Neuro Part 3

Looking at the nursing interventions listed by Nurse James in response to the identified nursing diagnosis, which of these would least likely be included in improving the mobility of Mr. Parker? * Supervised walking Environmental modifications Range of motion exercise Riding a bicycle stationary

Supervised walking

A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. The nurse recognizes that these impairments commonly contribute to the nursing diagnosis of: * A. impaired oral mucous membranes related to inability to swallow. B. impaired verbal communication related to difficulty articulating. C. disuse syndrome related to loss of muscle control. D. self-care deficit related to bradykinesia and rigidity.

B.

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?* A. Mid-afternoon B. Morning C. Evening D. Before bedtime

B. Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

Which of the following drugs is used for trigeminal neuralgia? * A. Riluzole (Rilutek) B. Levodopa (Larodopa) C. Carbamazepine (Tegretol) D. Ceftriaxone sodium (Rocephin)

C. Antiseizure agents, such as carbamazepine (Tegretol), relieve pain in most patients with trigeminal neuralgia by reducing the transmission of impulses at certain nerve terminals. Options A and D are for Amyotrophic Lateral Sclerosis (ALS). Option B is for Parkinson's disease

The health-care provider scheduled a lumbar puncture for a client admitted with rule-out Guillain-Barré syndrome. Which pre procedure intervention has priority? 1. Keep the client NPO. 2. Instruct the client to void. 3. Place in the lithotomy position. 4. Assess the client's pedal pulse.

2. The client should void prior to this procedure to help prevent accidental puncture of the bladder during the procedure.1. The client does not need to be NPO prior to this procedure.3. The lithotomy position has the client lying flat with the legs in stirrups, such as when Pap smears are obtained.4. The pedal pulses should be assessed postprocedure, not prior to the procedure.

Which of the following clinical manifestations suggest ALS? * A. Fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination B. Tremor, rigidity, bradykinesia (abnormally slow movements), and postural instability C. Paralysis of the facial muscles, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye D. Involuntary contraction of the facial muscles causing sudden closing of the eye or twitching of the mouth

A. Chief symptoms of ALS are fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and incoordination. Option B describes Parkinson's disease. Option C is Bell's Palsy. Option D describes Trigeminal neuralgia.

Neuropathic pain that radiates from the neck down to the spine and to the extremities is known as: * +) Uhtoff' Sign (+) Macewen's Sign (+) Lhermitte's Sign (+) Charcot's Sign

(+) Lhermitte's Sign

The nurse would expect a client with tic douloureux to exhibit: * A. Excruciating facial and head pain. B. Unilateral muscle weakness. C. Multiple petechiae. D. Uncontrollable tremors of the eyelid.

A.

Which of the following drugs would be ordered for persons with Parkinsonian disease? * Carisoprodol (Rela) CarbenicillinIndanyl sodium (Geocillin) Carbidopa/Levodopa (Sinemet) Carboplatin (Paraplatin)

Carbidopa/Levodopa (Sinemet)

Parkinsonian disease (PD) is referred to as an extrapyramidal syndrome because it manifests which of the following clinical symptoms? * Somnolence and poor gait Constipation and hypotension Diarrhea and sweating Tremor and bradykinesia

Tremor and bradykinesia

The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply. * A. Head tilt B. Vomiting C. Polydipsia D. Lethargy E. Increased appetite F. Increased pulse

A, B AND D. Head tilt, vomiting, and lethargy are classic signs assessed in a child with a brain tumor. Clinical manifestations are the result of location and size of the tumor.

A client with a neurological impairment experiences urinary incontinence. Which nursing action would be most helpful in assisting the client to adapt to this alteration? 1.Using adult diapers 2.Inserting a Foley catheter 3.Establishing a toileting schedule 4.Padding the bed with an absorbent cotton pad

3 A bladder retraining program, such as use of a toileting schedule, may be helpful to clients experiencing urinary incontinence. A Foley catheter should be used only when necessary because of the associated risk of infection. Use of diapers or pads is the least acceptable alternative because of the risk of skin breakdown.

The home care nurse is performing an assessment on a client with a diagnosis of Bell's palsy. Which assessment question will elicit specific information regarding this client's disorder? 1."Do your eyes feel dry?" 2."Do you have any spasms in your throat?" 3."Are you having any difficulty chewing food?" 4."Do you have any tingling sensations around your mouth?

3 Bell's palsy is a one-sided facial paralysis caused by compression of the facial nerve. Manifestations include facial droop from paralysis of the facial muscles; increased lacrimation; painful sensations in the eye, face, or behind the ear; and speech or chewing difficulties.

Select all the signs and symptoms below that can present in myasthenia gravis:* A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing

A, C, D, E, F, G, H

A male client with a spinal cord injury is prone to experiencing automatic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence? a. Strict adherence to a bowel retraining program b. Keeping the linen wrinkle-free under the client c. Preventing unnecessary pressure on the lower limbs d. Limiting bladder catheterization to once every 12 hours

Answer D. The most frequent cause of autonomic dysreflexia is a distended bladder. Straight catheterization should be done every 4 to 6 hours, and foley catheters should be checked frequently to prevent kinks in the tubing. Constipation and fecal impaction are other causes, so maintaining bowel regularity is important. Other causes include stimulation of the skin from tactile, thermal, or painful stimuli. The nurse administers care to minimize risk in these areas.

