Heme/neuro passpoint

A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching?

"This disease doesn't cause sensory impairment."

When teaching a client about levodopa-carbidopa therapy for Parkinson's disease, a nurse should include which instruction?

"Be aware that your urine may appear darker than usual.

A client newly diagnosed with multiple sclerosis worries that their employer will fire them now that the client has a condition that might interfere with work. How should the nurse respond?

"Groups like the National Multiple Sclerosis Society (Multiple Sclerosis Society of Canada) can assist with this issue."

A client with multiple sclerosis (MS) is receiving discharge instructions from the nurse. Which statement by the client indicates that more instruction is required?

"I will walk with my feet close together."

Using the Morse Fall Scale (see chart), order the following clients from lowest to highest fall risk. All options must be used.

27-year-old client with acute pancreatitis receiving morphine sulfate IV every 2 hours as needed for pain; has no significant medical history, smokes two packs of cigarettes per day, may be up independently, and has a steady gait. 48-year-old who is quadriplegic admitted for wound care of a stage IV pressure ulcer, receiving IV antibiotics per a peripherally inserted central catheter (PICC); the client is alert and oriented. 84-year-old client with non-insulin-dependent diabetes admitted with new-onset confusion, and forgets about limitations of activity. The client reportedly fell at home last week, is currently on bed rest, and has normal saline infusing per saline lock. 62-year-old client with Parkinson disease, admitted for pneumonia and receiving IV antibiotics. The client reports falling at home but continues to ambulate with a cane. During this hospitalization, the client has gotten out of bed without calling for assistance.

Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy?

30-year-old client with schizophrenia who is taking chlorpromazine

The nurse is assessing the client with Parkinson disease. Which finding is expected?

A stiff, masklike facial expression

The nurse is developing a care plan for a client who has leukemia. What instruction(s) should the nurse include in the plan? Select all that apply.

Avoid foods high in pyridoxine (vitamin B12)

In providing care to the client with leukemia who has developed thrombocytopenia, the nurse assesses the most common sites for bleeding. Which is not a common site?

Bilary system

A health care provider (HCP) has prescribed carbidopa-levodopa four times per day for a client with Parkinson disease. The client wants "to end it all now that the Parkinson disease has progressed." What should the nurse do? Select all that apply.

Contact the HCP before administering carbidopa determine if the patient is on an antidepressants or monoamine oxidase (MAO inhibitors) determine risk for suicide

The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply.

Drink 400to 500 ml with each meal drink fluids midmorning, midafternoon, and late afternoon attempt to void at least every 2 hrs use intermittent catheterization as needed

The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. What should the nurse do?

Explain how to overcome a freezing gait by telling the client to march in place

The nurse is assessing a client with multiple sclerosis for potential complications of the disease. Which symptom(s) would indicate the development of a complication? Select all that apply.

Falls skin breakdown fatigue

A client with a new diagnosis of myasthenia gravis asks, "What is happening to me?" What would be the most appropriate response by the nurse?

It is a chronic disease in which there is a disturbance in nerve transmission to the muscle, resulting in fatigue and muscle weakness.

The nurse is planning care with a client newly diagnosed with myasthenia gravis. Which is an appropriate goal to establish?

Maintain respiratory function

The nurse is developing a care plan for a client who has leukemia. What instruction(s) should the nurse include in the plan? Select all that apply.

Monitor temp and report elevation Recognize s/s of infection Avoid crowds Maintain the integrity of skin and mucous membranes

A client with suspected myasthenia gravis is to undergo a test with edrophonium. The client asks if edrophonium can be used to treat myasthenia gravis. What is the nurse's best response?

