Chronic Neurologic Problems: Degenerative Neurologic Disorders

Teriflunomide

For patients with an aggressive form of MS The risk factors associated with teriflunomide include serious liver disease and, because of its teratogenic effects, avoided during pregnancy

Lou Gehrig's disease

Or amyotrophic lateral sclerosis is a degenerative disorder of motor neurons in the brain and spinal cord. Does not exhibit characteristics related to sensory loss. Not an autosomal dominant disorder.

When admitted with status epilepticus, which long-acting antiseizure medications would the nurse associate with the treatment of a patient's seizure disorder? Select all that apply. 1 Phenytoin (Dilantin) 2 Diazepam (Valium) 3 Lorazepam (Ativan) 4 Lamotrigine (Lamictal) 5 Phenobarbital (Luminal)

Phenytoin, lamotrigine, and phenobarbital (long half-life) NOT Diazepam and lorazepam (rapid-acting drugs that have a short half-life)

Which disease process includes Lhermitte's sign as a clinical manifestation? 1 Multiple sclerosis 2 Myasthenia gravis 3 Lou Gehrig's disease 4 Huntington's disease

1. Lhermitte's sign is a transient sensory symptom manifested in the patients with MS and is described as an electric shock radiating down the spine or into the limbs with flexion of the neck. NOT 2. does not manifest as sensory loss

Which medication overdose may lead to paradoxical intoxication in a patient with parkinsonism? 1 Levodopa (L-dopa) 2 Biperiden (Akineton) 3 Trihexyphenidyl (Artane) 4 Diphenhydramine (Benadryl)

1. Paradoxical intoxication is the aggravation, rather than relief, of symptoms. This condition is mainly due to the excessive use of dopaminergic drugs such as levodopa NOT 2. an anticholinergic drug that blocks the cholinergic receptors and maintains the balance between dopaminergic and cholinergic activity 3. an example of an anticholinergic drug that does not aggravate the symptoms of the disease with overuse. 4. has anticholinergic effects and does not lead to paradoxical intoxication in a patient with parkinsonism when overdosed with this medication.

While the patient with Parkinson's disease, who is unresponsive to drug therapy, considers the surgical options presented by the health care provider, which procedures would the nurse anticipate providing as additional resources? Select all that apply. 1 Ablation 2 Thymectomy 3 Transplantation 4 Deep-brain stimulation 5 Dorsal-column electrical stimulation

1. stereotactic ablation of areas in the thalamus, globus pallidus, and subthalamic nucleus 4. involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus and connecting it to a generator placed in the upper chest. The provider programs the device to deliver a specific current to the targeted brain location. 3. The design of transplantation of fetal neural tissue into the basal ganglia is to provide dopamine-producing cells in the brain NOT 2. occurs in the treatment of MG 5. helps to minimize symptoms of MS

For the patient reporting difficulty with eye and eyelid movement, chewing, swallowing, speaking, and breathing, which diagnostic findings would the nurse associate with myasthenia gravis? Select all that apply. 1 Alteration of one copy of gene in DNA testing 2 Improved muscle contractibility during the Tensilon test 3 Presence of TRAP: tremor, rigidity, akinesia, and postural instability 4 Decreased response to repeated stimulation of hand muscles during electromyography (EMG) test 5 Increased immunoglobulin G levels in the cerebrospinal fluid (CSF) during CSF analysis test

2. 4. which would indicate muscle fatigue. NOT 1. diagnostic test for Huntington's disease 3. a confirmed diagnostic test for Parkinson's disease 5. confirms MS

Which neurodegenerative disorder has the characteristics of rigidity and bradykinesia? 1 Multiple sclerosis 2 Parkinson's disease 3 Lou Gehrig's disease 4 Huntington's disease

2. a chronic, progressive neurodegenerative disorder characterized by an increased muscle tone (known as rigidity), slowness in the initiation and execution of movement (known as bradykinesia), tremors, and gait disturbances NOT 1. characterized by progressive, chronic demyelination of nerve fibers of the spinal cord and brain 3. characteristics include limb weakness, dysarthria (unclear speech), and dysphagia 4. jerky movements and cognitive and psychiatric disorders.

