Degenerative Neuro

Guillan-Barre Syndrome (GBS)

segmental loss of myelin with edema and inflammation of affected nerves, autoimmune response that occurs a few days weeks after a viral or bacterial infection

b

Which assessment data for a patient who has Guillain-Barré syndrome will require the nurse's most immediate action? a. The patient's sacral area skin is reddened. b. The patient is continuously drooling saliva. c. The patient complains of severe pain in the feet. d. The patient's blood pressure (BP) is 150/82 mm Hg.

c

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size c. Respiratory effort b. Grip strength d. Level of consciousness

Myesthenia Gravis

fluctuating weakness caused by defective acetycholine worsens with exercise and improves with rest

c

A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives

multiple sclerosis

A chronic disease of the central nervous system marked by damage to the myelin sheath.

muscle strength, swallowing, chewing

Pyridostigmine improves ______________ and promotes ______________ and _______________

4

Steroid therapy is prescribed for a client with common signs and symptoms of multiple sclerosis. In response to the steroid therapy, what symptom does the nurse expect to decrease? 1 Emotional lability 2 Muscular contractions 3 Pain in the extremities 4 Episodes of vision loss

flaccid

no sensation to void, leads to urinary retention

1,5

A nurse is teaching a client with multiple sclerosis (MS) about how to manage urinary retention. Which instructions should the nurse include in the teaching session? Select all that apply. 1 Using Credé maneuver 2 Using an indwelling catheter 3 Using anticholinergic medications 4 Monitoring and restricting fluid intake to 800 mL daily 5 Monitoring for and reporting signs of urinary tract infection

double vision, red or green distortion , blindness in one eye

vision problem in multiple sclerosis

b

When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about a. oral corticosteroids. b. antiparkinsonian drugs. c. magnetic resonance imaging (MRI). d. electroencephalogram (EEG) testing.

heat

fatigue in MS is aggravated by

d

A patient hospitalized with a new diagnosis of Guillain-Barré syndrome has numbness and weakness of both feet. The nurse will anticipate teaching the patient about a. infusion of immunoglobulin b. intubation and mechanical ventilation. c. administration of corticosteroid drugs. d. insertion of a nasogastric (NG) feeding tube.

renal

Dalfampridine should not be given to patients with impaired _____________ function.

3

During an exacerbation of multiple sclerosis a client reports urinary urgency and frequency. What is the most appropriate initial nursing action? 1 Begin teaching self-catheterization. 2 Develop a plan to ensure high fluid intake. 3 Palpate the suprapubic area of the abdomen. 4 Initiate a regimen to monitor urinary output.

amyotrophic lateral sclerosis (ALS)

progressive neuromuscular disorder characterized by loss of motor neurons, poor prognosis, death is usualy 2-5 years frominitial manifestations

multiple sclerosis

related to multiple causes such as genetics and environmental exposure

resperiatory infection, GI infection, surgery, trauma

risk factors for GBS

spastic, hypotonic

in MS bladder can be

4

A client is admitted and diagnosed with myasthenia gravis. Pyridostigmine bromide therapy via tablets has been prescribed. The nurse anticipates that the dosage will be changed frequently during the first week of therapy. While the dosage is being adjusted, what action does the nurse perform? 1 Administer the medication after meals. 2 Administer the medication on an empty stomach. 3 Evaluate the client's psychological responses between medication doses. 4 Evaluate the client's muscle strength every hour after the medication is given

4

A client is admitted to the hospital with a diagnosis of acute Guillain-Barré syndrome. Which assessment is priority? 1 Urinary output 2 Sensation to touch 3 Neurologic status 4 Respiratory exchange

a

After change-of-shift report, which patient should the nurse assess first? a. Patient with myasthenia gravis who is reporting increased muscle weakness b. Patient with a bilateral headache described as "like a band around my head" c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms

vision, motor symptoms, fatigue, speech impairment, hearing loss, tremors/dizziness, dysphagia, bladder or bowel dysfunction, sexual dysfunction, impaired cognition, emotional changes

multiple sclerosis signs and symptoms

Myasthenic Crisis

an acute exacerbation of disease caused by inadequate amount of meds, infection fatigue or stress.