Ingrid, a female executive diagnosed of Diabetes Mellitus, frequently consumes "Coke Zero" with meals to satisfy her cravings for soda. This may place her at risk for developing Multiple Sclerosis because of her consumption of which component of diet soda? * Monosodium Glutamate Benzoate/Nitrate Sodium Cyclamate (Magic Sugar) Aspartame

Aspartame

To prevent precipitating a painful attack in a client with tic douloureux, the nurse should: A. Discontinue oral hygiene temporarily B. Avoid walking swiftly passing by the client's way C. Keep the client in prone position D. Massage both sides of the face frequently

B

Select all the TRUE statements about the pathophysiology of multiple sclerosis:* A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

B,C

When planning nursing care for a client with trigeminal neuralgia, the nurse should specifically: A. Apply iced compresses to the affected area B. Be alert to prevent dehydration or starvation C. Initiate exercises of the jaw and facial muscles D. Emphasize the importance of brushing the teeth

B. Patient with TN can be in so much pain with just a slight movement of face that they choose not to move it all including not eating or drinking.

A picture of the human brain is shown to Mr. Parker to identify the affected area involved in his disease. Which of these should be pinpointed by the nurse? * Hippocampus Basal Ganglia Corpus Callosum Frontal Cerebrum

Basal Ganglia

The physician came up with multiple sclerosis as the final diagnosis of Ms. Dionisia. She asked her nurse if there is an available cure for her disease. Gwyneth is right in giving which of these statements as her reply? A. There is currently no drugs that can cure MS but it can be reversed with surgery. B. Yes, there is a known cure for your disease but it is quite expensive. C. None, only treatment for the prevention of new attacks is available. D. Yes, but it is not yet available in the country.

C. None, only treatment for the prevention of new attacks is available.

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.* True False

False

Based on the nursing care plan prepared by Nurse James, impaired physical mobility has been identified as the nursing diagnosis. Which of these assessment data served as the bases of the nurse in formulating the diagnosis? * Depression and dysfunction Inability to move facial muscles Muscle rigidity Disease progression

Muscle rigidity

When evaluating the extent of Parkinson's disease, a nurse observes for which of the following conditions? * Diminished distal sensation Muscle rigidity Increased dopamine levels Bulging eyeballs

Muscle rigidity

A client has been started on benztropine (Cogentin) for relief of parkinsonian symptoms. Which of the following statements made by the client best indicates the drug is producing a therapeutic effect? I feel so calm and relaxed." "My hands aren't as shaky as they used to be." "I can tie my shoes now without difficulty." "That annoying lip smacking is much less frequent."

"My hands aren't as shaky as they used to be."

The nurse is performing an assessment on a client with a diagnosis of Bell's palsy. The nurse should expect to observe which finding in the client? 1.Facial drooping 2.Periorbital edema 3.Ptosis of the eyelid 4.Twitching on the affected side of the face

1 Bell's palsy is a one-sided facial paralysis caused by the compression of the facial nerve (cranial nerve VII). Assessment findings include facial droop from paralysis of the facial muscles; increased lacrimation; painful sensations in the eye, face, or behind the ear; and speech or chewing difficulty. The remaining options are not associated findings in Bell's palsy.

A client with myasthenia gravis arrives at the hospital emergency department in suspected crisis. The health care provider plans to administer edrophonium to differentiate between myasthenic and cholinergic crises. The nurse ensures that which medication is available in the event that the client is in cholinergic crisis? 1.Atropine sulfate 2.Morphine sulfate 3.Protamine sulfate 4.Pyridostigmine bromide

1 Clients with cholinergic crisis have experienced overdosage of medication. Edrophonium will exacerbate symptoms in cholinergic crisis to the point at which the client may need intubation and mechanical ventilation. Intravenous atropine sulfate is used to reverse the effects of these anticholinesterase medications. Morphine sulfate and pyridostigmine bromide would worsen the symptoms of cholinergic crisis. Protamine sulfate is the antidote for heparin.

The client diagnosed with Guillain-Barré syndrome asks the nurse, "Will I ever get back to normal?I am so tired of being sick." Which statement is the best response by the nurse? 1. "You should make a full recovery within a few months to a year." 2. "Most clients with this syndrome have some type of residual disability." 3. "This is something you should discuss with the health-care team." 4. "The rehabilitation is short and you should be fully recovered within a month."

1 Clients with this syndrome usuallyhave a full recovery, but it may take upto one (1) year.2. Only about 10% of clients are left with permanent residual disability.3. This is "passing the buck." The nurse should answer the client's question honestly, which helps establish a trusting nurse-client relationship.4. This indicates the nurse does not under-stand the typical course for a client diagnosed with Guillain-Barré syndrome.

Which assessment intervention should the nurse implement specifically for the diagnosis of Guillain-Barré syndrome? 1. Assess deep tendon reflexes. 2. Complete a Glasgow Coma Scale. 3. Check for Babinski's reflex. 4. Take the client's vital signs.