For patients with amyotrophic lateral sclerosis (ALS), which treatment goal focuses on preventing a common cause of death in patients with ALS? 1 Reduced fat intake 2 Reduced risk of aspiration 3 Decreased injury related to falls 4 Decreased pain secondary to muscle weakness

2. can help to prevent respiratory infections that are a common cause of death from deteriorating muscle function NOT 1. may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS 3. + 4. important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

Which potential medications would the nurse anticipate administering to a patient with myasthenia gravis who reports difficulty with swallowing, chewing, eye movement, and facial mobility? Select all that apply. 1 Tramadol (Ultram) 2 Azathioprine (Imuran) 3 Prednisone (Deltasone) 4 Chlorzoxazone (Paraflex) 5 Pyridostigmine (Mestinon)

3. Use of corticosteroids (prednisone) suppress the immune responses that cause such symptoms 2. Immunomodulators (Azathioprine) are used for immune suppression 5. Anticholinesterase (Pyridostigmine) prolong the action of acetylcholine at the neuromuscular junction NOT 1. an opioid analgesic; it is contraindicated for patients with MG 4. a muscle relaxant; contraindicated for patients with MG

Which diagnostic test would the nurse anticipate for a patient with progressive weakness suspected of having multiple sclerosis? 1 Positron emission tomography (PET) scan 2 Complete blood count (CBC) 3 Electroencephalogram (EEG) 4 Magnetic resonance imaging (MRI)

4. An MRI of the brain and spinal cord can show plaques, inflammation, atrophy, and tissue breakdown consistent with multiple sclerosis. NOT A PET scan, CBC, and EEG (can be used to diagnose seizure disorders)

Which information would the nurse provide a patient with multiple sclerosis who begins treatment with β-interferon? Select all that apply. 1 Monitor vital signs on a regular basis. 2 Rotate injection sites with each dose. 3 Do not drink grape juice or eat grapes. 4 Know that flulike symptoms are common. 5 Wear sunscreen while exposed to sunlight.

5. drug may cause photosensitivity 4. let the patient know that flulike symptoms are common with β-interferon 2. prevent lipodystrophy

Parkinson's disease (PD)

A chronic disease of the basal ganglia (center of the brain) characterized by increased muscle tone, tremor at rest, gait changes, and slowness in the initiation and execution of movement. Characteristics of Parkinson's disease include a lack of dopamine because of the degeneration of dopamine-producing neurons; this disrupts the normal balance between acetylcholine and dopamine in the brain. Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow.

Multiple sclerosis

A chronic progressive degenerative disorder of the CNS, not an autosomal dominant disorder. Demyelination of the nerve fibers of the brain and spinal cord is the principal characteristic of the disease. Cause of MS is unknown Important to identifying and avoiding such activities or factors (fatigue, stress, or events such as pregnancy or acute illness) which may prevent exacerbations.

For the patient with myasthenia gravis, which factors experienced in the patient's current life led to development of respiratory failure and a myasthenic crisis, requiring admission? Select all that apply 1 Attended the funeral of a family member earlier in week 2 Took an antibiotic prescribed for a urinary tract infection 3 Was diagnosed with urinary tract infection previous week 4 Omitted pyridostigmine (Mestinon) on the previous day 5 Consistently took prescribed corticosteroid every other day 6 Laid down for a nap in a personal recliner after the noon meal each day

A myasthenia crisis is an acute exacerbation of muscle weakness that often involves the respiratory muscles. Precipitation of exacerbations and crises occurs from many factors including infection (patient's urinary tract infection), emotional stress (funeral of family member), reaction to medications (antibiotic prescribed for urinary tract infection), and inadequate anticholinesterase (Pyridostigmine)medications. NOT 5. Taking corticosteroid medications as prescribed suppresses immunity to decrease the myasthenic effect of muscular weakness 6. Patients experience muscular weakness that improves with rest

During an acute exacerbation of the patient's multiple sclerosis, which interventions would the nurse implement? Select all that apply. 1 Assist the patient with the grieving process. 2 Prevent the complication of pressure ulcers. 3 Prevent the complication of urinary tract infections. 4 Teach the patient to build a general resistance to illness. 5 Teach the patient to maintain a good balance between exercise and rest.

A patient experiencing an acute exacerbation of MS may be immobile and confined to bed. 1ST interventions in this phase target the prevention of major complications associated with immobility. 2. Pressure ulcers may occur due to the immobility of the patient while confined to the bed. Implement immediate care to prevent this. 3. UTI are also common due to the stagnation of urine NOT 4. + .5 (general intervention not applicable for patients who are immobile) 1. intervention during the diagnostic phase of MS

Myasthenic crisis

Acute exacerbation of MG. A life-threatening condition when the muscles that control breathing and swallowing become too weak to perform their functions.