The short half-life of edrophonium makes it impractical for long-term use.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections

Diagnosis of myasthenia gravis is confirmed by evaluating the client's response to an intravenous injection of the cholinesterase inhibitor edrophonium. If the client responds positively, what would the nurse expect?

a rapid and dramatic increase in muscle strength

The nurse is discussing discharge instructions with a client with myasthenia gravis who is taking pyridostigmine. The nurse should tell the client to:

administer artificial tears

The nurse is admitting a client diagnosed with multiple sclerosis (MS). Which medication would the nurse expect to find on the client's record?

baclofen for muscle spasms

The nurse is developing a discharge teaching plan with a client with multiple sclerosis who has an impaired peripheral sensation. Which information should the nurse include in the discharge teaching plan? Select all that apply.

carefully test the temperature of bath water Avoid hot water bottles or heating pads Inspect the skin daily for injury or pressure points Wear warm clothing

The nurse is assessing a client receiving levodopa-carbidopa for treatment of Parkinson's disease. The nurse should document which assessment findings as evidence of a positive response to treatment? Select all that apply.

decreased dyskinesia reduced rigidity and tremor

A nurse is teaching a client, who has Parkinson's disease, and their family about dietary practices. Which signs and symptoms are most important for the nurse to address? Select all that apply.

drooling aspiration choking dysphagia

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

edrophonium

A client with multiple sclerosis (MS) is started on 20 mg of glatiramer subcutaneously daily. Immediately after the injection, the client experiences flushing and chest pain. What is the most appropriate nursing intervention?

monitor the client to see if the symptoms quickly dissipate Glatiramer helps to decrease the number of relapses in the MS client. Flushing, chest pain, palpitations, anxiety, shortness of breath, and itching occur in some clients following administration of the medication. They typically are transient and self-limiting and don't need specific treatment.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to

sit upright, leaning slightly forward.

A nurse is caring for a client with myasthenia gravis. What assessment findings would indicate an emergency?

sudden dyspnea, intensification of dysphagia, and dysarthria

A client with thrombocytopenia has developed a hemorrhage. The nurse should assess the client for which finding?

tachycardia

The nurse is assessing a client with Parkinson disease. Which is an initial sign of Parkinson disease?

tremor

A 35-year-old client diagnosed with multiple sclerosis three years ago presents the nurse with an advance directive refusing intubation, mechanical ventilation, and tube feedings. How should the nurse respond?

"You should review this information with your healthcare provider at every admission."

A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" Which response by the nurse is most appropriate?

"You sound upset. Please share with me what you're feeling."

After teaching a client about myasthenia gravis, the nurse would judge that the client has formed a realistic concept of the disease and the treatment plan when the client makes which statement?

"I'll be able to control the disease and enjoy a healthy lifestyle."

A client with stage IV Parkinson's disease is admitted to the emergency department with heart failure. The client's advance directive dictates no cardiopulmonary resuscitation, intubation, or artificial feedings. The client is receiving diuretics to treat heart failure. The licensed practical nurse states, "This client shouldn't have come to the hospital because they have an advance directive." Which response by the registered nurse is best?

"Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure."

A client with chronic progressive multiple sclerosis is learning to use a walker. What instruction will best ensure the client's safety?

"Place the walker directly in front of you and step into it as you move it forward."

The right hand of a client with multiple sclerosis trembles severely whenever they attempt a voluntary action. The client spills their coffee twice at lunch and cannot get their dress fastened securely. Which is the best legal documentation in the nurse's notes of the medical record for this client assessment?

"The client's slight shaking of the right hand increases to a severe tremor when the client tries to button their clothes or drink from a cup."

The rehabilitation nurse is caring for a client with a health history of multiple sclerosis (MS) for 10 years. Recently, the nurse has seen a significant decline in the client's function. When reevaluating the client's plan of care, the nurse considers the client's physiologic changes associated with the decline. Arrange the following degenerative changes in the order in which they occur. All options must be used.

1. Myelin attacked immune system 2. Demyelination throughout the CNS 3. degeneration of axons 4. Plaque formation that interrupts nerve impulses 5. periodic, unpredictable exacerbation and remission

A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find?

Vision changes

The nurse is planning care for a client with multiple sclerosis. Which problems should the nurse expect the client to experience? Select all that apply.