1 Hyporeflexia of the lower extremities is the classic clinical manifestation of this syndrome. Therefore, assessing deep tendon reflexes is appropriate.2. A Glasgow Coma Scale is used for clients with potential neurological deficits and used to monitor for increased intracranial pressure.3. Babinski's reflex evaluates central nervous system neurological status, which is not affected with this syndrome.4. Vital signs are a part of any admission assessment but are not a specific assessment intervention for this syndrome

A client with multiple sclerosis tells a home health care nurse that she is having increasing difficulty in transferring from the bed to a chair. What is the initial nursing action? 1.Observe the client demonstrating the transfer technique. 2.Start a restorative nursing program before an injury occurs. 3.Seize the opportunity to discuss potential nursing home placement .4.Determine the number of falls that the client has had in recent weeks.

1 Observation of the client's transfer technique is the initial intervention. Starting a restorative program is important but not unless an assessment has been completed first. Discussing nursing home placement would be inappropriate in view of the information provided in the question. Determining the number of falls is another important intervention, but observing the transfer technique should be done first.

The nurse is providing instructions to the client with trigeminal neuralgia regarding measures to take to prevent the episodes of pain. Which should the nurse instruct the client to do? 1.Prevent stressful situations. 2.Avoid activities that may cause fatigue. 3.Avoid contact with people with an infection. 4.Avoid activities that may cause pressure near the face.

1 The pain that accompanies trigeminal neuralgia is triggered by stimulation of the trigeminal nerve. Symptoms can be triggered by pressure such as from washing the face, brushing the teeth, shaving, eating, or drinking. Symptoms also can be triggered by stimulation by a draft or cold air. The remaining options are not associated with triggering episodes of pain.

The client diagnosed with Guillain-Barré syndrome is admitted to the rehabilitation unit after 23 days in the acute care hospital. Which interventions should the nurse implement?Select all that apply. 1. Refer client to the physical therapist. 2. Include the speech therapist in the team. 3. Request a social worker consult. 4. Implement a regimen to address pain control. 5. Refer the client to the Guillain-Barré Syndrome Foundation

1, 3, 4, 5 1.The physical therapist is an important part of the rehabilitation team who addresses the client's muscle deterioration resulting from the disease process and immobility. 3.The social worker could help with financial concerns, job issues, and issues concerning the long rehabilitation time for this syndrome. 4.Pain may or may not be an issue with this syndrome. Each client is different,but a plan needs to be established to address pain if it occurs. 5.This is an excellent resource for the client and the family 2. There is no residual speech deficit fromGuillain-Barré syndrome; therefore, this referral is not appropriate.

The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective? 1.Taking medications as scheduled 2.Eating large, well-balanced meals 3.Doing muscle-strengthening exercises 4.Doing all chores early in the day while less fatigued

1. clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.

The nurse is preparing a plan of care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). On assessment, the nurse notes that the client is severely dysphagic. Which intervention should be included in the care plan for this client? Select all that apply. 1.Provide oral hygiene after each meal. 2.Assess swallowing ability frequently. 3.Allow the client sufficient time to eat. 4.Maintain a suction machine at the bedside. 5.Provide a full liquid diet for ease in swallowing.

1234 A client who is severely dysphagic is at risk for aspiration. Swallowing is assessed frequently. The client should be given a sufficient amount of time to eat. Semisoft foods are easiest to swallow and require less chewing. Oral hygiene is necessary after each meal. Suctioning should be available for clients who experience dysphagia and are at risk for aspiration.

The client diagnosed with Guillain-Barré syndrome is on a ventilator. Which intervention will assist the client to communicate with the nursing staff? 1. Provide an erase slate board for the client to write on. 2. Instruct the client to blink once for "no" and twice for "yes." 3. Refer to a speech therapist to help with communication .4. Leave the call light within easy reach of the client.

2 The client will not be able to use the arms as a result of the paralysis but can blink the eyes as long as the nurse asks simple "yes-or-no" questions.1.The ascending paralysis has reached the client's respiratory muscles; therefore, the client will not be able to use the hands to write.3. A speech therapist will not be able to help the client communicate while the client is on the ventilator.4. The ascending paralysis has reached the respiratory muscles; therefore, the client will not be able to use the hands to push the call light

The nurse caring for the client diagnosed with Guillain-Barré syndrome writes the client problem "impaired physical mobility." Which long-term goal should be written for this problem? 1. The client will have no skin irritation. 2. The client will have no muscle atrophy. 3. The client will perform range-of-motion exercises. 4. The client will turn every two (2) hours while awake.

2 The client with Guillain-Barré syndrome will not be able to move the extremities; therefore, preventingmuscle atrophy is an appropriate long-term goal1. This is an appropriate long-term goal for the client problem "impaired skin integrity."3. The client will not be able to move the extremities. Therefore, the nurse will have to do passive range-of-motion exercises;this is an intervention, not a goal.4. This is a nursing intervention, not a goal,and the client should be turned while sleeping unless the client is on a special immobility bed

A client with myasthenia gravis is having difficulty with airway clearance and difficulty with maintaining an effective breathing pattern. The nurse should keep which most important items available at the client's bedside? 1.Oxygen and metered-dose inhaler 2.Ambu bag and suction equipment 3.Pulse oximeter and cardiac monitor 4.Incentive spirometer and cough pillow

2 The client with myasthenia gravis may experience episodes of respiratory distress if excessively fatigued or with development of myasthenic or cholinergic crisis. For this reason, an Ambu bag, intubation tray, and suction equipment should be available at the bedside.

