CH 58 EAQ Degenerative Neurologic Disorders

A patient with a family history of Huntington's disease suffers from a psychiatric disorder and is treated with sertraline and paroxetine. Tetrabenazine is added to the patient's prescription. Which assessment finding supports the addition of tetrabenazine to the prescription? a. Chorea b. Anxiety c. Depression d. Social withdrawal

ANS: A A patient with a family history of Huntington's disease has a 50 percent chance of inheriting the disease. The early stages of the disease are characterized by psychiatric symptoms. Movement disorders, such as chorea, characterized by abnormal and excessive involuntary movements of the face, the limbs, and the body, may appear at later stages of the disease. These are treated successfully with tetrabenazine. Anxiety can be managed with sertraline and paroxetine. Depression is a psychiatric symptom and can also be managed with sertraline and paroxetine. Social withdrawal is a psychiatric disorder symptom managed with sertraline and paroxetine,

A patient with Parkinson's disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition? a. Allow adequate time for the patient to eat meals. b. Administer prescribed carbidopa/levodopa with a protein drink. c. Encourage the patient to eat at least every two hours while awake. d. Include foods that are chewy so the patient builds up the jaw muscles.

ANS: A Allowing adequate time for the patient to eat will limit frustration and improve overall intake. Six small feedings may improve intake, but eating every two hours would exhaust the patient. Absorption of levodopa is impaired by protein, so it is best to avoid large amounts of protein when carbidopa/levodopa is administered. Foods should be easily chewable to increase the overall intake.

Which drug helps to increase the bioavailability of levodopa in the brain by inhibiting the enzyme dopa-decarboxylase? a. Carbidopa b. Tolcapone c. Rasagiline d. Entacapone

ANS: A Carbidopa is a dopamine decarboxylase inhibitor. This enzyme breaks down the dopamine peripheral tissues before reaching the brain, decreasing the bioavailability of the drug. Levodopa is the dopamine precursor converted to dopamine in the basal ganglia. Carbidopa, when administered along with levodopa, increases the bioavailability of the drug in the brain. This prevents peripheral tissue breakdown of the drug by the enzyme dopa-decarboxylase. Tolcapone and entacapone blocks the enzyme COMT that helps to increase the availability of drug levodopa. Rasagiline is a monoamine oxidase type B inhibitor that helps increase the half-life of the drug levodopa.

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority? a. Risk for injury b. Acute confusion c. Fluid volume deficit d. Ineffective thermoregulation

ANS: A In multiple sclerosis, one side is usually affected more than the other. Therefore the gait is unsteady, so the risk for falls is increased. Acute confusion may be a manifestation experienced by some patients later in the multiple sclerosis disease process. Deficient fluid volume and ineffective thermoregulation are not generally affected by multiple sclerosis. Visual disturbances and muscle spasticity may also contribute to the risk for injury.

Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

ANS: A Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS typically does not result in malnutrition, hypotension, or fluid volume excess or deficit.

Which disease exhibits Lhermitte's sign as a clinical manifestation? a. Multiple sclerosis b. Myesthenia gravis c. Lou Gehrig's disease d. Huntington's disease

ANS: A Lhermitte's sign is a transient sensory symptom manifested in the patients with multiple sclerosis. It is described as an electric shock radiating down the spine or into the limbs with flexion of the neck. Myasthenia gravis does not manifest as sensory loss. Lou Gehrig's disease, or amyotrophic lateral sclerosis, is a degenerative disorder of motor neurons and does not exhibit characteristics related to sensory loss. Huntington's disease is characterized by motor, cognitive, and psychiatric disorders, but there is no sensory loss.

A patient with an aggressive form of multiple sclerosis is not responding to the drugs teriflunomide and dalfampridine. The patient is then prescribed natalizumab and mitoxantrone. The patient is later diagnosed with progressive multifocal leukoencephalopathy. Which medication in the patient's prescription might be responsible for this complication? a. Natalizumab b. Mitoxantrone c. Teriflunomide d. Dalfampridine

ANS: A Natalizumab and mitoxantrone are prescribed for patients with aggressive forms of multiple sclerosis who have inadequate response to other drugs. The major risk factor associated with the monoclonal antibody drug natalizumab is the potentially fatal viral infection of the brain known as multifocal leukoencephalopathy. The risk factors associated with mitoxantrone include cardiotoxicity, leukemia, and infertility. The risk factors associated with teriflunomide include serious liver disease and, because of its teratogenic effects, it is avoided during pregnancy. Dalfampridine precipitates seizures, a major risk factor associated of the drug.

Which drug overdose may lead to paradoxic intoxication in a patient with parkinsonism? a. Levodopa b. Biperiden c. Trihexyphenidyl d. Diphenhydramine

ANS: A Paradoxic intoxication is the aggravation, rather than relief, of symptoms. This condition is mainly due to the excessive use of dopaminergic drugs such as levodopa. Biperiden is an anticholinergic drug that blocks the cholinergic receptors and maintains the balance between dopaminergic and cholinergic activity. Trihexyphenidyl is an example of an anticholinergic drug that does not aggravate the symptoms of the disease with overuse. Diphenhydramine is an antihistamine that has anticholinergic effects. It does not lead to paradoxic intoxication in a patient with Parkinsonism when the drug is overdosed.

