ADN 420 Test 1 (Development & Mobility)
A patient diagnosed with multiple sclerosis (MS) tells the healthcare provider, "I'm not sure if I'll be able to exercise anymore." Which of these is the most appropriate response? 1. "Swimming or exercising in the water can be both enjoyable and beneficial." 2. "You should get a personal trainer to help you plan a fitness program." 3. "It's important for you to conserve your strength by not being too active." 4. "Exercise often causes a relapse of the disease, so it should be avoided."
1. "Swimming or exercising in the water can be both enjoyable and beneficial."
A patient who has experienced a spinal cord injury has an ipsilateral loss of voluntary motor function and a contralateral loss of pain and temperature sensation. Based on these symptoms, which classification of spinal cord injury does the patient have? 1. Brown Sequard 2. Tetraplegia 3. Paraplegia 4. Anterior Cord Syndrome
1. Brown Sequard A condition called Brown-Séquard syndrome results from damage to a hemisection of the anterior and posterior cord. The effect is an ipsilateral loss of voluntary motor function from the corticospinal tract and proprioception loss with a contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion.
Which of the following should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? Select all that apply. 1. Carefully test the temperature of bathwater. 2. Avoid kitchen activities because of the risk of injury. 3. Avoid hot water bottles and heating pads. 4. Inspect the skin daily for injury or pressure points. 5. Wear warm clothing when outside in cold temperatures.
1. Carefully test the temperature of bath water. 3. Avoid hot water bottles and heating pads. 4. Inspect the skin daily for injury or pressure points. 5. Wear warm clothing when outside in cold temperatures.
Which of these assessment findings should the healthcare provider expect to identify as an early clinical characteristic of multiple sclerosis (MS)? 1. Vision loss 2. Dementia 3. Muscle atrophy 4. Clonus
1. Vision loss
A patient diagnosed with multiple sclerosis (MS) is prescribed baclofen (Gablofen). Which question will the healthcare provider ask when evaluating the effectiveness of the medication? 1. "Are you feeling stronger and less fatigued today?" 2. "Has the stiffness in your muscles decreased?" 3. "Did you have a bowel movement this morning?" 4. "Have you been able to urinate without difficulty?"
2. "Has the stiffness in your muscles decreased?"
Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? 1. Double vision. 2. Sudden bursts of energy. 3. Weakness in the extremities. 4. Muscle tremors.
2. Sudden bursts of energy.
A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? 1. The client exhibits intolerance to many drugs. 2. The client experiences spontaneous remissions from time to time. 3. The client requires multiple drugs simultaneously. 4. The client endures long periods of exacerbation before the illness responds to a particular drug.
2. The client experiences spontaneous remissions from time to time.
During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barre? syndrome in their medical history. The patient asks, "What is that?" How should the nursing student reply? 1. "A degenerative disease where you have trouble walking without the help of a cane or walker." 2. "Influenza-like illness where you had fever and chills for 2-3 days after your last flu shot." 3. "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." 4. "Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well."
3. "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." Gullain-Barre Syndrome is an acute immune-mediated polyneuropathy. The majority of people report having had an acute, influenza-like illness before the onset of symptoms. It progresses along the ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. The rate of disease progression varies, and there may be disproportionate involvement of the upper or lower extremities. Option B is anaphylaxis following the flu shot. It is not a degenerative disease.
Peripheral neuropathy occurs most commonly with which one of the following disorders? 1. Cancer 2. Alcoholism 3. AIDS 4. Diabetes
4. Diabetes Diabetes mellitus is a primary metabolic disorder that frequently leads to peripheral neuropathy.
The onset of fat emboli will typically occur within this many hours after surgery.
72 hours after the injury
What is autonomic dysreflexia?
An acute life-threatening emergency that occurs as a result of exaggerated autonomic responses to stimuli that are harmless in normal people
The nurse is assessing a client with a suspected diagnosis of multiple sclerosis. The nurse would anticipate the assessment data to include:
Ataxia and paresthesias
Where do the cranial nerves originate from?
Brainstem
Which part of the brainstem regulates respiratory, vasomotor, and cardiac functions?
Medulla oblongata
Which part of the brainstem mediates the auditory and visual reflexes?
Midbrain
The most common cause of spinal cord injuries?
Motor vehicle crashes
What is the phrenic nerve?
Nerve that stimulates the diaphragm
The cerebellum is located below which lobes of the cerebrum?
Occipital lobe
A patient has an S5 spinal fracture from a fall. What type of assistive device will this patient require?
The patient will be able to ambulate independently. Patients with spinal cord injuries from S1 to S5 should be able to ambulate independently, without an assistive device.
How many paired bundles of myelinated nerve fibers from communication pathways between the cerebellum and other parts of the central nervous system?