A client is admitted with an exacerbation of multiple sclerosis. The nurse is assessing the client for possible precipitating risk factors. Which factor, if reported by the client, should the nurse identify as being unrelated to the exacerbation? 1.Annual influenza vaccination 2.Ingestion of increased fruits and vegetables 3.An established routine of walking 2 miles each evening 4.A recent period of extreme outside ambient temperature

2 The onset or exacerbation of multiple sclerosis can be preceded by a number of different factors, including physical stress (e.g., vaccination, excessive exercise), emotional stress, fatigue, infection, physical injury, pregnancy, extremes in environmental temperature, and high humidity. No methods of primary prevention are known. Intake of fruits and vegetables is a healthy and an unrelated item.

Which statement by the client supports the diagnosis of Guillain-Barré syndrome? 1. "I just returned from a short trip to Japan." 2. "I had a really bad cold just a few weeks ago." 3. "I think one of the people I work with had this." 4. "I have been taking some herbs for more than a year."

2 This syndrome is usually preceded by a respiratory or gastrointestinal infection one (1) to four (4) weeks prior to the onset of neurological deficits.1. Visiting a foreign country is not a risk factor for contracting this syndrome.3. This syndrome is not a contagious or a communicable disease.4. Taking herbs is not a risk factor for developing Guillain-Barré syndrome

The nurse is providing discharge education to a client diagnosed with trigeminal neuralgia. Which medication will likely be prescribed upon discharge for this condition?1.Lorazepam 2.Gabapentin 3.Carisoprodol 4.Chlordiazepoxide

2 Trigeminal neuralgia is characterized by spasms of pain that start suddenly and last from seconds to minutes. The pain often is described as either stabbing or similar to an electric shock. It is accompanied by spasms of the facial muscles that cause twitching of parts of the face or mouth, or closure of the eye. It is treated by giving antiseizure medications, such as gabapentin, and sometimes tricyclic antidepressants. These medications work by stabilizing the neuronal membrane and blocking the nerve.

The client diagnosed with Guillain-Barré syndrome is having difficulty breathing and is placed on a ventilator. Which situation warrants immediate intervention by the nurse? 1. The ventilator rate is set at 14 breaths per minute. 2. A manual resuscitation bag is at the client's bedside. 3. The client's pulse oximeter reading is 85%. 4. The ABG results are pH 7.40, PaO288, PaCO235, and HCO324.

3 A pulse oximeter reading of less than 93% warrants immediate intervention;a 90% peripheral oxygen saturation indicates a PaO2 of about 60 (normal,80 to 100). When the client is placed on the ventilator, this should cause the client's oxygen level to improve.1. The rate of ventilation is usually 12 to 15 breaths per minute in adults who are on ventilators, so this rate does not require immediate intervention.2. A manual resuscitation (Ambu) bag must be at the client's bedside in case the ventilator malfunctions; the nurse must bag the client.4. These ABGs are within normal limits and do not warrant immediate intervention.

A client with multiple sclerosis is experiencing muscle weakness, spasticity, and an ataxic gait. On the basis of this information, the nurse should include which client problem in the plan of care?1.Inability to care for self 2.Interruption in skin integrity 3.Interruption in physical mobility 4.Inability to perform daily activities

3 Multiple sclerosis is a chronic, nonprogressive, noncontagious degenerative disease of the central nervous system characterized by demyelination of the neurons. Interruption in physical mobility is most appropriate for the client with multiple sclerosis experiencing muscle weakness, spasticity, and ataxic gait. The remaining options are not related to the data in the question.

The nurse has provided instructions to a client with a diagnosis of myasthenia gravis about home care measures. Which client statement indicates the need for further teaching? 1."I will rest each afternoon after my walk." 2."I should cough and deep breathe many times during the day." 3."I can change the time of my medication on the mornings when I feel strong." 4."If I get abdominal cramps and diarrhea, I should call my health care provider."

3 The client with myasthenia gravis and the family should be taught information about the disease and its treatment. They should be aware of the side and adverse effects of anticholinesterase medications and corticosteroids and should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If it is not given on time, the client may become too weak to even swallow. Resting after a walk, coughing and deep-breathing many times during the day, and calling the health care provider when experiencing abdominal cramps and diarrhea indicate a correct understanding of home care instructions to maintain health with thisneurological degenerative disease.

The nurse is caring for a client with Parkinson's disease. Which finding about gait should the nurse expect to note in the client? 1.Walking on the toes 2.Unsteady and staggering 3.Shuffling and propulsive 4.Broad-based and waddling

3 The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping. An ataxic gait is unsteady and staggering. A dystrophic gait is broad-based and waddling. Walking on the toes can occur from shortened Achilles tendons

The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The client asks for a snack and something to drink. The nurse should offer which best snack to the client? 1.Cocoa with honey and toast 2.Hot herbal tea with graham crackers 3.Iced coffee and peanut butter and crackers 4.Vanilla wafers and room-temperature water

4 Because mild tactile stimulation of the face can trigger pain in trigeminal neuralgia, the client needs to eat or drink lukewarm, nutritious foods that are soft and easy to chew. Extremes of temperature will cause trigeminal nerve pain. Therefore, the options that include cocoa, hot herbal tea, and iced coffee are incorrect.