A patient was just diagnosed with Huntington's disease. The patient's adult child is upset about the diagnosis. How can the nurse best help the patient's child? a. Provide emotional and psychologic support. b. Encourage him or her to get diagnostic genetic testing done. c. Tell him the cognitive deterioration will be treated with counseling. d. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).

ANS: A The patient's child will first need emotional and psychologic support. He or she should be taught about diagnostic genetic testing for him- or herself but should decide with a genetic counselor if and when he or she wants this done. The treatment plan for the father will be determined depending on the father's needs.

A patient being treated for multiple sclerosis complains of flu-like symptoms and reports feeling depressed. The patient also reports having frequent thoughts of committing suicide. Which drug in the patient's prescription may be responsible for these symptoms? a. β-interferon b. Natalizumab c. Mitoxantrone d. Dalfampridine

ANS: A β-interferon is an immunomodulator prescribed in the initial treatment of multiple sclerosis. It is known to cause flu-like symptoms, depression, and suicidal ideations. Natalizumab is prescribed for patients with active and aggressive forms of multiple sclerosis. This drug is not part of initial treatment, and the major risk factor associated with this drug therapy is progressive multifocal leukoencephalopathy. Mitoxantrone is also prescribed for patients with active and aggressive forms of multiple sclerosis, not in the initial treatment. The risk factors associated with this drug are cardiotoxicity, leukemia, and infertility. Dalfampridine is prescribed to improve walking speed.

When performing a physical assessment on a patient with amyotrophic lateral sclerosis, which manifestations is the nurse likely to find? Select all that apply. a. Limb weakness b. Difficulty swallowing c. Difficulty articulating words d. Twisting movements of the face e. Involuntary movements of the body

ANS: A B C Amyotrophic lateral sclerosis is a rare, progressive neurologic disorder characterized by loss of motor neurons. The disease is characterized by limb weakness, difficulty in articulating words (dysarthria), and difficulty in swallowing (dysphagia). The symptoms are due to denervation of the muscles and lack of stimulation and use. Twisting movements of the face and involuntary movements of the body do not occur in amyotrophic lateral sclerosis.

A patient is advised to use diazepam for multiple sclerosis. What patient teaching is important for those taking this drug? Select all that apply. a. Avoid driving while on the drug. b. Do not stop the drug abruptly. c. Avoid taking alcohol with the drug. d. Monitor blood pressure regularly. e. Avoid contact with large crowds.

ANS: A B C Diazepam is used as a muscle relaxant. Patients on diazepam should avoid driving and any such activities requiring the patient to be alert because of the sedative effects of the drug. They should not stop the drug abruptly without consulting the health care provider. The drug should not be taken along with alcohol because alcohol can potentiate the drug's effect. Monitoring blood pressure is a general health care measure and is not specific to diazepam. Because the drug has no effect on the immune system, avoiding crowds is not necessary.

The nurse is caring for a patient with Parkinson's disease. What adjustments should the nurse make in the dietary habits of the patient to prevent malnutrition and constipation? Select all that apply. a. Cut food into bite-size pieces. b. Serve hot foods on a warmed plate. c. Include whole grains and fruits in the diet. d. Include plenty of food items high in protein. e. Provide three large meals rather than six small meals.

ANS: A B C Patients with Parkinson's disease are predisposed to malnutrition and constipation, owing to inadequate food intake caused by difficulty in chewing and swallowing. To promote adequate nutrition, the nurse should include whole grains and fruits in the diet, which will prevent constipation. The food should be cut into bite size pieces so that chewing and swallowing are easy. Serving hot foods on a warmed plate makes the food more appealing. Food items high in protein should be limited in the diet because they can interfere with the absorption of carbidopa-levodopa, the most common drug used in the treatment of Parkinson's disease. Six small meals, rather than three large meals, would be less exhausting for the patients.

A patient with myasthenia gravis is admitted to the hospital in respiratory failure and diagnosed with myasthenic crisis. Which of the factors in the patient's current life situation led to the development of this myasthenic crisis? Select all that apply. a. Omitted pyridostigmine previous day. b. Attended funeral of family member earlier in week. c. Took antibiotic prescribed for urinary tract infection. d. Diagnosed with urinary tract infection previous week. e. Continued taking prescribed corticosteroid every other day.

ANS: A B C D Myasthenia gravis is an autoimmune disease in which acetylcholine receptors at the neuromuscular junction are destroyed. Patients experience muscular weakness that improves with rest. A myasthenia crisis is an acute exacerbation of muscle weakness that often involves the respiratory muscles. Exacerbations and crises can be precipitated by many factors including infection (patient's urinary tract infection), emotional stress (funeral of family member), reaction to medications (antibiotic prescribed for urinary tract infection), and inadequate anticholinesterase medications. Pyridostigmine is an anticholinesterase medication that prolongs acetylcholine present in the neuromuscular junction to improve muscle strength. Taking corticosteroid medications as prescribed suppresses immunity to decrease the myasthenic effect of muscular weakness.

