LEWIS Chapter 58: Chronic Neurologic Problems (Pgs. 1383-1396)
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.
ANS: B Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.
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
ANS: C Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
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
ANS: C Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.
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.
ANS: C Dalfampridine should not be given to patients with impaired renal function. The other information will not impact whether the dalfampridine should be administered.
A 40-yr-old patient is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and adult children about this disorder, the nurse will provide information about the a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. b. prophylactic antibiotics to decrease the risk for aspiration pneumonia. c. option of genetic testing for the patient's children to determine their own HD risks. d. lifestyle changes of improved nutrition and exercise that delay disease progression.
ANS: C Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing. Sinemet will increase symptoms of HD because HD involves an increase in dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective treatments or lifestyle changes that delay the progression of symptoms in HD.
The nurse provides dietary instructions to the in-home caregiver of a 45-yr-old man with Huntington's disease. The nurse is most concerned if the caregiver makes which statement? "Depression is common and may cause a decrease in appetite." "If swallowing becomes difficult, a feeding tube may be needed." "Calories should be restricted to prevent unnecessary weight gain." "Muscles in the face are affected, and chewing may become impossible."
"Calories should be restricted to prevent unnecessary weight gain." Patients with Huntington's disease may require 4000 to 5000 calories per day to maintain body weight. Weight loss occurs in patients with Huntington's disease because of choreic movements, difficulty swallowing, depression, and mental deterioration.
The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? A 42-yr-old patient with multiple sclerosis who was admitted with sepsis A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia A 38-yr-old patient with myasthenia gravis who declined prescribed medications A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings
A 38-yr-old patient with myasthenia gravis who declined prescribed medications Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will experience myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for methylprednisolone (Solu-Medrol) 150 mg IV. The label on the vial reads: methylprednisolone 125 mg in 2 mL. How many mL will the nurse administer?
ANS: 2.4 With a concentration of 125 mg/2 mL, the nurse will need to administer 2.4 mL to obtain 150 mg of methylprednisolone.
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
ANS: A Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications.
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."
ANS: A During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.
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.
ANS: A Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.
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.
ANS: A, B, D Because the patient with Parkinson's disease has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinson's disease is a steadily progressive disease without acute exacerbations.
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.
ANS: B ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
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.
ANS: B Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.
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.
ANS: B The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.
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.
ANS: B The clinical diagnosis of Parkinson's is made when tremor, rigidity, and akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
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).
ANS: B The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
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
ANS: D Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.
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.
ANS: D Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use.
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
ANS: D The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson's disease, but the data do not indicate that they are current problems for this patient.
Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? Acute confusion Bowel incontinence Activity intolerance Disturbed sleep pattern
Activity intolerance The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG. Although sleep disturbance is likely, activity intolerance is of primary concern.
When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests will the nurse expect (select all that apply.)? EEG ECG CT scan Carotid duplex scan Evoked response testing Cerebrospinal fluid analysis
CT scan Evoked response testing Cerebrospinal fluid analysis No definitive diagnostic test exists for MS. Along with history and physical examination, CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI are used to establish a diagnosis of MS. EEG, ECG, and carotid duplex scan are not used to diagnose MS.
The nurse observes a 74-yr-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate? Provide the patient with diversional activities. Document the activity in the patient's health record. Take the patient's blood pressure sitting and standing. Ask if the patient is feeling either anxious or depressed.
Document the activity in the patient's health record. Patients with Parkinson's disease are instructed to rock from side to side to stimulate balance mechanisms and decrease akinesia.
A 48-yr-old man was just diagnosed with Huntington's disease. His 20-yr-old son is upset about his father's diagnosis. What is the nurse's best response? Provide emotional and psychologic support. Encourage him to get diagnostic genetic testing. Explain that cognitive deterioration will be treated with counseling. Instruct that chorea and psychiatric disorders can be treated with haloperidol (Haldol).
Provide emotional and psychologic support. The patient's son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined based on his father's needs.
A male patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? Provide multivitamins with each meal. Provide a diet that is low in complex carbohydrates and high in protein. Provide small, frequent meals throughout the day that are easy to chew and swallow. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.
Provide small, frequent meals throughout the day that are easy to chew and swallow. Nutritional support is a priority in the care of individuals with PD. Patients may benefit from smaller, more frequent meals that are easy to chew and swallow. Multivitamins are not necessary at each meal. Vitamin and protein intake must be monitored to prevent interactions with medications. Introducing a minced or pureed diet is likely premature, and a low carbohydrate diet is not indicated.
A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS? Reduce fat intake. Reduce the risk of aspiration. Decrease injury related to falls. Decrease pain secondary to muscle weakness
Reduce the risk of aspiration. 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.
Which care measure is a priority for a patient with multiple sclerosis (MS)? Vigilant infection control and adherence to standard precautions Careful monitoring of neurologic assessment and frequent reorientation Maintenance of a calorie count and hourly assessment of intake and output Assessment of blood pressure and monitoring for signs of orthostatic hypotension
Vigilant infection control and adherence to standard precautions 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 does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.
Social effects of a chronic neurologic disease include (select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.
a, b, c, d, e, ALL
A 50-yr-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also reports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has a. cluster headaches. b. tension headaches. c. migraine headaches. d. medication overuse headaches.
a. cluster headaches.
A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. evaluating the home for environmental safety. c. promoting physical exercise and a well-balanced diet. d. designing an exercise program to strengthen and stretch specific muscles.
c. promoting physical exercise and a well-balanced diet.
The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching? a. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." b. "Even though the symptoms you are experiencing are severe, most people recover with treatment." c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."
d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."
The nurse finds an 87-yr-old woman with Alzheimer's disease is continually rubbing, flexing, and kicking her legs throughout the day. The night shift reports this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to a. ask the physician for a daytime sedative for the patient. b. request soft restraints to prevent her from falling out of her bed. c. ask the physician for a nighttime sleep medication for the patient. d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.
d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.