The nurse has given suggestions to a client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs further teaching if the client makes which statement? 1."I will wash my face with cotton pads." 2."I'll have to start chewing on my unaffected side." 3."I should rinse my mouth if toothbrushing is painful." 4."I'll try to eat my food either very warm or very cold."

4 Facial pain can be minimized by using cotton pads to wash the face and using room temperature water. The client should chew on the unaffected side of the mouth, eat a soft diet, and take in foods and beverages at room temperature. If brushing the teeth triggers pain, an oral rinse after meals may be helpful instead.

Which priority client problem should be included in the care plan for the client diagnosed with Guillain-Barré syndrome? 1. High risk for injury. 2. Fear and anxiety. 3. Altered nutrition. 4. Ineffective breathing pattern.

4 Guillain-Barré syndrome has ascendingparalysis causing respiratory failure.Therefore, breathing pattern is priority.1. Safety is an important issue for the client,but this is not the priority client problem.2. The client's psychological needs are important, but psychosocial problems are not priority over physiological problems.3. Clients with this syndrome may have choking episodes and are at risk for inability to swallow as a result of the disease process, but this is not the priority nursing problem because weight loss is not an expected complication of this syndrome.

The client admitted with rule-out Guillain-Barré syndrome has just had a lumbar puncture. Which intervention should the nurse implement post procedure? 1. Monitor the client for hypotension. 2. Apply pressure to the puncture site.. 3. Test the client's cerebrospinal fluid. 4. Increase the client's fluid intake.

4 Increased fluid intake will help prevent a postprocedure headache, which may occur after a lumbar puncture.1. Very little cerebrospinal fluid is removed the client. Therefore, hypotension is not a potential complication of this procedure.2. A bandage is placed over the puncture site,and pressure does not need to be applied to the site.3. The laboratory staff, not the nurse, complete tests on the cerebrospinal fluid; the nurse could label the specimens and take them to the laboratory

The client diagnosed with Guillain-Barré syndrome is on a ventilator. When the wife comes to visit she starts crying uncontrollably, and the client starts fighting the ventilator because his wife is upset. Which action should the nurse implement? 1. Tell the wife she must stop crying. 2. Escort the wife out of the room. 3. Medicate the client immediately. 4. Acknowledge the wife's fears.

4 It is scary for a wife to see her loved one with a tube down his mouth and all the machines around them. The nurse should help the wife by acknowledging her fears1. This action does not address the wife's fears, and telling her to stop crying will not help the situation.2. Making the wife leave the room will further upset the client and the client's wife.3. Medicating the client will not help the wife, but if the nurse can calm the wife,then it is hoped the client will calm down.

The nurse is planning care for the client with a neurogenic bladder caused by multiple sclerosis. The nurse plans for fluid administration of at least 2000 mL/day. Which plan would be most helpful to this client? 1.400 to 500 mL with each meal and 500 to 600 mL in the evening before bedtime 2.400 to 500 mL with each meal and additional fluids in the morning but not after midday 3.400 to 500 mL with each meal, with all extra fluid concentrated in the afternoon and evening 4.400 to 500 mL with each meal and 200 to 250 mL at midmorning, midafternoon, and late afternoon

4 Spacing fluid intake over the day helps the client with a neurogenic bladder to establish regular times for successful voiding. Omitting intake after the evening meal minimizes incontinence or the need to empty the bladder during the night.

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? 1."I can sit down to put on my pants and shoes." 2."I try to exercise every day and rest when I'm tired." 3."My son removed all loose rugs from my bedroom." 4."I don't need to use my walker to get to the bathroom.

4 The client with Parkinson's disease should be instructed regarding safety measures in the home. The client should use his or her walker as support to get to the bathroom because of bradykinesia. The client should sit down to put on pants and shoes to prevent falling. The client should exercise every day in the morning when energy levels are highest. The client should have all loose rugs in the home removed to prevent falling.

the nurse is caring for a client diagnosed with trigeminal neuralgia. The client asks the nurse, "Why do I have so much pain?" Which is the appropriate response by the nurse? 1."It's a local reaction to nasal stuffiness." 2."It's due to a hypoglycemic effect on the cranial nerve." 3."Release of catecholamines with infection or stress leads to the pain." 4."Pain is due to stimulation of the affected nerve by pressure and temperature."

4 The paroxysms of pain that accompany this neuralgia are triggered by stimulation of the terminal branches of the trigeminal nerve. Symptoms can be triggered by pressure from washing the face, brushing the teeth, shaving, eating, or drinking. Symptoms also can be triggered by thermal stimuli, such as a draft of cold air. The remaining options are incorrect.

The home care nurse is preparing to visit a client with a diagnosis of trigeminal neuralgia (tic douloureux). When performing the assessment, the nurse should plan to ask the client which question to elicit the most specific information regarding this disorder? 1."Do you have any visual problems?" 2."Are you having any problems hearing?" 3."Do you have any tingling in the face region?" 4."Is the pain experienced a stabbing type of pain?

4 Trigeminal neuralgia is characterized by spasms of pain that start suddenly and last for seconds to minutes. The pain often is characterized as stabbing or as similar to an electric shock. It is accompanied by spasms of facial muscles that cause twitching of parts of the face or mouth, or closure of the eye. The remaining options do not elicit data specifically related to this disorder.

