Chapter 58: Nursing Management: Chronic Neurologic Problems:Degenerative Neurologic Disorders

A patient was just diagnosed with Huntington's disease. The patient's adult child is upset about the diagnosis. How can the nurse best help the patient's child? Provide emotional and psychologic support. Encourage him or her to get diagnostic genetic testing done. Tell him the cognitive deterioration will be treated with counseling. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).

Provide emotional and psychologic support.

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority? Risk for injury Acute confusion Fluid volume deficit Ineffective thermoregulation

Risk for injury

A patient with multiple sclerosis has been advised to use dalfampridine to improve walking speed. What questions should the nurse ask the patient before administering the medication? Select all that apply. Do you have kidney disease? Does your work involve operating machinery? Do you have a history of any seizure disorder? Does any member of the family have diabetes? Have you been taking any over-the-counter medications?

Do you have kidney disease? Do you have a history of any seizure disorder?

The nurse is performing a physical examination on a patient with Parkinson's disease. What manifestations of Parkinson's disease is the nurse likely to find? Select all that apply. Nystagmus Drooling of saliva Patchy blindness Decreased arm swing Shuffling, propulsive gait

Drooling of saliva Decreased arm swing Shuffling, propulsive gait

A patient with Parkinson's disease is prescribed sinemet. Which side effects of the drug would the nurse monitor for in this patient? Select all that apply. Dizziness Dyskinesia Severe headache Involuntary eyelid movements Severe nausea and vomiting

Dyskinesia Involuntary eyelid movements Severe nausea and vomiting

A patient has been found to have amyotrophic lateral sclerosis. What classic symptom of the disorder does the nurse recognize? Dysuria Dyspnea Dysphagia Dysreflexia

Dysphagia

Which drug overdose may lead to paradoxic intoxication in a patient with parkinsonism? Levodopa Biperiden Trihexyphenidyl Diphenhydramine

Levodopa

When performing a physical assessment on a patient with amyotrophic lateral sclerosis, which manifestations is the nurse likely to find? Select all that apply. Limb weakness Difficulty swallowing Difficulty articulating words Twisting movements of the face Involuntary movements of the body

Limb weakness Difficulty swallowing Difficulty articulating words

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease? Lose balance and sit down Lose balance and fall forward Lose balance and fall backward Lose balance and become unconscious

Lose balance and fall backward

A patient is advised to use teriflunomide for multiple sclerosis. What nursing interventions are important for this patient? Select all that apply. Monitor liver function tests. Monitor blood pressure levels. Instruct the patient to avoid driving. Ask the patient to restrict salt intake. Instruct the patient to avoid pregnancy.

Monitor liver function tests. Instruct the patient to avoid pregnancy.

A patient who has multiple sclerosis has received a prescription for a medication to alleviate the major symptoms of the disease. The nurse expects the medication to be in what drug classification? Antipsychotics Muscle relaxant Antihypertensive Narcotic analgesic

Muscle relaxant

Which autoimmune disease is characterized by a decreased number of acetylcholine receptors in the neuromuscular junction? Multiple sclerosis Myasthenia gravis Lou Gehrig's disease Huntington's disease

Myasthenia gravis

A patient with an aggressive form of multiple sclerosis is not responding to the drugs teriflunomide and dalfampridine. The patient is then prescribed natalizumab and mitoxantrone. The patient is later diagnosed with progressive multifocal leukoencephalopathy. Which medication in the patient's prescription might be responsible for this complication? Natalizumab Mitoxantrone Teriflunomide Dalfampridine

Natalizumab

Which nerve is represented as [CN] V? Facial nerve Vagus nerve Trigeminal nerve Glossopharyngeal nerve

Trigeminal

What suggestion should the nurse give to the family members of a patient with Parkinson's disease to promote self-care and independence of the patient? Select all that apply. Use slip-on shoes. Use rugs on the floor. Use an elevated toilet seat. Use buttons and hooks on clothes. Elevate the legs on an ottoman when sitting.

Use slip-on shoes. Use an elevated toilet seat. Elevate the legs on an ottoman when sitting.

Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)? Vigilant infection control and adherence to standard precautions Careful monitoring of neurologic assessment and frequent reorientation Maintenance of a calorie count and hourly assessment of intake and output Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Vigilant infection control and adherence to standard precautions

A patient with Parkinson's disease is unresponsive to drug therapy and is being considered for surgery. After the physician discusses surgical options, about which options does the nurse anticipate educating the patient? Select all that apply. Ablation Thymectomy Transplantation Deep brain stimulation Dorsal-column electrical stimulation

Ablation Transplantation Deep brain stimulation

Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)? Acute confusion Bowel incontinence Activity intolerance Disturbed sleep pattern

Activity intolerance

A patient with Parkinson's disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition? Allow adequate time for the patient to eat meals. Administer prescribed carbidopa/levodopa with a protein drink. Encourage the patient to eat at least every two hours while awake. Include foods that are chewy so the patient builds up the jaw muscles.

Allow adequate time for the patient to eat meals.

Which type of drug is prescribed to patients with parkinsonism with a condition such as hypomobility? Ropinirole Pramiprexole Apomorphine Bromocriptine

Apomorphine

Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? Referring the patient for genetic counseling Teaching the patient about medications used during acute exacerbations Assisting the patient in identifying the factors that precipitate exacerbations Instructing the patient in the proper technique for self-administration of an enema

Assisting the patient in identifying the factors that precipitate exacerbations

A patient is advised to use diazepam for multiple sclerosis. What patient teaching is important for those taking this drug? Select all that apply. Avoid driving while on the drug. Do not stop the drug abruptly. Avoid taking alcohol with the drug. Monitor blood pressure regularly. Avoid contact with large crowds.

Avoid driving while on the drug. Do not stop the drug abruptly. Avoid taking alcohol with the drug.

The nurse is caring for a patient with a spastic bladder secondary to multiple sclerosis. What manifestations of spastic bladder should the nurse expect to find in the patient? Select all that apply. Bladder contractions are unchecked. The patient experiences urinary retention. The bladder has a small capacity for urine. The patient experiences incontinence and dribbling. There is no sensation of urge to void or no desire to void.

Bladder contractions are unchecked. The bladder has a small capacity for urine. The patient experiences incontinence and dribbling.

Which drug helps to increase the bioavailability of levodopa in the brain by inhibiting the enzyme dopa-decarboxylase? Carbidopa Tolcapone Rasagiline Entacapone

Carbidopa

A patient with a family history of Huntington's disease suffers from a psychiatric disorder and is treated with sertraline and paroxetine. Tetrabenazine is added to the patient's prescription. Which assessment finding supports the addition of tetrabenazine to the prescription? Chorea Anxiety Depression Social withdrawal

Chorea

The nurse is caring for a patient with Parkinson's disease. What adjustments should the nurse make in the dietary habits of the patient to prevent malnutrition and constipation? Select all that apply. Cut food into bite-size pieces. Serve hot foods on a warmed plate. Include whole grains and fruits in the diet. Include plenty of food items high in protein. Provide three large meals rather than six small meals.

Cut food into bite-size pieces. Serve hot foods on a warmed plate. Include whole grains and fruits in the diet.

The nurse is caring for a patient with multiple sclerosis in remission. What information should the nurse include when teaching the patient about advantages of exercise for multiple sclerosis? Select all that apply. Decreases spasticity Increases coordination Helps to regain bladder control Delays the demyelination process Retrains unaffected muscles to substitute for impaired ones

Decreases spasticity Increases coordination Retrains unaffected muscles to substitute for impaired ones

When establishing a diagnosis of multiple sclerosis (MS), about what diagnostic studies should the nurse teach the patient? Select all that apply. EEG Carotid duplex scan Evoked response testing Cerebrospinal fluid analysis Computed tomography (CT) scan

Evoked response testing Cerebrospinal fluid analysis Computed tomography (CT) scan

Which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder? Multiple sclerosis Myasthenia gravis Lou Gehrig's disease Huntington's disease

Huntington's disease

Which degenerative neurologic disorder is characterized by a deficiency of ϒ-aminobutyric acid (GABA) and acetylcholine? Myasthenia gravis Parkinson's disease Lou Gehrig's disease Huntington's disease

Huntington's disease

When performing a physical assessment of a patient with myasthenia gravis, what clinical manifestations is the nurse likely to find? Select all that apply. Muscle atrophy Abnormal reflexes Impaired facial mobility Difficulty in swallowing food Voice fading after a long conversation

