prep u neuro

...34.A nurse is preparing a client newly diagnosed with multiple sclerosis for discharge home from a rehabilitation center. The client has been prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol). Which instruction will the nurse include in a teaching plan for the client?

"Avoid people with colds." The client should be taught to avoid individuals with any type of upper respiratory illness because these medications are immunosuppressive.

...

...

The client with relapsing-remitting multiple sclerosis asks why continuous treatment with interferon beta-1a (Avonex) is necessary. Which is the nurse's best response?

..."This medication will help decrease the number and severity of relapses." Interferon beta-1a is a biologic response modifier that is given IM once weekly to decrease the number and severity of relapses.

Which clinical manifestations would serve to alert the nurse to the early onset of MS?

...Nystagmus and ataxia Early signs and symptoms of MS include changes in motor skills, vision, and sensation.

Health promotion activities the nurse could suggest to a community group for Huntington's disease include

...genetic screening for high-risk individuals.

The nurse reminds a group of students about the major component of pathophysiology in multiple sclerosis (MS), which is

...plaques occur anywhere in the white matter of the central nervous system (CNS). Although plaques may occur anywhere in the white matter of the CNS, the areas most commonly involved are the optic nerves, cerebrum, and cervical spinal cord.

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should

...provide the client with small, frequent feedings. The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

C

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse followed a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize the patient most likely has? A. benign B. primary progressive C. relapsing-remitting (RR) D. disabling

Which neurologic test or procedure requires the nurse to determine whether an informed consent has been obtained from the client before the test or procedure?

Lumbar puncture for cerebrospinal fluid (CSF) sampling A lumbar puncture is an invasive procedure with many potentially serious complications. The other assessments or tests are considered noninvasive.

3.The nurse correlates which clinical manifestation of Guillain-Barré syndrome as the most common?

Progressive, ascending weakness and paresthesia The most common clinical pattern of Guillain-Barré syndrome is the ascending variety. Weakness and paresthesia begin in the lower extremities and progress upward.

Which conditions or factors in a middle-aged woman diagnosed with Guillain-Barré syndrome are most likely to have contributed to this problem?

She had a viral infection about 2 weeks ago. The client with GBS often relates a history of acute illness, trauma, surgery, or immunization 1 to 3 weeks before the onset of neurologic symptoms.

What are the main bacteria that cause meningitis?

Streptococcus pneumoniae and Neisseria meningitidis.

C

The nurse is administering the IV antiviral medication ganciclovir (Cytovene) to the patient with HSV-1 encephalitis. What is the best way for the nurse to administer the medication to avoid crystallization of the medication in the urine? A. Administer the medication rapidly over 15 minutes with 100 mL of normal saline. B. Dilute the medicine in 500 mL of lactated Ringer's solution C. Administer via slow IV over 1 hour D. Administer in a drip over 4 hours

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? a) Diplopia and ptosis b) Numbness c) Patchy blindness d) Loss of proprioception

a) Diplopia and ptosis

Which of the following diseases is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia? a) Huntington disease b) Creutzfeldt-Jakob disease c) Multiple sclerosis d) Parkinson's disease

a) Huntington disease

The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform? a) Avoid swimming and any weight-bearing activity. b) Exercise following a circuit training regimen. c) Apply warm packs to the affected area. d) Relax in a hot bath.

c) Apply warm packs to the affected area.

The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest? a) Taking a hot bath at least once daily b) Increasing the dose of muscle relaxants c) Resting in an air-conditioned room whenever possible d) Avoiding naps during the day

c) Resting in an air-conditioned room whenever possible

A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research? a) "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." b) "Currently stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." c) "Stem cell clinical trials have only been attempted in patients with acquired immune deficiencies but plans are underway to begin human cloning using embryonic stem cells." d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."

d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."

Interventions in patients with Guillain-Barre Syndrome

enhancing physical mobility to prevent DVT, administer IV nutrition, assess swallowing and gag reflex, develop plan for communication, decrease fear and anxiety

clinical manifestations of HSV

initially - fever, headache, confusion, hallucinations. focal seizures and hemiparesis - indicates the area of cerebral inflammation and necrosis

What are initial and progressive symptoms of myasthenia gravis?

initially - ocular muscles (diplopia and ptosis) progressive - same as above with difficulty swallowing, respiratory difficulty, and weakness of voice.

The most helpful intervention by the nurse for a client experiencing a parkinsonian crisis would be to

place the client in a nonstimulating environment. Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or sudden or inadvertent withdrawal of anti-parkinsonian medication. Severe exacerbation of tremor, rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea occur. The client should be placed in a quiet room with subdued lighting. Medical treatment may include barbiturates in addition to anti-parkinsonian drugs.

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Choose all that apply. a) Validate family functioning b) Validate individual self-worth c) Die without comfort d) Ignore threats to identity e) Alleviate and manage symptoms

• Alleviate and manage symptoms • Validate family functioning • Validate individual self-worth

A client with multiple sclerosis is learning to perform intermittent self-catherizations of the urinary bladder. The nurse obtains the following equipment for teaching. Select all that apply. a) Syringe with sterile water b) Forceps c) Foley bag d) 16-French catheters e) Anatomically correct model

• Anatomically correct model • 16-French catheters

A patient with Parkinson's disease is admitted to the hospital for treatment of an acute infection. Which nursing interventions will be included in the plan of care? (Select all that apply.)

Cut patient's food into small pieces. Place an arm chair at the patient's bedside. Use an elevated toilet seat.

Which conditions or factors in an adult woman diagnosed with MS are most likely to have contributed to this health problem?

Heritability or genetic factors Having a first-degree relative with MS increases the individual's risk of developing the disease. There is a higher prevalence of certain genes in populations with higher rates of MS.

Which statement from the client with Guillain-Barré syndrome indicates that teaching about disease progression was effective?

"I may need a ventilator until the paralysis goes away." GBS is characterized by ascending paralysis that is not permanent. During the acute phase, if the paralysis affects the intercostal muscles, the client may require mechanical ventilation until the paralysis begins to descend. The client will not require a mechanical ventilator or wheelchair after recovery from the acute phase of the disease. There is no relationship of exacerbation of GBS to being around other people

Which statement indicates that the client has a correct understanding about recovery from Guillain-Barré syndrome?

"I will have to take things slowly for several months after I leave the hospital." Most clients make a full recovery from GBS. Recovery can take as long as 6 months to 2 years. Fatigue is a major lingering symptom for most of those diagnosed with this disorder. Clients are not permanently paralyzed. They are in an acute care environment during the acute phase of this disorder.

What does a positive Kerning's sign look like?

- when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended.

What does a positive Brudzinski sign look like?

- when the patient's neck is flexed (after ruling out cervical trauma) flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity.

myasthenia crisis vs. cholinergic crisis. Cause and symptoms

Myasthenia crisis: Results form disease exacerbation or precipitating event - most commonly a respiratory infection Symptoms include severe generalized muscle weakness and respiratory bulbar weakness Patient may develop respiratory compromise and failure Cholinergic Crisis: Results from over medication with cholinesterase inhibitors Symptoms include severe muscle weakness with respiratory bulbar weakness Patient may develop respiratory compromise and failure **main point: these look the same in the patient**

The nurse notes in the patient's medical history that the patient has a positive Romberg test. Which nursing diagnosis is appropriate?

Risk for falls related to dizziness or weakness Rationale: A positive Romberg test indicates that the patient has difficulty maintaining balance with the eyes closed.

A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? a) Vision changes b) Flaccid muscles c) Tremors at rest d) Absent deep tendon reflexes

a) Vision changes

The nurse formulates the following nursing diagnosis for a client with MS: Impaired Physical Mobility related to muscle weakness. Useful interventions the nurse could plan include

a. encouraging long naps or rest periods. b. encouraging strengthening exercises for affected muscles every 4 hours. c. having the client perform ROM exercises at least two times daily. d. performing all the activities of daily living (ADLs) for the client. ANS: C Range-of-motion exercises should be performed at least twice daily.

What is the direction of Guillain-Barre Syndrome (proximal to distal or distal to proximal)?

begins in distal legs, moves up slowly. Patient may recover, then they will get worse and progress further up.

A

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? A. within 24 hours after exposure B. within 48 hours after exposure C. within 72 hours after exposure D. therapy is not necessary prophylactically and should only be used if the person develops symptoms

16.Which nursing intervention is aimed at reducing muscle weakness in the client with myasthenia gravis?

Assisting the client with activities of daily living (ADLs) The hallmark of myasthenia gravis is muscle weakness that increases with fatigue. The nurse provides assistance with ADLs to prevent fatigue. The nurse also collaborates with the physical therapist in teaching the client energy conservation techniques.

d.In planning an inservice program on Huntington's disease, which information does the nurse include?

Risk identification and counseling should precede genetic testing. The risks of people knowing that they have a debilitating, progressive neurologic disorder range from depression to suicide. Before having genetic testing, clients should undergo risk identification and counseling to assist with decision making.

A patiA patient is seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. The nurse will anticipate teaching the patient about

antiparkinsonian drugs.

What is the pathophysiology of multiple sclerosis?

immune-mediated, progressive demylenation of neurons in the CNS. Demylenation results in impaired transmission of nerve impulses.

Which physical assessment finding does the nurse expect to observe in a client with myasthenia gravis?

...Difficulty or inability to perform the six cardinal positions of gaze The most common assessment finding in more than 90% of clients with myasthenia gravis is involvement of the extraocular muscles. The nurse observes for inability or difficulty with tests of extraocular function, such as the cardinal positions of gaze. Ptosis and incomplete eye closure also may be observed.

21.A client with myasthenia gravis is preparing for discharge. Which instructions will be included in the education of the client's family members or caregiver?

Cardiopulmonary resuscitation (CPR) Respiratory compromise is a common occurrence with myasthenia gravis. The client's family members are encouraged to learn CPR and to have resuscitation equipment available in the home.

Who is more affected by Herpes Simplex Virus -1 and Herpes Simplex Virus - 2

HSV -1 typically affects children and adults HSV -2 typically affects neonates who acquire form mother who has active infection at time of delivery

dA 28-year-old woman has had multiple sclerosis (MS) for 3 years and wants to have children before her disease worsens. When she asks about the risks associated with pregnancy, the nurse explains that

MS symptoms may be worse after the pregnancy. Rationale: 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. Pregnancy, labor, and delivery are not affected by MS.

A nurse is caring for a client with Guillain-Barré syndrome who has been admitted to the intensive care unit. During the last 2 hours, the nurse notes that the client's vital capacity has declined to 12 mL/kg, and the client is having difficulty clearing secretions. Which is the nurse's priority action?

Preparing the client for elective intubation Deterioration in vital capacity to less than 15 mL/kg and the inability to clear secretions are indications for elective intubation.

B

The nurse caring for a patient with bacterial meningitis is administering dexamethasone (Decadron) that has been ordered as an adjunct to antibiotic therapy. When does the nurse know is the appropriate time to administer this medication? A. 1 hour after the antibiotic has infused and daily for 7 days B. 15 to 20 minutes before the first does of antibiotic and ever 6 hours for the next 4 days C. 2 hours prior to the administration of antibiotics for 7 days D. it can be administered every 6 hours for 10 days

What are secondary complications of MS?

UTI, constipation, pressure ulcers, contracture deformaties, pedal edema, pneumonia, osteoporosis.

What are other causes of encephalitis?

West Nile Virus (mosquitoes) and fungal infections (mostly in immunocompromised)

Pathophysiology of encephalitis

a local necrotizing hemorrhage that becomes more generalized, followed by edema.

