Chp. 15 Disorders of Motor Function

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

ventilatory assessment and support.

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.

• Depression • Inattentiveness • Forgetfulness

The nurse is providing education to a client recently diagnosed with multiple sclerosis. The nurse instructs the client regarding which symptoms commonly occurring with multiple sclerosis? Select all that apply.

• Visual loss or blurring • Difficulty swallowing • Paresthesias of extremities

Duchenne muscular dystrophy usually does not produce any signs or symptoms until age 2 to 3. What muscles are usually first to be affected in Duchenne muscular dystrophy?

Postural muscles of the hip and shoulder

Throwing a ball or picking up a fork are movements controlled by which portion of the frontal lobe?

Premotor cortex

Which disorder is a manifestation of a serious condition that causes new-onset back pain in persons age 50 years or older?

Aortic aneurysm

A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:

Arms

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia have which effect on motor ability?

Disrupt movement without causing paralysis

The nurse is assessing a client diagnosed with myasthenia gravis (MG). The nurse would expect the assessment to include:

Inability to move eyes in multiple positions

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

Interneuron

Which neuron connects sensory and motor neurons?

Interneurons

A client with an acute spinal cord injury is developing spinal shock. The nurse should perform which priority assessment?

Loss of tendon reflexes below the injury

Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:

Multiple sclerosis (MS)

Muscular dystrophy is characterized by what pathophysiologic changes?

Muscular necrosis, with replacement with fat and connective tissue

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

Myasthenia gravis

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

Myasthenia gravis

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

Myasthenia gravis

A 60-year-old office worker has presented to a clinic reporting recent episodes of lower back pain. Which component of the client's assessment and history would be most indicative of a serious pathologic process?

The client's onset of pain has been gradual and the client has no prior history of back problems.

A client presents to a health clinic complaining of several vague symptoms. As the history/physical continues, the health care provider clearly thinks the client may have myasthenia gravis. Which statements by the client would correlate with this diagnosis? Select all that apply.

"Sometimes I have double vision." • "I have more energy in the morning but get worse as the day goes by." • "I feel like I don't have enough energy to chew my food sometimes.

The nurse is teaching a client about appropriate interventions for back pain. Select all that apply.

-Analgesics -Nonsteroidal anti-inflammatory drugs -Muscle relaxants

Myasthenic crisis may be precipitated by which causes? Select all that apply.

-Infection -Pregnancy -Surgery

Manifestations of peripheral neuropathy include which of the following? Select all that apply.

-Muscle weakness -Muscle wasting -Sensory changes

A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply.

-Tremor -Rigidity -Bradykinesia

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

A 25-year-old woman

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

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

Following a traumatic head injury from a severe blow to the back of the head, a client is unable to maintain steady posture while in a standing position, although the client is steadier when walking. Which brain disorder most likely resulted from this injury?

A vestibulocerebellar disorder

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

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

Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated loss of which physiologic function?

Acetylcholine receptors

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

Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease?

Bradykinesia

A client 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 client have?

Brown Sequard

A client has been involved in a motor vehicle accident and has sustained spinal cord damage. The client has voluntary motor function loss on one side and a loss of pain and temperature sensation from the contralateral side below the level of the lesion. What type of cord syndrome does the nurse recognize the client has sustained?

Brown squaed syndrome

Neurotoxins such as the botulism organism can produce paralysis by what mechanism?

By blocking release of acetylcholine

The nurse expects that loss of respiratory effort occurs with a spinal injury at which level?

C1-3

A client is brought into the emergency room after falling from a roof and landing on his chin and face. With this type of spinal extension injury, the nurse anticipates which location of the spinal cord will most likely be injured?

C4-C6

The nurse is caring for a client wth a spinal cord injury. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column?

C5

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

Cannot breathe on own, needs ventilator assistance

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

Carpal tunnel syndrome

An older adult has had a recent decrease in coordination, with gait being described as wide-based, unsteady, and lacking in fluidity, although the client's muscle tone appears normal. This client requires further assessment for which condition that is involved with coordination of movement?

Cerebellar disorder

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

Chorea

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

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

Which medication is used to treat acute attacks of multiple sclerosis (MS)?

Corticosteroids

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

Creatine kinase

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

Creatine kinase

The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which pathophysiologic event?

Decreased oligodendrocytes

After a spinal cord injury at S2-S4, most people experience constipation. Why does this occur?

Defecation reflex is lost

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

Degeneration of the nigrostriatal dopamine neurons occurs.

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the nigrostriatal dopamine system

The client presents with a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?

Diaphragm

A nurse is caring for a client with high-level paraplegia with known vasovagal response associated with severe bradycardia. Which preventive measure should NOT be included in the treatment plan for this client?

