medSure test 2 chap 58 & 32
which critereon would the nurse associate w the hcp diagnosis of PD? select all that apply
- positive response to antiparkinsonial med (ex carvidopa/levodopa) - presence of 2 of the 3 classif feutures: rigidity, bradykinesia, and tremor RATIONALE there are no specific test to diagnose PD. - you can not measure dopamine in the brain so there is no lab test
which diagnostic finding would the nurse associate w a pt diagnosis of MS? select all that apply
- presence of visual and auditory evoked potential -presence of increased immunoglobin G (IgG) abtibodies in the cerebrospinal fluid - presence of inflammation, tissue breakdown, and atrophy of the spinal cord in the MRI scan
which caregiver's actions, implementrd during the pt acute seizure episode, indicate understanding of the home care measures taught prior to discharge? select all that apply
- turning the pt on their side (to protect pt from injury) - loosening the pt tight clothing (ensure patent airway) - easing the pt to the floor, if seated (protect pt from injury) RATIONALE not necessary to take pt to hospital UNLESS the seizure is prolonged or another seizure immediately follows.
ALS
-reduce the risk of aspiration (#1 cause of death) -decrease injury related to falls
stage 2 HT
SBP greater than 140, and DBP greater than 90
stage 1 HT
SBP of 130-139 or diastolic BP (DBP) of 80-89)
when planning the care for a pt w MG, for which clinical manifestation would the nurse integrate specific interventions?
activity intolerance RATIONALE the primary future of MG is fluctuating weakness of skeletal muscle.
which medication helps to increase the bioavailability of levodopa in the brain by inhibiting the enzyme dopa-decarboxylase?
carbidopa (Lodosyn) RATIONALE it inhibits the breakdown of levodopa in the brain
secondary hypertension
caused by renal or kidney disease
multiple sclerosis (MS)
chronic progressive degenerative disorder of the central nervous system - chronic demyelination of the nerve fibers of the brain and spinal cord is the principal charecteristic - cause is unknown
Parkinson's disease
chronic, progressice neurodegenerative disorder charachterized my an increase muscle tone (rigidity), slowness in the initiation and execution of movement (bradykinesia), tremors, and gait disturbances. - lack of dopamine because of the degeneration of dopamine- producing neurons, which leads to a deficiency of dopamine release, this disrupts the normal balance between acetylcholine and dopamine in the brain
regarding a pt w parkinson's disease (PD) who recently entered a long-term care facility, which action would the health care tam implement to promote adequate nutrition for this pt?
provide small, frequent meals throughout the day that are easy to chew and swallow
for a pt w parkinson's disease who has difficulty swallowing, which intervention would the nurse initially include in the pt plan of care?
provide the pt w semisolid or soft foods RATIONALE in PD the pt mat have poor control of the tongue, increasing the risk of aspiration. semisolid foods w out lumps and thickened liquid stick together, allowing the tongue to direct the food bolus to the back of the mouth.
for pt w amyotrophic lateral sclerosis (ALS), which treatment goal focuses on preventing a common cause of death in pt w ASL?
reduce risk of aspiration RATIONALE aspiration can kead to infection wich is a common cause of death from deteriorating muscle function
central acting A- adrenergic antagonists
reduce sympathetic outflow from the CNS to produse vasodilation and decreases systeic vascular resistance (SVR) and BP
primary- progressive MS
steady and gradual neurologic dysfunction w/out remittance of the symptoms
to promote self-care and independence in pt w PD, which interventions would the nurse provide family members? select all that apply
- have the pt wear slip-on shoes (pt can easily put them on or take them off) - provide the pt w an elevated toilet seat (getting on/off the toilet easy) - encourage the pt to elevate the legs in an ottoman when sitting (prevents ankle edema)
a pt with hypertension has been prescribed an antihypertensive med. during a follow up visit the pt ask if the med. can be stopped because the BP is now with in the normal range. WHich response would the nurse provide?
"continue taking the medication unless your healthcare privider advises discontinuing it" RATIONALE antihypertensive med is effective at lowering BP, and should not be stoppped abruptly because it can cause a severe hypertensive reaction. The modification should be done only after consulting w the DR because medication taken regularly sustains the therapeutic effect
a pt is diagnosed w primary hypertension and asks the nurse what caused the condition. which response would the nurse give?
"there is no identified cause" RATIONALE also an increase in plasma renin levels
while the pt w PD, who is unresponsive to drug therapy, consider the surgical options presented by the HCP, which procedure would the nurse anticipate providing as additional resources? select all that apply
- ablation (steriostatic ablation of the areas in the thalamus, globus pallidus, and subthalamic nucleus) - transplantation (of fetal neural tissue on the basal ganglia to provide dopamine- producing cells in the brain) - deep-brain stimulation (placing electrode on the same areas as ablation)
treatment for MS exacerbation
- corticoid steroid med--> alter carb metabolism and elevate serum glucose
for the pt w PD who is taking levodopa with carbidopa (Sinemet), the nurse would monitor the potential developmet of which side effect? select all that apply
- dyskinesia (due to increase dopamine availability) - involuntary eyelid movement - severe n/v
When establishing a diagnosis of MS, which prescribed diagnostic studies would the nurse explain to the pt? selecet all that applt
- evoked response testing - Cerebrospinal fluid analysis - CT scan RATIONALE there is no definitive diagnostic test for MS. CT scan, and MRI plus the 3 answers and the pt history and physical examination are used to diagnose MS.
which systolic BP (SBP) measurement correlates w stage 1 hypertension?
132
for the pt receiving initial medication for treatment of MS, which medication would the nurse associate w the pt reports of flu-like symptoms, depressed feeling, and frequent thought of committing suicide?
B-1a interferon (Rebif)
diphenhydramine
Benadryl; antihistamine that has anticholinergic effets and does not lead to paradoxical in PD
which diagnostic test would the nurse anticipate fir a pt with progressive weakness suspected of having MS?
Magnetic resonance imaging (MRI) RATIONALE an MRI of the brain and spinal cord can show plaques, inflammation, atrophy, and tissue breakdown consistent w MS
a degeneration of dopamine-producing neurons and decreased levels of dopamine are characteristics of which disease?
PD
which neurologic disorder has paradoxical i ntoxication as a potential adverse effect of medication therapy?
PD RATIONALE paradocical intoxication involves the aggravation, rather than the relief, of symptoms, after using a drug. dopaminergic drugs, prescribed for parkisonism, may vause paradoxical intoxication after prolonged use.
which neurodegenerative disorder has the characteristics of rigidity and bradykinesia?
PD RATIONALE PD is a chronic, progressice neurodegenerative disorder charachterized my an increase muscle tone (rigidity), slowness in the initiation and execution of movement (bradykinesia), tremors, and gait disturbances.
the pt w PD lost 35 lbs ovr the last 2 months, and a swallow test study indicates ability to swallow w/ out aspiration. which intervention would the nurse discuss w the pt and spause to improve nutritional intake?
allow adequate time for the pt to eat each of the 6 small meals RATIONALE will limit frustration and improve overall intake
biperiden
anticholinergic drug that blocks the cholinergic receptor
trihexyphenidyl
antocholinergic drug that does not aggravate symptoms w ovr use
which medication would the nurse anticipate administering to a pt w parkinsonism as treatment for their hypomobility?
apomorphine (Apokyn) RATIONALE hypomobility is a condition in pt w parkinsonism. Drug such as apomorphine, a dopamine agonist, block the re uptake of dopamine into the presynaptic neurons and stimulates the postsynaptic dopamine receptor.
for the pt w MS, which action would the nurse classify as a PRIORITY intervention when developing the pt plan of care?
assest the pt identify the factors that precipitate exacerbations
which changes in vital signs indicate that the pt who has just stood up is experiencing postural hypotension?
decreased SBP, decrease DBP, and/or increased HR RATIONALE BP drops as the volume of circulating blood decreases when a pt abruptly stands from a lying or sitting position. The HR increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output.
