Neuro Nclex (Multiple Sclerosis, PD, MG , ALS)

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: a. Getting too little exercise b. Taking excess medication c. Omitting doses of medication d. Increasing intake of fatty foods

Answer C. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.

The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority? A) Prepare the patient for intubation. He is about to go into a myasthenic crisis. B) Perform teaching on medication side effects C) Assess for signs of infection D) Further assess for other thymectomy complications

C. Although the GI symptoms is a common side effect of medicaitons, it is important to follow up on the high temperature and assess for sings of infection. An infection can often exacerbate a Myasthenic crisis and should be carefully monitored for. There is no evidence that this person is about to have a myasthenic crisis and intubation should only be done if the patient is experiencing respiratory failure. There is no evidence that this patient has had a thymectomy.

The male client with MG is undergoing plasmapheresis at the bedside. Which assessment data would warrant immediate intervention by the nurse? 1. The client complains of being lightheaded and dizzy. 2. The client can smile and clamp his teeth together. 3. The client states that his leg cramps have gone away. 4. The client has a small hematoma at the vascular access site.

Correct answer 1: Hypovolemia is a complication of plasmapheresis, especially during the procedure when up to 15% of the blood volume is in the cell separator. The nurse should immediately assess for shock. All other options are expected.

Which response to the Tensilon (edrophonium chloride) injection indicates the client has myasthenia gravis? 1. The client has no apparent change in the assessment data. 2. There is reduced amplitude of electrical stimulation in the muscle. 3. The anti-acetylcholine receptor antibodies are present. 4. The client shows a marked improvement of muscle strength.

Correct answer 4: Clients with myasthenia gravis show a significant improvement of muscle strength that lasts approximately 5 minutes when Tensilon (edrophonium chloride) is injected.

The nurse is preparing a client diagnosed with amyotrophic lateral sclerosis (ALS) for discharge. The nurse realizes that interventions for the following nursing diagnosis should be stressed for this client: 1. Ineffective Breathing Pattern related to neuromuscular dysfunction. 2. Impaired Urinary Elimination related to spastic or flaccid bladder. 3. Alteration in Vision acuity related to ocular muscle involvement. 4. Disturbed Thought Processes related to cognitive decline.

1. Ineffective Breathing Pattern related to neuromuscular dysfunction. Rationale: ALS affects the neuromuscular function; the client is at risk for respiratory dysfunction as a result of this disease process. Impaired urinary elimination is a result of a spastic or flaccid bladder resulting from MS. Visual acuity is impaired in clients diagnosed with MG. Disturbed thought processes is seen in AD clients.

The male client diagnosed with multiple sclerosis states he has been investigating alternative therapies to treat his disease. Which intervention is most appropriate by the nurse? 1. Encourage the therapy if it is not contraindicated by the medical regimen. 2. Tell the client only the health-care provider should discuss this with him. 3. Ask how his significant other feels about this deviation from the medical regimen. 4. Suggest the client research an investigational therapy instead.

1.The nurse should listen without being judgmental about any alternative therapy the client is considering. Alternative therapies, such as massage and relaxation, are frequently beneficial and enhance the medical regimen.

The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride (Eldepryl). The nurse suspects that the client has which disorder? 1. Diabetes mellitus 2. Parkinson's disease 3. Alzheimer's disease 4. Coronary artery disease

2. Parkinson's disease Rationale: Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease.

At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1. Early in the morning, when the client's energy level is high. 2. To coincide with the peak action of drug therapy. 3. Immediately after a rest period. 4. When family members will be available.

2. Demanding physical activity should be performed during the peak action of drug therapy. Clients should be encouraged to maintain independence in self-care activities to the greatest extent possible. Although some clients may have more energy in the morning or after rest, tremors are managed with drug therapy.

The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? 1. Masklike facies and shuffling gait. 2. Difficulty swallowing and immobility. 3. Pill rolling of fingers and flat affect. 4. Lack of arm swing and bradykinesia.

2. Difficulty swallowing places the client at risk for aspiration. Immobility predisposes the client to pneumonia. Both clinical manifestations place the client at risk for pulmonary complications.

The home health nurse is visiting a client with a diagnosis of multiple sclerosis. The client has been taking oxybutynin (Ditropan XL). The nurse evaluates the effectiveness of the medication by asking the client which assessment question? 1. "Are you consistently fatigued?" 2. "Are you having muscle spasms?" 3. "Are you getting up at night to urinate?" 4. "Are you having normal bowel movements?"

3. "Are you getting up at night to urinate?" Rationale: Oxybutynin is an antispasmodic used to relieve symptoms of urinary urgency, frequency, nocturia, and incontinence in clients with uninhibited or reflex neurogenic bladder. Expected effects include improved urinary control and decreased urinary frequency, incontinence, and nocturia. Options 1, 2, and 4 are unrelated to the use of this medication.

The nurse is caring for clients on a medical-surgical floor. Which client should be assessed first? 1. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.

3. Body image is a concern for clients diagnosed with PD. This client is the one client who is not experiencing expected sequelae of the disease.

. Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia.

