Patho FINAL Prep U Chapter 36

Death caused by muscular dystrophy in early adulthood is usually due to which of the following? a. Respiratory and cardiac muscle involvement b. Severe skeletal muscle weakness c. Severe long bone fractures d. Malnutrition

Correct response: a. Respiratory and cardiac muscle involvement Explanation: Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.

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. a. Depression b. Hallucinations c. Delirium d. Inattentiveness e. Forgetfulness

Correct response: a. Depression d. Inattentiveness e. Forgetfulness Explanation: Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur. Hallucinations and delirium are not usually associated as a manifestation of MS.

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? a. The client has a sudden onset of severe weakness. b. The client begins to have projectile vomiting. c. The client begins to have tremors. d. The client has a fever, tachycardia, and low blood pressure.

Correct response: a. The client has a sudden onset of severe weakness. Explanation: People with myasthenia gravis may experience a sudden exacerbation of symptoms and weakness known as myasthenia crisis. Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation, to the extent that ventilatory support and airway protection are needed. Myasthenic crisis usually occurs during a period of stress, such as infection, emotional upset, pregnancy, alcohol ingestion, cold exposure, or surgery.

A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of: a. Dopamine b. Acetylcholine c. Serotonin d. Adenosine

Correct response: a. Dopamine Explanation: Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

Bowel dysfunction is one of the most difficult problems to deal with after a spinal cord injury. After a spinal cord injury, most people experience constipation. Why does this occur? a. Innervation of the bowel is absent b. Defecation reflex is lost c. Internal anal sphincter will not relax d. Peristaltic movements are not strong enough to move stool through the colon

Correct response: b. Defecation reflex is lost Explanation: Even though the enteric nervous system innervation of the bowel remains intact, without the defecation reflex, peristaltic movements are ineffective in evacuating stool. The other answers are incorrect.

A patient diagnosed with early multiple sclerosis (MS) will likely demonstrate which of the following symptoms? Select all that apply. a. Visual clouding b. Paresthesia c. Bladder dysfunction d. Fatigue e. Anxiety

Correct response: a. Visual clouding b. Paresthesia c. Bladder dysfunction d. Fatigue Explanation: Visual disturbances, paresthesias, abnormal gait (ataxia), bladder and sexual dysfunction, vertigo, nystagmus, fatigue, and speech disturbances are early signs of MS. Anxiety and depression are often seen later as a result of the changes the disease causes.

The nurse is providing client education to a client newly diagnosed with Parkinson's disease. The nurse most accurately describes the disease progression: a. Parkinson's is an acute disorder that can be surgically corrected. b. Parkinson's is a chronic condition and treatment aims to manage symptoms. c. Parkinson's has no known effective treatment. d d. Parkinson's disease, while chronic, will likely improve over time.

Correct response: b. Parkinson's is a chronic condition and treatment aims to manage symptoms. Explanation: Parkinson's disease is a chronic and progressive condition with no known cure. The goal of treatment is to manage uncomfortable symptoms.

A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care? a. Positioning the client to minimize hypertonia and muscle rigidity b. Seizure precautions with padded side rails and bed in lowest height c. Respiratory support and protection of the client's airway d. Monitoring the client for painful dyskinesias

Correct response: c. Respiratory support and protection of the client's airway Explanation: Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.

The nurse is caring for a client with Guillain Barre' syndrome. Which of the following are expected clinical manifestations? Select all that apply. a. Flaccid paralysis of extremities b. Asymmetrical limb weakness c. Pain d. Muscular hypertrophy e. Loss of tendon reflexes

Correct response: a. Flaccid paralysis of extremities c. Pain e. Loss of tendon reflexes Explanation: Flaccid paralysis of extremities occurs, often preceded by parasthesias. Limbs become weakened, symmetrically due to the nature of the demyelination. Pain and loss of tendon reflexes are expected. Muscle hypertrophy is not expected.

Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia? a. Position the patient in upright position, and correct the initiating stimulus. b. Increase the patient's blood pressure to allow for adequate perfusion. c. Place the patient in a supine position, and increase intravenous fluids. d. Apply binders and support hose to shunt the blood to the main organs.

Correct response: a. Position the patient in upright position, and correct the initiating stimulus. Explanation: Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (i.e., full bladder, pain). The nurse should place the patient in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. Intravenous fluids are not an immediate intervention for this condition.

A client has developed spinal shock. The most important assessment for the nurse to perform would be: a. Inability to void or defecate b. Loss of tendon reflexes c. Vasoconstriction causing hypertension d. Paresthesia of the extremities below the injury

Correct response: b. Loss of tendon reflexes Explanation: Spinal shock is characterized by flaccid paralysis with loss of tendon reflexes below the level of injury, absence of somatic and visceral sensations below the level of injury, and loss of bowel and bladder function. Loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension.