Impaired facial mobility Difficulty in swallowing food Voice fading after a long conversation

A patient complains of difficulty with eye and eyelid movement, chewing, swallowing, speaking, and breathing. Which findings in the patient's diagnostic results would indicate the presence of myasthenia gravis? Select all that apply. Alteration of one copy of gene in DNA test Improved muscle contractibility during the Tensilon test Presence of three signs of the classic triad: tremor, rigidity, and bradykinesia Decreased response to repeated stimulation of hand muscles during EMG test Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test

Improved muscle contractibility during the Tensilon test Decreased response to repeated stimulation of hand muscles during EMG test

A patient with Willis-Ekbom disease is admitted to the hospital. What are the signs and symptoms that the nurse is likely to find during data collection and assessment? Select all that apply. Numbness and tingling in the legs Discomfort that occurs during activity Leg pain localized to the calf muscles Sensation like bugs creeping on the legs Occurrence of symptoms mostly in the morning

Numbness and tingling in the legs Leg pain localized to the calf muscles Sensation like bugs creeping on the legs

A patient with myasthenia gravis is admitted to the hospital in respiratory failure and diagnosed with myasthenic crisis. Which of the factors in the patient's current life situation led to the development of this myasthenic crisis? Select all that apply. Omitted pyridostigmine previous day. Attended funeral of family member earlier in week. Took antibiotic prescribed for urinary tract infection. Diagnosed with urinary tract infection previous week. Continued taking prescribed corticosteroid every other day.

Omitted pyridostigmine previous day. Attended funeral of family member earlier in week. Took antibiotic prescribed for urinary tract infection. Diagnosed with urinary tract infection previous week.

A patient with parkinsonism on a dopamine agonist medication reports severe nausea and vomiting. After receiving the antiemetic, the patient lost consciousness due to a sudden drop in blood pressure. Which antiemetic drug interaction is responsible for the patient's condition? Ondansetron and amantadine Ondansetron and apomorphine Trimethobenzamide and amantadine Trimethobenzamide and apomorphine

Ondansetron and apomorphine

Which disease is characterized by a degeneration of dopamine-producing neurons and decreased levels of dopamine? Multiple sclerosis Parkinson's disease Lou Gehrig's disease Huntington's disease

Parkinson's disease

Which neurologic disorder has paradoxic intoxication as a potential adverse effect of medication therapy? Multiple sclerosis Myasthenia gravis Parkinson's disease Huntington's disease

Parkinson's disease

A patient with myasthenia gravis is concerned whether he or she will need a thymectomy. For which patients is thymectomy performed? Select all that apply. Patients with thymoma Patients with cholinergic crisis Patients with a positive Tensilon test Patients with purely ocular myasthenia gravis Patients between the ages of puberty and about 65 years

Patients with thymoma Patients with purely ocular myasthenia gravis Patients between the ages of puberty and about 65 years

The nurse is planning discharge teaching for a patient with myasthenia gravis. What instructions should the nurse include in the plan? Select all that apply. Plan activities with periods of rest. Practice hobbies such as playing golf. Include liquid rather than solid foods in the diet. Eat a balanced diet that can be easily chewed and swallowed. Schedule drugs so that the peak effect of the drug is at mealtime.

Plan activities with periods of rest. Eat a balanced diet that can be easily chewed and swallowed. Schedule drugs so that the peak effect of the drug is at mealtime.

A patient, whose parent died from Huntington's disease, is discussing the condition and genetic testing with a nurse. Which of the patient's statements needs to be corrected by the nurse? Currently there is no effective treatment or cure for Huntington's disease. Offspring of persons with Huntington's disease have a 50% risk to develop it. Positive genetic testing indicates the patient eventually will develop the disease. Positive genetic testing indicates at what age the symptoms of the disease will occur.

Positive genetic testing indicates at what age the symptoms of the disease will occur.