Three
Which cranial nerve is responsible for hearing and sense of balance?
VII- acoustic
Which of the following would be a symptom that is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? 1. Respiratory muscle impairment 2. Dysarthria 3. Fatigue 4. Optic nerve dysfunction
1. Respiratory muscle impairment Dysphagia with recurrent aspiration and weakness of the respiratory muscles produce the most significant acute complication of ALS. MS does not typically include respiratory muscle impairment.
The unique clinical presentation of a 3 month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? 1. "Has your baby ever been directly exposed to any chemical cleaning products?" 2. "Have you ever given your child any honey or honey-containing products?" 3. "Is there any family history of neuromuscular diseases?" 4. "Is there any mold in your home that you know of?"
2. "Have you ever given your child any honey or honey-containing products?" Botulism in infants is frequently attributable to honey. Family history is not a relevant consideration given the bacterial etiology, and mold and chemical cleaning products are not known to predispose to botulism toxicity.
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? 1. Myasthenia gravis 2. Carpal tunnel syndrome 3. Guillain-BarrÉ syndrome 4. Phalen syndrome
2. Carpal tunnel syndrome The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity. The other answers do not describe the clinical presentation of amyotrophic lateral sclerosis.
Which of the following is not a realistic outcome to establish with a client who has multiple sclerosis (MS)? The client will: 1. Develop joint mobility. 2. Develop muscle strength. 3. Develop cognition. 4. Develop mood elevation.
3. Develop cognition.
A client who has experienced a spinal cord injury still has use of the arms and has impaired motor and sensory function of the trunk, legs, and pelvic organs. The injury would be classified as: 1. Brown-Séquard syndrome 2. Quadriplegia 3. Tetraplegia 4. Paraplegia
4. Paraplegia The loss of motor and sensory function in the trunk, legs, and pelvic organs while maintaining use of the arms is called paraplegia. Tetraplegia is the loss of function in all areas. Quadriplegia is the loss of function of all four limbs. Clients with Brown-Séquard syndrome suffer from ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation.
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? 1. Guillain-BarrÉ syndrome 2. Myasthenia gravis 3. Huntington disease 4. Parkinson's disease
4. Parkinson disease The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis. The other answers are incorrect.
A patient is asked to stand with feet together, eyes open and hands by the sides. Then the patient is asked to close their eyes while the nurse observes for a full minute. What assessment is the nurse performing? 1. Segmental reflex. 2. Posture. 3. Crossed-extensor reflex. 4. Proprioception.
4. Proprioception Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception or the sense of body movement and position independent of vision. The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements so they function in a coordinated manner
This procedure is used for direct visualization of a joint.
Arthroscopy
Which of the following relays messages between upper and lower levels of the nervous system?
Brainstem
This is a pathophysiological change in osteoarthritis.
Cartilage affected
Which of the following has two hemispheres and integrates information from the vestibular system that indicates position/movement and uses this information to coordinate limb movements?
Cerebellum
What is orthostatic hypotension?
Drop in blood pressure caused by position changes
Restlessness, confusion, and petechiae in a client who has suffered a femur fracture may be indicative of this.
Fat emboli
The spinal cord joins the brainstem at the:
Foramen magnum
This disease is caused by prolonged elevations of serum uric acid caused by problems with synthesizing purines or poor renal excretion of uric acid.
Gout
This is an important assessment in the management of skin traction.
Head of bed at appropriate height
These two components of the CBC indicate blood loss.
Hemoglobin and hematocrit
Which cranial nerve is responsible for smell?
I- olfactory
Which cranial nerve is responsible for vision?
II- optic
Which cranial nerve is responsible for extraocular eye movement, pupil constriction, and eyelid elevation?
III- oculomotor
Which part of the brain excels at language and analytical tasks?
Left hemisphere
Which of the following rests deep in the temporal lobe and initiated primitive drives; such as: hunger, aggression, and sexual/emotional arousal?
Limbic system
Which lobe of the brain functions primarily in interpreting visual stimuli?
Occipital lobe
Universal prevalence of this disease is seen by age 80.
Osteoarthritis
What is tetraplegia (formerly called quadriplegia)?
Paralysis of all four extremities
Which of the following is associated with conservation, restoration, and maintenance of normal body functions? Such as reducing the heart rate, increasing gastrointestinal motility, vasodilatation, and bronchial construction?
Parasympathetic response (PNS)
Which lobe of the brain interprets and integrates sensations, including pain, temperature and touch; also interprets size, shape, distance, and texture?
Parietal Lobe
The collapse of bone caused by metastatic cancer or osteoporosis is called this.
Pathologic fracture
This type of pain is unique to the amputee.
Phantom pain
What is intermittent catherization?