Which one of the following is a manifestation of a serious condition that causes new-onset back pain in persons 50 years of age or older? a. Subdural hematoma b. Hypertension c. Arteriovenous malformation d. Aortic aneurysm

Correct response: d. Aortic aneurysm Explanation: New-onset pain in persons 50 years of age or older is more likely to be a manifestation of serious conditions such as an aortic aneurysm, malignancy, or compression fracture.

The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions? a. Disuse atrophy b. Muscular dystrophy c. Involuntary movements d. Pseudohypertrophy

Correct response: a. Disuse atrophy Explanation: Disuse atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.

Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. a. Rapid deterioration of respiratory status b. Lack of any physical pain c. Flaccid paralysis of limbs d. BP 90/62 e. Pale, cool, dry skin

Correct response: a. Rapid deterioration of respiratory status c. Flaccid paralysis of limbs d. BP 90/62 Explanation: Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome.

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Select all that apply.) a.Hypertension b. Fever c. Skin pallor d. Vasoconstriction e. Piloerector response

Correct response: a.Hypertension c. Skin pallor e. Piloerector response Explanation: Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. Fever and vasoconstriction are not manifestations of autonomic dysreflexia.

Bradykinesia occurring in Parkinson's disease places the Parkinson's client most at risk for which of the following? a. Weight loss b. Falls and injury c. Emotional dysfunction d. Incontinence

Correct response: b. Falls and injury Explanation: Slowed initiation of movement and poor response to sudden movements are characteristics of bradykinesia. These factors strongly correlate to risk of falls and injury.

The nurse is providing education to a patient recently diagnosed with multiple sclerosis. The nurse instructs the patient regarding which symptoms commonly occurring with multiple sclerosis? Select all that apply. a. Nausea and vomiting b. Visual loss or blurring c. Difficulty swallowing d. Headaches e. Paresthesias of extremities

Correct response: b. Visual loss or blurring c. Difficulty swallowing e. Paresthesias of extremities Explanation: Due to inflammation and demyelination of nerves, visual loss, difficulty swallowing, and paresthesias frequently occur with multiple sclerosis. Nausea and vomiting and headaches are not associated with this disorder.

A client sustained a spinal cord injury and is immediately brought to the emergency department. The client asks the physician if there is any medication he can get to possibly help him, regardless of risks. The physician assesses the client and determines the most important medication to administer would be: a. Naloxone b. Tirilazad c. Methylprednisone d. IV opioids

Correct response: c. Methylprednisone Explanation: Methylprednisone has been shown some neurological benefits if it is administered soon after SCI. The use of high-dose methylprednisolone has become controversial, largely based on the risk of serious adverse effects (e.g., gastric bleeding, wound infection, venous thrombosis, and steroid myopathy) versus what is perceived to be a modest neurologic benefit. Other neuroprotective agents, including monosialoganglioside sodium (GM-1 ganglioside), naloxone, and tirilazad, have been tested in multicenter clinical trials, but primary end points have not been achieved.c

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this? a. Depression over new diagnosis b. A side effect of treatment c. Psychological manifestation due to involvement of white matter of cerebral cortex d. Likely a pre-existing mental illness

Correct response: c. Psychological manifestation due to involvement of white matter of cerebral cortex Explanation: Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.

A client has been diagnosed with Guillain-Barre syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priority intervention when caring for this client? a. Inserting a foley catheter b. Assessing distal peripheral pulses c. Restarting the IV when it infiltrates d. Maintenance of the client's airway

Correct response: d. Maintenance of the client's airway Explanation: The rate of disease progression varies. Paralysis may progress to involve the respiratory muscles, which will mandate the use of a ventilator for this patient. Maintenance of the airway is the priority intervention at this time.

A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to: a. Check the mouth/throat for pustules and redness b. Check the jugular vein for distention c. Assess calves of legs for redness, warmth, or edema d. Scan his bladder to make sure it is empty

Correct response: d. Scan his bladder to make sure it is empty Explanation: Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. In many cases, the dysreflexic response results from a full bladder. There is no indication the client has right-sided heart failure (jugular vein distention); has a DVT (calf redness, warmth, or edema); or has strep throat (pustules and red throat/tonsils).

A 70 year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? a. Flaccid loss of muscle tone b. Difficulty starting movement, stopping movement and maintaining rhythmic movements. c. Tremor, rigidity and bradykinesia d. Unsteady gait and difficulty speaking and swallowing

Correct response: d. Unsteady gait and difficulty speaking and swallowing Explanation: An unsteady gait characterizes cerebellar ataxia and both swallowing and speaking are partly the domain of the cerebellum. Flaccid loss of muscle tone is not noted to accompany cerebellar insult and difficulties with starting movement, stopping movement and maintaining rhythmic movements are indicative of basal ganglia disorders. Tremor, rigidity and bradykinesia and associated with Parkinson disease.

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: a. Normal manifestations of Parkinson disease b. Signs of clinical deterioration c. Signs of clinical improvement d. Manifestations of another disease process

Correct response: a. Normal manifestations of Parkinson disease Explanation: The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement.