CH. 19 Disorders of Motor Function
Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)?
A 25 year old woman The age of onset is typically between 20 and 30 years, with women being affected twice as frequently as men
What best explains symptoms of ALS including dysphagia, muscle weakness and spasticity, and dysphonia?
ALS is caused by both an upper motor neuron and lower motor neuron disturbance ALS is both an upper motor neuron (UMN) and lower motor neuron (LMN) disorder, leading to wide variety of muscular symptoms.
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:
An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.
A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:
Arms A spinal cord injury at T8 would likely allow the client to retain normal function of the upper extremities, while innervations governing the function of the bowels, bladder, and perineum would be severed.
The cardinal symptoms of Parkinson disease (PD) include which of the following?
Bradykinesia The cardinal symptoms of Parkinson disease are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Because the basal ganglia also influence the autonomic nervous system, persons with PD often have excessive and uncontrolled sweating, sebaceous gland secretion, and salivation. Paresthesia is characteristic of demyelinating disease such as multiple sclerosis, rather than Parkinson disease.
A patient who has experienced a spinal cord injury has an ipsilateral loss of voluntary motor function and a contralateral loss of pain and temperature sensation. Based on these symptoms, which classification of spinal cord injury does the patient have?
Brown Sequard A condition called Brown-Séquard syndrome results from damage to a hemisection of the anterior and posterior cord. The effect is an ipsilateral loss of voluntary motor function from the corticospinal tract and proprioception loss with a contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion.
Neurotoxins such as the botulism organism can produce paralysis by what mechanism?
By blocking release of acetylcholine Myasthenia gravis is characterized by loss of acetylcholine receptors. A recessive single gene defect on X chromosome describes muscular dystrophy. Demyelination of peripheral nerves describes polyneuropathies
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?
Carpal tunnel syndrome The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity. The other answers do not describe the clinical presentation of amyotrophic lateral sclerosis
An elderly client has been brought to his primary care provider by his wife, who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the client's gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This client requires further assessment for which of the following health problems?
Cerebellar disorders An ataxic gait is characteristic of cerebellar and/or vestibular disorders. An LMN lesion typically results in decreased muscle tone. Impaired spinal reflexes would not normally manifest as ataxia, and muscle atrophy would cause weakness and decreased muscle tone
Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).
Creatine kinase Serum levels of the enzyme creatine kinase (CK), which leaks out of damaged muscle fibers, suggests the presence of the disease. A muscle biopsy, which shows a mixture of muscle cell degeneration and regeneration and reveals fat and scar tissue replacement, may be done to confirm the diagnosis
The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which of the following?
Decreased oligodendrocytes Multiple sclerosis is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves the demyelination of nerve fibers in the white matter of the brain, spinal cord, and optic nerve. In the CNS, myelin is formed by the oligodendrocytes, chiefly those lying among the nerve fibers in the white matter. This function of the oligodendrocytes is equivalent to that of the Schwann cells in the peripheral nervous system. The properties of the myelin sheath—-high electrical resistance and low capacitance--permit it to function as an electrical insulator. Demyelinated nerve fibers display a variety of conduction abnormalities, ranging from decreased conduction velocity to conduction blocks.
Regarding the pathophysiology of Parkinson disease, which of the following statements is true?
Degeneration of the nigrostriatal dopamine neurons occurs. The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.
Peripheral neuropathy occurs most commonly with which one of the following disorders?
Diabetes Diabetes mellitus is a primary metabolic disorder that frequently leads to peripheral neuropathy.
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?
Disuse atrophy Disuse atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
A client affected by postural hypotension will likely display what symptoms?
Dizziness and pallor when moved to upright position Postural hypotension is caused by interruption of sympathetic outflow to vessels in abdomen and extremities. Pooling of blood leads to impaired venous blood return and symptoms with position change to upright.
The underlying causative problem in Parkinsonism is which of the following?
Failure of dopamine release Lack of dopamine release is the primary cause of Parkinson's disease and associated symptoms
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 The highest level of function, which occurs at the level of the frontal cortex, is concerned with the purpose and planning of the motor movement. The other answers are incorrect.
A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which of the following?
Home-grown and canned vegetables Botulism spores may be present in soil-grown items, and may be resistant to heat and germinate over time. Home-canned items may not have been properly preserved.
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 vagus nerve exerts a continuous inhibitory effect on heart rate. Vagal stimulation that causes a marked bradycardia is called the vasovagal response. Preventative measures, such as hyperoxygenation before, during, and after suctioning, are advised.
Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS?