Process for emptying the bladder initially after a spinal cord injury
Which of the following is responsible for wakefulness?
Reticular activating system
A chronic disease characterized by inflammation of the synovial membrane, affecting more females than males.
Rheumatoid Arthritis
The spinal cord terminates near the:
Second lumbar vertebra
The patient is admitted following a fall from a ladder. During the nurse's first assessment, the findings are: blood pressure 88/62, flaccid paralysis on the left, absent bowel sounds, and palpation of a distended bladder. These signs are consistent with which of the following?
Spinal shock
The surface of the cerebrum has creases or fissures known as:
Sulci
Which of the following relays all sensory stimuli (except olfactory) as they ascend to the cerebral cortex with functions including primitive awareness of pain and focusing of attention?
Thalamus
Which level of nerve injury is corresponding to the loss of functional ability to T6-T10?
*Abdominal muscle control *Partial to good balance with trunk muscles
Which level of nerve injury is corresponding to the loss of functional ability to C7-C8?
*Full elbow extension *Wrist plantar flexion *Some finger control
Which level of nerve injury is corresponding to the loss of functional ability to T1-T5?
*Full hand and finger control *Use of intercostal and thoracic muscles
Which level of nerve injury is corresponding to the loss of functional ability to C5?
*Full head and neck control *Shoulder strength *Elbow flexion
Which level of nerve injury is corresponding to the loss of functional ability to S1-S5?
*Full leg, foot, and ankle control *Innervation of perineal muscles for bowel, bladder, and sexual function
Which level of nerve injury is corresponding to the loss of functional ability to C6?
*Fully innervated shoulder *Wrist extension or dorsiflexion
Which level of nerve injury is corresponding to the loss of functional ability to C4?
*Good head, neck sensation, and motor control *Some shoulder elevation *Diaphragm movement
A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: 1. Normal manifestations of Parkinson disease 2. Signs of clinical improvement 3. Signs of clinical deterioration 4. Manifestations of another disease process
1. Normal manifestations of Parkinson disease The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement.
After being thrown off the back of a bull, the bull rider can move their arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as being a: 1. Paraplegia. 2. Quadriplegia. 3. Anterior cord syndrome. 4. Tetraplegia.
1. Paraplegia. Tetraplegia and quadriplegia is loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.
During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? 1. The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction 2. Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers 3. Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response 4. Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission
1. The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.
The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions? 1. Pseudohypertrophy 2. Disuse atrophy 3. Muscular dystrophy 4. Involuntary movements
2. Disuse atrophy Disuse atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. -Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. -Pseudohypertrophy is associated with muscular dystrophy.-Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?1. Walking 2. Speech 3. Reading 4. Fine motor skills ReadingConjugate readjustment of eye position due to cerebellar damage can make reading very difficult. After being thrown off
3. Reading Conjugate readjustment of eye position due to cerebellar damage can make reading very difficult.
Reflex activity involves which of the following?1. All of the above 2. Efferent neurons 3. Afferent neurons 4. Interneurons
4. All of the above Afferent neurons synapse with efferent neurons directly, innervating a muscle or with an interneuron that synapses with an effector neuron.
When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated? 1. Encouraging the client to speak slowly. 2. Encouraging the client to speak distinctly. 3. Asking the client to repeat indistinguishable words. 4. Asking the client to speak louder when tired.
4. Asking the client to speak louder when tired.
Multiple sclerosis is characterized by what type of neuron damage? 1. Mononeuropathy 2. Transneuropathy 3. Aneuropathy 4. Polyneuropathy
4. Polyneuropathy MS is classified as a polyneuropathy due to many nerves being affected by the disease, involving demyelination of peripheral nerves.
What is a contracture?
A joint that is immobilized too long and becomes fixed in position
The brain and spinal cords are known as the:
Central nervous system
This complication of trauma involved necrosis of muscle caused by inadequate capillary blood flow with complaints of unrelenting pain.
Compartment syndrome
The surface of the cerebrum has convolutions known as:
Gyri
Which of the following detects and directs all incoming sensory information to appropriate areas of the brain for interpretation?
Reticular activating system
Which part of the brain excels in spatial, artistic, and musical function?
Right hemisphere
The nurse suspects a spinal cord injury client is developing autonomic dysreflexia. Which assessment findings would confirm the development of this complication? Select all that apply.
*BP 180/98 *Complains of a pounding headache *Pulse rate 49 Autonomic dysreflexia represents an acute episode of exaggerated sympathetic reflex responses that occur in people with injuries at T6 and above, in which CNS control of spinal reflexes is lost. It is characterized by hypertension (BP 180/98 mm Hg), skin pallor, vagal slowing of the heart rate (pulse 49), and headache ranging from dull to severe and pounding.