Visual disturbances Balance problems mood disorders

The nurse is reviewing assessment data and admission orders of a client. The provider has ordered the I.V. administration of phenytoin. The nurse determines that further intervention is required when the admission assessment includes which findings? Select all that apply.

nosebleeds Hx stroke-adams syndrome Hx bone marrow depression

A client is receiving intravenous (I.V.) heparin for the treatment of thrombophlebitis. Which laboratory value should the nurse monitor throughout heparin therapy? Select all that apply.

partial thromboplastin time (PTT) platelet count

The nurse assesses a child with leukemia. Which sign(s) or symptom(s) would lead the nurse to suspect the client has thrombocytopenia? Select all that apply.

petechiae epistaxis

A client is admitted to the hospital with an exacerbation of multiple sclerosis after an MRI revealed progressive demyelination. The nurse should assess for which symptom? Select all that apply.

progressive weakness of the extremities inability to ambulate independently urinary incontinence

When caring for a client with myasthenia gravis, the nurse should assess the client for which manifestation(s) of cholinergic crisis? Select all that apply.

ptosis fasciculation respiratory rate of 6 bpm

A client with amyotrophic lateral sclerosis (ALS) is admitted with weight loss and malnutrition. The client can swallow without difficulty. While caring for the client, the nurse discovers that the weight loss is related to the client's refusal to eat. The client states to the nurse that they would rather die than remain alive with this disease. How should the nurse intervene?

Explore the client's feelings about dealing with ALS using open-ended questions.

A nurse is administering neostigmine to a client with myasthenia gravis. Which nursing intervention should the nurse implement?

Give medications before meals to improve swallowing or chewing before eating

A nurse is caring for a client with multiple sclerosis. The client informs the nurse that a lawyer is coming to prepare a living will and requests the nurse to sign as witness. Which action should the nurse take?

Note that the nurse caring for the client cannot be a witness.

A client with Parkinson disease needs a long time to complete morning care but becomes annoyed when the nurse offers assistance and refuses all help. Which action should the nurse take?

Praise the client for the desire to be independent, and give extra time and encouragement

A client receiving intravenous heparin has developed hematuria and petechiae. What is the nurse's best action?

Protomine sulfate

A client with cancer has thrombocytopenia. Which information should the nurse include in the teaching plan? Select all that apply.

Use an electric razor. Soft-bristle tooth brush avoid frequent flossing report bleeding such as petechiae, melena, to HCP

A client is being treated for deep vein thrombosis (DVT) in the left femoral artery. The health care provider (HCP) has prescribed 60 mg of enoxaparin subcutaneously. Before administering the drug, the nurse checks the client's laboratory results. (See image.) Based on these results, what should the nurse do?

Withhold the dose of the medication, and contact the HCP.

A nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by

a lower motor neuron lesion.

The nurse is discussing discharge instructions with a client with myasthenia gravis who is taking pyridostigmine. What should the nurse instruct the client to do?

administer artificial tears The nurse instructs the client regarding the use of artificial tears because eyelid and extraocular muscles are frequently affected by myasthenia gravis and there is a risk for corneal abrasion if the eyelids do not close completely. The client is encouraged to maintain social contacts and prevent social isolation by staying at home. Medication is taken in the morning, before activities, so the client can complete them. A nutritious diet is encouraged, and there is no indication to limit protein.

The nurse is caring for a client diagnosed with idiopathic thrombocytopenia purpura (ITP). The nurse includes what intervention?

administering stool softeners as prescribed to prevent straining during defecation

A client with thrombocytopenia has a severe headache. The nurse should interpret this finding as resulting from which underlying cause?

cerebral bleeding

Which category of medications would the nurse expect to administer for a client with myasthenia gravis?

cholinesterase inhibitors and corticosteroids

A nurse administering medications is unfamiliar with ropinirole, the medication ordered for a client with Parkinson's disease. What actions should the nurse perform prior to administering the medication? Select all that apply.

contact pharmacy refer to drug guide

A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used?

experiences spontaneous remissions from time to time.