Which seizure activity would the nurse associate with a patient's jerky muscle movements of the extremities, as well as bowel and bladder incontinence during the event? 1 Aura seizures 2 Postictal seizures 3 Generalized seizures 4 Simple partial seizures

Generalized seizures (patient may experience incontinence along with jerking, or tonic-clonic, movements of the entire body) NOT Aura (an individualized, subjective auditory, visual, olfactory, or taste hallucination that may precede a seizure) Postictal (the period of recovery after a seizure and may include confusion and sedation)

Huntington's disease

Genetically transmitted, autosomal dominant disorder ("dominant" means that a single copy of the disease-associated mutation is enough to cause the disease) The offspring of a person with this disease have a 50% risk of inheriting it HD involves a deficiency of acetylcholine and γ-aminobutyric acid (GABA) neurotransmitters, which leads to the excessive release of dopamine

Drug therapy for multiple sclerosis includes

immunomodulators or corticosteroids and other drugs that help to reduce the symptoms

Dalfampridine

improves walking speed for patients with MS causes seizures, a major risk factor associated of the drug

Mitoxantrone

treats patients with active and aggressive forms of multiple sclerosis, not in the initial treatment. The risk factors associated with this drug are cardiotoxicity, leukemia, and infertility.

A patient suspected of having myasthenia gravis (MG) suffers injury and has related pain, infection, and inflammation. Which drugs must be used with caution? Select all that apply. 1 Nonsteroidal antiinflammatory drugs (NSAIDs) 2 Diuretics 3 Antibiotics 4 Corticosteroid 5 Opioid analgesics

2. they can worsen the condition by creating hypokalemia, which exacerbates MG 3. antibiotics can aggravate symptoms 5. contraindicated NOT 1. + 4. may be used safely in a patient with MG

Myasthenia gravis

An autoimmune disease of the neuromuscular junction and is not an autosomal dominant disorder.

Carbidopa and Levodopa

Carbidopa a dopamine decarboxylase inhibitor. This enzyme breaks down the dopamine peripheral tissues before reaching the brain, decreasing the bioavailability of the drug. Levodopa is the dopamine precursor converted to dopamine in the basal ganglia. Carbidopa, when administered along with levodopa, increases the bioavailability of the drug in the brain. This prevents peripheral tissue breakdown of the drug by the enzyme dopa-decarboxylase

Early symptoms of Parkinson's disease include

Coarse resting tremors of the fingers and thumb, also known as pill-rolling movements. NOT Akinesia (complete or partial loss of muscle movement), aspiration, and mental deterioration (occur later in the disease process)

For the older adult patient with impaired liver functions who is suspected of sustaining a recent seizure, which antiseizure medications would the nurse anticipate administering? Select all that apply. 1 Phenytoin (Dilantin) 2 Primidone (Mysoline) 3 Lamotrigine (Lamictal) 4 Gabapentin (Neurontin) 5 Carbamazepine (Tegretol)

Lamotrigine and gabapentin (newer antiseizure medications that have fewer interactions with other drugs; safe for older adults) NOT Primidone and carbamazepine (have significant drug interactions) Phenytoin (metabolized by the liver, so an older adult's impaired liver may not metabolize the drug completely)

Status epilepticus

State of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures

When establishing a diagnosis of multiple sclerosis (MS), which prescribed diagnostic studies would the nurse explain to the patient? Select all that apply. 1 Carotid duplex scan 2 Evoked response testing 3 Cerebrospinal fluid analysis 4 Electroencephalogram (EEG) 5 CT scan

There is no definitive diagnostic test for MS. 5. CT scan, 2. evoked response testing (measures the speed of nerve messages along sensory nerves to the brain), 3. CSF analysis, and MRI, along with the patient's history and physical examination, are used to establish a diagnosis for MS. NOT EEG and carotid duplex scan (ultrasound is performed to evaluate symptoms including dizziness, loss of memory, stroke, loss of musclecontrol and other symptoms that might result from narrowing or blockage of the vessels)

β-interferon

an immunomodulator prescribed in the initial treatment of multiple sclerosis and known to cause flu-like symptoms, depression, and suicidal ideations

Apomorphine (Apokyn)

dopamine agonist (PD) medication causes severe nausea and vomiting. Apomorphine, when administered along with antiemetics such as ondansetron, leads to very low BP and loss of consciousness

Natalizumab

treats patients with active and aggressive forms of multiple sclerosis, and this drug is not part of initial treatment. The major risk factor associated with this drug therapy is progressive multifocal leukoencephalopathy