3. Memory deficits are cognitive impairments. The client may also develop a dementia.

A patient with Parkinson's disease is admitted to the hospital for treatment of an acute infection. Which nursing interventions will be included in the plan of care (select all that apply)? a. Use an elevated toilet seat. b. Cut patient's food into small pieces. c. Provide high protein foods at each meal. d. Place an arm chair at the patient's bedside. e. Observe for sudden exacerbation of symptoms.

ANS: A, B, D Since the patient with Parkinson's has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High protein foods will decrease the effectiveness of L-dopa. Parkinson's is a steadily progressive disease without acute exacerbations.

Which information about a patient who is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease is most important for the nurse to report to the health care provider? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement

ANS: D 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.

The early manifestations of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are somewhat similar. What clinical feature of ALS distinguishes it from MS? A. Dysarthria B. Dysphagia C. Muscle weakness D. Impairment of respiratory muscles

D In ALS, there is progressive muscle atrophy until a flaccid quadriplegia develops. Eventually, there is involvement of the respiratory muscles, which leads to respiratory compromise.

The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective? 1. Eating large, well-balanced meals 2. Doing muscle-strengthening exercises 3. Doing all chores early in the day while less fatigued 4. Taking medications on time to maintain therapeutic blood levels

4. Taking medications on time to maintain therapeutic blood levels Rationale: Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.

Which goal is the most realistic and appropriate for a client diagnosed with Parkinson's disease? 1. To cure the disease. 2. To stop progression of the disease. 3. To begin preparations for terminal care. 4. To maintain optimal body function.

4. Helping the client function at his or her best is most appropriate and realistic. There is no known cure for Parkinson's disease. Parkinson's disease progresses in severity, and there is no known way to stop its progression. Many clients live for years with the disease, however, and it would not be appropriate to start planning terminal care at this time.

The nurse instructs a client who has myasthenia gravis to take prescribed medications on time and to eat meals 45 to 60 minutes after taking anticholinesterase drugs. The client asks why the timing of meals is so important. Which is the nurse's best response? a. "This timing allows the drug to have maximum effect, so it is easier for you to chew, swallow, and not choke." b. "This timing prevents your blood sugar level from dropping too low and causing you to be at risk for falling." c. "These drugs are very irritating to your stomach and could cause ulcers if taken too long before meals." d. "These drugs cause nausea and vomiting. By waiting a while after you take the me-dication, you are less likely to vomit."

A Skeletal muscle weakness extends to the ability to chew and swallow. Clients who have myas-thenia gravis are at risk for aspiration during meals. Timing the medication so that most of the meal is eaten when the drugs have produced their peak effect enables the client to chew and swallow more easily. The medication has no effect on blood glucose levels, ulcers, or nausea.

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to a. perform physically demanding activities in the morning. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception.

ANS: A 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 should be discontinued. There is no decrease in sensation with MG, and muscle atrophy does not occur because muscles are used during part of the day.

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

ANS: B 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.

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should: a. attempt to institute bowel-training activities. b. provide the client with small, frequent feedings. c. obtain an order for intermittent catheterization. d. orient the client to his or her surroundings frequently.

B The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

A 30-year-old was diagnosed with amyotrophic lateral sclerosis (ALS). Which statement by the client would indicate a need for more teaching from the nurse? A) "I will have progressive muscle weakness." B) "I will lose strength in my arms." C) "My children are at greater risk to develop this disease." D) "I need to remain active for as long as possible."

C Feedback: There is no known cause for ALS, and no reason to suspect genetic inheritance. ALS usually begins with muscle weakness of the arms and progresses. The client is encouraged to remain active for as long as possible to prevent respiratory complications.

Which statement by the 20-year-old female client diagnosed with MG indicates the client understands the discharge teaching? 1. "I can have children, but I will have to see my neurologist during my pregnancy." 2. "I have a new job at a children's day care center to help with expenses." 3. "I should not take a bath because I could pass out and drown while in the tub." 4. "I will drink at least 1000 mL of water or other liquid every day."

Correct answer 1: MG will not prevent conception or delivery but can cause the client to experience an exacerbation of the disease. The client should be seen regularly by the neurologist and the obstetrician. Young children are ill frequently, and infections can result in an exacerbation for the client. Option 3 applies to clients who have seizures. The client is not restricted to 1000 mL of fluid per day.

Your patient has been diagnosed with MS. You are teaching her about how to reduce muscle spasticity. Which of the following statements, if made by the patient would indicate the need for further teaching? A) Daily exercise, including weight bearing can help relieve spasticity B) My stretching routine can help with the spasms C) Taking Baclofen may help relieve these painful spasms in my legs D) At the end of a day, taking a nice hot bath may relieve the muscle spasms

D. The patient with MS should never use hot water for a bath due to sensory deficits. All other answers can help with muscle spasms. Warm compresses can be used to relieve muscle spasms.

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). The nurse plans care based on which understanding of the patient's prognosis? 1. The disease progresses slowly and is fatal. 2. The disease will progress over many years but the patient's quality of life will be good. 3. The disease progresses rapidly but can be halted by drug therapy. 4. The disease will progress slowly and can be controlled by medication.

1 correct answer Rationale 1: The disease is slowly progressive and fatal and is characterized by weakness and wasting of muscles under voluntary control. Rationale 2: Quality of life is profoundly affected by this disorder. Rationale 3: Riluzole (Rilutek) is available to treat the disease, but it does not halt it. Death usually occurs due to respiratory failure. Rationale 4: The disease is slowly progressive and cannot be controlled by medication.

