Unit 06 Chapters 36

During a flu shot clinic, one of the questions the student nurse asks relates to whether the client has a history of Guillain-Barré syndrome. The client asks, "What is that?" How should the nursing student reply?

"A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles."

The unique clinical presentation of a 3 month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?

"Have you ever given your child any honey or honey-containing products?"

Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)?

A 25-year-old woman

Which individual is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system?

A 32-year-old male who had his forearm partially crushed by gears during an industrial accident

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

Which principle best explains symptoms of amyotrophic lateral sclerosis (ALS), including dysphagia, muscle weakness and spasticity, and dysphonia?

ALS is caused by both an upper motor neuron and lower motor neuron disturbance.

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:

An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis. What assessments and interventions should the nursing staff of the unit prioritize in their care?

Assessment of swallowing ability and respiratory status.

A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column?

Cannot breathe on own, needs ventilator assistance

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

Carpal tunnel syndrome

A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady, her speech is slurred, and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which health problem most likely underlies her present state?

Cerebellar damage caused by a cerebrovascular accident

The nurse assesses the client with Huntington disease demonstrating irregular wriggling and writhing movements. The client is also having facial grimacing, raising the eyebrows, and rolling the eyes. How would the nurse document this finding?

Chorea

When initially assessing a client with verbalization of back pain, the nurse would prioritize rapid assessment for which client?

Client with gradual onset of back pain and history of intravenous drug use

A client had an arm cast fitted after suffering a right humeral fracture in a hockey game. The client reported a loss of sensation in the right hand, but sensation returned upon removal of the cast. Which was the most likely cause of the client's loss of sensation?

Compression lesion of the musculocutaneous nerve

Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).

Creatine kinase

Regarding the pathophysiology of Parkinson disease, which statement is true?

Degeneration of the nigrostriatal dopamine neurons occurs.

A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?

Dopamine nigrostriatal system

A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide?

Elevate the head of the bed.

The underlying causative problem in Parkinsonism is:

Failure of dopamine release

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a client having problems in her hand/wrist. In order to test Tinel sign, the nurse should give the client which direction?

I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem?

Increasing the functional ability of the underactive dopaminergic system

A client has been diagnosed with Guillain-Barré syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client?

Maintenance of the client's airway

The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?

Muscle atrophy

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. What disease falls into this category?

Myasthenia gravis

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction?

Myasthenia gravis

Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability?

Myasthenia gravis

A client who has experienced a spinal cord injury still has use of the arms but has impaired motor and sensory function of the trunk, legs, and pelvic organs. Which term best describes how this injury is classified?

Paraplegia

After being thrown off the back of a bull, a bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is referred to as:

Paraplegia

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?

Parkinson disease

Guillain-Barré syndrome is characterized by which form of neuron damage?

Polyneuropathy

Multiple sclerosis is characterized by what type of neuron damage?

Polyneuropathy

Which treatment should take place immediately in a client experiencing autonomic dysreflexia?

Position the client in upright position, and correct the initiating stimulus.

A client is asked to stand with feet together, eyes open, and hands by the sides. Then the client is asked to close the eyes while the nurse observes for a full minute. What assessment is the nurse performing?

Proprioception

The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which medical term?

Pseudohypertrophy

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this?

Psychological manifestation due to involvement of white matter of cerebral cortex

The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing mysasthenia crisis?

The client has a sudden onset of severe weakness.

A client has developed a tendency to have a back-and-forth tremor in his fingers as he reaches for an object. The client and his wife deny any changes to his cognition. Which signs/symptoms and diagnostic testing should primarily be the focus of the assessment?

The client's cerebellar function

A nurse is providing education to a client newly diagnosed with Guillain-Barré syndrome. Which statement reflects accurate information about the course of the disease?

The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process.

The health care provider is assessing a client for carpal tunnel syndrome. The health care provider performs light percussion over the median nerve at the wrist. This assessment is known as:

Tinel sign

Which statement best describes the pathophysiology of Parkinson disease?

degeneration of the nigrostriatal dopamine system

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

interneuron

Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?

reading

Death caused by muscular dystrophy in early adulthood is usually due to:

respiratory and cardiac muscle involvement.

Which complication of spinal cord injury is the most preventable in a paraplegic client?

skin breakdown

The health care provider is assessing a client to differentiate a herniated disk from other causes of acute back pain. The most important test for the provider to perform would be:

straight leg test

The nurse has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be:

ventilatory assessment and support.