A patient with multiple sclerosis has been advised to use dalfampridine to improve walking speed. What questions should the nurse ask the patient before administering the medication? Select all that apply. a. Do you have kidney disease? b. Does your work involve operating machinery? c. Do you have a history of any seizure disorder? d. Does any member of the family have diabetes? e. Have you been taking any over-the-counter medications?

ANS: A C Dalfampridine is a selective potassium channel blocker and improves nerve conduction in damaged nerve segments. Because it is a potassium channel blocker, it should not be administered to patients with a history of seizure disorders or moderate to severe kidney disease. Therefore the nurse should ask the patient about any history of seizure disorders or kidney diseases. The factors of family history of diabetes, operating machines, or taking over-the-counter drugs are not relevant to dalfampridine use or nonuse.

A patient with a family history of Huntington's disease (HD) who underwent genetic testing has positive results. What can the nurse infer from this finding? Select all that apply. a. There is no cure for this disease. b. The patient would not be treated completely with the help of drugs. c. The patient will develop a progressive, degenerative brain disorder. d. The onset of disease usually occurs between 30 and 50 years of age. e. The patient will be a carrier of the mutated gene but will not develop the disease.

ANS: A C D Huntington's disease is an autosomal dominant disorder caused by a mutation in the HTT gene located on chromosome 4. Genetic testing, or DNA testing, is useful in diagnosing the disease but is not helpful in predicting the onset of symptoms. There is no cure for the disease. The onset of disease usually occurs between 30 and 50 years of age. Huntington's disease is a progressive, degenerative brain disorder. The symptoms of behavioral problems and movement disorder can be controlled with drugs. Negative test results would indicate that the person does not carry the mutated gene and will not develop the disease.

A patient with Willis-Ekbom disease is admitted to the hospital. What are the signs and symptoms that the nurse is likely to find during data collection and assessment? Select all that apply. a. Numbness and tingling in the legs b. Discomfort that occurs during activity c. Leg pain localized to the calf muscles d. Sensation like bugs creeping on the legs e. Occurrence of symptoms mostly in the morning

ANS: A C D On assessment of the patient with Willis-Ekbom disease, the nurse may find that the patient has numbness and tingling in the legs. Pain may occur in the legs, usually localized to the calf muscles. The patient may have uncomfortable and annoying sensations, such as if bugs were creeping on the legs. The discomfort occurs when the patient is sedentary and is most common in the evening or at night.

A patient with Parkinson's disease is unresponsive to drug therapy and is being considered for surgery. After the physician discusses surgical options, about which options does the nurse anticipate educating the patient? Select all that apply. a. Ablation b. Thymectomy c. Transplantation d. Deep brain stimulation e. Dorsal-column electrical stimulation

ANS: A C D The surgical therapies for Parkinson's disease include ablation, deep brain stimulation, and transplantation. Ablation surgery involves stereotactic ablation of areas in the thalamus, globus pallidus, and subthalamic nucleus. Deep brain stimulation involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus and connecting it to a generator placed in the upper chest. The device is programmed to deliver a specific current to the targeted brain location. Transplantation of fetal neural tissue into the basal ganglia is designed to provide dopamine-producing cells in the brain. Thymectomy is used in the treatment of myasthenia gravis. Dorsal-column electrical stimulation helps in minimizing symptoms of multiple sclerosis.

The nurse is caring for a patient with a spastic bladder secondary to multiple sclerosis. What manifestations of spastic bladder should the nurse expect to find in the patient? Select all that apply. a. Bladder contractions are unchecked. b. The patient experiences urinary retention. c. The bladder has a small capacity for urine. d. The patient experiences incontinence and dribbling. e. There is no sensation of urge to void or no desire to void.

ANS: A C D A patient with spastic bladder may experience unchecked bladder contraction, and the bladder may have a small capacity for urine. Both of these factors may result in urine urgency and frequency and cause incontinence and dribbling. Sensation of an urge to void is present in patients with spastic bladder but absent in patients with flaccid bladder, who may have urinary retention due to a large bladder capacity for urine.

A patient with a suspected neurologic disorder has weakness of the limbs, blurred vision, patchy blindness, and bowel and bladder dysfunction. Which clinical findings would support the diagnosis of multiple sclerosis? Select all that apply. a. Presence of visual and auditory evoked potential b. Presence of IgM antibodies in the cerebrospinal fluid c. Presence of increased IgG antibodies in the cerebrospinal fluid d. Presence of an altered copy of the HTT gene located on chromosome 4 e. Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

ANS: A C E There is no definitive diagnostic for multiple sclerosis. To diagnose MS, the factors considered are the history, clinical manifestations, and results of certain diagnostic tests. The presence of evoked potential in the visual, auditory, and somatosensory potential testing is a diagnostic test for multiple sclerosis. Many patients with multiple sclerosis have increased IgG antibodies in the cerebrospinal fluid, and the occurrence of IgG bands is seen in most. Patients with multiple sclerosis also show damage to the spinal cord such as inflammation, tissue breakdown, and atrophy of the spinal cord, which can be seen in the MRI. The presence of IgM antibodies in the cerebrospinal fluid is not a characteristic of multiple sclerosis. The presence of an altered copy of the HTT gene, located on chromosome 4, is a characteristic of Huntington's disease.