spastic

urgency and frequency, incontinence

2

the family member of a client with newly diagnosed Guillain-Barré syndrome comes out to the nurse's station and informs the nurse that the client is having difficulty breathing. What is the first action the nurse should do? 1 Notify the healthcare provider. Correct2 Go with the family member to assess the client. 3 Send the nursing assistive personnel to take vital signs. 4 Assure the family member this is a normal response for this disease

2

A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response? 1 Stimulates the cerebral cortex 2 Blocks the action of cholinesterase 3 Replaces deficient neurotransmitters 4 Accelerates transmission along neural sheaths

3

A client with myasthenia gravis is to receive immunosuppressive therapy. What assures the nurse that this therapy will be effective? 1 Inhibits the breakdown of acetylcholine at the neuromuscular junction 2 Stimulates the production of acetylcholine at the neuromuscular junction 3 Decreases the production of autoantibodies that attack acetylcholine receptors 4 Promotes the removal of autoantibodies that impair the transmission of impulses

d

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage? a. Shuffling gait c. Cogwheel rigidity of limbs b. Tremor at rest d. Uncontrolled head movement

fatigue

most common characteristic of MS

acute inflammatory demyelination polyneuropathy

most common type of GBS

coordination and balance, paralysis, lhermitte's sign, muscle spasm

motor symptoms in MS

chronic inflammation, demyelination, gliosis in the CNS

multiple sclerosis charcteristics

a

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

d

A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage? a. The patient has a chronic dry cough. b. The patient has four loose stools in a day. c. The patient develops a deep vein thrombosis. d. The patient's blood pressure is 92/52 mm Hg.

1

A client exhibits blurred and double vision and muscular weakness, and diagnostic tests are prescribed. The client is informed that a diagnosis of multiple sclerosis (MS) has been made. The client becomes visibly upset. How should the nurse respond? 1 "That must have really shocked you. Tell me what the healthcare provider told you about it." 2 "You should see a psychiatrist who will help you cope with this overwhelming news." 3 "Don't worry; early treatment often alleviates symptoms of the disease." 4 "You should be glad that we caught it early so it can be cured."

3

A client is diagnosed with myasthenia gravis, and the anticholinesterase medication pyridostigmine is prescribed. When teaching the client about this medication, the nurse explains to expect an increase in what function? 1 Intestinal peristalsis 2 Salivary and gastric secretions 3 Contraction of skeletal muscles 4 Secretion and discharge of tears

3

A client is newly diagnosed with multiple sclerosis. The client is obviously upset with the diagnosis and asks, "Am I going to die?" Which is the nurse's best response? 1 "Most individuals with your disease live a normal life span." 2 "Is your family here? I would like to explain your disease to all of you." 3 "The prognosis is variable; most individuals experience remissions and exacerbations." 4 "Why don't you speak with your healthcare provider? You probably can get more details about your disease."

2

A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine, a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. What conclusion does the nurse make about these new developments? 1 Indicative of a myasthenic crisis 2 Cholinergic effects 3 A temporary response 4 Toxic effects of the medication

4

A client who has been experiencing double vision, drooping of the eyelids, and fatigue visits the neurologic clinic. A diagnosis of myasthenia gravis is made, and the healthcare provider prescribes pyridostigmine. The nurse should teach the client that it is important to take this drug based on what schedule? 1 On an empty stomach 2 One hour before meals 3 According to muscle strength 4 At the exact time intervals prescribed

4

A client with multiple sclerosis is admitted to the hospital. The client's exacerbations have become more frequent and more severe. One day, the client's partner confides to the nurse, "Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home." After listening to the partner's concerns, which is the best response by the nurse? 1 "You may be able to lessen your feelings of guilt by seeking counseling." 2 "It would be helpful if you become involved in volunteer work at this time." 3 "I recognize it's hard to deal with this, but try to remember that this too shall pass." 4 "Joining a support group of people who are coping with this problem may be helpful."

4

A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms. Recently, the client has begun experiencing increased difficulty in swallowing. What nursing action is most effective in preventing aspiration of food? 1 Place a tracheostomy set in the client's room. 2 Assess respiratory status after meals. 3 Request for the diet to be changed from soft to clear liquids. 4 Coordinate mealtimes with the peak effect of the medication

4

A client with myasthenia gravis, who is living in a nursing home, experiences inadequate symptomatic control with pyridostigmine bromide, and long-term steroid therapy has been initiated. What is especially important for the nurse to ensure? 1 The client increases sodium intake. 2 Protective isolation is established. 3 Total daily fluid intake is decreased. 4 The client is monitored for an exacerbation of symptoms.