A thymectomy accomplished via a median sternotomy approach is performed in a client with a diagnosis of myasthenia gravis. The nurse develops a postoperative plan of care for the client that should include which intervention? 1. Monitor the chest tube drainage. 2. Restrict visitors for 24 hours postoperatively. 3. Maintain intravenous infusion of lactated Ringer's solution. 4. Avoid administering pain medication to prevent respiratory depression.

1. Monitor the chest tube drainage. Rationale: A thymectomy may be used for management of clients with myasthenia gravis. The procedure is performed through a median sternotomy or a transcervical approach. Postoperatively the client will have a chest tube in the mediastinum. Lactated intravenous solutions usually are avoided because they can increase weakness. Pain medication is administered as needed, but the client is monitored closely for respiratory depression. There is no reason to restrict visitors.

The nurse and the unlicensed assistive personnel (UAP) are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? 1. Feed the 69-year-old client diagnosed with Parkinson's disease who is having difficulty swallowing. 2. Turn and position the 89-year-old client diagnosed with a pressure ulcer secondary to Parkinson's disease. 3. Assist the 54-year-old client diagnosed with Parkinson's disease with toilet-training activities. 4. Obtain vital signs on a 72-year-old client diagnosed with pneumonia secondary to Parkinson's disease.

1. The nurse should not delegate feeding a client who is at risk for complications during feeding. This requires judgment that the UAP is not expected to possess.

What is the primary goal collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? 1. To maintain joint flexibility. 2. To build muscle strength. 3. To improve muscle endurance. 4. To reduce ataxia.

1. The primary goal of physical therapy and nursing interventions is to maintain joint flexibility and muscle strength. Parkinson's disease involves a degeneration of dopamine-producing neurons; therefore, it would be an unrealistic goal to attempt to build muscles or increase endurance. The decrease in dopamine neurotransmitters results in ataxia secondary to extrapyramidal motor system effects. Attempts to reduce ataxia through physical therapy would not be effective.

The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess?Select all that apply. 1. Muscle flaccidity. 2. Lethargy. 3. Dysmetria. 4. Fatigue. 5. Dysphagia.

1.Muscle flaccidity is a hallmark symptom of MS. 3.Dysmetria is the inability to control muscular action characterized by overestimating or under estimating range of movement. 4.Fatigue is a symptom of MS. 5.Dysphagia, or difficulty swallowing, is associated with MS. 2. Lethargy is the state of prolonged sleepiness or serious drowsiness and is not associated with MS.

The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion? 1. The client should discuss feelings about being placed on a ventilator. 2. The client may have rapid mood swings and become easily upset. 3. Pill-rolling tremors will become worse when the medication is wearing off. 4. The client may automatically start to repeat what another person says.

2. These are psychosocial manifestations of PD. These should be discussed in the support meeting.

The nurse observes that a client's upper arm tremors disappear as he unbuttons his shirt. Which statement best guides the nurse's analysis of this observation about the client's tremors? 1. The tremors are probably psychological and can be controlled at will. 2. The tremors sometimes disappear with purposeful and voluntary movements. 3. The tremors disappear when the client's attention is diverted by some activity. 4. There is no explanation for the observation; it is probably a chance occurrence.

2. Voluntary and purposeful movements often temporarily decrease or stop the tremors associated with Parkinson's disease. In some clients, however, tremors may increase with voluntary effort. Tremors associated with Parkinson's disease are not psychogenic but are related to an imbalance between dopamine and acetylcholine. Tremors cannot be reduced by distracting the client.

The client diagnosed with multiple sclerosis is scheduled for a magnetic resonanceimaging (MRI) scan of the head. Which information should the nurse teach the client about the test? 1. The client will have wires attached to the scalp and lights will flash off and on. 2. The machine will be loud and the client must not move the head during the test. 3. The client will drink a contrast medium 30 minutes to one (1) hour before the test. 4. The test will be repeated at intervals during a five (5)- to six (6)-hour period.

2.MRI scans require the client to lie stilland not move the body; the clientshould be warned about the loud noise 1. This describes an evoked potential electroencephalogram (EEG). 3. The client does not drink any contrast medium. If contrast is used, it will be given IVP for a CT scan. 4. The test is performed at one time

The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends."

3. Scheduling appointments late in the morning gives the client a chance to complete ADLs without pressure and allows the medications time to give the best benefits.

The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 2. Hold the medication until after all cultures have been obtained. 3. Monitor the client's serum blood glucose levels frequently .4. Provide supplemental dietary sodium with the client's meals.

3.Steroids interfere with glucose metabolism by blocking the action of insulin;therefore, the blood glucose levels should be monitored. 1. Steroid medications increase gastric acid;therefore, a proton pump inhibitor is an appropriate medication for the client. 2. Cultures are ordered prior to administer-ing antibiotics, not steroids. 4. Steroid medications cause the client to retain sodium; therefore, a low-sodiumdiet should be encouraged

The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions? A) Insert NG tube B) Administer Ativan C) Monitor I&O D) Immediately stop anticholinesterase medications

A. Inserting the NG tube is the priority because it will help reduce risk for aspiration. The patient experiencing a myasthenic crisis is at a large risk for respiratory failure due to dysphagia and extreme muscle weakness. All priority actions should be focused on respiratory assessment and support. Ativan and any other sedating medication should NEVER be administered. Stopping anticholinesterase medications is associated with a cholinergic crisis. Monitoring I&O is important, but not as important as NG tube

. A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Assist with active range of motion. b. Observe for agitation and paranoia. c. Give muscle relaxants as needed to reduce spasms. d. Use simple words and phrases to explain procedures.

