MS: Module 8: Neuromuscular: Exam

A client with a tentative diagnosis of myasthenia gravis for diagnosis make up. Myasthenia gravis can confirmed by: A. Kernig's sign B. A positive edrophonium (Tensilon test) C. A positive seat chloride test D. Brudzinski's sign

B. A positive edrophonium (Tensilon test) The diagnosis is often confirmed by testing for anti-acetylcholine receptor antibodies or by observing the effects of intravenous edrophonium (Tensilon) injection.

A middle-aged woman has sought care from her primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What early sign or symptom is most likely to have prompted the woman to seek care? A. Cognitive declines B. Difficulty in coordination C. Contractures D. Personality changes

B. Difficulty in coordination The primary symptoms of MS most commonly reported are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, spasticity, and pain. Cognitive changes and contractures usually occur later in the disease.

A 64 year old patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? A. Use simple words and phrases to explain procedures B. Observe for agitation and paranoia C. Assist with active range of motion (ROM) D. Give muscle relaxants as needed to reduce spasms

C. Assist with active range of motion (ROM) ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.

A client diagnosed with ALS is dealing with muscle spasticity (spasms). Which of the following medications is most likely to be prescribed? A. Lidocaine (Xylocaine) B. Hydralazine C. Baclofen (Lisoreal) D. Methylprednisone (Solu-Medrol)

C. Baclofen (Lisoreal) Baclofen is a skeletal muscle relaxant and is the first drug of choice for muscle spasms in ALS, MS, and MG

A 76 year old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information is most important for the nurse to report to the health care provider? A. Cogwheel rigidity of limbs B. Tremor at rest C. Shuffling gait D. Uncontrolled head movement

D. Uncontrolled head movement Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease

When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about a. oral corticosteroids. b. antiparkinsonian drugs. c. magnetic resonance imaging (MRI). d. electroencephalogram (EEG) testing.

b. antiparkinsonian drugs. The diagnosis of Parkinson's is made when two of the liver three characteristic manifestations of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkisonian drugs are administered. This patient has symptoms of tremor and bradykinesia. The next anticipated step will be treatment with medications. MRI and ECG are not useful in diagnosis Parkinson's disease, and corticosteroid therapy is not used to treat it.

The nurse is creating a plan of care for a client who has a recent diagnosis of MS. Which of the following should the nurse include in the client's care plan? A. Instruct the client on daily muscle stretching B. Encourage client to nap every hour C. Provide total assistance with all ADLs D. Order a low-residue diet

A. Instruct the client on daily muscle stretching The client should participate in daily muscle stretching to help alleviate and relax muscle spasms. A client diagnosed with MS should be encouraged to increase the fiber in their diet and void 30 minutes after drinking to help train the bladder.

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

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

A client with amyotrophic lateral sclerosis (ALS) is being visited by the home health nurse who is creating a care plan. Which of the following nursing diagnosis is most likely for a client with this condition? A. Impaired urinary elimination B. Impaired verbal communication C. Bowel incontinence D. Chronic confusion

B. Impaired verbal communication Impaired communication is an appropriate nursing diagnosis; the voice in clients with ALS assumes a nasal sound and articulation becomes so disrupted that speech is unintelligible. Intellectual function is marginally impaired in clients with late ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that control muscles of the rectum and urinary bladder are not affected.

The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120bpm, rise in blood pressure (158/94), and was incontinent of urine and stool. What is your best first action at this time? A. Administer in acetaminophen suppository B. Notify the physician immediately C. Recheck vital signs in 1 hour D. Reschedule patient's physical therapy

B. Notify the physician immediately The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient's respiratory status. The patient may need incubation and mechanical ventilation. The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. The patient's vital signs need to be re-checked sooner than 1 hour. Rescheduling the physical therapy can be delegated to the unit clerk and is not urgent. Focus: Prioritization

A client has been diagnosed with Parkinson disease and the nurse is planning the client's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the client's family? A. Unilateral neglect B. Risk for injury C. Risk for infection D. Impaired spontaneous ventilation

B. Risk for injury Individuals with Parkinson disease face a significant risk for injury related to the effects if dyskinesia. Unilateral neglect is not characteristic of the disease, which affects both sides of the body. Parkinson disease does not directly constitute a risk for infection or impaired respiration.

The nurse advises a patient myasthenia gravis (MG) to A. do frequent weight-bearing exercise to prevent muscle atrophy B. perform physically demanding activities early in the day C. protect the extremities from injury due to poor sensory perception D. anticipate the need for weekly plasmapheresis treatments

B. perform physically demanding activities early in the day Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled, but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.

The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is "definitively" associated with a diagnosis of myasthenia gravis? A. Ascending paralysis and loss of motor function B. Cogwheel rigidity and loss of coordination C. Progressive weakness that is worse at the day's end D. Visual disturbances including diplopia

C. Progressive weakness that is worse at the day's end The client with myasthenia definitely develops progressive weakness that worsens during the day. Although visual disturbances, including diplopia is common in MG. It is also common in MS. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillan Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinson's disease

A client with Parkinson disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method? A. Minced foods and fluid restriction B. Total enteral nutrition (TEN) C. Semisolid food with thick liquids D. Total parenteral nutrition (TPN)

C. Semisolid food with thick liquids A semisolid diet with thick liquids is easier for a client with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the client's nutritional status. The client's status does not warrant TPN until all other options have been ruled out.

A 62 year old patient who has Parkinson's disease is taking bromocriptine (Paroldel). Which information obtained by the nurse may indicate a need for a decrease in the dose? A. The patient has a chronic, dry cough B. The patient develops a deep vein thrombosis C. The patient's blood pressure is 92/52 mmHg D. The patient has for loose stools in a day.

C. The patient's blood pressure is 92/52 mmHg Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use.

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

D. 1 hour before the patient eats (at 1100) Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because the medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used.. hence improving muscle strength.

Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? A. Activity intolerance B. Self-care deficit: toileting C. Ineffective self-health management D. Imbalanced nutrition: less than body requirements ability to swallow

D. Imbalanced nutrition: less than body requirements ability to swallow The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson's disease, but the data do not indicate that they are current problems for this patient.

A 25 year old client with multiple sclerosis has developed dysphagia as a result of dysfunction in her cranial nerves. Which of the following actions should the nurse perfom? A. Suction the client following each meal B. Withhold liquids until the client has finished eating C. Arrange for the client to receive a low residue diet D. Position the client upright during feeding

D. Position the client upright during feeding Upright positioning is necessary to prevent aspiration in the client with dysphagia. There is no need for a low-residue diet and suctioning should not be performed unless there is an apparent need. Liquids do not need to be withheld during meals in order to prevent aspiration.

When obtaining a health history and physical assessment for a 36-year-old female patient with possible multiple sclerosis (MS), the nurse should a. assess for the presence of chest pain. b. inquire about urinary tract problems. c. inspect the skin for rashes or discoloration. d. ask the patient about any increase in libido.

b. inquire about urinary tract problems. Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness

c. Respiratory effort Because respiratory insufficiency may be life threatening. It will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.