The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis. The nurse determines that the client is using the information most effectively if the client reports which action? 1.Drinking a total of 1000 mL/day 2.Giving herself an enema every morning before breakfast 3.Taking stool softeners daily and a glycerin suppository once a week 4.Initiating a bowel movement every other day, 45 minutes after the largest meal of the day

4 to manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate a bowel movement on an every-other-day basis and should sit on the toilet or commode. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.

Which assessment data should the nurse assess in the client diagnosed with Guillain-Barré syndrome? 1. An exaggerated startle reflex and memory changes. 2. Cogwheel rigidity and inability to initiate voluntary movement. 3. Sudden severe unilateral facial pain and inability to chew. 4. Progressive ascending paralysis of the lower extremities and numbness.

4 Ascending paralysis is the classic symptom of Guillain-Barré syndrome 1. These signs/symptoms, along with sleep disturbances and nervousness, support the diagnosis of Creutzfeldt-Jakob disease .2. These signs/symptoms support the diagnosis of Parkinson's disease. 3. These are signs/symptoms of trigeminal neuralgia.

Mr. Parker, a 72-year old male patient was admitted because of bruises and cut he incurred when he tumbled down the sidewalk while he was walking. After providing treatment to his wounds and injuries, the R.O.D. noticed some manifestations of Mr. Parker consistent with Parkinson's Disease. He then referred him to a Neurologist and a diagnosis of Parkinson's Disease was made. Supporting coping abilities is an important consideration in managing Mr. Parker's condition. This could be promoted in doing the actions listed below, apart from: * A. Providing complete assistance to Mr. Parker to make sure his needs are all met. B. Patient is encouraged to set achievable goals. C. Patient should remain as an active participant in his/her therapeutic program. D. There should be a planned program of activity throughout the day.

A

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?* A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.

A male client with Bell's Palsy asks the nurse what has caused this problem. The nurse's response is based on an understanding that the cause is: * A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem B. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia C. Primary genetic in origin, triggered by exposure to meningitis D. Primarily genetic in origin, triggered by exposure to neurotoxins

A. Bell's palsy is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown but may include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of these factors.

4. The nurse has given the male client with Bell's palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will: * A. Exposure to cold and drafts B. Massage the face with a gentle upward motion C. Perform facial exercises D. Wrinkle the forehead, blow out the cheeks, and whistle

A. Exposure to cold or drafts is avoided. Local application of heat to the face may improve blood flow and provide comfort.Options B and C: Prevention of muscle atrophy with Bell's palsy is accomplished with facial massage, facial exercises, and electrical stimulation of the nerves.

The nurse is working on a surgical floor. The nurse must logroll a male client following a: a. laminectomy. b. thoracotomy. c. hemorrhoidectomy. d. cystectomy.

Answer A. The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or may be assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery.

A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? a. "You may have difficulty believing this, but the paralysis caused by this disease is temporary." b. "You'll have to accept the fact that you're permanently paralyzed. However, you won't have any sensory loss." c. "It must be hard to accept the permanency of your paralysis." d. "You'll first regain use of your legs and then your arms."

Answer A. The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.

The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to: a. take a hot bath. b. rest in an air-conditioned room c. increase the dose of muscle relaxants. d. avoid naps during the day

Answer B. Fatigue is a common symptom in clients with multiple sclerosis. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue. Planning for frequent rest periods and naps can relieve fatigue. Other measures to reduce fatigue in the client with multiple sclerosis include treating depression, using occupational therapy to learn energy conservation techniques, and reducing spasticity.

The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which plan to use which of the following to test the client's peripheral response to pain? a. Sternal rub. b. Nail bed pressure c. Pressure on the orbital rim d. Squeezing of the sternocleidomastoid muscle

Answer B. Motor testing in the unconscious client can be done only by testing response to painful stimuli. Nail bed pressure tests a basic peripheral response. Cerebral responses to pain are tested using sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle.

A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? a. Anxiety b. Powerlessness c. Ineffective denial d. Risk for disuse syndrome

Answer B. This comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can't perform even simple daily tasks. Although Anxiety and Risk for disuse syndrome may be diagnoses associated with ALS, the client's comment specifically refers to an inability to act autonomously. A diagnosis of Ineffective denial would be indicated if the client didn't seem to perceive the personal relevance of symptoms or danger.

Nurse Maureen witnesses a neighbor's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to opens the airway in this victim by using which method? a. Flexed position b. Head tilt-chin lift c. Jaw thrust maneuver d. Modified head tilt-chin lift

Answer C. If a neck injury is suspected, the jaw thrust maneuver is used to open the airway. The head tilt-chin lift maneuver produces hyperextension of the neck and could cause complications if a neck injury is present. A flexed position is an inappropriate position for opening the airway.

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: a. Getting too little exercise b. Taking excess medication c. Omitting doses of medication d. Increasing intake of fatty foods

Answer C. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis

A female client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? a. Giving client full control over care decisions and restricting visitors b. Providing positive feedback and encouraging active range of motion c. Providing information, giving positive feedback, and encouraging relaxation d. Providing intravaneously administered sedatives, reducing distractions and limiting visitors

Answer C. The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client's condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.

Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has history of: a. Seizures or trauma to the brain b. Meningitis during the last 5 years c. Back injury or trauma to the spinal cord d. Respiratory or gastrointestinal infection during the previous month.

Answer D. Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.

