nervous system (CNS) 3 A high-frequency discharge of neurons from a specific focus area of the brain 4 An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone
2 Inflammation and myelin destruction in the central nervous system (CNS) The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the CNS. The demyelination leads to the characteristic neurologic symptoms associated with MS.
Which enzyme is inhibited by the antiparkinson drug selegiline? 1 Cholinesterase 2 Monoamine oxidase 3 Superoxide dismutase (SOD) 4 Catechol O-methyltransferase (COMT)
2 Monoamine oxidase Selegiline is the selective inhibitor of the monoamine oxidase enzyme. Selegiline does not show any action on the COMT enzyme. Selegiline does not bind to cholinesterase, the enzyme useful in breaking down cholinergic neurotransmitters. SOD is an enzyme that has antioxidant activity and is useful in the prevention of Alzheimer's disease. Selegiline does not alter levels of the SOD enzyme.
The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures? 1 Vomiting 2 Sedation 3 Lethargy 4 Dry mouth
2 Sedation Side effects of phenobarbital include sedation during the initial phase of therapy; however, with continued treatment, sedation declines while full protection from seizures is retained. This is thought to be related to adaptive change within the brain during prolonged phenobarbital drug exposure. Vomiting, lethargy, and dry mouth are not expected side effects of phenobarbital.
Which neurotransmitter level is decreased by as much as 90% in patients with severe Alzheimer's disease (AD)? 1 Serotonin 2 Dopamine 3 Acetylcholine 4 Norepinephrine
3 Acetylcholine Acetylcholine levels naturally decline by a small percentage with age. Patients with severe AD may have acetylcholine levels that are as much as 90% below normal. This is likely part of the explanation for the pathophysiology of AD. Alterations in serotonin, dopamine, and norepinephrine levels do not explain the pathophysiology of AD.
Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? 1 Phenytoin 200 mg IV over 4 minutes 2 Phenobarbital 30 mg intramuscularly (IM) 3 Lorazepam 4 mg intravenously (IV) over 2 minutes 4 Valproic acid 250 mg in 100 mL of normal saline infused IV over 60 minutes
3 Lorazepam 4 mg intravenously (IV) over 2 minutes Intravenous benzodiazepines, such as lorazepam or diazepam, are used to abruptly terminate convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. After seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines. Phenobarbital may be used to treat continuous seizures, but the IM route would delay the effects.
Natalizumab is a very effective agent for treating multiple sclerosis. Which problem is associated with the administration of this drug that makes it a second-line agent? 1 Increased risk for sudden cardiac death 2 Documented reports of necrotizing colitis 3 Rare cases of dangerous brain infections 4 Increased risk of Stevens-Johnson syndrome
3 Rare cases of dangerous brain infections Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug now is available only through a specialized, carefully controlled prescribing program.
A 25-year-old female patient has begun taking phenobarbital therapy for seizure control. What information is essential for the nurse to include in discharge teaching? 1 "Skip the medication dosage if headaches occur." 2 "Make certain to keep the medication out of light." 3 "Do not take the medication when not having seizures." 4 "Discuss forms of birth control with the healthcare provider."
4 "Discuss forms of birth control with the healthcare provider." The nurse should instruct the patient that this medication poses a significant risk of a major fetal malformation; effective birth control is essential to prevent pregnancy while taking phenobarbital. The medication is taken daily to prevent seizures; it is not stopped if the patient has headaches and does not need to be kept out of the light.
The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? 1 "Epilepsy medication does not reduce seizures in most patients." 2 "These drugs will help control your seizures until you have surgery." 3 "With proper treatment, we can completely eliminate your seizures." 4 "Our goal is to reduce your seizures to an extent that helps you live a normal life."
4 "Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in most patients and can help the patient live a normal life. The dosages needed to completely eliminate seizures, however, may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.
A patient newly diagnosed with multiple sclerosis (MS) asks the nurse how a person gets this disease. Which response by the nurse is mostaccurate and appropriate? 1 "MS is a congenital condition that typically manifests itself in late adulthood." 2 "MS is a disease believed to be caused by exposure to drugs during a mother's pregnancy." 3 "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system." 4 "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger."
4 "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger." Although the exact cause is unknown, MS is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS also may be associated with the Epstein-Barr virus, human herpes virus 6, and Chlamydia pneumoniae infection.
Why is levodopa the mainstay of treatment for a patient with Parkinson's disease? 1 It enhances dopamine release. 2 It impairs dopamine breakdown. 3 It promotes dopamine synthesis. 4 It provides a dopamine precursor.
4 It provides a dopamine precursor. Levodopa is a biologic precursor of dopamine that must be combined with carbidopa so the brain can use it to synthesize dopamine; it is the only agent that acts in this manner. Other dopaminergic agents increase the brain's dopamine by stimulating its release, directly and indirectly; inhibiting enzymes that degrade it; and stimulating its synthesis.
What is the main anatomic area of the brain that is affected in a patient with Parkinson's disease (PD)? 1 Thalamus 2 Cerebellum 3 Globus pallidus 4 Substantia nigra
4 Substantia nigra The substantia nigra is a part of the extrapyramidal system, which is involved in motor function, including posture, muscle tone, and smooth muscle activity. Dopamine depletion in this area causes PD. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The thalamus is the relay station for brain impulses. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with PD.