Huntington's disease
deficiency of the neurotransmitters GABA and acetylcholine, which leads to the excessive release of dopamine. - genetacally transmitted - autosimal dominant disorder - no effective treatment - offspring has 50% chance - advanced HD provide palliative care as the collaborative approach
Lou gehrig's disease
degeneration of motor neurons in the brain and spinal cord and is not related to the deficiency of neurotransmitters
which classic symptom of ALS would the nurse expect to identify when performing an assessment?
dysphagia RATIONALE weakness of the muscles of the legs that progress to weakness in the upper extremities, disarthria (difficulty in speech), and dysphagia ( difficulty swallowing) are classic symptoms of ALS.
progressive-relapsing MS
frequent relapses w a partial recovery w/out the pt returning to baseline
secondary progressive MS
has a relapsing-remitting course that later becomes steadily progressive, with or with out occasional relapses, minor remissions, and plateaus
which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder?
hubtington's disease RATIONALE ofspring has 50% chance
a pt has not reached goal BP despite taking full doses of an appropiate 3 drug regimen, including a diuretic. which finding in the pt history is the likely cause of resisteant hypertension?
increasing obesity RATIONALE and - licorice - excess salt more than 1500 ml/day - oral contraceptives (not erectyle disfunction med)
a pt w hypertension receives a prescription for lisipril. which mechanism of action would the nurse expect from this medication?
inhibits conversion of angiotensin I to angiotensin II RATIONALE lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II mediated vasoconstriction and sodium and water retention
relapsing-remitting MS
involves developing and resolving symptoms ovr a few weeks to months before the pt returns to the baseline.
which medication overdose may lead to paradocical intoxication in a pt w PD
levodopa (L-dopa)
the nurse provides discharge teaching to a female pt whi was newly diagnosed w primary hypertension. Which instruction would be included?
limit the intake of alcohol to no more than one drink per day RATIONALE excessive alcohol is strongly associated w hypertension. Women and lighter-weight men should limit to no more than 1 drink a day. - sodium should be less than or equal to 1500 mg/day
which medication should be used with caution in ot w diabetes because the drug may depress the tachycardia associated w hypoglycemia?
metoprolol RATIONALE it is a B-adrenergic receptor blocker (B-blocker), slows the heart rate. tachycardia is a classic sympto, of hypoglycemia, therefor the pt must be aware of the decrease hr to devrease glucose levels
the nurse is assessing a pt for orthostatic HYPOtension. first, the nurse measured the BP and HR w the pt in supine position. which action would the nurse take next?
move the pt to a sitting position and measure the BP and HR within 2 minutes: - and then the pt stand and the BP and HR are measured with in 2 minutes - decrease by 20 or more in SBP - decrease of 10 or more in DBP - increase in pulse >20 b/per minute from supine to standing
which disease process includes Lhermitte's sign as a clinical manifestation?
multiple sclerosis (MS) RATIONALE lhermitte's sign is a transient sensory symptom manifested in pt w MS and is decribed as an electric shock radiating down the spine or into the limbs w flexion of the neck.
which medication classification would the nurse expect for a new med prescribed to treat the major symptoms of a pt w MS?
muscle relaxant RATIONALE MS causes muscle spascity as loss of the myelin sheath progressess. Muscle relaxants ease this spasms. - use of analgestics treats severe pain which is NOT associates w MS
a decreased # of acetylcholine receptors in the neuromuskular junction is a characterestiv of which autoimmune diseas?
myasthenia gravis RATIONALE antibodies attach acetylcholine receptors MEDICATION - azathioprine (Imuran) immunomodulator - prednisone (deltrasone); corticosteroid - pyridostigmine (Mestinon) anticholinergic Symptoms - difficulty swallowin - dif chewing - dif eye movement - dif facial mobility
for the pt w an aggressive form of MS who is not responding to teriflunomide (Aubagio) and dalfampridine (Ampyra), the prescriber changed the medication to natalizumab )Tysabri) and mitoxantrone (Novantrone). Later, when the pt develops progressive multifocal leukoencephalopathy, which prescribed med. might be responsible?