Guillain-Barre Syndrome pathophysiology

cell-mediated and humoral immune attack on peripheral nerve myelin proteins that causes inflammatory demyelination. The best-accepted theory of cause is molecular mimicry, in which an infectious organism contains an amino acid that mimics the peripheral nerve myelin protein.

Diagnosis of meningitis

lumbar puncture

A patient with multiple sclerosis (MS) has a nursing diagnosis of urinary retention related to sensorimotor deficits. An appropriate nursing intervention for this problem is to

teach the patient how to use the Credé method. Rationale: The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.

When a client is admitted to the hospital with Guillain-Barré syndrome (GBS), the most important assessment the nurse should make is for a. decreasing alertness. b. respiratory difficulty. c. seizure activity. d. urinary retention.

ANS: B The two most dangerous features of GBS are respiratory muscle weakness and autonomic neuropathy involving both the sympathetic and the parasympathetic systems.

Common nursing interventions

Activity w/ rest, bowel/bladder voiding schedule and training schedule, swallowing instructions, reduce risk of aspiration, memory aides, structured environment, minimize stress, support of coping

A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

Assisting the patient with active range of motion (ROM)

C

During the Tensilon test to determine if the patient has myasthenia gravia, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42 and respiration 18. What intervention should the nurse prepare to do? A. place the patient in the supine position B. administer diphenhyramine (Benadryl) for the allergic reaction C. administer atropine to control the side effects of the edrophonium D. call the rapid response team because the patient is preparing to arrest

Manifestations of meningitis

Headache, high fever - initially Neck immobility, Disorientation and memory impairment - can be early sign Positive Kerning's sign Positive Brudzinski sign Photophobia

What is the most common cause of acute encephalitis?

Herpes simplex virus (HSV)

7.The nurse monitors for which complication in the client with Guillain-Barré syndrome who is undergoing plasmapheresis?

Hypovolemia The client undergoing plasmapheresis is at risk of hypovolemia. The nurse monitors fluid status, assesses vital signs, and administers replacement fluid, as indicated.

d.35.The early manifestations of amyotrophic lateral sclerosis (ALS) and MS are somewhat similar. Which clinical feature of ALS distinguishes it from MS?

Impairment of respiratory muscles In ALS, there is progressive muscle atrophy until a flaccid quadriplegia develops. Eventually, there is involvement of the respiratory muscles, which leads to respiratory compromise.

a.The nurse prioritizes which nursing diagnosis for the client admitted with Guillain-Barré syndrome?

Ineffective Breathing Pattern related to skeletal muscle weakness The most common cause of death for the client with Guillain-Barré syndrome is complications from respiratory compromise. Airway and breathing problems should receive priority nursing diagnoses.

A client tells the nurse that he is experiencing some leg stiffness when walking and slowness when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This information leads the nurse to suspect

Parkinson's disease (PD). Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common early manifestation that usually occurs in one of the upper limbs.

What are the medical management techniques for meningitis?

Prevention - vaccination Treatment - early administration of IV antibiotics (bacterial) dexamethasone (reduce inflammation) Treatment of dehydration, shock, seizure - as needed

B

The nurse is caring for the patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What interventions should be provided in order to determine the presence of autonomic dysfunction. A. assess the respiratory rate and oxygen saturation. B. assess the blood pressure and heart rate C. assess the peripheral pulses D. listen to the bowel sounds

6.A client with Guillain-Barré syndrome is undergoing plasmapheresis. The nurse determines shunt patency through which parameter?

The presence of a bruit Nursing care of the client undergoing plasmapheresis includes care of the shunt. The nurse checks for bruits every 2 to 4 hours for patency.

Diagnosis in Guillain-Barre Syndrome

ineffective breathing, impaired gas exchange, impaired mobility, imbalanced nutrition, impaired communication, fear, anxiety

Meningitis

inflammation of the meninges, which cover and protect the brain and spinal cord. The three main causes of meningitis are bacterial, viral, and fungal.

medications for MS

interferon beta-1a and interferon beta-1b. with methylprednisolone

Assessment emphasis in Guillain-Barre Syndrome

resp - vital capacity, respiratory failure Cardio - dysrythmias, DVT Social - coping ability

A patient with myasthenia gravis (MG) is admitted to the hospital with severe weakness and acute respiratory insufficiency. The health care provider performs a Tensilon test to distinguish between myasthenic crisis and cholinergic crisis. During the test, it will be most important to monitor the patient's

respiratory function.Rationale: Because the patient's respiratory insufficiency is life threatening, it will be most important to monitor respiratory function during the Tensilon test. Pupillary size and muscle strength may also be affected by the test but are not as important to monitor. LOC is not typically affected by MG, although the LOC may be affected by oxygenation in this patient.

Which of the following is the most common clinical manifestation of multiple sclerosis? a) Ataxia b) Fatigue c) Pain d) Spasticity

b) Fatigue

A nurse is performing an assessment on a client who is suspected of having MG. The complaint made by the client that reflects a manifestation commonly seen in clients with this disease is

..."By the end of the day, my eyelids usually are drooping." The primary feature of MG is increasing weakness with sustained muscle contraction. After a period of rest the muscles regain their strength. Muscle weakness is greatest after exertion or at the end of the day. Ocular manifestations are most common, with ptosis or diplopia occurring in a majority of clients.

To prevent complications caused by a common problem of Huntington's disease, the nurse should

...pad wheelchairs and beds. Excessive movements and falling can cause injury in the client with Huntington's disease. Interventions include padding wheelchairs and beds, providing shin guards, and using gait belts for ambulation. Communication does become difficult and alternative forms of communication are appropriate before the client becomes completely demented, but this does not take priority over safety precautions. The client does not need an exercise regimen as the client is already hyperactive, and seizures do not occur.

When a client is admitted to the hospital with Guillain-Barré syndrome (GBS), the most important assessment the nurse should make is for

...respiratory difficulty. The two most dangerous features of GBS are respiratory muscle weakness and autonomic neuropathy involving both the sympathetic and the parasympathetic systems.