What suggestion should the nurse give to the family members of a patient with Parkinson's disease to promote self-care and independence of the patient? Select all that apply. a. Use slip-on shoes. b. Use rugs on the floor. c. Use an elevated toilet seat. d. Use buttons and hooks on clothes. e. Elevate the legs on an ottoman when sitting.

ANS: A C E To promote self-care and independence of the patient, certain changes in the home environment can be made. Slip-on shoes should be used because they can be easily put on or taken off by the patient. Elevated toilet seats help with getting on and off the toilet easily. Legs can be elevated on an ottoman to prevent ankle edema. Rugs should be removed because they can cause the patient to fall. Hooks and buttons as clothing fasteners may be difficult for the patient to use; instead, hook-and-loop (Velcro) fasteners or zippers should be used.

The nurse is planning discharge teaching for a patient with myasthenia gravis. What instructions should the nurse include in the plan? Select all that apply. a. Plan activities with periods of rest. b. Practice hobbies such as playing golf. c. Include liquid rather than solid foods in the diet. d. Eat a balanced diet that can be easily chewed and swallowed. e. Schedule drugs so that the peak effect of the drug is at mealtime.

ANS: A D E The discharge teaching should focus on the neurologic deficits and their effect on daily living. Teach the patient about a balanced diet that can easily be chewed and swallowed. Help the patient plan activities of daily living to avoid fatigue. Scheduling doses of drugs so that peak action is reached at mealtime may make eating less difficult. Semisolid foods may be easier to eat than solids or liquids. Arrange diversional activities that require little physical effort and match the patient's interests. Playing golf may be too exhausting.

A patient with myasthenia gravis is concerned whether he or she will need a thymectomy. For which patients is thymectomy performed? Select all that apply. a. Patients with thymoma b. Patients with cholinergic crisis c. Patients with a positive Tensilon test d. Patients with purely ocular myasthenia gravis e. Patients between the ages of puberty and about 65 years

ANS: A D E Thymectomy is found to improve the symptoms in most patients with myasthenia gravis. The surgery is usually done in patients with thymoma, those with purely ocular myasthenia gravis, and patients with generalized myasthenia gravis between the ages of puberty and about 65 years. A cholinergic crisis or a positive Tensilon test does not support the need for thymectomy.

A patient is advised to use teriflunomide for multiple sclerosis. What nursing interventions are important for this patient? Select all that apply. a. Monitor liver function tests. b. Monitor blood pressure levels. c. Instruct the patient to avoid driving. d. Ask the patient to restrict salt intake. e. Instruct the patient to avoid pregnancy.

ANS: A E Teriflunomide is an immunomodulatory agent with antiinflammatory properties. The exact mechanism of action is unknown but may involve a reduction in the number of activated lymphocytes in the central nervous system. Teriflunomide is specifically indicated for treatment of relapsing forms of multiple sclerosis. The drug may cause serious liver disease; therefore, it is important to monitor liver function tests. Women should avoid getting pregnant when taking this drug because teratogenicity may occur. Avoiding driving, restricting salt intake, and monitoring blood pressure may not be important interventions related to this drug.

The registered nurse supervises a student nurse providing care to a patient with Huntington's disease (HD). Which action of the student nurse needs correction? a. Providing more fluid diet to the patient b. Providing a low-calorie diet not more than 2000 calories/day c. Providing palliative care is the only option for collaborative care d. Providing comfortable environment by maintaining physical safety

ANS: B Choreic movements are the clinical manifestations of Huntington's disease. So, caloric requirements can be as high as 4000 to 5000 calories/day to maintain a patient's body weight. Alternate sources of nutrition may be indicated as the disease progresses. Providing a fluid diet may help the patient to swallow more easily and prevent complications such as aspiration. There is no cure for HD, so the collaborative care would be palliative. Physical safety of the patient and caregiver should be maintained by providing a comfortable environment.

Which measure should the nurse initially include in the plan of care for a patient who has difficulty swallowing as a result of Parkinson's disease? a. Arranging for someone to feed the patient b. Providing the patient with semisolid or soft foods c. Encouraging the patient to drink fluids with meals d. Placing food in the unaffected side of the patient's mouth

ANS: B In Parkinson's disease, the patient may have poor control of the tongue, increasing the risk for aspiration. Semisolid food without lumps and thickened liquids stick together, allowing the tongue to direct the food bolus to the back of the mouth. The patient should be encouraged to self-feed to maintain independence and function. Clear fluids with meals or at any time may present a risk of aspiration if there is difficulty swallowing. In Parkinson's disease, the tongue and entire mouth are likely affected, so placing food in the unaffected side of the patient's mouth is not an appropriate choice.

A patient is diagnosed with multiple sclerosis (MS) and is prescribed interferon. What should the nurse include in medication teaching? a. The medication should be taken before meals on an empty stomach. b. The medication often causes patients to experience flu-like symptoms. c. The medication is given during exacerbation of symptoms to promote remission. d. The medication alters carbohydrate metabolism and elevates serum glucose levels.

ANS: B Interferon is an immunomodulator medication that treats the disease process and prevents relapses. The medication often causes flu-like symptoms, achiness, and headache, which are treated effectively with mild analgesics such as acetaminophen or ibuprofen. The medication is administered subcutaneously every other day. Exacerbations of MS are treated with corticosteroid medications. Corticosteroids alter carbohydrate metabolism and elevate serum glucose levels.