natalizumab (monoclonal, risk is a potentially fatal viral infection known as multifocal leukoencephalopathy)
a pt w PD is taking a dopamine agonist med reprted n/v. the pt lost conscioussness from a dudden drop in BP after receiving an IV antiemetic. Which antiemetic med interaction would the nurse associate w the pt response?
ondansetron (Zofran) and apomorphine (Apokyn) RATIONALE when administering dopamine agonist apomorphine alone, the med causes n/v. When administered w antiemetic such as ondansetron, leads to very low BP and loss consciousness.
the nurse is teaching an older pt w hypertension about developing an exercise program. Which instruction woild the nurse include?
perform muscle- stregthening activities twice a week RATIONALE - weightlifting is not recommended for hypertension becuase it increases BP. -
when evaluating the presence of an initial symptom of PD, which clinical manifistation would the nurse evaluate
pill-rolling tremors RATIONALE this are coarse resting tremmors of the fingers and thumb "pill rolling movement"
which mechanism of hypertension causes target organ damage
promotion of atherosclerosis and damage ti the walls of the arteries RATIONALE hypertension is a major risk factor for the development of atherosclerosis by mechanis, not known yet. once atherosclerosis develops it damages the walls of the arteries and reduces the circulation to target organs and tissue.
for which major complication would the nurse monitor development in a pt experiencing a myasthenic crisis?
repiratory indufficiency
the nurse is preparing to measure the BP of a pt who is lying down on a bed. Which techniques should the nurse use?
rest the pt arm on a pillow during the BP measurement RATIONALE raise and support the arm with a small pillow at the heart level. this allows the blood to drain from the arm and prevents inaccurate reading
which instruction is important for the nurse to provide ti a pt about the management of stage 1 hypertension?
restrict sodium intake RATIONALE salt leads to water retention
B- afrenergic receptor blockers (B-blockers)
result in vasodialation and decreases heart rate
when planning the care for a pt w MS who has an exacerbation of sensory deficits, for which pt problem would the nurse develop nursing interventions?
risk for injury RATIONALE MS usually exhibits itself on one side more than another. therefore the gait is unsteady, so there is an increase in the pt fall risk.
a relapsing-remitting initial course followed by the disease w or with out relapses are chareacteristics of which type of MS?
secondary- progressive
which lab test result indicates the presence of target organ damage in a pt w hypertension
serum creatine of 2.6 mg (normal 0.6-1.30) RATIONALE indicater target organ damage to the kidneys
which intervention would the nurse implement as a priority when providing care for a pt w MS?
vigilant infection control and adherence to standard precautions RATIONALE infection control is a PRIORITY in the care of pt w MS because infections is the most common cause of an exacerbation of the disease.
as treatment for hypertension crisis, a pt has received sodium nitroprusside for 3 days. for which reason would the nurse plan on monitoring the pt thiocynate levels?
the medication is metabolized to cyanide, then thiocyanate RATIONALE sodium nitoprusside causes arterial vasodilation and reduces systemic vascular resistance. this in turn, decreases the BP. It can ren reach lethal levels of thiocynate
Which instruction would the nurse provide the pt w MS who received a new prescription for interferon?
the medication often causes pt to experience flu- like symptoms RATIONALE it is an immunomodulator that treats the disease process and prevents relapse. -it is administered sub q every other day
a pt who has been taking clonifine for 10 years tells the nurse, "I decided to quit taking the medication a few days ago'. for which manifestation would the nurse monitor this pt?
tremors RATIONALE sudden discontinuation may cause withdrawal syndrome, including - rebound hypertension - tachycardia - HA - tremors - apprehension - sweating