The client diagnosed with the Huntington gene but who has no symptoms asks for options related to family planning. Which is the nurse's best response?

..."Tell me more specifically what information you need about family planning so that I can direct you to the right information or health care provider." The presence of the Huntington gene means that the trait will be passed on to all offspring of the affected individual. Understanding options for contraception and conception (e.g., surrogate mother options) and implications for children may require the expertise of a genetic counselor or reproductive specialist.

In discussing advanced directives, a client with ALS states that he does not want to be placed on a mechanical ventilator. Which is the nurse's best response?

..."What would you like to be done if you begin to have difficulty breathing?" ALS is an adult-onset upper and lower motor neuron disease, characterized by progressive weakness, muscle wasting, and spasticity, eventually leading to paralysis. Once muscles of breathing are involved, the client must include in the advanced directives what is to be done when breathing is no longer possible without intervention.

Nursing activities for a client with ALS and family include helping themThe nurThe Nurse cautions clients with ALS and their families to be aware that (Select all that apply)

...activities should be spaced throughout the day. muscle weakness may cause a risk for injury. Safety is a prime concern with ALS (and with any degenerative neurologic disorder). Muscle weakness is progressive, leading to increased risk of falls. Some interventions to prevent this include spacing activities throughout the day, conserving energy, avoiding extremes of hot and cold, and using assistive devices such as canes or wheelchairs. Clients with ALS usually do not experience incontinence and cognition remains intact for the duration of the disorder.

A

A patient with myasthenia gravis is in the hospital for the treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? A. the muscles will become fatigued and the patient will not be able to chew food or swallow pills B. there should not be a problem, since the medication was only delayed about 2 hours C. the patient will go into cardiac arrest D. the patient will require a double dose prior to lunch

B, C, D

The nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. What interventions can the nurse provide to assist with relieving the spasms? (Select all that apply.) A. have the patient take a hot tub bath to allow muscle relaxation B. demonstrate daily muscle stretching exercises C. apply warm compresses to the affected areas D. allow the patient adequate time to perform exercises E. assist with a rigorous exercise program to prevent contractures

Pathophysiology of myasthenia gravis

autoimmune disorder affecting the mineral junction. Antibodies directed at acetylcholine at the mineral junction impair transmission of impulses.

When teaching the patient with newly diagnosed multiple sclerosis (MS) about the disease, the nurse explains that?

autoimmune processes cause gradual destruction of the myelin sheath of nerves in the brain and spinal cord. Rationale: The primary pathology in MS is an autoimmune process that leads to loss of the myelin sheath and results in decreased nerve transmission. Although MS susceptibility does appear to be inherited, the disease is not congenital because the interaction of multiple factors precipitates MS development. Impulse transmission along nerve fibers is slowed. Antibodies to acetylcholine receptors do not cause MS.

A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? a) "You'll continue to experience progressive muscle weakness and sensory deficits." b) "You'll need to take edrophonium (Tensilon) to treat the disease." c) "The disease is a disorder of motor and sensory dysfunction." d) "This disease doesn't cause sensory impairment."

d) "This disease doesn't cause sensory impairment."

What is required in management of pt with Myasthenia Gravis?

patient education - signs and symptoms of crises (myasthenia and cholinergic) Ensuing adequate ventilation, intubation and mechanical ventilation Assessment of supportive measures - - ensure airway - ABG's, electrolytes, I&O, daily weights - ensure ability to swallow - avoid sedatives and tranquilizers - energy manifestations - help with ocular manifestations

When planning care for a patient with MS who has a nursing diagnosis of risk for activity intolerance related to extremity weakness secondary to stress, the most appropriate patient goal is

"The patient will complete ADLs without fatigue." Rationale: Because the nurse has identified the patient's problem as activity intolerance, a patient goal that indicates improvement in activity tolerance, such as ability to accomplish ADLs without fatigue, is most appropriate. The other goals are appropriate for nursing diagnoses such as ineffective coping, impaired physical mobility, and inadequate nutritional intake.

A hospitalized patient with myasthenia gravis (MG) has a nursing diagnosis of imbalanced nutrition: less than body requirements related to impaired swallowing. To promote nutrition, the nurse suggests that before meals the patient should avoid

...talking on the phone. Rationale: The same muscles are used for talking and swallowing, so the patient should avoid fatiguing the muscles of the mouth and throat before meals. The other activities will not affect the muscles used for chewing and swallowing.

To assist the client with Parkinson's disease to reduce tremor, the nurse suggests that the client

...tightly hold change in the pocket. Clasping change tightly in the pocket, using both hands to complete tasks, and sleeping on the tremorous side will help lessen the tremor.

A patient who has been taking bromocriptine (Parlodel) and benztropine (Cogentin) for Parkinson's disease is experiencing a worsening of symptoms. The nurse will anticipate that patient may benefit from

...use of levodopa (L-dopa)-carbidopa (Sinemet). Rationale: After the dopamine receptor agonists begin to fail to relieve symptoms, the addition of L-dopa with carbidopa can be added to the regimen. Complete drug withdrawal will result in worsening of symptoms. Anticholinergic therapy should be continued to help maintain the balance between the actions of dopamine and acetylcholine. Increasing the dose of bromocriptine will increase the risk for toxic effects.

15.The client suspected to have myasthenia gravis is about to undergo the Tensilon (edrophonium chloride) test. Which drug will the nurse have available for complications of this test?

Atropine sulfate Tensilon increases cholinergic responses and can slow the heart rate down so that ectopic beats dominate, causing cardiac fibrillation or arrest. Atropine sulfate is an anticholinergic drug.

What are common nursing diagnoses for patients with MS?

Impaired physical mobility, risk of injury, impaired bowel and bladder function.

A client is being treated in the clinic for an exacerbation of multiple sclerosis. The nurse would anticipate administering which drug?