A patient who has multiple sclerosis has received a prescription for a medication to alleviate the major symptoms of the disease. The nurse expects the medication to be in what drug classification? a. Antipsychotics b. Muscle relaxant c. Antihypertensive d. Narcotic analgesic

ANS: B Multiple sclerosis (MS) causes muscle spasticity as loss of the myelin sheath progresses. Muscle relaxants ease these spasms. Antihypertensives are not routinely used; hypertension is not related to MS. Narcotic analgesics are used to treat severe pain, which is usually not associated with MS. Antipsychotics are sometimes used in the treatment of Huntington's Disease, not MS.

Which autoimmune disease is characterized by a decreased number of acetylcholine receptors in the neuromuscular junction? a. Multiple sclerosis b. Myasthenia gravis c. Lou Gehrig's disease d. Huntington's disease

ANS: B Myasthenia gravis is an autoimmune disease of the neuromuscular junction. This occurs due to an attack of antibodies on the acetylcholine receptors, which results in a decreased number of receptor sites at the neuromuscular junction. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system due to demyelination of the nerve fibers. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves degeneration of motor neurons in the brain and spinal cord. It is not an autoimmune disease of the neuromuscular junction. Huntington's disease is a genetically transmitted autosomal dominant disorder, not an autoimmune disease of the neuromuscular junction.

Which neurodegenerative disorder is characterized by rigidity and bradykinesia? a. Multiple sclerosis b. Parkinson's disease c. Lou Gehrig's disease d. Huntington's disease

ANS: B Parkinson's disease is a chronic, progressive neurodegenerative disorder characterized by an increased muscle tone (known as rigidity), slowness in the initiation and execution of movement (known as bradykinesia), tremors, and gait disturbances. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system characterized by progressive, chronic demyelination of nerve fibers of the spinal cord and brain. Lou Gehrig's disease is a rare progressive neurologic disorder that involves degeneration of motor neurons in the spinal cord and brain. It is characterized by limb weakness, dysarthria, and dysphagia. Huntington's disease is a genetically transmitted, autosomal dominant disorder characterized by chorea movements and cognitive and psychiatric disorders.

Which disease is characterized by a degeneration of dopamine-producing neurons and decreased levels of dopamine? a. Multiple sclerosis b. Parkinson's disease c. Lou Gehrig's disease d. Huntington's disease

ANS: B Parkinson's disease is characterized by a lack of dopamine because of the degeneration of dopamine-producing neurons; this disrupts the normal balance between acetylcholine and dopamine in the brain. Multiple sclerosis is due to the demyelination of the nerve fibers of the brain and spinal cord. Characteristics of this disease are not associated with a deficiency of neurotransmitters. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord, not the degeneration of neurons producing dopamine. Huntington's disease involves a deficiency of the neurotransmitters acetylcholine and γ-aminobutyric acid. This disease is characterized by increased levels of dopamine.

A patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS? a. Reduce fat intake b. Reduce the risk of aspiration c. Decrease injury related to falls d. Decrease pain secondary to muscle weakness

ANS: B Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

A patient with parkinsonism on a dopamine agonist medication reports severe nausea and vomiting. After receiving the antiemetic, the patient lost consciousness due to a sudden drop in blood pressure. Which antiemetic drug interaction is responsible for the patient's condition? a. Ondansetron and amantadine b. Ondansetron and apomorphine c. Trimethobenzamide and amantadine d. Trimethobenzamide and apomorphine

ANS: B When the dopamine agonist apomorphine is administered alone, it causes severe nausea and vomiting. Apomorphine, when administered along with antiemetics such as ondansetron, leads to very low blood pressure and loss of consciousness. Amantadine does not have any drug-drug interactions with antiemetics such as ondansetron. Amantadine would not cause any side effects such as nausea and vomiting; therefore co-administration with an antiemetic such as trimethobenzamide is not required. Trimethobenzamide is the preferred antiemetic to be co-administered with apomorphine, because it causes nausea and vomiting when taken alone.

What nursing interventions would be applied first for the patient with acute exacerbation of multiple sclerosis? Select all that apply. a. Assisting the patient with the grieving process b. Preventing the complication of pressure ulcers c. Preventing the complication of urinary tract infections d. Teaching the patient to build a general resistance to illness e. Teaching the patient to maintain a good balance between exercise and rest

ANS: B C A patient experiencing an acute exacerbation of multiple sclerosis may be immobile and confined to bed. The first nursing interventions in this phase are aimed at preventing major complications associated with immobility. Pressure ulcers may occur due to the immobility of the patient while confined to the bed. Immediate care should be taken to prevent this. Urinary tract infections are also common due to the stagnation of urine. Assisting the patient with the grieving process is an important intervention during the diagnostic phase of multiple sclerosis. It is not applicable to a patient with an acute exacerbation of the disease. Teaching the patient to build general resistance to illness is a general intervention for a patient suffering from multiple sclerosis. Teaching the patient to maintain a good balance between exercise and rest is a general intervention for a patient with multiple sclerosis. It is not applicable for patients who are immobile.

