Ch.70

Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)? Epinephrine Dopamine Serotonin Glutamate

Glutamate

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? Discourage the client from doing any range-of-motion (ROM) exercises. Have the client sit up in a chair as much as possible. Logroll the client from side to side. Elevate the head of the bed to 90 degrees.

Logroll the client from side to side.

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? Glutamate Acetylcholine Dopamine Serotonin

Dopamine

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? Drugs administered may not cause the requisite therapeutic effect. Clients take an assortment of different drugs. Clients generally do not adhere to the drug regimen. Drugs administered may cause a wide variety of adverse effects.

Drugs administered may cause a wide variety of adverse effects.

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Dyskinesia Bradykinesia Micrographia Dysphonia

Dyskinesia

The nurse is caring for a client who is scheduled for a cervical discectomy the following day. During health education, the client should be made aware of what potential complications? Vertebral fracture Hematoma at the surgical site Scoliosis Renal trauma

Hematoma at the surgical site

A client is admitted to the hospital with pneumonia. He has a history of Parkinson disease, which his family says is worsening. Which assessment should the nurse expect? Impaired speech Muscle flaccidity Pleasant and smiling demeanor Tremors in the fingers that increase with purposeful movement

Impaired speech

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 diagnoses is most likely for a client with this condition? Chronic confusion Impaired urinary elimination Impaired verbal communication Bowel incontinence

Impaired verbal communication

Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? Imbalanced nutrition: Less than body requirements Ineffective airway clearance Impaired urinary elimination Risk for injury

Ineffective airway clearance

While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? Page the health care provider and report this sign of infection. Reinforce the dressing and reassess in 1 to 2 hours. Reposition the client to prevent further hemorrhage. Inform the surgeon of the possibility of a dural leak.

Inform the surgeon of the possibility of a dural leak.

A client has undergone a cervical discectomy. The nurse determines which interventions are essential to teach the client? Select all that apply. Keep staples or sutures clean and dry Cover incision with dry dressing Call health care provider if the area is red or irritated Avoid twisting or flexing the neck Do not remove dressing until the next visit Sit as much as possible; standing can cause pain

Keep staples or sutures clean and dry Cover incision with dry dressing Call health care provider if the area is red or irritated Avoid twisting or flexing the neck Do not remove dressing until the next visit

A nurse is preparing a teaching plan for a client diagnosed with amyotrophic lateral sclerosis (ALS) and his family about the disorder and changes that may occur. Which of the following would the nurse least likely include in the discussion? Spasticity Difficulty swallowing Loss of bladder control Speech difficulties

Loss of bladder control

Which diagnostic is most commonly used for spinal cord compression? Magnetic resonance imaging (MRI) Computed tomography (CT) Positron emission tomography (PET) X-ray

Magnetic resonance imaging (MRI)

Which topic is most important for the nurse to include in the teaching plan for a client newly diagnosed with Parkinson's disease? Involvement with diversion activities Enhancement of the immune system Establishing balanced nutrition Maintaining a safe environment

Maintaining a safe environment

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance? Make sure the client is sitting with the head of bed elevated to 90 degrees. Assist the client into a comfortable position and stay alert for coughing, which signifies aspiration. Clients with Parkinson's disease shouldn't have liquids; remove them from the dinner tray before serving food to the client. There are no special precautions for the client with Parkinson's disease.

Make sure the client is sitting with the head of bed elevated to 90 degrees.

A client with a herniated lumbar disc has asked about nonsurgical strategies to help with mobility. What strategies will the nurse teach the client? Select all that apply. Muscle relaxants Weight reduction Physical therapy Hydrotherapy Nonsteroidal anti-inflammatory medications Positive feedback and attitude

Muscle relaxants Weight reduction Physical therapy Nonsteroidal anti-inflammatory medications

During assessment of a hospitalized client who is recovering from a cervical discectomy, the client reports sudden and severe pain. Which of the following interventions is the nurse's priority? Give the client something to help induce sleep. Change the client's bandages. Notify the client's surgeon. Increase the client's pain medication.

Notify the client's surgeon.

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? Pain radiating down the posterior thigh Back pain when the knees are flexed Atrophy of the lower leg muscles Homans' sign

Pain radiating down the posterior thigh

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? Multiple sclerosis Parkinson disease Huntington disease Creutzfeldt-Jakob disease

Parkinson disease

A client comes to the clinic reporting low back pain and muscle spasms. He states, "The pain seems to travel into my hip and down to my leg." A herniated lumbar disk is suspected. Which of the following would help to confirm the suspicion? Select all that apply. Postural deformity Muscle weakness Negative straight leg test Altered tendon reflexes Increased pain with bed rest

Postural deformity Muscle weakness Altered tendon reflexes

A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? Anxiety Powerlessness Ineffective denial Risk for disuse syndrome

Powerlessness

A client with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses? Prepare an advance directive. Designate a most responsible health care provider (MRP) early in the course of the disease. Collaborate with representatives from the Amyotrophic Lateral Sclerosis Association. Ensure that witnesses are present when he provides instruction.