Interferon 1b (Betaseron) Drugs used to treat exacerbations in ambulatory clients include Interferon 1b, Interferon 1a (Avonex), and glatiramer acetate (Copaxone). Diazepam and lioresal could be used to treat spasticity, while steroids are used for acute relapses.

The client with myasthenia gravis in cholinergic crisis has been treated with atropine. Which nursing intervention is a priority for this client?

Suctioning the client Atropine can cause thickening of secretions and formation of mucous plugs. The client is maintained on a ventilator during the crisis. Measures to remove secretions to prevent the buildup of secretions and the possibility of pneumonia are most important.

20.Immediately after undergoing a thymectomy, the nurse monitors for which complication in the client with myasthenia gravis?

Sudden onset of shortness of breath The complication to be alert for is pneumothorax or hemothorax. The nurse monitors the client for chest pain, sudden onset of shortness of breath, diminished chest wall expansion, decreased breath sounds, restlessness, and change in vital signs. The other symptoms are not likely to occur or are not related to the removal of the thymus.

The diagnosis of multiple sclerosis is based on which of the following tests? a) Cerebrospinal fluid (CSF) electrophoresis b) Evoked potential studies c) Magnetic resonance imaging (MRI) d) Neuropsychological testing

c) Magnetic resonance imaging (MRI) The diagnosis of MS is based on the presence of multiple plaques in the CNS observed with MRI.

The nurse is caring for a client hospitalized with a severe exacerbation of myasthenia gravis. When administering medications to this client, what is a priority nursing action? a) Assess client's reaction to new medication schedule. b) Document medication given and dose. c) Give client plenty of fluids with medications. d) Administer medications at exact intervals ordered.

d) Administer medications at exact intervals ordered.

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? a) Padded tongue blade b) Nasal cannula and oxygen c) Sphygmomanometer d) Suction machine with catheters

d) Suction machine with catheters

A patient has a diagnosis of multiple sclerosis. The nurse is aware that neuromuscular disorders such as multiple sclerosis may lead to a decreased vital capacity. What does vital capacity measure? a) The volume of air inhaled and exhaled with each breath b) The volume of air in the lungs after a maximal inspiration c) The maximal volume of air inhaled after normal expiration d) The maximal volume of air exhaled from the point of maximal inspiration

d) The maximal volume of air exhaled from the point of maximal inspiration

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). In planning the patient teaching necessary with the use of the drug, the nurse recognizes that the patient will need to be taught

how to draw up and administer injections of the medication. Rationale: Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. No laboratory monitoring is needed. The purpose of the medication is to modify the MS disease process.

What is ataxia?

impaired coordination of movements, and tremor. Loss of the control connections between the cortex and the basal ganglia

What are common nursing interventions for meningitis?

instituting infection control precautions until 24 hours after initiation of antibiotic (oral and nasal discharge is considered infectious) assisting with pain management assisting with getting rest implementing interventions to treat the elevated temperature encouraging patient to stay hydrated close monitoring of neurologic function seizure precautions I/O, serum electrolytes, urine volume, specific gravity, osmolality

A client with MS is being taught self-care measures to prevent constipation. The nurse would realize goals for teaching had been met when the client states he/she will avoid

laxatives. A high-fiber diet, bulk formers, and stool softeners are useful for maintaining stool consistency. Explain that laxatives and enemas should be avoided because they lead to dependence.

a.A nurse has instructed the client with myasthenia gravis to take drugs on time and to eat meals 45 to 60 minutes after taking the anticholinesterase drugs. The client asks why the timing of meals is so important. Which is the nurse's best response?

"This timing allows the drug to have maximum effect, so it is easier for you to chew, swallow, and not choke." The skeletal muscle weakness extends to the ability to chew and swallow. Clients who have myasthenia gravis are at risk for aspiration during meals. Timing the medication so that most of the meal is eaten when the drugs have produced their peak effect enables the client to chew and swallow more easily.

The nurse assesses for which clinical manifestation in the client with MS of the relapsing-remitting type?

...Attacks becoming increasingly frequent The classic picture of relapsing-remitting MS is characterized by increasingly frequent attacks.

The nurse correlates which pathophysiologic process to the client with a diagnosis of multiple sclerosis (MS)?

...Damage to the myelin sheath causes an inflammatory response. In MS, the myelin sheath is damaged, leading to an inflammatory response.

A patiA patient with Guillain-Barré syndrome asks the nurse what has caused the disease. In responding to the patient, the nurse explains that Guillain-Barré syndrome

...is due to an immune reaction that attacks the covering of the peripheral nerves.

What is the medical management of Myasthenia graves?

cholinesterase inhibitor, plasmapheresis, thymectomy

Huntington's disease is inherited in an autosomal-dominant pattern. Genetic testing is available to families in which a member has Huntington's disease. The availability of the testing has created some ethical conflicts.

...

Which statement by the client indicates understanding of treatment for pain related to Guillain-Barré syndrome?

..."A combination of morphine and distraction seems to help bring me relief right now." Typical pain from GBS is often not relieved by medication other than opiates. Distraction, repositioning, massage, heat, cold, and guided imagery may enhance the opiate effects.

Which statement by the client with a family history of Huntington's disease indicates that teaching about this disease was effective?

..."The disease progresses differently if inherited from the father." Huntington's disease is a hereditary disorder with an autosomal dominant pattern of transmission. The client who inherits the mutation from his or her father has an earlier onset and shorter life expectancy than the client who inherits the disease from the mother.

For which side effects in the client with Parkinson's disease who has been taking a combination carbidopa-levodopa drug (Sinemet) for 3 years will the nurse monitor?

...Abnormal movements Following 3 or more years of treatment, about one third of clients develop involuntary movements that are thought to be treatment-related.

A client with multiple sclerosis has been treated for 6 months with mitoxantrone (Novantrone). Which clinical manifestation alerts the nurse to an adverse effect of this medication?

...Crackles in the lungs Mitoxantrone (Novantrone) is an antineoplastic agent that can cause cardiotoxicity when used for long periods. Adverse effects are congestive heart failure and dysrhythmias.