The healthcare provider is planning care for a patient diagnosed with multiple sclerosis (MS). Which of the following is the priority intervention? 1. Advise the patient to drink liquids through a straw 2. Monitor the patient's temperature to avoid overheating 3. Teach the patient's family how to meet the patient's needs 4. Encourage bed rest in order to conserve strength
1. Advise the patient to drink liquids through a straw Problems related to dysphagia (such as aspiration) can be minimized if the patient drinks liquids through a straw. Sensitivity to heat is a concern with MS, but monitoring the patient's temperature is not necessary.
Which of the following neurons connect sensory and motor neurons? 1. Interneurons 2. Efferent neurons 3. Cranial nerves 4. Afferent neurons
1. Interneurons Neurons that connect sensory and motor neurons are known as interneurons. Motor neurons receive input from axons descending from higher centers. These supraspinal signals can modify reflex responses to peripheral stimuli by facilitating or inhibiting different populations of interneurons. They also coordinate movements through these interneurons.
Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. 1. Rapid deterioration of respiratory status 2. Pale, cool, dry skin 3. Flaccid paralysis of limbs 4. BP 90/62 5. Lack of any physical pain
1. Rapid deterioration of respiratory status 2. Flaccid paralysis of limbs 3. BP 90/62 Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome.
In a patient with MS, which of the following will the healthcare expect to identify? Select all that apply. 1. Flaccid paralysis 2. Nystagmus 3. Resting tremors 4. Scanning speech 5. Seizures
2. Nystagmus (involuntary eye movements which may cause the eye to rapidly move) 4. Scanning speech Common findings can be remembered as the Charcot triad: nystagmus (and/or double vision), scanning speech (slow, hesitant pronunciation of words as syllables), and intention tremor.
A client with multiple sclerosis (MS) lives with her daughter and 3-year-old granddaughter. The daughter asks the nurse what she can do at home to help her mother. Which of the following measures would be most beneficial? 1. Psychotherapy. 2. Regular exercise. 3. Day care for the granddaughter. 4. Weekly visits by another person with MS.
2. Regular exercise.
What is spinal shock?
A sudden depression of reflex activity in the spinal cord (areflexia) below the level of injury
Which of the following controls body temperature, appetite, water balance, pituitary secretions, emotions and autonomic functions including the sleep/wake cycle?
Hypothalamus
Which cranial nerve is responsible for swallowing movements?
IX- glossopharyngeal
The cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus) fall into which category?
Mixed sensory and motor
The cranial nerves I (olfactory), II (optic), and VII (acoustic) fall into which category?
Sensory
This is a symptom of a closed fracture.
Shortening of extremity
What are primary injuries?
Type of spinal cord injury that results from initial insult or trauma and are usually permanent
What are secondary injuries?
Type of spinal injury that most generally results from a contusion or tear injury, in which the nerve fibers begin to swell and disintegrate
This lab value is analyzed to determine the effectiveness of allopurinol therapy.
Uric acid
Which cranial nerve is responsible for transmitting stimuli from face, head, and corneal reflex?
V- trigeminal
This diet component is important to promote healing in musculoskeletal injuries.
Vitamin B and C
The elevation in this component of the CBC indicates infection.
White blood cells
Which cranial nerve is responsible for the movement of the palate, swallowing, gag reflex, activity of thoracic and abdominal viscera such as heart rate and peristalis?
X- vagus
Which cranial nerve is responsible for tongue movement?
XII- hypoglossal
Which cranial nerve is responsible for tongue movements?
XII- hypoglossal
Which level of nerve injury is corresponding to the loss of functional ability to C2-C3?
*Head and neck sensation *Some neck control *Independent of mechanical ventilation for short periods
Which level of nerve injury is corresponding to the loss of functional ability to T11-T15?
*Hip flexors *Hip abductors *Knee extension *Knee flexion and ankle dorsiflexion
What are applicable nursing diagnosis for spinal cord injury patients?
*Ineffective breathing pattern *Ineffective airway clearance *Impaired bed and physical mobility *Risk for injury *Risk for impaired skin integrity *Impaired urinary elimination *Constipation *Acute pain *Autonomic dysreflexia
Which level of nerve injury is corresponding to the loss of functional ability to C1?
*Little or no sensation or control of head and neck *No diaphragm control *Requires continuous ventilation
What are methods to prevent thromboembolism?
*Low-dose anticoagulation therapy *Anti-embolism stockings *Pneumatic compression devices
Predominant risk factors for spinal cord injury?