1,4

A home care nurse is counseling a client with amyotrophic lateral sclerosis (ALS). What information should the nurse include in the discussion? Select all that apply. 1 Space activities throughout the day. 2 Engage in social interactions with large groups. 3 Request an opioid if leg pain becomes excessive. 4 Anticipate the use of alternate ways to communicate. 5 Use leg restraints to decrease the risk of physical injury

3

A nurse is caring for a group of clients with myasthenia gravis, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS). Which information should the nurse consider when planning care for this group of clients? 1 Progressive deterioration until death 2 Deficiencies of essential neurotransmitters 3 Increased risk for respiratory complications 4 Involuntary twitching of small muscle groups

2

A nurse is teaching a client with multiple sclerosis about the disease. Which statement by the client indicates to the nurse that further teaching is needed? 1 "I avoid use of a straw to drink liquids." 2 "I will take a hot bath to help relax my muscles." 3 "I plan to use an incontinence pad when I go out." 4 "I may be having a rough time now, but I hope tomorrow will be better."

c

A patient is hospitalized with new onset of Guillain-Barré syndrome. The most essential assessment for the nurse to complete is a. determining level of consciousness. b. checking strength of the extremities. c. observing respiratory rate and effort. d. monitoring the cardiac rate and rhythm.

b

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

b

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

a,b,d

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

a

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

b

After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate the patient's bowel sounds. b. Notify the patient's health care provider. c. Administer the prescribed PRN antiemetic drug. d. Give the scheduled dose of prednisone (Deltasone).

1,2,3,4

An ambulatory client with relapsing-remitting multiple sclerosis is to receive every-other-day injections of interferon beta-1a. What adverse effects does the nurse explain may occur when taking this medication? Select all that apply. 1 Depression 2 Constipation 3 Flulike symptoms 4 Increased heart rate 5 Decreased perspiration

4

Pyridostigmine is prescribed for a client with myasthenia gravis. Why does the nurse instruct the client to take pyridostigmine about one hour before meals? 1 This timing limits the appetite. 2 It promotes absorption. 3 Taking it before meals prevents gastric irritation. 4 Taking it before meals increases ability to chew.

2

The healthcare provider prescribes neostigmine for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client makes what statement regarding drug management plans? 1 "Keep the drug in a container in the refrigerator." 2 "Take the drug at the exact time that is listed on the prescription." 3 "Plan to take the drug between meals to promote absorption." 4 "Expect that the onset of the action of the drug will occur several hours after I take it."

Cholinergic Crisis

Too much medication N&V, diarrhea, cramps hypotension Tensilon to distinguish from Myasthenia Crisis Atropine to reverse Respiratory support may be needed

b

When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should a. assess for the presence of chest pain. b. inquire about urinary tract problems. c. inspect the skin for rashes or discoloration. d. ask the patient about any increase in libido.

b

Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a. Encourage a decreased evening intake of fluid. b. Teach the patient how to use the Credé method. c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.

1

Which cytokine is used to treat multiple sclerosis? 1 β-Interferon 2 Interleukin-2 3 Erythropoietin 4 Colony-stimulating factor

3

Which immunomodulatory is beneficial for the treatment of clients with multiple sclerosis? 1 Interleukin 2 2 Interleukin 11 3 Beta interferon 4 Alpha interferon

c

Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient walks a mile each day for exercise. b. The patient complains of pain with neck flexion. c. The patient has an increased serum creatinine level. d. The patient has the relapsing-remitting form of MS.

d

Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? a. Activity intolerance b. Self-care deficit: toileting c. Ineffective self-health management d. Imbalanced nutrition: less than body requirements

d

Which of these nursing actions for a patient with Guillain-Barré syndrome is appropriate for the nurse to delegate to experienced unlicensed assistive personnel (UAP)? a. Nasogastric tube feeding q4hr b. Artificial tear administration q2hr c. Assessment for bladder distention q2hr d. Passive range of motion to extremities q4hr

Steroids

decrease the inflammatory process around the optic nerve

crede method

done by gently pressing down on the bladder to try to trigger urination

Lhermitte's sign

electric shock that radiates down the spine with flexion of the neck

ACh receptors

in myesthenia gravis antibodies attack

parkinson's disease

lack of dopamine from degeneration of dopamine producing neurons

impaired cognition

late sign of MS