The nurse identifies the nursing diagnosis of impaired physical mobility related to bradykinesia for a patient with Parkinson's disease. To assist the patient to ambulate safely, the nurse should

...instruct the patient to rock from side to side to initiate leg movement. Rationale: Rocking the body from side to side stimulates balance and improves mobility. The patient should initially be ambulated with assistance but might not require continual assistance with ambulation. The patient should maintain a wide base of support to help with balance. The patient should lift the feet and avoid a shuffling gait.

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to

...perform necessary physically demanding activities in the morning. Rationale: 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 in situations where corticosteroid therapy should be discontinued. There is no decrease in sensation with MG, and muscle atrophy does not occur because muscles are used during part of the day.

A, B, C

A college student goes to the infirmary with a fever, headache, and stiff neck. The nurse suspects the student may have meningitis and has the student transferred to the hospital. If the diagnosis is confirmed, what should the nurse institute for those who have been in contact with this student? (Select all that apply.) A. administration of rifampin (Rifadin) B. administration of ciproflaxocin hydrochloride (Cipro) C. administration of ceftriaxone sodium (Rocephin) D. amoxicillin (Amoxil) E. rofecoxib (Vioxx)

B

A patient suspected of having GBS has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? A. glucose in the CSF B. elevated protein levels in the CSF C. red blood cells present in the CSF D. white blood cells in the CSF

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should a. attempt to institute bowel-training activities. b. provide the client with small, frequent feedings. c. obtain an order for intermittent catheterization. d. orient the client to his or her surroundings frequently.

ANS: B The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

The nurse explains that the pathology of Huntington's disease involves a. a decrease in the neurotransmitter norepinephrine. b. an excess of the neurotransmitter dopamine. c. destruction of white matter in the brain. d. formation of neurofibrillary tangles and plaques.

ANS: B The degeneration of the caudate nucleus leads to a reduction in several neurotransmitters, including gamma-aminobutyric acid, acetylcholine, substance P, and metenkephalin, and their synthetic enzymes. This change leaves relatively higher concentrations of the other neurotransmitters, dopamine and norepinephrine.

12. A client with MG began to experience a sudden worsening of her condition with difficulty in breathing. The nurse explains that this complication of MG is usually initially treated with a. admission and administration of IV corticosteroids. b. an increased dose of anticholinesterase drugs. c. bolus doses of atropine titrated to effect. d. rest and increased sleep.

ANS: B With myasthenic crisis, if an increase in the dosage of the anticholinesterase drug does not improve the weakness, endotracheal intubation and mechanical ventilation may be required. None of the other options is used to treat a myasthenic crisis.

When do you start antibiotics in bacterial meningitis?

Adults: after results of lumbar puncture come back Children: IMMEDIATELY - don't wait for lumbar puncture results

Chest Tube Management of the Chest Tube Chart 21-21

Chest Tube Management on Patient Chart 21-21 -auscultate lung sounds and assess for rate, rhythm, and depth -monitor oxygenation with pulse oximetry -monitor ECG for rate and rhythm changes -assess cap refill, skin color, and status of the surgical dressing -encourage and assist patient to turn, cough and take deep breaths. -verify that all connection tubes are patent and connected securely -assess that the water seal is intact when using a wet suction system, ans assess the regulator dial in dry suction systems -monitor characteristics of drainage, including color, amount and consistency -assess for significant increases and decreases in drainage output -note fluctuations in the water seal chamber for wet suction systems and the air leak indicator in dry suction systems -keep system below the patients chest level -assess suction control chamber for bubbling in wet suction systems -keep suction at prescribed level -maintain appropriate fluid in water seal in wet suction systems -keep air vent open when suction is off

A patient who has numbness and weakness of both feet is hospitalized with Guillain-Barré syndrome. The nurse will anticipate that collaborative interventions at this time will include

IV infusion of immunoglobulin (Sandoglobulin). Rationale: Because the Guillain-Barré syndrome is in the earliest stages (as evidenced by the symptoms), use of high-dose immunoglobulin is appropriate to reduce the extent and length of symptoms. Mechanical ventilation and tube feedings may be used later in the progression of the syndrome but are not needed now. Corticosteroid use is not helpful in reducing the duration or symptoms of the syndrome.

4.In reviewing laboratory data on a client, the nurse correlates which findings with Guillain-Barré syndrome (GBS)?

Increased cerebral spinal fluid (CSF) protein level without increased cell count A lumbar puncture is performed to evaluate the CSF. An increased CSF protein level without increased cell count is a distinguishing feature of GBS.

A

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? A. thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes B. after administration of the medication, there will be no change in the status of the ptosis or facial weakness C. the patient will have recovery of symptoms for at least 24 hours after the administration of Tensilon D. eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylecholine and will relieve symptoms

The nurse is preparing to provide care for a patient diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what? a) A lower motor neuron lesion b) Genetic dysfunction c) Decreased conduction of impulses in an upper motor neuron lesion d) Upper and lower motor neuron lesions

a) A lower motor neuron lesion

A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? a) Help the client perform range-of-motion (ROM) exercises every 8 hours. b) Use pressure-relieving devices when the client is in bed or in a wheelchair. c) Change body position every 2 hours. d) Use a footboard and trochanter rolls.

a) Help the client perform range-of-motion (ROM) exercises every 8 hours.

A patient diagnosed with multiple sclerosis (MS) has ataxia. Which of the following medications could be used to treat this clinical manifestation? a) Neurontin b) Baclofen c) Valium d) Dantrium

a) Neurontin Ataxia is a chronic problem most resistant to treatment. Medications used to treat ataxia include beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), and benzodiazepines (Klonopin).

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder? a) The immune system recognizes one's own tissues as "foreign." b) Excess cytokines cause tissue damage. c) The immune system recognizes one's own tissues as "self." d) Regulatory mechanisms fail to halt the immune response.

a) The immune system recognizes one's own tissues as "foreign."