Prepare an advance directive.

The nurse caring for a client diagnosed with Parkinson disease has prepared a plan of care that would include what goal? Promoting effective communication Controlling diarrhea Preventing cognitive decline Managing choreiform movements

Promoting effective communication

A client has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? Hemorrhage Bowel incontinence Respiratory dysfunction Skin breakdown

Respiratory dysfunction

A client is diagnosed with amyotrophic lateral sclerosis (ALS) in the early stages. Which medication would the nurse most likely expect to be prescribed as treatment? Riluzole Benztropine mesylate Amantadine Bromocriptine

Riluzole

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? Baclofen Riluzole Dantrolene sodium Diazepam

Riluzole

A client has just 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? Risk for infection Impaired spontaneous ventilation Unilateral neglect Risk for injury

Risk for injury

A client diagnosed with Parkinson's disease has developed slurred speech and drooling. The nurse knows that these symptoms indicate which of the following? The client is having an exacerbation. Medication needs to be adjusted to higher doses. The client is exhibiting signs of medication overdose. The disease has entered the late stages.

The disease has entered the late stages.

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? The patient will have unilateral resting tremors and then will have a period of no tremors present. The patient will have a slow, shuffling gait and then will be able to move at a faster pace. The patient will have a period when medication with levodopa will be unnecessary. The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

Nursing students are reviewing information about Parkinson's disease in preparation for class the next day. The students demonstrate understanding of the material when they identify which of the following as a cardinal sign of this disorder? Select all that apply. Tremor Rigidity Bradykinesia Postural instability Intellectual decline

Tremor Rigidity Bradykinesia Postural instability

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action? Keeping a pillow under the client's knees at all times Placing the client in semi-Fowler's position Maintaining bed rest for 72 hours after the laminectomy Turning the client from side to side, using the logroll technique

Turning the client from side to side, using the logroll technique

A nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding requires immediate intervention? More back pain than the first postoperative day Paresthesia in the dermatomes near the wounds Urine retention or incontinence Temperature of 99.2° F (37.3° C)

Urine retention or incontinence

A client has just returned from surgery after undergoing a lumbar laminectomy. Which of the following would be most important to do when positioning the client in bed? Using a logrolling motion to change positions Keeping the knees flat with the head on a pillow Maintaining full knee flexion when lying on the side Allowing the client to sit up at the edge of the bed

Using a logrolling motion to change positions

A patient is diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease. The nurse understands that the symptoms of the disease will begin in what way? Ascending paralysis Numbness and tingling in the lower extremities Weakness starting in the muscles supplied by the cranial nerves Jerky, uncontrolled movements in the extremities

Weakness starting in the muscles supplied by the cranial nerves

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). Doppler scanning. Doppler ultrasonography. quantitative spectral phonoangiography.

electromyography (EMG).

A nurse is working on a surgical floor. The nurse must logroll a client following a: laminectomy. thoracotomy. hemorrhoidectomy. cystectomy.

laminectomy.

The nurse is caring for a patient with Parkinson's disease and is preparing to administer medication. What does the nurse administer to the patient that is considered the most effective drug currently given for the tremor of Parkinson's? Requip Levodopa Symmetrel Permax

Levodopa

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? Multiple sclerosis Myasthenia gravis Parkinson's disease Huntington's disease

Parkinson's disease

Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells? Multiple sclerosis Parkinsons disease Huntington disease Creutzfeldt-Jakob disease

Parkinsons disease

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? "Treatment aims at keeping you independent as long as possible." "Treatment really doesn't matter; the disease is going to progress anyway." "Treatment for Parkinson's is only palliative; it keeps you comfortable." "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease."

"Treatment aims at keeping you independent as long as possible."

The nurse responds to the call light of a client who has had a cervical discectomy earlier in the day. The client states that she is having severe pain that had a sudden onset. What is the nurse's most appropriate action? Palpate the surgical site. Remove the dressing to assess the surgical site. Call the surgeon to report the client's pain. Administer a dose of an NSAID.

Call the surgeon to report the client's pain.

A nurse is planning discharge education for a client who underwent a cervical discectomy. What strategies would the nurse assess that would aid in planning discharge teaching? Care of the cervical collar Technique for performing neck ROM exercises Home assessment of ABGs Techniques for restoring nerve function

Care of the cervical collar

A client is admitted reporting low back pain. How will the nurse best determine if the pain is related to a herniated lumbar disc? Ask the client if there is pain on ambulation. Ask if the client can walk. Have the client lie on the back and lift the leg, keeping it straight. Ask if the client has had a bowel movement.