A female client is admitted in a disoriented and restless state after sustaining a concussion during a car accident. Which nursing diagnosis takes highest priority in this client's plan of care? a. Disturbed sensory perception (visual) b. Self-care deficient: Dressing/grooming c. Impaired verbal communication d. Risk for injury

Answer D. Because the client is disoriented and restless, the most important nursing diagnosis is risk for injury. Although the other options may be appropriate, they're secondary because they don't immediately affect the client's health or safety.

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: a. Eating large, well-balanced meals b. Doing muscle-strengthening exercises c. Doing all chores early in the day while less fatigued d. Taking medications on time to maintain therapeutic blood levels

Answer D. Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.

The patient's lumbar puncture results are back. Which finding below correlates with Guillain-Barré Syndrome?* A. high glucose with normal white blood cells B. high protein with normal white blood cells C. high protein with low white blood cells D. low protein with high white blood cells

B

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.* A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.

Which nursing diagnosis takes highest priority for a client with Parkinson's crisis? * A. Imbalanced nutrition: Less than body requirements B. Ineffective airway clearance C. Impaired urinary elimination D. Risk for injury

B. In Parkinson's crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes highest priority. Although the other options also are appropriate, they aren't immediately life-threatening.

A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test? * A. Immobilize the neck before the client is moved onto a stretcher. B. Determine whether the client is allergic to iodine, contrast dyes, or shellfish. C. Place a cap on the client's head. D. Administer a sedative as ordered

B. Because CT commonly involves the use of a contrast agent, the nurse should determine whether the client is allergic to iodine, contrast dyes, or shellfish. Option A: Neck immobilization is necessary only if the client has a suspected spinal cord injury. Option C: Placing a cap over the client's head may lead to misinterpretation of test results; instead, the hair should be combed smoothly. Option D: The physician orders a sedative only if the client can't be expected to remain still during the CT scan.

Tic douloureux is characterized by paroxysms of pain and burning sensations. It is a disorder of which cranial nerve? A. Third B. Fifth C. Seventh D. Eighth

B. Trigeminal neuralgia is a condition of the fifth cranial nerve that is characterized by paroxysms of pain in the area innervated by any of the three branches.

Which patient below is MOST at risk for developing a cholinergic crisis?* A. A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication. B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

D Remember patients who experience a cholinergic crisis are most likely to because they've received too much of their anticholinesterase medications (example Pyridostigmine). However, on the other hand, patients who have received insufficient amount of their anticholinesterase medication or have experienced an illness/stress/surgery are most likely to experience a myasthenia crisis. Both conditions will lead to muscle weakness and respiratory failure but from different causes, which is why a Tensilon test is used to help differentiate between the two conditions.

To limit triggering the pain associated with trigeminal neuralgia the nurse should instruct the client to A. Avoid oral hygiene B. Apply warm compresses C. Drink iced liquids D. Chew on the unaffected side

D. This way the client will minimize the episode of pain.

The initial neurologic symptom of Guillain Barré syndrome is A. Transient hypertension B. Absent tendon reflexes C. Dysrhythmias D. Paresthesia of the legs

D. Paralysis that starts from feet and ascends.

When evaluating the extent of Parkinson's disease, a nurse observes for which of the following conditions? * A. Bulging eyeballs B. Diminished distal sensations C. Increased dopamine levels D. Muscle rigidity

D. Parkinson's disease is characterized by the slowing of voluntary muscle movement, muscular rigidity, and resting tremor. Bulging eyeballs occur in Grave's disease. Diminished distal sensation doesn't occur in Parkinson's disease. Dopamine is deficient in this disorder.

True or False: Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system.* True False

FALSE: Guillain-Barré Syndrome is an autoimmune neuro condition where the immune system attacks the nerves in the PERIPHERAL NERVOUS SYSTEM and cranial nerves. This condition does NOT occur in the central nervous system (CNS).

In studying the predisposing factor of multiple sclerosis, it is emphasized by Gwyneth that it can be attributed on the presence of a specific cluster of human leukocyte antigens on the cell wall. In other words, this is attributed on the: Presence of infection Severe stress Environment Genes

Genes

The nurse instructs Ms. Mariaha's husband about daily administration of Glatiramer Acetate (Copaxone). The nurse advises the patient to administer the drug via: * Intramuscular route Subcutaneous route Intravenous route Oral route

Subcutaneous route

You're educating a patient about treatment options for Guillain-Barré Syndrome. Which statement by the patient requires you to re-educate the patient about treatment?* A. "Treatments available for this syndrome do not cure the condition but helps speed up recovery time." B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." C. "When I start plasmapheresis treatment a machine will filter my blood to remove the antibodies from my plasma that are attacking the myelin sheath." D. "Immunoglobulin therapy is where IV immunoglobulin from a donor is given to a patient to stop the antibodies that are damaging the nerves.

The answer is B. This statement is incorrect. Plasmapheresis and immunoglobin therapies are treatment options available for GBS, BUT they are only really effective when given within 2 weeks from the onset of symptoms (not 4 weeks).

A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action?* A. The patient reports a headache. B. The patient has a weak cough. C. The patient has absent reflexes in the lower extremities. D. The patient reports paresthesia in the upper extremities.