Discouraging use of stimulants such as caffeine

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?

Dopamine

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

Dopamine nigrostriatal system

Loss of coordinated movement and balance is likely due to damage to which physical structure?

Extrapyramidal structures

The underlying causative problem in Parkinsonism is:

Failure of dopamine release

The nurse notes that the client is experiencing visible squirming and twitching movements that can be seen as flickers under the skin. The nurse would recognize this as:

Fasciculations SUBMIT ANSWER

Knowing that she is a carrier for Duchenne muscular dystrophy (DMD), a pregnant woman underwent prenatal genetic testing that diagnosed her child with DMD. As her child develops, the woman should watch for which early signs that the disease is progressing?

Frequent falls and increased muscle size

The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement?

Frontal cortex

In what part of the body does the highest level of motor function occur?

Frontal cortex of the brain

What do deep tendon reflexes assess?

Functioning of the "motor strip"

A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which food?

Home-grown and canned vegetables

The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring?

Hyperoxygenate prior to suctioning.

The health care provider is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which assessment finding is congruent with the client's diagnosis?

Hypotonia

Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration?

Immunomodulators

Which peripheral nerve injury will likely result in cellular death with little chance of regeneration?

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

A neurologic nurse is explaining the structure and function of motor units to a client who has a spinal cord injury. The nurse should describe which components of a motor unit? Select all that apply.

Neuromuscular junction, Skeletal muscle, Lower motor neuron

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:

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.

UGGGGHhhhh i messed up anf refreshed the page so....

Now there will be more than 100qyes. :(

While there is no laboratory test that is diagnostic for multiple sclerosis, some clients have alterations in their cerebrospinal fluid (CSF) that can be seen when a portion of the CSF is removed during a spinal tap. What finding in CSF is suggestive of multiple sclerosis?

Oligoclonal patterns

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding?

Paralysis

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

Paraplegia

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

Parkinson disease

Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?

Parkinson disease

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

Polyneuropathy

Multiple sclerosis is characterized by what type of neuron damage?

Polyneuropathy

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

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

The nurse is performing an assessment for a client suspected of having symptoms that correlate with carpal tunnel disorder. The client states he feels a tingling sensation that radiates into the palm of the hand when the nurse lightly percusses over the median nerve. How would the nurse document this finding?

Positive Tinel sign

A client has sustained an acute spinal cord injury in a fall from a tree stand during a hunting trip. The client will require surgical intervention for the unstable spinal cord. What does the nurse recognize is the goal of early surgical intervention for this client?

Provide internal skeletal stabilization.

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

Reading Conjugate readjustment of eye position due to cerebellar damage can make reading very difficult.

Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)?

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.

A client with a diagnosis of myasthenia gravis underwent a mastectomy. The surgery was a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which priority measure should the care team initiate immediately?

Respiratory support and protection of the client's airway

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?

Respiratory ventilation assessment and prevention of aspiration pneumonia

Cerebellar tremor is exhibited by which symptom?

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.

While teaching a class of nursing students about spinal cord injury, the instructor mentions that male SCI clients will be able to have a sexual response if their injury is at which level on the spinal column?

S4

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 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

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?

Slow to start walking and has difficulty when asked to "stop" suddenly

An individual experiencing spinal cord damage (SCD) is at high risk for developing deep vein thrombosis (DVT) and pulmonary emboli (PE) due to which pathophysical cause? Select all that apply.

Stasis of blood flow Hypercoagulation of blood Impaired vasomotor tone Impaired mobility

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

Straight-leg test

A nurse caring for a client with a spinal cord injury knows that control of sweat gland activity and temperature regulation is managed by the direct action of which body system?

Sympathetic nervous system

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

The client has a sudden onset of severe weakness.

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction

A client has been recovering from a stroke for several weeks and has been reluctant to participate in physical therapy. As a result, the client has experienced disuse atrophy. The nurse should recognize that the client is experiencing the consequences of which physiologic process?

The diameter of the client's muscle cells has decreased

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

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

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

Tinel sign

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on which region of the brain?

Upper and lower motor neurons

Which of these project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS?

Upper motor neurons

Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following?

Vasospasms and hypertension

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

respiratory and cardiac muscle involvement.

A nurse is caring for a client experiencing muscle fasciculation. Fasciculations appear as:

spontaneous contractions of muscle fibers presenting as twitching.

Loss of coordinated movement, muscle rigidity, and immobility without paralysis is likely due to damage to:

extrapyramidal tracts.

The most common cause of C. botulinum in infants is:

ingestion of honey products containing C. botulinum spores.