ANS: A ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help to maintain strength as long as possible. Psychotic symptoms 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.

8. A 28-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "Symptoms of MS are likely to become worse during pregnancy." d. "MS is associated with a slightly increased risk for congenital defects."

ANS: A During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.

A patient with multiple sclerosis (MS) has urinary retention caused by a flaccid bladder. Which action will the nurse plan to take? a. Teach the patient how to use the Credé method. b. Decrease the patient's fluid intake in the evening. c. Suggest the use of incontinence briefs for nighttime use only. d. Assist the patient to the commode every 2 hours during the day.

ANS: A The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.

The nurse is assisting with care of a resident diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment findings does the nurse anticipate? (Select all that apply.) a. Progressive weakness b. Pill-rolling tremor c. Ascending paralysis d. Hemiparesis e. Decreased coordination of extremities f. Bradykinesia

ANS: A, E Primary symptoms of ALS include progressive muscle weakness and decreased coordination of arms, legs, and trunk. Atrophy of muscles and twitching (fasciculations) also occur. Pill-rolling tremor and bradykinesia are symptoms of Parkinson's disease. Ascending symptoms occur in Guillain-Barré syndrome. Paralysis on one side of the body occurs in strokes.

A patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care? a. Instruct the patient in activities that can be done while lying or sitting. b. Suggest that the patient rock from side to side to initiate leg movement. c. Have the patient take small steps in a straight line directly in front of the feet. d. Teach the patient to keep the feet in contact with the floor and slide them forward.

ANS: B Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.

A patient is seen in the health clinic with symptoms 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. the purpose of electroencephalogram (EEG) testing. d. preparation for magnetic resonance imaging (MRI).

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

28. When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take? a. Check pupillary size. b. Monitor grip strength. c. Observe respiratory effort. d. Assess level of consciousness.

ANS: C 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.

Which information about a patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient has relapsing-remitting MS. b. The patient enjoys walking for relaxation. c. The patient has an increased creatinine level. d. The patient complains of pain with neck flexion.

ANS: C Dalfampridine should not be given to patients with impaired renal function. The other information will not impact on whether the dalfampridine should be administered.

A patient has a new prescription for bromocriptine (Parlodel) to control symptoms of Parkinson's disease. 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 has four loose stools in a day. c. The patient develops a deep vein thrombosis. d. The patient's blood pressure is 90/46 mm Hg.

ANS: D 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 Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. Which nursing diagnosis is of highest priority? a. Activity intolerance b. Self-care deficit: toileting c. Ineffective self-health management d. Imbalanced nutrition: less than body requirements

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

The client is admitted with Parkinson's disease. His face is expressionless and his speech is monotone. Which of the following observations is the most accurate? A) The client is mostly likely depressed and should be left alone B) These are common symptoms of Parkinson's disease that produce an undesired façade of an alert and responsive individual C) The client's antipsychotic medications should be adjusted D) The client probably has dementia

Answer: B. The nurse should recognize that these are commons symptoms of Parkinson's disease.

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 3 to 4 L daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives

C. Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.

Which of the following would be most likely given as a top nursing diagnosis for a patient experiencing a cholinergic crisis? A) Impaired Gas Exchange B) Acute Fatigue C) Ineffective airway clearance D) Altered mental status

C. During a cholinergic crisis, secretions are increased and the gag reflex is decreased, putting the patient at risk for a blocked airway. Impaired gas exchange, while has to do with respiratory, is not as appropriate as ineffective airway clearance based on the problems of the crisis. Acute fatigue and altered mental status are not priorities.

The nurse is discharging a client diagnosed with MG. Which statement by the client indicates an understanding of the discharge instructions? 1. "I can control the MG with medication, but an adenectomy will cure it." 2. "I should take a holiday from my medications every 4 or 5 weeks." 3. "I must take my medications on time every day, or I could have problems." 4. "I should take my steroid medications with food so it won't upset my stomach."

Correct answer 3: The anti cholinesterase medications used to treat MG must be taken on time in order to prevent muscle weakness and respiratory complications. These medications are one of the very few that the nurse should administer at the exact scheduled time. Steroids are not prescribed for MG.

Which referral is appropriate for the client in the late stages of myasthenia gravis? 1. The infection control nurse. 2. The occupational health nurse. 3. A vocational guidance counselor. 4. The speech therapist.

Correct answer 4: Speech therapists address swallowing problems, and clients with myasthenia gravis are dysphagic and at risk for aspiration. The infection control and occupational health nurses do not consult with the client. A vocational counselor helps with the client finding a position suited for the disability, but clients with late-stage myasthenia gravis are usually not able to work.