*Young age *Male gender *Alcohol and drug abuse
Which of the following statements made by a patient diagnosed with multiple sclerosis (MS) would alert the healthcare provider that the patient requires additional instruction about the disease? Select all that apply. 1. "A hot bath in the evenings will help relax my muscles and relieve pain." 2. "I will avoid foods that are high in fiber to prevent problems with my bowels." 3. "It's important for me to inspect my skin daily make sure there aren't any injuries." 4. "Use of stress reduction strategies can decrease the severity of my symptoms."
1. "A hot bath in the evenings will help relax my muscles and relieve pain." 2. "I will avoid foods that are high in fiber to prevent problems with my bowels." The patient should be taught about factors that can exacerbate symptoms, such as heat and stress. In addition, the patient is at risk for burns due to impaired peripheral sensation, so bathing temperatures should be carefully monitored.
Several months ago, a 20 year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? 1. Conus medullaris syndrome 2. Brown-Sequard syndrome 3. Anterior cord syndrome 4. Central cord syndrome
1. Conus medullaris syndrome Functional deficits resulting from conus medullaris syndrome usually result in flaccid bowel and bladder and altered sexual function. Sacral segments occasionally show preserved reflexes if only the conus is affected. Motor function in the legs and feet may be impaired without significant sensory impairment. Anterior cord syndrome and Brown-Sequard syndrome include a loss of pain and temperature sensation while central cord syndrome manifests in spastic paralysis and is more common among older adults.
Guillain-Barré syndrome is characterized by which of the following forms of neuron damage? 1. Polyneuropathy 2. Transneuropathy 3. mM 4. Aneuropathy
1. Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy.
The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client: 1. "You will need to accept the necessity for a quiet and inactive lifestyle." 2. "Keep active, use stress reduction strategies, and avoid fatigue." 3. "Follow good health habits to change the course of the disease." 4. "Practice using the mechanical aids that you will need when future disabilities arise."
2. "Keep active, use stress reduction strategies, and avoid fatigue."
The healthcare provider is teaching a group of patients diagnosed with multiple sclerosis (MS) about common bladder problems. Which of the following will the healthcare provider include? Select all that apply. 1. "Drinking caffeinated beverages can help you empty your bladder completely." 2. "MS may cause the bladder to contract and empty more often than usual." 3. "You should not attempt to urinate until you feel that your bladder is full." 4. "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." 5. "Drinking lots of citrus juices will decrease the amount of bacteria in your urinary tract." 6. "Patients with MS are at increased risk of developing urinary tract infections."
2. "MS may cause the bladder to contract and empty more often than usual." 4. "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." 6. "Patients with MS are at increased risk of developing urinary tract infections." MS heightens a patient's risk of urinary tract infections. Patients should plan to void on a regular basis. Voiding at least every 2 hours will decrease urine stasis.
A client is experiencing pain, tingling, and numbness of the thumb and first, second, third, and half of the fourth digits of the hand. She states that she has pain in the wrist and hand, which worsens at night, and she has noticed that they have become clumsy. The nurse recognizes these manifestations as: 1. Lou Gehrig disease 2. Carpal tunnel syndrome 3. Muscular dystrophy
2. Carpal tunnel syndrome Carpal tunnel syndrome is characterized by pain, paresthesia (tingling), and numbness of the thumb and first, second, third, and half of the fourth digits of the hand; pain in the wrist and hand, which worsens at night; atrophy of the abductor pollicis muscle; and weakness in precision grip. All of these abnormalities may contribute to clumsiness of fine motor activity.
A client affected by postural hypotension will likely display what symptoms? 1. Flushing of skin with repositioning 2. Dizziness and pallor when moved to upright position 3. Sudden pain with movement to sitting position 4. Inability to sit upright due to muscle weakness
2. Dizziness and pallor when moved to upright position Postural hypotension is caused by interruption of sympathetic outflow to vessels in abdomen and extremities. Pooling of blood leads to impaired venous blood return and symptoms with position change to upright
The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. 1. Restrict fluids to 1,000 mL/ 24 hours. 2. Drink 400 to 500 mL with each meal. 3. Drink fluids midmorning, midafternoon, and late afternoon. 4. Attempt to void at least every 2 hours. 5. Use intermittent catheterization as needed.
2. Drink 400 to 500 mL with each meal. 3. Drink fluids midmorning, midafternoon, and late afternoon. 4. Attempt to void at least every 2 hours. 5. Use intermittent catheterization as needed.
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? 1. Disimpact the stool from the anal vault. 2. Elevate the head of the bed. 3. Give the client some orange juice and sugar. 4. Insert an indwelling catheter.
2. Elevate the head of the bed. Autonomic dysreflexia is a clinical emergency, and without prompt and adequate treatment, convulsions, loss of consciousness, and even death can occur. The major components of treatment include monitoring blood pressure while removing or correcting the initiating cause or stimulus. The person should be placed in an upright position, and all support hose or binders should be removed to promote venous pooling of blood and reduce venous return.
