Neurological Disorders
A nurse is caring for a female patient with myasthenia gravis. The patient states that she has been angry and depressed and says, "I can't do anything for longer than a few minutes." How should the nurse respond? "You may need to hire a home health aide." "Why do you feel that you can't do anything?" "Do you have family at home who can help you?" "Try to adapt your schedule so you aren't as tired."
"Try to adapt your schedule so you aren't as tired." Patients with myasthenia gravis should adapt their schedule to include ample rest periods and prevent fatigue. The nurse should not recommend a home health aide as the first option. Asking "why" questions is not therapeutic and may cause the patient to become defensive. The nurse should assess the presence of a support system, but that is not the best response.
A patient with Parkinson's disease presents for continued care. The patient was initially taking carbidopa-levodopa and was later prescribed bromocriptine after the effectiveness of carbidopa-levodopa appeared to wear off. The patient is not responding to these medication changes and has developed difficulty walking and holding objects. Which collaborative care treatments are options for this patient? Select all that apply. Surgical thymectomy Deep brain stimulation Dorsal column stimulation Ablation of the affected area Transplantation of fetal neural tissue
Deep brain stimulation Ablation of the affected area Transplantation of fetal neural tissue Deep brain stimulation is used in patients with Parkinson's disease to control symptoms when medication therapy is ineffective.Ablation surgery targets problem areas in patients with Parkinson's disease when medication therapy is ineffective.Transplantation of fetal neural tissue into the basal ganglia is designed to provide dopamine receptor agonist—producing cells in the brains of patients with Parkinson's disease when medication therapy is ineffective. Thymectomy is indicated for almost all patients with thymoma, a condition associated with myasthenia gravis, not Parkinson's disease.Dorsal column stimulation is used to treat spasticity in multiple sclerosis.
A nurse is caring for a patient with Parkinson's disease. Which points should the nurse teach the patient to aid muscle development and decrease the risk of injury? Select all that apply. Elevate the toilet seat. Avoid all caffeinated beverages. Place nonskid pads under all rugs. Use assistive devices when necessary. Include light weight training in an exercise regimen. Follow a diet with balanced carbohydrates and protein
Elevate the toilet seat. Place nonskid pads under all rugs. Use assistive devices when necessary. Include light weight training in an exercise regimen. Follow a diet with balanced carbohydrates and protein An elevated toilet seat decreases the distance the patient has to move for sitting. Nonskid rugs help prevent falls. Assistive devices help to prevent falls Weight training strengthens muscles and helps prevent injury.Protein and carbohydrates are necessary for a healthy diet and muscle development. Proper muscle development is critical for strength and stability to prevent falls and other injuries. Avoiding caffeine is a suggestion for patients with multiple sclerosis, not Parkinson's disease.
Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? Activity intolerance Self-care deficit: toileting Ineffective self-health management Imbalanced nutrition: less than body requirements
Imbalanced nutrition: less than body requirements The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson's disease, but the data do not indicate that they are current problems for this patient.
A patient with suspected myasthenia gravis (MG) is scheduled for an edrophonium test and questions the nurse regarding the procedure. The nurse would explain that the diagnosis will be confirmed if which action is witnessed after the edrophonium injection? Causes pupil constriction Dulls deep tendon reflexes Worsens muscle weakness Improves muscle contractility
Improves muscle contractility The edrophonium test is the diagnostic evaluation for MG. If muscle contractility improves with administration of the medication, the patient is diagnosed with MG. Pupillary constriction with edrophonium administration would not warrant a diagnosis of MG.Dulled deep tendon reflexes with edrophonium administration would not warrant a diagnosis of MG.Worsened muscle weakness with edrophonium administration would not warrant a diagnosis of MG.
A patient has been newly diagnosed with multiple sclerosis (MS). Which points should the nurse include in a teaching plan on nutrition therapy? Select all that apply. Minimize caffeine Increase roughage Eat semisolid foods Increase fluid intake Cut food into bite-sized pieces
Minimize caffeine Increase roughage Increase fluid intake The nurse should instruct patients with MS to minimize caffeine, as excessive caffeine intake can worsen symptoms. The nurse should instruct patients with MS to increase roughage to prevent constipation. The nurse should instruct patients with MS to increase fluid intake to prevent dehydration and constipation. Dysphagia is not associated with MS. Therefore it is not necessary for patients with MS to eat semisolid foods.Dysphagia is not associated with MS; therefore it is not necessary for patients with MS to cut food into bite-sized pieces.
A 28-year-old patient sprained a knee while running and has had pain and swelling that comes and goes for over a month. The patient presents today with paresthesias of the hand and a repeat fall. With which degenerative neurologic problem would this patient be diagnosed? Multiple sclerosis Cholinergic crisis Myasthenia gravis Parkinson's disease
Myasthenia gravis Intermittent muscle weakness and leg swelling are indicative of myasthenia gravis. Intermittent muscle weakness and leg swelling are not indicative of multiple sclerosis. Intermittent muscle weakness and leg swelling are not indicative of a cholinergic crisis. ntermittent muscle weakness and leg swelling are not indicative of Parkinson's disease.
A patient with a 15-year history of multiple sclerosis (MS) presents with chronic pain and inflammation. The patient receives opioid therapy and home treatment to preventing MS triggers. The patient asks the nurse whether there are any other treatment options. The nurse explains that the provider should discuss the benefits and risks of which procedures? Select all that apply. Neurectomy Thymectomy Deep brain stimulation Intrathecal baclofen pump Dorsal column electrical stimulation
Neurectomy Deep brain stimulation Intrathecal baclofen pump Dorsal column electrical stimulation Neurectomy is removal of all or part of a nerve. This procedure is used to treat symptoms of MS that are not relieved by drug therapy.Deep brain stimulation is used to treat symptoms of MS that are not relieved by drug therapy.An intrathecal baclofen pump is used to treat symptoms of MS that are not relieved by drug therapy.Dorsal column electrical stimulation is used to treat symptoms of MS that are not relieved by drug therapy. A thymectomy is removal of the thymus gland. Research suggests that dysfunction in the thymus gland can lead to myasthenia gravis. Removing it is a treatment for myasthenia gravis, not MS.
After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? Auscultate the patient's bowel sounds. Notify the patient's health care provider. Administer the prescribed PRN antiemetic drug. Give the scheduled dose of prednisone (Deltasone).
Notify the patient's health care provider. The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
A nurse is caring for a patient with myasthenia gravis admitted for observation related to hypertension. Which provider order would the nurse question? Ondansetron IV PRN Lisinopril PO daily Oral Lasix twice daily Acetaminophen PRN for pain
Oral Lasix twice daily The nurse would question an order for diuretics for a patient with myasthenia gravis because diuretics such as oral Lasix can cause fluid and electrolyte imbalance and worsen the patient's muscle weakness. The nurse would not question the order for ondansetron, as it has no effect on the patient's symptoms. Angiotensin-converting enzyme inhibitors such as lisinopril do not affect the patient's symptoms. The nurse would not question a PRN order for acetaminophen.
A nurse is caring for a patient with Parkinson's disease in long-term care who coughs when drinking and eating. How should the nurse modify the patient's diet? Select all that apply. Start the patient on a pureed diet. Perform a dysphagia screening test. Increase roughage in the patient's diet. Only allow the patient to consume thickened liquids. Remove shredded and ground meats from the diet.
Perform a dysphagia screening test. Only allow the patient to consume thickened liquids. Remove shredded and ground meats from the diet. It is important to conduct a swallow study before administering any oral food or fluids. This will determine the severity of the patient's dysphagia and the types of foods the patient can eat.Thickened liquids are prescribed for patients at risk for aspiration.Patients with dysphagia should be encouraged to eat ground or shredded meat that is no larger than ¼ inch. A pureed diet is often prescribed for patients with severe dysphagia.Increasing roughage helps treat constipation but does not address the patient's dysphagia.
A 52-year-old patient presents with recurring facial weakness. He says, "I feel fine in the morning, but my face is so weak in the afternoon that I can't even talk." Which drug would the nurse anticipate administering to aid in facial muscle contraction? Furosemide Pyridostigmine Dexamethasone Carbidopa-levodopa
Pyridostigmine Pyridostigmine is used to increase muscle strength in patients with myasthenia gravis. Furosemide is a diuretic used to treat fluid overload and hypertension. It is contraindicated in patients with myasthenia gravis.Dexamethasone is a corticosteroid. It may be prescribed to a patient with myasthenia gravis, but it does not facilitate muscle contraction.Carbidopa-levodopa is administered to patients with Parkinson's disease.
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? Pupil size Grip strength Respiratory effort Level of consciousness
Respiratory effort Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
The nurse is giving discharge instructions to a patient with multiple sclerosis (MS). Put the symptoms the patient should monitor for in order, from highest to lowest importance. Shortness of breath Difficulty swallowing Peripheral edema Vomiting Leg cramps
Shortness of breath Difficulty swallowing Peripheral edema Vomiting Leg cramps
Which factors are believed to contribute to the development of multiple sclerosis (MS)? Select all that apply. Smoking Genetics Infection Radiation Emotional stress
Smoking Genetics Infection Emotional stress Smoking is associated with the development of MS. Researchers believe the disease develops in a genetically susceptible person as a result of an environmental exposure, such as an infection. Infection is associated with the development of MS. Emotional stress is associated with the development of MS Radiation is not associated with the development of MS.
A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage? The patient has a chronic dry cough. The patient has four loose stools in a day. The patient develops a deep vein thrombosis. The patient's blood pressure is 92/52 mm Hg.
The patient's blood pressure is 92/52 mm Hg. Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use.
A nurse is reviewing the discharge orders for a patient newly diagnosed with myasthenia gravis (MG). Which information should the nurse teach the patient regarding the use of pyridostigmine? Select all that apply. It must be taken with food or milk. Missed doses should be taken immediately. This medication should be taken on schedule. Plan medication so that peak time is during activity. Taking too much medication can lead to a cholinergic crisis.
This medication should be taken on schedule. Plan medication so that peak time is during activity. Taking too much medication can lead to a cholinergic crisis. Strict planning of drug therapy for MG improves muscle function for the height of daily activity.It is important to take medications at regular intervals to maintain therapeutic serum levels.Overmedication may cause a cholinergic crisis. It is not necessary to take all medications with food or milk. Missed doses may not need to be taken immediately to prevent toxicity.
What are the primary symptoms used to help diagnose patients with Parkinson's disease? Select all that apply. Tremor Rigidity Dysphagia Paraplegia Bradykinesia
Tremor Rigidity Bradykinesia Tremors are a classic sign of Parkinson's disease. Muscle rigidity is a classic symptom of Parkinson's disease. Bradykinesia (slow movements) is a classic sign of Parkinson's disease. Dysphagia, difficulty swallowing, is not a classic symptom of Parkinson's disease.Paraplegia is not a classic sign of Parkinson's disease.
A 40-yr-old patient is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and adult children about this disorder, the nurse will provide information about the use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. prophylactic antibiotics to decrease the risk for aspiration pneumonia. option of genetic testing for the patient's children to determine their own HD risks. lifestyle changes of improved nutrition and exercise that delay disease progression.
option of genetic testing for the patient's children to determine their own HD risks. Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing. Sinemet will increase symptoms of HD because HD involves an increase in dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective treatments or lifestyle changes that delay the progression of symptoms in HD.
The nurse advises a patient with myasthenia gravis (MG) to perform physically demanding activities early in the day. anticipate the need for weekly plasmapheresis treatments. do frequent weight-bearing exercise to prevent muscle atrophy. protect the extremities from injury due to poor sensory perception.
perform physically demanding activities early in the day. Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.
A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? Recommendation to drink at least 4 L of fluid daily Need to avoid driving or operating heavy machinery How to draw up and administer injections of the medication Use of contraceptive methods other than oral contraceptives
How to draw up and administer injections of the medication Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.
What is the result of acetylcholine receptor destruction in myasthenia gravis? Diminished sensory function Impaired skeletal muscle function Diminished cardiac muscle function Increased smooth muscle dysfunction
Impaired skeletal muscle function Acetylcholine receptor destruction causes progressive skeletal dysfunction and alters motor function. Acetylcholine receptor destruction does not cause impaired sensory function, impaired cardiac function or smooth muscle dysfunction.
A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? "MS symptoms may be worse after the pregnancy." "Women with MS frequently have premature labor." "MS is associated with an increased risk for congenital defects." "Symptoms of MS are likely to become worse during pregnancy."
"MS symptoms may be worse after the pregnancy." During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.
A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? Observe for agitation and paranoia. Assist with active range of motion (ROM). Give muscle relaxants as needed to reduce spasms. Use simple words and phrases to explain procedures.
Assist with active range of motion (ROM). ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
Which pathologic process affects the development of relapse in multiple sclerosis (MS)? Demyelination Thymic tumors Autoantibody production Blocked acetylcholine receptors
Demyelination Demyelination is the destruction of myelin sheaths surrounding neurons and has the greatest effect on relapse in MS. Thymic tumors affect the development of myasthenia gravis, not MS.Autoantibody production affects the development of myasthenia gravis, not MS.Blocked acetylcholine receptors affect the development of myasthenia gravis, not MS.
A patient with myasthenia gravis is having difficulty swallowing and breathing. Which nursing intervention should be implemented for this patient? Insert an oral airway. Provide thickened liquids. Administer pain medication. Provide oxygen via nonrebreather mask.
Insert an oral airway. An oral airway will help maintain the patency of the airway. Thickened liquids are ordered for patients with dysphagia, but this does not address the immediate problem. Pain medication is not indicated because of the patient's respiratory distress. Oxygen should be provided, but this is not the priority intervention.
Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? The patient walks a mile each day for exercise. The patient complains of pain with neck flexion. The patient has an increased serum creatinine level. The patient has the relapsing-remitting form of MS.
The patient has an increased serum creatinine level. Dalfampridine should not be given to patients with impaired renal function. The other information will not impact whether the dalfampridine should be administered.
A patient presents with symptoms of Parkinson's disease. Which medical history finding would be most concerning for the nurse? The patient takes ibuprofen daily for headaches. The patient was prescribed an antibiotic last week. The patient takes medication daily for schizophrenia. The patient has a history of malignant hyperthermia with anesthesia.
The patient takes medication daily for schizophrenia. Some antipsychotic medications can cause Parkinson-like symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cause Parkinson's symptoms.A history of antibiotic administration does not cause Parkinson's disease. The nurse would use anesthetics cautiously in patients with myasthenia gravis, not those with Parkinson's disease.
When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about oral corticosteroids. antiparkinsonian drugs. magnetic resonance imaging (MRI). electroencephalogram (EEG) testing.
antiparkinsonian drugs The clinical diagnosis of Parkinson's is made when tremor, rigidity, and akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should assess for the presence of chest pain. inquire about urinary tract problems. inspect the skin for rashes or discoloration. ask the patient about any increase in libido.
inquire about urinary tract problems. Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.