Your patient diagnosed with Myasthenia Gravis begins taking Mestinon. During the first week, the dosage is changed frequently. While the dosage is being adjusted, the nurse's priority intervention is to: A) Administer the medication with food or an 8 oz. glass of water B) Evaluate the client's muscle strength hourly after medication C) Take a full set of vital signs every 15 minutes D) Administer the medication exactly on time

D) Peak response occurs 1 hour after administration and lasts up to 8 hours. By giving the medication exactly on time, this will help determine dosage levels. Mestinon can be given with or without food/water. There is nothing in this question that indicates vitals should be taken every 15 minutes. The client's muscle strength is important to assess, but the priority intervention is to give the medication on time.

The nurse is caring for a patient with Multiple Sclerosis (MS) and appropriately plans to: A) Teach the patient to avoid all forms of weight bearing exercise B) Avoid the use of an eyepatch as this could cause further damage to vision C) Encourage the patient to consume a low-residue diet D) Teach the patient how to inject medications as all MS medications are administered via SQ or IM injection

D. It is important for the patient to understand how to inject medication as all MS medication is required to be injected. Weight bearing exercise should be done in moderation and may help with muscle spasticity and prevention of joint contractures. An eyepatch may be beneficial the patient experiencing diplopia. A low-residue diet is low in fiber - patients with MS should consume adequate amounts of fiber to prevent constipation.

The nurse is discussing the future with a client recently diagnosed with amyotrophic lateral sclerosis (ALS). When the client asks about the possibility of continuing to work at his family's construction business, the nurse responses: 1. "Work as long at your job as you feel capable of keeping up with the demands it makes on you.". 2. "This is a progressively debilitating disease; you need to think of ways to conserve your energy, not expend it.". 3. "Can you do work that is less strenuous?" 4. "Is there a way that you can switch over to the office side of the business?"

1. "Work as long at your job as you feel capable of keeping up with the demands it makes on you.". Rationale: People with ALS do maintain careers and interests. They are encouraged to remain active for as long as possible. While it is important to minimize stress and conserve energy, it is not necessary to alter one's life dramatically until the symptoms of the disease demand it.

After the male client receives a diagnosis of amyotrophic lateral sclerosis (ALS), he expresses sadness and states he does not know what to do next. Which is the most effective response by the nurse to facilitate communication? 1. Ask the client what he finds comforting in his life. 2. Reassure the client his family will take care of him. 3. Refer the client to a church for spiritual counseling. 4. Tell the client hospice care is available immediately.

1. ALS is a progressive, degenerative neurological disease with no cure and, because of the grim diagnosis, the client expresses confusion and lacks a clear direction. To reduce anxiety enhance coping skills, and facilitate communication, the nurse provides a calm atmosphere by redirecting the client to identify comforting things. The nurse uses the comfort measures hoping they will reduce tension so the client can process information and make decisions.

The nurse is preparing an educational program on amyotrophic lateral sclerosis (ALS). The nurse recognizes that this information is most appropriately presented at a: 1. Men's "50 or older" bowling league banquet. 2. Mother-and-daughter softball league season kickoff brunch. 3. "Singles over 60" wellness health fair. 4. A teenage men's hockey team annual fund raising event.

1. Men's "50 or older" bowling league banquet. Rationale: The onset of ALS typically occurs between 40 and 60 years of age, affecting men more often than women. While it can affect younger and older people of either gender, the 50-or-older male group would be the target population of the available options.

The client newly diagnosed with multiple sclerosis (MS) states, "I don't understand how I got multiple sclerosis. Is it genetic?" On which statement should the nurse base the response? 1. Genetics may play a role in susceptibility to MS, but the disease may be caused by a virus. 2. There is no evidence suggesting there is any chromosomal involvement in developing MS. 3. Multiple sclerosis is caused by a recessive gene, so both parents had to have the gene for the client to get MS. 4. Multiple sclerosis is caused by an autosomal dominant gene on the Y chromosome,so only fathers can pass it on.

1.The exact cause of MS is not known,but there is a theory stating a slow virus is partially responsible. A failure of apart of the immune system may also beat fault. A genetic predisposition involving chromosomes 2, 3, 7, 11, 17, 19, and X may be involved. 2. There is some evidence supporting a genetic component involved in developing MS. 3. A specific gene has not been identified to know if the gene is recessive or dominant. 4. The X chromosome, not the Y chromosome,may be involved.

The nurse writes the client problem of "altered sexual functioning" for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented? 1. Encourage the couple to explore alternative ways of maintaining intimacy. 2. Make an appointment with a psychotherapist to counsel the couple. 3. Explain daily exercise will help increase libido and sexual arousal. 4. Discuss the importance of keeping physically calm during sexual intercourse.

1.This will assist the client and significant other to maintain a close relationship without putting undue pressure on the client. 2. This is a real physical problem, not a psychological one. 3. The problem is impotence, not libido 4. The problem is not psychosocial. It is a physical problem, and staying calm will not help

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate (Cogentin) orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs? 1. Shuffling gait 2. Inability to urinate 3. Decreased appetite 4. Irregular bowel movements

2. Inability to urinate Rationale: Benztropine mesylate is an anticholinergic, which causes urinary retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. Options 1, 3, and 4 are unrelated to the use of this medication.

A client with Parkinson's disease is prescribed levodopa (l-dopa) therapy. Improvement in which of the following indicates effective therapy? 1. Mood. 2. Muscle rigidity. 3. Appetite. 4. Alertness.

2. Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease.

The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make? 1. "Why are you crying?The medication will help the disease." 2. "You seem upset. I will sit down and we can talk for awhile." 3. "Multiple sclerosis is a disease that has good times and bad times." 4. "I will have the chaplain come and stay with you for a while."

2.This is stating a fact and offering self. Both are therapeutic techniques for conversations. 1. "Why" is requesting an explanation, and the client does not owe the nurse an explanation. 3. The client did not ask about the nature of MS. The client needs to be able to verbalize feelings. 4. This is "passing the buck." Therapeutic communication is an integral part of nursing.

The nurse has given instructions to a client with Parkinson's disease about maintaining mobility. Which action demonstrates that the client understands the directions? 1. Sits in soft, deep chairs to promote comfort. 2. Exercises in the evening to combat fatigue. 3. Rocks back and forth to start movement with bradykinesia. 4. Buys clothes with many buttons to maintain finger dexterity.

3. Rocks back and forth to start movement with bradykinesia. Rationale: The client with Parkinson's disease should exercise in the morning when energy levels are highest. The client should avoid sitting in soft deep chairs because they are difficult to get up from. The client can rock back and forth to initiate movement. The client should buy clothes with Velcro fasteners and slide-locking buckles to support the ability to dress self.

The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), .an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

3. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in the periphery, thereby making more levodopa available to the central nervous system. Sinemet is the most effective treatment for PD

The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance? 1. The client refuses to have a gastrostomy feeding. 2. The client wants to discuss if she should tell her fiancé. 3. The client tells the nurse life is not worth living anymore .4. The client needs the flu and pneumonia vaccines.

3.A potential suicide statement is priority for the nurse when caring for the client with MS.

The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception?"

3.These are clinical manifestation of MS and can go un diagnosed for years be-cause of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS. 1. MS does not affect the menstrual cycle. 2. A rash across the bridge of the nose suggests systemic lupus erythematosus 4. Taking birth control medications should not produce these symptoms or the pattern of occurrence.

The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis. The nurse determines that the client is using the information most effectively if the client reports which action? 1. Drinking a total of 1000 mL/day 2. Giving herself an enema every morning before breakfast 3. Taking stool softeners daily and a glycerin suppository once a week 4. Initiating a bowel movement every other day, 45 minutes after the largest meal of the day

4. Initiating a bowel movement every other day, 45 minutes after the largest meal of the day Rationale: To manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate the bowel program on an every-other-day basis. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.

The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? 1. Consult the occupational therapist for adaptive appliances for eating. 2. Request a low-fat, low-sodium diet from the dietary department. 3. Provide three (3) meals per day that include nuts and whole-grain breads. 4. Offer six (6) meals per day with a soft consistency.

4. The client's energy levels will not sustain eating for long periods. Offering frequent and easy-to-chew (soft) meals of small proportions is the preferred dietary plan.

The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.

4. The major goal of treating PD is to maintain the ability to function. Clients diagnosed with PD experience slow, jerky movements and have difficulty performing routine daily tasks.

The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention? 1. The client has scanning speech and diplopia. 2. The client has dysarthria and scotomas. 3. The client has muscle weakness and spasticity. 4. The client has a congested cough and dysphagia.

4.Dysphagia is a common problem of clients diagnosed with multiple sclerosis,and this places the client at risk for aspiration pneumonia. Some clients diagnosed with multiple sclerosis eventually become immobile and are at risk for pneumonia.

The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving related to progressive loss." Which intervention should be implemented? 1. Consult the physical therapist for assistive devices for mobility. 2. Determine if the client has a legal power of attorney. 3. Ask if the client would like to talk to the hospital chaplain. 4. Discuss the client's wishes regarding end-of-life care.

4.The client should make personal choices about end-of-life issues while it is possible to do so. This client is progressing toward immobility and all the complications related to it. 1. The problem is grieving R/T loss of functioning. Assistive devices will not prevent loss of functioning and do not address grieving. 2. A legal power of attorney is for personal property and control of financial issues,which is not the focus of the nurse's care. A legal power of attorney for health care maybe appropriate. 3. The nurse should and must discuss end-of-life issues with the client and does not need to contact the hospital chaplain.

The nurse and a licensed practical nurse (LPN) are caring for a group of clients.Which nursing task should not be assigned to the LPN? 1. Administer a skeletal muscle relaxant to a client diagnosed with low back pain. 2. Discuss bowel regimen medications with the HCP for the client on strict bed rest. 3. Draw morning blood work on the client diagnosed with bacterial meningitis. 4. Teach self-catheterization to the client diagnosed with multiple sclerosis.

4.The nurse should not assign assessing,teaching, or evaluation to the LPN. Evaluating the client's ability to per-form self-catheterization should not beassigned to the LPN

The nurse is teaching the client with MS about the use of corticosteroids for treatment. Which of the following statements, if made by the patient indicates correct understanding? A) I should watch for side effects such as euphoria and insomnia while taking this medication B) This medication will need to be administered for at least 2 weeks before I begin to see improvements in my condition C) The corticosteroids will reduce my chances of relapsing in the future D) I could see flu-like symptoms while taking this medication

A. Some side effects of corticosteroid use include euphoria, mood changes, and insomnia. This medication should only be used for short periods of time (3-5 days) and is often tapered off. This medication is for use in shortening the duration of a relapse, not preventing relapse. Flu-like medications are often seen in Interferon beta-1a or 1b medications (Betaseron, avonex) which are used to for long-term treatment of MS.