A patient diagnosed with myasthenia gravis reports difficulty in swallowing, chewing, eye movement, and facial mobility. Which drugs are most suitable for the patient? Select all that apply. a. Tramadol b. Prednisone c. Azathioprine d. Chlorzoxazone e. Pyridostigmine

ANS: B C E Difficulty in swallowing, chewing, eye movement, and facial mobility are the symptoms of myasthenia gravis. The most common drug therapies for this condition include anticholinesterase drugs, corticosteroids, and immunosuppressants. Corticosteroids, especially prednisone, are used to suppress the immune responses that are the main reason for such symptoms. Azathioprine is an immunomodulator used for immune suppression. Pyridostigmine is an example of an anticholinesterase that prolongs the action of acetylcholine at the neuromuscular junction. Tramadol is an opioid analgesic; it is contraindicated for patients with myasthenia gravis. Chlorzoxazone is an example of a muscle relaxant; it is contraindicated for patients with myasthenia gravis.

A patient suspected of having myasthenia gravis suffers injury and has related pain, infection, and inflammation. Which drugs must be used with caution? Select all that apply. a. NSAIDs b. Diuretics c. Antibiotics d. Corticosteroid e. Opioid analgesics

ANS: B C E Injury-related pain, infection, and inflammation are generally treated with analgesics, antiinflammatory drugs, antibiotics, and corticosteroids. Diuretics are contraindicated in myasthenia gravis because they can worsen the condition. Caution should be exercised when administering antibiotics to the patient suspected of having myasthenia gravis because antibiotics can aggravate symptoms. Opioid analgesics are also contraindicated for a patient suspected to have myasthenia gravis. NSAIDs and corticosteroids can be used safely in a myasthenia gravis patient.

A patient complains of difficulty with eye and eyelid movement, chewing, swallowing, speaking, and breathing. Which findings in the patient's diagnostic results would indicate the presence of myasthenia gravis? Select all that apply. a. Alteration of one copy of gene in DNA test b. Improved muscle contractibility during the Tensilon test c. Presence of three signs of the classic triad: tremor, rigidity, and bradykinesia d. Decreased response to repeated stimulation of hand muscles during EMG test e. Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis

ANS: B D Patients with myasthenia gravis experience improved muscle contractibility after intravenous administration of the anticholinesterase agent edrophonium chloride. This test aids in diagnosis of myasthenia gravis. EMG testing may show a decreased response to repeated stimulation of muscles in the hands, which would indicate muscle fatigue. Single-fiber EMG is a confirmative test for myasthenia gravis. The alteration of one copy of a gene in a DNA test is a diagnostic test for Huntington's disease, a genetically transmitted autosomal dominant disorder. The presence of three signs of the classic triad, tremor, rigidity, and bradykinesia, is a confirmed diagnostic test for Parkinson's disease. Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test confirms multiple sclerosis, not myasthenia gravis.

A patient with Parkinson's disease is prescribed sinemet. Which side effects of the drug would the nurse monitor for in this patient? Select all that apply. a. Dizziness b. Dyskinesia c. Severe headache d. Involuntary eyelid movements e. Severe nausea and vomiting

ANS: B D E Sinemet is a combination of levodopa and carbidopa that is prescribed to patients suffering from parkinsonism. The drug has few side effects. These side effects include dyskinesia due to increased dopamine availability. Severe nausea and vomiting is another important side effect, because the dopaminergic pathway is the major pathway involved in emesis. Increased dopamine levels in the body many trigger the sensation of nausea and vomiting. Involuntary eyelid movements are due to the increased levels of the neurotransmitter dopamine in the body. Dizziness or fainting, due to orthostatic hypotension, is a side effect of the drug bromocriptine. A severe headache is also a side effect of bromocriptine.

The nurse is performing a physical examination on a patient with Parkinson's disease. What manifestations of Parkinson's disease is the nurse likely to find? Select all that apply. a. Nystagmus b. Drooling of saliva c. Patchy blindness d. Decreased arm swing e. Shuffling, propulsive gait

ANS: B D E The patient may manifest drooling of saliva; shuffling, propulsive gait; and decreased arm swing. These symptoms are due to the combination of tremors, rigidity of muscles, and bradykinesia. Patchy blindness and nystagmus are not found in Parkinson's disease.

Which type of drug is prescribed to patients with parkinsonism with a condition such as hypomobility? a. Ropinirole b. Pramiprexole c. Apomorphine d. Bromocriptine

ANS: C Hypomobility is a condition that occurs towards the end of the dosing interval of standard medication in patients with parkinsonism. Drugs such as apomorphine, a dopamine agonist, block the reuptake of dopamine into the presynaptic neurons and stimulate the postsynaptic dopamine receptors. Carbidopa and entacapone block the COMT enzyme. Ropinirole, pramiprexole, and bromocriptine are classified as dopamine receptor agonists that act by stimulating the dopamine receptors. These dopamine receptor agonists are not used during hypomobility.

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease? a. Lose balance and sit down b. Lose balance and fall forward c. Lose balance and fall backward d. Lose balance and become unconscious

ANS: C In a pull test, when the examiner stands behind the patient and gives a tug backward on the shoulder, the patient loses balance and falls backward. This reaction indicates postural instability, a common feature in Parkinson's disease. Sitting down, falling forward, or becoming unconscious after losing balance is not indicative of postural instability related to Parkinson's disease.

A patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? a. Provide multivitamins with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

ANS: C Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or pureed diet, and a low-carbohydrate diet is not indicated.

Which neurologic disorder has paradoxic intoxication as a potential adverse effect of medication therapy? a. Multiple sclerosis b. Myasthenia gravis c. Parkinson's disease d. Huntington's disease

ANS: C Paradoxic intoxication involves the aggravation, rather than relief, of symptoms, after using a drug. Dopaminergic drugs, prescribed for parkinsonism, may cause paradoxic intoxication after prolonged use. Drug therapy for multiple sclerosis includes immunomodulators or corticosteroids, and other drugs that help reduce the symptoms. These drugs help reduce the symptoms but do not cause paradoxic intoxication. Drug therapy for Huntington's disease includes managing the symptoms of chorea and cognitive and psychiatric disorders. These drugs help reduce the symptoms but do not cause paradoxic intoxication. Drug therapy for myasthenia gravis includes using anticholinergics, corticosteroids, and immunosuppressive agents. These drugs help reduce the symptoms but do not cause paradoxic intoxication.

Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? a. Referring the patient for genetic counseling b. Teaching the patient about medications used during acute exacerbations c. Assisting the patient in identifying the factors that precipitate exacerbations d. Instructing the patient in the proper technique for self-administration of an enema

ANS: C The cause of multiple sclerosis is unknown, although fatigue, stress, or events such as pregnancy or acute illness can bring on an exacerbation. Identifying and avoiding such activities or factors may prevent exacerbations. Multiple sclerosis does not have a genetic link. Teaching the patient about medications and the proper technique for the self-administration of an enema is important but not as high of a priority as preventing exacerbations of the disease and complications.

Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)? a. Acute confusion b. Bowel incontinence c. Activity intolerance d. Disturbed sleep pattern

ANS: C The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.

Which nerve is represented as [CN] V? a. Facial nerve b. Vagus nerve c. Trigeminal nerve d. Glossopharyngeal nerve

ANS: C The trigeminal nerve is represented as [CN] V. The facial nerve is represented as [CN] VII. The vagus nerve is represented as [CN] X. The glossopharyngeal nerve is represented as [CN] IX.

A patient has been found to have amyotrophic lateral sclerosis. What classic symptom of the disorder does the nurse recognize? a. Dysuria b. Dyspnea c. Dysphagia d. Dysreflexia

ANS: C Weakness of the muscles of the legs that progresses to weakness in the upper extremities, dysarthria (difficulty in speech), and dysphagia (difficulty swallowing) are all classic symptoms of ALS. Although dyspnea and dysuria may be present in later stages of ALS, they are not considered classic symptoms of the disease. Dysreflexia is seen in patients with spinal cord injuries; it is a life-threatening, uninhibited response of the nervous system to a noxious stimuli and is not seen in ALS.

When performing a physical assessment of a patient with myasthenia gravis, what clinical manifestations is the nurse likely to find? Select all that apply. a. Muscle atrophy b. Abnormal reflexes c. Impaired facial mobility d. Difficulty in swallowing food e. Voice fading after a long conversation

ANS: C D E Myasthenia gravis is characterized by a fluctuating weakness of skeletal muscles. The patient may have impaired facial mobility and expressions. Chewing and swallowing food may become difficult. Speech may be affected, and the voice fades after a long conversation. Apart from this muscle weakness, there is no other dysfunction such as muscle atrophy or abnormal reflexes.

A patient with multiple sclerosis is under treatment with β-interferon. What patient teaching would be appropriate for this patient? Select all that apply. a. Do not drink grape juice. b. Monitor vital signs regularly. c. Rotate injection sites with each dose. d. Know that flu-like symptoms are common. e. Wear sunscreen while exposed to sunlight.

ANS: C D E Patients on β-Interferon should wear sunscreen when exposed to sunlight because the drug may cause photosensitivity. The injection site should be rotated with each dose to prevent lipodystrophy. The nurse should let the patient know that flu-like symptoms are common with β-interferon. The symptoms usually subside on their own; if they do not, they can be treated with nonsteroidal antiinflammatory drugs. The drug does not interact with grape juice; therefore, grape juice can be consumed. Monitoring of vital signs is not a specific teaching related to the drug.

When establishing a diagnosis of multiple sclerosis (MS), about what diagnostic studies should the nurse teach the patient? Select all that apply. a. EEG b. Carotid duplex scan c. Evoked response testing d. Cerebrospinal fluid analysis e. Computed tomography (CT) scan

ANS: C D E There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and magnetic resonance imaging (MRI), along with the patient's history and physical examination, are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS.