Interferon-β, a cytokine injection Disease-modifying agents include interferon-β and glatiramer acetate. These agents have shown some benefit in reducing exacerbations in persons with relapsing-remitting MS. Interferon-β is a cytokine that acts as an immune enhancer. Corticosteroids are the mainstay of treatment for acute attacks of MS. These agents are thought to reduce the inflammation, improve nerve conduction, and have important immunologic effects. Long-term administration does not, however, appear to alter the course of the disease and can have harmful side effects. Mitoxantrone, an anticancer drug, is recommended for persons with worsening forms of the disease. Baclofen is a muscle relaxer for helping with symptom relief.
Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:
Multiple sclerosis (MS) The pathophysiology of MS involves the demyelination of nerve fibers in the white matter of the brain, spinal cord, and optic nerve. As such, the restoration of myelin would have the potential to slow or stop the progression of the disease. Myelin is not attacked during the pathogenesis and progression of ALS, DMD, or botulism poisoning
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson disease The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis. The other answers are incorrect.
Multiple sclerosis is characterized by what type of neuron damage?
Polyneuropathy MS is classified as a polyneuropathy due to many nerves being affected by the disease, involving demyelination of peripheral nerves
Guillain-Barré syndrome is characterized by which of the following forms of neuron damage?
Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy.
Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia?
Position the patient in upright position, and correct the initiating stimulus utonomic 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
Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia?
Position the patient in upright position, and correct the initiating stimulus. Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (i.e., full bladder, pain). The nurse should place the patient in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. Intravenous fluids are not an immediate intervention for this condition.
A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug
Produces paralysis of the larynx muscles by blocking acetylcholine release Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release. Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD. Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects.
The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which of the following medical terms?
Pseudohypertrophy Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this?
Psychological manifestation due to involvement of white matter of cerebral cortex Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions
Death caused by muscular dystrophy in early adulthood is usually due to which of the following?
Respiratory and cardiac muscle involvement Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.
Which of the following would be a symptom that 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.
Which of the following complications of spinal cord injury is the most preventable in a paraplegic patient?
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.
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. 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.
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 The Tinel sign is the development of a tingling sensation radiating into the palm of the hand that is elicited by light percussion over the median nerve at the wrist. The Phalen maneuver is performed by having the person hold the wrist in complete flexion for approximately a minute; if numbness and paresthesia along the median nerve are reproduced or exaggerated, the test result is considered to be positive. Trousseau and Chvostek signs assess calcium levels.
Which of the following project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS?
Upper motor neurons Upper motor neurons project from the brain and are completely within the CNS. Lower motor neurons are found in the PNS. The motor unit is found in both CNS and PNS as a functional unit.
Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following?
Vasospasms and hypertension 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. Continued hypertension produces a baroreflex-mediated vagal slowing of the heart rate to bradycardic levels. There is an accompanying baroreflex-mediated vasodilation with flushed skin and profuse sweating above the level of injury.
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 Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. Assessment of the airway is the top priority. Treatment includes support of vital functions and prevention of complications such as skin breakdown and thrombophlebitis
in myasthenia gravis, periods of stress can produce myasthenic crisis. When does myasthenic crisis occur?
When muscle weakness becomes severe enough to compromise ventilation In Parkinson disease, also known as idiopathic parkinsonism, dopamine depletion results from degeneration of the dopamine nigrostriatal system. The other answers are incorrect.
Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:
Without causing paralysis Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, spasticity, hypokinetic disorders, and hyperkinetic disorders. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement but do not cause paralysis. Disorders of the upper motor neuron pyramidal tracts are characterized by spasticity and paralysis
The most common cause of C. botulinum in infants is:
ingestion of honey products containing C. botulinum spores. Infants younger than one year of age have immature gastrointestional tracts, allowing growth of C botulinum spores. This is the most frequent cause of botulism.
A nurse is caring for a client experiencing muscle fasiculations. Fasiculations appear as
spontaneous contractions of muscle fibers presenting as twitching. Fasiculations are characterized by twitching or squirming movements of muscle fibers. Paresis is weakness/loss of movement. Spasticity is increased resistance with ROM. Rhythmic movements describe tremors
A patient 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. Amyotrophic lateral sclerosis is a mixed upper motor neuron (UMN) and lower motor neuron (LMN) disorder; the pathophysiology of the disease is not rooted in the vestibulocerebellar system or at neuromuscular junctions.
Manifestations of peripheral neuropathy include which of the following? Select all that apply.
• Muscle weakness • Sensory changes • Muscle wasting Polyneuropathy effects several nerves and can cause muscle weakness and/or paralysis, resulting in muscle wasting. Numbness and tingling are common sensory changes associated with this type of neuropathy
A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson's disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply.
• Tremor • Rigidity • Bradykinesia The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement. Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.
A patient diagnosed with early multiple sclerosis (MS) will likely demonstrate which of the following symptoms? Select all that apply.
• Visual clouding • Paresthesia • Bladder dysfunction • Fatigue 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.