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). What is the nurse's primary focus of care? 1. Respiratory support as the muscles of breathing fail, and managing secretions due to the inability to swallow and communicate 2. Providing gastrostomy feedings as soon as possible to build up muscle mass when motor functions return 3. Pain management and active range-of-motion (ROM) exercises 4. Administering immunosuppressants

Answer 1. Respiratory support as the muscles of breathing fail, and managing secretions due to the inability to swallow and communicate 2. Providing gastrostomy feedings as soon as possible to build up muscle mass when motor functions return 3. Pain management and active range-of-motion (ROM) exercises 4. Administering immunosuppressants

A female 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? a. Anxiety b. Powerlessness c. Ineffective denial d. Risk for disuse syndrome

Answer B. This comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can't perform even simple daily tasks. Although Anxiety and Risk for disuse syndrome may be diagnoses associated with ALS, the client's comment specifically refers to an inability to act autonomously. A diagnosis of Ineffective denial would be indicated if the client didn't seem to perceive the personal relevance of symptoms or danger.

A client who is recently diagnosed with amyotrophic lateral sclerosis (ALS) is to be discharged home. The nurse should teach the family to: 1. monitor the client's urine output at home. 2. check the client's level of consciousness frequently. 3. check bony prominences and reposition the client every 2 hours. 4. serve the client a high red meat diet.

Answer: 3 1. It is not necessary to monitor the client's urine output, but the family is encouraged to provide good hydration. 2. Clients with ALS maintain their mental acuity. 3. The client is usually bedridden, and should be turned every 2 hours and monitored for breakdown on bony prominences. 4. Clients with ALS lose their ability to swallow, and could aspirate on pieces of meat.

You are teaching your patient diagnosed with myasthenia gravis about treatments. Which of the following statements, if made by the patient indicates the need for further teaching? A) Plasmapheresis is way to reduce symptoms but will need to be done every day B) A thymectomy is a removal of my thymus gland and will show some immediate relieving of my symptoms C) Corticosteroids can be used for short periods of time to help improve my symptoms, but it isn't good for long periods of time D) I need to take my Mestinon four times a day at the same time each day.

Answer: B. A thymectomy may help reduce symptoms, but the effects may not be seen for many months after surgery. Plasmapheresis is the removal of antibodies from blood plasma. It must be done daily for a period of time. Corticosteroids are mostly used for short periods of time unless the patient is experiencing ocular complications. Pyridostigmine bromide (Mestinon) is divided into several doses and should be taken at the same time daily.

Which nursing intervention is aimed at reducing muscle weakness in the client with myas-thenia gravis? A. Therapeutic massage B. Assisting the client with ADLs C. Providing pressure-reducing devices D. Repositioning the client every 2 hours

B The hallmark of myasthenia gravis is muscle weakness that increases with fatigue. The nurse provides assistance with ADLs to prevent fatigue. The nurse also collaborates with the physical therapist in teaching the client energy conservation techniques.

The nurse is educating the family of a patient in the late stages of amyotrophic lateral sclerosis (ALS). What teaching point is most important for the nurse to include? a. The patient's ability to move the upper limbs may be affected. b. The patient's cognitive and mental capacity will most likely remain intact throughout the disease progression. c. The patient's breathing should not be affected by the disease. d. The patient's ability to swallow will remain intact.

B Whereas the ability to move the upper limbs will likely be affected by the disease, it is important for families to remember that the patient's cognitive and mental capacity stays intact as the motor activity rapidly declines. Breathing and swallowing are often significantly affected by ALS.

The nurse is teaching a client about myasthenia gravis. Which statement, if made by the patient indicates the need for further teaching? A) The doctor will take me off of my beta blocker because it could exacerbate my symptoms B) I should report any signs of infection to my PCP C) I can take a ibuprofen to help with pain that may occur with spasms D) I should avoid taking long walks

C. OTC medication should be avoided as they may worsen MG symptoms. The doctor may stop a beta blocker as they can exacerbate symptoms (unless benefit outweighs the risk). Any signs of infection should be reported as they can exacerbate a myasthenic crisis. Long walks should be avoided due to muscle weakness and fatigue

Which surgical procdure should the nurse anticipate the client with myasthenia gravis undergoing to help prevent the s/s of the disease process? A) There is no surgical option B) A transsphenoidal hypophysectomy C) A thymectomy D) An adrenalectomy

C. Thymectomy or removal of thymus can reduce the production of antibodies that binds the acetylcholinesterase receptors resulting reduce muscle contraction

The client is diagnosed with MG. Which intervention should the nurse implement when administering the anticholinesterase pyridostigmine (Mestinon)? 1. Assess for excess salivation and abdominal cramps. 2. Administer the medication before the client has eaten. 3. Break the capsule and sprinkle the medication on the food. 4. Assess the client's potassium level prior to administering medication.