A nurse caring for a patient in myasthenic crisis identifies a priority concern as: 1. Ongoing physical therapy to maintain strength. 2. Maintenance of airway and respiration. 3. Monitoring for difficulty chewing. 4. Monitoring for ptosis.
2. Maintenance of airway and respiration. All symptoms and issues are present with myasthenia gravis. However, a priority concern during crisis is maintenance of airway and ventilatory support because of muscular weakness that may compromise breathing/respiration.
Death caused by muscular dystrophy in early adulthood is usually due to which of the following? 1. Severe skeletal muscle weakness 2. Respiratory and cardiac muscle involvement 3. Severe long bone fractures 4. Malnutrition
2. Respiratory and cardiac muscle involvement Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.
Which intervention should the nurse suggest to help a client with multiple sclerosis avoid episodes of urinary incontinence? 1. Limit fluid intake to 1,000 mL/ day. 2. Insert an indwelling urinary catheter. 3. Establish a regular voiding schedule. 4. Administer prophylactic antibiotics, as ordered.
3. Establish a regular voiding schedule.
Which of the following organs found in muscle tendons transmits information about muscle tension or force of contraction at the junction of the muscle and the tendon that attaches to the bone? 1. Myofibrils 2. Effector neuron 3. Golgi tendon 4. Muscle spindles
3. Golgi tendon Golgi tendon organs are found in muscle tendons and transmit information about muscle tension or force of contraction at the junction of the muscle and the tendon that attaches to the bone. Normal muscle tone depends on stretch reflexes initiated by the muscle spindles, which monitors changes in muscle length.
The nurse should anticipate they will need to teach the newly diagnosed multiple sclerosis patient how to give injections if they are prescribed which medication to modify the course of the disease by reducing exacerbations? 1. Plasmapheresis. 2. Corticosteroids. 3. Interferon-beta. 4. Mitoxantrone.
3. Interferon-beta. Interferon-beta helps modify the course of treatment of MS. It may also reduce exacerbations in persons with relapsing-remitting MS. It is a cytokine that acts as an immune enhancer. It is administered by injection. The other medications are prescribed for MS but not given by injection.
Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration? 1. Crushing injury where the nerve is traumatized but not severed 2. Incomplete amputation where tubular implants are used to fill in the gaps of nerves 3. Nerve fibers destroyed close to the neuronal cell body 4. Cutting injury where slow-regeneration axonal branches are located
3. Nerve fibers destroyed close to the neuronal cell body The successful regeneration of a nerve fiber in the PNS depends on many factors. If a nerve fiber is destroyed relatively close to the neuronal cell body, the chances are that the nerve cell will die; if it does, it will not be replaced. If a crushing type of injury has occurred, partial or often full recovery of function occurs.- Cutting-type trauma to a nerve is an entirely different matter. A number of scar-inhibiting agents have been used in an effort to reduce this hazard, but have met with only moderate success. Various types of tubular implants have been used to fill longer gaps in the endoneurial tube but again only with moderate success
Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia? 1. Apply binders and support hose to shunt the blood to the main organs. 2. Increase the patient's blood pressure to allow for adequate perfusion. 3. Position the patient in upright position, and correct the initiating stimulus. 4. Place the patient in a supine position, and increase intravenous fluids.
3. Position the patient in upright position, and correct the initiating stimulus. Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (i.e., full bladder, pain). The nurse should place the patient in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure.-Intravenous fluids are not an immediate intervention for this condition.
A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug: 1. Inhibits the peripheral metabolism of dopamine 2. Prevents the depolarizing effect of the neurotransmitters 3. Produces paralysis of the larynx muscles by blocking acetylcholine release 4. Will slow the decline in muscle strength and function
3. Produces paralysis of the larynx muscles by blocking acetylcholine release Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release.-Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD.- Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. -Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. -Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects
A client with multiple sclerosis (MS) is receiving baclofen (Lioresal). The nurse determines that the drug is effective when it achieves which of the following? 1. Induces sleep. 2. Stimulates the client's appetite. 3. Relieves muscular spasticity. 4. Reduces the urine bacterial count.
3. Relieves muscular spasticity.
The nurse is reviewing the care plan of a client with Multiple Sclerosis. Which of the following nursing diagnoses should receive further validation? 1. Impaired mobility related to spasticity and fatigue. 2. Risk for falls related to muscle weakness and sensory loss. 3. Risk for seizures related to muscle tremors and loss of myelin. 4. Impaired skin integrity related bowel and bladder incontinence.