Which criterion is included to establish that a patient has Parkinson's disease? Select all that apply. a. Decreased serum dopamine levels. b. Tumor present in the thymus gland. c. Positive response to antiparkinsonian medications. d. Magnetic resonance imaging (MRI) shows areas of plaque on cranial nerves. e. Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

ANS: C E Presently there is no specific test to diagnose Parkinson's disease. Diagnosis is made when the patient demonstrates two of the three classic signs: rigidity (increased resistance to passive motion as a cogwheel); bradykinesia (slowed and loss of automatic coordinated movement); and tremor (a tremor that is more severe at rest and pill-rolling hand tremor). The diagnosis is confirmed with positive response to medications used to treat the disease such as carbidopa/levodopa. Parkinson's disease is caused by decreased dopamine levels in the brain and is not measured in the serum. Tumors of the thymus gland are associated with myasthenia gravis. Areas of plaque are seen on MRI of patients with multiple sclerosis.

A patient, whose parent died from Huntington's disease, is discussing the condition and genetic testing with a nurse. Which of the patient's statements needs to be corrected by the nurse? a. Currently there is no effective treatment or cure for Huntington's disease. b. Offspring of persons with Huntington's disease have a 50% risk to develop it. c. Positive genetic testing indicates the patient eventually will develop the disease. d. Positive genetic testing indicates at what age the symptoms of the disease will occur.

ANS: D A positive genetic testing does not tell the patient at what age symptoms of the disease will appear. Continuous and excessive involuntary movements will occur. Onset of the disease occurs between the ages of 30 and 50 years. Offspring have a 50 percent risk of developing the disease because it is an autosomal dominant transmission. If the patient has the gene, eventually the symptoms of the disease will occur. There is no cure for Huntington's disease currently, but there is treatment.

The nurse is caring for a patient with suspected Parkinson's disease. What is an initial symptom of the disease? a. Akinesia b. Aspiration c. Forgetfulness d. Pill-rolling tremors

ANS: D Early symptoms of Parkinson's disease include coarse resting tremors of the fingers and thumb, also known as pill-rolling movements. Akinesia (complete or partial loss of muscle movement), aspiration, and mental deterioration occur later in the disease process.

Which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder? a. Multiple sclerosis b. Myasthenia gravis c. Lou Gehrig's disease d. Huntington's disease

ANS: D Huntington's disease is a genetically transmitted, autosomal dominant disorder. The offspring of a person with this disease have a 50 percent risk of inheriting it. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system, not an autosomal dominant disorder. Demyelination of the nerve fibers of the brain and spinal cord is the principle characteristic of the disease. Myasthenia gravis is an autoimmune disease of the neuromuscular junction and is not an autosomal dominant disorder. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord. This is not an autosomal dominant disorder.

What is the major complication associated with myasthenic crisis? a. Speech alteration b. Difficulty chewing c. Impaired facial mobility d. Respiratory insufficiency

ANS: D Myasthenic crisis is the acute exacerbation of myasthenia gravis. This is a life-threatening condition that occurs when the muscles that control breathing and swallowing become too weak to perform their functions. The clinical manifestations of myasthenia gravis include speech alteration due to muscle weakness related to speech. However, this is not a major complication associated with myasthenic crisis. Difficulty in chewing is due to the weakness of muscles related to chewing but is not a major complication associated with myasthenic crisis. Impaired facial mobility and expression are the clinical manifestations of myasthenia gravis due to the weakness of facial muscles but are not a major complication associated with myasthenic crisis.

Which type of multiple sclerosis is characterized by a relapsing-remitting initial course followed by disease with or without relapses? a. Relapsing-remitting b. Primary-progressive c. Progressive-relapsing d. Secondary-progressive

ANS: D Secondary-progressive multiple sclerosis has a relapsing-remitting course that later becomes steadily progressive, with or without occasional relapses, minor remissions, and plateaus. Relapsing-remitting multiple sclerosis involves developing and resolving symptoms over a few weeks to months before the patient returns to the baseline. Primary-progressive multiple sclerosis involves steady and gradual neurologic dysfunction without remittance of the symptoms. Progressive-relapsing multiple sclerosis involves frequent relapses with a partial recovery, without the patient returning to the baseline.

Which degenerative neurologic disorder is characterized by a deficiency of ϒ-aminobutyric acid (GABA) and acetylcholine? a. Myasthenia gravis b. Parkinson's disease c. Lou Gehrig's disease d. Huntington's disease

ANS: D The pathologic process of Huntington's disease involves a deficiency of the neurotransmitters ϒ-aminobutyric acid (GABA) and acetylcholine, which leads to the excessive release of dopamine. Myasthenia gravis occurs due to a decrease in the acetylcholine receptors because of an autoimmune process. In this disease, there is no deficiency of the neurotransmitters. The pathologic process of Parkinson's disease involves degeneration of dopamine-producing neurons, which leads to a deficiency of dopamine release. Lou Gehrig's disease involves degeneration of motor neurons in the brain and spinal cord and is not related to the deficiency of neurotransmitters.

The nurse is caring for a patient with multiple sclerosis in remission. What information should the nurse include when teaching the patient about advantages of exercise for multiple sclerosis? Select all that apply. a. Decreases spasticity b. Increases coordination c. Helps to regain bladder control d. Delays the demyelination process e. Retrains unaffected muscles to substitute for impaired ones

ANs: A B E Patients with multiple sclerosis in remission should be encouraged to exercise. Regular exercise can help to decrease spasticity, increase coordination, and retrain unaffected muscles to substitute for the impaired ones. The exercise does not help in regaining bladder control or delaying the demyelination process.