Correct answer 1: Anticholinesterase medications can cause the client to have excessive salivation and abdominal cramping. When this occurs, the client receives the antidote atropine simultaneously in small doses. Mestinon is administered with milk and/or crackers to prevent stomach upset. Mestinon does not affect potassium levels.

The client diagnosed with MG is being discharged home. Which intervention should the nurse teach the significant other? 1. Discuss how to perform the Heimlich maneuver. 2. Explain how to perform oral hygiene on a conscious client. 3. Teach how to perform isometric exercises. l 4. Demonstrate correct hand placement for chest compressions.

Correct answer 1: The client is at risk for choking, and knowing specific measures to help the client helps decrease the client's as well as significant other's anxiety and promotes confidence in managing potential complications. The client should perform oral care. The client should perform isotonic exercises, not isometric exercises, and the client is not at an increased risk for cardiac complications, so teaching about chest compression is not necessary.

Which statement by the client supports the diagnosis of myasthenia gravis (MG)? 1. "I have weakness and fatigue in my feet and legs." 2. "My eyelids droop, and I see double everything." 3. "I get chest pain and faint after I walk in the hall." 4. "I gained 3 pounds this week, and I am spitting up pink frothy sputum."

Correct answer 2: These are ocular signs/symptoms of MG. Ptosis is drooping of the eyelid, and diplopia is unilateral or bilateral double vision. Weakness and fatigue of upper body muscle occur with MG. Option 3 is angina. Option 4 is heart failure.

The client diagnosed with MG is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a myasthenic crisis? 1. The serum assay of circulating acetylcholine receptor antibodies is increased. 2. The client's symptoms improve when administering on a cholinesterase inhibitor. 3. The client's blood pressure, pulse, and respirations improve after intravenous (IV) fluid. 4. The Tensilon test does not show improvement in the client's muscle strength.

Correct answer 2: This assessment datum indicates a myasthenic crisis that is due to undermedication, missed doses of medication, or developing an infection. Serum assays are useful in diagnosing the disease, not in identifying a crisis. Vital signs do not differentiate the type of crisis. No improvement after Tensilon indicates a cholinergic crisis, not a myasthenic crisis.

The male client diagnosed with MG is prescribed the cholinesterase inhibitor neostigmine (Prostigmin). Which data indicate the medication is not effective? 1. The client is able to perform activities of daily living (ADLs) independently. 2. The client states that his vision is clear. 3. The client cannot speak or look upward at the ceiling. 4. The client is smiling and laughing with the nurse.

Correct answer 3: Dysphonia and inability to utilize the muscles of the eye and eyelid indicate the medication is not effective. Performing ADLs, having clear vision, and smiling and laughing using the facial muscles indicate the medication is effective

A client with ALS is having trouble swallowing. What is the next intervention to maintain the client's nutritional status? a. total parenteral nutrition b. liquid protein diet c. nasoenteric feeding tube d. gastrostomy tube

D A regular diet adapted to provide soft, easily chewed food is maintained as long as the client can swallow. A tube feeding is required to prevent aspiration as chewing and swallowing difficulties arise. A gastrostomy tube is preferred over a nasoenteric tube for long term feeding.

A client tells the nurse that he is experiencing some leg stiffness when walking and slowness when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This in-formation leads the nurse to suspect a. amyotrophic lateral sclerosis (ALS). b. Huntington's disease. c. myasthenia gravis (MG). d. Parkinson's disease (PD).

D Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common early manifestation that usually occurs in one of the upper limbs.

Your patient has just been diagnosed with myasthenia gravis. Which of the following orders should be questioned? A) Prednisone PO daily B) Eyepatch to be worn every night C) Pyrodostigmine bromide (Mestinon) 4 times daily PO D) Procaine (Novocain) SQ stat to reduce pain in lower limb

D. Novocain is contraindicated in patients with MG because of its long lasting effects.

The patient with myasthenia gravis is complaining about dealing with muscle weakness. Which of the following could the nurse do for this patient? A) Administer antispasmodic medication B) Teach the patient to do physical exercise for several hours each day to help strengthen muscles C) Teach the patient it is important to avoid all forms of physical activity whenever possible D) Help the patient form a plan to take medications on time

D. Taking medications at the same time each day will help reduce the exacerbation of muscle weakness. Antispasmodic medications are not indicated for this patient. Exercising for that much time each day will worsen muscle weakness and fatigue and is not feasible. The patient does not need to avoid all forms of physical activity. They need to time out physical activity with peaks of the medication in order to conserve energy.

A patient with multiple sclerosis states "After I started taking my medication, I feel nauseous and feel fatigued. I also am also running a fever". After looking in the patient's chart you note that she is taking Interferon beta 1b (Betaseron). What is the nurses' best response? A) "We are going to stop your medication immediately. This is a sign of an adverse reaction" B) "It would probably be best to admit you to the hospital. Your MS is relapsing and we will need to begin you on a corticosteroid regimen" C) "This is only a side effect of your medication. It will just eventually go away" D) "Taking your medication at bedtime with a Tylenol my help reduce these symptoms"

D. Taking the medication at bedtime and managing symptoms with ibuprofen or acetaminophen can help reduce the side-effects of this medication. While option C is true, it is not the most therapeutic response. It offers no suggestion for management. A and B are incorrect because the symptoms are not a sign of adverse reaction or relapsing MS.