The most helpful intervention by the nurse for a client experiencing a parkinsonian crisis would be to

a. administer oxygen by nasal catheter. b. give the client IV fluids that contain potassium. c. place the client in a nonstimulating environment. d. provide the client with foods high in calcium. ANS: C Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or sudden or inadvertent withdrawal of anti-parkinsonian medication. Severe exacerbation of tremor, rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea occur. The client should be placed in a quiet room with subdued lighting. Medical treatment may include barbiturates in addition to anti-parkinsonian drugs.

Secondary complications with Guillain-Barre Syndrome

autonomic dysfunction, DVT, pulmonary embolism, urinary retention

In evaluating laboratory data, the nurse correlates which results with the diagnosis of myasthenia gravis?

...Elevated acetylcholine receptor antibody levels Testing for acetylcholine receptor (AChR) antibodies is important, because 80% to 90% of clients with the disease have elevated AChR antibody levels.

The client with myasthenia gravis develops a sudden increase in weakness, accompanied by an increase in heart rate from 76 to 100 beats/min and an increase in blood pressure from 122/72 to 152/82 mm Hg. Which conclusion will the nurse reach from these findings?

...The client is experiencing myasthenic crisis. The client in myasthenic crisis experiences a rise in heart rate and blood pressure as well as an increase in muscle weakness.

The nurse recognizes which pathophysiologic feature as a hallmark of Guillain-Barré syndrome?

...The immune system destroys the myelin sheath.

A client is being treated in the clinic for an exacerbation of multiple sclerosis. The nurse would anticipate administering which drug?

a. Diazepam (Valium) b. Interferon β1b (Betaseron) c. Lioresal (Baclofen) d. Methylprednisolone (Solu-Cortef) ANS: B Drugs used to treat exacerbations in ambulatory clients include Interferon β1b, Interferon β1a (Avonex), and glatiramer acetate (Copaxone). Diazepam and lioresal could be used to treat spasticity, while steroids are used for acute relapses.

A client with MS is being taught self-care measures to prevent constipation. The nurse would realize goals for teaching had been met when the client states he/she will avoid

a. a high-fiber diet. b. citrus fruits. c. laxatives. d. stool softeners. ANS: C A high-fiber diet, bulk formers, and stool softeners are useful for maintaining stool consistency. Explain that laxatives and enemas should be avoided because they lead to dependence.

A 42-A 42 year-old patient who was adopted at birth is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the

availability of genetic testing to determine the HD risk for the patient's children.

Which of the following is the first-line therapy for myasthenia gravis (MG)? a) Deltasone (Prednisone) b) Pyridostigmine bromide (Mestinon) c) Lioresal (Baclofen) d) Azathioprine (Imuran)

b) Pyridostigmine bromide (Mestinon) (Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction)

A client with multiple sclerosis is being seen by a neuroophthalmologist for her routine eye exam. The nurse explains to the client that during the examination, she will be asked to fix her gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when she can see the object. The nurse further explains that the test being performed is called a ________. a) retinal angiography b) perimetry test c) slit-lamp examination d) color vision test

b) perimetry test

The nursing instructor is teaching the senior nursing class about neuromuscular disorders. When talking about Multiple Sclerosis (MS) what diagnostic finding would the instructor list as being confirmatory of a diagnosis of MS? a) An elevated acetylcholine receptor antibody titer b) Episodes of muscle fasciculations c) Oligoclonal bands d) IV administration of edrophonium

c) Oligoclonal bands

The nurse is caring for a patient with myasthenia gravis. The nurse generates a plan of care for the patient based on which of the following types of hypersensitivity reaction? a) Immune complex b) Delayed c) Anaphylactic d) Cytotoxic

d) Cytotoxic

The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder began? a) Muscle spasms b) Shortness of breath c) Sensitivity to bright light d) Drooping eyelids

d) Drooping eyelids

Which of the following is considered a central nervous system (CNS) disorder? a) Myasthenia gravis b) Guillain-Barré c) Bell's palsy d) Multiple sclerosis

d) Multiple sclerosis

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? a) Huntington disease b) Parkinson's disease c) Creutzfeldt-Jakob disease d) Multiple sclerosis (MS)

d) Multiple sclerosis (MS)

Which statement indicates that the family has a good understanding of the changes in motor movement associated with Parkinson's disease?

d. "I can offer smaller meals with bite-size portions and a liquid supplement." A masklike face, drooling, and excess perspiration are common in clients with Parkinson's disease. Changes in facial expression or a masklike facies in a Parkinson's disease client can be misinterpreted. Because chewing and swallowing can be problematic, small frequent meals and a supplement are better for meeting the client's nutritional needs.

What are primary complications of MS?

fatigue, depression, weakness, numbness, spacticity, pain, loss of balance, and difficulty in coordination

The nurse formulates the following nursing diagnosis for a client with MS: Impaired Physical Mobility related to muscle weakness. Useful interventions the nurse could plan include

having the client perform ROM exercises at least two times daily. Range-of-motion exercises should be performed at least twice daily.

When obtaining a health history and physical assessment for a patient with possible multiple sclerosis (MS), the nurse should

question the patient about any leg weakness or spasm.

Do patient's recover from Guillain-Barre Syndrome?

recovery rates vary, but most patients recover completely.

ImportaImportant self-care measures a nurse can teach a client with Parkinson's disease in order to prevent contractures and improve mobility include which of the following? (Select all that apply.)

...Bend over with your head over your toes to get out of chairs. Exercise first thing in the morning. Look up when you walk, not down at the floor. Clients with PD need to maintain mobility and prevent contractures. Options a, b, and d are important self-help measures. The client should use a wide-based gait. If it is too hard to get on the floor to exercise, the client should do exercises in bed.

Which nursing intervention will assist in preventing respiratory complications in the client with Parkinson's disease?

...Elevation of the back rest will help prevent aspiration. Maintaining the back rest elevation at greater than 30 degrees

Which teaching intervention is most appropriate for the client with Parkinson's disease?