3. Risk for seizures related to muscle tremors and loss of myelin.
Which of the following complications of spinal cord injury is the most preventable in a paraplegic patient? 1. Deep vein thrombosis 2. Muscle atrophy 3. Skin breakdown 4. Autonomic dysreflexia
3. Skin breakdown The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the spinal cord-injured person at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable
Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Select all that apply.) 1. Vasoconstriction 2. Fever 3. Skin pallor 4. Piloerector response 5. Hypertension
3. Skin pallor 4. Piloerector response 5. Hypertension Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. -Fever and vasoconstriction are not manifestations of autonomic dysreflexia
The right hand of a client with multiple sclerosis trembles severely whenever she attempts a voluntary action. She spills her coffee twice at lunch and cannot get her dress fastened securely. Which is the best legal documentation in nurses' notes of the chart for this client assessment? 1. "Has an intention tremor of the right hand." 2. "Right-hand tremor worsens with purposeful acts." 3. "Needs assistance with dressing and eating due to severe trembling and clumsiness." 4. "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup."
4. "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup."
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of: 1. Degeneration of the lower cell bodies of the lower motor neurons in the gray matter 2. Degenerative changes in the musculoskeletal system 3. Circulating antibodies attacking the postsynaptic acetylcholine levels 4. 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
4. 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 MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.
When assessing a patient diagnosed with multiple sclerosis (MS), which of the following would require immediate action by the healthcare provider? 1. Fatigue and depression 2. Paresthesia and tremor 3. Nystagmus and diplopia 4. Dysphagia and congested cough
4. Dysphagia and congested cough
Loss of coordinated movement and balance is likely due to damage to which of the following? 1. Peripheral neurons 2. Pyramidal structures 3. Cranial nerves 4. Extrapyramidal structures
4. Extrapyramidal structures Disorders affecting the extrapyramidal system include involuntary movement, muscle rigidity, and immobility without paralysis.
The underlying causative problem in Parkinsonism is which of the following? 1. Genetic defect 2. Autoimmune disorder 3. Viral infection 4. Failure of dopamine release
4. Failure of dopamine release Lack of dopamine release is the primary cause of Parkinson's disease and associated symptoms.
A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is inappropriate? 1. Eating a diet high in fiber. 2. Setting a regular time for elimination. 3. Using an elevated toilet seat. 4. Limiting fluid intake to 1,000 mL/ day.
4. Limiting fluid intake to 1,000 mL/ day.
Myelinated neurons found in the central nervous system are covered by which of the following cells? 1. T cells 2. Lewy bodies 3. Schwann cells 4. Oligodendrocytes
4. Oligodendrocytes In the central nervous system, myelin is formed by the oligodendrocytes, chiefly those lying among the nerve fibers in the white matter. This function of oligodendrocytes is equivalent to that of the Schwann cells in the peripheral nervous system. The properties of the myelin sheath—high electrical resistance and low capacitance—permit it to function as an electrical insulator.
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 of the following medical terms? 1. Dysdiadochokinesia 2. Chorea 3. Fasciculations 4. Pseudohypertrophy
4. Pseudohypertrophy Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this? 1. Likely a pre-existing mental illness 2. Depression over new diagnosis 3. A side effect of treatment 4. Psychological manifestation due to involvement of white matter of cerebral cortex
4. Psychological manifestation due to involvement of white matter of cerebral cortex Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.
Cerebellar tremor is exhibited by which symptom? 1. Over- or underreaching for a target, followed by overcorrection 2. Slow, slurred speech of continuous, varying loudness 3. Constant conjugate readjustment of eye position 4. Rhythmic movement of the finger or toe that worsens as a target is approached
4. Rhythmic movement of the finger or toe that worsens as a target is approached Cerebellar tremor is a rhythmic back-and-forth movement of a finger or toe that worsens as the target is approached. Symptoms associated with damage to the cerebellum are manifested based on the site of injury. Cerebellar tremor results from the inability of the damaged cerebellum to maintain ongoing fixation of a body part and to make smooth, continuous correction in the trajectory of movement; overcorrection occurs, first in one direction and then in the other. The other options reflect the inability to establish fixation in other areas.
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. MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve.
A client with multiple sclerosis (MS) is frustrated by tremors associated with the disease. How should the nurse explain why these tremors occur? Due to the demyelination of neurons that occurs in MS:
Communication being sent through neurons is slowed. Myelin acts as an insulator that allows for rapid conduction of nerve impulses; therefore, the client with MS will have these impulses slowed, not quickened. Because the pattern of demyelination is sporadic, the signals arrive in a disorganized way. There are still some signals being sent, and this condition is not limited to neurons in the basal ganglia (although these can be involved).
This is the chief cause of mortality in clients with hip fractures within the first year of injury.
Complications from immobility
The right and left cerebral hemispheres of the brain are joined by the:
Corpus callosum
Which medication is used to treat acute attacks of multiple sclerosis (MS)?