Which criterion is included to establish that a patient has Parkinson's disease? Select all that apply. Decreased serum dopamine levels. Tumor present in the thymus gland. Positive response to antiparkinsonian medications. Magnetic resonance imaging (MRI) shows areas of plaque on cranial nerves. Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

Positive response to antiparkinsonian medications. Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

A patient diagnosed with myasthenia gravis reports difficulty in swallowing, chewing, eye movement, and facial mobility. Which drugs are most suitable for the patient? Select all that apply. Tramadol Prednisone Azathioprine Chlorzoxazone Pyridostigmine

Prednisone Azathioprine Pyridostigmine

A patient with a suspected neurologic disorder has weakness of the limbs, blurred vision, patchy blindness, and bowel and bladder dysfunction. Which clinical findings would support the diagnosis of multiple sclerosis? Select all that apply. Presence of visual and auditory evoked potential Presence of IgM antibodies in the cerebrospinal fluid Presence of increased IgG antibodies in the cerebrospinal fluid Presence of an altered copy of the HTT gene located on chromosome 4 Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

Presence of visual and auditory evoked potential Presence of increased IgG antibodies in the cerebrospinal fluid Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

What nursing interventions would be applied first for the patient with acute exacerbation of multiple sclerosis? Select all that apply. Assisting the patient with the grieving process Preventing the complication of pressure ulcers Preventing the complication of urinary tract infections Teaching the patient to build a general resistance to illness Teaching the patient to maintain a good balance between exercise and rest

Preventing the complication of pressure ulcers Preventing the complication of urinary tract infections

A patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? Provide multivitamins with each meal. Provide a diet that is low in complex carbohydrates and high in protein. Provide small, frequent meals throughout the day that are easy to chew and swallow. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

Provide small, frequent meals throughout the day that are easy to chew and swallow.

The registered nurse supervises a student nurse providing care to a patient with Huntington's disease (HD). Which action of the student nurse needs correction? Providing more fluid diet to the patient Providing a low-calorie diet not more than 2000 calories/day Providing palliative care is the only option for collaborative care Providing comfortable environment by maintaining physical safety

Providing a low-calorie diet not more than 2000 calories/day

Which measure should the nurse initially include in the plan of care for a patient who has difficulty swallowing as a result of Parkinson's disease? Arranging for someone to feed the patient Providing the patient with semisolid or soft foods Encouraging the patient to drink fluids with meals Placing food in the unaffected side of the patient's mouth

Providing the patient with semisolid or soft foods

A patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS? Reduce fat intake Reduce the risk of aspiration Decrease injury related to falls Decrease pain secondary to muscle weakness

Reduce the risk of aspiration

What is the major complication associated with myasthenic crisis? Speech alteration Difficulty chewing Impaired facial mobility Respiratory insufficiency

Respiratory insufficiency

A patient with multiple sclerosis is under treatment with β-interferon. What patient teaching would be appropriate for this patient? Select all that apply. Do not drink grape juice. Monitor vital signs regularly. Rotate injection sites with each dose. Know that flu-like symptoms are common. Wear sunscreen while exposed to sunlight.

Rotate injection sites with each dose. Know that flu-like symptoms are common. Wear sunscreen while exposed to sunlight.

Which type of multiple sclerosis is characterized by a relapsing-remitting initial course followed by disease with or without relapses? Relapsing-remitting Primary-progressive Progressive-relapsing Secondary-progressive

Secondary-progressive

A patient is diagnosed with multiple sclerosis (MS) and is prescribed interferon. What should the nurse include in medication teaching? The medication should be taken before meals on an empty stomach. The medication often causes patients to experience flu-like symptoms. The medication is given during exacerbation of symptoms to promote remission. The medication alters carbohydrate metabolism and elevates serum glucose levels.

The medication often causes patients to experience flu-like symptoms.

A patient with a family history of Huntington's disease (HD) who underwent genetic testing has positive results. What can the nurse infer from this finding? Select all that apply. There is no cure for this disease. The patient would not be treated completely with the help of drugs. The patient will develop a progressive, degenerative brain disorder. The onset of disease usually occurs between 30 and 50 years of age. The patient will be a carrier of the mutated gene but will not develop the disease.

There is no cure for this disease. The patient will develop a progressive, degenerative brain disorder. The onset of disease usually occurs between 30 and 50 years of age.

A patient being treated for multiple sclerosis complains of flu-like symptoms and reports feeling depressed. The patient also reports having frequent thoughts of committing suicide. Which drug in the patient's prescription may be responsible for these symptoms? β-interferon Natalizumab Mitoxantrone Dalfampridine

β-interferon