Have the client lie on the back and lift the leg, keeping it straight

Which anticholinergic agent is used to control tremor and rigidity in Parkinson disease? Bromocriptine mesylate Benztropine Mesylate Amantadine Levodopa

Benztropine Mesylate

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Dysphagia Dysphonia Hypokinesia Micrographia

Dysphonia

The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care? Raise the head of the client's bed about 30 degrees during meals. Encourage the use of liquids that are thin in consistency. Arrange for specialized utensils for the client to use when eating. Encourage the client to massage the facial and neck muscles before eating.

Encourage the client to massage the facial and neck muscles before eating.

A client with a cervical disc herniation in the acute phase reports of numbness and tingling in the arms. What are the priority interventions for the nurse to perform? Select all that apply. Have the client wear a cervical collar daily Assist the client in isometric exercises of the arms Provide NSAID therapy Encourage weight lifting to strengthen arms Encourage exercises to strengthen the legs

Have the client wear a cervical collar daily Provide NSAID therapy

A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? Help the client assume a more comfortable position. Administer hydrocodone (Vicodin) as ordered. Provide teaching on nonpharmacologic measures to control pain. Notify the physician of the client's pain.

Help the client assume a more comfortable position.

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? Keeping the head in a neutral position Wearing the cervical collar when sleeping Removing the entire collar when shaving Moving the neck from side to side when the collar is off

Keeping the head in a neutral position

Which medication is the most effective agent in the treatment of Parkinson disease? Benztropine Amantadine Levodopa Bromocriptine mesylate

Levodopa

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? Total parenteral nutrition (TPN) Provision of a low-residue diet Semisolid food with thick liquids Minced foods and a fluid restriction

Semisolid food with thick liquids

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis? Hypoactive bowel sounds Severe lower back pain Sensory deficits in one arm Weakness and atrophy of the arm muscles

Severe lower back pain

A nurse is assessing a client with Parkinson's disease. Which of the following would the nurse expect to find? Gait with the body leaning backward Continuous tremors Muscle flaccidity Slowing of activity

Slowing of activity

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? Slows the progression of the disease Replaces dopamine Relieves symptoms of dyskinesia Prevents side effects from carbidopa-levodopa

Slows the progression of the disease

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? When the client is resting When the client is ambulating When the client is preparing his or her meal tray to eat When the client is participating in occupational therapy

When the client is resting

An older adult has encouraged her husband to visit their primary provider, stating that she is concerned that he may have Parkinson disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson disease? "Lately he seems to move far more slowly than he ever has in the past." "He often complains that his joints are terribly stiff when he wakes up in the morning." "He's forgotten the names of some people that we've known for years." "He's losing weight even though he has a ravenous appetite."

"Lately he seems to move far more slowly than he ever has in the past."

A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following? Serotonin Acetylcholine Dopamine Norepinephrine

Dopamine

A client with Parkinson disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The client states that he has been achieving relief for the past few weeks by using over-the-counter laxatives. How should the nurse respond? "It's important to drink plenty of fluids while you're taking laxatives." "Make sure that you supplement your laxatives with a nutritious diet." "Let's explore other options, because laxatives can have side effects and create dependency." "You should ideally be using herbal remedies rather than medications to promote bowel function."

"Let's explore other options, because laxatives can have side effects and create dependency."

The nurse is providing care for a client who just discussed palliative care with the primary health care provider. The client's family member was also part of the discussion and asks the nurse, "I feel like this kind of treatment means we've given up on trying." How should the nurse respond? Choose the best option. "The goal of this type of care is to promote the best quality of life that is now possible." "This is your best option considering the end is near for the client. " "You are not giving up. Unfortunately the tumor has won the fight." "The prognosis for the client is poor, so it would be wasteful to provide any more aggressive treatment."

"The goal of this type of care is to promote the best quality of life that is now possible."

A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate? "You're doing a great job. Just keep it up." "It must be difficult for you to see your husband like this." "Are you upset about how your husband is doing?" "You sound a bit overwhelmed. Tell me more about what's happening."

"You sound a bit overwhelmed. Tell me more about what's happening."

A client with Parkinson's disease is prescribed amantadine hydrochloride 100 mg twice a day. The pharmacy supplies amantadine syrup, because the client has a history of difficulty swallowing tablets. The label reads 50 mg/5 mL. How many milliliters would the nurse administer to the client for each dose? Enter the correct number ONLY.

10

A client who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The client and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the client's medication regimen? The client is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident. Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. The client's temporary improvement in status is likely unrelated to levodopa-carbidopa. Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern? Take psyllium (Metamucil) daily. Take a laxative whenever bloating is experienced. Adopt a diet with moderate fiber intake. Adopt a high-fiber diet.

Adopt a diet with moderate fiber intake.

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Parkinson disease Amyotrophic lateral sclerosis Alzheimer disease Huntington disease

Amyotrophic lateral sclerosis

The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect should the nurse assess this client? Pruritus Dyskinesia Lactose intolerance Diarrhea

Dyskinesia

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? Acetylcholine Dopamine Serotonin Phenylalanine

Dopamine

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. Fluid overload Dysphagia Choking Constipation Anorexia

Dysphagia Choking Constipation