Corticosteroids Corticosteroids are the mainstay of treatment for acute attacks of MS. These agents are thought to reduce inflammation, improve nerve conduction, and have important immunologic effects.
Which of the following go from the brain to the eyes, mouth, ears and other parts of the body?
Cranial nerves
What is neurogenic shock?
Develops as a result of the loss of autonomic nervous system function below the level of the lesion
What is the Halo device?
Device used initially with traction or may be applied after removal of tongs. It consists of a stainless steel ring that is fixed to the skull by four pins
Which of the following is located beneath the cerebral hemispheres and contains the thalamus and hypothalamus?
Diencephalon
A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis?
Help the client perform range-of-motion (ROM) exercises every 8 hours. Helping the client perform ROM exercises every 8 hours helps in promoting joint flexibility and muscle tone in a client with muscle weakness. Measures such as using pressure-relieving devices or changing the body positions every 2 hours prevents skin breakdown. The nurse should use a footboard and trochanter rolls to promote a neutral body position that will keep the body in good alignment.
Which cranial nerve is responsible for sensations of the throat and taste receptors in the posterior one-third of the tongue?
IX- glosspharyngeal
What is first-line emergency response?
Immediate immobilization on a spinal (back) board, with the head and neck maintained in a neutral position, to prevent an incomplete injury from being complete
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 patient was body surfing in the ocean and sustained a cervical spinal cord fracture. A halo traction device was applied. How does the patient benefit from the application of the halo device?
It allows for stabilization of the cervical spine along with early ambulation. Halo devices provide immobilization of the cervical spine while allowing early ambulation.
Which of the following screens all sensory messages traveling to the cerebral cortex?
Limbic system
What is parapalegia?
Lower motor neuron damage caused by spinal cord injury (Paralysis of the lower body)
This disease has specific symptoms that include sensitivity to light and butterfly erythema.
Lupus
Pacemakers and hearing aids are contraindicated for this test.
MRI
The diagnosis of multiple sclerosis is based on which test?
Magnetic resonance imaging (MRI) The diagnosis of MS is based on the presence of multiple plaques in the central nervous system observed on MRI. Electrophoresis of CSF identifies the presence of oligoclonal banding. Evoked potential studies can help define the extent of the disease process and monitor changes. Neuropsychological testing may be indicated to assess cognitive impairment.
The cranial nerves III (oculomotor), IV (trochlear), VI (abducens), XI (accessory), and XII (hypoglossal) fall into what category?
Motor
Which of the following go from the spinal cord to the lungs, heart, stomach, intestines, bladder, and sex organs?
Peripheral autonomic nerves
Which of the following go from the spinal cord to the arms, hands, legs, and feet?
Peripheral somatic nerves
The nurse is caring for a client immediately after a spinal cord injury. Which assessment finding is essential when caring for a client in spinal shock with injury in the lower thoracic region?
Pulse and Blood Pressure Spinal shock is a loss of sympathetic reflex activity below the level of the injury within 30 to 60 minutes after insult. In addition to the paralysis, manifestations include pronounced hypotension, bradycardia, and warm, dry skin. Numbness and tingling and pain are not as high of a concern at this time due to the cord injury. Because the level of impairment is below the first thoracic vertebrae, respiratory failure is not a concern.
The transmission of impulses at the neuromuscular junction is mediated by which of the following actions? 1. Release of neurotransmitter acetylcholine from autonomic nerve endings 2. Nerve origin in thoracolumbar spine 3. Connection to paraspinal ganglion chain 4. Nerve stimulation of the adrenal medulla
Release of neurotransmitter acetylcholine from autonomic nerve endings The neuromuscular junction serves as a synapse between a motor neuron and a skeletal muscle fiber. It consists of the axon terminals of a motor neuron and a specialized region of the muscle membrane called the endplate. The transmission of impulses at the neuromuscular junction is mediated by the release of the neurotransmitter acetylcholine from the axon terminals. Acetylcholine binds to specific receptors in the endplate region of the muscle fiber surface to cause muscle contraction. Acetylcholine is active in the neuromuscular junction only for a brief period, during which an action potential is generated in the innervated muscle cell.
This type of traction uses pins, screws, wires, or tongs.
Skeletal traction
Which complication of spinal cord injury is the most preventable in a paraplegic client?
Skin breakdown The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the person with spinal cord injury at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable.
Which of the following is responsible for "fight or flight" response resulting in vasoconstriction, elevated blood pressure, improved blood flow to skeletal muscles, reduction in gastric secretions, and dilation of bronchioles?
Sympathetic nervous system (SNS)
Which lobe of the brain controls hearing, motivation, language comprehension, storage, and recall of memories?
Temporal lobe
What is "Neurologic Level"?
Term used to describe the lowest level at which sensory and motor functions are intact