The answer is B. The patient's signs and symptoms in this scenario are typical with Guillain-Barré Syndrome. The syndrome tends to start in the lower extremities (with paresthesia that will progress to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system may be compromised (ex: weak cough, shortness of breath, dyspnea...patient says it is hard to breath etc.). The nurse should immediately report this to the MD because the patient may need mechanical ventilation. Absent reflexes is common in GBS and paresthesia can extend to the upper extremities as the syndrome progresses. A headache is not common.

During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with:* A. signs and symptoms that are unilateral and descending that start in the lower extremities B. signs and symptoms that are symmetrical and ascending that start in the upper extremities C. signs and symptoms that are asymmetrical and ascending that start in the upper extremities D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

The answer is D. GBS signs and symptoms will most likely start in the lower extremities (ex: feet), be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common type in the U.S. and this is how this syndrome tends to present.

A patient with Guillain-Barré Syndrome has a feeding tube for nutrition. Before starting the scheduled feeding, it is essential the nurse? Select all that apply:* A. Assesses for bowel sounds B. Keeps the head of bed less than 30' degrees C. Checks for gastric residual D. Weighs the patient

The answers are A and C. Some patients who experience GBS will need a feeding tube because they are no longer able to swallow safely due to paralysis of the cranial nerves that help with swallowing. GBS can lead to a decrease in gastric motility and paralytic ileus. Therefore, before starting a scheduled feeding the nurse should always assess for bowel sounds and check gastric residual.

You're teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate they understood the autonomic involvement of this syndrome? Select all that apply:* A. Altered body temperature regulation B. Inability to move facial muscles C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

The answers are A, C, D, and E. All these are some signs and symptoms that can present in severe cases of GBS when the autonomic nervous system is involved.

Your patient is back from having a lumbar puncture. Select all the correct nursing interventions for this patient?* A. Place the patient in lateral recumbent position. B. Keep the patient flat. C. Remind the patient to refrain from eating or drinking for 4 hours. D. Encourage the patient to consume liquids regularly.

The answers are B and D. The patient will need to stay flat after the procedure for a prescribed amount of time to prevent a headache, and the nurse will need to encourage the patient to drink fluids regularly to help replace the fluid lost during the lumbar puncture.

Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select all that apply:* A. Edrophonium Test B. Sweat Test C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

The answers are C, D, and E. These are the tests that can be ordered to help the MD determine if the patient is experiencing GBS.

You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below:* A. Recent upper respiratory infection B. Patient's age: 3 years old C. Positive stool culture Campylobacter Jejuni D. Hyperthermia E. Epstein-Barr F. Diabetes G. Myasthenia Gravis

The answers are: A, C, and E. Risk factors for developing Guillain-Barré Syndrome include: experiencing upper respiratory infection, GI infection (especially from Campylobacter Jejuni), Epstein-Barr infection, HIV/AIDS, vaccination (flu or swine flu) etc.

Nurse Jona is assessing Janet, a 38-year-old client, diagnosed of multiple sclerosis. Which of the following symptoms would the nurse expect to find? * Vision changes Flaccid muscles Tremors at rest Absent deep tendon reflexes

Vision changes

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?* A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

c The thymus is located anteriorly in the upper part of the chest behind the sternum in between the lungs.

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis?* A. The patient experiences worsening of the muscle weakness. B. The patient experiences wheezing along with facial flushing. C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. D. The patient experiences improved muscle strength.

d During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction....hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.

The client with Parkinson's disease has a nursing diagnosis of risk for falls related to an abnormal gait documented in the nursing care plan. The nurse assesses the client expecting to observe which type of gait? * Broad based and waddling Steady and staggering Shuffling and propulsive Accelerating with walking on toes

Shuffling and propulsive

The nurse instructor discussed in a Medical-Surgical Nursing class important points to remember about Gullain Barré Syndrome, Multiple Sclerosis and Amyotropic Lateral Sclerosis. What do these neurologic conditions have in common? * A. They all result from genetic mutation . B. These diseases involve demyelination of nerves in either/both Central and/or Peripheral Nervous System. C. These diseases primarily attack the nerve cells of the Central Nervous System. D. They are all consequences of cellular aberrations in the Nervous System.

B

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition?* A. Plasmapheresis B. Cholinesterase medications C. Thymectomy D. Corticosteroids

B These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?* A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. at 1200 right before the patient eats

C Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

Which meal option would be the most appropriate for a patient with myasthenia gravis?* A. Roasted potatoes and cubed steak B. Hamburger with baked fries C. Clam chowder with mashed potatoes D. Fresh veggie tray with sliced cheese cubes

C. Patients with MG have weak muscles and this can include the muscles that are used for chewing and swallowing. The patient should choose meal options that require the least amount of chewing and that are easy to swallow. Option C is a thick type of soup and the mashed potatoes are soft....both are very easy to eat and swallow compared to the other options.

A nurse is teaching a class of nursing students on the unit about the pathophysiology of MS. To evaluate their understanding, the nurse asks the students, "Which part of a neuron would be the most damaged in a patient with multiple sclerosis?" The students' best response would be which of the following components of the nervous system? * Nucleus Myelin sheath Cell body Dendrite

Myelin sheath

You're about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome. Before sending the patient you will have the patient?* A. Clean the back with antiseptic B. Drink contrast dye C. Void D. Wash their hair

The answer is C. The patient will need to void and empty the bladder before going for a LP. This will help decrease the chances of the bladder becoming punctured during the procedure.