A client with Parkinson's disease is receiving carbidopa-levodopa therapy. Which clinical manifestations are common side effects associated with this medication? Select all that apply. Facial ticks head bobbing pill rolling aphasia blurred vision

facial tics head bobbing pill rolling

Which is an expected outcome for a client with Parkinson's disease who has had a pallidotomy?

improved functional ability

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

inspecting the skin for petechiae once every shift

A physician diagnoses a client with myasthenia gravis, and orders pyridostigmine, 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which preexisting condition should lead the nurse to question this drug order?

intestinal obstruction Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury aren't contraindications for use of the drug.

The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which result indicates the presence of inflammation?

leukocytosis

A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is not appropriate?

limiting fluid intake to 1,000 mL/day

The nurse is working with an interprofessional team to plan care for a client with Parkinson disease. Which goal is best collaboratively established by the client with Parkinson disease, the nurse, and the physical therapist?

maintaining joint flexibility

The nurse is assessing a client with multiple sclerosis. Which is an expected health problem?

mood disorder

A client with Parkinson disease is prescribed levodopa (L-dopa) therapy. Improvement in which area indicates effective therapy?

muscle rigidity

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to

rest in an AC room

A client in the emergency department with a cardiac dysrhythmia is to receive a prescribed dose of procainamide. For which conditions in the client's history would the nurse withhold the medication until the order is clarified? Select all that apply.

second-degree heart block myasthenia gravis systemic lupus erythematosus (SLE

A client with respiratory complications of multiple sclerosis (MS) is admitted to the intensive care unit. Which equipment is most important for the nurse to keep at the client's bedside?

suction machine with catheters MS weakens the respiratory muscles and impairs swallowing, putting the client at risk for aspiration. To ensure a patent oral airway, the nurse should keep a suction machine and suction catheters at the bedside. A sphygmomanometer is no more important for this client than for any other. A padded tongue blade is an appropriate seizure precaution, but should not be used in this client because its large size could cause oral airway obstruction. A nasal cannula and oxygen would be ineffective to ensure adequate oxygen delivery; this client requires a mechanical ventilator.

A client with suspected myasthenia gravis is scheduled for a edrophonium test. The nurse identifies which test finding that most likely indicates a positive test result?

temporarily muscle improvement

The nurse notices that a client with Parkinson disease is coughing frequently when eating. Which action should the nurse take?

thicken all liquids before offering them to the client

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/µl. What term should the nurse use to describe this low platelet count?

thrombocytopenia

Which goal is the most realistic for a client diagnosed with Parkinson disease?

to maintain optimal body function

What emergency procedures would the nurse anticipate being implemented during a myasthenia gravis crisis?

tracheotomy with mechanical ventilation

The nurse is teaching a client with Parkinson disease about managing hyperkinesia. At what time of day should the nurse encourage the client to schedule the most demanding physical activities to minimize the effects of hypokinesia?

when the peak action of drug therapy occurs

The nurse is assessing the home care needs of a group of clients. Which client(s) qualify for home care services? Select all that apply.

who has episodes of vertigo that result in falls who has multiple sclerosis with an open, draining lesion on the foot

The partner of a client with end-stage amyotrophic lateral sclerosis (ALS) discusses with the nurse that the partner is uncomfortable, does not want to be the health care proxy decision maker, and wishes that one of the children take on this responsibility. What is the nurse's first action to facilitate support of the client's family member after their discussion?

Explore with the partner how to hold a family meeting and address this concern with all of the children.

The nurse is assessing a client with multiple sclerosis who is experiencing mobility problems. What question about diagnostic studies would the nurse ask the client while obtaining the client's history?

Have you had a recent dual-energy x-ray absorptiometry (DEXA) scan?

What manifestations are important for the nurse to assess in a 43-year-old client who has developed thrombocytopenia after undergoing colon cancer treatment? Select all that apply.