...Fall precautions Rigidity in movement increases the risk of falls.

In planning discharge for the client with Parkinson's disease, the nurse collaborates with the physical therapist for which outcome?

...Maintaining physical strength and mobility Early in the disease process, collaborate with physical and occupational therapists to plan and implement a program to keep the client mobile and flexible by incorporating active and passive range-of-motion (ROM) exercises, muscle stretching, and activity.

A client presents with an acute exacerbation of multiple sclerosis. Which drug will the nurse be prepared to administer?

...Methylprednisolone (Medrol) Methylprednisolone is the drug of choice for acute exacerbations of the disease.

For which motor changes in the client with Huntington's disease will the nurse monitor?

...Rapid hand movements with no purpose An imbalance between excitatory and inhibitory neurotransmitters leads to uninhibited motor movements, such as brisk, jerky, purposeless movements of the hands, face, tongue, and legs.

In providing discharge teaching to the client with Parkinson's disease who is taking monamine oxidase type B (MAO-B) inhibitors (MAOIs), the nurse instructs the client to avoid which foods or beverages? (Select all that apply.)

...Smoked ham Sausage Beer Red wine Teach clients taking MAOIs about the need to avoid foods, beverages, and drugs that contain tyramine, including aged, smoked, or cured foods and sausage. Remind them also to avoid red wine and beer to prevent severe headache and life-threatening hypertension.

A patient has a new prescription for levodopa (L-dopa) to control symptoms of Parkinson's disease. Which assessment data obtained by the nurse may indicate a need for a decrease in the dose?

...The patient's blood pressure is 90/46 mm Hg. Rationale: Hypotension is an adverse effect of L-dopa, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with L-dopa use.

The nurse recognizes which pathophysiologic change in the client diagnosed with myasthenia gravis?

...There is a defect in the transmission of nerve impulses to the skeletal muscles. The major pathologic defect in myasthenia gravis is that nerve impulses are not transmitted to skeletal muscles at the neuromuscular junction

The nurse explains that the pathology of Huntington's disease involves

...an excess of the neurotransmitter dopamine. The degeneration of the caudate nucleus leads to a reduction in several neurotransmitters, including gamma-aminobutyric acid, acetylcholine, substance P, and metenkephalin, and their synthetic enzymes. This change leaves relatively higher concentrations of the other neurotransmitters, dopamine and norepinephrine

A client with MG began to experience a sudden worsening of her condition with difficulty in breathing. The nurse explains that this complication of MG is usually initially treated with

...an increased dose of anticholinesterase drugs. With myasthenic crisis, if an increase in the dosage of the anticholinesterase drug does not improve the weakness, endotracheal intubation and mechanical ventilation may be required. None of the other

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

...impaired verbal communication related to difficulty articulating. Rationale: The inability to use the tongue and facial muscles decreases the patient's ability to socialize or communicate needs. Disuse syndrome is not an appropriate nursing diagnosis because the patient is continuing to use the muscles as much as possible. There is no indication in the stem that the patient has a self-care deficit, bradykinesia, or rigidity. The oral mucous membranes will continue to be moist and should not be impaired by the patient's difficulty swallowing.

A 24A 29 -year-old patient is hospitalized with the onset of Guillain-Barré syndrome. During this phase of the patient's illness, the most essential assessment for the nurse to carry out is

...performing constant evaluation of respiratory function.

Nursing activities for a client with ALS and family include helping them a. decide on an acceptable level of care early in the course of the disease. b. determine if they want to share the diagnosis to allow genetic testing. c. incorporate nonpharmacologic pain control techniques in the plan of care. d. plan for extensive rehabilitation after exacerbations.

ANS: A Disease management in ALS includes topics such as tube feedings and mechanical ventilation. Planning for an acceptable level of care should begin early in the disease, before a crisis occurs. Of course, decisions should be re-evaluated occasionally as the client's wishes may changes with their experiences with the disease. ALS is not a genetically-acquired disorder. Pain control is usually not an issue in the disease, and as the disease is relentlessly progressive (rather than characterized by remissions and exacerbations), extensive rehabilitation is not utilized.

he nurse cautions clients with ALS and their families to be aware that (Select all that apply) a. activities should be spaced throughout the day. b. clients experience incontinence, an early cause of falling. c. cognition will usually decline late in the disease. d. muscle weakness may cause a risk for injury.

ANS: A, D Safety is a prime concern with ALS (and with any degenerative neurologic disorder). Muscle weakness is progressive, leading to increased risk of falls. Some interventions to prevent this include spacing activities throughout the day, conserving energy, avoiding extremes of hot and cold, and using assistive devices such as canes or wheelchairs. Clients with ALS usually do not experience incontinence and cognition remains intact for the duration of the disorder.

A client tells the nurse that he is experiencing some leg stiffness when walking and slowness when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This information leads the nurse to suspect

a. amyotrophic lateral sclerosis (ALS). b. Huntington's disease. c. myasthenia gravis (MG). d. Parkinson's disease (PD). ANS: D Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common early manifestation that usually occurs in one of the upper limbs.

The nurse reminds a group of students about the major component of pathophysiology in multiple sclerosis (MS), which is

a. damage occurs primarily to the dendrites and oligodendrites. b. once damaged, myelin cannot regenerate at all. c. plaques occur anywhere in the white matter of the central nervous system (CNS). d. Schwann cells are destroyed slowly but relentlessly. ANS: C Although plaques may occur anywhere in the white matter of the CNS, the areas most commonly involved are the optic nerves, cerebrum, and cervical spinal cord.

Manifestations of Guillain-Barre Syndrome

weakness, paralysis, parestheis, pain, diminished reflexes, bulbar weakness. - All symptoms start in lower extremities and progress upward

Which of the following are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. a) Aphasia b) Numbness c) Fatigue d) Spasticity e) Depression f) Pain

• Numbness • Pain • Spasticity • Fatigue • Depression