Hematuria Ecchymosis Melena Epistaxis

The nurse is teaching a client with a history of acquired thrombocytopenia about how to prevent and control hemorrhage. Which statement indicates that the client needs further instruction?

I can count the number of tissues saturated to detect blood loss during a nosebleed."

The nurse is assigned to four clients. After receiving a change-of-shift report at 0700, the nurse should assess which client first?

a 63-year-old with multiple sclerosis who has an oral temperature of 101.8°F (38.8°C) and flank pain

The nurse is planning staffing assignments for a group of clients. Which client is most appropriate for the nurse to assign to a nurse who normally works on the maternity unit?

a client who had an open appendectomy yesterday

A client with thrombocytopenia has just had a bone marrow aspirate performed to monitor for treatment effectiveness. Which nursing intervention takes priority?

applying pressure to the puncture site for a full 10 minutes

The nurse is developing a teaching plan with a client with myasthenia gravis. The nurse should include information about the risk for which health problem?

aspiration

A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery — this will go away on its own." In considering her response to the client, the nurse must depend on the ethical principle of:

autonomy.

A client with Parkinson's disease visits the physician's office for a routine checkup. The nurse notes that the client takes benztropine, 0.5 mg P.O. daily, and asks when the client takes the drug each day. Which response indicates that the client understands when to take benztropine?

bedtime To minimize the risk of adverse drug reactions, the client should take benztropine as a single dose at bedtime. Taking it on arising in the morning or taking it with or after a meal wouldn't minimize adverse effects.

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

edrophonium (acetylcholinesterase inhibitor IV test)

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order

electromyography (EMG)

A client with Parkinson's disease needs assistance with eating but does not require thickened liquids to aid swallowing. For what action by the unlicensed assistive personnel should the nurse intervene?

elevating the head of the client's bed to 45 degrees

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that the client has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?

ineffective tissue perfusion; cerebral, cardiopulmonary, GI

A client with idiopathic thrombocytopenic purpura (ITP) is being treated with prednisone and rituximab. The nurse prioritizes what aspect of care planning?

infection control methods

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?

injury related to the decrease of platelet count

A nurse is taking a medication history on a client with multiple sclerosis before administering an initial dose of baclofen. What should the nurse check before administering the drug? Select all that apply.

muscle weakness muscle spasms serum creatinine blood glucose

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used

to provide long-term access to central veins.

.A client is discharged to home following hospitalization for percutaneous endoscopic gastrostomy tube placement to assist with nutrition. The client's primary diagnosis is amyotrophic lateral sclerosis (ALS). The client can transfer from the bed to a chair but can't walk. The client and their family are concerned about the client's ability to maintain mobility at the highest possible level following a surgical procedure. The nursing diagnosis most appropriate for this client is

Impaired physical mobility related to decreased motor agility secondary to ALS as manifested by inability to ambulate.

A nurse is caring for a client recovering from cardiac revascularization surgery of 3 days ago. Upon analysis of lab reports, the nurse notes the client's platelet count decreased from 230,000 to 5,000 ml (5,000 mmol/L). Which condition is suspected?

Heparin Induced thrombocytopenia

The nurse is teaching a client with myasthenia gravis how to prevent a myasthenic crisis. What topic is most important to include?

Receive an annual influenza vaccination.

An older adult client in stage 2 of Parkinson disease is being discharged with cellulitis of the right lower extremity. The nurse should base the discharge plan on which information? Select all that apply.

Risk for skin breakdwon Potential for falls

A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an I.V. injection of a medication. What is the medication the nurse tells the client they'll receive during this test?

edrophonium

The nurse is assisting a client with multiple sclerosis (MS) set long-term goals. Which goal is realistic?

improved muscle strength

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation?

increased restlessness

The nurse is caring for a 19-year-old client recently diagnosed with multiple sclerosis (MS). What interventions would be important for the nurse to include when teaching this client ways to prevent the exacerbation of symptoms? Select all that apply.

promoting regular physical activity planning activities to avoid fatigue suggesting a support group or meditation to decrease stress